The Institute of Public Health is monitoring the situation related to the reported multinational cluster of hantavirus infection cases associated with travel on the cruise ship MV Hondius in the South Atlantic Ocean region.

According to information published by the World Health Organization (WHO), the European Centre for Disease Prevention and Control (ECDC), and the national health authorities of the affected countries, a total of 8 confirmed and suspected cases have so far been registered among passengers and crew members, including 3 fatalities.

Epidemiological, clinical, and laboratory investigations are ongoing, and international health institutions are conducting a coordinated investigation aimed at determining the source of the infection, the possible mode of exposure, and the assessment of risk.

According to the currently available information, exposure is most likely linked to activities and stays in areas where rodents — the natural reservoirs of hantaviruses — are naturally present. Additional analyses are underway to determine the exact virus type and any factors that may have contributed to the emergence of the cluster.

At this time, there are no registered cases, passengers, or close contacts associated with the Republic of North Macedonia, nor are there any indications of a public health risk within the country.

Hantaviruses are a group of zoonotic viruses that circulate among various rodent species. Humans are most commonly infected through inhalation of aerosols contaminated with urine, feces, or secretions from infected rodents, as well as through direct contact with contaminated surfaces.

Limited human-to-human transmission has been documented only for certain types of hantaviruses and is considered rare.

The disease may present with a wide range of clinical manifestations, from a mild febrile illness to more severe forms involving the kidneys or lungs. Clinically, hantavirus infections most commonly present in two main syndromes: Hemorrhagic Fever with Renal Syndrome (HFRS), which has been registered in our country, and Hantavirus Pulmonary Syndrome (HPS).

Hemorrhagic Fever with Renal Syndrome occurs predominantly in Europe and Asia and is caused by viruses such as Hantaan, Dobrava-Belgrade, and Puumala viruses. The disease usually begins suddenly, with high fever, headache, back and abdominal pain, and general weakness, followed by the development of renal syndrome (reduced or complete cessation of urine output) and hemorrhagic syndrome (increased permeability of blood vessels and bleeding into the skin, mucous membranes, and organs). The mortality rate is relatively low, ranging from 1% to 15%.

Hantavirus Pulmonary Syndrome, also known as Hantavirus Cardiopulmonary Syndrome, occurs mainly in North and South America and is most commonly associated with the Sin Nombre virus. Unlike Hemorrhagic Fever with Renal Syndrome, it is characterized by predominant involvement of the lungs. Initial symptoms are nonspecific and resemble influenza (fever, malaise, muscle pain), but respiratory failure develops rapidly. It has a significantly higher mortality rate, often between 30% and 50%.

For most hantaviruses, including those that cause Hemorrhagic Fever with Renal Syndrome in Europe (for example, Puumala and Dobrava-Belgrade viruses), human-to-human transmission has not been proven. Infection almost always occurs through contact with excreta from infected rodents. However, limited interhuman transmission has been confirmed for the Andes virus in South America, most commonly through close contact (for example, among family members or healthcare workers) via respiratory secretions during the early stage of the disease.

There is no specific antiviral therapy or vaccine for hantavirus infection. Treatment is supportive. Prevention of hantavirus infections primarily depends on reducing contact between humans and rodents.

According to current knowledge and assessments by international health institutions, the risk to the general population remains low.

The World Health Organization and the European Centre for Disease Prevention and Control currently do not recommend introducing additional restrictive measures regarding travel or trade. However, increased caution is recommended when staying in areas where there is a risk of exposure to rodents and their excreta.

The Institute of Public Health remains in continuous communication with international early warning and response health networks, continuously monitors the situation, and will timely inform the public about any new findings, risk assessments, and possible recommendations.

The Department of Virology at the Institute of Public Health has reagents available for the detection of this group of viruses.

Institute of Public Health
Skopje