Doctors have spoken out about hantavirus after three people suspected to have contracted it were medically evacuated from a cruise ship. They include a 56-year-old British man named Martin Anstee, an expedition guide onboard the ship, the MV Hondius.
“I’m doing OK. I’m not feeling too bad. There are still lots of tests to be done. I have no idea how long I’ll be in the hospital for. I’m in isolation at the moment,” he later told Sky News.
Very little was known about the Andes strain before an outbreak in Epuyen, southern Argentina, in 2018, which killed at least 11 people, said Dr. Gustavo Palacios, a microbiologist at the Icahn School of Medicine at Mount Sinai in New York, according to CNN.
“There is very limited experience handling this virus,” said Palacios, who was the director of the Center for Genome Sciences at the US Army Medical Research Institute of Infectious Diseases when he helped determine how the virus moved from person to person.
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The study of the outbreak was published in the New England Journal of Medicine back in 2020.
“Probably we are having less than – I don’t know, I’m giving you a number, just for a ballpark number – 300 cases in history,” said Palacios, who is part of a group of experts advising on the ongoing cruise ship outbreak.
What the study found
An investigation of the Epuyen outbreak revealed that the window for transmission of the Andes virus appears to be short, about a day, Palacios said. An individual is at their peak of infectiousness on the day they develop a fever.
The study found that the virus could be passed relatively easily during this window, following periods of brief proximity to someone else. In fact, the first patient, a 68-year-old man, infected someone else after being in contact with them at a birthday party for just a few moments, on the way to the restroom.
Humans are typically infected through contact with rodents’ urine, feces or saliva, sometimes when the virus becomes aerosolized during cleaning. Rodents around the world, including in the US Southwest, harbor hantaviruses.
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The most recent case that made headlines in the US was the Betsy Arakawa case. Gene Hackman’s wife died of the virus, an autopsy found.
In hantavirus cases, a human gets infected after contact with animal droppings but does not pass it on to anyone. However, in the case of the Andes virus, it can spread between people.
The Andes virus’ incubation period is another problem. The time between a person’s exposure to the virus and when they first begin to show symptoms can be a long interval, making it hard to track down people who may have been exposed.
More than 80 healthcare workers in the Epuyen outbreak were exposed to patients with symptoms. However, none of them infected themselves, even though very few used any personal protective equipment. There were just two infected healthcare workers at the local rural hospital, which may have been the first to see sick patients.
This limited spread in the Epuyen outbreak pointed at the short window of time that a person may be infectious, experts said.
“This is not Covid. This is really not Covid. It’s not even influenza. It’s an unusual person-to-person event, and it might have happened because, perhaps, of a closed environment on a ship,” said Dr. Lucille Blumberg, an infectious disease specialist who is the former deputy director of the National Institute for Communicable Diseases in South Africa, of the cruise ship outbreak.
Is there need for concern?
Dr. William Schaffner, a disease expert at Vanderbilt University, said that the situation on the Hondius does not worry him, but interests him instead.
“I am transfixed,” Schaffner said. “It’s an extraordinarily unusual circumstance where there’s hantavirus infection on a boat, and I’m even impressed that they’ve made this diagnosis.”
“It’s serious, and for us, scientifically, it has all these other curiosities about location and behaviors of new hantavirus variants,” Schaffner added. “So there are lots of scientific issues, there are public health issues, there are issues of, how do you deal with seriously ill people on a cruise ship who have a communicable disease in the middle of the ocean?”
The World Health Organization says the threat posed from the current outbreak on Hondius is low. However, WHO has classified hantaviruses as emerging priority pathogens with high potential to spark international public health emergencies. In fact, Hantavirus infection can be lethal in up to 40% of cases.
