Officials in Arizona, Georgia monitoring some hantavirus cruise ship passengers who have returned to US
The total number of confirmed hantavirus cases aboard a cruise ship has risen to five as global health authorities work to contain a potentially deadly cluster of the disease.
More than 100 passengers remain on the ship, MV Hondius, and the World Health Organization (WHO) is monitoring their health. Officials said that the "overall public health risk remains low" but that there may be some person-to-person spread.
In its first public statement on the outbreak on Wednesday evening, the U.S. Centers for Disease Control and Prevention said, "the risk to the American public is extremely low" and urged Americans aboard the ship to follow the guidance of health officials.
"Our top priority remains the health and safety of all U.S. passengers," the CDC statement said. "The Department of State is leading a coordinated, whole-of-government response including direct contact with passengers, diplomatic coordination, and engagement with domestic and international health authorities."
Officials in Arizona, Georgia monitoring passengers who have returned to US
Health officials in multiple states in the U.S. say they are monitoring some passengers who have returned to the U.S. after being aboard the ship for potential hantavirus infections.
The Arizona Department of Health Services said it is monitoring one resident that was a passenger on the ship. The Georgia Department of Public Health said it is monitoring two residents who returned home after disembarking from the Hondius.
None of the former passengers being monitored in the U.S. have shown any signs of illness, officials said.
Ship's route
The ship, which was off the coast of Africa in Cape Verde, is now en route to the Canary Islands after officials medically evacuated three people, including two in "serious condition."
The trip is expected to take three to four days, the ship's operator, Oceanwide Expeditions, said Wednesday.
Some passengers disembarked the ship before knowledge of the cluster and are back in their home countries. In some cases, authorities are advising those passengers to self-isolate.
The two patients who were evacuated have landed in the Netherlands and "have been received by specialist medical and screening teams," Oceanwide Expeditions said Wednesday.
In addition to those two, a third person, who is asymptomatic but a close contact of a German national who died on May 2, was also removed from the ship, WHO officials in Cape Verde told ABC News. The medical aircraft transporting the individual is experiencing a delay, Oceanwide Expeditions said Wednesday.
"WHO continues to work with the ship’s operators to closely monitor the health of passengers and crew, working with countries to support appropriate medical follow-up and evacuation where needed," Dr. Tedros Adhanom Ghebreyesus, the director-general of the WHO, said in a post on X on Wednesday, in which he confirmed the evacuations.
"Monitoring and follow-up for passengers on board and for those who have already disembarked has been initiated in collaboration with the ship's operators and national health authorities," he continued.
Tedros added that "the overall public health risk remains low."
For now, there are no symptomatic passengers who remain on board the ship, Dr. Freddy Banza, a WHO doctor who helped evacuate the three people, told reporters Wednesday. The people now considered at highest risk are the crew members and medical staff who spent the most time caring for sick passengers, he said.
Health officials confirmed two additional cases of hantavirus among crewmembers, bringing the total confirmed cases to five.
"Swiss authorities have confirmed a case of hantavirus identified in a passenger from the MV Hondius cruise ship," the WHO said on X on Wednesday. "He had responded to an email from the ship’s operator informing the passengers of the health event, and presented himself to a hospital in Zurich, Switzerland, and is receiving care."
3 deaths recorded
The three previously confirmed hantavirus cases include a woman who disembarked and was on her way home from the Netherlands, a British national who is in critical but stable condition in a hospital in Johannesburg, and a passenger who traveled on the first leg of the voyage and is currently being treated at the University Hospital Zurich, according to Oceanwide Expeditions.
So far, three deaths have been recorded.
In a statement, the Dutch airline KLM said it had been informed by Dutch health authorities that one of the people who died from the hantavirus was briefly aboard a KLM aircraft in Johannesburg, South Africa, on April 25.
"Due to the passenger’s medical condition at the time, the crew decided not to allow the passenger to travel on the flight," the airline said in the statement. "The passenger sadly later passed away in Johannesburg."
The airline said all passengers who were on board the flight were being notified.
The type of virus in this outbreak has been confirmed as Andes hantavirus by the National Institute for Communicable Diseases in South Africa and Geneva University Hospitals in Switzerland, the WHO said Wednesday. The Andes hantavirus historically has been shown to potentially transmit between people, according to the WHO.
Oceanwide Expeditions said of the three passengers who were evacuated from the ship, two are symptomatic and in serious condition and the third is asymptomatic but a close contact of a German national who died on May 2.
"In partnership with the RIVM (Dutch Institute for Public Health and Environment), Oceanwide Expeditions is expanding medical care on board with two infectious disease physicians, arriving today by plane from the Netherlands. This ensures that optimal medical care can be provided if necessary, during the next stage of this evolving situation," the company said in a statement.
Cape Verde officials said on Tuesday that the vessel was expected to sail to the Spanish island of Tenerife, but the president of the Canary Islands, a Spanish archipelago off the northwestern coast of Africa, said on Wednesday that the regional government was opposed to allowing the luxury cruise ship to dock in Tenerife.
"This decision is not based on any technical criteria, nor is there sufficient information to reassure the public or guarantee their safety," President Fernando Clavijo told radio station COPE, according to Reuters.
Clavijo said on social media that he had requested a meeting with the Spanish prime minister to discuss the ship. He added that the Canary Islands "always acts with responsibility, but it cannot accept decisions taken behind the backs of the Canary Islands institutions and without sufficient information to the population."
Mónica García, Spain's minister of health, said once the ship arrives at the port of Granadilla de Abona in the Canary Islands, there will be a "joint screening and evacuation mechanism will be launched to repatriate all passengers," according to RTVE, a Spanish national public broadcaster.
“Unless their medical condition prevents it, all foreign passengers will be repatriated through the European civil protection mechanism, about which the Interior Minister will provide further details later," Garcia said in Spanish.
WHO officials earlier on Wednesday said the three evacuated people were to be transferred to planes bound for both the Netherlands and Tenerife, but later updated the plan so that all would be sent to the Netherlands, officials told ABC News.
ABC News' Othon Leyva contributed to this report.
