Three cruise passengers have died aboard the MV Hondius along the coast of Africa during a suspected hantavirus outbreak. One case has been confirmed as hantavirus, with several other suspected cases still pending.

Hantavirus, which is typically contracted from infected rodents, made headlines in March of last year when it was determined to be the cause of death of Betsy Arakawa, the classical pianist married to Gene Hackman.

The virus is extremely rare in humans but can lead to two very serious diseases.

The first disease, hantavirus pulmonary syndrome (HPS), is the more common form in the US. HPS was Arakawa’s cause of death at the age of 65.

Patients can develop flu-like symptoms that quickly progress to breathing difficulties. The condition can significantly damage lung tissue, causing fluid to accumulate in the lungs, leading to serious lung and heart problems.

The second, hemorrhagic fever with renal syndrome (HFRS), is found more often in Europe and Asia and has its worst effects on the kidneys.

While officials have not said which hantavirus disease they suspect is on the ship, the first victim, a 70-year-old man, died from a fatal hemorrhagic fever.

How do you get hantavirus?

Humans primarily contract hantavirus by inhaling particles from infected rodent droppings, urine or nesting materials.

Infection can also occur by eating food contaminated with mouse saliva, urine or droppings or rarely, by being bitten or scratched by a rat carrying the virus. The virus is not typically spread from person to person.

In the US, over 90% of infections occur west of the Mississippi River. Sin Nombre virus is the most common cause of hantavirus pulmonary syndrome.

Deer mice are the main culprit in North America and New Mexico, but there are others as well. Rice rats and cotton rats are carriers in the Southeast and white-footed mice in the Northeast.

Around 865 cases of the disease were reported in the US between 1993 and 2022, according to the Centers for Disease Control and Prevention.

What are the symptoms of hantavirus pulmonary syndrome?

Symptoms for HPS usually start a week to eight weeks after exposure. Breathing problems may begin four to 10 days after initial symptoms.

• Fever
• Tiredness
• Muscle aches
• Headache
• Dizziness
• Chills
• Nausea and vomiting
• Diarrhea
• Shortness of breath
• Cough 
• Stomach pain

What are the symptoms of hemorrhagic fever with renal syndrome?

The other hantavirus infection, hemorrhagic fever with renal syndrome, focuses more on the kidneys.

Symptoms usually develop one to two weeks after exposure to the virus. However, it can take up to eight weeks for symptoms to begin. They include:

• Headaches
• Fever
• Chills
• Back and stomach pain
• Nausea
• Blurred vision
• Eye inflammation or redness
• Rash
• Low blood pressure
• Acute shock
• Vascular leakage (in which blood vessels leak fluid, proteins and blood cells into the rest of the body)
• Acute kidney failure

What are the treatment options for hantavirus infections?

There is no specific treatment for hantavirus pulmonary syndrome. Early admission to a hospital is critical, and oxygen therapy and a ventilator may be needed.

For hemorrhagic fever with renal syndrome, care includes hydration, as well as maintenance of oxygen and blood pressure. If caught early, patients can take the antiviral ribavirin via IV.

How deadly is hantavirus?

Hantavirus pulmonary syndrome is much more deadly than hemorrhagic fever with renal syndrome.

The mortality rate for HPS is about 35% to 40%, while HFRS’s mortality rate varies from less than 1% to 15%, depending on the specific virus.

How can you reduce your risk of an hantavirus infection?

• Trap all mice.
• Air out closed spaces where the mice made their home.
• Use a disinfectant to soak down nests and droppings.
• Don’t sweep rodent droppings into the air.
• Move hay, wood and compost piles far from your home.
• Get rid of trash and junk piles that could draw rodents.
• Don’t leave your pet’s food and water where mice can reach it.