'AP: Inside the Cruise Ship at the Center of the Hantavirus Outbreak'

 Footage obtained by the Associated Press of a cruise ship at the center of a rare-virus outbreak shows deserted decks and gathering areas, medical teams in protective gear, and a still landscape ahead as the vessel and its nearly 150 passengers and crew waited another day for direction and help off the coast of West Africa.

Three passengers have died and at least four people are sick in what health officials say is an outbreak of hantavirus, which usually spreads by inhaling contaminated rodent droppings. The World Health Organization (WHO) said passengers are isolating in their cabins and that the vessel -- in the Atlantic off Cape Verde -- might be moved to Spain's Canary Islands. But Spanish officials said Tuesday that they were monitoring the situation and haven't made a decision.

Maria Van Kerkhove, PhD, the WHO's director of epidemic and pandemic preparedness, said that WHO is investigating possible human-to-human transmission on the ship, and that officials suspect the first infected person likely contracted the virus before boarding. She said officials have been told there are no rats on board.

The MV Hondius, a Dutch ship on a weeks-long polar cruise, departed April 1 from Argentina for Antarctica and several isolated islands in the South Atlantic.

"Our days have been close to normal, just waiting for authorities to find a solution," passenger Qasem Elhato, 31 -- who sent AP the video footage -- said via WhatsApp. "But morale on the ship is high and we're keeping ourselves busy with reading, watching movies, having hot drinks, and that kind of things."

Helene Goessaert, another passenger, told Belgian broadcaster VRT that everyone onboard is "in the same boat, literally."

"You don't embark on a trip with the idea that one of your fellow passengers won't make it," she said.

"We receive information at regular intervals. It is accurate. For the rest, it is a waiting game," she added. "Today we received fresh fruit and fresh vegetables. That was very important to us."

Evacuation Plans Remain to Be Seen

Authorities in Cape Verde sent teams of doctors, surgeons, nurses, and laboratory specialists to provide the vessel with medical support. They were seen in Elhato's video footage -- wearing white overalls, boots, and face masks as they disembarked to a smaller vessel.

Officials in Cape Verde's capital of Praia, a city of less than 200,000 people, said they have stepped up safety protocols, particularly near the port, as a precautionary measure against the rodent-borne illness.

Elhato said passengers were wearing masks and social distancing -- practices that became hallmarks of the early days of the COVID-19 pandemic. Ship operator Oceanwide Expeditions said it had implemented its highest level of response plan, with isolation measures, hygiene protocols, and medical monitoring.

Oceanwide Expeditions said Tuesday evening that two specialized aircraft were flying to Cape Verde to evacuate two people who need urgent medical care and one person who was traveling with a German woman who died on board Saturday. They were to be taken to the Netherlands, though exactly when that would happen was not immediately clear.

Once the medical evacuation happens, the ship plans to sail to the Canary Islands, either Gran Canaria or Tenerife, a voyage of some 3 days, the company said in its statement, adding that "discussions are ongoing with relevant authorities."

Spanish health officials had said in an earlier statement that they were monitoring and that "the most appropriate port of call will be decided. Until then, the Ministry of Health will not adopt any decision, as we have informed the World Health Organization."

The Situation Is Under Careful Monitoring

The ship left Ushuaia in southern Argentina on April 1, according to Argentine provincial authorities.

Officials in Argentina -- where hantavirus led to 28 deaths nationwide last year, according to the health ministry -- said they confirmed no passengers had symptoms when the Hondius departed. Symptoms can appear up to 8 weeks after exposure, officials have said.

The WHO said Monday night that, as of then, no new people on the ship had shown symptoms of the virus, but the situation is being "carefully monitored" for further developments.

"The outbreak is being managed through coordinated international response, and includes in-depth investigations, case isolation and care, medical evacuation, and laboratory investigations," the WHO has also said.

https://www.medpagetoday.com/infectiousdisease/generalinfectiousdisease/121113

Bariatric Surgery Procedures Fall Below 200,000, First Time Since 2020

 The number of metabolic and bariatric surgery procedures in the United States dropped below 200,000 in 2024 for the first time since 2020, a more than 20% decline from the prior year, according to new research presented today at the annual scientific meeting of the American Society for Metabolic and Bariatric Surgery (#ASMBS2026).

Researchers from Loyola University in Chicago based their 2020-2024 estimates after review of the American College of Surgeons Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (ACS-MBSAQIP) database, which includes reported outcomes from all MBSAQIP-accredited bariatric centers.

Year	Total Cases	Sleeve, n (%)	RYGB, n (%)	Band, n (%)	BPD-DS, n (%)	SADI, n (%)	OAGB, n (%)	Other, n (%)
2020	168,228	108,260 (64.35)	47,846 (28.44)	1,002 (0.60)	2,070 (1.23)	488 (0.29)	1,338 (0.80)	7,224 (4.29)
2021	210,811	134,637 (63.87)	61,031 (28.95)	1,102 (0.52)	2,760 (1.31)	841 (0.40)	943 (0.45)	9,497 (4.51)
2022	230,207	145,005 (62.99)	69,159 (30.04)	1,081 (0.47)	3,634 (1.58)	1,338 (0.58)	903 (0.39)	9,087 (3.95)
2023	217,387	133,550 (61.43)	67,461 (31.03)	732 (0.34)	3,102 (1.43)	1,963 (0.90)	457 (0.21)	10,122 (4.66)
2024	177,297	103,452 (58.35)	58,183 (32.82)	505 (0.28)	2,255 (1.27)	2,670 (1.51)	232 (0.13)	10,000 (5.64)

“After years of steady growth, the number of metabolic and bariatric procedures in the U.S. is experiencing a decline amid persistently high obesity rates and a surge in the use of GLP-1 medications,” said lead study author Tyler Cohn, MD, Associate Professor at Loyola University Medical Center. “While we did not study causation, the concern is that many patients are selecting non-surgical therapies for obesity without fully understanding all of their available options. Millions more are living with obesity and are not receiving treatment at all.”

Beyond the overall recent decline, the study found meaningful shifts in the types of operations being performed. Between 2020 and 2024, sleeve gastrectomy, long the dominant procedure, fell from 64% of all surgeries to 58%. Gastric bypass increased from 28.44% to 32.82%, its highest share of procedures in five years. Conversions, or revisions or modifications of prior surgeries, rose from about 9% in 2020 to 11% in 2024.

Other bariatric procedures, including gastric banding, biliopancreatic diversion with duodenal switch (BPD/DS), single anastomosis duodeno-ileal bypass (SADI) and one anastomosis gastric bypass (OAGB), each accounted for less than 2% of procedures.

“GLP-1s are starting a conversation in doctors’ offices that really wasn’t happening as much as it should have been,” said Richard M. Peterson, MD, MPH, FASMBS, President, ASMBS and Professor of Surgery at UT Health San Antonio, who was not involved in the study. “The high demand for these drugs and greater attention on the dangers of obesity has created an unprecedented opportunity to educate and engage patients on all proven treatments, not just medications, which is essential to effectively treating this chronic disease.”

According to ASMBS, less than 1% of people eligible for metabolic and bariatric surgery currently get it in any given year. More than 270,000 procedures were performed in the U.S. in 2023, the latest estimates available. ASMBS estimates are based on multiple datasets including the MBSAQIP database used in this study.

Metabolic and bariatric or weight-loss surgery, such as gastric bypass and sleeve gastrectomy, have been shown to be the most effective and long-lasting treatment for severe obesity. The operations improve or resolve diseases including type 2 diabetes, heart disease and high blood pressure and lead to significant and durable weight loss. It has a safety profile comparable to some of the safest and most commonly performed surgeries in the U.S., including gallbladder surgery, appendectomy and knee replacement.

*EXAMINING TRENDS IN THE DECLINE OF BARIATRIC SURGERY – AN MBSAQIP ANALYSIS

Rachel Ferguson Loyola University Chicago; Mason Friesch Loyola University Chicago; Irena Helenowski Loyola University Medical Center; Laura Wool Loyola University Medical Center; Monica Edwards Loyola University Medical Center; Kevin Brown Loyola University Medical Center; Tyler Cohn Loyola University Medical Center — Abstract ID: 4730

https://asmbs.org/news_releases/bariatric-surgery-procedures-fall-below-200000-first-time-since-2020-new-research-finds/

Study Raises Questions About Effects, Risks of Drugs for Geographic Atrophy

 An analysis of real-world data suggested that use of complement inhibitors to treat geographic atrophy (GA) is associated with an increase in incidence of exudative age-related macular degeneration (eAMD) and progression to subfoveal GA.

Patients treated for a year had a roughly fourfold increased risk of developing eAMD as compared with a control group and more than a twofold higher risk of progression to subfoveal GA. The hazard for low vision or blindness was increased with pegcetacoplan (Syfovre) and avacincaptad pegol (Izervay) but reached statistical significance only for the latter drug. Intraocular inflammation rarely occurred, and the data suggested no increased risk of systemic adverse events.

The findings highlight the need for additional studies to determine more clearly the risks and benefits of the drugs, said David Ramsey, MD, PhD, of the University of Massachusetts Chan Medical School in Burlington, at the Association for Research in Vision and Ophthalmology meeting.

"In the population we studied, there was no evidence of any benefit on progression towards subfoveal GA during the 1-year follow-up period," said Ramsey.

Based on data from the TriNetX clinical network, the study had multiple limitations, Ramsey acknowledged, including:

• Limitations inherent to the retrospective, observational design
• The potential for residual confounding despite propensity matching
• Potential selection bias for treatment
• Limited patient-level data
• Variable data quality and completeness
• Limited ophthalmic data, such as imaging and other vision assessments

Ramsey also pointed to limitations associated with reliance on diagnostic codes.

"The outcomes rely exclusively upon the coding accuracy of the clinicians who contribute data to this repository, and there are very broad definitions for our outcomes, so with this heterogeneous group we may mis-estimate the outcomes," he said. "The coded GA population likely underestimates the true disease burden and may not really reflect the full spectrum of GA severity. Treatment patterns were very likely influenced by access and early adoption of the drugs."

Session moderator Philip Rosenfeld, MD, PhD, of the University of Miami Bascom Palmer Eye Institute, wasted no time in questioning the reliability of the data.

"Can this data be believed?" he asked. "I ask you that because clinicians are notoriously bad in making the diagnosis simply of subfoveal, non-subfoveal. More importantly, you don't know what they were using to diagnose the wet age-related macular degeneration."

Rosenfeld referred to an ARVO poster presentation showing that treatment with pegcetacoplan increases exudation "that can be easily misdiagnosed if you're using an OCT [optical coherence tomography]-only approach to the diagnosis of macular neovascularization. It goes away if you extend the interval from 4 to 8 weeks."

"So this is pretty suspect," he added. "The only way you could even attempt to make this relevant to the real world is to see how it compares to clinical trial data. I believe that those numbers [in the study] align very well to published clinical trial data, but we don't know that because you didn't show any comparison to published clinical trial data."

Ramsey agreed that including data from published clinical trials would have been helpful.

Approved in 2023, pegcetacoplan and avacincaptad pegol slow GA lesion growth, but the drugs' ability to slow vision loss in patients with late-stage AMD has not been established, Ramsey noted in his introduction. Functional outcomes in clinical trials varied. Anatomical benefits may not translate into gains in visual acuity, and "persistent structure-function disconnect has been debated by many," he said.

Injection burden, need for long-term treatment and follow-up, and need for imaging studies all have implications for patient counseling.

"When we counsel patients about these medications, we need to set expectations," he said. "There are, of course, issues related to cost, coverage, travel, time burden, and, from the vitreoretinal specialist perspective, clinic flow."

Ramsey and colleagues wanted to evaluate utilization patterns of the two drugs in a clinical population with GA. Objectives included studying associations between clinical use and progression to subfoveal GA, new-onset low vision, incident eAMD, and other ocular adverse events.

The investigators queried the TriNetX database to identify patients with GA treated or not treated with complement inhibitors. Eligible patients had at least 1 year of follow-up. The investigators identified 576 patients treated with either of the two complement inhibitors and a propensity-matched cohort of 576 patients with GA not treated with either drug. None of the patients had a history of eAMD documented by an ICD code.

The 576 patients treated with a complement inhibitor had a median age of 80.6, and women accounted for 66% of the group. Sixty-eight percent of the patients were treated with pegcetacoplan. Two-thirds of the patients continued treatment, and 3.3% switched drugs during treatment.

Overall, the analysis showed a hazard ratio of 4.05 for eAMD (95% CI 2.04-8.05, P<0.001) versus the control population, 2.49 for progression to subfoveal GA (95% CI 1.45-4.27, P=0.001), and 1.80 for low vision or blindness (95% CI 1.05-3.11, P=0.032). Use of complement inhibitors was associated with an increased risk of uveitis and intraocular inflammation (HR 3.04, 95% CI 1.08-8.55, P=0.027) but not glaucoma/ocular hypertension or retinal detachments/breaks. Endophthalmitis and vascularis occurred infrequently.

Results were similar for the individual drugs with the exception of development of low vision/blindness, which did not reach statistical significance for pegcetacoplan (HR 1.63, 95% CI 0.81-3.25) but did for avacincaptad pegol (HR 6.89, 95% CI 1.96-24.2, P=0.001).

Rates of cardiovascular complications were similar between the study and control groups.

Disclosures

Ramsey disclosed relationships with Regeneron and Beaver-Visitec International.

Rosenfeld reported no relevant financial disclosures.

Primary Source

Association for Research in Vision and Ophthalmology

Source Reference: Ramsey DJ, et al "Risk of exudative age-related macular degeneration and progression to subfoveal geographic atrophy with complement inhibitors" ARVO 2026; Abstract 1843.

https://www.medpagetoday.com/meetingcoverage/arvo/121123

Home-Based Neuromodulator Shows Promise for Suppressing Ventricular Arrhythmias

 

• A device for home-based stellate ganglion phototherapy (SGP) was used daily for managing ventricular arrhythmia in 28 Japanese patients.
• The number of antitachycardia pacing or ICD shocks fell to a median zero events during a month of at-home SGP therapy.
• While one in four individuals reported a warm sensation at the irradiation site during portable SGP, there were no burns or any adverse events requiring treatment.

Home-based daily neuromodulation was feasible for managing ventricular arrhythmia, and it produced good preliminary results at one Japanese center.

A portable device for stellate ganglion phototherapy (SGP), the Super Lizer mini, was used every day by 28 patients who'd experienced antitachycardia pacing (ATP) or implantable cardioverter-defibrillator (ICD) shocks 1 month prior. The number of ATPs or ICD shocks was significantly reduced during the first month of daily at-home SGP therapy (median 0 vs 3.9, P<0.01), reported Yuki Komatsu, MD, PhD, of the University of Tsukuba in Japan, and colleagues in Circulation.

All patients were able to apply SGP appropriately by themselves, and they stayed on this therapy for a median 57 days in the study. While a quarter of the individuals reported a warm sensation at the irradiation site during portable SGP, there were no burns or any adverse events requiring treatment.

"Daily SGP requires neither hospitalization nor specialized skills from healthcare professionals while demonstrating favorable monthly effectiveness in suppressing ventricular arrhythmic burden. Therefore, this therapy has the potential to expand its clinical implementation in outpatient settings, distinguishing itself from conventional neuromodulation therapies," the authors wrote.

The portable SGP device emits near-infrared light as a noninvasive autonomic neuromodulation strategy for suppressing ventricular tachycardia (VT) events. This sets it apart from other neuromodulation techniques requiring a clinic visit (e.g., stellate ganglion block, spinal cord stimulation).

"Notably, this study supports that daily SGP may serve as a practical and effective treatment option for patients with VTs who require skill-dependent treatments but face social or physical barriers to accessing highly experienced institutions," according to Komatsu and colleagues.

Their single-center retrospective study included 28 consecutive patients with VT who underwent daily portable SGP between January 2023 and June 2025.

The cohort had a mean age of 66.6 years and was 78.6% men. The group was split between the 39.3% with single- or dual-chamber transvenous ICDs and the remainder with cardiac resynchronization therapy defibrillators. Roughly one in seven had ischemic cardiomyopathy.

Implantable device electrograms demonstrated monomorphic VT in 92.9% of the patients, the remainder showing polymorphic VT.

Oral antiarrhythmic medications used included beta-blockers (92.9%), amiodarone (46.4%), and sotalol (32.1%). Most people (64.3%) had previously undergone at least one catheter ablation procedure. Median serum BNP was 176.5 pg/mL and left ventricular ejection fraction was 37.0%.

Patients applied the portable SGP bilaterally at home for 10 minutes on each side of the neck with high or medium output level while in a sitting or supine position.

During their time using the SGP device, no patient underwent radiofrequency catheter ablation or a change or escalation in antiarrhythmic medications, according to Komatsu and colleagues.

"However, given the retrospective observational design, our findings are limited by the lack of compliance data, nonstandardized device programming, short pre-SGP and post-SGP assessment periods, uncertainty regarding which cervical neural structures were modulated, potential confounding from concurrent change in guideline-directed medical therapy, and possible placebo effect," the authors cautioned.

"Further prospective investigations are warranted to establish [at-home SGP's] effectiveness, reproducibility, and optimal role in the therapeutic armamentarium for outpatient ventricular arrhythmia management," they wrote.

Disclosures

Study devices were purchased by an industry-supported university research department; a portion of the devices were temporarily used as free-of-charge units provided by Tokyo Iken.

Komatsu reported honoraria from Abbott, Johnson & Johnson, and Japan Lifeline.

Co-authors disclosed relationships with Toray Industries, Medtronic, Abbott Medical, Japan Lifeline, Boston Scientific, Astec, DVX, Biotronik, Johnson & Johnson, and Boehringer Ingelheim.

Primary Source

Circulation

Source Reference: Harano Y, et al "Daily stellate ganglion phototherapy for ventricular arrhythmias: a noninvasive neuromodulation approach for outpatient care" Circulation 2026; DOI: 10.1161/CIRCULATIONAHA.125.078175.

https://www.medpagetoday.com/cardiology/arrhythmias/121126

Hantavirus That Can Spread Between Humans May Be Involved in Cruise Ship Outbreak

 Infectious disease specialists suspect that Andes virus, a type of hantavirus that causes cardiopulmonary syndrome, is responsible for an outbreak aboard a small cruise ship that has killed three people and potentially infected at least four others.

Andes virus, which is found in Argentina and other South American countries, has been shown to transmit from person to person.

"I think it's likely that this is going to turn out to be Andes virus and there may have been a cluster of human-to-human transmission," James Lawler, MD, MPH, of the University of Nebraska Medical Center's Global Center for Health Security in Omaha, told MedPage Today.

Aneesh Mehta, MD, of Emory University in Atlanta and the National Emerging Special Pathogens Training and Education Center (NETEC), agreed that Andes virus is likely, given the number of severe cases and the cruise origination in Argentina. That raises alarms about broader spread of the virus, he said.

"The case fatality rate is quite high, and quite impactful on healthcare systems trying to care for these individuals because they're very sick and progress to death quickly," Mehta told MedPage Today.

An outbreak of Andes virus in Argentina that ran from November 2018 through February 2019 resulted in 34 confirmed infections and 11 deaths, according to a report in the New England Journal of Medicine. There was a single introduction of Andes virus from a rodent reservoir into humans, and then transmission was driven by three symptomatic people who attended crowded social events.

That virus was similar to the strain involved in the first person-to-person transmission of hantavirus cardiopulmonary syndrome caused by Andes virus, which occurred in Argentina in 1996, researchers reported.

Several other instances of human-to-human transmission, mostly in Argentina but also in Chile, have been reported in the literature.

Lawler noted that it's possible that cruise ship guests "all could have been infected at one event, before the ship got underway, and these are all just cases from a single point source," which is why an epidemiological investigation is critical. However, "if there are multiple generations of cases, waves of cases, then that makes it more likely that there was human-to-human transmission," he added.

Seven Cases

The WHO reported that epidemiological investigations are underway to determine the source of exposure. The ship -- the MV Hondius, operated by Dutch company Oceanwide Expeditions -- was denied permission to dock in Cape Verde on Monday. Passengers are isolated in their cabins.

On Monday night, the WHO reported a total of seven cases -- two lab-confirmed cases of hantavirus and five suspected cases -- including three deaths, one critically ill patient, and three people reporting symptoms. Illness onset began April 6-28 and was characterized by fever, gastrointestinal symptoms, rapid progression to pneumonia, acute respiratory distress syndrome, and shock.

The ship had departed Ushuaia, Argentina, on April 1 with 147 passengers including crew, stopping at several remote islands including the Falkland Islands, the British Overseas Territory of Saint Helena, Ascension Island, and Tristan da Cunha.

According to the WHO and South African health officials, the first patient was a 70-year-old man who died on board on April 11. His 69-year-old wife collapsed at the O.R. Tambo International Airport near Johannesburg, South Africa, and died at a local hospital on April 26. The couple had traveled in South America, including Argentina, before they boarded the ship.

A third patient, a British national, was medically evacuated to South Africa on April 27, where he remains in critical condition and in isolation.

A fourth patient, a woman with pneumonia, died on May 2, with symptoms beginning on April 28.

Three other suspected cases have reported high fever and/or gastrointestinal symptoms and remain on board, where they are being evaluated by medical teams and having additional samples collected for testing.

Other Hantaviruses

Another type of hantavirus that causes cardiopulmonary syndrome is Sin Nombre virus, which is found in North America and is particularly common in the Four Corners region of the U.S. Late actor Gene Hackman's wife died in 2025 of a hantavirus infection.

Other hantaviruses can cause hemorrhagic fever with renal syndrome (HFRS), including Seoul virus, which is found in wharf rats in port cities around the world, Lawler said.

The virus affecting the cruise ship is unlikely to be Seoul virus, but if it was, it "might change your thought process" in an epidemiological investigation, he added. "There's not known human-to-human transmission of Seoul virus, so you'd have to think that maybe this was a continuing source that might be on the ship that was infecting multiple people," such as a rodent infestation, he said.

Hantaviruses are primarily acquired through contact with the urine, feces, or saliva of infected rodents or by touching contaminated surfaces. Symptoms typically occur 2 to 4 weeks after exposure, but may appear as early as 1 week or as late as 8 weeks after exposure, according to WHO.

Mehta said NETEC is disseminating targeted communications to healthcare workers about how to recognize hantavirus infections, how to prepare healthcare staff and hospitals for potentially receiving patients, and how to treat patients. A total of 17 passengers on the ship are American.

Treating Hantavirus

Mehta noted there are 13 facilities in the U.S. that are designated level 1 regional emerging special pathogen treatment centers that can provide highly specialized care, along with dozens of level 2 centers that can care for additional patients. There's also a national program for monitoring exposed individuals once they return to the U.S., so that they can get appropriate care quickly if needed.

There's no specific treatment for hantavirus; it's just best supportive care, Lawler said. It "focuses on keeping folks oxygenated, usually intubating them and putting them on a ventilator."

"You get heart failure and fluid backing up into the lungs, so if you can put people on positive pressure ventilation and you can support their heart function and try to reduce the impact of the fluid buildup that impedes gas exchange in their lungs, then you can keep the person going until their immune system clears the infection, and their immune dysregulation calms down," he explained.

The WHO noted that given the rapid progression of hantavirus cardiopulmonary syndrome, "close monitoring and early transfer to ICU are critical for more severe cases."

There's no antiviral approved for the condition, WHO said. While ribavirin has shown efficacy against HFRS, it hasn't shown any effectiveness for hantavirus cardiopulmonary syndrome.

Lawler said that, at this stage, it's likely the State Department in coordination with the CDC and the Administration for Strategic Preparedness and Response at HHS are starting to plan contingencies for managing exposed or ill Americans.

"It's helpful to be cautious at this stage, but you also need to make sure that the passengers on board are safe and being taken care of, that anybody needing medical attention is receiving it," Lawler said. "That's one of the most important first priorities, then it's understanding what you're dealing with."

https://www.medpagetoday.com/infectiousdisease/generalinfectiousdisease/121112