The U.S. citizens who were aboard the Hondius cruise ship hit by a hantavirus outbreak have arrived in Nebraska for assessment, including one patient who is in a specialized biocontainment unit after testing positive for the rare respiratory disease.

The infected American and another French passenger tested positive for the Andes strain of the virus less than a day after passengers were evacuated from the expedition vessel. There have been at least eight confirmed infections, including the two new cases. All were caused by the Andes strain, the only one known to move from person to person.

The French woman developed symptoms on the repatriation flight from the Canary Islands and worsened overnight, the country’s health minister said. She and four other French passengers are now hospitalized and in isolation.

Governments are taking extensive precautions after a multi-country response to evacuate passengers from the Dutch-flagged ship at the center of an outbreak that has left three people dead. While public-health authorities continue to say the general risk from hantavirus is low and broader contagion is unlikely, others are urging caution to contain the outbreak.

“It’s a virus we know,” said French Health Minister Stephanie Rist said. “The incubation period is quite long and we need to break the potential chain of transmission from the start.”

The French passengers will be isolated for 42 days as France takes the strictest measures of any European Union country, Rist said.

The U.S. is taking a less stringent approach.

“We don’t want to treat it like Covid,” Jay Bhattacharya, acting director of the Centers for Disease Control and Prevention, told CNN’s State of the Union on Sunday. “We don’t want to cause a public panic over this.”

U.S. passengers who arrived at the National Quarantine Unit, a secured facility on the University of Nebraska Medical Center campus in Omaha, are now being interviewed and assessed for risk based on their proximity to those who were infected. Most will be given the choice to stay in the Nebraska unit or return to their communities to quarantine if “their home situation allows it,” Bhattacharya said. They will be under the supervision of state and local public-health agencies with CDC support, he said.

All 17 U.S. citizens who left the ship were flown to the U.S. via a State Department airlift. Two passengers traveled in biocontainment units “out of an abundance of caution,” the Department of Health and Human Services said late Sunday in a post on X. Besides the confirmed case, another is showing mild symptoms.

Precautions

The vigilant government responses reflect the uncertainty that remains around how the virus may have spread on the ship, even as health authorities emphasize that hantavirus is far less transmissible than Covid-19.

Repatriation flights began Sunday after the ship anchored off Tenerife in Spain’s Canary Islands, with passengers being flown to countries that also include Spain, Canada, the U.K. and the Netherlands, according to WHO officials. The agency has recommended active monitoring of travelers for up to 42 days, reflecting the virus’s long incubation period.

Australia will repatriate and quarantine six people from the ship, Health Minister Mark Butler said Monday, even though none are showing symptoms.

Several people left the Hondius earlier during the voyage, including a British resident who is now being monitored for a suspected infection in Tristan da Cunha. The U.K. government said military personnel parachuted onto the remote island territory to deliver medical supplies, underscoring the logistical challenges of reaching what is considered one of the world’s most isolated locations.

Quarantine measures

Some experts say the outbreak may challenge assumptions about how the virus spreads. Emerging evidence suggests transmission may not always require prolonged close contact, Ashish Jha, former White House Covid-19 response coordinator, said in a post on X, calling for strict quarantine measures for passengers.

Previous research on Andes hantavirus outbreaks has found transmission occurring in shared settings without direct physical contact, including brief encounters in crowded indoor environments, according to a study published in the New England Journal of Medicine.

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—With assistance from James Mayger.

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