Andes virus, the type of hantavirus responsible for the outbreak on the MV Hondius cruise ship earlier this year, has a fatality rate of up to 36%. Precautions such as isolation of infected individuals and use of personal protective equipment by healthcare personnel can prevent transmission if implemented at the earliest stages of infection.

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Source: Wvdp

Warning sign reading “VERBODEN TOEGANG BIO HAZARD ZONE” with a biohazard symbol on a fence at the cordoned-off area around MV Hondius in the Port of Rotterdam, after the hantavirus outbreak on board.

But because human-to-human transmission of Andes virus was only detected for the first time in 1996, and because outbreaks occur infrequently, clinicians worldwide were unfamiliar with Andes virus clinical presentation, epidemiological risk factors, and infection prevention strategies when the cruise ship outbreak occurred.  

To help healthcare facilities, clinicians, and public health agencies prepare for future Andes virus outbreaks, researchers from Mass General Brigham systematically surveyed the published literature for prior reports of Andes virus exposure in healthcare settings.

Based on eight studies from seven Andes virus transmission events, the researchers concluded that incidents of Andes virus transmission to healthcare personnel were associated with delays in implementing transmission-based precautions or control measures. Their findings are published in Clinical Infectious Diseases.

Real difference

“Healthcare-associated transmission of Andes virus is uncommon, but it can occur when the infection is not recognized early or when appropriate protective measures are delayed,” said lead author Loukas Kakoullis, MD, PhD, MPH, of the Division of Infectious Diseases in the Mass General Brigham Department of Medicine. “This is a situation in which outbreak preparedness and infection prevention can make a real difference in protecting both patients and healthcare personnel.”

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The research team identified eight reports based on seven exposure events that occurred between 1996 and 2018. Overall, 118 healthcare personnel were exposed to Andes virus, and eight healthcare personnel were infected, four of whom died. Healthcare personnel infections were reported in three of the seven outbreaks studied.

The researchers found that Andes virus transmission to healthcare personnel occurred primarily in settings where transmission-based precautions, such as using personal protective equipment and isolating patients, were either absent or not described. This highlights the importance of early implementation of infection prevention and control strategies to stop disease transmission.

Outbreak response

In late June, the U.S. Centers for Disease Control reported the conclusion of the outbreak response, with no additional cases of Andes virus noted among American citizens repatriated from the ship. The total cases globally reported remains at 13.

“The 2026 Andes virus outbreak associated with cruise ship travel is a reminder of the need for healthcare institutions to be prepared to respond to emerging and re-emerging infectious disease threats,” said co-senior author Erica S. Shenoy, MD, PhD, Chief of Infection Control at Mass General Brigham. Shenoy and her team collaborated with colleagues both at Mass General Brigham and at the University of Iowa, including co-senior author Karen Brust, MD, Clinical Associate Professor of Internal Medicine-Infectious Diseases and Hospital Epidemiologist at University of Iowa Health Care.

Authorship: In addition to Kakoullis and Shenoy, Mass General Brigham authors include Erin Rebecca Carr, Stephanie Friree Ford, and Jacob E Lazarus. In addition to Brust, additional authors include Jhony Baissary, and Shinya Hasegawa.

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