A hantavirus outbreak that originated on the Dutch-flagged cruise ship MV Hondius has spread across multiple countries, with at least three deaths and seven confirmed cases as passengers are repatriated to Europe, North America and beyond, the World Health Organization (WHO) and US Centers for Disease Control and Prevention (CDC) said.

The outbreak was first reported to the WHO on May 2, with the World Health Organization confirming on May 6 that the Andes virus, the only hantavirus strain documented to spread person to person, was responsible. The Andes virus causes hantavirus pulmonary syndrome (HPS), a severe disease that affects the lungs with an estimated case fatality rate of approximately 38% among patients with severe respiratory symptoms, the CDC said. Symptoms typically appear between 4 and 42 days after exposure.

Three passengers have died, including a Dutch couple and a German woman. As of May 11, the WHO had recorded seven confirmed cases and two additional probable cases awaiting laboratory results, according to WHO data, with US media reporting a total of nine cases.

The MV Hondius, operated by Dutch tour company Oceanwide Expeditions, left Ushuaia, Argentina on April 1 carrying 147 passengers and crew. The first patient, a Dutch citizen, died on board on April 11. His wife, who disembarked at Saint Helena on April 24 with gastrointestinal symptoms, died on April 26 after evacuation to Johannesburg, South Africa. A third passenger died on May 2.

The Argentine health ministry on May 6 published a report detailing the movements of the index case, who had undertaken a four-month road trip between November 27, 2025 and April 1 spanning Chile, Uruguay and Argentina.

The National Ministry of Health and the Malbrán Institute have advanced the epidemiological investigation, capturing and testing rodents along the route the Dutch passenger had travelled, alongside contact tracing.

The Hondius docked at Praia in Cabo Verde for three days without disembarking any passengers because local facilities could not handle a safe evacuation. After the Spanish health ministry approved the vessel's arrival in the Canary Islands, the ship departed for Tenerife on May 6 with additional medical resources and arrived on May 10. Evacuation flights have repatriated passengers to six European countries and Canada.

The US CDC sent a team to meet the ship in the Canary Islands on May 7. Eighteen American passengers were flown back to the United States and are being monitored at medical units, with 16 in Nebraska, including one who tested positive, and two in Atlanta, where one is experiencing symptoms, CNN reported. Most are in specialised quarantine units, with some in biocontainment units at the University of Nebraska Medical Center.

The CDC has classified the outbreak as a level 3 emergency response. Patients are hospitalised in South Africa, the Netherlands, Germany, Saint Helena, Spain, France and Switzerland.

A British national admitted to hospital in Johannesburg is clinically improving but still ill, a spokesperson for the South African health ministry. A French woman who fell ill after being evacuated near Tenerife is in intensive care in stable condition, French Prime Minister Sébastien Lecornu said in a post on X.

On May 10, British military personnel from the 16 Air Assault Brigade parachuted into Tristan da Cunha from an RAF A400M Atlas after a suspected case was identified among the island's 220 residents, an earlier passenger on the ship.

The genome of the virus isolated from a Swiss patient was published on virological.org on May 8 under the designation ANDV/Switzerland/Hu-3337/2026.

The Pathoplexus team published a preliminary analysis of known sequences from five patients, including two from Johannesburg, two from the Netherlands and the Swiss case.

The WHO has assessed the risk to the global population as low. Routine travel can continue as normal, the CDC said, with no Andes virus cases reported in the United States as a result of the outbreak.