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.
Shazia Irum, MSc, MBA, RN, CIC, CPH!, FAPIC, CBIC, AL-CIP, Certification Board of Infection Control and Epidemiology member for APIC
“Infection prevention professionals understand that emerging threats like hantavirus are not isolated incidents; they are urgent reminders that preparedness is the foundation of global health security. In highly concentrated environments such as cruise ships, where international travel, confined spaces, and constant human interaction accelerate the potential for disease transmission, infection prevention cannot be passive.
It must be strategic, relentless, and driven by unwavering vigilance. The increasing concern surrounding hantavirus in maritime settings powerfully reinforces the critical role infection preventionists play in safeguarding public health through rapid risk identification, aggressive surveillance, environmental protection, and decisive outbreak management.
Effective infection prevention programs extend far beyond routine adherence measures. They require a culture of continuous readiness built on rigorous environmental hygiene, comprehensive rodent control, early respiratory illness detection, workforce training, and resilient emergency preparedness systems. Every proactive intervention implemented before an outbreak emerges represents lives protected, health care systems preserved, and public confidence strengthened.
This is a defining reminder that infection prevention is not merely the response to known pathogens; it is the anticipation of emerging biological threats before they escalate into global crises. In an era shaped by unprecedented mobility and interconnectedness, infection prevention professionals remain among the most vital defenders of public health, leading with science, expertise, resilience, and an uncompromising commitment to protecting travelers, health care systems, and communities across the world.”
“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
