Genetic fingerprinting can explore if the virus has the same historical mutation that allowed human-to-human transmission to emerge in previous outbreaks (which were easily controlled with basic isolation and infection control). If a new mutation was found, this would raise concerns of greater transmission risks.
For the public and health authorities considering receiving the passengers from the quarantined ship, the key message is not to panic.
Most hantaviruses are not spread between people. Even with Andes virus, person-to-person transmission is uncommon and usually requires close or prolonged contact. WHO currently assesses the risk to the global population as low. This virus does not spread like influenza or COVID-19.
But for outbreak investigators, this is exactly the sort of cluster that demands disciplined shoe-leather epidemiology: confirm the diagnosis, build the timeline, test the competing hypotheses, and let the pattern of exposure, illness and laboratory evidence tell the story.
The third case would need either an independent exposure to infected rodents before boarding, or another exposure during the voyage. None of these is impossible. But as more cases appear, and if they cluster in time around contact with earlier cases, the human-to-human hypothesis becomes harder to dismiss.
The approximate gap between the first case’s illness and the later cases is also important. If person-to-person transmission is occurring, severe hantavirus illness is likely to coincide with a higher risk of being infectious and infecting others. So, we would expect symptoms that start two to three weeks after close contact with an earlier severe case, and this is what we’re seeing from the cruise ship.
Craig Dalton is a Conjoint Associate Professor at the School of Medicine and Public Health, University of Newcastle. This article first appeared in The Conversation.