When rare zoonoses travel: Andes virus, hantavirus cardiopulmonary syndrome, and the preparedness gap

The perspective discusses how the suspected Andes virus (ANDV) associated hantavirus cluster on the expedition cruise ship MV Hondius illustrates a critical preparedness gap in managing rare zoonotic infections in mobile, closed, and medically constrained settings. Focusing on the reported multi-country cluster involving severe hantavirus cardiopulmonary syndrome, deaths, and international passenger dispersal, it highlights the associated diagnostic, clinical, and epidemiological challenges. The perspective also explains why ANDV is distinct among hantaviruses, including its documented potential for limited person-to-person transmission during close and prolonged contact, with insights into the virology and pathogenesis of ANDV. Additionally, it highlights ecological exposure hazards in Patagonia, rodent reservoirs, clinical progression, the necessity for laboratory confirmation, candidate severity biomarkers such as IL-6 and intestinal fatty acid-binding protein, and the lack of specific antiviral therapy. Furthermore, it discusses risk factors, including European ethnicity and host genetic susceptibility linked to αVβ3 integrin variation. Overall, this perspective argues that expedition travel, maritime medicine, One Health surveillance and outbreak preparedness must be better integrated in order to detect, investigate and manage rare but high-consequence zoonotic infections before they escalate into international public health events.