The hantavirus outbreak has been well-handled but there are still dangerous days ahead | Devi Sridhar

"So, for now, the risk to the general public is low colleagues and I are still carrying on as normal and watching to see whether new infections arise outside the original cruise ship group. Those new infections would be the key step-change determining whether we see further spread and higher-risk public health alerts or whether we're at the end of this outbreak. We'll only know for sure in the weeks to come."

"The first thing to know is that Hantavirus outbreaks happen all the time across the world. You just don't hear about them. In fact, you probably didn't hear about the Andes strain hantavirus outbreak in 2018 in Argentina, with 34 confirmed cases and 11 deaths. Part of what makes the current outbreak unique and newsworthy is it being on a cruise ship with about 150 people of 23 nationalities."

"Cruise ships are notorious for making outbreak control difficult, given the close living conditions, the frequent stops in various ports, the globetrotting nature of passengers and the difficulty in managing a public health response on the ship once a virus is detected. Do you keep everyone on the ship, with the risk that further people become infected and unwell? Or do you take people off the ship and risk spread in each of their home nations?"

"In this instance, quite a few passengers disembarked before the outbreak was detected and took commercial flights back home, meaning there is already wider potential exposure to the virus. We'll only know for sure in the weeks to come. When hantavirus was first mentioned, public health experts were hoping it was any strain beside the Andes strain, which can transm"

Hantavirus outbreaks happen regularly across the world but often receive little attention. A recent outbreak is notable because it occurred on a cruise ship with about 150 people from 23 nationalities, creating challenges for outbreak control due to close living conditions, frequent port stops, and difficulties managing a response once a virus is detected. Decisions about keeping passengers onboard versus disembarking can affect further spread, and in this case some passengers left before detection and returned home by commercial flights, increasing potential exposure. Risk to the general public is currently low, and the key factor for determining whether spread continues is whether new infections arise outside the original cruise-ship group.

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