Two hantavirus-linked cases that entered South Africa have raised fresh concerns about the country’s ability to detect and manage infectious diseases at its borders, with MPs questioning whether current screening protocols are sufficient.
Health minister Dr Aaron Motsoaledi briefed parliament’s portfolio committee on health on Wednesday after the deaths of two international travellers linked to a hantavirus outbreak on a cruise ship in the Atlantic Ocean, including a woman who collapsed at OR Tambo International Airport.
MPs pressed the minister on whether airport health officials had been alerted in advance, particularly in the case of the 69-year-old woman who later died at a hospital in Kempton Park.
Motsoaledi said airlines are expected to communicate with health authorities when passengers show signs of illness, but in this case, there had been no prior warning.
“In this instance, there was no alert from the airline, as they were also unaware. When the passenger arrived at OR Tambo, she presented like any other traveller and not as someone who was visibly ill,” he said.
He explained that on May 2, the World Health Organisation (WHO) received notification from the UK’s International Health Regulations National Focal Point regarding a cluster of severe respiratory illness on a Dutch-flagged cruise vessel carrying 147 people from 23 countries.
The vessel had departed Ushuaia in southern Argentina on April 1 en route to Cape Verde.
Motsoaledi outlined the timeline of the outbreak: a 70-year-old Dutch man developed symptoms on April 6 and died on board five days later after his condition worsened. His body was later removed to St Helena.
His 69-year-old wife, who had disembarked on St Helena on April 24 with gastrointestinal symptoms, was travelling home via OR Tambo when she collapsed at the airport. She was rushed to the hospital in Kempton Park, where she died on April 26.
A third patient, a UK national, developed fever and respiratory symptoms on April 24. His condition deteriorated, and he was medically evacuated to South Africa on April 27, where he was admitted to a hospital in Sandton.
Motsoaledi emphasised that while temperature screening is conducted at ports of entry, it is not foolproof.
“The woman passed through temperature screening without any abnormal reading. This does not mean our systems failed, not all ill patients present with fever at the time of screening,” he said.
Within 24 hours of receiving information from a colleague in the UK about a possible outbreak, we confirmed hantavirus. It is not a virus we typically see in South Africa and is an unusual cause of respiratory illness on ships.
— Epidemiologist Prof Lucille Blumberg
He added that health workers remain trained and vigilant, cautioning against the perception that systems were negligent.
Epidemiologist Prof Lucille Blumberg, former deputy director at the National Institute for Communicable Diseases (NICD), said South African authorities acted swiftly once alerted.
“Within 24 hours of receiving information from a colleague in the UK about a possible outbreak, we confirmed hantavirus. It is not a virus we typically see in South Africa and is an unusual cause of respiratory illness on ships,” she said.
Blumberg noted that hantavirus is rarely transmitted from person to person, though the possibility cannot be entirely excluded in this outbreak.
“All the affected individuals are elderly and have comorbidities. Unfortunately, this is not unexpected in such settings,” she said, adding that ships generally do not carry specialised tests for rare viruses such as hantavirus.
She said the NICD was alerted to the third patient in Johannesburg through international collaboration, with information rapidly pieced together via cross-border communication.
At the time, authorities were not yet aware of the woman who collapsed at OR Tambo.
“She had not reported being ill while travelling. We know that the later stages of hantavirus can progress very rapidly. A blood sample retrieved after her death tested positive,” Blumberg said.
Contact tracing began immediately, with all individuals who had interacted with the patient, including airport personnel, transport staff and healthcare workers, identified and monitored.
“Even before we had a confirmed diagnosis, contacts were traced and assessed. They are now in the incubation period, which can last up to six weeks, and are being closely monitored,” she said.
Blumberg stressed that hantavirus does not spread easily between people and that the overall risk remains low.
Meanwhile, the government of St Helena confirmed it is working with the UK Health Security Agency and international partners to monitor the situation linked to the expedition vessel MV Hondius, which docked on the island between April 22 and 24.
Authorities there said no cases have been detected on the island, with high-risk contacts under daily medical follow-up and lower-risk contacts advised on symptoms and precautions.
South African health officials have reiterated that while the incident highlights the limits of airport screening, the country’s surveillance and response systems remain active, co-ordinated and responsive to emerging global health threats.
Motsoaledi said there were 62 contacts, which included six cruise ship passengers, 32 health workers and facility security and cleaners. So far, there are 42 contacts that have been traced.
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