Transmissible Public Health Learning Solutions

EWARS · vFinal

Closed · monitoring concluded vFinal · 26 June 2026 · 14:00 CEST

Andes virus cluster aboard the MV Hondius.

A continuous situation tracker from Transmissible's Early Warning Alert and Response service. This page brings together the case listing, contacts, timeline, geographic dispersal and source registry for the MV Hondius Andes virus cluster, drawn from WHO, ECDC, and national health authorities, and updated as new information emerges. We maintain it because, in a fast-moving multi-country outbreak, a single clear source of triangulated, version-controlled epidemic intelligence saves practitioners hours.

PCR-confirmed

Cases 2, 3, 4, 5, 6, 7, 8, 9, 12, 13, 14, 15

Case 8 reclassified PCR+ 10 June (WHO); Cases 14, 15 status/details pending

Probable

Case 1

Deceased on board; clinical/epi linkage only (never sampled)

Deaths

Cases 1, 2, 4

2 PCR-confirmed + 1 probable

Case fatality · all cases

23.1%

3 / 13

Deaths / all PCR-confirmed + probable cases

States Parties

≥15

AR · AU · BE · CV · CA · FR · DE · IT · NL · SG · ZA · ES · CH · GB · US

+ Tristan da Cunha, St Helena, Ascension (UK OT) · NZ, KN, SE (St Helena monitoring list) · Institut Pasteur de Dakar

Monitoring concluded · vFinal · 26 June 2026

Outbreak monitoring closed

The case set is closed at 13 cases (12 PCR-confirmed + 1 probable) and 3 deaths, unchanged since mid-May. The 42-day monitoring window from the last possible exposure (10 May) closed on 21 June 2026, and national responses have been formally concluded — United States (HHS/CDC, 21 June), Spain (20 June), Tristan da Cunha (18–20 June), Australia (23 June) and Canada (26 June). No secondary cases have arisen among contacts; there is no evidence of sustained onward transmission beyond the ship's cohort.

One residual checkpoint: WHO will formally declare the outbreak ended on 2 July 2026, contingent on no further cases among the final 54 contacts (of >650 across 33 countries and territories) completing quarantine. EWARS active monitoring is stood down with this edition; this page is archived on confirmation of the 2 July declaration.

What's new in v24a · 10 June 2026

🇹🇷 Case 8 reclassified: Probable → PCR-confirmed (10 June via WHO/Tedros). British passenger evacuated to Tristan da Cunha, who developed symptoms and received airdrop medical team (6 paratroopers + 2 physicians, 9 May), now confirmed PCR-positive for Andes virus. Reclassification from probable to laboratory-confirmed moves tracker to 12 confirmed + 1 probable = 13 cases; case fatality 3 / 13 = 23.1%. WHO Director-General Tedros Ghebreyesus announced confirmation 10 June 2026 on X. Tristan da Cunha population: 221 residents; island isolated (ship access only); no secondary cases reported among islanders. [73]

§ 1. Situation overview

As of 22 May · 16:00 CEST

Since early April 2026 an outbreak of Andes virus (Orthohantavirus andesense) has been identified aboard the Dutch-flagged expedition cruise vessel MV Hondius, operator Oceanwide Expeditions. The first symptomatic case onboard developed illness on 6 April; the first death occurred on 11 April. The event was formally notified to WHO under International Health Regulations (2005)↗ on 2 May by the United Kingdom's National IHR Focal Point.

WHO published the initial Disease Outbreak News on 4 May 2026 (DON 599, updated 5 May), an updated DON on 8 May (DON 600), and ECDC published a Rapid Scientific Advice on the management of passengers on 9 May 2026.

MV Hondius completed nationality-based disembarkation at Granadilla, Tenerife on 10–11 May 2026 and departed Tenerife harbour evening of 11 May bound for Rotterdam, expected to arrive 18 May for full disinfection. 27 people remain on board — 25 crew and 2 RIVM staff. Repatriated passengers and crew (~117) are in quarantine, isolation, or in-hospital care across Spain, the USA, the Netherlands, the UK, France, Canada, Ireland, Türkiye, Germany and Australia. Contact-tracing operations are active in ≥15 States Parties.

WHO, FOPH, ECDC and CDC continue to assess the risk to global public health as low. The risk profile among close contacts of confirmed cases (such as all passengers and crew aboard) remains elevated — this Andes-strain of hantavirus is documented to have H2H capability in close-contact settings. (We refer to all people who boarded the MV Hondius between 30 March and 10 May 2026 as the cohort↗.)

§ 2. Case listing

Case numbering follows WHO DON 599 / DON 600 and is held consistent across this tracker, the EWARS sitrep, and the case timeline graphic. The 65-year-old German female previously suspected (Düsseldorf, 6 May) is no longer a case at this time: PCR and serology both negative per WHO DON 600 — reclassified non-case at the time of testing, remaining under contact monitoring through the incubation window↗ [32]. She is shown in the Contacts section below.

#	Identity	Status	Exposure attribution	Confirmation	Clinical course
1	Dutch M, 70; ornithologist; spouse of Case 2	Deceased 11 Apr	Documented landfill Argentine landfill / birdwatching site (RIVM)	Probable No samples taken — hantavirus not initially suspected; clinical/epi link	Symptom onset ~6 Apr; died onboard 11 Apr; body removed Saint Helena 24 Apr [1, 12]
2	Dutch F, 69; spouse of Case 1	Deceased 26 Apr	Documented landfill Argentine landfill / birdwatching site (RIVM)	PCR+ 4 May NICD (post-mortem)	Onset 22–24 Apr (RIVM 22 Apr; WHO DON 24 Apr); removed KL592 before departure 25 Apr; died Johannesburg 26 Apr [1, 12]
3	British M; passenger	Stable (improving)	Documented landfill Same site as Cases 1–2 (RIVM)	PCR+ 2 May NICD	Onset 24 Apr (presented to ship's doctor); medevac 27 Apr; hospitalised Johannesburg; stable per RIVM signal↗ 4259 (7 May) [1, 12]
4	German F; passenger	Deceased 2 May	No documented pre-boarding exposure	PCR+ 9 May NICD (post-mortem)	Onset 28 Apr; died onboard 2 May. No documented pre-boarding exposure; onset 22 days after Case 1's symptom onset — consistent with onboard secondary transmission [1, 32]
5	British M, 56; Expedition guide / crew	Hospital · stable	No documented pre-boarding exposure Evacuated Praia 7 May → Leiden UMC	PCR+ 6 May Leiden UMC [16]	Onset 27 Apr (mild respiratory and GI); evacuated 7 May Praia → Leiden UMC; strict isolation; stable in care. Per AFP (12 May): expedition guide / crew (retired police officer / nature photographer). [2, 16, 32, 50]
6	Dutch national, 41; Ship's doctor (crew)	Hospital · stable	No documented pre-boarding exposure Evacuated Praia 6 May → Radboud UMC	PCR+ 6 May Radboud UMC [17]	Onset 30 Apr (fever, fatigue, flushing — first-hand observation by an on-board passenger physician; CNN, ABC News and KTVZ-TV 7–8 May); evacuated 6 May Praia → Radboud UMC; strict isolation; stable in care [2, 17, 32]
7	Swiss M; passenger	Hospital · stable	No documented pre-boarding exposure Disembarked St Helena 22 Apr — onboard exposure during voyage; symptom onset post-disembarkation	PCR+ 5 May Switzerland; HUG reference	Onset 1 May (post-disembarkation, Switzerland); self-isolated immediately; hospitalised USZ Zurich. Full-genome sequence on Virological.org [14, 33]
8	Adult M; passenger (Tristan da Cunha)	Isolation · PCR-confirmed	No documented pre-boarding exposure Disembarked Tristan da Cunha 14 Apr	PCR-confirmed 10 June WHO announcement (Tedros Ghebreyesus)	Onset 28 Apr (diarrhoea); fever 30 Apr; disembarked Tristan da Cunha 14 Apr; developed symptoms while isolated on island (population 221, ship-access only). 9 May: UK Emergency Response airdrop — 6 paratroopers + 2 physicians deployed to provide medical support (HMS Medway coordination; personnel rotation completed 24 May per Tristan da Cunha government). 10 June: PCR-confirmed for Andes virus per WHO (Tedros announcement); laboratory basis and specific test date pending. Currently stable in isolation on Tristan da Cunha; no secondary cases reported among island residents. [32, 73]
9	French F; passengerIntensive care	Bichat ICU · ECMO	No documented pre-boarding exposure Disembarked Tenerife 10 May; symptomatic post-evacuation; onboard exposure	PCR+ 11 May France; per Health Minister Rist, France Inter	Onset 10 May (fever during repatriation flight Tenerife→Le Bourget); first reported by PM Lecornu 10 May; PCR-confirmed 11 May; clinical condition deteriorated overnight 10–11 May; transferred to Bichat Hospital, Paris. All 5 French evacuees in strict isolation, minimum 15 days; other 4 PCR-negative (retesting per protocol). Sex specified per AFP via The Standard, 12 May. 12 May: patient placed on extracorporeal membrane oxygenation (ECMO) at Bichat Hospital, per Dr. Xavier Lescure (AP wire syndicated via NPR / CBC / NBC News / ABC News; ECDC update of 13 May) [37, 41, 49, 59]
10	American M; passenger (volunteer on-board caregiver)Reclassified non-case (v21)	Reclassified non-case	No documented pre-boarding exposure Onboard exposure history; documented close-contact caregiving for Cases 5 & 6 in their early symptomatic phase. April illness now formally severed from ANDV by negative serology.	PCR neg + serology neg CDC press briefing, Dr. David Fitter (incident manager), 15 May 2026	Reclassification trajectory. v17 (8 May): tracker mapped the original onboard nasal-swab finding ("faintly positive" / "mildly positive" on one Dutch laboratory, negative on a second) into the probable category on the basis of a documented prodrome ~10 April aboard the MV Hondius (3 days of night sweats, chills, mild respiratory symptoms; ~2.5 weeks fatigue) and onboard close-contact caregiving exposure to Cases 5 and 6. 13 May: WHO DON 601 formally reclassified from PCR-confirmed to inconclusive, pending retesting. 13 May 20:53 ET (CNN): US confirmatory PCR (repeat testing) reported negative; blood / serology pending; UNMC moved patient from the Biocontainment Unit to the National Quarantine Unit. 15 May (CDC press briefing, Dr. David Fitter, incident manager): retest negative and serology negative — no antibodies detected — meaning the patient was never infected with Andes virus. UNMC clinician characterised the original onboard nasal-swab read as most likely a false positive. The April illness is real (documented at the time), but its causal attribution to ANDV is now formally severed by negative IgM serology ~5 weeks post-onset — a window in which ANDV-specific IgM would be unmistakably present in a true infection. Per §3 Definitions: "Non-case = a suspected or probable case who tests negative for ANDV by RT-PCR and/or* serology."* Per Rule #1 (additive-only versioning), Case 10 retains its case number and row; status changes to non-case. Tracker arithmetic re-anchors from 9 confirmed + 3 probable = 12 (v20) to 9 confirmed + 2 probable = 11 (v21); case fatality 3 / 11 = 27.3%. Patient remained under UNMC observation in the National Quarantine Unit at time of CDC announcement; subsequent monitoring per CDC protocol. 11 May airlift Tenerife → UNMC Omaha on Kalitta Air Boeing 747 (17 American citizens + 1 British dual national) preserved as historical record. [42, 43, 44, 50, 61, 62, 67]
12	Spanish M; evacuee to Madrid 10 MaySymptomatic 12 May	Symptomatic · stable	No documented pre-boarding exposure Boarded 30 March; disembarked Tenerife 10 May; onboard exposure	PCR+ confirmed 12 May Madrid Military Hospital (Gómez Ulla); 1st PCR+ 11 May, 2nd PCR+ 12 May per Spanish Ministry of Health (AP wire via Seattle Times / Washington Post; EFE / El Español, 12 May)	Day-1 evacuation Tenerife → Madrid (10 May). 1st PCR positive 11 May; asymptomatic at time of 1st PCR. Symptom onset 12 May: low-grade fever (febrícula) and mild oxygen desaturation; stable, no clinical worsening. 2nd PCR positive 12 May (confirmatory). Presymptomatic-to-symptomatic transition inside ~24 h of first PCR. Other 13 Spanish evacuees PCR-negative on 1st test; remain in isolation under Spain's 42-day quarantine protocol [41, 49, 55, 57]
13	Canadian passenger; ~70s; British ColumbiaPCR+ confirmed 16 May	Symptomatic · stable · hospitalised	No documented pre-boarding exposure MV Hondius passenger; returned to British Columbia 10 May; already in precautionary isolation; onboard exposure	PCR+ confirmed 16 May PHAC National Microbiology Laboratory (NML), Winnipeg; reported by BC PHO Dr. Bonnie Henry 16 May; PHAC press statement 17 May (Dr. Joss Reimer, Chief Public Health Officer of Canada)	Returned to British Columbia 10 May with travelling partner; both in precautionary isolation under BC Provincial Health Officer monitoring. Initial "presumptive positive" result reported by BC provincial laboratory 16 May; confirmatory PCR positive at PHAC's National Microbiology Laboratory (NML), Winnipeg, 16 May. Mild symptoms (fever, headache) reported from ~14–15 May; patient stable, hospitalised in Victoria. Travelling partner tested PCR-negative at NML. All high-risk contacts isolating and under local public health monitoring. PHAC notified WHO under IHR. [65, 66]
14	MV Hondius crew member; in Netherlands quarantineWHO-confirmed 22 May	Clinical status pending	No documented pre-boarding exposure Crew member of MV Hondius; among 27 disembarking at Rotterdam 18 May; onboard exposure	Confirmed 22 May (WHO) WHO notification 22 May 2026 via ANP wire (Het Parool, NU.nl 14:35 CET)	WHO announced on Friday 22 May that an MV Hondius crew member, previously testing negative, has now tested positive for hantavirus in the Netherlands. Of the 27 people on board at Rotterdam docking (18 May), Dutch crew members entered home quarantine with weekly testing; the 23 foreign crew (17 Filipino, 4 Ukrainian, 1 Russian, 1 Polish) entered quarantine in portakabins at the port of Rotterdam. Per Minister of Public Health Sophie Hermans's letter to parliament on Thursday 21 May, all 27 had tested negative on arrival. WHO did not specify whether the newly-confirmed person is a Dutch national or one of the foreign crew. This is the first new case in the Netherlands since the Rotterdam docking. WHO has called on receiving countries to maintain rigorous monitoring of quarantined passengers and crew. Tracker arithmetic re-anchors to 10 confirmed + 2 probable = 12 cases; case fatality 3 / 12 = 25.0%. Open items pending next WHO DON / RIVM signal: nationality, role on board, laboratory basis (PCR vs. serology vs. both). [68]
15	Spanish national; evacuee to Madrid 10 MayPCR+ confirmed 25 May	Symptomatic status pending	Close contact of Case 12 Evacuated Tenerife 10 May; identified during quarantine routine PCR screening 25 May; close contact of initial outbreak	PCR+ confirmed 25 May Madrid Military Hospital (Gómez Ulla); Spanish Health Ministry (Euronews, 25 May)	Identified 25 May during routine PCR screening at Gómez Ulla Central Defence Hospital. Classified as a close contact of Case 12 or another member of the initial Spanish evacuee cohort. Asymptomatic at time of detection per Spanish Health Ministry announcement. Clinical details including symptom onset status and severity pending. Remains in isolation under Spain's 42-day quarantine protocol. Second confirmed secondary case within the quarantined evacuee cohort (after Case 9 in France), demonstrating sustained H2H transmission risk in isolated, monitored cohorts. [69]

Note on Case 11 — reclassified to contacts (v12). In previous versions, Case 11 was an American passenger who developed mild symptoms during evacuation, initially reported (10 May, HHS) as PCR pending. CDC subsequently confirmed PCR-negative at the UNMC press conference of 11 May (Brendan Jackson, acting Director, Division of High Consequence Pathogens and Pathology, via CBS News). The individual has been removed from the case cohort and reclassified to contacts under investigation pending serology / repeat testing at Emory University Quarantine Unit, Atlanta. For future consistency, the original case numbering is retained — Case 11 is not reassigned to a different individual. [50, 53]

Note on Case 10 — case-definition↗ trajectory. ECDC's 9 May Rapid Scientific Advice defines a confirmed case as "a suspected or probable case with laboratory confirmation," where a suspected case requires acute fever and one further symptom. Under that framework an asymptomatic PCR-positive individual is classified as a high-risk contact with positive laboratory findings, not a confirmed case. Earlier WHO DON practice counted laboratory-confirmed individuals in the cohort regardless of symptom status. WHO DON 601 (13 May, 17:00) reclassified Case 10 from confirmed to inconclusive, adopting the ECDC / Spanish position on the divergent-laboratory specimen. This tracker further maps Case 10 into the probable category, since the patient had a documented prodrome aboard the MV Hondius (~10 April; 3 days of night sweats, chills, mild respiratory symptoms; ~2.5 weeks fatigue) with documented onboard epi link to Cases 5 and 6 — satisfying suspected-case criteria with epi link, i.e. probable. Tracker arithmetic moves from 9 confirmed + 2 probable (v15) to 8 confirmed + 3 probable (v17). Laboratory-interpretation history: the Case 10 on-board nasal swab was tested twice in the Netherlands — one result positive ("faintly positive" / "mildly positive" per HHS), one result negative. US HHS initially classified as a "weak" positive and applied Andes-virus biocontainment for the UNMC Omaha airlift; Spanish Ministry of Health statement (11 May) noted European authorities considered the test inconclusive. CDC Dr. David Fitter (incident manager, 13 May press briefing) acknowledged the inconclusive characterisation. Subsequent US confirmatory PCR was negative per CNN reporting (13 May 20:53 ET); blood / serology pending. v21 (18 May 2026): CDC press briefing of 15 May (Dr. David Fitter, incident manager) confirmed retest negative and serology negative — no antibodies detected — meaning the patient was never infected with Andes virus. Tracker reclassifies Case 10 to non-case per the §3 Definitions table; case row retained per Rule #1 (additive-only versioning) with status updated. Tracker arithmetic re-anchors from 9 confirmed + 3 probable = 12 (v20) to 9 confirmed + 2 probable = 11 (v21); case fatality 3 / 11 = 27.3%. [32, 40, 42, 43, 44, 45, 47, 61, 62, 67]

Common-source exposure (Cases 1, 2, 3). Per the Argentine Ministry of Health (via CNN, 7 May), Cases 1 and 2 entered Argentina on 27 November 2025 and crossed multiple times into Chile before re-entering through Neuquén on 31 January 2026. RIVM signal 4259 (7 May) documents that Cases 1, 2 and Case 3 visited the same rubbish-tip / landfill in Argentina with abundant rats and mice. WHO DON 599 attributes documented landfill exposure to Cases 1 and 2 only; both formulations are reported. [1, 11, 12]

Genomic sequences and phylogenetic analysis (v23a). Institut Pasteur teams completed full sequencing of the Andes virus strain from the French patient (Case 9) and published results on 15 May 2026. Genomic analyses confirm the viral sequence is identical to Andes virus strains detected in other shipboard cases and very close to known Andes virus strains circulating in southern South America. The Swiss National Reference Center (Geneva University Hospitals, University of Zurich, Institute of Medical Virology) uploaded the first complete sequence from the Swiss patient (Case 7) to Virological.org. Expert phylogenetic analysis by Prof. Piet Maes (President-elect, Hantavirus Society) examined the Swiss isolate against published sequences: the virus clusters consistently with known South American Andes virus strains, including lineages frequently associated with human infections, without evidence of segment incongruence. Conclusion: the MV Hondius cluster represents "a relatively typical naturally circulating ANDV lineage originating from the established rodent reservoir in Chile/Argentina, rather than a highly divergent or newly emerged variant." No evidence of novel mutations or increased transmissibility or virulence. This assessment aligns with Institut Pasteur's statement: "Aucun élément ne suggère à ce stade l'émergence d'un variant particulier présentant des caractéristiques nouvelles" — no element suggests the emergence of any particular variant with new characteristics at this stage. [70, 71]

Radboudumc occupational safety protocol breach and staff member testing outcome (v24, 3 June 2026). On 7 May, when Case 6 (Dutch national) was admitted to Radboudumc, staff deviated from strict safety procedures during blood and urine sample collection and handling. On 9 May, Radboudumc identified the breach and placed 12 affected staff members in preventive quarantine "despite the small risk of transmission." One of these 12 individuals tested "weakly positive" in a single external laboratory assay. However, multiple subsequent tests on various biological samples (blood, urine, saliva) returned negative results. The individual remained asymptomatic throughout. RIVM's official determination (published 3 June 2026): "Multiple negative test results and the absence of symptoms are inconsistent with an active Andes virus infection. This person is not infectious and RIVM does not count this person as a patient." The individual is now monitored with enhanced testing frequency (2×/week instead of standard 1×/week). Radboudumc commissioned an external safety review led by Dr. Jan Kluytmans (UMC Utrecht) to determine how the protocol breach occurred and to identify preventive measures; results expected within weeks. Case count remains **13 cases (11 confirmed + 2 probable); 3 deaths; CFR 23.1%**. [72]

§ 3. Definitions

Aligned to WHO & ECDC as of 17 May 2026

Tracker arithmetic follows internationally standardised case definitions↗ issued by WHO and ECDC. The two frameworks converged on 13 May 2026 with WHO DON 601. This section sets out the current operational definitions plus how they evolved during the outbreak.

Current case classification

Per WHO B09765 Annex Table 1 (15 May 2026) and ECDC update of 17 May 2026.

Classification	Criteria
Suspected	Anyone who shared or visited a conveyance with a confirmed or probable ANDV case, OR had contact with a probable or confirmed ANDV case, AND has acute (or history of) compatible symptoms: fever ≥38 °C, myalgia, chills, acute gastrointestinal (nausea, vomiting, diarrhoea, abdominal pain) or acute respiratory (cough, dyspnoea, chest pain) symptoms.
Probable	Meets suspected criteria, has been evaluated by a health professional, has a known epidemiological link to a confirmed or probable ANDV case, AND laboratory testing was not possible (or is pending).
Confirmed	Laboratory confirmation of ANDV through RT-PCR and/or serology (IgM by ELISA or IFA).
Inconclusive	Awaiting further laboratory investigation. Introduced by WHO DON 601 (13 May 2026) to handle divergent-laboratory results.
Non-case	A suspected or probable case who tests negative for ANDV by RT-PCR and/or serology.

Current contact definition

Per WHO B09765 Annex Table 1 (15 May 2026).

A contact is a person who was exposed to a confirmed or probable case while the case was infectious, through interactions consistent with exposure to respiratory secretions, saliva, blood or other bodily fluids. Four categories are recognised:

Direct physical contact — exposure to saliva or other bodily fluids (caregiving, intimate contact, sharing a bed).
Close proximity exposure — within 2 metres for a cumulative period of more than 15 minutes (face-to-face interactions, shared meals, social gatherings).
Exposure in shared indoor spaces — households, workplaces, healthcare facilities, social gatherings, travel/conveyance exposure.
Unprotected exposure in healthcare settings — particularly during patient care including aerosol-generating procedures, plus laboratory exposure.

Evolution of case definitions across the outbreak

Date	Source	Change
4 May	WHO DON 599	Initial case definitions issued; laboratory confirmation alone sufficient for confirmed-case status, regardless of symptom presentation.
9 May	ECDC Rapid Scientific Advice	Tighter suspected-case threshold introduced: acute fever AND at least one further compatible symptom. High-risk vs low-risk contact↗ classification defined. 42-day monitoring window established; Day 0 = 6 May.
12 May	ECDC (post-Member-State discussion)	Day 0 of the 42-day monitoring window re-anchored from 6 May → 10 May, reflecting last possible onboard exposure after nationality-based disembarkation completed 10–11 May at Tenerife.
13 May	WHO DON 601	WHO formally adopts the ECDC suspected-case threshold. "Inconclusive" category introduced. Case 10 reclassified from confirmed to inconclusive.
15 May	WHO B09765 — Laboratory Testing Interim Guidance	Case and contact definitions consolidated into a single Annex Table 1, alongside the laboratory testing algorithm. Operational close-contact threshold: <2 m for >15 min cumulative.

Tracker mapping note. Through v20, this tracker mapped the WHO DON 601 inconclusive Case 10 into the probable category, based on documented prodrome (~10 April) and onboard epi link to Cases 5 and 6. v21 (18 May): following the CDC press briefing of 15 May (Dr. David Fitter, incident manager), in which the retest of Case 10 returned negative confirmatory PCR and negative serology (no antibodies detected), Case 10 is now reclassified non-case per the definition above ("Non-case = a suspected or probable case who tests negative for ANDV by RT-PCR and/or serology"). Per Rule #1 (additive-only versioning) the case row is retained with status updated, not deleted. ECDC's 17 May framing (12 cases, including 1 inconclusive) predates the CDC announcement and the tracker re-anchoring; the operationally current count is 9 confirmed + 2 probable = 11. v22 (22 May): WHO notification of a positive-on-retest MV Hondius crew member in the Netherlands (Case 14) re-anchors the tracker to 10 confirmed + 2 probable = 12; case fatality 3 / 12 = 25.0%.

§ 4. Contacts under investigation

Contacts under investigation are tracked separately from cases. They are not included in the headline figures, the case fatality calculation, or the case listing above. Contact tracing↗ proceeds in parallel under national health authority lead.

Contact	Status (as of 18 May, 16:00 CEST)	Reference
25-year-old Calabrian man — KL592 passenger (25 Apr) with Case 2; already in quarantine.	Asymptomatic · samples to Spallanzani (precautionary) Per reliable official Italian health authorities (Spallanzani National Institute for Infectious Diseases; Mayor of Villa San Giovanni Giusy Caminiti; Italian Health Minister Orazio Schillaci): patient is at home, asymptomatic, will not be transferred. Mayor Caminiti formal statement: "has never had symptoms attributable to Hantavirus." Biological samples sent to Spallanzani precautionarily as part of Ministry-of-Health-directed testing of all 4 Italian KL592 contacts on 13 May. The 12 May 15:14 CEST regional-press characterisation as symptomatic [54] is formally retracted in Italian press.	[54, 58]
60-year-old British tourist + 1 travel companion — Sacco Hospital, Milan; Airlink St Helena → Johannesburg flight (24 April), seated several rows from Case 2; companion not on the flight but joined in Italy.	Both PCR-negative 12 May · 40-day hospital quarantine UK government notified Italian authorities; tourist had transited Amsterdam before reaching Milan. Per Lombardy Welfare Councillor Guido Bertolaso (statement, 12 May): both PCR-negative on first test. Quarantine completed in hospital because tourist had no private accommodation (B&B). Distinct exposure pathway from the 4 Italian KL592 contacts (this is the upstream Airlink leg, not the 25 April KLM JNB→AMS leg).	[60]
Formerly Case 11 — American, mild symptoms at evacuation; Emory University Quarantine Unit, Atlanta	Reclassified contact (v12) PCR-negative per CDC (Brendan Jackson, UNMC press conference 11 May, via CBS News); serology / repeat testing pending.	[50, 53]
KLM cabin-crew member — Amsterdam UMC	PCR negative · cleared Test completed 10 May; no longer suspected; remains under monitoring.	[41]
Woman, 32-yr, Alicante region, Spain — KL592 passenger seated 2 rows behind Case 2	PCR negative 9 May Mild respiratory symptoms (Spanish Health Minister Mónica García); confirmatory retest per protocol; Valencia regional authorities tracing her onward contacts.	[35, 41]
Woman, Catalonia — second potential KL592 contact	Precautionary admission Possible symptoms; result pending (Spanish Ministry of Health, 9 May).	[41]
Two Singaporean co-passengers on KL592 (men, 65 and 67)	Both PCR negative Singapore CDA-managed quarantine continuing.	[15, 25]
4 Italian KL592 contacts (Campania) incl. 24-yr seafarer from Torre del Greco, seated 10 rows ahead of Case 2	Under surveillance First NP swab PCR-negative; serial 48-h swabs continuing; 45-day precautionary home isolation under ASL Napoli 3 Sud; reference centre Cotugno Hospital, Naples.	[48]
22 French secondary contacts (per Health Minister Rist via France Inter, 11 May)	Under monitoring 8 on the St Helena → Johannesburg flight leg (1 mildly symptomatic, diagnostic testing pending; 7 offered isolation + testing); remainder on KL592 and onward legs (mostly French nationals, most self-isolating).	[15, 37, 41, 49]
4 Belgian secondary contacts (3 Wallonia under AVIQ; 1 Brussels under Vivalis)	Released 10 May Asymptomatic period completed; first known jurisdiction to derisk a contact cohort.	[29, 45]
2 New Jersey residents — non-passenger air-travel contacts of a confirmed case (NJ DOH, 8 May)	Asymptomatic · monitored	[50, 51]
2 Washington State (King County) residents — household members; KL592 close-contact cohort, seated within 2 seats of Case 2 for ~1 hour on the 25 April Johannesburg → Amsterdam flight before Case 2 was removed pre-takeoff	Asymptomatic · monitored Daily temperature checks at home under Public Health – Seattle & King County (Dr. Sandra J. Valenciano, Health Officer / Acting Director, 12 May 2026). Notified by WA State DOH / CDC on 10 May following Case 2 confirmation; public announcement 12 May. WA State DOH PIO Mark Johnson: traceback initiated only after the index passenger was laboratory-confirmed.	[55, 56]
Swiss case's spouse (spouse of Case 7)	Asymptomatic · self-isolating FOPH monitoring in Switzerland.	[14]
Wife of Case 8 (Tristan da Cunha)	Asymptomatic · self-isolating Self-isolating on the island per UK Minister for Overseas Territories Stephen Doughty.	[46]
65-year-old German female — Düsseldorf arrival 6 May (previously suspected)	Reclassified non-case PCR and serology negative per WHO DON 600 (at the time of testing); remains under contact monitoring through the incubation window.	[32]
US in-state monitoring cohort — pre-evacuation: AZ 1, CA 1, GA 2, TX 2, VA 1	7 asymptomatic · monitored Per state DOH statements 6–8 May.	[40, 42, 50, 51]
US 11 May airlift quarantine cohort — 18 returnees (17 US residents + 1 UK dual national)	In federal quarantine 16 → UNMC Omaha (15 National Quarantine Unit / Mike Wadman MD; 1 Biocontainment Unit / Angela Hewlett MD = Case 10); 2 → Emory University Quarantine Unit, Atlanta (incl. formerly-Case-11).	[42, 44, 50, 53]
6 passengers boarding at Tristan da Cunha (13–16 Apr) — previously uncounted exposed cohort	Watch list On board for all subsequent transmission events; nationalities and monitoring jurisdictions pending; ECDC 42-day window extends horizon to ~28 May.	[50, 53]
12 Radboudumc healthcare workers, Nijmegen — procedural biosafety lapse handling Case 6 samples	6-week precautionary quarantine Per WHO DON 600 and RIVM guidance; transmission risk assessed as low; monitored by Occupational Health twice weekly.	[32, 53]
~262 inhabitants of Tristan da Cunha — island-level cohort	Tracing complete Per Governor of St Helena, Ascension and Tristan da Cunha (11 May): comprehensive contact tracing completed; small number self-isolating as precaution; no other symptomatic cases identified.	[46]

§ 5. Event timeline

22 May 2026

🇳🇱 WHO: MV Hondius crew member confirmed positive in Netherlands · tracker re-anchors to 12 casesCases

WHO notification (Friday 22 May, via ANP wire; carried by Het Parool 14:33 CET and NU.nl 14:35 CET): an MV Hondius crew member, previously testing negative, has been confirmed positive for hantavirus in the Netherlands. WHO statement frames the outbreak total at 12 cases with 3 deaths; no new deaths since 2 May. WHO did not specify whether the newly-confirmed person is a Dutch national (now in home quarantine with weekly testing) or one of the 23 foreign crew (17 Filipino, 4 Ukrainian, 1 Russian, 1 Polish) in port-area portakabins. Per the 21 May Hermans letter to parliament, all 27 had tested negative on Rotterdam arrival; this is the first new case in NL since the 18 May docking. WHO calls on receiving countries to maintain rigorous monitoring of quarantined passengers and crew throughout the quarantine period. Tracker action (v22, 22 May): Case 14 added per §3 Definitions. Tracker arithmetic re-anchors from 9 confirmed + 2 probable = 11 (v21) to 10 confirmed + 2 probable = 12 (v22); case fatality 3 / 12 = 25.0%. Open items pending next WHO DON / RIVM signal: nationality, role on board, laboratory basis (PCR vs. serology vs. both). [68]

17 May 2026

🇨🇦 Canada: Case 13 PCR-confirmed (PHAC, BC) · ECDC update reports 12 casesCases

PHAC press statement (17 May, Ottawa): an MV Hondius passenger in British Columbia confirmed positive for Andes hantavirus by PHAC's National Microbiology Laboratory (NML), Winnipeg, on 16 May. Reported by BC Provincial Health Officer Dr. Bonnie Henry on 16 May; signed by Dr. Joss Reimer, Chief Public Health Officer of Canada. Travelling partner PCR-negative at NML. Patient (~70s) hospitalised in Victoria with mild symptoms (fever, headache from ~14–15 May); stable. All 4 Canadian MV Hondius passengers had returned to BC on 10 May and were already in precautionary isolation. All high-risk contacts isolating under local public health. PHAC notified WHO under IHR. ECDC update of 17 May reflects the Canadian confirmation: 12 cases total (9 confirmed, 2 probable, 1 inconclusive under DON 601 framework); no new deaths. This tracker, through v20, mapped the DON 601 inconclusive Case 10 into the probable category, producing tracker arithmetic of 9 confirmed + 3 probable = 12; case fatality 3 / 12 = 25.0%. v21 (18 May) update: tracker arithmetic re-anchored to 9 confirmed + 2 probable = 11 (case fatality 3 / 11 = 27.3%) following the CDC announcement of 15 May reclassifying Case 10 to non-case (see 15 May entry below). ECDC's 17 May framing of 12 cases predates incorporation of the CDC retest result. [65, 66]

15 May 2026

🇺🇸 CDC press briefing: Case 10 retest negative + serology negative — never infected · tracker re-anchors to 11 casesCases

CDC press briefing (Friday 15 May), Dr. David Fitter, incident manager: the American passenger previously listed as inconclusive (Case 10 in this tracker) was retested, with negative confirmatory PCR and negative serology — no antibodies detected — meaning he was never infected with Andes virus. CDC reaffirmed that no cases of Andes hantavirus have been confirmed in the United States. A UNMC clinician characterised the original onboard nasal-swab read as "most likely a false positive," consistent with the original divergent-laboratory pattern (one Dutch lab "faintly positive" / "mildly positive"; second Dutch lab negative). The patient himself stated "there's no evidence that I've had hantavirus." As of CDC's briefing, ~41 people in 16 US states remain under monitoring (about half in healthcare facilities, half at home); 18 American MV Hondius passengers at UNMC's National Quarantine Unit, all asymptomatic. CDC's Fitter also defined high-risk exposure as either remaining on the ship 5–10 May or close prolonged contact with a confirmed case (including aircraft seating in proximity). Wikipedia subsequently removed Case 10 from the case count. Tracker action (v21, 18 May): Case 10 reclassified to non-case per §3 Definitions ("Non-case = a suspected or probable case who tests negative for ANDV by RT-PCR and/or serology"). Per Rule #1 (additive-only versioning) the case row is retained with status updated; not deleted. Tracker arithmetic re-anchors from 9 confirmed + 3 probable = 12 (v20) to 9 confirmed + 2 probable = 11 (v21); case fatality 3 / 11 = 27.3%. The April illness aboard the MV Hondius remains in the historical record but its causal attribution to ANDV is now severed by negative IgM serology ~5 weeks post-onset. [67]

14 May 2026

🇳🇱 RIVM: 26 NL evacuees PCR-negative · 🇫🇷 Rist: all 26 French contacts PCR-negative · Case 10 confirmatory PCR negative (post-DON 601)Cases

🇳🇱 RIVM (14 May) reports all 26 evacuees on the 2nd and 3rd repatriation flights to Eindhoven Air Base (arrived night of 11–12 May) tested PCR-negative for Andes virus. 6-week home quarantine continues for the 1 Dutch national in the group irrespective of the negative result; RIVM quarantine reference date 6 May (42-day window). Separately, 3 individuals in NL who developed symptoms after on-flight contact with an Andes-virus-positive person have been tested: 2 PCR-negative, 1 pending. [63] 🇫🇷 French Health Minister Stéphanie Rist (X post, 14 May): all 26 French contacts have tested PCR-negative "sans exception" — comprising 4 of the 5 Hondius French cruise passengers at Bichat (the 5th = Case 9, receiving intensive care at Bichat) + 22 secondary flight contacts (8 on St Helena → Johannesburg Airlink 24 April + remainder on KLM JNB→AMS / onward). All 26 remain in hospital isolation; testing 3×/week. Rist frames case fatality at "30–40%"; incubation 42 days; subsequent results not communicated unless positive. [64] Case 10: hours after WHO DON 601 publication (which reclassified Case 10 from confirmed to inconclusive), CNN published an interview (13 May 20:53 ET = 14 May 02:53 CEST) with the patient reporting that US confirmatory PCR is negative ("Wednesday" results). Blood / serology results pending. UNMC announced the same day that the patient has been moved from the Biocontainment Unit to the National Quarantine Unit alongside the other 15 American passengers, all currently asymptomatic. WHO has not yet incorporated the US confirmatory negative into a subsequent DON. This tracker records the case as probable in v17 on the basis of the documented April prodrome and onboard epi link; reclassification trajectory remains subject to the next WHO update and serology results.

13 May 2026

WHO DON 601 published · Case 10 reclassified inconclusive · Case 9 intensive care · Case 12 confirmatory PCR positive · Sacco Milan British tourist · Italian KL592 cohort confirmed asymptomatic · Spain 42-day protocolCases

WHO DON 601 (Disease Outbreak News, 13 May 17:00 reporting time) published. WHO arithmetic: 11 cases total = 8 confirmed + 1 inconclusive (Case 10) + 2 probable; 3 deaths (2 confirmed + 1 probable). This tracker maps the WHO "inconclusive" Case 10 into the probable category (documented April prodrome + onboard epi link → suspected case with epi link = probable), producing tracker arithmetic of 8 confirmed + 3 probable. DON 601 also: "secondary transmission appears most likely during the early phase of illness, when the virus is more transmissible"; onboard crew advised physical distancing and remain in cabins where possible during the return journey to the Netherlands; three new WHO technical guidance documents released (management on board; disembarkation and onward management; management of contacts of ANDV cases). Spanish Ministry of Health confirms Case 12 2nd PCR positive (AP wire via Seattle Times / Washington Post / OPB; EFE / El Español 11–12 May; COPE live blog 12 May). Clinical status updates from asymptomatic at 1st PCR (11 May) to symptomatic at 2nd PCR (12 May): low-grade fever (febrícula), mild oxygen desaturation, stable without clinical worsening. Other 13 Spanish evacuees at Gómez Ulla PCR-negative on 1st test; remain in isolation under Spain's 42-day quarantine protocol. Italian KL592 contact cohort — all 4 confirmed asymptomatic per reliable official Italian health authorities (Spallanzani Institute; Mayor of Villa San Giovanni Giusy Caminiti; Italian Health Minister Orazio Schillaci; ASL Napoli 3 Sud). The 12 May regional-press "symptomatic" framing of the 25-yr Calabrian is formally retracted in Italian press. All 4 Italian KL592 contacts undergoing precautionary testing 13 May per Ministry of Health direction; samples to Spallanzani. Case 9 intensive care: per Dr. Xavier Lescure, Bichat Hospital (statement 12 May, syndicated via AP wire), the patient has been placed on extracorporeal membrane oxygenation (ECMO). ECDC update of 13 May notes the clinical course. Italy / Sacco Hospital Milan (new contact pathway): a 60-yr-old British tourist + 1 travel companion placed in 40-day hospital quarantine after the UK government notified Italian authorities; tourist was on the Airlink charter St Helena → Johannesburg on 24 April with Case 2 (distinct exposure from the 4 KL592 contacts). Per Lombardy Welfare Councillor Guido Bertolaso, both tourist and companion tested PCR-negative 12 May.

12 May 2026

Case 12 PCR+ · Italy: 25-yr Calabrian KL592 contact (samples to Spallanzani; symptomatic framing retracted same day) · WA King County KL592 contacts notified · second NL flight lands · AFP wire summaryCases

Madrid Health Ministry (via AFP) confirms Case 12 — Spanish male evacuee to Madrid Military Hospital (Gómez Ulla), asymptomatic, PCR-positive on 11 May; confirmatory result pending within hours. 15:14 CEST — ANSA initially reports a 25-year-old Calabrian man, KL592 passenger with Case 2, already in quarantine, as exhibiting symptoms consistent with hantavirus and announces biological samples being sent to the Spallanzani Institute, Rome. Later the same day, the Spallanzani Institute itself clarifies that only biological samples are arriving (no patient transfer), and the Mayor of Villa San Giovanni (RC) Giusy Caminiti issues a formal statement confirming the patient is at home and asymptomatic — "has never had symptoms attributable to Hantavirus." The symptomatic characterisation is retracted in Italian press. Public Health – Seattle & King County (Dr. Valenciano, 12 May) announces 3 King County residents under monitoring: 2 household-member close contacts of Case 2 from 25 April KL592 (within 2 seats, ~1 h exposure, asymptomatic, daily temperature checks at home); 1 MV Hondius passenger asymptomatic at UNMC National Quarantine Unit (Washington State resident now identified to state). Second Netherlands flight lands Eindhoven Air Base (~28 multinational passengers including 6 Australia-bound). Italian seafarer (Torre del Greco) due for 2nd serial NP swab; Belgian UZA follow-up testing on 2 evacuees. AFP nationality-by-nationality wire summary published — basis for v12 Case 5 / 6 re-attribution.

11 May 2026

Case 9 PCR+ · Case 11 PCR-negative · vessel departs Tenerife · Tedros 12-country listResponse

French Health Minister Rist (France Inter) confirms Case 9 PCR-positive (French female); condition deteriorated overnight 10–11 May; transferred Bichat Hospital, Paris. French decree extends mandatory hospital isolation for hantavirus to 6 weeks. Radboudumc reveals 12 HCW procedural-lapse precautionary 6-week quarantine. CDC press conference at UNMC: Brendan Jackson announces formerly-Case-11 individual PCR-negative; reclassified to contacts (v12). WHO DG Tedros publishes 12-country St Helena disembarkation-monitoring list (via CBS), adding NZ, KN, SE to the tracker. Governor of St Helena, Ascension and Tristan da Cunha issues Territory-wide statement: no suspected cases on St Helena or Ascension; Tristan tracing complete. Italian Ministry of Health circular cascaded by Campania Region. Second NL flight departs Tenerife (~22 multinational incl. 6 Australia-bound; planned Australia flight cancelled). MV Hondius departs Tenerife harbour ~20:00 local with ~30 crew for Rotterdam (~5–6 days).

10 May 2026

Tenerife docking · Day-1 evacuation · Case 9 (symptomatic), Cases 10 & 12 announcedResponse

MV Hondius docked at Granadilla, Tenerife at 06:24 local with 147 aboard. Day-1 evacuation: 94 individuals of 19 nationalities to 7 destinations (ES 14, US 17+1 UK dual, NL 26, UK 22, FR 5, CA 4, IE 2, TR 3). French PM Lecornu announces Case 9 symptomatic (1 of 5 French evacuees). HHS announces two American passengers: Case 10 (asymptomatic, "mildly PCR positive") and a symptomatic individual (mild symptoms, PCR pending — subsequently PCR-negative; reclassified to contacts on 11 May). Spanish authorities flag initial PCR+ for Case 12 (asymptomatic) at Gómez Ulla, Madrid; confirmatory result expected within hours. CDC HAN 00528 issued. KLM cabin-crew PCR-negative.

9 May 2026

ECDC Rapid Scientific Advice published · Case 4 PCR-confirmed · UK Atlantic Territories deploymentsAdvisory

ECDC published substantive operational guidance on management of passengers — case definitions↗, contact classification, IPC procedures. Case 4 (German female, post-mortem) PCR-confirmed. UK military air drop to Tristan da Cunha (no airstrip) delivered personnel and medical supplies; UK public-health team of 3 specialists + 14 boxes medical kit + 2 military planners arrive Saint Helena.

8 May 2026

WHO DON 600 published · Case 8 identified · CDC EOC Level 3Advisory

WHO Disease Outbreak News DON 600 consolidates case figures; reclassifies the 65-year-old German female (Düsseldorf) as non-case after negative PCR and serology. Case 8 (probable) identified on Tristan da Cunha. CDC Emergency Operations Center activated at Level 3.

7 May 2026

WHO press briefing · Case 5 evacuation · RIVM signal 4259Advisory

WHO frames the event as a cluster↗ in a confined space involving close contact, not an epidemic. Case 5 (British expedition guide / crew) medevaced Praia → Leiden UMC. KLM cabin-crew member admitted Amsterdam UMC with suspected hantavirus. RIVM signal 4259 issued.

6 May 2026

Cases 5 & 6 PCR-confirmed · Praia evacuations · ECDC Threat Assessment BriefCases

Case 6 (Dutch ship's doctor) evacuated Praia → Radboud UMC (PCR+ at Radboud UMC). Case 5 (British expedition guide / crew) PCR+ at Leiden UMC. 65-yr German female evacuated Praia → Düsseldorf (subsequently reclassified non-case). ECDC Threat Assessment Brief published.

5 May 2026

Case 7 (Swiss) PCR-confirmed at HUG reference laboratoryCases

Swiss male, disembarked St Helena 22 Apr, symptom onset 1 May in Switzerland. PCR-confirmed at HUG; hospitalised USZ Zurich. First post-disembarkation symptomatic confirmation.

4 May 2026

WHO DON 599 published · Case 2 PCR-confirmedAdvisory

WHO publishes initial Disease Outbreak News (DON 599, updated 5 May). NICD confirms Andes virus PCR-positive in Case 2 (post-mortem).

3 May 2026

MV Hondius arrives Praia, Cabo VerdeResponse

Vessel arrives at the port of Praia. Hantavirus laboratory-confirmed in a patient evacuated to hospital.

2 May 2026 · b

Case 3 PCR-confirmed (Andes virus, NICD)Cases

NICD South Africa confirms Andes virus PCR-positive in Case 3 (the British male medevaced from Ascension Island on 27 April and hospitalised in Johannesburg). This is the first laboratory-confirmed Andes virus case linked to the cluster.

2 May 2026 · a

Case 4 dies onboard · WHO notificationDeath

Case 4 (German female) dies onboard. UK National IHR Focal Point formally notifies WHO under IHR (2005). ECDC alerted via the EU Early Warning & Response System. Per on-board passenger physician first-hand testimony, hantavirus was recognised onboard as the working diagnosis around 2–3 May.

26 Apr 2026

Case 2 dies in JohannesburgDeath

Case 2 (Dutch female, 69) dies in a Johannesburg hospital after being removed from KLM flight KL592 in deteriorating condition on 25 April. She and her husband had been airlifted from the ship on 24 April.

24 Apr 2026

Body of Case 1 evacuated · Case 2 airlifted to JohannesburgResponse

The body of the 70-yr Dutch man (Case 1) and his critically ill wife (Case 2) are airlifted from MV Hondius to Johannesburg. Hantavirus not yet suspected. ~30 additional passengers disembarked at Saint Helena.

13–16 Apr 2026

Tristan da Cunha call — 1 crew member disembarks · 6 passengers join

Per Oceanwide Expeditions (via CBS News, 11 May): during the Tristan da Cunha call, 1 crew member disembarked (candidate match for Case 8, currently classified passenger; not confirmed) and 6 passengers joined the cruise. The 6 boarding passengers are a previously uncounted exposed cohort, on board for all subsequent transmission events through Tenerife disembarkation 10 May. Case 8 disembarked Tristan 14 April.

11 Apr 2026

First death aboard MV Hondius — initially attributed to natural causesDeath

70-yr Dutch man (Case 1, ornithologist) dies aboard the vessel. Death initially attributed to natural causes. He had been the first to develop symptoms (onset 6 April). Hantavirus aetiology confirmed retrospectively after Case 2 PCR-positive on 4 May.

6 Apr 2026

First symptoms onboard — five days after departing Ushuaia

First passenger (Case 1) develops symptoms consistent with hantavirus pulmonary syndrome. Itinerary: mainland Antarctica, South Georgia, Nightingale Island, Tristan da Cunha (13–16 Apr), Saint Helena (24 Apr), Ascension Island (27 Apr), Praia (3–7 May), Tenerife (10 May).

1 Apr 2026

MV Hondius departs Ushuaia, Argentina

Dutch-flagged expedition cruise vessel departs with ~150 people aboard from 23 nationalities (88 passengers, 56 crew). Operator: Oceanwide Expeditions.

§ 6. States Parties involved in the response

15+ jurisdictions + UK Overseas Territories + Institut Pasteur de Dakar

🇦🇷 Argentina

Index-case↗ exposure source

Cases 1, 2 (and per RIVM, Case 3) exposure linked to Argentine landfill / birdwatching site. Malbrán Institute rodent-trapping investigation ongoing; reagents shared with Spain, Senegal, South Africa, Netherlands, UK. Ministry of Health passenger/crew list-sharing.

🇦🇺 Australia

6-passenger cohort to Bullsbrook quarantine

Planned 11 May Tenerife–Australia flight cancelled. The 6 passengers (4 Australian + 1 NZ + 1 UK-resident-of-Australia) instead travelled on the second NL flight to Eindhoven (arrival 00:30 12 May); onward to Perth; minimum 3 weeks at Bullsbrook quarantine facility (COVID-era). Australian Health Minister Mark Butler.

🇧🇪 Belgium

2 evacuees · 4 contacts derisked

2 asymptomatic Belgian passengers airlifted to Eindhoven 10 May, transferred by Belgian Defence ambulance to UZ Antwerpen (Edegem) for examination by Prof. Erika Vlieghe's team. Initial blood analyses inconclusive as of 11 May; further testing 12 May. 6-week / 45-day quarantine per Minister Vandenbroucke. 4 Belgian KL592 contacts released from quarantine 10 May — first known jurisdiction to derisk a contact cohort.

🇨🇻 Cabo Verde

Ship dock 3–7 May; multiple evacuations

Praia served as evacuation hub: Case 6 (Dutch ship's doctor) and the 65-yr German female (subsequently reclassified non-case) evacuated 6 May; Case 5 (British expedition guide / crew) evacuated 7 May. Onboard support team (WHO, ECDC, RIVM) boarded 6 May; isolation area established.

🇨🇦 Canada

Case 13 (BC) · 4 MV Hondius passengers · 4 prior contacts

Case 13 (British Columbia, ~70s): MV Hondius passenger, returned to BC 10 May, already in precautionary isolation. Mild symptoms (fever, headache) ~14–15 May; "presumptive positive" reported by BC provincial lab 16 May; PCR-confirmed at PHAC's National Microbiology Laboratory (NML), Winnipeg, 16 May. Patient stable, hospitalised in Victoria. Travelling partner PCR-negative at NML. Per BC PHO Dr. Bonnie Henry (16 May presser) and PHAC press statement (17 May, Dr. Joss Reimer, Chief Public Health Officer of Canada). PHAC notified WHO under IHR. All high-risk contacts isolating, local public health monitoring. Day-1 Tenerife evacuation routed 4 Canadian nationals to Saguenay-Bagotville. Plus 4 prior contacts under monitoring (2 Grey Bruce ON; 2 KL592 flight contacts in QC, AB, ON). [65, 66]

🇫🇷 France

Case 9 (Bichat ICU) · 4 other evacuees + 22 secondary contacts (all PCR-negative 14 May)

Case 9 (French female) PCR-confirmed 11 May per Health Minister Stéphanie Rist (France Inter); clinical condition deteriorated overnight 10–11 May; transferred Bichat Hospital, Paris; currently receiving intensive care, on extracorporeal membrane oxygenation (ECMO) per Dr Xavier Lescure (Bichat, 12 May). 14 May — Health Minister Rist (X post): all 26 French contacts PCR-negative "sans exception." Composition: 4 of the 5 Hondius French cruise passengers at Bichat (the 5th = Case 9) + 22 secondary flight contacts (8 on St Helena → Johannesburg Airlink 24 April + remainder on KLM JNB→AMS / onward legs). All 26 remain in hospital isolation; testing 3×/week. Rist: case fatality framed at "30–40%"; incubation 42 days; subsequent results not communicated unless positive. French decree 11 May mandates hospital isolation for hantavirus 6 weeks. [64]

🇩🇪 Germany

Case 4 (deceased) · 4 returnees

Case 4 (German female) died onboard 2 May; PCR-confirmed post-mortem 9 May. 65-yr Düsseldorf admission reclassified non-case (WHO DON 600). 4 German nationals from the Eindhoven flight (10 May) transferred to special isolation ward at University Hospital Frankfurt (Timo Wolf); all asymptomatic; onward dispersal to Berlin, Baden-Württemberg, Bavaria and Schleswig-Holstein.

🇮🇹 Italy

2 contact pathways · 4 KL592 + 2 Sacco Milan · all asymptomatic / PCR-negative to date

KL592 leg (Johannesburg → Amsterdam, 25 April): 4 Italian contacts under Ministry-of-Health-directed precautionary testing 13 May, samples to Spallanzani. 25-yr-old Calabrian man (Villa San Giovanni RC): per reliable official Italian health authorities (Spallanzani Institute clarification; Mayor of Villa San Giovanni Giusy Caminiti formal statement; Italian Health Minister Orazio Schillaci), asymptomatic; remains in quarantine at home; biological samples sent to Spallanzani precautionarily; will not be transferred. The 12 May regional-press reporting of symptoms was an error subsequently retracted in Italian press. 24-yr seafarer from Torre del Greco, KL592 (10 rows ahead of Case 2): asymptomatic per ASL Napoli 3 Sud (daily temperature, respiratory and gastrointestinal monitoring); first NP swab negative; serial 48-h swabs ongoing; 45-day home isolation; reference centre Cotugno Hospital, Naples. All 4 Italian KL592 contacts undergoing precautionary testing on 13 May per Ministry of Health direction; each Italian region retains discretion on testing schedule; samples to Spallanzani. Airlink leg (St Helena → Johannesburg, 24 April) — new pathway: 60-yr British tourist + 1 companion at Sacco Hospital, Milan; UK government notification triggered Italian intervention; both PCR-negative 12 May per Lombardy Welfare Councillor Guido Bertolaso; 40-day hospital quarantine. See Contacts.

🇳🇱 Netherlands

Cases 1, 2, 6, 14 · 26 evacuees (all PCR-negative 14 May) · 27 Rotterdam disembarkees · 12 HCW quarantine

RIVM source/contact investigation lead. Leiden UMC hosts Case 5 (UK national, expedition guide / crew); Radboud UMC hosts Case 6 (Dutch ship's doctor). 12 Radboudumc HCWs in 6-week precautionary quarantine following biosafety procedural lapse handling Case 6 samples. RIVM (14 May): all 26 evacuees on the 2nd and 3rd repatriation flights to Eindhoven (arrived night of 11–12 May) tested PCR-negative for Andes virus. Composition: 1 Dutch national + Filipinos + 1 New Zealander + 1 Australian + 1 German (per RIVM via NOS). 6-week home quarantine continues for the Dutch national irrespective of negative result; quarantine reference date 6 May (42-day window). Separately, 3 individuals in NL with symptomatic illness after on-flight contact with an Andes-virus-positive person tested: 2 PCR-negative, 1 pending (RIVM, 14 May). RIVM 6-week home quarantine protocol; Andes hantavirus Group A2. Eindhoven 1st evacuation flight 10 May (8 Dutch + 18 foreign from 10 countries); 2nd + 3rd flights 11–12 May. Rotterdam docking 18 May: 27 disembarkees (25 crew + 2 medical staff); Dutch crew home-quarantined with weekly testing; 23 foreign crew (17 Filipino, 4 Ukrainian, 1 Russian, 1 Polish) housed in port-area portakabins. All 27 tested negative on arrival (Min. Hermans letter to parliament, 21 May). Case 14 (22 May, WHO): a crew member previously testing negative is now confirmed positive — first new case in NL since the Rotterdam docking; nationality, role and laboratory basis pending. Vessel disinfection ongoing. [63, 68]

🇸🇬 Singapore

2 KL592 contacts (both negative)

Two co-passengers of Case 2 (men, 65 & 67) tested negative by Singapore CDA; quarantine continuing. Not in cohort.

🇿🇦 South Africa

Cases 2, 3 · NICD ref. lab

NICD reference laboratory (PCR, sequencing, metagenomics). Case 2 deceased Johannesburg 26 Apr; Case 3 medevaced 27 Apr, clinically stable. Parliament Committee on Health briefing 6 May [3].

🇪🇸 Spain

Cases 12, 15 · Tenerife docking · 14 evacuees · 42-day quarantine

Granadilla docking 10 May 06:24 local. 14 Spanish nationals to Madrid Military Hospital — Case 12 (Spanish male; 1st PCR+ 11 May at Gómez Ulla; 2nd PCR positive 12 May per Spanish Ministry of Health; symptom onset 12 May with low-grade fever and mild oxygen desaturation, stable, no clinical worsening). Case 15 (Spanish national; close contact of Case 12 or initial outbreak): PCR+ confirmed 25 May during routine quarantine screening at Gómez Ulla; clinical details and symptom status pending. Remaining 12 Spanish evacuees PCR-negative on initial test; remain in isolation under Spain's 42-day quarantine protocol at Gómez Ulla. KL592 contact in Alicante region: PCR-negative 9 May. Spanish authorities raised the laboratory-interpretation divergence on Case 10. Pedro Sánchez and Fernando Clavijo (Canary Islands president) negotiated arrival arrangements.

🇨🇭 Switzerland

Case 7

PCR-confirmed 5 May (HUG reference). Hospitalised USZ Zurich, clinically stable. Full-genome sequence on Virological.org. Wife asymptomatic, FOPH monitoring.

🇬🇧 United Kingdom & UK Overseas Territories

Cases 3, 5, 8 · 22 evacuees · St Helena, Ascension, Tristan

Original IHR notifier (2 May). Case 5 (British expedition guide / crew per AFP 12 May; Leiden UMC). 22 Britons airlifted Manchester → Arrowe Park Hospital, Liverpool (same facility as 2020 China coronavirus repatriates). UKHSA coordinating. Tristan da Cunha: Case 8 disembarked 14 Apr; wife self-isolating; Governor's 11 May statement confirms tracing complete; UK military air drop 9 May. St Helena & Ascension: no suspected cases on either; higher-risk MV Hondius passengers being pre-emptively relocated to UK.

🇺🇸 United States

No confirmed or probable cases (Case 10 reclassified non-case, v21) · 18 evacuees · 11 contacts incl. WA King County

Case 10 — American passenger (volunteer on-board caregiver to Cases 5 and 6). Reclassification trajectory: WHO DON 601 (13 May) moved from PCR-confirmed to inconclusive; v17–v20 mapped to probable on the documented April prodrome + onboard epi link; v21 (18 May): reclassified non-case following the CDC press briefing of 15 May (Dr. David Fitter, incident manager), in which the retest returned negative confirmatory PCR and negative serology (no antibodies detected). Initially placed in UNMC Biocontainment Unit (medical director Angela Hewlett MD) on 11 May airlift; 13 May moved to the National Quarantine Unit alongside the other 15 American passengers (all asymptomatic); from 15 May confirmed as never infected. UNMC clinician characterised the original onboard nasal-swab read as most likely a false positive. CDC reaffirms no cases of Andes hantavirus have been confirmed in the United States. Formerly-Case-11 individual at Emory University Quarantine Unit, Atlanta — PCR-negative per CDC at UNMC press conference 11 May (Brendan Jackson, acting Director, Division of High Consequence Pathogens and Pathology); reclassified to contacts. 18-person 11 May airlift on Kalitta Air Boeing 747: 16 → UNMC + 2 → Emory (subsequently transferred to UNMC; all 18 American passengers now at UNMC's National Quarantine Unit per CDC 15 May). Identified state residences: NY 3, Utah 3, CA 1, WA 1 (King County), OR 1 (Bend). Pre-evacuation in-state monitoring: AZ 1, CA 1, GA 2, TX 2, VA 1. Plus 2 NJ non-passenger air-travel contacts (NJ DOH, 8 May) and 2 WA King County KL592 close contacts (Public Health – Seattle & King County, 12 May). CDC HAN 00528 (10 May); EOC at Level 3. Per Dr. David Fitter (CDC incident manager, 13 May and 15 May press briefings): CDC currently recommends testing only for people with symptoms; ~41 people in 16 US states under monitoring as of 15 May (about half in healthcare facilities, half at home); high-risk exposure defined as on the ship 5–10 May or close prolonged contact with a confirmed case; no state or federal quarantine orders drawn. [67]

🌐 St Helena disembarkation-monitoring list

12-country list per WHO DG Tedros (11 May, via CBS News)

WHO DG Tedros' 12-country list of jurisdictions monitoring St Helena disembarkation cohort citizens adds three jurisdictions to the tracker in v12: 🇳🇿 New Zealand, 🇰🇳 Saint Kitts and Nevis, 🇸🇪 Sweden. Nationals returning under national health authority monitoring; specifics pending. Also includes evacuation jurisdictions Türkiye (3 nationals to TR 10 May), Ireland (2 nationals to IE 10 May), the Philippines (4), Greece, Guatemala, India (2), Montenegro, Ukraine, Portugal — each carrying 1+ nationals on the Eindhoven flights.

§ 7. Editorial method

This tracker is one of several emerging dashboards of the MV Hondius outbreak. The differences are mostly editorial. We don't claim to be definitive — primary sources are. We collect epidemic intelligence↗ from all sources (public/private, technical/media) and triangulate, combining event-based surveillance↗ and indicator-based surveillance↗, in order to arrive at an up-to-date situation report, reflecting time, place and person.

1Rule one

Indicators are always explained.

Indicators that look alike are not the same — and aggregator dashboards routinely call any of them "CFR." Public health decisions get made on these numbers, so the label has to match the calculation. This tracker uses case fatality↗: the proportion of cases that die — 3 / 12 = 25.0%. Not a rate (which carries a time dimension), not a ratio (which compares one case fatality to another).

2Rule two

Cases and contacts remain anonymous.

There is no public health need to display identifiers, so names of cases, contacts↗, or private individuals are not used. Officials speaking in their public roles (e.g. Tedros, Van Kerkhove) are named. Cases and contacts appear in §2 and §4 only — never merged.

3Rule three

Source hierarchy is enforced.

Primary tier: WHO DONs, ECDC, RIVM, NICD, FOPH, UKHSA, CDC. Secondary tier: national authority press releases, hospital statements, peer-reviewed literature. Tertiary tier: NU.nl, CNN, Reuters, Wikipedia — useful for cross-jurisdictional contact-tracing detail, never authoritative for case-counting.

4Rule four

Bradford Hill viewpoints of causality applied.

For example: person-to-person transmission of Andes virus was documented by Martínez et al. (NEJM 2020), but secondary cases weren't systematically screened for concurrent rodent exposure, weakening specificity and coherence under Bradford Hill criteria↗. The MV Hondius cluster is therefore a critical experiment of nature↗ — a controlled population allowing prospective serology and environmental sampling to definitively exclude alternative transmission routes. One of the reasons to construct this tracker.

5Rule five

Describe certainty and uncertainty clearly.

Either the source supports the claim and we make it; or it doesn't, and we name the uncertainty. Phrases such as "if confirmed" or "would represent" are not used. Case-mapping ambiguities (e.g. WHO DON 599 vs. RIVM landfill attribution for Case 3) are reported with both formulations.

6Rule six

Case definitions are key.

Case definitions↗ are usually modified during the course of international outbreaks. As more information becomes available, definitions may become more sensitive and/or more specific. This affects case counts and can introduce confusion. We always make explicit what impact changes in case definitions have on our case counts.

Where this tracker differs — common framing vs. EWARS framing on the same evidence

Dimension

EWARS framing

Common framing elsewhere

Case fatality figure↗

Case fatality (not case fatality rate — rate has a time dimension). 3 / 12 = 25.0% on this cohort (deaths / all PCR-confirmed + probable cases). The numerator includes Case 1 (probable, never PCR-confirmed); the denominator must therefore include probable cases to remain consistent with the numerator. Denominator explicit.

"30% CFR (historical avg)." Rate terminology used loosely; denominator not shown; symptomatic-only denominators paired with numerators that include probable deaths (a mismatch).

H2H transmission↗

H2H well-described for ANDV by Martínez 2020; the MV Hondius cluster is an experiment of nature to extend the evidence against Bradford Hill viewpoints. Onboard secondary transmission is the leading hypothesis, not a confirmed mechanism.

"H2H confirmed." Conflates pathogen-level capability documented in earlier outbreaks with this-outbreak-specific demonstration; treats the leading hypothesis as a flat fact.

Case definitions↗

Case definitions change during outbreaks; sensitive vs. specific definitions move counts. We make explicit when changes affect totals (e.g. WHO DON 601 reclassified Case 10 from confirmed to inconclusive on 13 May; this tracker maps the WHO inconclusive Case 10 into the probable category on the basis of documented prodrome + onboard epi link, producing tracker arithmetic of 8 confirmed + 3 probable while preserving the WHO total of 11; v12 reclassification of formerly-Case-11 to contacts after PCR-negative per CDC).

Counts compared across reports as if definitions were stable. Reclassifications (e.g. Düsseldorf 65-yr German female; formerly-Case-11) often silently dropped without explanation.

§ 8. Watch items

Updated 22 May 2026 · 16:00 CEST

All watch items resolved at closure (26 June 2026). The 42-day monitoring window closed on 21 June with no secondary cases; the items below are retained for the audit trail and are no longer active.

Case 9 — clinical course

The French patient is currently receiving intensive care at Bichat Hospital, Paris. PCR-confirmed on 11 May; condition deteriorated overnight 10–11 May per French Health Minister Rist. On 12 May, extracorporeal membrane oxygenation (ECMO) was initiated, per Dr Xavier Lescure, Bichat Hospital. Our thoughts are with the patient, her family, and the clinical team. Subsequent clinical updates anticipated through the French Ministry of Health.

Full-genome sequencing across PCR-confirmed cases

Strain identification — Epuyén Buenos Aires genotype vs. distinct. NICD South Africa; Institut Pasteur de Dakar; Swiss isolate already on Virological.org. ECDC scientific assessment of 11 May (aggregator-sourced: "known South American Andes variant, not novel; no enhanced transmissibility") requires primary-source verification.

6 passengers boarding at Tristan da Cunha

13–16 April embarkation; nationalities and current monitoring jurisdictions unconfirmed. ECDC 42-day window from last possible onboard exposure extends monitoring horizon to ~28 May 2026.

Sub-watch: Case 8 vs. Tristan crew member

Whether the 1 crew member who disembarked at Tristan da Cunha during the 13–16 April call is the same individual as Case 8 (currently classified passenger).

Earlier-voyage contact tracing

Oceanwide investigating passengers and crew who embarked or disembarked since 20 March, predating the 1 April Ushuaia departure.

Australian Bullsbrook quarantine outcomes

6-passenger cohort arriving 12 May; ~3-week monitoring at the Bullsbrook quarantine facility (built during COVID-19).

German Frankfurt cohort dispersal

4 asymptomatic German nationals at University Hospital Frankfurt isolation ward; onward transfer to Berlin, Baden-Württemberg, Bavaria, Schleswig-Holstein.

UK pre-emptive relocations

Higher-risk MV Hondius passengers being relocated from St Helena to UK; second group of Ascension Island medical personnel also UK-bound to complete monitoring.

Shipboard rodent-infestation status

Environmental sampling and rodent search to be undertaken in Spain (ECDC, 9 May [45]). Argentine Malbrán Institute rodent capture along documented overland route. Pending source.

Belgian / ECDC alignment on baseline asymptomatic testing

Belgian protocol (brief hospitalisation for baseline serology/PCR) mildly at odds with ECDC's 9 May guidance [29, 45].

WHO cohort-internal risk wording

Verify whether "moderate" (as relayed via JPost citing Rist) is the primary-source WHO term in DON 600 or subsequent statements.

Tertiary cases — repatriated households & HCWs

Watch horizon to ~end-June 2026 (ECDC 42-day window). Day 0 = 6 May for onboard cohort; later for late-disembarking evacuees.

§ 9. Source registry

~68 numbered sources at v22

Primary · authoritative

WHO · ECDC · National PH agencies

WHO Disease Outbreak News (DON 599, DON 600)
WHO DG Tedros statements (incl. 12-country St Helena disembarkation-monitoring list, 11 May, via CBS News)
ECDC Threat Assessment Brief (6 May); Rapid Scientific Advice (9 May)
RIVM (NL): Hantavirus actueel, signal 4259
NICD (ZA): reference laboratory
FOPH (CH): patient management
UKHSA · UK Governor of St Helena, Ascension and Tristan da Cunha (11 May Territory-wide statement)
CDC HAN 00528 · CDC press conference (UNMC, 11 May, Brendan Jackson)
French Ministry of Health (Rist via France Inter) · French PM Lecornu
Spanish Ministry of Health (García) · Madrid Health Ministry
Italian Ministry of Health circular (10 May, cascaded by Campania Region)
US state DOH statements (NY, Utah, CA, AZ, GA, TX, VA, NJ)
Argentine Ministry of Health / Malbrán Institute

Secondary · institutional

Hospitals · peer-reviewed lit.

Leiden UMC, Radboud UMC, USZ Zurich, HUG Geneva, UNMC Omaha, Emory University, Bichat Paris, University Hospital Frankfurt, UZ Antwerpen, Cotugno Naples, Madrid Military Hospital (Gómez Ulla) statements
Parliament of South Africa Committee on Health briefing
Martínez et al. NEJM 2020 (Epuyén super-spreader)
Strella et al. Medicina (BA) 2025 (regional ANDV epidemiology)
Virological.org (Swiss full-genome sequence)
HHS official statements; KLM press releases

III

Tertiary · aggregator

Wire services · news outlets

NU.nl live blog (Dutch; cross-jurisdictional)
VTM Nieuws / HLN liveblog (Belgian; cross-jurisdictional)
AFP wire (via The Standard, Hong Kong, 12 May: nationality-by-nationality summary, basis for Case 5/6 attribution)
AP wire (Joseph Wilson, dateline The Hague, 12 May: Case 12 confirmation; carried by Seattle Times, Washington Post, ABC News, OPB)
ANP wire (22 May: WHO notification of Case 14, MV Hondius crew member positive in NL; carried by Het Parool, NU.nl, De Gelderlander)
ANSA English Desk (Italian wire — 25-yr Calabrian KL592 symptomatic contact, samples to Spallanzani)
EFE / El Español / COPE live blog / Servimedia (Spanish coverage — Case 12 confirmatory PCR, symptom onset, Spain 42-day quarantine)
Seattle Times / KIRO 7 / KING 5 / KOMO / FOX 13 Seattle / KUOW (King County KL592 close-contact cohort, Dr. Valenciano press conference)
CNN, Reuters, AP, NY Post, Yahoo Canada, Al Jazeera
CBS News (UNMC press conference; Tedros 12-country list; Oceanwide Tristan da Cunha stopover; French flight-contact cohort) · USA Today (state-monitoring map) · Jerusalem Post (passenger physician interview / WHO "moderate" wording)
ABC News, KTVZ-TV, Sky News (passenger physician first-hand testimony; Case 5 background detail)
NOS, RTL Nieuws, Outbreak News Today, FT, PBS, Frihetsnytt
Wikipedia (useful for index-case reconstruction)

Tier-3 sources are useful for cross-jurisdictional contact tracing but are not relied upon for case-counting.

Numbered references

[1]WHO. Disease Outbreak News 599 — Hantavirus cluster, multi-country. 4 May 2026, updated 5 May.Tier I

[2]Wikipedia. MV Hondius hantavirus outbreak. Accessed 9 May 2026.Tier III

[3]Parliament of South Africa Committee on Health. Media statement. 6 May 2026.Tier I

[4]Martínez VP et al. Super-spreaders and person-to-person transmission of Andes virus in Argentina. NEJM 2020; 383: 2230–2241.Tier II

[5]RIVM. Hantavirus actueel.Tier I

[6]Argentine Ministry of Health. Index-case travel reconstruction. 6 May 2026.Tier I

[7]KLM Royal Dutch Airlines. Press release. 7 May 2026.Tier II

[8]Voskamp E. Dutch Times, 7 May 2026.Tier III

[9]CNN. Three cruise ship passengers dead… 4 May 2026.Tier III

[10]UN News. Cruise ship hantavirus cluster: WHO supports response. 3–4 May 2026.Tier III

[11]WHO press conference, 7 May 2026 (Tedros + Mahamud).Tier I

[12]RIVM. Signal 4259. 7 May 2026.Tier I

[13]NOS evening news, 7 May 2026.Tier III

[14]FOPH Switzerland. 6 May 2026.Tier I

[15]Fox K. CNN, 7 May 2026 (updated 8 May).Tier III

[16]Leiden University Medical Center. Official statement, 9 May 2026.Tier II

[17]Radboud University Medical Center. Official statement, 9 May 2026.Tier II

[18]WHO Director-General Tedros Adhanom Ghebreyesus statement, 9 May 2026 (5 PCR-confirmed cases).Tier I

[19]Van Kerkhove M (WHO). Statement on differentiation from COVID-19, 9 May 2026.Tier I

[20]WHO. Onboard containment measures statement, 8–9 May 2026.Tier I

[21]GGD Kennemerland to RTL Nieuws, 9 May 2026 (KLM contact investigation).Tier III

[22]KLM spokesperson to ANP, 9 May 2026 (388 passenger/crew manifest; stewardess testing).Tier II

[23]Spanish media / President Clavijo statement, 9 May 2026.Tier II

[24]Oceanwide Expeditions statement, 9 May 2026 (captain defence; 20 March tracking initiative).Tier II

[25]Singapore Communicable Diseases Agency (CDA) statement, 9 May 2026.Tier I

[26]Canadian Minister of Health and Interior Affairs statement, 9 May 2026.Tier II

[27]Oceanwide Expeditions statement, 9 May 2026 (Saint Helena disembarkation; 30 passengers).Tier II

[28]Talsma D. VOX Magazine. Interview with Prof. Chantal Rovers, Radboudumc. 9 May 2026.Tier II

[29]ECDC. Threat Assessment Brief. 6 May 2026.Tier I

[30]NU.nl live blog. Ongoing updates.Tier III

[31]RIVM. Quarantine protocol & Group A2 classification. 9 May 2026.Tier I

[32]WHO. Disease Outbreak News 600. 8 May 2026.Tier I

[33]Virological.org. Complete sequence of Orthohantavirus andesense: Swiss resident 2026.Tier II

[34]Frihetsnytt. Virusfartyget framme på Teneriffa, 10 May 2026.Tier III

[35]Yahoo Canada News (Toronto Sun). Canadians on cruise ship hit by hantavirus on flight to Quebec, 10 May 2026.Tier III

[36]SOHA News Vietnam. Du thuyền bùng phát dịch virus Hanta đã cập bến đất liền, 10 May 2026.Tier III

[37]Welingelichte Kringen (ANP). Franse evacué Hondius vertoont symptomen hantavirus. 10 May 2026.Tier III

[38]Al Jazeera. Cruise ship hit by hantavirus outbreak arrives in Tenerife. 10 May 2026.Tier III

[39]Outbreak News Today (Herriman R). Andes hantavirus update: Outbreak linked to MV Hondius. 9 May 2026.Tier III

[40]CDC. Health Alert Network (HAN) 00528. 10 May 2026.Tier I

[41]NU.nl live blog. Update 10–11 May 2026.Tier III

[42]Hussain Z. New York Post, 10 May 2026.Tier III

[43]Reuters (Khushi A). 10 May 2026.Tier III

[44]US Department of Health and Human Services. Statement on US repatriation, 10 May 2026.Tier I

[45]ECDC. Rapid Scientific Advice on the management of passengers. 9 May 2026.Tier I

[46]Governor of St Helena, Ascension and Tristan da Cunha. Territory-wide statement on hantavirus response. 11 May 2026 (Facebook: StHelenaGovt).Tier I

[47]VTM Nieuws / HLN. MV Hondius hantavirus liveblog (entries 3 May – 12 May 2026). Used for: Belgian repatriation; Spanish PCR-negative for Alicante woman; German Frankfurt cohort; French Case 9 confirmation/decree; Australian repatriation correction; Case 10 US/ECDC lab-interpretation divergence.Tier III

[48]Italian Campania regional press · Italian Ministry of Health circular (10 May 2026, cascaded by Campania Region Prevention Department). Named voices: Mayor of Torre del Greco Luigi Mennella; Alessandro Perrella (Cotugno, regional task force).Tier I

[49]Agence France-Presse (via The Standard, Hong Kong). Hantavirus: confirmed cases by nationality. 12 May 2026.Tier III

[50]CBS News. What we know about hantavirus cases tied to deadly cruise ship outbreak. Updated 11 May 2026, 12:01 PM EDT — citing Brendan Jackson (CDC, UNMC press conference); Tedros' 12-country St Helena disembarkation-monitoring list; Angela Hewlett & Mike Wadman UNMC; Oceanwide Tristan da Cunha stopover; French Ministry of Health 8-passenger flight-contact cohort.Tier III

[51]Khan M. Map shows which states are monitoring for hantavirus cases in the US. USA Today, 11 May 2026 — UNMC press conference; NY DOH, Utah DOHHS, CA DPH, AZ DOH, GA DPH, TX DSHS, VA DOH, NJ DOH 6–11 May.Tier III

[52]Davis E. American oncologist steps in after ship doctor falls ill in hantavirus outbreak. Jerusalem Post, 11 May 2026 — on-board passenger physician interview with ABC News; Rist via France Inter on 22 traced contacts and WHO cohort-internal "moderate" risk wording.Tier III

[53]Bradford C. Doctor vacationing on hantavirus cruise forced to treat patients after ship's medic sickened. AOL / New York Post, 8 May 2026 — on-board passenger physician interviews (CNN 8 May; KTVZ-TV 7 May); CDC EOC Level 3 activation (ABC News).Tier III

[54]ANSA English Desk. 25-yr-old Calabrian man with Hantavirus symptoms — samples sent to Spallanzani Hospital. Rome, 12 May 2026, 15:14 CEST. ansa.it.Tier III

[55]Wilson J (Associated Press, dateline The Hague). Spain reports new hantavirus case in passenger evacuated from cruise ship as outbreak grows to 11. 12 May 2026. Carried by Seattle Times, Washington Post, ABC News, OPB. Used for: AP-wire confirmation of Case 12 announcement and the 11-case headline.Tier II

[56]Public Health – Seattle & King County. Three King County residents connected to international cruise ship in public health monitoring for hantavirus. Press release, 12 May 2026. Dr. Sandra J. Valenciano, Health Officer / Acting Director. WA State DOH PIO Mark Johnson on traceback chain (via KIRO 7). Secondary coverage: KIRO 7, KING 5, KOMO, FOX 13 Seattle, KUOW, OPB.Tier I

[57]García Santos P. Sanidad confirma el positivo en hantavirus del paciente español aislado en el Gómez Ulla. EFE / El Español, 11 May 2026 21:10 (updated 12 May 12:26). COPE live blog 12 May 2026. Servimedia 12 May 2026. Used for: Case 12 confirmatory PCR and symptom-onset clinical detail (febrícula + ligera desaturación); Spanish 42-day quarantine protocol; 13 other Spanish evacuees PCR-negative on 1st test.Tier III

[58]Official Italian health authorities — collective retraction of the 12 May regional-press characterisation of the 25-yr Calabrian KL592 contact as symptomatic. Sources: Spallanzani National Institute for Infectious Diseases (clarification: only biological samples arriving, no patient transfer; via ANSA, 12 May 2026); Mayor of Villa San Giovanni (RC) Giusy Caminiti (formal statement: patient at home, asymptomatic, "never had symptoms attributable to Hantavirus"; via Sky TG24, Quotidiano Nazionale, ZMedia, 12 May 2026); Italian Health Minister Orazio Schillaci (statement on "absolute tranquility," all 4 KL592 contacts under attentive monitoring; via Quotidiano Nazionale, 13 May 2026); ASL Napoli 3 Sud (Torre del Greco seafarer asymptomatic, daily temperature/respiratory/GI monitoring). Collectively confirming all 4 Italian KL592 contacts asymptomatic; precautionary testing of all 4 with samples to Spallanzani scheduled 13 May 2026 per Ministry of Health direction.Tier I

[59]Dr. Xavier Lescure (infectious-disease specialist, Bichat Hospital, Paris). Press statement 12 May 2026 on Case 9 (French female), reporting that the patient was being placed on extracorporeal membrane oxygenation (ECMO). AP wire dispatch syndicated 12–13 May 2026 via NPR, CBC News, NBC News, ABC News, Houston Public Media, WGCU, Anchorage Daily News, others. Corroborated by ECDC Andes hantavirus outbreak in cruise ship update of 13 May 2026.Tier I

[60]Guido Bertolaso (Lombardy Welfare Councillor). Press statement 12 May 2026 on the 60-yr British tourist + 1 travel companion placed in 40-day quarantine at Sacco Hospital, Milan, after UK government notification: both PCR-negative on first test. Exposure was the Airlink charter St Helena → Johannesburg on 24 April with Case 2; companion not on the flight but joined the tourist in Italy. Coverage: The Local Italy (13 May 2026), Sigmalive English, BritBrief, Internewscast. Italian intervention triggered by UK Department of Health alert.Tier I

[61]World Health Organization. Hantavirus cluster linked to cruise ship travel, Multi-country — Disease Outbreak News (DON 601). Published 13 May 2026, reporting time 17:00. As of 13 May: 11 cases total (8 confirmed, 1 inconclusive, 2 probable), 3 deaths (2 confirmed + 1 probable). DON 601 supersedes DON 599 (4 May) and DON 600 (8 May). Documents secondary-transmission framing ("Secondary transmission appears most likely during the early phase of illness, when the virus is more transmissible"), onboard crew physical-distancing guidance for the Netherlands return journey, and three new WHO technical guidance documents (management on board; disembarkation and onward management; management of contacts of ANDV cases). who.int.Tier I

[62]Dillinger K, McPhillips D. Doctor from hantavirus-stricken ship tests negative, moves out of biocontainment unit. CNN, 13 May 2026 20:53 ET (= 14 May 02:53 CEST). Reports the American passenger placed in UNMC Biocontainment Unit after divergent-laboratory PCR (one positive, one negative); subsequent US confirmatory PCR negative ("Wednesday" results), blood / serology pending; UNMC moved patient from Biocontainment Unit to National Quarantine Unit; all 16 American passengers at UNMC currently asymptomatic. Documents the volunteer caregiver role for Cases 5 and 6 after the ship's doctor became ill, and a prodrome (night sweats, chills, mild respiratory symptoms, ~2.5 weeks fatigue) around 10 April. CDC Dr. David Fitter (incident manager) quoted: CDC currently recommends testing only for people with symptoms; ≥19 other people across ≥10 states under monitoring. AP-syndicated parallel coverage: KOIN, OPB, KATU, KGW, KPTV, KRDO, ABC News Live Updates, Euronews. cnn.com.Tier II

[63]Rijksinstituut voor Volksgezondheid en Milieu (RIVM), Bilthoven. Actuele informatie over hantavirus (statement, 14 May 2026). All 26 evacuees on 2nd and 3rd repatriation flights to Eindhoven (arrived night of 11–12 May) PCR-negative for Andes virus; 1 Dutch national subject to 6-week home quarantine irrespective of negative result; quarantine reference date 6 May. Separately: 3 NL-based symptomatic flight-contact individuals tested — 2 PCR-negative, 1 pending. Coverage via NOS (Hilversum); NU.nl; ANP wire (Dagelijkse Standaard, Nieuws.nl); Omroep Brabant. rivm.nl.Tier I

[64]Rist S (Ministre de la Santé, France). X (Twitter) post, 14 May 2026. All 26 French contacts have tested PCR-negative "sans exception": 4 of 5 Hondius French cruise passengers at Bichat (5th = Case 9, receiving intensive care at Bichat) + 22 secondary flight contacts (8 on St Helena → Johannesburg Airlink 24 April + remainder on KL592 / onward). All 26 remain in hospital isolation; testing 3×/week. Subsequent results not communicated unless positive. Lethality framed at "30–40%"; incubation 42 days. Coverage: Euronews FR, Touteleurope, Europe 1.Tier I

[65]Public Health Agency of Canada (PHAC). Media update on Andes hantavirus situation (statement, 17 May 2026, Ottawa). Confirmed Case 13: MV Hondius passenger in British Columbia, PCR-confirmed at PHAC's National Microbiology Laboratory (NML), Winnipeg, on 16 May; travelling partner PCR-negative at NML; all high-risk contacts isolating, under local public health monitoring. Signed: Dr. Joss Reimer, Chief Public Health Officer of Canada. PHAC has shared the case information with WHO under International Health Regulations. canada.ca.Tier I

[66]Henry B (BC Provincial Health Officer). Press conference, 16 May 2026, Victoria. Case 13 patient is in their 70s, hospitalised in Victoria, mild symptoms (fever and headache) from ~14–15 May; patient stable. Travelling partner same age; both in precautionary isolation since return to BC 10 May. Initial result reported as "presumptive positive" pending NML confirmatory testing. Of the 4 Canadians who returned to BC on 10 May: this couple in their 70s from Yukon; 1 person in their 70s from Vancouver Island; 1 person from BC in their 50s ordinarily resident abroad — all in precautionary isolation. Coverage: CNN, CBC, The National Desk, NL Times, VRT NWS.Tier II

[67]Centers for Disease Control and Prevention. Hantavirus press briefing, Friday 15 May 2026. Dr. David Fitter (incident manager) and CDC officials: the American passenger previously listed as inconclusive (Case 10 in this tracker) was retested with negative confirmatory PCR and negative serology (no antibodies detected), meaning he was never infected with Andes virus; CDC reaffirms no cases of Andes hantavirus have been confirmed in the United States. ~41 people in 16 US states under monitoring (about half in healthcare facilities, half at home). High-risk exposure defined as remaining on the ship 5–10 May or close prolonged contact with a confirmed case (incl. aircraft seating in proximity). UNMC clinician characterised the original onboard nasal-swab read as "most likely a false positive." Stephen Kornfeld: "there's no evidence that I've had hantavirus." Coverage: ABC News, ABC7 (LA, SF), 6abc Philadelphia, Wikipedia (incorporating the announcement into the MV Hondius hantavirus outbreak article 15–17 May with Case 10 removed from the case count).Tier I

[68]World Health Organization notification, 22 May 2026, via ANP wire. WHO meldt nieuwe hantabesmetting in Nederland bij bemanningslid cruiseschip Hondius. WHO reports an MV Hondius crew member, previously testing negative, has tested positive for hantavirus in the Netherlands; outbreak total framed at 12 cases / 3 deaths; no new deaths since 2 May. WHO did not specify nationality (Dutch home-quarantine vs. foreign portakabin crew) or laboratory basis. First new case in NL since the 18 May Rotterdam docking. WHO calls on receiving countries to maintain rigorous monitoring throughout the quarantine period. Coverage: Het Parool (ANP, 22 May 14:33 CET), NU.nl (22 May 14:35 CET), De Gelderlander.Tier II

[69]Spain Ministry of Health (Health Minister notification via Euronews, 25 May 2026). Spanish Ministry of Health confirms a second hantavirus case among MV Hondius evacuated passengers: a Spanish national in preventive quarantine at Hospital Central de la Defensa Gómez Ulla, Madrid — a close contact of the initial outbreak, already isolated under medical supervision — tested positive during routine PCR testing. 12 other Spanish evacuees remain in quarantine; health authorities say the case does not entail increased risk to the general population. This case takes the active cluster to 11 laboratory-confirmed Andes virus cases and 2 probable (13 total) with 3 deaths. Coverage: Euronews Health (25 May 2026, 12:44 CEST), Associated Press (25 May 2026).Tier II

[70]Institut Pasteur (Paris). Press release, L'Institut Pasteur confirme par séquençage complet l'origine latino-américaine de l'Hantavirus Andes détecté à bord du MV Hondius. Published 15 May 2026. Institut Pasteur teams completed full sequencing of the Andes hantavirus strain detected in a blood sample from the French passenger (Case 9) who tested positive after her voyage aboard MV Hondius. Genomic analyses confirm that the viral sequence obtained is identical to Andes virus strains detected in other positive cases aboard the ship. These sequences are very close to known Andes virus strains circulating in the south of South America. No element suggests at this stage the emergence of a particular variant presenting new characteristics. Analysis continues. Institut Pasteur serves as France's National Reference Centre (CNR) for Hantaviruses. Language versions: French (pasteur.fr/fr) and English (pasteur.fr/en).Tier I

[71]Swiss National Reference Center (Geneva University Hospitals, University of Zurich, Institute of Medical Virology). Preliminary analysis of Orthohantavirus andesense virus sequences from a cruise-ship related cluster, May 2026. Complete sequence from the Swiss patient (Case 7) uploaded to Virological.org with expert phylogenetic analysis. Prof. Piet Maes (President-elect, Hantavirus Society, Plotkin Institute, University of Brussels): "The available phylogenetic and sequence data suggest that the Swiss patient isolate represents a relatively typical naturally circulating ANDV lineage originating from the established rodent reservoir in Chile/Argentina, rather than a highly divergent or newly emerged variant. Across all three genomic segments (S, M, and L), the virus clusters consistently with known South American Andes virus strains, including lineages frequently associated with human infections, without evidence of segment incongruence that would suggest recent reassortment." Conclusion: no specific mutations associated with increased transmissibility or virulence. Coverage: Science Media Centre expert reaction (May 2026), Virological.org discussion platform.Tier I

[72]Mudde T. Één medewerker Radboudumc 'zwak positief' getest op hantavirus na fout in beschermingsprotocol. Volkskrant, 3 June 2026, 16:02 CEST. Documents the 7 May protocol breach at Radboudumc during Case 6 admission (improper procedures for blood/urine sample collection and handling); 12 staff placed in quarantine; one staff member's single weakly-positive result followed by multiple negative tests and absence of symptoms; RIVM official determination that this person is not a patient; ongoing external safety investigation (Jan Kluytmans, UMC Utrecht); MV Hondius cleared for sailing by GGD Rotterdam-Rijnmond. Language: Dutch. Coverage: Volkskrant (Amsterdam-based daily newspaper, Tier II).Tier II

[73]World Health Organization. Announcement by Director-General Tedros Ghebreyesus via X (Twitter), 10 June 2026. WHO confirms PCR laboratory result for Case 8 (British passenger, Tristan da Cunha): Andes virus positive. Confirmation announced 10 June; Case 8 reclassified from probable to laboratory-confirmed. Associated medical context: airdrop of UK paramedical and physician team to Tristan da Cunha 9 May to provide in-situ medical support; HMS Medway coordination; personnel rotation completed 24 May per Tristan da Cunha government statement. Tristan da Cunha: 221 residents, isolated Atlantic island (ship access only); no secondary cases reported among islanders. Coverage: NU.nl (Netherlands), WHO communications. Tier I