Hantavirus Tracker

Federal caution in outbreak control—illustrated by HHS Secretary Robert F.

Kennedy Jr.'s refusal to release Angela Perryman despite a CDC physician's recommendation for home monitoring—clashes with international clinical practice, where countries used differing, test-based discharge criteria for Andes hantavirus and explicitly advise against relying on blood PCR for clearance.

Together these accounts underscore a core tension between legal/operational demands for intensive, in-person surveillance and evolving clinical guidance (saliva, oropharyngeal and urine PCRs; early pre-symptomatic infectiousness)—watch how quarantine standards, monitoring requirements, and test-based discharge practices are reconciled amid legal and public-trust pressures.

Tracking: hantavirus

Geography: United States (notably Four Corners region, New Mexico, Colorado), Chile, Argentina, China, South Korea, Finland, Sweden, Russia, Balkans, Latin America, Europe, Asia, rural and wilderness areas (forest, agricultural settings)

1. HHS Secretary keeps hantavirus-exposed passenger in Nebraska quarantine

Health Secretary Robert F.

Kennedy Jr. this week refused to release Angela Perryman, a cruise ship passenger exposed to hantavirus, from the National Quarantine Unit at the University of Nebraska Medical Center despite a federal medical review recommending home monitoring.

Perryman, who left the cruise ship in early May, remained symptom-free five weeks later and has been confined under strict conditions — limited roof access watched by armed guards and nurses in gloves, masks and face shields delivering meals.

CDC physician Dr. Michael Bell oversaw the medical review and concluded Florida’s proposal for once-daily checks was reasonable and recommended Perryman be allowed home, but federal officials insisted on daily in-person monitoring and round-the-clock surveillance that Florida would not provide; Kennedy nevertheless signed the order Monday.

The decision prompted legal and advocacy criticism and highlights tensions over federal quarantine authority, monitoring requirements, and public trust during outbreak responses.

Key facts:

- Robert F. Kennedy Jr. signed the order keeping the passenger in Nebraska.

- Angela Perryman left the cruise ship in early May and remained symptom-free five weeks later.

- CDC physician Dr. Michael Bell oversaw a June 11 medical review recommending home release.

- Florida declined federal conditions requiring daily in-person and round-the-clock monitoring.

- Quarantine monitoring period set to expire end of day Sunday, June 21.

Why it matters: The case pits federal quarantine authority against state practicality and civil liberties, risking legal challenges and public backlash.

Keeping a symptom-free person in distant, resource-intensive isolation may erode trust in public health directives and politicize outbreak control measures.

Watch for litigation, federal-state negotiations on monitoring protocols, and communications from CDC and HHS clarifying when strict in-person surveillance is required versus home-based symptom checks.

Associated Press

2. Countries applied differing discharge criteria for Andes hantavirus cruise patients

Medical teams in the Netherlands, Spain and Switzerland used differing discharge criteria for cruise-ship–associated Andes hantavirus cases, but none required a negative blood PCR because blood RNA can remain detectable for weeks to months.

Netherlands discharged two patients after two negative saliva tests; Spain discharged two confirmed cases only after two negative oropharyngeal and urine PCRs while managing 12 asymptomatic contacts; Switzerland discharged a 64‑year‑old man after saliva and nasopharyngeal swabs turned negative, despite persistent blood and urine detection.

Experts at a WHO Epi-WIN briefing emphasized early/prodromal-stage respiratory transmission risk, with infectiousness beginning about two days before symptoms and substantial uncertainty about asymptomatic spread, prompting the UK to treat Andes as a high-consequence infectious disease and recommend strict PPE.

Spain advised four months of safe sex and monthly follow-up; Switzerland required 42 days' self-isolation for contacts; clinicians and labs should not rely on blood PCR for clearance and must balance tests with clinical timing.

Key facts:

- Netherlands discharged two Andes hantavirus patients after two negative saliva tests.

- Spain treated two confirmed cases and managed 12 asymptomatic contacts.

- Spain required two negative oropharyngeal and urine PCRs to discharge patients.

- Swiss case: 64-year-old man hospitalized 4 May, discharged 18 May after saliva and nasopharyngeal negatives.

- Switzerland required contacts to observe 42 days of self-isolation.

Why it matters: Variation in discharge rules and persistent blood PCR detection create cross-jurisdictional inconsistencies in isolation, contact tracing, and clearance criteria, complicating international case management and traveler follow-up.

Public health agencies, clinicians, laboratories and hospitals should prioritize harmonizing guidance on sampling sites for clearance, sexual-transmission precautions, contact quarantine durations, and PPE use; watch for data clarifying whether prolonged RNA detection equals infectiousness and for any new clusters that would stress ECMO-capable critical care resources.

Healthpolicy Watch