Dutch Government Brings Hantavirus Patients Home as Suspected Cases Reach Europe
Three passengers have been evacuated from the cruise ship to hospitals in the Netherlands and Germany, a KLM flight attendant has been hospitalised in Amsterdam, and the ship is now sailing to Tenerife with around 150 people still on board.
A week after the suspected hantavirus outbreak on the Dutch polar cruise ship MV Hondius first came to light, the situation has evolved quickly. Several patients have been flown to Europe, the strain has been identified as the rarer human-to-human transmissible Andes variant, and the ship itself has now left Cape Verde and is sailing for the Canary Islands. Three passengers, a Dutch couple and a German national, have died in the outbreak, and the World Health Organization (WHO) has counted eight suspected cases in total.
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The patients evacuated to Europe
After the Dutch government agreed to lead the repatriation effort, two medical evacuation flights were arranged from the Cape Verdean capital Praia. They were carrying three people: a 41-year-old Dutch national, a 56-year-old British crew member, and a 65-year-old German woman closely related to one of the deceased passengers.
The first flight landed at Schiphol around 8 pm on Wednesday. The British crew member, identified by Sky News as Martin Anstee, was transferred to the Leiden University Medical Centre (LUMC), where he is in isolation. He has told reporters he feels "okay" but is still being tested. The German woman was taken on to the academic hospital UKD in Düsseldorf, where her condition is described as stable and where, according to local emergency services, she shows no signs of an infection.
The second flight, carrying the Dutch national, ran into trouble en route. After a technical fault on board, it had to make an unscheduled landing on Gran Canaria, where the aircraft remained connected to the airport's electrical supply while a replacement plane was arranged. The flight eventually landed at Schiphol on Thursday morning.
A KLM flight attendant in isolation
In a development closer to home, a KLM flight attendant from Haarlem has been hospitalised in isolation at Amsterdam UMC after showing mild symptoms of hantavirus. The Dutch ministry of health has confirmed that she came into contact with the 69-year-old Dutch woman who later died of the virus in Johannesburg.
The contact happened on KLM flight KL592 from Johannesburg to Amsterdam on 25 April. The Dutch woman, whose husband had already died on board the Hondius, had boarded the plane to fly home but was deemed too ill to travel and was removed before take-off. The flight then continued to Amsterdam without her. The flight attendant who is now being tested worked on that flight. Dutch health authorities are also contacting other passengers from KL592 as a precaution.
Confirmed: the Andes variant
A central question in the past few days has been which strain of hantavirus is involved. The South African National Institute for Communicable Diseases (NICD) has now confirmed the Andes variant in two patients linked to the Hondius: the Dutch woman who died and the British crew member now in Leiden.
The Andes variant is the only known hantavirus strain that can spread directly from person to person, although the South African health authorities and the WHO stress that this kind of transmission is "very rare" and only happens with very close contact. Most hantavirus infections still occur through contact with rodents or their droppings, urine or saliva.
The variant is mostly found in South America, including Argentina, where the Hondius cruise began in March in the southern port of Ushuaia. The Argentine health ministry has now announced rodent trapping and analysis in Ushuaia and will supply hantavirus tests to the European authorities. According to Argentine officials, the Dutch couple travelled in Argentina, Chile and Uruguay before boarding the ship, and their full route is now being reconstructed; it has not yet been confirmed where they were infected.
Ship sails to Tenerife
With the three symptomatic patients off the ship, the operator, Oceanwide Expeditions, said on Thursday morning that "no symptomatic individuals are present on board." The Hondius then departed from the Cape Verde coast on Wednesday evening and is now sailing to the Spanish island of Tenerife, where it is expected to dock on Saturday.
About 150 people are still on board, including ten Dutch nationals, according to Dutch foreign affairs minister Tom Berendsen. On the recommendation of the Dutch public health institute RIVM, two infectious disease specialists from the Netherlands are travelling with the ship from Cape Verde to Tenerife.
The arrival in Tenerife is politically delicate. The regional Canary Islands government has objected to the central Spanish government's decision to allow the ship to dock, saying it is "not based on technical criteria." The Spanish health minister has confirmed that the 14 Spanish passengers on the ship will be flown to a military hospital in Madrid and quarantined for around 45 days, given the long incubation period of hantavirus. The Irish health ministry is also drawing up plans for two Irish passengers, who are likely to be assessed at the National Isolation Unit at Mater University Hospital in Dublin.
Wider European cases
Beyond the Hondius itself, isolated cases have surfaced in other European countries. A Swiss national who had been on the ship tested positive for the Andes variant in Zurich and is being treated at the city's university hospital. His partner is in self-isolation as a precaution. The Swiss federal health office said it considers further cases in Switzerland unlikely.
The UK Health Security Agency has said that no British nationals currently on the Hondius, or who were on board and have since returned to the UK, have so far reported symptoms. Around 30 passengers disembarked the Hondius on Saint Helena on 24 April, including the body of the first deceased passenger. The first laboratory-confirmed case of hantavirus, however, was only reported on 4 May, leaving health authorities to retrace the movements of those who left the ship more than a week before.
For now, attention in the Netherlands is on the patients in Leiden and Amsterdam, the unfolding contact tracing around the KLM flight, and what awaits the ship and its remaining passengers when it reaches Tenerife at the weekend.
