Cruise-linked Andes virus and severe hantavirus lung disease: A narrative review

The 2026 cruise-linked Andes virus (ANDV) outbreak represents a rare but high-consequence travel-associated zoonotic event, combining likely land-based acquisition before embarkation, limited onboard human-to-human transmission, delayed clinical recognition, and multinational public health coordination. This narrative review synthesizes current evidence on the outbreak, ANDV biology, transmission dynamics, clinical presentation, diagnostics, management, and implications for maritime and expedition travel medicine. As of 2 July 2026, the World Health Organization (WHO) had reported 13 cases linked to the motor vessel (M/V) Hondius outbreak, including 12 laboratory-confirmed infections, one probable case, and three deaths. Following completion of the 42-day follow-up period for all identified contacts without additional secondary cases, WHO considered transmission interrupted and the outbreak contained. Available evidence supports likely land-based acquisition before embarkation followed by limited onboard human-to-human transmission, without sustained spread. Severe hantavirus cardiopulmonary syndrome may begin with nonspecific fever, malaise, myalgia, gastrointestinal symptoms, or respiratory complaints, then progress abruptly to pulmonary oedema, shock, and fatal cardiopulmonary collapse. Because no licensed antiviral therapy or vaccine is available, early recognition, cautious fluid management, intensive supportive care, ventilatory support, and timely transfer to intensive care or extracorporeal membrane oxygenation-capable centres remain central. The outbreak highlights critical preparedness gaps in shipboard triage, contact tracing, specimen transport, genomic surveillance, risk communication, and cross-border follow-up. Strengthening One Health-informed pre-travel counseling, post-travel symptom surveillance, and maritime outbreak protocols is essential for future expedition-associated zoonotic threats.