World Health Organisation update on hantavirus outbreak

Key Concepts

• High-Risk Contact: A classification used by the WHO to operationalize the safe movement and monitoring of passengers and crew.
• International Health Regulations (IHR): The legal framework and mandate that guides the WHO’s coordination of international health emergencies.
• Exposure Assessment: A detailed medical evaluation to determine the level of risk for individuals based on their interactions and activities on the ship.
• Repatriation: The process of returning passengers and crew to their home countries via controlled, medicalized transport.
• Active Monitoring: A 42-day follow-up period starting from the last point of exposure to ensure no further spread of the virus.

---

1. Medical Assessment and Risk Management

The WHO, in collaboration with the European Centers for Disease Control (ECDC) and Dutch physicians, is conducting a comprehensive medical and exposure assessment of everyone on board the ship.

• Methodology: Experts are interviewing passengers and crew to determine their specific level of interaction with suspected cases. This allows for a nuanced risk profile rather than a blanket assumption.
• Current Status: Despite the high-risk classification for all on board, the WHO emphasizes that the risk to the general public and the Canary Islands remains low.
• Case Statistics: As of the briefing, there are 8 confirmed cases and 3 deaths. One previously reported case was discarded due to negative lab results, and one new case was added, keeping the total stable at 8.

2. Repatriation Framework

The WHO is coordinating a multi-disciplinary effort to disembark passengers and crew safely over a 48-hour window.

• Step-by-Step Process:
  1. Docking/Anchoring: The ship will anchor off Tenerife.
  2. Transfer: Small boats will transport passengers in groups to the dock.
  3. Screening: All individuals will undergo medical screening upon arrival.
  4. Evacuation vs. Repatriation: Symptomatic individuals will be immediately medevaced to the Netherlands. Asymptomatic individuals will be transported to their home countries via chartered flights.
• Logistics: To avoid overloading the airport, countries are coordinating shared flights (e.g., the U.S. and Canada).
• Timeline: The goal is to complete all repatriation flights by Sunday and Monday, ahead of an incoming weather system.

3. Communication and Solidarity

Dr. Tedros, Director-General of the WHO, traveled to Madrid and the Canary Islands to oversee operations and provide reassurance.

• Public Reassurance: Dr. Tedros issued a letter to the people of the Canary Islands, acknowledging their concerns and thanking them for their solidarity. This was described as a "human letter" intended to provide transparency and maintain public trust.
• Stakeholder Alignment: The WHO has maintained constant communication with the ship’s operator, captain, and crew to ensure that all public updates are aligned and accurate.

4. Global Coordination and Research

The WHO is leveraging its "convening power" to manage the outbreak through international cooperation.

• Expert Networks: The WHO has convened global networks specializing in clinical care, infection prevention and control (IPC), and laboratory analysis.
• Collaborative Research: Experts from Argentina and Chile, who have experience with the Andes virus, are assisting in analyzing sequences and epidemiological data to trace transmission patterns.
• Follow-up: Active monitoring is required for 42 days post-exposure. This includes tracking passengers who disembarked earlier in St. Helena and those who traveled to Johannesburg.

5. Notable Statements

• Dr. Maria Van Kerkhove: "We as WHO, we classify everybody on board as what we call a high-risk contact. That might sound scary, but it's really what it's how we will operationalize the movement of the passengers and the crew safely home."
• On Coordination: "This requires a multi-disciplinary approach. This requires collaboration, solidarity, cooperation, not just among technical disciplines but many different countries."

---

Synthesis and Conclusion

The situation on the ship is being managed through a highly structured, evidence-based framework governed by the International Health Regulations. The WHO’s primary focus is the safe, dignified repatriation of passengers and crew while preventing further transmission through rigorous medical screening and a 42-day active monitoring period. By coordinating with multiple member states, specialized medical experts, and local authorities, the WHO is successfully managing a complex, dynamic event while prioritizing clear communication to mitigate public fear.