The North Carolina Department of Health and Human Services issued guidance for clinicians regarding hantavirus on May 13, following a cluster of infections reported by the World Health Organization among passengers aboard the cruise ship MV Hondius. As of May 8, eight cases have been reported, including three deaths. The Centers for Disease Control and Prevention has assessed the risk to the American public as low.
The memo aims to increase awareness and understanding of hantavirus among North Carolina clinicians and provides guidance for assessing potential cases. Hantaviruses are primarily spread by rodents and can cause severe illness in humans. The specific virus linked to the cruise ship cases is the Andes virus, native to South America. According to the memo, "Andes virus is the only type of hantavirus that has evidence of spread from person-to-person, generally after prolonged contact with an infected person. Its rodent reservoir is the long-tailed pygmy rice rat, which is not found in the U.S. Andes virus has not been identified among rodents in the U.S." In contrast, most human infections in the United States are associated with Sin Nombre virus, with most cases occurring in western states. Hantavirus infection is extremely rare in North Carolina; only one case was reported in 1995.
People become infected mainly through inhalation or mucous membrane contact with urine, fecal matter, or saliva from infected rodents or through prolonged close contact with a person infected with Andes virus. Early symptoms are often nonspecific but may progress to hantavirus pulmonary syndrome (HPS), characterized by sudden respiratory distress. Symptoms typically appear two to four weeks after exposure but can develop anytime from one to eight weeks postexposure.
There is no specific treatment for hantavirus infections; early supportive care is critical due to rapid progression of severe symptoms. Management may require respiratory support in facilities equipped with intensive care units and ECMO capacity.
Diagnosis relies on serological testing for IgM and IgG antibodies available at CDC laboratories; molecular tests for Andes virus are still under development. Testing should be limited to patients who have both clinically compatible illness and epidemiologic risk factors such as rodent exposure or travel to endemic regions because unnecessary testing may result in false positives given how rare hantavirus is locally.
All passengers from MV Hondius are being closely monitored by public health officials. The risk posed by this outbreak remains low for North Carolina residents according to the organization's press release.
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