Americans from hantavirus-hit cruise ship, including one who tested positive, arrive in Nebraska

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By Chris Boyette, Hanna Park, CNN

(CNN) — American passengers from the cruise ship at the center of the hantavirus outbreak, including at least one who tested positive, arrived in Nebraska early Monday for evaluation at a highly specialized quarantine unit.

They will eventually continue on to their homes – and weeks of monitoring for symptoms of infection.

The virus, typically associated with rodents, may have passed from human to human aboard the MV Hondius cruise ship, the World Health Organization has said. Since April 11, three people from the ship have died, and a handful of others have gotten sick.

The hantavirus outbreak was first reported to the WHO on May 2 and remains a low risk to the general public, the global health agency says. The cruise ship left Argentina on April 1 and docked early this month in Spain’s Canary Islands.

The plane carrying the American passengers landed at Eppley Airfield in Omaha shortly before 2:30 a.m. local time Monday. Seventeen US citizens and one British national who lives in the US were on the flight, Spain’s Health Minister said.

Here’s what we know about the passengers’ journey back to the United States and what will happen next:

Presumed positive US case

One of the Americans has tested “mildly” positive for the virus and another has mild symptoms, the US Department of Health and Human Services said late Sunday. Both traveled in biocontainment units on the plane “out of an abundance of caution,” HHS said in a post on X.

The passenger who tested positive does not have symptoms but will be taken directly to the biocontainment unit at the University of Nebraska Medical Center in Omaha, the facility said late Sunday. The other passengers will go to the center’s National Quarantine Unit for assessment and monitoring.

The positive test result came after an official from the European Centre for Disease Prevention and Control boarded the ship to evaluate passengers, the Spanish Ministry of Health said.

“A diagnostic test was carried out and sent to two laboratories; in one of them, the result was considered by the U.S. authorities to be a weak positive, although for us it was not conclusive,” a statement from the health ministry said. “The second test result was negative.”

The passenger did not show symptoms while in Cape Verde, Spanish officials said. Even so, US authorities chose to treat the case as positive out of caution, the statement said.

The American reported to have symptoms without testing positive “developed a mild cough on May 6, which resolved after that day,” Spanish officials said.

Staff from the US Centers for Disease Control and Prevention have been monitoring the passengers since they disembarked in Tenerife, Spain, a CDC official said.

CNN has reached out to HHS for more information on the passengers.

Highly specialized facilities

The Omaha facility is “the only federally funded quarantine unit in the United States, designed specifically to safely house and monitor people who may have been exposed to high-consequence infectious diseases,” according to Nebraska Medicine.

There are 20 single-person, 300-square-foot rooms fitted with negative air pressure systems to contain any possible viruses. Doctors there describe them like hotel rooms, designed with en suite bathrooms, exercise equipment, food delivery and Wi-Fi for patients staying for long periods.

The CDC was not considering this a quarantine for the cruise ship passengers but rather a brief visit to monitor their health, an agency official said. The CDC has classified its hantavirus response as Level 3, its lowest level of emergency, a person involved in the situation said.

Once at the facility, the passengers will be checked for symptoms signaling the early stages of hantavirus, including fever, muscle aches and diarrhea, the hospital’s interim chancellor, Dr. H. Dele Davis, told CNN.

The site’s biocontainment unit, where the positive patient and anyone else who may fall ill will be taken, is a specialized unit that treated patients during the Ebola outbreak in 2014 and some of the first Covid-19 patients from the Diamond Princess cruise ship in 2020, Nebraska Medicine officials said.

The airlift will then continue to take remaining passengers, including the person showing mild symptoms who hasn’t tested positive, to one of more than a dozen Regional Emerging Special Pathogen Treatment Centers, which are regional hubs focused on special pathogen readiness. The centers work closely with the Administration for Strategic Preparedness and Response, which is part of HHS.

Passengers may also be given the option to go home after their assessment in Omaha if safety protocols allow, National Institutes of Health Director Dr. Jay Bhattacharya told CNN’s Jake Tapper on Sunday.

The CDC will interview passengers and determine those not in contact with someone who was symptomatic to be “low risk,” said Bhattacharya, who is also acting director of the CDC.

The CDC’s advice to the travelers includes “an offer to stay in Nebraska if they’d like or, if they want to go back home and their home situation allows it, to safely drive them home without exposing other people on the way, and then be put in the control … under the auspices of their state and local public health agencies,” Bhattacharya said.

Daily monitoring at home

Once the passengers get back to their own homes, they will undergo daily home-based monitoring for the next 42 days, a CDC official said.

The goal is to monitor the passengers during the virus’ incubation period, which can last up to six weeks, and to reduce the risk of spreading the disease, according to Nebraska Medicine.

Passengers who do not test positive will not be quarantined, but will be advised to take certain precautions, health officials have said.

“If it’s a high-risk exposure … there will be some modified activities that we would recommend, limiting activities outside the house that don’t involve extensive interactions with other people,” a CDC official said. “Also, they need to be working with their departments of health … with regards to the nature around other activities.”

The CDC is following the safety protocols used successfully during a 2018 outbreak of the same hantavirus strain, Bhattacharya said.

Low risk to the general public

Hantavirus typically spreads to humans through contact with rodent urine or droppings, though this strain, the Andes virus, can in rare cases spread person-to-person through very close, prolonged contact with an infected person.

As of May 8, there were eight total cases connected to the MV Hondius cruise ship – six lab-confirmed plus two probable cases.

Passengers were screened Sunday after the ship docked in Tenerife, and all were asymptomatic, according to Spanish health authorities. One French passenger later showed symptoms while flying home and tested positive. All five evacuees on that flight will enter isolation protocols, the country’s prime minister said.

As of May 9, three passengers – a Dutch couple and one German national – had died after contracting hantavirus, according to WHO.

Seven other American passengers who previously disembarked the ship are being monitored in five states: Arizona, California, Georgia, Texas and Virginia, officials said. New Jersey officials are monitoring two others who were not on the ship but may have been exposed on a flight, the state’s Department of Health said.

Symptoms can include fever, muscle aches, chills, nausea, vomiting, diarrhea, cough, difficulty breathing and chest pain.

This outbreak is “not another Covid-19,” WHO Director General Tedros Adhanom Ghebreyesus stressed before the passengers disembarked.

This story has been updated with additional information.

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CNN’s Pau Mosquera contributed to this report.