An American national and a French passenger evacuated from a cruise ship struck by a deadly hantavirus outbreak have tested positive for the infection, officials said Monday, deepening concerns as a complex, multi-country repatriation effort continues across Europe and beyond.

The cases emerged among passengers removed from the Dutch-flagged expedition vessel MV Hondius, where three deaths have already been confirmed and several other infections reported during a voyage that began in late April from Ushuaia.

French Health Minister Stephanie Rist said one of five French evacuees flown to Paris and placed under isolation began showing symptoms Sunday night before testing positive.

In the United States, health officials confirmed that one evacuated passenger developed mild symptoms while another tested positive for the Andes strain, a rare hantavirus variant capable of human-to-human transmission.

The outbreak has already been linked to the deaths of a Dutch couple and a German woman.

Authorities say the virus is typically carried by rodents and is endemic in parts of Argentina, raising questions over where the initial infection occurred and how it spread in the confined environment of the ship.

Health agencies, including the World Health Organization, have stressed that global risk remains low, while warning that close-contact transmission in enclosed settings can accelerate clusters if not rapidly contained.

Evacuation operations have unfolded at speed but under tight medical controls.

Spanish authorities said 94 passengers of 19 nationalities were disembarked from the ship as it anchored off Tenerife, with crews in protective suits guiding passengers ashore at the port of Granadilla.

From there, repatriation has split along national lines.

Greece imposed a 45-day hospital quarantine for its evacuee, Australia transferred citizens to a dedicated quarantine facility near Perth, and Britain placed its passengers in hospital isolation for testing and short observation.

The United States adopted a more flexible approach, with health officials saying quarantine decisions would depend on individual risk assessments and exposure levels.

WHO Director-General Tedros Adhanom Ghebreyesus, who has been monitoring the operation in Tenerife, warned that less restrictive approaches carry potential risks, particularly given the uncertainty surrounding incubation periods and secondary transmission.

The ship is expected to complete evacuations before departing later Monday with remaining crew on board, after a large-scale operation involving multiple European ports and coordinated air transfers.

At the center of the investigation is how the outbreak escalated so quickly in a controlled cruise environment. The Andes virus strain involved is known for its rare ability to spread between humans, typically through prolonged close contact, setting it apart from other hantavirus types that circulate mainly through rodent exposure.

Epidemiologists have pointed to Argentina as a likely origin point, though officials there have questioned whether infection may have occurred earlier due to the virus’s incubation window and the ship’s multi-stop route across the Atlantic.

The current crisis has also revived stark memories in Patagonia, particularly in the village of Epuyen, where a 2018 to 2019 outbreak caused 11 deaths and exposed how quickly the virus can move through families and social gatherings.

That episode, which involved strict isolation measures later echoed during the COVID-19 pandemic, is now being cited by health officials as a reference point for containment strategy.