The Minister of Health, Dr Aaron Motsoaledi, has addressed the hantavirus outbreak on the MV Hondius. Two positive cases — the Andes strain, rare for person-to-person transmission and primarily found in the Americas — were detected in South Africa: a Dutch woman who collapsed at OR Tambo International Airport and later died, and a British passenger in critical condition at a Johannesburg hospital.
A person in protective clothing walks next to an ambulance during an evacuation operation of suspected hantavirus patients, following an outbreak on the cruise ship MV Hondius, in Praia, Cape Verde. Image credit: Reuters/Danilson Sequeira
While speaking to Moneyweb's Jeremy Maggs, Motsoaledi clarified that this outbreak cannot be compared to the Covid-19 pandemic.
“The hantavirus is not like Covid. Because Covid was never known, it was a new virus that just jumped on us, and we had to start from the beginning to understand what it is,” said the minister.
WHO-guided response
Motsoaledi explained that the World Health Organisation (WHO) guides South Africa's national strategy for containing imported infectious diseases.
The WHO gets its directives from the World Health Assembly, a gathering of all ministers of health which has an annual caucus in Geneva, Switzerland.
“In the World Health Assembly, they adopted what they call (the) International Health Regulations 2005, that guides all the countries on what to do,” explained the minister.
“Especially, the core of the International Health Regulations 2005 is to contain diseases where they occur in order not to spread them all over the world.”
The minister added that the Border Management Authority (BMA) has a special port health unit, a chief directorate of the Department of Health that deals with matters arriving from other countries.
If the matter is dire — as with the Covid-19 pandemic — the WHO will declare a Public Health Emergency of International Concern (PHEIC).
The PHEIC will then, in turn, advise countries on how to respond.
Cases found in SA
The National Institute for Communicable Diseases (NICD) immediately started contact tracing after it confirmed that the two passengers were positive for the Andes strain of the hantavirus.
There are 38 strains of hantavirus.
The Andes strain is the only one that causes person-to-person transmission, which is predominant in South America.
This strain was the cause of the infection detected in the patients who died in South Africa.
“Person-to-person contact is very rare, and it has happened under specific conditions, namely: there must be very close person-to-person contact for transmission to occur from one human to another,” said the minister.
“It happens to be the only strain out of the 38 that is known to cause human-to-human transmission. But such transmission is very rare and only happens due to very close contact,” Motsoaledi told Parliament’s Portfolio Committee on Health.
The minister explained that hantavirus is a zoonotic disease transmitted from wild animals to humans and is endemic to the Americas.
“Whether South African rats carry this… as far as I know, I have never been told of any presence of hantavirus on the African continent.
“From the information I have, South African rats do not carry hantavirus because it’s a virus that is found in the Americas, Europe (and), India,” he said.
Contact tracing
The minister indicated that contact tracing continues, with 62 people already identified.
“The lady who arrived at OR Tambo flew in from St Helena… we needed to know the people who were there at the airport before she collapsed (sic). The third contact traces are healthcare workers in Kempton Park, where the lady went.
“The fourth contact traces relate to the gentleman in a hospital in Sandton (and the ambulance crew). He was airlifted directly and didn’t come by commercial flight.
“The total number of people who were traced and who could have come in contact with them was 62. (Some) 42 of them have already been traced, and they are being observed. The work is ongoing,” Motsoaledi said.
WHO is also conducting contact tracing internationally.
Allowed entry to SA
Addressing questions on how one of the patients had been allowed to come into OR Tambo International Airport, the minister explained that the woman had not presented herself as ill to airline staff in St Helena, making it difficult to flag her in advance.
“On a routine basis, air staff are in touch with countries to report any person who might be sick in the aircraft to warn them...
“In this case, there was no warning coming in because even the staff did not pick up anything. When she arrived at the airport, she came in just like any traveller, not as a sick person.
“When people arrive, especially from international destinations, we have a temperature measuring (machine), but it does not mean that every human being who is sick (has a high) temperature.
“This lady went through the scan. It did not record anything from temperature (sic). It cannot be said that South Africa’s safety mechanisms were so lax that they just allowed people in without screening,” Motsoaledi said.
The other patient currently in the hospital was medically evacuated from Ascension Island to a South African private health facility in Sandton.
Detection within 24 hours
At the same briefing, infectious diseases expert at the NICD, Professor Lucille Blumberg, told the committee that South African authorities had confirmed detection of the virus “within 24 hours of alert” from international colleagues about concerns about the cruise ship.
“On a ship, it’s not unusual for elderly people to travel… and deaths do occur. The first three cases are elder persons, all of whom have comorbidities.
“(A colleague) alerted me to patient three, who was admitted to a hospital in Johannesburg as a pneumonia patient... Within 12 hours, we had an international call, and we had a number of players discussing this. It is quite a remarkable effort to make that diagnosis of a most unusual pathogen in a most unusual setting in such a short time.
“As a country, we’ve done extremely well. Patients don’t come and say, ‘I’m part of (this)’, and it does take a bit of time to get all the facts. Within 24 hours, we knew what we were dealing with, and we had a large amount of information,” Blumberg said.
Furthermore, contacts were identified, and contact tracing began.
“All the names of people who were involved – at OR Tambo, those at the hospital close to the airport and all of those who either transported or admitted the patient – were put on a list, and contact monitoring was started.
“It was started even before we knew what we were dealing with. That is in progress and is really working quite well. The incubation period is quite long… and they will have to be monitored. We will go back and identify who is a high risk and decide what we are going to do, and maybe intensify monitoring on those people,” Blumberg explained.
Collaboration with experts in other countries is also underway.
“We have had a number of consultations with counterparts in South America, who have a lot of experience with Hantavirus.
“There’s been lab consultations. The international community have come together to support…in an extraordinary way, and all of this has been coordinated through the WHO.
“This is quite an extraordinary response to what was an unknown, unusual virus in an unusual setting,” she said.
