Portugal’s Directorate-General of Health (DGS) has issued new guidance on “contact procedures” following the hantavirus outbreak linked to the cruise ship MV Hondius, which has been regarded by clinicians as being of low-risk in regards to its ability to spread.
According to the DGS, the guidance, which “sets out measures to be adopted by Portuguese healthcare professionals for the management of potential contacts”, was prompted by the “need to define procedures” in light of the possibility that individuals exposed to cases associated with the outbreak may arrive in Portugal.
However, the health authority stressed that the guidance does not reflect any change in Portugal’s risk assessment, underlining that “there has been no alteration to the evaluation of risk”.
“The risk for Portugal remains very low, and therefore no preventive measures are required at national level for the general population,” the DGS said in a social media statement.
Under the published guidance, a suspected case is defined as any person who has shared or travelled on a means of transport, such as a ship or aircraft, where a confirmed or probable infection with Andes hantavirus (ANDV) occurred, or anyone who had contact with a passenger or crew member from the MV Hondius and develops acute fever, or a history of fever, alongside symptoms including muscle pain, chills, headaches, gastrointestinal symptoms (such as nausea, vomiting, diarrhoea or abdominal pain), or respiratory symptoms including cough, shortness of breath, chest pain or breathing difficulties.
A probable case refers to an individual presenting compatible symptoms together with a known epidemiological link to a confirmed or probable Andes hantavirus infection. A confirmed case is defined as a suspected or probable case in which ANDV nucleic acids are detected through RT-PCR testing, positive serological tests are obtained, or the virus is isolated from a biological sample.
The DGS defines a “contact” as a person exposed to a confirmed or probable Andes hantavirus case during the infectious period, from two days before symptom onset until symptom resolution, through interaction involving exposure to respiratory secretions, saliva, blood or other bodily fluids.
In the guidance, all individuals aboard the cruise ship are classified as high-risk contacts, with the exception of public health specialists who boarded in Cape Verde on 6th May. High-risk exposure also includes people sharing a cabin, intimate partners, individuals sharing bathroom or sleeping facilities, those remaining within two metres of a case for prolonged periods in confined spaces, people sharing meals or extended social interactions, healthcare or care workers with unprotected exposure, individuals present during medical procedures without appropriate personal protective equipment (PPE), airline passengers seated in the same row and within two rows of a case on long-haul flights exceeding six hours, transport staff with repeated close contact, and anyone handling contaminated bedding, clothing, medical waste or bodily fluids without adequate PPE.
Low-risk contacts include individuals without known direct or prolonged contact with confirmed or probable cases, such as airline passengers seated outside the defined proximity zone, brief casual contacts in airports or ports, people sharing large outdoor spaces without sustained interaction, and healthcare professionals or staff using appropriate PPE throughout exposure.
The DGS guidance, prepared in line with recommendations from the World Health Organization (WHO) and the European Centre for Disease Control (ECDC), also states that Portugal’s National Institute of Medical Emergency (INEM) should be activated to ensure the safe transport of suspected cases to designated reference hospitals.
These reference hospitals are the São José Local Health Unit, including Curry Cabral Hospital for adult patients, and Dona Estefânia Hospital for paediatric patients.
So far, seven hantavirus infections linked to passengers travelling aboard the MV Hondius, which departed southern Argentina in early April, have been confirmed by international health authorities. Three people have died, and additional suspected or probable cases remain under investigation.
Early symptoms resemble influenza and may include cough, fatigue, headaches, and muscle pain.
The WHO has stated that the overall risk posed by the outbreak to the general population remains low.
Source: DGS
