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Countries preparing for the arrival of a hantavirus-stricken cruise ship near Spain’s Canary Islands still face major unknowns about how the outbreak began, who may have been exposed, and where some people who left the vessel have gone, according to reporting by the Associated Press.
The cruise ship is expected to reach the Spanish island of Tenerife, off the coast of West Africa, early Sunday, AP reported. Health authorities have reported that at least three passengers have died and that several other people have been infected.
Hantavirus is typically spread through inhalation of contaminated rodent droppings and is not easily transmitted between people, AP said. Some scientists believe an Andes virus implicated in the cruise ship outbreak could spread between people in rare cases, while the World Health Organization said the risk to the wider public is low. Symptoms typically appear between one and eight weeks after exposure.
AP said one central gap is where the outbreak originated. Argentine investigators suspect a Dutch couple may have first contracted the virus while on a bird-watching trip before they boarded the cruise ship in Argentina on April 1, but no organization has confirmed where or how they acquired the disease. Argentina’s Health Ministry has focused on Ushuaia, in the country’s southernmost region, and officials said they plan to travel there in the coming days, according to a written statement to AP.
A second uncertainty involves what happens next to the remaining passengers and crew as Spain prepares to receive them. Spanish authorities said the group will be evacuated in small boats to buses only once repatriation flights are ready to take them, AP reported. AP said the United States agreed to send a plane to pick up its citizens, while the British government is doing the same, and that American passengers will be brought to a dedicated biocontainment and quarantine unit in Nebraska for assessment.
Other countries, AP reported, had not yet made plans public, leaving unclear how long some boat passengers might have to wait for their flights. Spain also requested medically equipped planes for passengers experiencing symptoms, Virginia Barcones, Spain’s head of emergency services, said Friday.
A further question is how many people may have been exposed before health authorities confirmed hantavirus on the ship. Cruise operator Oceanwide Expeditions and Dutch officials said Thursday that more than two dozen people from at least 12 different countries left the ship at the remote island of St. Helena in the South Atlantic on April 24, AP reported. AP said the group included a Dutch woman who disembarked with her husband’s body, and that her husband was the first passenger to die aboard the ship. However, health authorities first confirmed hantavirus in a ship passenger only on May 2, leaving countries scrambling to track the people who disembarked about two weeks earlier.
AP said one of those passengers was a resident of Tristan da Cunha who has been hospitalized with symptoms of hantavirus, according to the British Foreign Office. Stephen Doughty, the U.K. minister of overseas territories, wrote to the British overseas territory that “the islander currently in hospital and their spouse who is isolating” were in his thoughts.
Even where governments say they know the whereabouts of their citizens, AP reported there are still gaps in contact history. Many passengers who disembarked at St. Helena traveled onward to other countries, including South Africa and the Netherlands. AP said Dutch and South African authorities are trying to trace where a Dutch woman who left the ship went and who she had contact with during her travels, after she flew to Johannesburg and later briefly boarded a plane preparing to fly to Amsterdam before being removed because she was too ill to travel. AP reported that she later died.
AP said in the U.K., officials have confirmed the whereabouts of their citizens who left the boat but have not made public how many others they have had contact with since. In the U.S., some state officials said they were monitoring a small number of residents who had been on the ship and already returned home, and that none of those residents had symptoms.
While countries work through those missing details, officials are also preparing for the biology of the virus and what it means for risk, AP reported. With the World Health Organization describing the risk to the wider public as low and hantavirus typically not spreading easily between people, the decisions now depend heavily on completing the outbreak picture—especially identifying when and where exposures happened.