Spain has granted permission for a luxury cruise ship hit by a deadly hantavirus outbreak and anchored off the coast of Cape Verde to sail to the Canary Islands.

Spain’s Ministry of Health said in a statement late on Tuesday that the World Health Organization (WHO) had explained that Cape Verde in West Africa was unable to receive the 147 crew and passengers of the MV Hondius.

“The Canary Islands are the closest location with the necessary capabilities,” it said. “Spain has a moral and legal obligation to assist these people, among whom are also several Spanish citizens.”

The ministry said it would receive a medical flight carrying the ship’s doctor, a Dutch national, who it said was gravely ill, following a formal request from the Dutch government.

A Dutch couple and a German national have died of the rare disease, which is usually spread from infected rodents through urine, droppings and saliva, on board the ship in early April. A British national, who was evacuated from the ship, is in intensive care in South Africa, officials said.

Two crew members require urgent medical care, ⁠according to the Dutch-flagged ship’s operator, Oceanwide Expeditions. Another person on board with a suspected case has only reported a mild fever.

Medical evacuations

The Spanish Health Ministry said the MV Hondius will journey on to the Canary Islands once those who need evacuation are taken off the ship.

The Dutch government said earlier on Tuesday that it was preparing to receive the evacuated passengers. Oceanwide Expeditions said the journey to the Canary Islands will take three days of sailing and that the MV Hondius will dock in either Gran Canaria or Tenerife.

When the rest of the crew and passengers arrive in the Canary Islands, they will be examined, treated and repatriated to their respective countries, Spain’s Health Ministry said, in coordination with the European Centre for Disease Prevention and Control and the WHO.

All necessary safety measures would be taken, the ministry said, with medical care and transportation provided in special facilities and vehicles to avoid contact with the local population and protect health workers.

According to the WHO, the cruise ship, which set sail from Ushuaia, Argentina, on April 1 for Cape Verde, had 88 passengers and 59 crew members from 23 countries on board.

A WHO official said on Tuesday that she suspected some rare human-to-human transmission had occurred between close contacts on board the ship.

“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 have shared cabins,” Maria Van Kerkhove, the director of epidemic and pandemic preparedness and prevention at the WHO, told reporters in Geneva.

Van Kerkhove also sent a direct message to the people on board.

“We just want you to know we are working with the ship’s operators,” she said. “We are working with the countries where you are from. We hear you. We know that you are scared.”

Andes strain

Human-to-human transmission is not common, and the WHO reiterated that ⁠the risk to the wider public was low, adding that it had been told that “there are no rats on board” the ship.

A limited spread among close contacts has been observed in some previous outbreaks of the Andes strain of the virus, which spreads in South America, including Argentina.

Van Kerkhove said the typical incubation period for hantavirus was between one and six weeks, leading the WHO to believe that the Dutch couple, who had been travelling in Argentina before boarding the cruise, “were infected off the ship”.

Other cases may also have been infected while on bird-watching trips to islands where birds and rodents live, the WHO said.

Such trips are part of the cruise.

The Hondius is carrying mostly British, American and Spanish passengers on the luxury cruise, which set off from the southern tip of Argentina in late March.

The cruise visited the Antarctic Peninsula, South Georgia and Tristan da Cunha, some of the remotest islands ‌on the planet.

The voyage was marketed as an Antarctic nature expedition, with berth prices ranging from 14,000 to 22,000 euros ($16,000 to $25,000).

The first stricken passenger, the Dutch man, died on April 11. His body remained on board until April 24, when it “was disembarked on St Helena, with his wife accompanying the repatriation”, Oceanwide Expeditions said.

His wife had gastrointestinal symptoms when she was disembarked, and deteriorated during a flight to Johannesburg. She died upon arrival at the emergency department on ‌April ‌26, the WHO said, adding that contact tracing was under way for passengers on the flight.

South African authorities have confirmed that the British patient, who is being treated in a Johannesburg hospital, tested positive for the hantavirus.