Like many of you, I was deeply troubled when, on May 3, news broke that three people had died of a probable hantavirus infection and others had fallen ill on the MV Hondius, a Dutch-flagged Arctic-expedition vessel with the amenities of a four-star hotel. The outbreak occurred while the ship was traveling from Argentina to Cape Verde.
Two of the people who perished were a husband and wife from the Netherlands, ages 70 and 69. South African health officials later said the husband fell ill on the ship and passed on April 11, while his wife died in a South African hospital more than 2 weeks later.
Hantavirus? I scratched my head as the facts sketchily emerged, recalling that members of the family of two dozen potentially deadly pathogens are almost always contracted by inhaling aerosolized excreta of infected rodents. Here in the U.S., our leading nemesis is the Sin Nombre virus, which I described in detail in a 2024 MedPage Today column. That pathogen was first identified following a 1993 outbreak of a rapidly progressive respiratory illness followed by shock and non-cardiogenic pulmonary edema that killed 52% of 106 initial patients (many of whom were previously healthy young adults) in the Four Corners region of New Mexico, Colorado, Arizona, and Utah.
For the record, Sin Nombre’s rodent host is Peromyscus maniculatus, a deceptively cute North American deer mouse with black shiny eyes, big ears, and a white belly.
But then another hantavirus I happened to mention in my 2024 column suddenly sprang to mind: the species Andes orthohantavirus, which contains multiple strains including Andes (ANDV), Castelo dos Sonhos, Lechiguanas, and Oran viruses, among others. These agents, mainly spread by dried, aerosolized particles from the urine, droppings, and saliva of long-tailed pygmy rice rats, comprise South America’s leading hantaviral threat. To this day ANDV remains the sole hantavirus outlier that has passed from person to person — a fact first learned during a 1990s outbreak in Patagonia. Of equal note: ANDV can be transmitted during a human’s early, prodromal infection while the virus’s clinical incubation preceding a full-blown case of hantavirus pulmonary syndrome can be as long as 40 days.
This leads us to further disturbing facts, first reported by MedPage Today on May 6. In short, we now know that 26 MV Hondius passengers disembarked at St. Helena on April 24 and that seven Americans among them are now back in California, Arizona, Texas, Georgia, and Virginia. Although none are currently known to be ill, at the time of this writing, we still lack details about: 1) how these Americans traveled home and who they may have exposed en route; 2) whether they have self-isolated or been quarantined since their return; or 3) whether they have been monitored or undergone repeated viral testing over the last 2 weeks.
What’s Wrong With This Picture? A Seasoned Veteran Weighs In
Now for a confession. Despite decades spent studying, writing about, and caring for patients with infectious diseases, am I qualified to opine on the “woulda, coulda, shoulda’s” of the recent high-seas outbreak and its ideal mitigation and management? In a word: no.
But I do know someone who is. In fact, 33 years ago, as a young infectious diseases epidemiologist, Rob Breiman, MD, led CDC’s investigation of our country’s first outbreak of the highly lethal hantavirus pulmonary syndrome in the Four Corners area, then later oversaw many international investigations involving deadly emerging infections. Today, he’s someone whose well-honed professional instincts never falter when facing a situation that is unclear, unprecedented, or utterly frightening. At the same time, he’s dismayed that the U.S. can no longer assist optimally in addressing such global health crises.
As Breiman told me this week, the U.S. worked over decades to build strong, functional connections and capacities with a wide set of strategically-important countries around emerging infections. “And, while we played a major role in helping local systems detect and respond to emerging threats, more importantly we nurtured relationships with countries and regions with ‘boots on the ground’ to assure the best possible outcomes when something dangerous was happening.”
“And the U.S. would want to be front and center,” he added, “making sure we understood what was going on, and that people were being protected as rapidly and effectively as possible. It’s hard to be able to do that well working outside of the WHO [World Health Organization] umbrella.”
Instead, that overseas infrastructure is now fractured. As a result, he stressed, it may be challenging to fill knowledge gaps for controlling this outbreak. For instance, Breiman asked, is it known if current or future sufferers of Andes virus stemming from the MV Hondius outbreak experienced a common environmental exposure? Or did the first set of infections sequentially spread from person to person, and are they continuing to do so? And, given a long incubation period, could presymptomatic exposed people shed virus in urine, stool, or respiratory secretions?
But the biggest story is that our country has isolated itself without a clear benefit to the U.S. or the world, and pulled back on decades of human and other investments in Africa and beyond. This, in turn, makes it much harder for us to apply our vast technical skills and expertise to solve problems like this one.
Finally, now that U.S. citizens are back home, here’s one more key question. Who exactly is watching these potentially exposed former passengers? In normal times, CDC and state health departments would be deeply engaged in providing the public with regular updates. To date, we’ve heard what seems to me the absolute minimum from federal health leaders. Why is communication barely happening?
President Trump, [HHS] Secretary [Robert F.] Kennedy [Jr.], and [CDC leader Jay] Bhattacharya, [MD, PhD], are you listening?
Source link : https://www.medpagetoday.com/opinion/parasites-and-plagues/121175
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Publish date : 2026-05-08 16:16:00
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