Hantavirus Cluster Linked to Cruise Ship Travel: A Comprehensive Review of a Looming Global Public Health Concern.

Hantaviruses are globally distributed, rodent-borne orthohantaviruses that cause hemorrhagic fever with renal syndrome in Eurasia and hantavirus cardiopulmonary syndrome (hantavirus pulmonary syndrome) in the Americas. Human infection usually results from environmental spillover through inhalation of aerosolized rodent excreta. However, the 2026 Andes virus (ANDV) cluster linked to the MV Hondius expedition cruise ship demonstrated how international travel networks can transform a rare zoonosis into a complex public health challenge. Following the Scale for the Assessment of Narrative Review Articles framework, this review synthesizes literature from 2019 to 2026 using explicit Boolean search strategies ("hantavirus" OR "orthohantavirus" OR "Andes virus" OR "ANDV") AND ("cruise" OR "maritime health" OR "shipboard medicine" OR "travel medicine" OR "outbreak response" OR "One Health") to evaluate global health governance and maritime outbreak preparedness. Unlike other human-pathogenic hantaviruses, ANDV is uniquely capable of limited person‑to‑person transmission through close, prolonged contact. Epidemiological investigation of the 2026 cluster confirmed that index cases were exposed during pre-embarkation terrestrial travel in highly endemic rural regions of Argentina and Chile, later manifesting on board. Clinically, hantavirus infection is characterized by severe endothelial dysfunction, capillary leak, and abrupt cardiopulmonary or renal failure following a nonspecific febrile prodrome. In the absence of curative antivirals or licensed vaccines, management depends on early risk recognition supported by a tiered diagnostic framework: rapid field-ready complete blood counts detecting thrombocytopenia and hemoconcentration to trigger stabilization and evacuation, followed by definitive molecular confirmation at centralized reference laboratories. The MV Hondius incident thus represents an operational biosecurity stress test rather than a pandemic threat, underscoring the need for integrated One Health surveillance, standardized maritime health governance, and legally codified protections for crew mental health and labor equity during isolation.