"This is not Covid, this is not influenza"
There is rising concern over hantavirus after passengers from the cruise ship MV Hondius were sent home to isolate and receive treatment where necessary.
Officials say the risk of the infection spreading to the wider public remains low despite the multi-country response.
Three people died either on board or after leaving the vessel, which departed Argentina around a month ago.
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The origin of the outbreak remains unclear, with investigators still examining possible exposure routes during the voyage.
The cruise visited remote wildlife areas, meaning exposure may have occurred before boarding or during shore excursions.
Hantavirus typically spreads from rodents, with infection occurring through inhalation of contaminated particles from urine, droppings or saliva.
Health experts also note the Andes strain can spread between humans through very close and prolonged contact in rare circumstances.
Cruise ship environments, including shared cabins and dining spaces, may increase transmission risk due to prolonged close proximity.
One Dutch woman who left MV Hondius at St Helena on April 24 later died, after her husband died on board on April 11.
It remains unclear whether he is one of the confirmed hantavirus cases linked to the outbreak.
The World Health Organisation said: “This is not Covid, this is not influenza, it spreads very, very differently.”
Hantavirus is not spread through everyday social contact in public spaces such as shops, workplaces or schools, according to the UK Health Security Agency (UKHSA).
Symptoms typically appear two to four weeks after exposure, though cases can develop more than a month later.
This extended incubation period has driven the long isolation requirements for returning passengers.
Professor Robin May, chief scientific officer at the UKHSA, said contact tracing has been a “quite a mammoth effort”.
He added it is a task “we will continue to do… for some time”.
Fourteen Spanish nationals are undergoing mandatory quarantine at a military hospital in Madrid.
Twenty Britons are isolating at Arrowe Park Hospital after flying into Manchester via a chartered flight from Tenerife.
They will remain in hospital isolation for 72 hours before completing a further 42 days of home isolation.
Professor May said all British evacuees are “healthy and asymptomatic”.
He also warned that isolation guidance may be updated depending on emerging scientific evidence, adding that the risk to the wider public remains “extremely low indeed”.
Meanwhile, one French passenger has developed symptoms during repatriation.
In the United States, one passenger has begun showing mild symptoms and another has tested mildly positive for the Andes strain.
Both were transported in aircraft biocontainment units as a precaution, according to US health authorities.
Hantavirus symptoms include fever, fatigue and muscle aches similar to flu.
Patients may also experience shortness of breath, abdominal pain, nausea, vomiting or diarrhoea.
There is no specific antiviral treatment, but hospital care can improve survival through supportive management.
Contact tracing continues across multiple countries, including on flights, in hospitals and among shipboard contacts.
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