Hantavirus infection outbreak in a cruise ship: Management errors and public health issues

Forty years ago, in 1986, the same year as the Chernobyl nuclear disaster, the first case of what would have become popularly known as "mad cow disease", officially defined as "bovine spongiform encephalopathy" (BSE), was identified (Wells et al., 1987).
Go to the profile of Giovanni Di Guardo
Giovanni Di Guardo
Retired Professor of General Pathology and Veterinary Pathophysiology, University of Teramo, Faculty of Veterinary Medicine
Like

Share this post

Choose a social network to share with, or copy the URL to share elsewhere

Share with...

...or copy the link

This is a representation of how your post may appear on social media. The actual post will vary between social networks

Explore the Research

science.org science.org

Just a moment...

www.science.org
With the primary aim of managing the many gaps in knowledge and, together with them, the potential risk of transmission to humans associated with this new nosological entity—the only prion disease with proven zoonotic capability (Almond & Pattison, 1997)—the "precautionary principle" came into play, an "ad hoc" expression coined for the first time on that occasion (Agrimi et al., 1992). This principle is based on risk analysis, which is in turn subdivided into the various components comprising it, namely "hazard identification", "risk quantification", "risk management", and "risk communication". The first two fall within the domain of the Scientific Community, whereas risk management and communication involve both the scientific and the political-governmental levels.  
In short, the less is known about a given health issue and the effects resulting from human (and animal) exposure to the responsible agent, the greater the need to rely on the precautionary principle.
Applying these basic concepts and making an "ad hoc" assessment regarding the recent Hantavirus infection/disease outbreak that occurred aboard the Dutch cruise ship “MV Hondius,” I personally believe—as a veterinary pathologist and former university professor who devoted 40 years of his life to the study of infectious diseases—it was a serious mistake to allow passengers from as many as 23 Countries to disembark before their real health conditions had been ascertained. By “health conditions” I obviously mean those verified through appropriate laboratory investigations, first and foremost sero-epidemiological analyses, considering that since at least thirty years "ad hoc" tests (immunofluorescence, ELISA, etc.) are available to demonstrate the presence of specific anti-Hantavirus antibodies (Weissenbacher et al., 1996). Since all the cruise passengers were already on the ship—which, in such an unprecedented situation, could rightly have been considered a sort of “quarantine facility”—why was the decision made to let them disembark before the aforementioned serological tests aimed at establishing viral exposure and the degree of infection spread among the passengers were carried out? A bizzarre and incomprehensible decision in open contradiction with the precautionary principle!
The first confirmed case of person-to-person Hantavirus transmission dates back to 1996, in Argentina, where a South American endemic rodent, the long-tailed pygmy rice rat (Oligoryzomys longicaudatus), was also implicated—as it still is today—in the primary transmission of the infection to humans, in a manner almost analogous to that observed for all other members of the genus Orthohantavirus, transmitted to humans through the inhalation of aerosols containing faecal, urinary and/or salivary materials from infected mice, rats and voles (Leuenroth, 2006). More in detail, reference is being made to the viral strain called “Andes” (ANDV), the only one considered capable of human-to-human transmission—albeit with limited efficiency, far lower than that of SARS-CoV-2, the betacoronavirus responsible for the COVID-19 pandemic—and itself responsible for a severe respiratory disease (“Hantavirus Cardio-Pulmonary Syndrome,” HCPS). The three cruise passengers who died aboard the “MV Hondius,” like all those who fell ill, had contracted an ANDV infection, which in 2018–2019 had already been responsible, once again in Argentina, for a cluster of 34 cases, 11 of which were fatal (Martínez et al., 2020).
Particularly noteworthy in this regard is the role played by three “super-spreaders” of the virus who, during a birthday party, most likely transmitted the infection to numerous individuals. Although the three aforementioned “big spreaders” were all symptomatic, the authors of this study report that the severity of clinical manifestations and the length of time patients spent in hospital did not carry the same relevance, in terms of probability of transmitting the infection to others, as did the especially high viral titers in aerosols and droplets released by infected individuals, together with close and prolonged contacts between people (Martínez et al., 2020).
Let us imagine for just a moment how such a situation could occur, all the more so, on a cruise ship where close, prolonged and repeated contacts would have taken place not merely for the duration of a birthday party, but actually for weeks, considering that the “MV Hondius” reportedly set sail from the Argentine coast at the beginning of April!
Keeping firmly in mind, once again, the precautionary principle, attention should be also drawn to ANDV Hantavirus endoteliotropism, which would plausibly allow the pathogen to spread to numerous host tissue districts, with subsequent shedding into the external environment through various biological fluids such as urine and saliva (Velavan et al., 2026). By leaving the human body through the aforementioned biological matrices, as well as through aerosols and/or saliva droplets emitted by infected individuals carrying high viral loads—i.e. super-spreaders—, combined with the long incubation period characteristic of ANDV infection (up to 6 weeks and beyond), the virus could also contaminate several surfaces and/or materials. Following repeated contact with and/or prolonged exposure to contaminated surfaces or materials 
further cases of secondary infection could occur, although the environmental resistance of ANDV does not appear to be particularly high. Different degrees of genetic susceptibility to viral infection among individuals could also play a role, with particular reference to patients of European ethnicity and certain molecular configurations/properties of integrin αVβ3 (Velavan et al., 2026).
To what extent all the aforementioned factors and variables have thus far been taken into account in assessing the risk of human-to-human transmission associated with the ANDV outbreak in the cruise ship "MV Hondius"?
Very little, I'm afraid.
Still noteworthy, alongside the big differences of ANDV and SARS-CoV-2 in terms of transmissibility and lethality rates, emphasis should be also placed upon the scientific knowledge gained on both viruses. Indeed, while it is true we have known SARS-CoV-2 only since December 2019, whereas we have known ANDV for at least 30 years, there is a tremendous gap
between the enormous body of papers published on the betacoronavirus responsible for the COVID-19 pandemic and the far smaller amount available on the ANDV Hantavirus. Consequently, very much remains to be learned about the latter, so that the unprecedented disease outbreak recently recorded aboard the Dutch cruise ship “MV Hondius” may undoubtedly contribute significantly, if properly studied, to filling the many current gaps in knowledge, with special reference to the role of asymptomatic and paucisymptomatic individuals in spreading the infection.
It would also appear beneficial, if not necessary, recalling the valuable and precious lessons taught by the COVID-19 pandemic, in order to avoid repeating the serious mistakes of the recent past, foremost among them the “hospital-centered” management of an infectious disease caused by a zoonotic pathogen.
In this respect, it should be additionally emphasized that at least 70% of "emerging infectious diseases" have their origin, either proven or suspect, from one or more animal reservoirs (Casalone & Di Guardo, 2020). Consequently, substantial efforts and energies should be focused on the study of the ecological interfaces between wild animals/domestic animals/humans, in terms of resources and human capital invested in related research activities. In the current era of the Anthropocene, in which the overbearing, short-sighted and reckless human ecological footprint has produced and continues increasingly to produce all the conditions (climate crisis, global warming, deforestation, desertification, biodiversity loss, demographic growth, human-animal promiscuity, wet markets, etc.) that cause the aforementioned ecological interfaces to narrow progressively, the transfer of infectious agents from wild animals to domestic animals and people becomes increasingly likely.
The only approach capable of effectively combating and preventing all this therefore remains that based on the principle/concept of “One Health,” which constantly reminds us of the intimate and inextricable connection between human, animal and environmental health.
Errare humanum est perseverare autem diabolicum!
References 
1. Agrimi U, Di Guardo G, Pocchiari M. Bovine spongiform encephalopathy: An overview. Ann. Ist. Super. Sanita 1992;28:497-505.
2. Almond J, Pattison J. Human BSE. Nature 1997;389:437-438.  
3. Casalone C, Di Guardo G. COVID-19 and mad cow disease: So different, yet so similar! Science 2020 (e.Letter).  
4. Leuenroth S. Hantavirus Pulmonary Syndrome Infobase Publishing, 2006, ISBN 978-0-7910-8676-6.
5. Martínez VP, Di Paola N, Alonso DO, Pérez-Sautu U, Bellomo CM, Iglesias AA, Coelho RM, López B, Periolo N, Larson PA, Nagle ER, Chitty JA, Pratt CB, Díaz J, Cisterna D, Campos J, Sharma H, Dighero-Kemp B, Biondo E, Lewis L, Anselmo C, Olivera CP, Pontoriero F, Lavarra E, Kuhn JH, Strella T, Edelstein A, Burgos MI, Kaler M, Rubinstein A, Kugelman JR, Sanchez-Lockhart M, Perandones C, Palacios G. “Super-Spreaders” and Person-to-Person Transmission of Andes Virus in Argentina. N. Engl. J. Med. 2020;383:2230-2241.  
DOI:10.1056/NEJMoa2009040.
6. Velavan TP, Schmidt-Chanasit J. When Rare Zoonoses Travel: Andes virus, Hantavirus Cardiopulmonary Syndrome, and the Preparedness Gap. Int J Infect Dis. 2026 May 8:108778. doi: 10.1016/j.ijid.2026.108778.  
Weissenbacher MC, Cura E, Segura EL, Hortal M, Baek LJ, Chu YK, Lee HW. Serological evidence of human Hantavirus infection in Argentina, Bolivia and Uruguay. Medicina (B Aires). 1996;56(1):17-22.
7. Weissenbacher MC, Cura E, Segura EL, Hortal M, Baek LJ, Chu YK, Lee HW. Serological evidence of human Hantavirus infection in Argentina, Bolivia and Uruguay. Medicina (B Aires). 1996;56(1):17-22.
8. Wells GA, Scott AC, Johnson CT, Gunning RF, Hancock RD, Jeffrey M, Dawson M, Bradley R. A novel progressive spongiform encephalopathy in cattle. Vet Rec. 1987 Oct 31;121(18):419-20. doi: 10.1136/vr.121.18.419. PMID: 3424605.






Go to the profile of Giovanni Di Guardo
Giovanni Di Guardo (He/Him)
Retired Professor of General Pathology and Veterinary Pathophysiology, University of Teramo, Faculty of Veterinary Medicine

Born in Turin, Italy, on July. 04. 1958. Married on July. 12. 1987 with Letizia Curini, MD and father of two children, Cecilia (25-years-old) and Benedetta (24-years-old). Degree in Veterinary Medicine, cum laude, Bologna University, Faculty of Veterinary Medicine, December. 20. 1982. "Post-graduate Fellow", Bologna University, Faculty of Veterinary Medicine, Institute of General Pathology and Veterinary Pathological Anatomy, 1982-1985. State Veterinary Officer, Italian Ministry of Health, General Directorate of Veterinary Services, Rome, Italy, 1985-1987. "Assistant Veterinarian", Istituto Zooprofilattico Sperimentale (IZS) delle Regioni Lazio e Toscana, Rome, Italy, 1987-1993. "Chief Veterinary Pathologist", IZS delle Regioni Lazio e Toscana, Rome, Italy, 1993-January. 31. 2002. "Associate Professor", teaching "General Pathology and Veterinary Pathophysiology" (Academic Years 2001-2002, 2002-2003, 2003-2004, 2004-2005, 2005-2006, 2006-2007, 2007-2008, 2008-2009, 2009-2010, 2010-2011, 2011-2012, 2012-2013, 2013-2014, 2014-2015, 2015-2016, 2016-2017, 2017-2018, 2018-2019 and 2019-2020), as well as "Necropsy Techniques and Post-Mortem Diagnostic Pathology" (Academic Years 2001-2002 and 2002-2003), "Immunology" (Academic Year 2002-2003), "Cell Pathophysiology" (Academic Years 2003-2004, 2018-2019 and 2019-2020), University of Teramo, Faculty of Veterinary Medicine. Recipient of a unanimously positive/favourable evaluation, on behalf of the Examining/Evaluating Commission (composed by 5 distinguished Full Professors active in the concerned Disciplines, with one of them being a highly qualified foreign Member, namely Prof. Lluis Ferrer, from the Veterinary Faculty of the Universitat Autònoma de Barcelona, Barcelona, Spain), within "Abilitazione Scientifica Nazionale" (ASN) for "Full Professorship in Veterinary Pathology" (SSD 07/H2, VET/03) (ASN-2012; January. 09. 2014). Since January 05, 2021 officially retired from the position of Associate Professor of General Pathology and Veterinary Pathophysiology at the Veterinary Medical Faculty of the University of Teramo. Recipient of a unanimously positive/favourable evaluation, on behalf of the Examining/Evaluating Commission (composed by 5 distinguished Full Professors active in the concerned Disciplines), within "Abilitazione Scientifica Nazionale" (ASN) for "Full Professorship in Animal Infectious and Parasitic Diseases" (SSD 07/H3, VET/05) (ASN-2016-2018; March. 27. 2018). "Visiting Professor" and "Fulbright Scholar", in charge also of a research grant in "Comparative Oncology" from the Italian National Research Council (CNR), Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Iowa State University, Ames, Iowa, USA, October 1987-January 1988. "Visiting Scientist", Department of Agriculture and Rural Development for Northern Ireland (current denomination: Agri-Food and Biosciences Institute for Northern Ireland), Veterinary Sciences Division, Stormont, Belfast, Northern Ireland (UK), 4-14. December. 1991 (first visit) and 14-18. April. 2008 (second visit), carrying out research activity on the pathology and pathogenesis of infectious disease conditions affecting free-living sea mammals (cetaceans, in particular), with special emphasis on Morbillivirus infections. "Diplomate", European College of Veterinary Pathologists (Dipl., ECVP), 1995-to date. Member of the "Fondazione Cetacea" Scientific Commission, Riccione, Italy, 1997-to date. Member of the "Consulting and Operative Animal TSE Unit for Latium and Tuscany Regions", 1997-2002. Member of the "Italian TSE National Surveillance Group", 1998-2002. Member of the "Technical and Scientific Committee for the Regional Plan of Genetic Selection for Resistance to Transmissible Spongiform Encephalopathies" (Abruzzo Region, Department of Health and Welfare), January 2003-to date. "International Training Expert", EU Phare Project 2003 on "TSE Control in Poland - Part 2", Training Course on "Control and Diagnostic Methods of Transmissible Spongiform Encephalopathies (TSE)", Warsaw (Poland), 3-7. April. 2006. Italian Delegate, Scientific Committee, 59th, 60th and 64th "International Whaling Commission" (IWC) Annual Conferences. Member/Component of the "ACCOBAMS Task Force for Special Cetacean Mortality and Stranding Events", 2008-to date; Scientific Expert, Group on "Cetacean Emerging and Recurring Diseases" (CERD), "Scientific Committee", "International Whaling Commission" (IWC), 2007-to date. Member/Component of the "EFSA Expert Database" (European Food Safety Authority, EFSA), June 2010-to date. External Scientific Member/Component of the "Body/Committee for Animal Welfare" of the Italian National Institute of Health (since 2015). Member/Component of the "National Experts' Committee of the Italian Marine Mammal Stranding Network" (following the official, joint nomination achieved on behalf of the Italian Ministry for the Environment and by the Italian Ministry for Health) (since 2016). Member/Component of the Working Group on the "Reduction of the list of specified risk materials from small ruminants, sheep and goat", Italian National Health Council (Sections III & IV); official invitation made by the President of the Italian National Health Council, as well as by the two Presidents of Sections III & IV of the Council itself, January 2017-. Member/Component of the "Histology Study Committee" within the "Italian Association of Veterinary Laboratory Diagnosticians" (S.I.Di.L.V.), September 2017-. Enrolled into the "Italian National Registry" of the "Experts" ("Scientific Discipline Experts"), handled/held by the "Italian National Agency for the Evaluation of University and Scientific Research" (ANVUR), February 2019-. Member of several International and National Scientific Societies, as well as of the Scientific Committee of the "Italian Association of Veterinary Pathology" (AIPVet) and of the Scientific Committee of the "Italian Society for Preventive Veterinary Medicine" (SIMeVP) (2007-2010). Member/Component of 3 (three) distinct PhD Thesis International Examining Boards/Committees, University of Las Palmas de Gran Canaria, Faculty of Veterinary Medicine, Las Palmas, Gran Canaria, Canary Islands, Spain; International and National (PRIN) Research Project evaluator, as highlighted - among others - by the peer review evaluation activities conducted on a number of transnational research projects submitted within the second call (2011) in the framework of the "EMIDA (Emerging and Major Infectious Diseases of Animals) ERA-Net" (European Union, EU) network, as well as on a number of international research proposals presented both in the context of the "7th Framework Programme (FP7; 2007-2013) for Scientific Research of the European Union" (EU "People" Programme/Action) and in the framework of the "EXPRO Tender", under the umbrella of the "Czech Science Foundation". External Scientific Member of the "Organism for Animal Welfare", Italian National Institute of Health, November 2014-to date. Member/Component of the Scientific Research Board/Committee of the University of Teramo (as Delegate/Representative of the Veterinary Medical Faculty), June 2013-to date. Member/Component of the "Examining and Certifying Board for Professional Licensing/Qualification as a Veterinarian" (University of Teramo, Faculty of Veterinary Medicine, Years 2007 and 2019, June and November Sessions). "Scientific Editor" (for "Veterinary Pathology") and Member of the Editorial Board of the international Journal "Research in Veterinary Science", September 2010-to date; Member of the Editorial Board of the international Journal "Journal of Biological Regulators and Homeostatic Agents", March 2015-to date; Member of the Editorial Board of the international Journal "Pathogens", November 2019-to date; Member of the Editorial Board of the scientific Journal "Tabaccologia", March 2020-to date; Member of the Editorial Board of the scientific Journal "Ittiopatologia", 2007-to date; past-Member of the Editorial Board of the scientific Journal "Aggiornamenti di Medicina e Chirurgia". Scientific coordinator of a number of research projects concerning both animal TSEs and cetaceans' pathology, all financially supported by the Italian Ministry of Health, by the Italian Ministry for Education, University and Research (MIUR) and by the Italian Ministry for the Environment. Author or coauthor of over 500 scientific publications, 190 of which published in international peer-reviewed Journals (see "ad hoc" publications' list). Main research interests concern infectious disease conditions in animals and man, with particular emphasis on TSE pathogenesis (more specifically, on sheep and goat scrapie pathogenesis) and on sea mammals' pathology (more in detail, on free-living cetaceans' pathology).

Please sign in or register for FREE

If you are a registered user on Research Communities by Springer Nature, please sign in

Sign In Register

Cookies

We use cookies to ensure the functionality of our website, to personalize content and advertising, to provide social media features, and to analyze our traffic. If you allow us to do so, we also inform our social media, advertising and analysis partners about your use of our website. You can decide for yourself which categories you want to deny or allow. Please note that based on your settings not all functionalities of the site are available.

Further information can be found in our privacy policy.

Cookie Control

Customise your preferences for any tracking technology

The following allows you to customize your consent preferences for any tracking technology used to help us achieve the features and activities described below. To learn more about how these trackers help us and how they work, refer to the cookie policy. You may review and change your preferences at any time.

See the full cookie policy See the full privacy policy
More information

These trackers are used for activities that are strictly necessary to operate or deliver the service you requested from us and, therefore, do not require you to consent.

More information

These trackers help us to deliver personalized marketing content and to operate, serve and track ads.

More information

These trackers help us to deliver personalized marketing content to you based on your behaviour and to operate, serve and track social advertising.

More information

These trackers help us to measure traffic and analyze your behaviour with the goal of improving our service.

More information

These trackers help us to provide a personalized user experience by improving the quality of your preference management options, and by enabling the interaction with external networks and platforms.