Hantavirus Concerns and Cruise Ship Hygiene: What Infection Preventionists Need to Know

The recent reports of hantavirus cases have renewed attention on how infectious diseases can emerge in unexpected environments, including travel settings.

On May 2, 2026, a cluster of severe respiratory illness was reported on a cruise ship carrying 147 passengers and crew, according to the World Health Organization (WHO). By May 4, 7 cases had been identified, including 2 confirmed hantavirus infections, 3 deaths, 1 critical case, and 3 mild cases. Illness began between April 6 and 28, progressing from fever and gastrointestinal symptoms to pneumonia and respiratory distress. Hantavirus is usually spread through contact with rodent excreta and, while rare, can be severe. Only a few cases of human-to-human transmission of the Andes virus have been reported. WHO currently assesses the global risk as low while investigations and response efforts continue.

To get an infection prevention and control perspective on the situation, Infection Control Today^® reached out to its editorial advisory board (EAB) members. Brenna Doran, PhD, MA, ACC, CIC, AL-CIP, a consultant and coach for Innovation Partners Institute, LLC, in San Francisco, California, explained the overarching issue.

“Global travel is more than a destination; it includes every stop made and every pathogen encountered along the way. Regardless of the setting, hygiene is the universal practice that protects the journey, whether on land or at sea.”

While hantavirus is not typically associated with cruise ships, the broader discussion highlights a critical issue: maintaining rigorous hygiene and infection prevention practices in high-density, global travel environments.

Hantavirus is primarily transmitted to humans through contact with infected rodent urine, droppings, or saliva. In the US, hantavirus pulmonary syndrome (HPS) is rare but severe, with a mortality rate of approximately 30% to 40%. According to the CDC, most infections occur in rural or semirural areas where individuals are exposed to rodent habitats, such as cabins, sheds, or poorly ventilated spaces.¹

"The recent Hantavirus outbreak on a cruise ship highlights how different viruses, even within the same family (in this case, Hantaviridae) can behave quite differently and may require different infection prevention approaches,” explained Matthew Pullen, MD, assistant professor of medicine in the division of infectious diseases and international medicine at the University of Minnesota Medical School. “The Hantavirus family member we primarily see in North America (Sin Nombre virus) is not known to transmit human-to-human, while the family member seen in the Andes region (Andes virus) has been shown to occasionally transmit between individuals. Given the ship's recent travel to the Andes region, the WHO is appropriately recommending handling this outbreak with possible human-to-human transmission in mind until proven otherwise."

Although cruise ships are not typical settings for hantavirus transmission, the global movement of passengers, supplies, and waste introduces potential vulnerabilities. Ships dock at multiple ports, sometimes in regions where rodent-borne diseases are more prevalent. This underscores the importance of strict environmental controls, including pest management programs and sanitation protocols.

More commonly, cruise ships experience outbreaks of gastrointestinal and respiratory illnesses, including norovirus, influenza, and COVID-19. These outbreaks spread rapidly due to close quarters, shared dining spaces, and high-touch surfaces. The CDC’s Vessel Sanitation Program (VSP) has long emphasized that hand hygiene is the cornerstone of infection prevention in these environments.²

“This hantavirus outbreak is a reminder that infection risks don’t always start where we think,” Maureen Spencer, MEd, BSN, RN, CIC, FAPIC, infection prevention consultant and owner of Surgical Infection Consultants, said. “Exposure may have come from rodent-contaminated environments during travel, or even been brought onboard by an infected passenger. In infection prevention, we have to think beyond people and look closely at the environments we enter.”

Hand hygiene adherence on cruise ships can be challenging. Passengers may underestimate risks while on vacation, leading to lapses in behavior. Studies have shown that visible cues, such as hand sanitizer stations, staff reminders, and signage, significantly improve adherence rates.³ However, as infection preventionists increasingly recognize, adherence alone is not enough; effectiveness matters. Proper technique, adequate sanitizer volume, and access to soap and water are essential for reducing transmission.

Environmental hygiene also plays a critical role. Cruise ships must adhere to strict cleaning and disinfection standards, particularly for high-touch surfaces like handrails, elevator buttons, and dining areas. The World Health Organization (WHO) recommends routine cleaning with appropriate disinfectants and rapid response protocols when cases are identified.⁴

“I love cruising and have been on several cruises,” began Donald Sipp, MBA, RESE, CHESP, CHTI-2, CMIP, PMP, senior director for Ruck-Shockey Associates, Inc. “Outbreaks like hantavirus are concerning, especially when you’re in a confined space for days on end. The real issue isn’t standards, it’s system reliability. When cleaning, waste handling, and pest control are executed consistently as 1 system, risk is reduced and managed. Passengers can help by practicing good hand hygiene and following onboard sanitation practices, creating a safer cruise, and helping break the chain of infection.”

Ventilation and water systems are additional areas of concern. Poorly maintained systems can contribute to the spread of pathogens such as Legionella. Cruise operators are required to implement water management programs and conduct regular monitoring to ensure safety.⁵

“As a frequent cruiser, a cruise ship hantavirus outbreak never crossed my mind until recently,” said Peter Graves, BSN, RN, CNOR, independent surgical infection prevention consultant and CEO of Clinical Solution, LLC, in Texas. “As an operating room nurse, I am relentless with managing environmental hygiene and our sterile fields. We do not get a second chance to get it right. Cruise ships must be just as diligent in preventing outbreaks. Whenever there are breaches in pest control, waste handling, hand hygiene, and a plethora of other infection prevention practices, you are looking at a potential disaster in the making.”

The hantavirus discussion adds another layer to this conversation by highlighting the importance of integrated pest management. While rare, the presence of rodents on ships or in port facilities could pose a risk if not properly controlled. Preventive measures include secure food storage, waste management, and regular inspections.

Ultimately, the lessons from both hantavirus and cruise ship outbreaks converge on a central principle: infection prevention requires a systems-based approach. This includes environmental design, behavioral interventions, and ongoing surveillance.

For infection prevention professionals, cruise ships serve as a microcosm of broader public health challenges. They demonstrate how quickly pathogens can spread when hygiene practices falter—and how effective interventions can mitigate risk. Another consideration is the education of the health care workers onboard.

“Although most cruise ships have public health officers onboard to ensure the safety of both staff and passengers, many of these professionals are not equipped with the level of training and expertise in infection prevention found among dedicated infection preventionists (IPs),” said Shahbaz Salehi, MD, MPH, MSHIA, director of infection prevention and control and employee health at Foothill Regional Medical Center in Tustin, California. “Postpandemic, IPs have demonstrated the ability to manage and control outbreaks more effectively than any other discipline, and this is a capability that is often lacking in the cruise ship industry. The cruise ship industry should consider adopting and emulating hospital-based infection control practices for their public health staff.”

As global travel continues to rebound, maintaining vigilance in hygiene practices is essential. Whether addressing rare threats like hantavirus or more common cruise-related outbreaks, the goal remains the same: reducing transmission and protecting public health through consistent, evidence-based infection prevention strategies.

References

1. About Hantavirus. CDC. Updated May 13, 2024. Accessed May 6, 2026. https://www.cdc.gov/hantavirus/
2. Vessel Sanitation Program (VSP). CDC. Updated 2025. https://www.cdc.gov/nceh/vsp/
3. Mouchtouri VA, Rudge JW. Legionnaires’ disease in hotels and passenger ships: a systematic review of evidence. J Travel Med. 2015;22(5):325-337.
4. Guide to Ship Sanitation. 3rd ed. WHO. April 1, 2011. Accessed May 6, 2026. https://www.who.int/publications/i/item/9789241546690
5. Legionella (Legionnaires’ Disease and Pontiac Fever). CDC. Updated 2024. Accessed May 6, 2026. https://www.cdc.gov/legionella/