汉坦病毒相关游轮疾病聚集性事件：ECDC评估与建议

Hantavirus-associated cluster of illness on a cruiseship: ECDC assessment and recommendations 6 May 2026 This is a rapidly evolving incident, and this document contains a preliminary assessment andrecommendations. ECDC will provide updates as information becomes available. Summary Epidemiological situation As of 6 May 2026, seven cases have been reported in a hantavirus-associated cluster of illness on a cruiseship, including three deaths, one critically ill, two symptomatic and one with unknown status. ECDC was notified on 2 May 2026 by the Netherlands via the European Union (EU) Early Warning andResponse System (EWRS) about a cluster of unknown disease with severe respiratory symptoms on a cruiseship in the South Atlantic, operating under a Dutch flag. There were 149 people on board from 23 differentnationalities, including nine EU/EEA Member States: Belgium, France, Germany, Greece, Ireland, theNetherlands, Poland, Portugal, and Spain. At the time, two people had died and one had been medicallyevacuated to South Africa, where the person remained critically ill. A PCR test result for a sample taken fromthis person came back positive for hantavirus on 3 May 2026. As of 6 May, a total of seven people had presented with symptoms that included fever, respiratory symptoms,and gastrointestinal symptoms, with at least four rapidly progressing to pneumonia, acute respiratory distressand shock. Of these seven people, three died, one was medically evacuated to South Africa and admitted to anintensive care unit (ICU), two remained symptomatic on board, requiring medical assistance, and one wasdiagnosed after disembarking the ship and returning to Switzerland. In total, samples from two patients testedpositive for hantavirus by PCR; a sample from one additional patient tested positive for Andes virus (ANDV) byPCR. Further laboratory investigations are ongoing. Orthohantavirus infections are viral zoonotic diseases transmitted to humans primarily through the inhalationof aerosols contaminated with the urine, faeces or saliva of infected rodents. Human disease can be caused byseveral orthohantavirus species, including the Andes (ANDV) and Sin Nombre (SNV) viruses in the Americasand Puumala and Dobrava viruses in Europe. The incubation time is usually around two weeks but ranges fromseven days up to six weeks. Clinical manifestation of hantavirus infection is divided in two clinical syndromes:Hantavirus Pulmonary Syndrome (HPS), seen in the Americas; and Haemorrhagic Fever with Renal Syndrome(HFRS) seen in Europe and Asia. Severe cases can rapidly deteriorate and become life-threatening. ANDV is ahantavirus primarily found in South America that causes HPS with a high fatality rate. Human-to-human transmission is rare but has been documented in the case of ANDV. No effective antiviral treatment isavailable; supportive care is key for a better chance of survival. ECDC provides this risk assessment for discussion at the level of the Health Security Committee including theinvolved countries, UK HSA and the WHO. Risk assessment Person-to-person transmission of ANDV has only been documented following close and prolonged contact. Thecurrent hypothesis is that some passengers were exposed to ANDV while spending time in Argentina beforeembarking, where ANDV is endemic, and may subsequently have transmitted the virus to other passengersonboard the cruise ship.At this early stage of the investigation with limited available information, we considereveryone on the ship to be close contacts, due to the closed setting and shared social areas and activities,aligned with the precautionary principle. Measures are already implemented on board to reduce the likelihood of infection for passengers and crew onthe cruise ship. The cruise ship company and the relevant port authorities have also been advised on how toprepare for the management of cases and contacts (e.g. isolation of cases, use of appropriate personalprotective equipment, testing, etc). Even if transmission of ANDV were to happen from passengers evacuated from the ship, ANDV does nottransmit easily so it is unlikely that it would cause many cases or a widespread outbreak in the community, ifinfection prevention and control measures are applied. In addition, the natural reservoir for ANDV is not present in Europe, so introduction to the rodent populationand potential rodent-to-human transmission in Europe is not expected. The risk to the general population in the EU/EEA from ANDV spreading from this cruise ship outbreak is very low. Recommendations •Symptomatic people should be managed proactively and medically evacuated as soon as possible.•Upon disembarking, diagnostic testing should be carried out by serology or PCR in people with symptoms.However, negative test results may not exclude infection and subsequent virus shedding. TheEURL-PH-ERZVoffers diagnostic services to EU/EEA countries lacking capability to diagnose ANDV infection.•Passengers and crew should