Cruise ship passengers being monitored in hospital after hantavirus outbreak
Over 20 people are isolating in hospital in the North West of England following an outbreak of hantavirus on a cruise ship.
The UK Health and Security Agency (UKHSA) confirmed the passengers – who are not symptomatic – will be monitored at Arrowe Park Hospital in Wirral for 72 hours before self-isolating at home for a further 42 days.
They were passengers on the Dutch-flagged cruise ship called the MV Hondius, which departed from Argentina on 1 April, and was hit by an outbreak of hantavirus. It was crossing the Atlantic Ocean when several passengers fell ill. Three people died following the outbreak.
The World Health Organization (WHO) confirmed last week (9 May) that there are now eight cases of hantavirus, six confirmed and two suspected – including three British nationals.
Hantavirus is associated with rodents and includes symptoms such as fever, extreme fatigue, muscles aches, stomach pain, nausea, vomiting, diarrhoea, and shortness of breath.
People tend to get infected when they breathe in particles from infected rodent urine, droppings, or saliva. The incubation period is typically two to five weeks.
The UKHSA has confirmed that public health specialists and infectious diseases specialists from the NHS will assess the current condition of those isolating at Arrowe Park Hospital, and determine where they can suitably isolate.
During their isolation period, regular testing and care will be provided by NHS and UKHSA alongside daily contact with health protection teams to check on their wellbeing.
Chief scientific officer at UKHSA Professor Robin May said: ‘We are pleased to confirm that all British nationals onboard the MV Hondius have now safely returned to the UK and are being supported by UKHSA and NHS medical experts at Arrowe Park, who have worked at pace to prepare for the safe arrival of passengers at the facility.
‘Staff at Arrowe Park have once again demonstrated their commitment and professionalism in responding rapidly to a health emergency, and we are very grateful.’
Professor May added: ‘The safety and wellbeing of those passengers remains our priority. The risk remains very low for members of the general public.’
Public health minister Sharon Hodgson said: ‘I want to thank all those who have worked to bring our British nationals home and the NHS workers now caring for them at Arrowe Park Hospital – their dedication and professionalism show our NHS at its very best.
‘None of the passengers are symptomatic but we will monitor them closely over the next 72 hours at the hospital, as part of a precautionary isolation period.
‘With no cases or symptoms among them and our stringent monitoring and isolation measures, the risk to the public remains extremely low.’
A public health expert’s view on what healthcare professionals need to know:
Speaking to Cahal McQuillan for our sister title, The Pharmacist, Dr Michael Head, an expert in public health research and epidemiology at the University of Southampton, said: ‘Hantavirus is probably little known to the wider general public, but there are probably around 150,000 to 200,000 cases globally every year.’
‘It is a very nasty pathogen,’ Dr Head added. ‘The case fatality rate can be 20-50%, as we’ve seen with previous outbreaks.’
‘So the fact that people have died in this outbreak is tragic, but it’s also not necessarily surprising,’ he said.
What is different in terms of the MV Hondius outbreak is the fact that possible human-to-human transmission has occurred.
Dr Head said that this is not unprecedented: ‘The Andes strain – which is the variant identified in this outbreak – is unusual in that there has been documented human to human transmission in the past.’
In an outbreak of the Andes strain of hantavirus in Argentina in 2018 and 2019, ‘There were 34 confirmed cases and 11 deaths,’ noted Dr Head.
‘Only three or four of the cases were known to have an initial environmental exposure, and then one or more of those cases subsequently infected other people. So human-to-human transmission has been seen before.’
Threat to the UK
Hantavirus already exists in the UK. However, only Seoul hantavirus, which does not transmit person to person, has ever been identified in the UK.
Since 2012, 11 confirmed human cases of Seoul hantavirus infection have been reported in the UK, with nine linked to pet rats or rats bred for reptile feeding.
When asked if the Andes strain could become established in UK rodent populations, Dr Head said: ‘Rats are mobile. They can get on planes and boats and go to other continents. So, there is a theoretical risk.’
But he noted: ‘The risk of the Andes virus becoming imported and sustained in the UK is extremely low I would think.’
‘The Andes hantavirus would need to establish as host in the rats here, and it might also need some kind of competitive advantage to outweigh the Seoul hantavirus in order to become the dominant strain. So, the risk to somebody based in the UK, is as close to zero as it gets.’
‘If you’re a close contact to those on board the ship, then there are certainly greater concerns, but beyond that environment, there is little reason to be concerned for the wider general public.’
Dr Head highlighted that hantavirus symptoms overlap with many common viral illnesses.
‘The symptoms, across many respiratory diseases are often similar to each other. They might start with a fever, maybe you might get some nausea or vomiting, you might get coughing.
‘With hantavirus, there is quite a sudden onset to severe disease, and it can happen quite quickly where that difficulty in breathing increases, and where fluid starts to get into the lungs.’
‘So, in relation to this specific hantavirus outbreak, I think travel history is going to be a key one for clinicians to keep an eye out for.
‘But, if there was some kind of environmental behaviour that could have involved exposure to rats and their droppings, then that again could be a diagnostic clue for clinicians as well. And also, occupational exposures or social exposures.’
If a case is suspected, Dr Head stated that hantavirus is a notifiable disease, so healthcare professionals would need to report it to the appropriate public health authorities – the UKHSA.
After that, diagnosis is usually made via polymerase chain reaction (PCR) testing, there is no antiviral available to treat the infection and clinicians are only able to provide ‘what’s known as supportive care’, said Dr Head.
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