Lethal hantavirus at sea: Infectious disease outbreaks on cruise ships and limits of preparedness
6 affiliations
- 1Center for Clinical Microbiology, Institute of Infection, Immunity and Transplantation, University College London, and University College London Hospitals NHS Foundation Trust, London, United Kingdom. Electronic address: [email protected]
- 2Department of Infectious Disease Epidemiology and International Health, London School of Hygiene and Tropical Medicine, London, United Kingdom. Electronic address: [email protected]
- 3Unicamillus International Medical University, Rome, Italy. Electronic address: [email protected]
- 4World Health Organization, Regional Office for Africa, Dakar Emergency Hub, Dakar, Senegal. Electronic address: [email protected]
- 5Special Infectious Agents Unit - BSL3, King Fahd Medical Research Center, Medical Laboratory Sciences Department, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia. Electronic address: [email protected]
- 6Faculty of Health Sciences, Universidad Científica del Sur, Lima, Peru. Electronic address: [email protected]
Abstract
Maritime health One Health Rodent-borne Outbreak preparedness Zoonotic infections Hantavirus pulmonary syndrome Hemorrhagic fever with renal syndromeRecent global public health and media attention has focused on a lethal hantavirus cluster aboard the expedition cruise ship Hondius [1,2].On 2 May 2026, the World Health Organization (WHO) was notified of cases of severe acute respiratory illness, including two deaths and one critically ill passenger, aboard the Dutch-flagged cruise ship [1].Laboratory testing conducted in South Africa confirmed hantavirus infection in one patient requiring intensive care.By 3 May, one additional death had been reported, with a further three suspected cases remaining on board.As of 6 May 2026, a total of eight cases (three confirmed and five suspected), including three deaths, have been identified [1].Hondius, carrying 147 individuals (88 passengers and 59 crew) representing 23 nationalities, departed Ushuaia, Argentina, on 1 April 2026 and followed an itinerary across the South Atlantic, with multiple stops in remote and ecologically diverse regions, including mainland Antarctica, South Georgia, Nightingale Island, Tristan da Cunha, Saint Helena, and Ascension Island.Some of the passengers had traveled in South America before boarding the cruise.Still, the extent of passenger exposure to local wildlife before embarkation, or on board, remains to be defined.Coordinated public health responses have been initiated by WHO and public health authorities in the Netherlands, Cabo Verde, Spain, South Africa, and the United Kingdom [1].Whilst ongoing investigations determine the origin and modes of transmission of the unprecedented cluster, the incident raises several important issues regarding the occurrence of infectious diseases among passengers on cruise ships, and preparedness for outbreak events in maritime settings (Table 1).Hantavirus is acquired primarily through environmental exposure to infected rodent reservoirs [3], rather than sustained human-to-human transmission [4][5][6][7].The occurrence of cases in a cruise environment is therefore unusual and raises important questions about how emerging zoonotic risks intersect with global travel and ecological exposure.In contrast to more typical cruise-associated outbreaks [8-18] (Table 2), hantavirus transmission dynamics suggest a point-source exposure, either onboard, during shore excursions, or before embarkation, rather than sustained transmission within the ship environment [1,[4][5][6][7].Importantly, the identification of cases linked to a single vessel does not establish where or when exposure occurred.Public health investigations must therefore consider multiple potential sources, including environmental contamination, rodent exposure, and pre-travel activities, and require laboratory confirmation and viral sequencing to clarify the origin and characteristics of the infection [1].Hantaviruses are zoonotic, negative-sense RNA viruses of the genus Orthohantavirus, family Hantaviridae, maintained in specific small mammal reservoirs, predominantly rodents [4][5][6][7].There are several hantaviruses, with different geographical distributions and causing different clinical diseases.Hantaviruses are usually specific to certain rodent reservoir hosts, reflecting long-standing co-evolutionary relationships.Three main clinical syndromes can be distinguished after hantavirus infection: hemorrhagic fever with renal syndrome (HFRS), mainly caused by Seoul virus, Puumala virus (PUUV), and Dobrava virus (DOBV) prevalent in Europe; nephropathia epidemica, a mild form of HFRS caused by PUUV; and hantavirus cardiopulmonary syndrome, which may be caused by Andes virus, Sin Nombre virus, and several others prevalent in the Americas.The clinical presentation ranges from subclinical to mild, moderate, and severe, depending in part on the causative agent.Table 3 illustrates major hantavirus species, reservoir hosts, transmission pathways, clinical syndromes, and global distribution.Transmission to humans occurs primarily through inhalation of aerosolized excreta, whilst direct contact with contaminated surfaces
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BibTeX
@article{zumla2026lethal,
title = {{Lethal hantavirus at sea: Infectious disease outbreaks on cruise ships and limits of preparedness}},
author = {Alimuddin I. Zumla and Brian McCloskey and Giuseppe Ippolito and Tieble Traore and Esam I. Azhar and Alfonso J Rogriguez-Morales},
journal = {Travel Medicine and Infectious Disease},
year = {2026},
month = may,
doi = {10.1016/j.tmaid.2026.102989},
url = {https://doi.org/10.1016/j.tmaid.2026.102989},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Lethal hantavirus at sea: Infectious disease outbreaks on cruise ships and limits of preparedness
AU - Alimuddin I. Zumla
AU - Brian McCloskey
AU - Giuseppe Ippolito
AU - Tieble Traore
AU - Esam I. Azhar
AU - Alfonso J Rogriguez-Morales
PY - 2026
DA - 2026/05/12
JO - Travel Medicine and Infectious Disease
DO - 10.1016/j.tmaid.2026.102989
UR - https://doi.org/10.1016/j.tmaid.2026.102989
AB - Maritime health One Health Rodent-borne Outbreak preparedness Zoonotic infections Hantavirus pulmonary syndrome Hemorrhagic fever with renal syndromeRecent global public health and media attention has focused on a lethal hantavirus cluster aboard the expedition cruise ship Hondius [1,2].On 2 May 2026, the World Health Organization (WHO) was notified of cases of severe acute respiratory illness, including two deaths and one critically ill passenger, aboard the Dutch-flagged cruise ship [1].Laboratory testing conducted in South Africa confirmed hantavirus infection in one patient requiring intensive care.By 3 May, one additional death had been reported, with a further three suspected cases remaining on board.As of 6 May 2026, a total of eight cases (three confirmed and five suspected), including three deaths, have been identified [1].Hondius, carrying 147 individuals (88 passengers and 59 crew) representing 23 nationalities, departed Ushuaia, Argentina, on 1 April 2026 and followed an itinerary across the South Atlantic, with multiple stops in remote and ecologically diverse regions, including mainland Antarctica, South Georgia, Nightingale Island, Tristan da Cunha, Saint Helena, and Ascension Island.Some of the passengers had traveled in South America before boarding the cruise.Still, the extent of passenger exposure to local wildlife before embarkation, or on board, remains to be defined.Coordinated public health responses have been initiated by WHO and public health authorities in the Netherlands, Cabo Verde, Spain, South Africa, and the United Kingdom [1].Whilst ongoing investigations determine the origin and modes of transmission of the unprecedented cluster, the incident raises several important issues regarding the occurrence of infectious diseases among passengers on cruise ships, and preparedness for outbreak events in maritime settings (Table 1).Hantavirus is acquired primarily through environmental exposure to infected rodent reservoirs [3], rather than sustained human-to-human transmission [4][5][6][7].The occurrence of cases in a cruise environment is therefore unusual and raises important questions about how emerging zoonotic risks intersect with global travel and ecological exposure.In contrast to more typical cruise-associated outbreaks [8-18] (Table 2), hantavirus transmission dynamics suggest a point-source exposure, either onboard, during shore excursions, or before embarkation, rather than sustained transmission within the ship environment [1,[4][5][6][7].Importantly, the identification of cases linked to a single vessel does not establish where or when exposure occurred.Public health investigations must therefore consider multiple potential sources, including environmental contamination, rodent exposure, and pre-travel activities, and require laboratory confirmation and viral sequencing to clarify the origin and characteristics of the infection [1].Hantaviruses are zoonotic, negative-sense RNA viruses of the genus Orthohantavirus, family Hantaviridae, maintained in specific small mammal reservoirs, predominantly rodents [4][5][6][7].There are several hantaviruses, with different geographical distributions and causing different clinical diseases.Hantaviruses are usually specific to certain rodent reservoir hosts, reflecting long-standing co-evolutionary relationships.Three main clinical syndromes can be distinguished after hantavirus infection: hemorrhagic fever with renal syndrome (HFRS), mainly caused by Seoul virus, Puumala virus (PUUV), and Dobrava virus (DOBV) prevalent in Europe; nephropathia epidemica, a mild form of HFRS caused by PUUV; and hantavirus cardiopulmonary syndrome, which may be caused by Andes virus, Sin Nombre virus, and several others prevalent in the Americas.The clinical presentation ranges from subclinical to mild, moderate, and severe, depending in part on the causative agent.Table 3 illustrates major hantavirus species, reservoir hosts, transmission pathways, clinical syndromes, and global distribution.Transmission to humans occurs primarily through inhalation of aerosolized excreta, whilst direct contact with contaminated surfaces
SN - 1477-8939
SN - 1873-0442
ER -