American Hantavirus Cruise Passenger Develops Symptoms, Transferred to Atlanta

A total of 18 passengers from the cruise ship hit by a hantavirus outbreak arrived at the University of Nebraska Medical Center (UNMC) in Omaha for quarantine, but a couple was transported to Emory University in Atlanta after one partner developed symptoms, officials said.

Another passenger had previously tested PCR-positive for the virus, and while remaining asymptomatic, was moved to UNMC’s biocontainment unit for monitoring.

The other 15 passengers are in UNMC’s quarantine unit, where they all remain asymptomatic, officials said during a UNMC press briefing on Monday morning. They will continue to be assessed before any decisions are made about their next steps.

Previous reports indicated there were 17 American passengers; an additional passenger who has dual U.S. and U.K. citizenship opted to be repatriated into the U.S., officials said.

Also, of the two people who were transported to Emory, only one was symptomatic; the other was their partner, a UNMC spokesperson told MedPage Today. Brendan Jackson, MD, MPH, the CDC’s acting director of the division of high-consequence pathogens and pathology, said the decision was made to preserve space in Nebraska’s biocontainment unit for others who might need it.

Passengers range in age from their late 20s to late 70s or early 80s, UNMC officials said.

A French national also became symptomatic and tested positive for hantavirus as she was flying from Tenerife, Spain, to Paris after leaving the ship. She was in intensive care in stable condition at a Paris hospital on Monday. French passengers who returned with her on Sunday have tested negative but remain in isolation at the same hospital.

UNMC has the only official national quarantine unit in the U.S., according to John Knox, the principal deputy assistant secretary for preparedness and response at the Administration for Strategic Preparedness & Response (ASPR). It has “extensive expertise in handling special pathogens” and has participated in responses including the 2014 Ebola outbreak and the early days of the COVID-19 pandemic.

The quarantine unit is “much more like a hotel than a patient care space,” set up like a living space with exercise equipment, television, and other comforts, said Angela Hewlett, MD, an infectious disease physician and medical director of the UNMC biocontainment unit.

The passengers will remain there “at least a few days while we do assessments” and then coordinate their next steps, Jackson said. For those who remain asymptomatic, the decision about where to quarantine will rest with them, Jackson said, noting they “have the option to stay here for the entire 42-day period if that’s the safest and most effective option for them.”

Jackson noted that 42 days is “the maximum incubation seen with Andes virus” and “most people who end up infected with this virus will develop symptoms much sooner than that, so it’s a conservative timeframe.”

Assessments for whether people can safely quarantine at home include questions about whether passengers can contact their state public health department for testing if needed, and that they have access to appropriate levels of care near their home. If they do return home, they will be escorted under appropriate circumstances from start point to endpoint, officials said.

Hewlett noted that being able to access critical care is essential with hantavirus disease, which can involve rapid decompensation.

“We do think that being able to provide aggressive measures to people can change outcomes, and that’s the importance of being close to this type of care … should they need it,” she said.

Michael Wadman, MD, an emergency physician and medical director of Nebraska’s quarantine unit, echoed that it offers vast benefits to passengers who opt for it: “the best teams, the best policies and procedures, the best training, and the experience we’ve had over the years to provide this care in a safe manner — that track record is one of the things that sets us apart.”

“If I was exposed to this and I had the option to stay in a quarantine unit proximate to that care, I would definitely take that, because you’re putting yourself in a position, if you were to turn positive, to take advantage of all those things that will give you the best chance of survival,” he said.

Both UNMC and Emory University are among the country’s 13 Regional Emerging Special Pathogen Treatment Centers (RESPTCs), which ASPR established “over the years to prepare for high-consequence infectious disease outbreaks, with trained personnel ready to safely manage situations like this,” Knox said.

Jackson added that the seven American passengers who previously disembarked the ship on St. Helena, a remote island off the western coast of Africa, on April 24 — as first reported by MedPage Today — have all been contacted and state health departments are monitoring them on a daily basis, conducting symptom and temperature checks. They live in Arizona, California, Georgia, Texas, and Virginia.

In the early morning hours on Saturday, the CDC issued a Health Alert Network health advisory to healthcare professionals about being aware of the potential for imported cases of hantavirus disease in connection with the outbreak.

When asked whether he can guarantee that no Americans will catch the virus from passengers who have returned to the U.S., Jackson said, “There are no guarantees in life.”

“We are putting as many measures in place as possible to ensure that people are safe and healthy, and that we keep the community safe and healthy as well,” he said.