A dangerous hantavirus outbreak had been spreading aboard a cruise ship in the Atlantic Ocean for the past month. Three people on board have died. On 10 May, the ship reached an island in Spain, where all passengers were disembarked. They will now be sent back to their respective countries. Two Indians are also among them. The virus enters the human body through the respiratory system. It causes fever and flu-like symptoms at first, but then begins infecting vital organs such as the kidneys and lungs, leading to death within days in severe cases. How dangerous is hantavirus infection, could it trigger a pandemic like coronavirus, and how much of a threat does it pose to India? We explain… What is the hantavirus outbreak case linked to the cruise ship? On 1 April, a cruise ship named MV Hondius departed from the Argentine city of Ushuaia. There were 170 passengers and 71 crew members from 23 countries on board, and the vessel was scheduled to visit several islands. However, soon after the journey began, passengers started falling ill… On 6 April, the condition of a 70-year-old passenger deteriorated. He first developed a mild fever and later began facing breathing difficulties. The ship’s medical team administered medicines. As his condition worsened, he was placed on oxygen support and a ventilator, but he died on 11 April. His body was kept in cold storage as the ship continued towards its next stop. Two weeks later, the body was taken off at Saint Helena island. The deceased man’s 69-year-old wife and three others, who were also showing symptoms, disembarked there as well. On 24 April, the wife’s condition worsened at Johannesburg airport and she also died. A post-mortem revealed that both had been infected with hantavirus, which spreads through burrowing animals such as rats and squirrels. Meanwhile, no one aboard the ship was aware of this. Then, on 2 May, a German woman also developed a high fever followed by pneumonia and later died. A post-mortem again confirmed hantavirus infection. The same day, the Netherlands informed the WHO through the European Union that an unknown virus outbreak had spread aboard the cruise ship. On 6 May, the WHO officially shared details about hantavirus during a press conference. According to the organisation, six people have tested positive for the virus so far, and two of them are in critical condition. Meanwhile, nearly 30 passengers had already left the cruise and returned to their home countries. The ship reached the port of Granadilla on Tenerife island in Spain’s Canary Islands on 10 May. All 147 passengers have disembarked there. A WHO team will test them for the virus, after which countries will repatriate their citizens. How did hantavirus reach the ship? WHO Director-General Dr Tedros Adhanom Ghebreyesus has suggested that the outbreak may have started with a Dutch couple who had gone birdwatching near a garbage dump in Ushuaia, Argentina. It is believed they came into contact with virus-infected rats or their droppings there. What is hantavirus and when was the first case reported? Hantavirus is named after South Korea’s Hantan River. More than 20 strains of the virus are known, and almost all are linked to rodents, or burrowing animals. The virus is found in the urine, saliva and droppings of rats and squirrels. According to the WHO, a specific strain called ‘Andes’ can spread from one human to another. The virus does not make rodents sick, but it can prove fatal for humans. Virus particles from infected patients do not spread far through the air. It spreads through physical contact, eating from the same utensils, sleeping in the same bed, and through saliva or sputum from infected individuals. Caregivers are considered to be at higher risk. According to a report by Harvard University, the first recorded hantavirus case emerged in 1993, when an American couple died from the infection. Investigators found several rodent burrows and virus samples near the couple’s home. According to the US National Institutes of Health, around 150,000 hantavirus cases are reported worldwide every year, most of them in Europe and Asia. More than half of these cases are reported from China. The Andes strain of hantavirus is commonly found in Argentina and Chile. In 2018, the virus spread among 34 people during a birthday party in the Argentine city of Epuyén, killing 11 of them. How dangerous is hantavirus? Symptoms of hantavirus in humans can take between one and eight weeks to appear, but once symptoms begin, the patient’s condition can deteriorate rapidly. According to the WHO, 35–40% of infected people die within six weeks. This is why doctors focus heavily on a patient’s ‘exposure history’ — where they travelled or stayed during the previous three to four weeks — whenever hantavirus is suspected. Hantavirus is difficult to identify because its symptoms are very common. It can easily be mistaken for influenza, flu, dengue or viral fever. This often delays treatment. Experts say that anyone who has visited areas with rats or squirrels, garbage dumps, old storage rooms, animal sheds or long-abandoned buildings should get tested for hantavirus if they develop fever, body pain or related symptoms. What is the treatment for hantavirus? At present, there is no specific medicine or vaccine for hantavirus. Doctors around the world treat its symptoms. For example… According to Harvard University, patients who develop respiratory complications are immediately given oxygen therapy to maintain oxygen levels in the body. Critically ill patients are admitted to intensive care units. If the lungs stop functioning properly, patients are placed on ventilators. Dialysis is performed if kidney failure occurs. Medicines and IV drips are used to stabilise falling blood pressure. When the virus affects the lungs and heart, an antiviral drug called ribavirin is used. However, this medicine is only given to patients who are considered at low risk of kidney failure. Could hantavirus trigger a pandemic like coronavirus? The WHO has currently ruled out the possibility of a coronavirus-like pandemic caused by hantavirus. Maria Van Kerkhove, Director of the WHO’s Pandemic Department, said: “This is not the beginning of another Covid pandemic. The outbreak aboard the ship remains extremely limited.” According to WHO Director-General Ghebreyesus, none of the passengers aboard the ship are currently showing symptoms. Passengers had been instructed to remain inside their cabins, and the cabins were continuously sanitised. Ghebreyesus has personally arrived at Tenerife port to oversee the mission. According to him, passengers disembarking from the ship will be transported to the airport in special vehicles to avoid contact with the general public. They will then be flown to their respective countries on chartered aircraft. However, according to the cruise operator Oceanwide Expeditions, nearly 30 passengers disembarked at Saint Helena due to fears over the virus. Agencies suspect that several of them may also be infected with hantavirus. These passengers belong to 12 countries, including the United States, Canada, Singapore, Switzerland, Germany, the United Kingdom and the Netherlands. The WHO has formed a group with 23 countries to trace these individuals and ensure they are tested. How much of a threat does hantavirus pose to India? When a European Union-linked agency shared details of the passengers aboard the ship, it emerged that two Indians were also among them. They are members of the cruise ship’s crew. According to a Euronews report, passengers and crew members will be sent back to their countries after undergoing testing. In response, India’s Health Ministry has begun precautionary monitoring and instructed health agencies across the country to remain prepared. According to Health Ministry sources, the two Indian citizens aboard the ship are not showing any symptoms of the virus. India is monitoring the situation in coordination with the WHO. According to Dr Naveen Kumar, Director at the Indian Council of Medical Research (ICMR), the outbreak aboard the cruise ship does not pose an immediate threat to Indians. The virus has not spread on a large scale so far, meaning the situation remains under control. Hantavirus cases have been reported in India before In 2007, a 46-year-old man in Andhra Pradesh was infected with the virus. According to an article published in the journal Nature, 28 rat and snake catchers tested positive for infection in 2008. The most recent case dates back to 2016. According to the Indian Journal of Critical Care Medicine, a woman in Mumbai died due to hantavirus infection. Eight days after childbirth, she developed severe abdominal pain, fever and dizziness. Her blood pressure dropped and she began experiencing breathing difficulties. She died within 10 days. A post-mortem later confirmed hantavirus infection.
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