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By Khaleda Rahman and Anna Skinner
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The U.S. Centers for Disease Control and Prevention (CDC) currently doesn't have a polymerase chain reaction, or PCR, test to detect the Andes strain of the hantavirus in patients, as 10 people who were potentially exposed to the virus are being monitored in five U.S. states.
Officials in those states—California, Kansas, Maryland, New Jersey and Washington—have said the individuals had not been on board the hantavirus-stricken cruise ship the MV Hondius, but that all had contact with someone who later tested positive for hantavirus.
None of the individuals is displaying symptoms, and officials said the risk level in each state remains low.
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The CDC does have a PCR test to detect the virus, but it cannot be used for patient management, as it is in the research stage, Andrew Nixon, a spokesperson for the US Department of Health and Human Services, told WIRED. Efforts are being made to validate the test for diagnostic use.
How Does a PCR Test Work?
Samples for a PCR test are usually in the form of nasal or throat swabs or blood tests. PCR tests can detect viruses early, even before someone is showing symptoms.
Currently, tests to detect hantavirus in asymptomatic individuals are conducted "using molecular methods, such as RT-qPCR, which measures viral genomes in the blood, as well as serological assays that detect hantavirus-specific antibodies, i.e., the immune response mounted against the virus," Alexander Ploss, co-director of the Global Health Program and a molecular biology professor at Princeton University, told Newsweek.
"These assays can only be carried out by specialized labs," he said.
How Many Americans Were On the Hondius?
Eighteen Americans were evacuated from the Hondius after it docked in Spain’s Canary Islands on Sunday. They were then flown to Nebraska, and 15 are staying at the National Quarantine Unit at the University of Nebraska Medical Center (UNMC), while one passenger who tested positive for hantavirus is being isolated in the medical center’s biocontainment unit.
Two other Americans, a couple, were transported to Emory University Hospital in Atlanta. One had mild symptoms**,** but that person tested negative for the Andes strain of hantavirus, the Department of Health and Human Services (HHS) said on Tuesday.
Health officials are also monitoring seven Americans in five states who returned home in April after being on the cruise ship.
Which States Are Monitoring People For Hantavirus Exposure?
California
The California Department of Public Health (CDPH) said on Monday that it is monitoring a California resident who was on an international flight sitting near one of the cruise ship passenger's who was confirmed to have the Andes strain of hantavirus.
The department said in a news release that the individual is "under active monitoring in California due to potential exposure with a confirmed case on a shared flight."
Kansas
The Kansas Department of Health and Environment (KDHE) said on Tuesday it is monitoring three individuals, who do not have symptoms, in coordination with the U.S. Centers for Disease Control and Prevention (CDC) and the local health department.
"The exposure occurred internationally after contact with an individual from the MV Hondius cruise ship who later tested positive for Andes hantavirus," the KDHE said in a news release.
KDHE said there are no suspected or confirmed cases of hantavirus in Kansas and that the risk to the public is "extremely low."
Maryland
The Maryland Department of Health said on Monday that it is monitoring two residents who were "on a flight that briefly included [an] M/V Hondius cruise ship passenger infected with hantavirus."
The department said: "Health authorities are taking these steps out of an abundance of caution. At this time, the risk to the public in Maryland remains very low."
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New Jersey
The New Jersey Department of Health said on May 8 that it was notified by the CDC that two residents were "potentially exposed to a person infected with hantavirus" during air travel.
The department said neither individual was reporting symptoms "suggestive of hantavirus."
It added: "At this time, the risk to the general public in New Jersey remains very low. No current hantavirus cases have been identified in the state, and there is no history of a confirmed hantavirus case reported in New Jersey."
Washington
Health officials for Seattle and King County said they were notified by the Washington State Department of Health (DOH) and the CDC that two King County residents were on a plane near a passenger from the cruise ship who was removed before takeoff and later tested positive for hantavirus.
The two residents returned to King County and are not showing any symptoms, officials said.
"They are being monitored for symptoms at home in coordination with Public Health – Seattle & King County," the department said.
Confirmed Cases
The outbreak has since hit 11 total reported cases, nine of which have been confirmed.
Three people on the cruise have died, including a Dutch couple that health officials believe were the first to be exposed to the virus while visiting South America.
Director General of the World Health Organization (WHO) Tedros Adhanom Ghebreyesus said confirmed and suspected cases have only been reported among the cruise ship's passengers or crew.
Hantavirus usually spreads from rodent droppings and is not easily transmitted between people. But the Andes virus detected in this outbreak may be able to spread between people in rare cases. Symptoms of the virus—which can include fever, chills and muscle aches—usually show between one and eight weeks after exposure. While there is no cure or vaccine for hantavirus, the WHO says early detection and treatment improves survival rates.
American Who Tested Positive For Hantavirus Speaks
Dr. Stephen Kornfeld, a retired oncologist who helped care for sick passengers while traveling on the Hondius, told CNN on Tuesday that he is being held in a biocontainment unit at the University of Nebraska Medical Center (UNMC) in Omaha after testing positive for hantavirus.
Kornfeld said he is not experiencing any symptoms at the moment. But he added: "It’s still possible that the test represents an evolving disease, and I will get symptoms down the road. This is why I’m in the biocontainment unit."
He said: "I'm here to be monitored closely. And this is a very secure facility. So if I am to get sick and spill virus, there's no way that virus is getting out of this building."
Kornfeld described his room inside the unit as like a hospital room with "the usual equipment and a very comfortable hospital bed" with multiple layers of protection outside it.
He and 17 other Americans were evacuated from the ship after it arrived in Tenerife, the largest of Spain's Canary Islands, on Sunday. One passenger had tested "mildly PCR positive" for hantavirus, while another was displaying symptoms, the Department of Health and Human Services (HHS) said in a statement on Sunday.
Kornfeld said his samples had been tested for hantavirus in two labs in the Netherlands while he was still aboard the Hondius.
"One lab was negative and one lab was faintly positive," he said. "So I was told the test was intermediate. But I think since it wasn't a negative, it's sort of being looked at as a potential positive. And the Dutch authority communicated these results to the CDC. And here I am."
He is awaiting the results of another round of testing, which he said could come by Friday.
Kornfeld said he and other passengers on the ship fell ill with flu-like symptoms in mid-April.
"I had three days of night sweats, a lot of chills, some mild respiratory and a lot of fatigue. And while the night sweats and the respiratory stuff cleared up pretty quickly, the fatigue lingered for two and a half weeks," he said.
"At the time, it was felt like this was just some virus. And now, in retrospect, there is a question, could it have been hantavirus? But it's just speculation. There's no way to really know."
But Kornfeld acknowledged that he was at "higher risk" after caring for passengers who were later confirmed to have hantavirus.
Fifteen other Americans evacuated from the ship are in the National Quarantine Unit at the UNMC, while two are being monitored in the serious communicable disease unit at Emory University Hospital in Atlanta.
Which US States Are Monitoring Returned Passengers?
Health officials are monitoring seven Americans in five states—Arizona, California, Georgia, Texas and Virginia—who had already returned home after being on the cruise ship
Dr. Jay Bhattacharya, the acting director of the Centers for Disease Control, said on CNN’s State of the Union on Sunday that the Americans who earlier left the cruise ship have been in the U.S. for roughly two weeks.
"There are already, as you know, Jake, seven Americans that already flew back home I think two or three weeks ago, and are in various states," Bhattacharya told host Jake Tapper.
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