At least one American headed to Nebraska from hantavirus-hit ship presumed positive. Here’s what we know

(CNN) — American passengers from the cruise ship at the center of the hantavirus outbreak, including at least one presumed positive case, are headed to a highly specialized quarantine unit in Nebraska for evaluation before eventually continuing on to their homes – and weeks of monitoring for symptoms of infection.

The virus, typically associated with rodents, may have passed from human to human aboard the MV Hondius cruise ship, according to the World Health Organization. Since April 11, three people from the ship have died while a handful of others are sick.

After docking Sunday near Tenerife in Spain’s Canary Islands, dozens of passengers have been evacuated. There are 17 US citizens, and one British national who resides in the US, on the plane to Omaha, Spanish Health Minister Mónica García said.

This is what we know about the American passengers’ journey back to the United States and what will happen once they’re home:

Presumed positive US case

One of the Americans has tested positive for the virus and another has mild symptoms, the US Department of Health and Human Services said late Sunday. Both were traveling in biocontainment units on the plane “out of an abundance of caution,” HHS said in a post on X.

The passenger who tested positive does not have symptoms but will be taken directly to the biocontainment unit at the University of Nebraska Medical Center in Omaha, the facility said late Sunday. The other passengers will go to the center’s National Quarantine Unit for assessment and monitoring.

Staff from the US Centers for Disease Control and Prevention have been monitoring the passengers since disembarking in Tenerife, according to a CDC official.

CNN has reached out to HHS for more information on the passengers.

The Omaha facility is “the only federally funded quarantine unit in the United States, designed specifically to safely house and monitor people who may have been exposed to high-consequence infectious diseases,” according to Nebraska Medicine.

There are 20 single-person, 300-square-foot rooms fitted with negative air pressure systems to contain any possible viruses. Doctors there describe them like hotel rooms, designed with en-suite bathrooms, exercise equipment, food delivery and Wi-Fi for patients staying for long periods.

A CDC official said earlier that the agency was not considering this a quarantine for the cruise ship passengers, but rather a brief visit to monitor their health.

Once at the facility, the passengers will be checked for symptoms signaling the early stages of hantavirus, including fever, muscle aches and diarrhea, the interim chancellor of the hospital, Dr. H. Dele Davis, told CNN.

The site’s biocontainment unit, which is where the positive patient and anyone else who may fall ill will be taken, is a specialized unit that previously treated patients during the Ebola outbreak in 2014 and some of the first Covid-19 patients from the Diamond Princess cruise ship in 2020, according to Nebraska Medicine officials.

The airlift will then continue to take remaining passengers, including the person showing mild symptoms who hasn’t tested positive, to one of more than a dozen Regional Emerging Special Pathogen Treatment Centers, which are regional hubs focused on special pathogen readiness. The centers work closely with the Administration for Strategic Preparedness and Response, which is part of HHS.

The passengers will also be given the option to go home after their assessment in Omaha if safety protocols allow, National Institutes of Health Director Dr. Jay Bhattacharya told CNN’s Jake Tapper on Sunday.

Bhattacharya, who is also acting director of the CDC, said the agency will interview the passengers to determine their risk. They will be deemed “low risk” if they were not in contact with someone who was symptomatic.

Bhattacharya said the CDC’s advice to the travelers would include “an offer to stay in Nebraska if they’d like, or if they want to go back home and their home situation allows it, to safely drive them home without exposing other people on the way, and then be put in the control … under the auspices of their state and local public health agencies.”

Daily monitoring at home

Once the passengers get back to their own homes, they will undergo daily home-based monitoring for the next 42 days, according to a CDC official.

The goal, according to Nebraska Medicine, is to monitor the passengers during the virus’ incubation period, which can last up to six weeks, and to reduce the risk of spreading the disease.

Health officials have said that passengers who do not test positive will not be quarantined, but will be advised to take certain precautions.

“If it’s a high-risk exposure … there will be some modified activities that we would recommend, limiting activities outside the house that don’t involve extensive interactions with other people,” a CDC official said. “Also, they need to be working with their departments of health … with regards to the nature around other activities.”

Bhattacharya said the agency is following the safety protocols previously used successfully during a 2018 outbreak of the same hantavirus strain.

Low risk to the general public

The hantavirus outbreak was first reported to the WHO on May 2 and remains a low risk to the general public, the organization says.

Hantavirus typically spreads to humans through contact with rodent urine or droppings, though this strain, the Andes virus, can in rare cases spread person-to-person through very close, prolonged contact with an infected person.

The CDC has classified its hantavirus response as Level 3, the agency’s lowest level of emergency, according to a person involved in the situation.

As of May 8, there were eight total cases connected to the MV Hondius cruise ship — six lab-confirmed plus two probable cases.

Passengers were screened Sunday after the ship docked in Tenerife, and all were asymptomatic, according to Spanish health authorities. One French passenger later showed symptoms while flying home, and all five evacuees on that flight will enter isolation protocols, the country’s prime minister said.

As of May 9, three passengers — a Dutch couple and one German national — have died after contracting hantavirus, according to WHO.

Seven other American passengers who previously disembarked the ship are being monitored in five states — Arizona, California, Georgia, Texas and Virginia, officials said.

New Jersey said it is also monitoring two people who were exposed, and Utah reported that at least one passenger was from that state.

Symptoms can include fever, muscle aches, chills, nausea, vomiting, diarrhea, cough, difficulty breathing and chest pain.

Hoping to quell concerns before the passengers disembarked, WHO Director General Tedros Adhanom Ghebreyesus said this hantavirus outbreak is “not another Covid-19.”

This story has been updated with additional information.

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