(NEW YORK) -- An epidemiologist at the World Health Organization (WHO) said that there may be some person-to-person spread in the suspected hantavirus outbreak aboard a cruise ship.

As of Monday, there have been seven cases reported aboard the MV Hondius, of which two are laboratory-confirmed and five are suspected. Among those seven, there have been three deaths, including a married couple from the Netherlands, one of whom has been confirmed to have been infected with hantavirus.

"We do believe that there may be some human-to-human transmission that's happening among the really close contacts, the husband and wife, people who've shared cabins, [et cetera]," Maria Van Kerkhove, an infectious disease epidemiologist and director of Epidemic and Pandemic Management at the WHO, said during a press conference Tuesday.

"So again, our assumption is that has happened, and that's why we are operating and working with the ship to make sure that anyone who is symptomatic, anyone caring for patients, is wearing full personal protective equipment," she added.

Van Kerkhove noted that hantaviruses normally don't transmit from person to person because it's a "rodent infection." Patients typically become infected when they come into contact with rodent urine, droppings or saliva, according to the WHO.

The initial patients who fell ill may have become infected before they boarded the ship, Van Kerkhove added.

Symptoms of hantavirus infections sometimes do not start until eight weeks after contact with the virus, according to the Centers for Disease Control and Prevention.

The WHO is working under the assumption that the strain of hantavirus in the suspected outbreak is the Andes virus, which historically has been shown to potentially transmit between people, although sequencing is still ongoing, according to Van Kerkhove.

In a post on its website, the WHO said the onset of illnesses aboard the MV Hondius occurred between April 6 and April 28, with patients experiencing fever, gastrointestinal symptoms, rapid progression to pneumonia, acute respiratory distress syndrome and shock.

"The outbreak is being managed through coordinated international response, and includes in-depth investigations, case isolation and care, medical evacuation and laboratory investigations," the WHO wrote in the post.

WHO Director-General Dr. Tedros Ghebreysus wrote in a post on X Tuesday that the infection risk to the global population is low and that the agency will continue to monitor the situation and provide updates.

Timeline of cases

The first suspected hantavirus case occurred in a 70-year-old male passenger from the Netherlands who developed fever, headache and mild diarrhea on April 6, according to the WHO and South African health officials.

On April 11, the passenger developed respiratory distress and died on board the ship the same day. His body was removed from the ship to the British territory of St. Helena on April 24. No microbiological tests were performed on the man, according to the WHO.

Also on April 24, the male passenger's 69-year-old wife developed gastrointestinal symptoms, health officials said. Her health rapidly declined while on a flight to Johannesburg, South Africa, on April 25 and she died upon arrival to an emergency department the next day, the WHO said.

On Monday, May 4, laboratory testing confirmed that the wife was infected with hantavirus.

Health workers have begun working to identify anyone who may have come into contact with the couple. According to the WHO, the couple had traveled in South America, including Argentina, before they boarded the cruise ship on April 1.

During Tuesday's press conference, Van Kerkhove said officials suspect the couple was infected with hantavirus before boarding the ship.

"The initial patients, the initial case and his wife, they joined the boat in Argentina. And with the timing of the incubation period of hantavirus, which can be anywhere from one to six weeks, our assumption is that they were infected off the ship, perhaps doing some activities there," she said.

A British passenger started developing symptoms on April 24, including shortness of breath and signs of pneumonia, according to the WHO and South African health officials.

His condition worsened and he was medically evacuated from Ascension, another British territory, to South Africa on April 27, where he is currently hospitalized in an intensive care unit. Laboratory testing confirmed hantavirus infection over the weekend, the WHO said.

Another passenger, an adult female, began experiencing symptoms on April 28, including a general feeling of being unwell, according to the WHO. She later presented with pneumonia and died on May 2. Oceanwide Expeditions, which operates the cruise ship, previously revealed that the patient was a German national.

In addition, there are three suspected cases currently onboard the MV Hondius reporting high fever and/or gastrointestinal symptoms, the WHO said. The ship is currently off the coast of Cape Verde, where medical teams in the area are evaluating the patients and collecting additional specimens for testing, according to the WHO.

Van Kerkhove said the highest priority is to medically evacuate the symptomatic individuals onboard the ship so they receive the care they need.

"The plan now is for the ship to continue on to the Canary Islands. We're working with Spanish authorities who will welcome the ship, have said that they will welcome the ship, to do a full investigation, a full epidemiological investigation, full disinfection of the ship, and of course to assess the risk of the passengers that are actually on board," she said.

"The medical evacuation of two individuals currently requiring urgent medical care, and the individual associated with the guest who passed away on 2 May, will occur using two specialized aircraft that are en route to Cape Verde," Oceanwide Expeditions said in a statement Tuesday.

"From here, the patients are to be medically evacuated to the Netherlands," the statement continued, noting that there currently was no "exact timeline" for the evacuation.

The company added that once the guests have been safely transferred and are in transit to the Netherlands, the ship will proceed to the Canary Islands, and further plans will be shared once they are available.

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