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Pandemics and Biosecurity
12MAY

WHO upgrades Hondius Andes risk to MODERATE

3 min read
16:29UTC

WHO revised Disease Outbreak News 600 on 9 May, upgrading the ship-level risk for the MV Hondius Andes hantavirus cluster from LOW to MODERATE and confirming all six laboratory-tested cases as Andes virus by PCR and sequencing, with a 38% case-fatality rate across 8 cases and 3 deaths.

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Key takeaway

WHO's MODERATE upgrade on 9 May confirmed Andes virus in all six lab cases, with a 38% case-fatality rate.

WHO revised DON 600 on 9 May, upgrading the ship-level risk for the MV Hondius cluster from LOW to MODERATE and confirming that all six laboratory-tested cases were Andes virus by PCR and full genome sequencing. 1 The revision supersedes the original DON 599 assessment, which logged 7 cases, 3 deaths, and applied standard hantavirus droplet precautions rather than the Andes-specific airborne isolation tier. The Swiss case , confirmed days after DON 599 was published, is the event that forced the upgrade: the Andes strain identification changed both the transmission model and the infection-control calculus.

At the point of revision, the WHO case count stood at 8 cases (6 confirmed, 2 probable) and 3 deaths, producing a 38% case-fatality rate. That CFR is consistent with the baseline for Andes hantavirus in laboratory-confirmed cases, which historically runs 30-40%. The six reporting countries at the time of revision were the Netherlands, South Africa, Switzerland, Germany, the United Kingdom, and Spain. A MODERATE ship-level risk assessment indicates that transmission from the MV Hondius environment to passengers is considered plausible, though person-to-person secondary transmission ashore had not been confirmed.

PAHO's December 2025 epidemiological alert had already placed Southern Cone health authorities on notice about rising hantavirus case-fatality figures before the voyage , and the pre-voyage birding expedition traversed Oligoryzomys longicaudatus habitat in Chile, Uruguay, and Argentina, according to WHO's Maria Van Kerkhove, establishing the most plausible rodent-exposure window. 2 The vessel completed disembarkation at Tenerife on 11 May, closing the primary exposure environment. The MODERATE designation remains in force while contact tracing and 45-day incubation monitoring continue across all six countries.

Deep Analysis

In plain English

Most viruses spread through large droplets, which means a surgical mask and keeping your distance from the patient is enough protection for nurses and doctors. A smaller number of viruses spread through tiny airborne particles that can drift across a room, and those require a different kind of mask (called an N95 or FFP3 respirator) and a room designed to stop air flowing outward. **Andes hantavirus** is the only type of hantavirus known to spread between people, so on 8 May the **US Centers for Disease Control** issued guidance requiring hospitals to treat suspected cases as airborne until proved otherwise. The guidance also had a practical message for doctors: a life-support machine called **ECMO** (which does the work of the heart and lungs for a patient) raises survival to about 80% if started early. US patients suspected of having Andes virus are being sent to a specialist hospital in **Nebraska** that has both the ECMO capacity and the bio-containment rooms needed.

What could happen next?
  • Consequence

    Community hospitals receiving suspected Andes cases will need to transfer them to negative-pressure facilities, creating a transfer-delay risk during which nosocomial exposure can occur if precautions are not escalated at the referring hospital.

  • Precedent

    HAN00528 is the first CDC guidance to require airborne precautions for a hantavirus; it will be cited in future guidance for other hantaviruses with potential person-to-person transmission should new evidence emerge.

First Reported In

Update #2 · B3.13 gets better at humans as testing ends

CDC· 12 May 2026
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This Event
WHO upgrades Hondius Andes risk to MODERATE
The LOW-to-MODERATE upgrade is the first formal threshold crossing since the Swiss Andes confirmation, and it triggers more demanding case-management guidance for the six countries now reporting cases.
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