The Japan Times - Suspected hantavirus cases to be evacuated from cruise ship

The MV Hondius has been at the centre of an international health scare since Saturday, when the World Health Organization was informed that the rare disease -- usually spread from infected rodents typically through urine, droppings and saliva -- was suspected of being behind the deaths of three of its passengers.

As others fell ill, passengers and crew have been in isolation after Cape Verde authorities barred the ship from docking, and health authorities scrambled to find a port that would take the Hondius, anchored just off the island nation's capital Praia.

The Dutch operator Oceanwide Expeditions indicated Tuesday that a solution was in sight, with plans to evacuate two sickened crew members to the Netherlands for "urgent medical care", along with a third person who had been in close contact with a German passenger who died on Saturday.

The WHO also said medical evacuation plans were under way.

Once the evacuation has taken place, MV Hondius "can continue its route", Ann Lindstrand, the WHO's representative in Cape Verde, told AFP, adding that the ship looked set to sail either to the Canaries or to the Netherlands.

Oceanwide Expeditions meanwhile said its plan was for the ship to sail north "to the Canary Islands, either Gran Canaria or Tenerife, which will take three days of sailing", adding that "discussions are ongoing with relevant authorities".

- 'Complicated' -

The cruise, which set sail from Ushuaia in Argentina on April 1 destined for Cape Verde, counted 88 passengers and 59 crew members, with 23 nationalities onboard, the WHO said.

One of the dead, a Dutch woman, had left the ship at the Atlantic island of Saint Helena and had flown to Johannesburg where she died on April 26.

Health authorities have been racing to find a port for the ship to dock, with Spanish authorities insisting they wanted health data from the expedition vessel before opening up a Canary Islands port.

On Tuesday afternoon, Lindstrand said an ambulance would take three people from the port in Praia, to the nearby airport, from which they will be evacuated by plane.

While the situation was "changing by the hour", Lindstrand said that once that "complicated expedition" had been carried out, "the boat will be able to leave sometime in the middle of the night".

- Human-to-human transmission? -

So far, two hantavirus cases have been confirmed -- including in one of the fatalities and a British passenger currently in intensive care in Johannesburg -- with five further suspected cases, the WHO said.

Three of those seven have died; the one in Johannesburg was critically ill, and three still on board had reported milder symptoms, including one who is now asymptomatic, it said.

The WHO was trying to deduce how hantavirus had appeared on the ship, with the first person who died having developed symptoms on April 6.

Human-to-human transmission has only been reported in previous outbreaks of one specific hantavirus called Andes virus, which circulates in South America.

WHO epidemic and pandemic preparedness and prevention director Maria Van Kerkhove told reporters the virus species had yet to be confirmed, but highlighted that WHO had been told "there are no rats on board" the ship.

South African researchers were sequencing the data, said Van Kerkhove, who added that "our working assumption is that it is the Andes virus".

"We do believe that there may be some human-to-human transmission that is happening among the really close contacts".

- Contact-tracing -

The first two fatalities were a Dutch couple -- a man who died on April 11 and his wife who died after she disembarked in Saint Helena to accompany his body.

The wife was suffering from "gastrointestinal symptoms" and "deteriorated" during a flight to Johannesburg on April 25, the WHO said. She died the following day.

Efforts are under way to trace people on that flight, which South African-based carrier Airlink said was carrying 82 passengers and six crew.

The South African authorities had asked the airline to notify the passengers that they must contact the health department, a representative, Karin Murray, told AFP.

Van Kerkhove said the typical incubation period for hantavirus was between one and six weeks, leading the WHO to believe that the Dutch couple, who had been travelling in South America, "were infected off the ship".

The Hondius, she highlighted, was an expedition vessel, with passengers going ashore on Atlantic islands to do birdwatching and other activities -- meaning there could be "some source of infection on the islands".

The WHO has said the risk to the global population from the outbreak is "low".

H.Nakamura--JT