The MV Hondius left Ushuaia, Argentina, on April 1 carrying 88 passengers and 59 crew members from 23 countries on an expedition across the South Atlantic. For the people aboard, it was meant to be the journey of a lifetime. The Dutch expedition cruise ship was headed towards Antarctica, South Georgia Island and some of the world’s most remote territories, places associated with glaciers, penguins and silence, not international health alerts. Days aboard the ship revolved around icy landscapes, freezing winds and endless stretches of grey ocean disappearing into the horizon.
Then, during the voyage, passengers began falling ill. At first, it did not seem extraordinary. Long voyages often leave people tired or unwell, and respiratory symptoms in freezing weather did not immediately suggest the beginning of an international public health response. But as more passengers became seriously ill and deaths were reported, concern spread far beyond the ship itself. On May 2, health authorities formally reported a cluster of severe respiratory illness linked to the voyage.
Soon, countries across the world were tracing passengers, issuing advisories and preparing quarantine systems. By then, three people had died.
Health authorities later identified the virus as the Andes strain of hantavirus, a rare pathogen unfamiliar to most people outside infectious disease circles. The relatively small outbreak became an international public health concern because the world no longer reacts to outbreaks the way it once did. Especially after COVID-19.
Why the Andes virus drew global attention
Hantaviruses are usually spread through contact with infected rodent urine, saliva or droppings. In severe cases, they can cause hantavirus pulmonary syndrome, a respiratory illness that can become fatal very quickly.
What made the Andes strain different and more concerning to health authorities was that it is the only hantavirus known to have documented person-to-person transmission, though such spread remains rare and usually linked to prolonged close contact with a symptomatic person.
According to the US Centers for Disease Control and Prevention, transmission may occur through direct physical contact, shared enclosed spaces or exposure to respiratory secretions and body fluids. That single detail changed the response.
Several countries initiated contact tracing, quarantine measures and long-term monitoring for potentially exposed passengers. Canada has since confirmed its first hantavirus case linked to a passenger from the MV Hondius outbreak, adding another layer to the international public health response.
How health authorities responded
The outbreak has also brought renewed attention to Nebraska Medicine and the University of Nebraska Medical Center (UNMC), which became internationally recognised during the Ebola outbreak and later played significant roles during COVID-19.
Nebraska Medicine’s National Quarantine Unit is widely regarded as the only federally funded quarantine unit in the United States, designed specifically to safely house and monitor individuals exposed to high-consequence infectious diseases.
In an exclusive interaction with The Week, Dr Jeffrey P. Gold, president of the University of Nebraska System, said special attention is being paid to specialised pathogen response systems and quarantine infrastructure in the United States.
In India, where public health systems remain highly alert to unusual infectious disease clusters after COVID-19 and recurring concerns around zoonotic outbreaks such as Nipah in Kerala, Dr Gold says it is important to get the quarantine right.
At the moment, he feels that effective handling of the latest outbreak has helped contain the spread. “Whenever outbreaks of this nature occur, it is essential to address them quickly, effectively and with the highest level of expertise possible. I believe that is exactly what has happened here.”..
Excerpts from the interview:
Q. How serious is the current Andes hantavirus outbreak from a public health perspective, and how should the public understand the risks without panic?
From a public health perspective, we have demonstrated across the globe approximately 11 confirmed cases of the Andes variant of this virus. Certainly, the 16 individuals that we are caring for are undergoing very close monitoring for the development of symptoms and signs of the disease. None have developed any signs or symptoms at this time.
From a public health perspective, there appears to be a very low transmission rate other than through close contact. Obviously, this is something that needs to be monitored carefully for every exposure, whether high-risk or low-risk, along with adequate contact tracing in the event there are any future cases. Right now, the overall risk appears extremely low.
Q. Cruise ships are often seen as high-risk environments during outbreaks. What makes them particularly vulnerable to infectious disease spread?
Certainly, cruise ships, because they involve close quarters over long periods of time, tend to create a higher risk of outbreaks of any nature, whether viral or otherwise. That is why the industry has put tremendous attention into surface cleaning, air handling, decontamination, handwashing and food services.
They have done a really good job of trying to reduce the risks. But at some level, there is still an increased risk because of the close-quarter environment. We continue to see examples of this, whether it is gastrointestinal viruses such as norovirus or, in this case, hantavirus disease.
Q. Nebraska Medicine and UNMC played major roles during Ebola and COVID-19. What lessons from those experiences continue to shape your preparedness systems today?
This reinforces the fact that our medical centre is uniquely prepared because of past experience, training and the use of cutting-edge science to maintain readiness to quarantine, isolate and, if ever necessary, treat individuals exposed to high-risk pathogens such as this.
Having a destination in our country where we know the highest standards of care are available sends a very clear message of safety in this area. I am very honoured that our medical centre can rise to the occasion to do this.
Q. Why are specialised quarantine and biocontainment facilities so critical when dealing with rare infectious diseases?
If quarantine, isolation, and, if needed, biocontainment are not adequately managed, you create significant public health risks because these are pathogens with very high case-fatality rates that often lack clearly identified treatment modalities.
It is really important to get it right. There is nothing like having an experienced team and world-class facilities to manage these situations effectively, and we check all those boxes.
Q. Could you tell us about the kind of infectious disease research currently being conducted at Nebraska Medicine and UNMC?
Our medical centre conducts an incredible amount of research in infectious diseases, including both commonly acquired infectious diseases and what we call 'special pathogens'. We are uniquely licensed and partner with state public health laboratories to carry out this kind of research.
So we not only provide the clinical care, but also the scientific research that goes with it.
Q. What is the most important message the world should take away about emerging infectious diseases and preparedness after COVID-19?
Emerging infectious diseases and preparedness remain both a global public health responsibility and a challenge for us to continue maintaining vigilance, communicating effectively across the globe and sharing best practices.
Whenever outbreaks of this nature occur, it is essential to address them quickly, effectively and with the highest level of expertise possible. I believe that is exactly what has happened here.
