Fifteen American passengers from a cruise ship at the centre of a rare hantavirus outbreak are being monitored at the National Quarantine Unit in Omaha, Nebraska, as health authorities work to contain a cluster that has spread across several countries.

The outbreak was identified in April aboard the Dutch-operated expedition ship MV Hondius, which departed Ushuaia, Argentina, on April 1 and crossed the South Atlantic, calling at remote destinations including Antarctica, South Georgia, Tristan da Cunha, Saint Helena and Ascension Island.

At least nine passengers have been infected and three have died, officials said. As of May 13, the World Health Organization had been notified of 11 cases of Andes hantavirus linked to the voyage.

The Andes virus is unusual among hantaviruses in that it can spread directly from person to person, a feature that has prompted particular caution among public-health agencies tracking the cluster.

Sixteen of 18 passengers transferred to the United States arrived in Omaha earlier in the week for evaluation, after disembarking the ship in Spain’s Canary Islands. The Nebraska facility was last used in 2020 to house passengers evacuated from the Diamond Princess during the early days of the coronavirus pandemic.

The US Centers for Disease Control and Prevention has issued a health advisory to clinicians, and authorities in California said five residents of the state had been exposed. Health officials have stressed that the risk to the general public remains low.