Andes Virus Outbreak on a Cruise Ship: Frequently Asked Questions

Andes virus is a type of hantavirus that can cause severe respiratory disease in people. It is not a new virus and is normally found in areas of South America. Hantavirus disease surveillance in the United States began in 1993 during an outbreak of severe respiratory illness in the Four Corners region – the area where Arizona, Colorado, New Mexico, and Utah meet. From 1993 to 2023, a total of 890 cases of hantavirus disease were reported in the United States.

CDC staff are among the world's foremost hantavirus experts, with decades of experience responding to and controlling outbreaks. For example, CDC worked on the 2018 Andes virus contact tracing investigation after a case of Andes virus was identified in Delaware. CDC has conducted field investigations, laboratory diagnostics, and case identification to identify sources of infection, limit transmission, provide public health guidance, and educate communities about prevention

Early symptoms of hantavirus pulmonary syndrome (HPS) caused by Andes virus can include:

• Fatigue

• Fever

• Muscle aches, especially in large muscle groups like the thighs, hips, back, and sometimes shoulders

About half of all patients with HPS also experience:

• Headaches

• Dizziness

• Chills

• Abdominal problems, like nausea, vomiting, diarrhea, and abdominal pain

Signs and symptoms of Andes virus appear between 4 to 42 days after exposure to the virus. Typically, people are only infectious (able to transmit the virus to others) while they have symptoms.

Andes virus can cause hantavirus pulmonary syndrome (HPS), which affects the lungs. HPS can be deadly. Among patients who have severe respiratory symptoms, the case fatality rate is approximately 38%.

CDC recommends that only people who have symptoms and a known exposure history be tested for Andes virus. CDC and a few states are able to test specimens for Andes virus.

There is no specific treatment for hantavirus infection. Patients with Andes virus receive supportive care, including rest, hydration, and treatment of symptoms.

Although the Andes virus is the only type of hantavirus that is known to spread person-to-person, it does not spread easily. Person-to-person spread is usually limited to people who have close contact with a person with symptoms. Close contact includes

• Prolonged direct physical contact
• Prolonged time spent in close or enclosed spaces
• Exposure to the infected person's saliva, respiratory secretions, or other body fluids (e.g., kissing, sharing utensils, handling contaminated bedding)

Typically, hantavirus is spread by rodents.

This outbreak is not like the COVID-19 pandemic and the risk to the American public is extremely low. Andes virus does not spread easily from person-to-person like a respiratory virus like COVID-19. The risk of a pandemic caused by this outbreak and the overall risk to the American public and travelers remains extremely low. The Andes virus is the only type of hantavirus that is known to spread person-to-person. This spread is usually limited to people who have close contact with a person with symptoms. Close contact includes

• Prolonged direct physical contact
• Prolonged time spent in close or enclosed spaces
• Exposure to the infected person's saliva, respiratory secretions, or other body fluids (e.g., kissing, sharing utensils, handling contaminated bedding)

If you think you had contact with a person with Andes virus and are experiencing symptoms, contact a medical professional immediately.

HHS's Administration for Strategic Preparedness and Response's RESPTCs provide highly specialized, long-term care for people infected with or suspected of having high-consequence infectious diseases like hantavirus. University of Nebraska Medical Center was selected as the U.S. entry point due to its extensive expertise in handling special pathogens. It is one of 13 within the National Special Pathogen System. Should additional capabilities be needed, the federal government has access to all 13 RESPTCs across the National Special Pathogen System.

We might hear about more cases because people who were exposed to the Andes virus are still within the time period when symptoms can appear. Public health officials in the United States and other countries are monitoring passengers and taking precautions to reduce the chance of further spread.

CDC, in coordination with state and federal partners, has identified the Nebraska Biocontainment Unit as an appropriate location for assessing returning travelers and coordinating how and where they will be monitored for a 42-day period.

The countdown to the 42-day monitoring period for the cruise ship passengers began when they departed the cruise ship.

Because symptoms can take up to 42 days to appear, passengers are being asked to take extra precautions during the monitoring period. These precautions include:

• Avoiding close contact with others unless emergency care is needed or public health authorities advise otherwise.
• Washing hands regularly, covering coughs and sneezes, improving ventilation, wearing a well-fitting mask indoors around others, and keeping distance from others.
• Avoiding activities that could expose others to bodily fluids or involve sharing personal items, food, or drinks.
• Staying home, avoiding visitors, and not sharing a bedroom with anyone.
• Delaying nonessential medical or dental care and coordinating urgent care with the health department before arrival.

No. Passengers are being asked not to travel during the monitoring period unless the travel is essential and coordinated by public health authorities.

Passengers should not travel except for essential purposes such as getting urgent medical care and travel must be coordinated by public health authorities.

As part of its contact investigation process, CDC sent contact information for U.S. residents who previously disembarked the cruise ship to the state or local health departments. State and local health departments are monitoring the health of these returned passengers. CDC also has developed guidance for public health departments specifically about the public health management of passengers returning from this cruise ship and has distributed this guidance to partners. This guidance is publicly available at Interim Guidance for Public Health Assessment and Management of People with Potential Exposure to Andes Virus.

CDC, in coordination with state and federal partners, repatriated 18 passengers who remained on the cruise ship on May 10. These passengers are currently at the Nebraska Quarantine Unit at the University of Nebraska Medical Center for assessing and coordinating how and where they will be monitored for a 42-day period. Seven passengers who returned early are at home being monitored by their state and local health.

CDC recommends that only people who have symptoms and a known exposure to Andes virus be tested. The overall risk to the American public and travelers remains extremely low. If you think you had contact with a person with Andes virus and are experiencing symptoms, contact a medical professional or your state or local health department immediately.

The overall risk to the American public and travelers remains extremely low. If you think you had contact with a person with Andes virus and are experiencing symptoms, contact a medical professional or your state or local health department immediately.