French national shows symptoms after returning from hantavirus-affected cruise ship
A 58-year-old French woman who returned from the MV Hondius, the cruise ship at the centre of the hantavirus outbreak, has been admitted to Paris's Hôpital Necker. According to Santé Publique France, the country's public-health agency, the passenger presented with a temperature of 38.6 degrees Celsius and rapid respiratory distress; she has been placed in an isolation ward and is being treated as a possible Andes hantavirus case.
The agency says the patient is among the 234-strong French group that disembarked from the ship on 28 April. Senior officials report that she shared a cabin with a Dutch citizen confirmed as the third fatal case from the ship. Tests are being conducted at the Pasteur Institute's reference laboratory, and genome sequencing will be used to confirm whether the virus was contracted aboard the Hondius.
The World Health Organization's most recent update places the number of Hondius-linked cases at 31, including three deaths. The cases include nationals of the Netherlands, Belgium, Germany, Singapore and the United Kingdom. The Andes hantavirus normally passes to humans from rodent populations in Chile and Argentina; the cases observed on the Hondius represent the first documented examples of person-to-person transmission of this kind. The strain has been designated "Andes 1."
French health minister Catherine Vautrin emphasised that the risk to the wider public is low: "For any French citizen who was not aboard the Hondius, the risk of transmission is virtually nil. The issue concerns only close contacts. Our precaution for citizens is limited to medical surveillance." Vautrin noted that 12 researchers from the Pasteur Institute have been working on the epidemiological mapping of the cases since the outbreak began in February.
Professor Anastasia Lemoine, head of the Pasteur Institute's Haemorrhagic Fevers Unit, summarised the behaviour of the Andes 1 strain in comments to BBC Health: "The mutations that confer person-to-person transmissibility are clustered in the glycoprotein G2 region. We are currently observing incubation periods of between 9 and 33 days; the longer end of that range means many returning passengers may have reached home before showing symptoms." Lemoine said the rapid PCR test that Pasteur is working to produce will be distributed within ten days to other European reference laboratories.
In response to the Hondius cases, France's health system has activated a "hantavirus surveillance protocol" at eight ports. Passengers disembarking at Marseille, Bordeaux and Cherbourg are receiving a 14-day daily check-in by phone. Senior official Cyrille Schott told Le Monde that the system draws on infrastructure developed during the COVID-19 pandemic, well before the outbreak's first signs appeared in February.
According to BBC News, the United Kingdom's UK Health Security Agency is operating a similar tracking system; Singapore's health authority has completed two rounds of medical follow-up for Singaporean passengers from the ship. The Singapore Ministry of Health announced that the second round of testing on 14 May was entirely negative. This is a positive development for the country; however, given the long incubation period of Andes 1, the surveillance period has been extended to 60 days to prevent late-emerging cases.
MV Hondius operator Oceanwide Expeditions confirmed in a statement that the vessel has reached port at Las Palmas and is under monitoring by the European Centre for Disease Prevention and Control (ECDC). The company said that during the outbreak 117 passengers had been evacuated from the ship and brought ashore to Las Palmas Bigastro hospital for observation. The vessel will only re-enter service after its cleaning and disinfection process is approved by the ECDC. Oceanwide Expeditions executive Jorma Hansen said: "We will provide a financial support package for our passengers and crew, and we express our profound sadness at the losses suffered."
The other 233 French passengers in the medical surveillance group have to date shown no symptoms. Santé Publique France, however, anticipates that the observation period will cover the next three weeks and that new cases may emerge in that window. Vautrin asked citizens not to carry additional concern: "Our surveillance system is functioning. We will protect our citizens first by tracking, then by treating where necessary. This is one of the most significant tests of public-health surveillance systems globally over the past decade."
The risk of Andes 1 cases across Europe will continue to be monitored. Epidemiologists meeting at ECDC headquarters in Stockholm are modelling potential community transmission dynamics. Initial simulations in the academic literature suggest a person-to-person reproduction number (R) of between 1.2 and 1.6 — comparable to a seasonal influenza outbreak. ECDC spokeswoman Dr Andrea Ammon said the outbreak is classified as "medium-risk" for public health and that the assessment will be updated as data evolves.