Health authorities raced Tuesday to find a port for a cruise ship battling a hantavirus outbreak, as it remained off the West African coast with passengers isolating after three people died.
The World Health Organization said the MV Hondius could head from Cape Verde to Spain's Canary Islands, though Spanish authorities said they wanted health data from the expedition vessel before opening up a port.
The ship had been on an adventure cruise from Ushuaia in Argentina to Cape Verde off west Africa. It has been at the center of an international alert since Saturday after it was revealed that the rare disease -- spread from infected rodents typically through urine, droppings and saliva -- was suspected in three deaths.
The priority now is to evacuate two sick crew members who require urgent care -- potentially to the Netherlands -- and "then the ship can move", WHO epidemic and pandemic preparedness and prevention director Maria Van Kerkhove said in Geneva.
So far, two hantavirus cases have been confirmed -- including in one of the fatalities -- with five further suspected cases among the 147 passengers and crew, the WHO said.
Three of those seven have died, one was critically ill and three had reported milder symptoms, including one who is now asymptomatic, it said.
One of the dead, a Dutch woman, had left the ship at the Atlantic island of Saint Helena and had flown to Johannesburg where she died on April 26. The WHO said it was trying to contact people who were on the same flight.
Passengers and crew have meanwhile been in isolation on the MV Hondius, operated by Dutch company Oceanwide Expeditions, after Cape Verde authorities barred it from docking.
- Human-to-human transmission? -
According to Van Kerkhove, Spanish authorities had "said that they will welcome the ship to do... a full epidemiologic investigation". They would also conduct a "full disinfection of the ship and... assess the risk of the passengers."
Spain's health ministry said that a decision on where to send the vessel would be based "on the epidemiological data collected from the ship during its stopover in Cape Verde". The Canary Islands government said it wanted the ship sent to mainland Spain.
Passengers from Britain, Spain and the United States, as well as crew largely from the Philippines, were among 23 nationalities on the MV Hondius.
The WHO was scrambling for answers about how hantavirus had appeared on the ship, which set off from Ushuaia on April 1.
The first person who died developed symptoms on April 6, according to the UN health agency which said it was alerted on Saturday.
Human-to-human transmission has only been reported in previous outbreaks of one specific hantavirus called Andes virus, which circulates in South America.
Van Kerkhove said the virus species had yet to be confirmed, but highlighted that WHO had been told "there are no rats on board" the ship.
South African researchers were working sequencing the data, said Van Kerkhove, who added that "our working assumption is that it is the Andes virus".
"We do believe that there may be some human-to-human transmission that is happening among the really close contacts".
- Contact tracing -
The first two people to die were a Dutch couple -- a man who died on April 11 and his wife who died after she disembarked in Saint Helena to accompany his body.
The wife was suffering from "gastrointestinal symptoms" and "deteriorated" during a flight to Johannesburg on April 25, the WHO said. She died the following day.
Van Kerkhove said contact tracing had been initiated for people on the flight. She stressed that human-to-human transmission typically only happened "among very close contacts".
The ship's operator said a British passenger was in intensive care in Johannesburg. The two crew still on board -- one British and one Dutch -- needed urgent care, WHO said.
Van Kerkhove said the typical incubation period for the hantavirus was between one and six weeks, leading the WHO to believe that the Dutch couple, who had been travelling in South America, "were infected off the ship".
The Hondius, she highlighted, was an expedition vessel, with passengers going ashore on Atlantic islands to do birdwatching and other activities -- meaning there could be "some source of infection on the islands".
The WHO has said the risk to the global population from the outbreak is "low".
