A rare hantavirus cluster linked to an international cruise ship has placed South African health authorities on alert after two passengers entered the country, one of whom later died, while another remains in critical condition in Sandton.

The Department of Health has confirmed the deaths of tourists who developed severe acute respiratory illness while travelling on the international cruise ship MV Hondius.

The vessel, carrying about 150 tourists, left Ushuaia in Southern Argentina for the Canary Islands about three weeks ago, travelling via several islands, including mainland Antarctica, the Falklands, South Georgia, Tristan da Cunha, St Helena and Ascension.

According to the department, the first patient, a 70-year-old male passenger, became ill on the ship with fever, headache, abdominal pain and diarrhoea, and died on arrival at St Helena.

His 69-year-old wife later collapsed at OR Tambo International Airport while trying to connect to a flight home to the Netherlands. She was taken to a health facility near Kempton Park, where she also died.

A third patient, a British national, became ill while the ship was travelling from St Helena to Ascension. He was medically evacuated to South Africa and is currently in critical condition in isolation at a private health facility in Sandton. His laboratory results tested positive for hantavirus.

The World Health Organisation said that, as of May 4, seven cases had been identified, including two laboratory-confirmed cases and five suspected cases. These include three deaths, one critically ill patient and three people with mild symptoms.

What is hantavirus?

Hantavirus is a rare but potentially deadly virus mainly spread through contact with infected rodents, especially their urine, droppings or saliva. People can become infected when they breathe in contaminated particles, touch contaminated surfaces and then their mouth or nose, or, rarely, through a rodent bite or scratch.

What are the symptoms?

Early symptoms can include fever, fatigue, muscle aches, headaches, chills, dizziness, nausea, vomiting, diarrhoea and abdominal pain.

In serious cases, the illness can progress to coughing, shortness of breath, pneumonia, acute respiratory distress and shock. WHO said illness in this cluster was marked by fever, gastrointestinal symptoms and rapid progression to severe respiratory illness.

Should South Africans be worried?

The Department of Health said there is no need for the public to panic, as only two patients from the cruise ship had been in South Africa.

The department is working with the NICD and Gauteng Health Department on contact tracing to identify and monitor people who may have been exposed.

WHO is also coordinating a multi-country response with affected islands and countries, and currently assesses the risk to the global population as low.

When should you seek help?

Anyone who develops flu-like symptoms that worsen, especially after possible rodent exposure or recent travel linked to affected areas, should seek medical attention and mention possible exposure. The CDC says early symptoms can resemble other respiratory illnesses, making diagnosis difficult at first.

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