A cruise ship hit with a deadly hantavirus outbreak is headed for Spain's Canary Islands, where most of the nearly 150 people on board will be evacuated and flown home after weeks at sea. 

There are six confirmed cases of hantavirus so far out of eight suspected ones following the outbreak, the World Health Organization said.

'High-risk' contacts

"As of 8 May, a total of eight cases, including three deaths (case fatality ratio 38%), have been reported. Six cases have been laboratory-confirmed as hantavirus infections, with all identified as Andes virus (ANDV)," it said in a statement.

"WHO assesses the risk to the global population posed by this event as low and will continue to monitor the epidemiological situation and update the risk assessment.

"The risk for passengers and crew on the ship is considered moderate," it added.

The World Health Organization said it considered everyone on board a cruise ship hit with a deadly hantavirus outbreak as "high-risk" contacts who should be actively monitored for 42 days.

Currently, "there's nobody on board that has any symptoms," WHO's epidemic and pandemic preparedness and prevention director Maria Van Kerkhove told a social media event.

She added though that "active monitoring and follow-up of all the passengers and crew who disembark for a 42-day period" was recommended.

An island on edge

The Dutch-flagged MV Hondius is expected to reach waters off Tenerife at dawn on Sunday, with WHO chief Tedros Adhanom Ghebreyesus due to help coordinate the ship's evacuation there. 

Three passengers from the ship - a Dutch husband and wife and a German woman - have died, while others have fallen sick with the rare disease, which usually spreads among rodents.

The only hantavirus type that can transmit from person to person - the Andes virus - has been confirmed among those who have tested positive, fueling international concern. 

At the port of Granadilla de Abona in Tenerife, journalists saw white tents had been sent up along the quay. 

Despite the situation, daily life appeared largely normal: some people were swimming, others shopping at the market or sitting at cafe terraces. 

Regional authorities have refused to allow the vessel to dock. Instead, it will remain offshore while passengers are screened and evacuated between Sunday and Monday - the only window health officials say the weather will allow. 

The MV Hondius is sailing from Cape Verde, where three infected people had already been evacuated earlier in the week. 

It was expected to arrive between 0300 and 0500 GMT on Sunday, Spanish Health Minister Monica Garcia Gomez said, adding that part of the crew would remain on board as the ship continues on to the Netherlands. 

Nearest port

Before its arrival, the WHO chief was to meet Spanish  Prime Minister Pedro Sanchez in Madrid before traveling with the health and interior ministers to the archipelago later Saturday.

The WHO chief insisted the request for Spain to receive the ship "was not made arbitrarily," pointing out that under International Health Regulations, "the nearest port with sufficient medical capacity must be identified to ensure the safety and dignity of those on board."

"Nearly 150 people from 23 countries have been at sea for weeks, some of them grieving, all of them frightened, all of them longing for home," he said.

Tedros said he was traveling to Tenerife to observe the evacuation operation personally, to "stand alongside"  health workers and port staff, and to "pay my respects" to the island and its response.

"The WHO stands with you, and with every person on that ship, every step of the way," he said.

'Not another Covid'

Tedros, who arrived in Spain on Saturday, assured the people of Tenerife that the risk to them from the incoming ship was "low" and thanked them for their "solidarity."

"I need you to hear me clearly: this is not another Covid," he wrote in an open letter to the people of the Spanish island.

Tedros said he had thanked Spanish Prime Minister Pedro Sanchez personally for Spain agreeing to take on its "moral duty" and receive the ship.

"I know you are worried," Tedros wrote. "I know that when you hear the word 'outbreak' and watch a ship sail toward your shores, memories surface that none of us have fully put to rest. The pain of 2020 is still real, and I do not dismiss it for a single moment."

Tedros acknowledged that the Andes strain of hantavirus "is serious."

"Three people have lost their lives, and our hearts go out to their families," he said, stressing though that "the risk to you, living your daily life in Tenerife, is low."

"This is the WHO's assessment, and we do not make it lightly."

Step-by-step evacuation plan

An expert with the United Nations health agency was on board and had determined that currently "there are no symptomatic passengers," Tedros said.

He also highlighted that "medical supplies are in place" and stressed that Spanish authorities had prepared a "careful, step-by-step plan" for the evacuation.

According to that plan, he said, "passengers will be ferried ashore at the industrial port of Granadilla, far from residential areas, in sealed, guarded vehicles, through a completely cordoned-off corridor, and repatriated directly to their home countries."

"You will not encounter them. Your families will not encounter them."

Speaking to reporters in Madrid, Spain's health and interior ministers insisted there would be "no contact" with the local population. 

Interior Minister Fernando Grande‑Marlaska said the operation would be swift, with passengers leaving "by nationality groups."

'Unlikely adventure'

After being examined on board, they will be taken on smaller boats and transferred by bus to the airport. There, they will be flown back to their home countries, including to the United States, Britain, and France.

"All areas (the passengers) pass through will be sealed off," the interior minister said, adding a maritime exclusion zone would be in force around the vessel.

The 14 Spanish nationals on the ship will be evacuated first, Garcia Gomez added. 

Julia and Roland Seitre, a French couple aboard the cruise ship hit by a deadly hantavirus outbreak, said passengers remained calm, called their journey an "unlikely adventure", and urged against unnecessary drama.

The MV Hondius left Ushuaia, Argentina on April 1 for a cruise across the Atlantic Ocean to Cape Verde.  

Provincial health official Juan Petrina said there was an "almost zero chance" the Dutch man linked to the outbreak contracted the disease in Ushuaia based on the virus's incubation period, among other factors. 

Tracking and tracing

Health authorities in several countries have been tracking passengers who had already disembarked and anyone who may have come into contact with them.

Two Singapore residents who had been on the ship tested negative for the disease but would remain in quarantine, the city state's authorities said.

British health authorities also said there was a suspected case on Tristan da Cunha, one of the world's most isolated settlements with around 220 people. 

The United States said Friday it was organizing an evacuation flight for Americans on a hantavirus-struck cruise ship that has sailed to the Canary Islands, which are part of Spain.

"The Department of State is arranging a repatriation flight to support the safe return of American passengers on this ship," a State Department spokesperson said.

The State Department said it was coordinating with the Spanish government as well as other US federal agencies.

"We are in direct communication with Americans on board and are prepared to provide consular assistance as soon as the ship arrives in Tenerife, Spain," the spokesperson said on condition of anonymity.

The ship operator earlier said that 17 Americans were onboard. The State Department did not immediately give a number of US passengers.