Archived: Rapid risk assessment: Hantavirus (Andes virus) outbreak on international cruise ship

Assessment completed: May 8, 2026 (based on information available up to May 7, 2026)

On this page

• Reason for the assessment
• Risk question
• Risk statement
• Event summary (current situation as of May 7, 2026)
• Considerations for pathogens with pandemic potential
• Risk assessment details
• Limitations, knowledge gaps, and uncertainties
• Proposed actions
• Reassessment
• Methods
• Footnotes
• References

Reason for the assessment

Canadian travellers have been identified as passengers on the MV Hondius cruise ship where there is an Andes virus (ANDV) outbreak and on flights carrying passengers infected with ANDV, a specific strain of hantavirus (see Event summary). This is the first documented ANDV outbreak in a cruise ship setting.^{Footnote 1} There is a need to identify and inform appropriate public health actions, including border measures, contact tracing, and risk communication. ANDV is not endemic to Canada and is epidemiologically distinct from the hantavirus strain endemic in Canada (the Sin Nombre virus).^{Footnote 2}

Risk question

What is the likelihood and impact of a traveller infected with ANDV in connection with the MV Hondius cruise ship outbreak^{Footnote a} entering Canada within the next two weeks?

Risk statement

The overall risk of acquiring ANDV for the general population in connection with the ongoing cruise ship outbreak is low (moderate uncertainty), given that onward spread within Canada is not expected, even if an infected individual were to arrive in Canada.

The likelihood of importation of ANDV into Canada in the next two weeks is moderate (moderate uncertainty). Six Canadians were on the vessel when it departed Argentina and four remain on board. Additionally, a few Canadians were on flights carrying symptomatic individuals and may have been in close contact with those infected. The impact on those infected is expected to be major (moderate uncertainty) as ANDV illness often requires hospitalization and can result in death. If importation into Canada was to occur, the impact of ANDV on the general population in Canada would be minor (low uncertainty), given that close, prolonged contact is required for person-to-person spread of ANDV, making onward spread unlikely. However, exposure is more likely for close contacts of cases and health care workers not using sufficient personal protective equipment (PPE).

These risk levels could change if evidence were to emerge suggesting that person-to-person transmission is occurring beyond close contacts.

Event summary (current situation as of May 7, 2026)

A cluster of Andes virus (ANDV) infections has been reported among passengers of the cruise ship MV Hondius. Eight cases have been reported, including three deaths and three hospitalizations. Five of the eight cases have been confirmed as hantavirus, and the other three are suspected. The MV Hondius was carrying 147 passengers and crew, 6 of whom were reported to be Canadian nationals. To date, all Canadians known to have been aboard the MV Hondius are asymptomatic. Canadians identified as vessel passengers (2), and a contact of a symptomatic individual on an aircraft (1) have returned home and have received guidance to self-quarantine and are being monitored by local authorities. Additionally, a confirmed case disembarked the MV Hondius and travelled from the island of St. Helena to Johannesburg, South Africa, via commercial airplane and then spent a short period on a flight bound for The Netherlands; 6 Canadians were on one or the other flight.

Considerations for pathogens with pandemic potential

At this time, ANDV is not considered to be a pathogen with pandemic potential. While person-to-person transmission of ANDV has been reported in the past, to date it has mainly been associated with close and prolonged contact and has not demonstrated the capacity for widespread prolonged transmission.^{Footnote 3} Additionally, there is evidence from in vivo passage studies that ANDV has high genomic stability and does not mutate easily.^{Footnote 4}

Risk assessment details

Limitations, knowledge gaps, and uncertainties

The overall uncertainty in this assessment is moderate, due to the following:

• The specific exposure history (timing, duration and closeness of any contact) of some of the contacts that will be repatriated to Canada in the next two weeks, related to this event.
  • For example, the number of Canadians considered contacts on the airline flights with symptomatic individuals and their proximity to these symptomatic individuals while on the aircraft.
• The evidence for person-to-person transmission during this event based on an epidemiological analysis of the event and if so, how easily the virus is being transmitted (e.g., the risk of transmission at different time points in the evolution of infection including the prodromal period, for different proximity, types and durations of exposure, characteristics of cases and contacts, and estimates of the basic reproduction number associated with this outbreak).
• If the present ANDV differs from recently circulating ANDV in endemic areas.

Factors that would decrease the risk include the ongoing assessments on board the ship and also planned by the Spanish authorities on arrival to Tenerife, implementation of sufficient infection control and public health measures including quarantine measures that effectively prevent onward spread on the ship, passengers following public health protocols as they disembark from the ship as well as en route home to Canada, followed by self-quarantine for the duration of the potential incubation period upon arrival in Canada.

Proposed actions

• At this time, the precautionary principle should be utilized to assume ANDV is spreading person-to-person, presenting a risk to contacts of infected persons. ANDV should be treated as a communicable disease as noted in the Quarantine Act. Adhere to all established case and contact follow-up protocols and infection control and prevention guidance for provincial, territorial, and local jurisdictions, including those applicable to healthcare facilities and medical professionals.
• Contacts should be monitored per WHO guidelines and should compatible symptoms develop, be promptly taken into appropriate health care settings with infection control measures in place during and after the transfer.
• Continue timely coordinated risk communications informing people in Canada of the ANDV outbreak, the level of risk, actions taken by public health authorities, and provide concrete actions individuals can take to protect themselves from hantavirus in general (not ANDV specifically).
• Enhance targeted communications to healthcare professionals for awareness and readiness in implicated jurisdictions to support early detection, diagnosis/testing, management, and notifying public health authorities as per their protocols.

Reassessment

This situation is rapidly evolving. The risk assessment team will reconvene to review new evidence and evaluate the need for reassessment if there is new evidence changing our understanding of person-to-person transmission of ANDV or if the situation escalates.

Methods

This assessment was completed by the Public Health Agency of Canada. The rapid risk assessment (RRA) methodology is based on the World Health Organization (WHO) Member State RRA tool.^{Footnote 7} Likelihood, impact, and overall risk were estimated using previously described scales and risk matrix (see risk assessment methods page), and capacity to respond was estimated using the WHO tool.^{Footnote 7} The overall risk level for the general population was obtained using the overall population impact estimate, as it contains the driving component of risk for the general population, i.e., impact given that onward spread within Canada is not expected.