The global race to contain a deadly rat-borne virus spread by passengers on a disease-struck cruise ship is underway - as fears mount that hundreds of people may have come in contact with infectious carriers of the illness.
The MV Hondius has been at the centre of an international health scare since Saturday following the outbreak of a rare hantavirus infection.
Although the disease is typically spread by rodents through urine, droppings and saliva the World Health Organisation (WHO) has confirmed the less common Andes virus is the cause of the cruise ship spread.
The strain is believed to be the only hantavirus transmitted from person to person.
The Hondius' voyage was split into three separate bookable cruises, which could be taken individually - but with a discount given to passengers taking the whole trip.
A total of seven suspected cases of the virus on the vessel travelling from Ushuaia in Argentina to Cape Verde in Africa have been confirmed.
However, it is unclear whether the earlier bookable cruise - to and from Antarctica from Ushuaia - was boarded by the infected Dutch couple, and if so, how many other people were onboard.
It follows the revelation that the deadly virus may have been brought onto the vessel after the husband and wife went birdwatching in Ushuaia on March 20.
Aerial view shows health personnel assisting patients onto a boat from the cruise ship MV Hondius, while stationary off the port of Praia
Martin Anstee (pictured), 56, was one of three suspected hantavirus patients removed from the ship and flown to the Netherlands for treatment on Wednesday morning
Investigators said the pair visited a landfill site to snap birds in the city and may have been exposed to rodents carrying the disease.
They later travelled on the cruise from Ushuaia which left the Argentinian city on April 1 with 88 passengers and 59 crew members - and a total of 23 nationalities - onboard.
The WHO has been trying to deduce how the hantavirus appeared on the ship, with the first person who died having developed symptoms on April 6.
The stricken passenger, a 70-year-old Dutch man, died on April 11 as the ship steamed towards Tristan da Cunha.
His body remained on board until April 24, when it 'was disembarked on St Helena, with his wife accompanying the repatriation,' Oceanwide Expeditions said.
At this point 23 other passengers are understood to have disembarked - creating a possible international exposure point.
The man's 69-year-old widow fell sick on a flight from St Helena to South Africa, and she died on April 26 upon arrival at the emergency department of Johannesburg hospital.
The WHO confirmed the woman had been flown to the city on April 25 on a plane operated by Airlink, carrying 82 passengers and six crew members.
The outbreak of the rare, rat-borne illness that has a 40 per cent mortality rate has left three people dead and several others seriously ill
Spain's Canary Islands expressed opposition to allowing the cruise to dock on the archipelago, fearing a possible outbreak in the community
Forensics are seen leaving an aircraft after a patient was evacuated at Schiphol-East. According to the Ministry of Foreign Affairs, three medical evacuees from the cruise ship MV Hondius were on board
She had also briefly boarded a flight from Johannesburg to the Netherlands while presenting severe symptoms - but was removed by staff amid fears around her condition.
Health officials are now trying to trace at least 80 passengers who were on board the same two flights as the Dutch woman before she died.
On April 27, a British passenger on the cruise became 'seriously ill and was medically evacuated to South Africa' from Ascension Island.
A few days later, another passenger - of German national
The MV Hondius arrived at Cape Verde a day later on May 3 - but was not allowed to dock, leaving passengers 'trapped at sea'.
Three patients have since been flown to hospital in the Netherlands, a man in Switzerland has been hospitalised after arriving home and two British passengers are confirmed to be self-isolating in UK after being among those who flew home from St Helena.
According to the UK Government's hantavirus advice, symptoms typically appear between two and four weeks after exposure, but can range from two days to eight weeks, meaning illness may develop in other passengers in the coming days or weeks.
Around 40 per cent of cases result in death, according to the US Centers for Disease Control.
A demonstration by chefs on the MV Hondius before the hantavirus outbreak
The crew is pictured sitting down for a meal before the ship's departure
Passengers seen enjoying themselves on the vessel before the deadly outbreak
Common spaces were empty as passengers isolated in their cabins
A British man was taken to intensive care after the virus spread on board the MV Hondius, travelling from Ushuaia in Argentina to Cape Verde in Africa
Early on Thursday morning it was confirmed that an Australian who was onboard the luxury cruise ship during the outbreak was among those who had returned home. A night view of the ship anchored at a port in Cape Verde
During a previous Andes virus outbreak in 2018 and 2019 in the small town of Epuyen in Chubut Province, Argentina, the infection rate was 2.2 prior to public health interventions, meaning each infected person on average infecting more than two others.
Early on Thursday morning it was confirmed that an Australian who was onboard the luxury cruise ship during the outbreak was among those who had returned home after disembarking the ship at St Helena on April 21.
A Spanish passenger still onboard the vessel told the El Pais newspaper: 'Until three days ago, no one had contacted them.
'The Australian went back to Australia, the one from Taiwan to Taiwan, the Americans to all corners of North America. The Englishman to England, the Dutch to their homes.'
The passenger also claimed that the World Health Organisation did not start contacting disembarked passengers until earlier this week - a month after the first infected passenger fell ill.
All passengers have been instructed to remain inside their cabins to prevent any potential spread of the virus. The number of cases currently stands at eight.
'Oceanwide Expeditions remains in close and continual discussion with relevant authorities regarding our exact point of arrival, quarantine and screening procedures for all guests, and a precise timeline,' the cruise operator said in a statement.
'We are unable to confirm the details of onward travel for guests at this stage.'
The vessel left Cape Verde this afternoon following the evacuation of patients with suspected cases of the virus.
Canary Islands authorities tried to reject orders from Spain, fearing anyone on board the ship could bring the deadly virus onto their territory.
Their fears only grew when it emerged today that the disease had spread to Switzerland after a passenger - who left the cruise before the virus outbreak - developed symptoms upon arriving home and is now being treated in Zurich.
The man is being held in an isolation unit and may be quarantined for up to 45 days to 'ensure that there is no risk to other patients,' the head physician of the Zurich hospital told local news outlet 20 Minuten.
The disease has an incubation period of up to eight weeks - which, in theory, is how long the 21 British passengers face being held in quarantine if the UK government decides to copy Spain's example.
The outbreak of the rare, rat-borne illness that has a 40 per cent mortality rate has left three people dead and several others seriously ill on the luxury cruise costing £10,000 per person.
But despite the outbreak having sparked international alarm, the World Health Organization has said the situation does not have similarities with the start of the Covid pandemic.
'This is not the next Covid, but it is a serious infectious disease,' WHO's top epidemic expert Maria Van Kerkhove said. 'Most people will never be exposed to this.'
Footage shows medics wearing hazmat suits boarding the luxury MV Hondius off the coast of Cape Verde in a desperate attempt to get three patients to specialist treatment in Europe.
Separate videos and images show the patients - also wearing personal protective equipment - lying on stretchers as they are wheeled into an ambulance.
Meanwhile the UK Government is putting 'plans in place' for the onward travel of Britons stuck aboard the cruise ship.
In a post on X, Prime Minister Sir Keir Starmer said: 'My thoughts are with those affected by the hantavirus outbreak onboard the MV Hondius.
'We are working closely with international partners to support British nationals on board, and we're putting plans in place for their safe onward travel.
'The risk to the wider public remains very low - protecting the British people is our number one priority.'