Cruise passengers arrive in the US after one tests positive for hantavirus

Seventeen U.S. cruise passengers returned to the U.S. early Monday, after weeks aboard the MV Hondius, the cruise ship at the center of a deadly hantavirus outbreak, the Associated Press reported. The Americans disembarked the cruise in the Canary Islands on Sunday and boarded a medical repatriation flight, arranged by the U.S. government, bound for Nebraska.

The Dutch-flagged cruise ship departed from southern Argentina on April 1, and followed an itinerary across the South Atlantic with multiple stops in remote islands. Three of the passengers have died since the outbreak began.

During the U.S. return flight, one of the Americans tested "mildly" positive for the virus and another showed mild symptoms, according to an X post by the official @HHSGov account. The two potentially affected passengers traveled in biocontainment units aboard the plane, according to the X post.

Also on Monday, a French woman tested positive for hantavirus, French Health Minister Stephanie Rist said. The woman was among five French passengers repatriated Sunday to Paris.

What's ahead for the 17 American passengers

After landing at the Offutt Air Force Base near Omaha, most passengers will head to the National Quarantine Unit at the University of Nebraska Medical Center (UNMC) for an initial evaluation, according to the Centers for Disease Control and Prevention. The passenger with symptoms will proceed to another specialized treatment center, according to the X post, though it did not specify where that would be.

"For the passengers getting off the ship, I'd say, 'Welcome to Nebraska.' You are coming to the premier facility in the United States, if not the world, to take care of you," says Dr. Ali Khan, dean of the College of Public Health at UNMC.

The 17 U.S. passengers are among the total of nearly 150 people who were on the ship from 23 different countries. They've endured in the midst of a hantavirus outbreak which has caused at least eight cases, including three deaths, according to the World Health Organization.

The returning Americans had been isolating in their cruise cabins. They will now be monitored for several more weeks, U.S. health officials said in a media call on Saturday.

Most of the passengers are arriving at America's only federally funded quarantine unit, which also received cruise passengers from a different outbreak — the Diamond Princess Cruise, in early 2020 — which was one of the first known superspreading events of the COVID-19 pandemic.

Unlike COVID, which was a novel pathogenic strain when it emerged, scientists have been studying hantaviruses — and specifically the Andes variant which caused this outbreak — for decades. "We do know that you can get small clusters of disease, but in 30 years we've never seen any large outbreaks," says Khan, "so this is unlikely to become a pandemic."

This strain of hantavirus can be deadly, but it isn't very contagious between people. It tends to take prolonged, close contact with someone who's showing symptoms.

So far, most of the U.S. passengers are well. But symptoms can take up to 42 days after exposure to show up, according to the CDC.

"It's appropriate to be cautious," Khan says, "To monitor these people for 42 days [to make sure] they don't get sick. And if they do get sick during those 42 days, to make sure to put them into isolation."

Health officials said the U.S. passengers would all be assessed clinically upon arrival, though they would not be officially quarantined. They suggested that some passengers could continue monitoring at home, with daily check-ins from their health departments.

Seven U.S. passengers who had left the cruise ship earlier are being monitored in several states, including Texas, California, Georgia and Virginia.

Public health experts have been raising alarms over what they consider to be a muted public response by the U.S. government to this outbreak.

Lawrence Gostin, professor of global health law at Georgetown University, says the U.S. response has been fragmented, disjointed, and delayed for weeks, but it's finally coming together. "The CDC was missing in action for quite a long time," he says. "Better late than never — but it is very late."

In response to a request for comment from NPR, Emily Hilliard, a spokesperson for the Department of Health and Human Services: "These claims are completely inaccurate. The U.S. government is conducting a coordinated, interagency response led by the Department of State. HHS, through ASPR [Administration for Strategic Preparedness and Response] and CDC, is supporting efforts to protect the health and safety of U.S. citizens, including repatriation, medical evaluation, and public health guidance."

She further described CDC's response activities, including setting up its Emergency Operations Center, deploying teams to the Canary Islands and Nebraska, and notifying state health departments of returning U.S. travelers.

Many of these activities have come recently, and Gostin agrees that the U.S. government is now taking active measures to ensure that the passengers, their families, and the communities they're returning to are safe.

But health officials got lucky this time: the Andes virus is not very contagious, and health officials say this outbreak will likely be contained. The way the U.S. has handled this episode shows glaring gaps in its pandemic preparedness, Gostin says: "If this was a highly transmissible virus, you could imagine what chaos we would be facing now."

Gostin says the U.S. should invest more in infectious disease prevention, containment and control.
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