Hantavirus cardiopulmonary syndrome
Hantavirus outbreak linked to cruise ship
A cluster of hantavirus cases have been reported on a Dutch-flagged cruise ship, which departed Argentina on April 1, 2026. The ship has traveled across the South Atlantic, with various stops in remote regions, and carries 147 passengers and crew.
The outbreak was first reported to the World Health Organization (WHO) on May 2, 2026. As of May 4, 2026, 7 cases had been reported (2 laboratory-confirmed cases and 5 suspected cases), including 3 deaths, 1 critically ill person, and 3 people with mild symptoms. Another case has been reported since then, and people who disembarked from the ship before infection prevention and control measures were put in place are undergoing contact tracing.
Illness has been characterized by fever, gastrointestinal symptoms, and rapid progression to pneumonia, acute respiratory distress syndrome, and shock.
Hantaviruses are primarily transmitted to humans from contact with infected rodents or their urine, saliva, or feces (or with contaminated surfaces). Symptoms typically occur 2-4 weeks after exposure, but can occur as late as 8 weeks after exposure. Infection can cause a range of illnesses including severe disease, and even death. Clinical manifestations are divided into two clinical syndromes:
Hantavirus cardiopulmonary syndrome (HCPS) - seen in the Americas
Hemorrhagic fever with renal syndrome (HFRS) - seen in Asia and Europe
One patient in this outbreak has tested positive for the Andes virus, which is associated with HCPS.[12] The fatality rate for HCPS has been reported to be up to 50%.
The risk of human-to-human transmission is considered to be low. However, limited transmission has been reported in previous outbreaks of Andes virus in community settings involving close and prolonged contact, and among healthcare professionals looking after infected patients.
The situation is developing, and you should consult your local public health authority for updates. Information is available from the WHO, the Centers for Disease Control and Prevention (CDC), and the UK Health Security Agency (UKHSA).
The WHO has currently assessed the risk to the global population as low.
Summary
Definition
History and exam
Key diagnostic factors
- exposure to rodent excreta/bite
- dyspnea
- hypotension
Other diagnostic factors
- fever
- myalgias
- gastrointestinal symptoms
- headache
- normal or low oxygen saturation
- lung rales
Risk factors
- exposure to rodent excreta/bite
- close contact with hantavirus-infected humans
Diagnostic tests
1st tests to order
- CBC
- chest x-ray
- IgM and IgG serologies for hantavirus
- reverse transcriptase polymerase chain reaction (RT-PCR)
Tests to consider
- ABG
- serum lactate
- ECG
- echocardiogram
- flow-directed pulmonary artery catheter (Swan-Ganz catheter)
- lung biopsy
Treatment algorithm
sepsis of unknown cause
confirmed hantavirus infection
Contributors
Authors
Michael Sands, MD, MPH &TM, FIDSA
Professor of Medicine
College of Medicine
University of Florida
Jacksonville, FL
Disclosures
MS declares that he has no competing interests.
Carmen Isache, MD
Professor of Medicine
College of Medicine
University of Florida
Jacksonville, FL
Disclosures
CI declares that she has no competing interests.
Peer reviewers
Tze Wai Wong, FFPH, FRCP (Glasg)
Professor
School of Public Health and Primary Care
The Chinese University of Hong Kong
Prince of Wales Hospital
Shatin
Hong Kong
Disclosures
TWW declares that he has no competing interests.
Mary Joung Won Choi, MD, MPH
Medical Officer
Viral Special Pathogens Branch
US Centers for Disease Control and Prevention
Atlanta, GA
Disclosures
MC declares that she has no competing interests.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
References
Key articles
Jonsson CB, Hooper J, Mertz G. Treatment of hantavirus pulmonary syndrome. Antiviral Res. 2008 Apr;78(1):162-9.Full text Abstract
Mertz GJ, Hjelle B, Crowley M, et al. Diagnosis and treatment of new world hantavirus infections. Curr Opin Infect Dis. 2006 Oct;19(5):437-42. Abstract
Chang B, Crowley M, Campen M, et al. Hantavirus cardiopulmonary syndrome. Semin Respir Crit Care Med. 2007 Apr;28(2):193-200. Abstract
Centers for Disease Control and Prevention. Clinician brief: hantavirus pulmonary syndrome (HPS). May 2024 [internet publication].Full text
Centers for Disease Control and Prevention. Hantavirus pulmonary syndrome (HPS) 2015 case definition. 2015 [internet publication].Full text
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Viral upper respiratory tract infection
- Influenza
- Mycoplasma pneumoniae pneumonia
More Differentials
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