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Revisiting Animal Reservoirs of Hantavirus and Other Zoonotic Viruses on Cruise Ships: Impact and Prevention

Submitted:

02 August 2026

Posted:

03 August 2026

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Abstract
The sustained growth of international maritime tourism and the expansion of the cruise industry have increased the importance of emerging zoonotic diseases as a significant challenge to global public health. Cruise ships constitute complex epidemiological settings characterized by high population density, rapid international mobility, and constant interaction between humans, animals, and coastal environments, factors that favor the introduction and spread of emerging infectious agents. Among the main threats are hantaviruses and other zoonotic viruses, such as dengue, chikungunya, Zika, yellow fever, and avian influenza, which are associated with animal reservoirs and vectors present in ports, tourist destinations, and tropical ecosystems. This review examines the ecology of animal reservoirs of hantaviruses and other zoonotic pathogens relevant to maritime tourism, including peri-urban rodents, bats, migratory birds, and other mammals. It discusses the impact of climate change, coastal urbanization, and environmental change on viral transmission dynamics. Epidemiological risks linked to international cruises are highlighted, particularly exposure during ecotourism excursions, pathogen introduction, and challenges for maritime surveillance. The review also addresses travel medicine, biosecurity, and infection control, emphasizing a One Health approach. Strengthening integrated surveillance and prevention systems is essential to ensure safer, more sustainable, and resilient maritime tourism in the 21st century.
Keywords: 
hantavirus
;  
viral zoonoses
;  
international cruises
;  
One Health
;  
travel medicine
Subject: 
Medicine and Pharmacology  -   Other

Introduction

The sustained expansion of international maritime tourism over the past few decades has transformed cruise ships into one of the most dynamic sectors of the global tourism industry [1]. Before the COVID-19 pandemic, millions of passengers traveled annually on vessels connecting multiple continents, ports, and ecosystems in relatively short periods. In fact, global cruise passenger numbers reached approximately 29.7 million in 2019, reflecting the scale and international reach of the cruise industry before the pandemic [2]. While the pandemic highlighted the vulnerability of cruise ships to respiratory and highly transmissible infectious diseases, it also underscored the need to expand surveillance to other emerging infectious agents, particularly those of zoonotic origin, in line with One Health approaches to pandemic preparedness [3]. In this context, cruise ships represent complex environments where high population density, international mobility, environmental exposure, and indirect contact with animal reservoirs and vectors converge, creating conditions conducive to the introduction and dissemination of emerging and re-emerging viruses [4].
Among the viral zoonoses of increasing importance are hantaviruses, a group of RNA viruses belonging to the Hantaviridae family, maintained mainly in reservoirs of wild and peri-urban rodents [5]. These infections can produce severe clinical pictures, including hantavirus cardiopulmonary syndrome and hemorrhagic fever with renal syndrome, both associated with high morbidity and mortality [6]. Although hantaviruses have traditionally been linked to rural areas and agricultural activities, urban expansion, environmental alteration and increasing human mobility have created new opportunities for interaction between humans and rodent reservoirs, extending potential exposure to peri-urban environments, transport hubs, storage facilities and tourism-related settings [7,8]. Particularly relevant is the role of the Seoul virus, associated with rats of the genus Rattus, widely distributed in port cities and commercial vessels around the world [9].
The close ecological association between urban rats and maritime infrastructure makes Seoul virus particularly relevant in international shipping and cruise-related environments [10]. The historical role of maritime trade in the global dissemination of Rattus species may also contribute to the worldwide circulation of this hantavirus in port ecosystems [11].
In addition to hantaviruses, other zoonotic viruses pose significant threats to passengers and crews on international cruise ships. Arboviruses such as dengue, chikungunya, Zika, and yellow fever continue to spread in tropical and subtropical regions highly frequented by maritime tourism [12]. Likewise, emerging viruses associated with bats, migratory birds, and other mammals have become increasingly important due to the increase in ecotourism and excursions in jungle, coastal, or island areas [13]. The interaction between susceptible travelers, biodiverse ecosystems, and environmental changes favors increasingly complex transmission scenarios, especially in the context of climate change, coastal urbanization, and the expansion of maritime routes into new ecological areas [14,15,16].
From a One Health perspective, cruises are dynamic interfaces where human, animal, and environmental health converge [17]. Epidemiological surveillance in these scenarios requires multidisciplinary approaches that integrate traveler's medicine, maritime public health, reservoir ecology, vector control, and environmental monitoring [18]. However, despite the growing relevance of viral zoonoses in international tourism, there is limited conceptual and operational integration on the role of animal reservoirs in the epidemiology of cruise ship-associated infections [19].
The present review aims to analyze the ecology and diversity of animal reservoirs involved in hantaviruses and other zoonotic viruses relevant to maritime tourism, and to discuss epidemiological risks, prevention strategies, and future perspectives from a One Health approach. In addition, the implications for traveler's medicine, maritime biosecurity, and preparedness for future emerging infectious threats on international cruise ships are reviewed.

Ecology and Diversity of Animal Reservoirs of Hantavirus and Other Zoonotic Viruses Relevant to Cruise Ships

The ecology of animal reservoirs plays a fundamental role in the emergence and re-emergence of zoonotic viruses, as reservoir distribution, population dynamics and host–pathogen interactions strongly influence spillover risk in environments characterized by intense human mobility, including maritime tourism and international travel [20,21,22]. Environmental changes, the expansion of human mobility and the growing interaction between natural ecosystems and tourism activities have favored complex scenarios of viral transmission in coastal regions, ports and highly visited islands [23]. In this context, multiple animal species act as natural reservoirs or amplifiers of emerging viruses, facilitating the circulation of infectious agents with potential impact on passengers, crews and port communities [24].
Wild and peri-urban rodents are the main reservoirs of hantaviruses, RNA viruses belonging to the Hantaviridae family [25]. Each species of hantavirus is usually associated with specific hosts, mainly rodents of the families Muridae and Cricetidae [7]. In Asia and Europe, viruses related to hemorrhagic fever with renal syndrome predominate, while in the Americas, hantaviruses associated with hantavirus cardiopulmonary syndrome stand out [6]. Of particular importance is the Seoul virus, due to its association with urban rats of the genus Rattus, especially Rattus norvegicus and Rattus rattus, widely distributed in seaports, cargo terminals, warehouses, and commercial vessels [26]. These species have a remarkable capacity to adapt to urban and maritime environments, favoring viral persistence and international dispersal through trade routes and maritime transport [27,28].
The remarkable adaptability of these rodents to ships, cargo terminals, food storage facilities, and urban coastal environments facilitates long-term viral maintenance in maritime ecosystems [29]. In addition, rodent infestations associated with waste accumulation and port infrastructure deterioration may increase opportunities for indirect human exposure to contaminated excreta [30].
Cruise ships and tourist ports offer favorable conditions for the proliferation of rodents due to the availability of food, organic waste, and closed structures that facilitate shelter and reproduction [31,32]. Although cases of hantavirus directly associated with cruise ships are rare, the persistent presence of infected reservoirs in port areas poses a potential risk of exposure, particularly during logistics operations, food storage, and visits to destinations with high rodent infestation [28]. Likewise, disorderly urban sprawl and health deterioration in some coastal regions have increased the interaction between humans and peri-urban reservoirs [33,34].
In addition to rodents, other mammals and vertebrates play an important role in the epidemiology of emerging viral zoonoses linked to maritime tourism [13]. Bats have become especially important as reservoirs of various RNA viruses, including coronaviruses, filoviruses, paramyxoviruses, and lyssaviruses [35]. Their extraordinary biological diversity, wide geographical distribution, and flight capacity facilitate the dispersal of pathogens in multiple island and coastal ecosystems [36]. In tropical tourist destinations and ecotourism excursions, indirect contact with caves, forests, and bat habitats can increase the risk of viral exposure [37]. The growing interest in ecotourism activities in caves, nature reserves, and jungle areas visited during cruise itineraries has expanded human-wildlife interfaces.
Migratory birds also represent reservoirs and dispersal vehicles for important zoonotic viruses, especially avian influenza viruses [38]. Migratory routes connect continents and marine ecosystems, allowing the introduction of viral strains into ports, wetlands, and coastal areas frequented by tourists [39]. Outbreaks of highly pathogenic avian influenza have demonstrated the ability of these viruses to spread globally through migratory movements, trade, and human activities [40]. In maritime scenarios, the interaction between wild birds, port facilities, and coastal urban environments favors opportunities for interspecific transmission [41,42].
On the other hand, non-human primates and other wild mammals play an important role in the ecology of arboviruses such as Yellow Fever, particularly in jungle regions of South America and Africa [43,44]. Cruises that include excursions to tropical forests, natural parks, or ecological reserves can increase the risk of exposure to mosquito vectors and animal reservoirs [45]. Similarly, other emerging zoonotic viruses, including orthopoxviruses and emerging arboviruses, have been related to wild mammals in ecosystems altered by human and tourist activities [46,47].
The geographical distribution of these reservoirs reflects their ecological and biogeographical constraints; however, global connectivity through international maritime transport and cruise tourism may facilitate the movement of infected hosts and vectors, as well as the introduction of synanthropic reservoir species in port environments, thereby linking distant endemic regions through anthropogenic mobility networks [48,49]. Tropical islands are particularly vulnerable ecosystems, where the introduction of invasive species, such as rodents, can profoundly alter ecological dynamics and facilitate the transmission of zoonotic pathogens [50]. In addition, the increase in tourism in polar and subpolar regions has raised concerns about the introduction of infectious agents into previously isolated ecosystems [51,52].
Climate change is one of the main factors that modify the dynamics of transmission of zoonotic viruses in maritime and coastal environments [53]. The global increase in temperatures, alterations in precipitation patterns, and the greater frequency of extreme weather events directly influence the distribution of reservoirs and vectors [54]. These changes favor the geographic expansion of arbovirus-transmitting mosquitoes, alter the reproductive cycles of rodents, and modify the migrations of wild birds [55,56,57]. Climate phenomena such as El Niño-Southern Oscillation have been associated with rodent population increases and hantavirus outbreaks in different regions [58,59]. At the same time, deforestation, coastal urbanization, and loss of biodiversity generate ecological imbalances that increase the opportunities for contact between humans and infected wildlife [60].
From the perspective of One Health, maritime and coastal scenarios constitute dynamic interfaces where human, animal and environmental factors converge that favor the emergence of viral zoonoses [61]. Ports, cruise terminals and tourist destinations function as nodes of ecological and epidemiological interaction where global mobility facilitates the introduction and dispersion of pathogens between continents [62,63]. In these contexts, integrated surveillance should incorporate animal reservoir monitoring, vector control, environmental surveillance, and early detection systems in travelers and crews [64]. Likewise, cooperation between health authorities, environmental sectors, the shipping industry, and specialists in travel medicine is essential to strengthen preparedness against future zoonotic threats associated with international maritime tourism [65,66]. The main animal reservoirs, transmission pathways, and ecological characteristics of zoonotic viruses relevant to aritime tourism are summarized in Table 1.

Epidemiological Risks of Viral Zoonoses on International Cruises

International cruises represent particularly complex scenarios for the transmission of infectious diseases due to the simultaneous interaction of epidemiological, environmental, and social factors [67]. The combination of high population density, accelerated global mobility and contact with multiple ecosystems makes these vessels favorable spaces for the introduction, amplification and dispersion of emerging zoonotic viruses [19]. Although historically health care on cruise ships has focused on gastrointestinal and respiratory diseases, in recent years there has been increased concern about viral zoonoses associated with animal reservoirs and vectors present in tropical tourist destinations and international ports [68].
One of the main factors that facilitates the transmission of infectious diseases on cruise ships is the inherent overcrowding of this mode of transport, as thousands of passengers and crew share relatively confined spaces for extended periods, including restaurants, theaters, swimming pools, gyms, and recreational areas [69]. These conditions facilitate close contact and the transmission of infectious agents, especially when there is high turnover among travelers from different continents [70]. The global experience during the COVID-19 pandemic evidenced the epidemiological vulnerability of cruise ships as environments that amplify infectious outbreaks [71]. However, beyond respiratory viruses, these conditions can also favor the late detection and spread of viral zoonoses acquired during port calls or tourist excursions [62].
Among the viral zoonoses of greatest relevance for maritime travelers are hantaviruses, mainly associated with wild and peri-urban rodents present in ports and coastal destinations [66]. Although cases directly related to cruise ships are rare, the potential risk of exposure exists during visits to rural areas, food storage, or indirect contact with environments contaminated by infected rodent droppings [72]. Particularly important is the Seoul virus, linked to urban rats widely distributed in port facilities and commercial vessels [73]. The ability of these rodents to colonize maritime environments makes international ports strategic points for the circulation and dispersion of hantavirus [74]. Due to the nonspecific clinical manifestations of hantavirus infections and the limited epidemiological surveillance routinely available in many maritime and port settings, Seoul virus infections may remain underrecognized among travelers, port workers, and maritime personnel, further complicating early detection and control efforts [75].
The unprecedented 2026 outbreak aboard the expedition cruise ship M/V Hondius represents the first documented cruise-ship-associated cluster of Andes virus (ANDV) infection. The vessel departed Ushuaia, Argentina, on 1 April 2026 and followed an itinerary through Antarctica and several remote South Atlantic islands. Ultimately, 13 cases were identified, 12 laboratory-confirmed and one probable, including three deaths, corresponding to a case-fatality ratio of 23%. Although the precise zoonotic source was not identified, epidemiological and genomic evidence suggested that the initial infection was probably acquired on land before embarkation, followed by limited human-to-human transmission aboard the vessel. Thus, the event should not be interpreted simply as evidence of an infected rodent population established on board; rather, it demonstrates how a zoonotic infection acquired at a terrestrial human–rodent interface can be amplified by prolonged close contact within a confined, highly mobile population. The response required medical evacuations, international laboratory coordination, and contact tracing in 33 countries and territories, including 42-day quarantine and monitoring of high-risk contacts. No additional secondary cases were detected, and WHO declared the outbreak contained on 2 July 2026 [76,77].
On the other hand, mosquito-borne arboviruses pose a growing threat to cruise ship passengers and crews; in this context, dengue remains one of the main infectious disease risks in tropical regions visited by maritime tourism, particularly in the Caribbean, Latin America, and Southeast Asia [78]. The geographic expansion of Aedes aegypti and Aedes albopictus, driven by climate change and urbanization, has increased dengue incidence in many tourist destinations. Similarly, Chikungunya and Zika Virus Disease have caused major epidemics in areas frequented by international cruise ships, affecting both residents and travelers [79,80]. The ability of these viruses to cause explosive outbreaks and the possibility of transmission among asymptomatic travelers pose significant challenges for maritime health surveillance.
Yellow fever remains a significant concern in certain regions of Africa and South America [81]. Excursions to endemic jungle areas can expose unvaccinated passengers to infected mosquitoes and jungle reservoirs, especially non-human primates [82,83,84]. Likewise, the ongoing emergence and re-emergence of arboviruses pose new challenges for travel medicine and biosecurity on cruise ships. Other zoonotic viruses of interest include avian influenza associated with migratory birds and coastal environments, emerging orthopoxviruses, and respiratory viruses with pandemic potential [85].
Historical evidence shows that shipping and international tourism have contributed to the global spread of infectious diseases. Various outbreaks of influenza, coronavirus, and vector-borne diseases have been linked to maritime travel and international mobility [86,87,88,89,90]. During the COVID-19 pandemic, multiple cruise ships experienced extensive outbreaks that highlighted the limitations of onboard health surveillance and response systems [69,91,92]. Although most events reported on cruise ships involve respiratory and gastrointestinal infections, the risk of introducing emerging viral zoonoses remains a growing concern due to increased ecotourism and the expansion of routes into tropical and ecologically sensitive regions.

Travel Medicine and Risk Assessment in Passengers and Crew

The growing expansion of international maritime tourism has made cruise ships relevant scenarios for travel medicine and the prevention of emerging infectious diseases [93]. Accelerated mobility between continents, contact with multiple ecosystems, and constant interaction between passengers and crews of different origins create conditions that favor exposure to infectious agents, including various zoonotic viruses [94,95]. In this context, comprehensive risk assessment before, during, and after the voyage is an essential component to reduce the impact of emerging diseases on passengers, maritime workers, and host communities [96].
The risk factors associated with viral zoonoses on cruise ships are multiple and depend on both individual and occupational characteristics. Individual factors include advanced age, chronic diseases, immunosuppression, pregnancy, and pre-existing cardiovascular or respiratory conditions, which can increase susceptibility to serious infections and clinical complications [97,98]. This is especially relevant given that a significant proportion of cruise passengers are older adults, a group particularly vulnerable to emerging infectious diseases. Likewise, the lack of prior vaccination, ignorance of epidemiological risks, and participation in high-exposure ecotourism activities increase the probability of acquiring zoonotic infections during the trip [99].
From an occupational point of view, crew members are a population particularly exposed due to prolonged stays on ships and continuous contact with travelers from different geographical regions [100]. Workers responsible for food handling, cleaning, maintenance, storage of goods, and waste management may be at greater risk of indirect exposure to animal reservoirs, vectors, and contaminated environments [101]. In addition, port and maritime personnel frequently travel among multiple international destinations, increasing the risk of cumulative exposure to emerging pathogens. Prolonged working conditions, physical stress, and living in close quarters can also promote the transmission of infectious diseases within the crew [102,103].
Pre-trip evaluation is one of the fundamental pillars of Travel Medicine, especially in passengers who will make itineraries to tropical regions or areas with active circulation of viral zoonoses [104]. This assessment should carefully consider the entire cruise itinerary, port calls, planned activities, and the epidemiological situation of the destinations visited. It is important to identify risks associated with exposure to mosquitoes, contact with wildlife, visits to rural or jungle areas, and participation in ecotourism excursions [105]. Relevant medical history, immune status, and possible contraindications to vaccines or prophylactic medications should also be evaluated [106].
Pre-trip recommendations should include detailed education on preventative measures and safe behaviors during excursions [107]. Travelers should receive information about the risk of mosquito-borne diseases, including Dengue, Chikungunya, and Zika Virus Disease, particularly in tropical regions of the Caribbean, Latin America, Africa, and Southeast Asia [108,109]. Similarly, there may be a risk of exposure to Yellow Fever on certain itineraries, especially during excursions to endemic jungle areas; the recommendations must be individually adapted according to the traveler's profile and the epidemiological characteristics of each sea route [110,111].
Vaccination represents one of the most effective preventive strategies for maritime travelers. Depending on the destination, vaccination against yellow fever, influenza, hepatitis A, hepatitis B, and COVID-19, among other preventable diseases, may be recommended [112]. In some cases, international yellow fever vaccination certificates remain mandatory requirements for entry into certain countries [113]. In addition to vaccines, personal protective measures are essential to reduce exposure to animal vectors and reservoirs. These include the use of repellents, long-sleeved clothing, mosquito nets, protection against arthropod bites, and avoiding contact with wild animals or environments that may be contaminated by rodent droppings [114]. It is also important to promote proper hand hygiene and food safety practices during travel.
The clinical manifestations of viral zoonoses in maritime travelers are often non-specific and represent a significant diagnostic challenge [100,115]. Many emerging infections begin with acute febrile symptoms, headache, myalgias, and malaise, making it difficult to differentiate between various viral etiologies clinically [116]. Hantaviruses, for example, may initially manifest with influenza-like symptoms before progressing to severe cardiopulmonary or renal involvement [5,49]. Similarly, dengue, chikungunya, and Zika share early clinical manifestations that make differential diagnosis difficult, especially in resource-limited settings or during extended travel [117].
Diagnostic challenges are increased due to the itinerant nature of cruise ships and the possibility of extended incubation periods. Some passengers may develop symptoms after leaving the ship or after returning to their home countries, making it difficult to identify the source of exposure; likewise, the coexistence of multiple endemic diseases in certain tropical destinations increases the diagnostic complexity [88,118]. Arbovirus co-infection, the simultaneous circulation of respiratory viruses, and diagnostic limitations at sea represent additional obstacles to timely case recognition [119].
In this context, clinical and laboratory surveillance is of critical importance both in seaports and on board ships. Cruise ship medical services should have clear protocols in place for the early identification, isolation, and initial management of suspected cases of emerging infectious diseases [62]. Syndromic surveillance can facilitate the early detection of unusual patterns of disease among passengers and crew members, allowing control measures to be activated before outbreaks spread [120]. In addition, access to rapid diagnostic tests, molecular tools, and telemedicine systems can significantly improve healthcare response capacity in maritime environments [100].
Collaboration between port authorities, national health systems, reference laboratories and the shipping industry is essential to strengthen international epidemiological surveillance [121]. From the One Health approach, travel medicine must integrate human, environmental and veterinary epidemiological information to anticipate emerging risks associated with maritime tourism [122]. Adequate preparedness, health education and continuous surveillance represent fundamental tools to reduce the impact of viral zoonoses on international cruises and strengthen global health security in the face of future emerging infectious threats [123].

Prevention, Biosecurity and Infection Control on Cruise Ships

The prevention and control of infectious diseases on international cruise ships are priority challenges for global public health due to high human mobility, population concentration, and the constant interaction among passengers, crew, and various port ecosystems [62]. Cruise ships function as dynamic environments where environmental, biological, and operational factors converge, favoring the introduction and spread of infectious agents, including emerging zoonotic viruses [97]. In this context, biosecurity strategies must integrate epidemiological surveillance programs, reservoir and vector control, environmental sanitation, health education, and international cooperation under a comprehensive One Health approach [17].
One of the fundamental pillars in the prevention of viral zoonoses on cruise ships corresponds to rodent and vector control programs both on ships and in port terminals [31,124]. Rodents represent important reservoirs of various zoonotic pathogens, including hantaviruses, leptospires and other infectious agents with potential health impacts; particularly, urban species such as Rattus norvegicus and Rattus rattus have a great capacity to adapt to maritime and port environments, favoring the colonization of warehouses, kitchens, and food storage systems [125,126,127,128]. The presence of these animals on ships and in ports can facilitate the contamination of surfaces and food with infected urine, feces, and secretions [129].
Effective rodent control programs should include regular inspections, ongoing monitoring, sealing of entry points, and proper handling of food and waste [32,129]. Integrated surveillance, trapping, and pest management programs are essential to prevent infestations and the establishment of invasive vectors at ports of entry; these measures are particularly important in tropical cruise ports, where Aedes mosquitoes can proliferate and increase the risk of dengue, chikungunya, and Zika virus transmission among travelers and local populations [130].
Food safety is another priority aspect within the preventive strategies on international cruises [131]. Contaminated food can act as a vehicle for the transmission of a variety of infectious agents, including viruses, bacteria, and parasites. Kitchens and food preparation areas require strict hygiene measures, temperature control, sanitary supervision, and continuous training of handling personnel [132]. Likewise, the supply of food at international ports involves risks of microbiological contamination and exposure to animal reservoirs during transport and storage. Additionally, regular health inspections and the implementation of hazard analysis systems and critical control points are essential to ensure safe feeding conditions on board [133,134].
Early detection and rapid response to suspected cases are critical components of infection control on cruise ships. The experience gained during the COVID-19 pandemic evidenced the importance of having clear protocols for the identification, isolation and initial management of emerging infectious diseases in maritime environments [92,101]. Medical services on board should have syndromic surveillance systems capable of early detection of symptoms compatible with communicable infectious diseases [135]. Early identification of fever, respiratory symptoms, rashes, or bleeding syndromes allows isolation and epidemiological control measures to be activated quickly [136].
Response protocols should include initial clinical evaluation, immediate notification to health authorities, contact tracing, and coordination with destination ports for hospital referral when necessary [137]. It is also important to have adequate isolation areas, personal protective equipment, and access to basic diagnostic tools [138]. Telemedicine and digital communication technologies have become increasingly relevant for supporting clinical decision-making at sea, particularly during complex or emerging infectious events [139,140].
Health education for passengers is a critical preventive tool to reduce the risk of zoonotic diseases and other infections associated with maritime travel [88,141]. Travelers should be given clear information about personal hygiene measures, mosquito bite prevention, food safety, and safe behaviors during ecotourism excursions [105]. In addition, it is important to encourage early notification of symptoms compatible with infectious diseases and promote adherence to medical and health recommendations during the trip; therefore, adequate risk perception and effective communication are essential elements to strengthen the active participation of passengers in prevention strategies [72,96].
International regulations play an essential role in the surveillance and sanitary control of international cruise ships. The World Health Organization's International Health Regulations establish regulatory frameworks for the prevention of the international spread of disease and strengthen coordination between countries and port authorities [142]. Similarly, programs such as the U.S. Centers for Disease Control and Prevention's Vessel Sanitation Program have contributed significantly to improving sanitary conditions on cruise ships through periodic inspections and specific hygiene and environmental control standards [96].
Maritime health surveillance requires close cooperation between national authorities, international organizations, shipping companies, and public health services [142]. Seaports are strategic points for detecting emerging diseases and implementing preventive measures to avoid the cross-border introduction of pathogens [143]. From the One Health approach, prevention and biosecurity strategies must integrate human, animal, and environmental components to strengthen global preparedness against future zoonotic threats associated with international maritime tourism [144].
These preventive, surveillance, and response measures should be implemented throughout the cruise travel continuum, from itinerary planning and pre-embarkation assessment to onboard operations, shore excursions, outbreak management, and post-disembarkation follow-up, as summarized in Table 2.

One Health Approach and Future Perspectives for the Prevention of Viral Zoonoses in Maritime Tourism

The growing complexity of international maritime tourism has increased the importance of comprehensive strategies for the prevention and control of emerging infectious diseases [145,146]. The expansion of cruise routes, ecotourism activities, and interactions between humans, animals, and coastal ecosystems have created favorable conditions for the emergence and spread of viral zoonoses [3,147]. In this context, the One Health approach has become essential by recognizing the interdependence of human, animal, and environmental health.
Cruise ships are dynamic environments where passengers, crew members, wildlife, vectors, and diverse port ecosystems interact. These conditions can facilitate the introduction and dissemination of infectious agents across regions and continents [96]. Therefore, surveillance systems should extend beyond human disease monitoring and incorporate information on animal reservoirs, vectors, environmental conditions, and ecological changes along maritime routes [142]. The integration of epidemiological, veterinary, and environmental data improves understanding of transmission dynamics and supports the early detection of emerging threats [148].
Seaports and tourist destinations with high biodiversity represent critical points for surveillance because of the intense movement of people, goods, and animal species [149,150]. Port facilities and vessels may serve as entry points for invasive vectors, reservoirs, and pathogens; continuous monitoring of rodents, mosquitoes, birds, and other animals potentially involved in zoonotic transmission cycles is therefore essential [142,151]. Effective surveillance requires close collaboration among public health professionals, veterinarians, environmental scientists, and travel medicine specialists [152].
Recent advances in molecular diagnostics, genomics, and metagenomics have significantly improved the detection and characterization of emerging pathogens [153,154]. These technologies enable the identification of viruses circulating in animal reservoirs and environmental samples before major outbreaks occur and facilitate the monitoring of viral evolution, transmission patterns, and interspecies spillover events [155]. Environmental surveillance of wastewater and surfaces aboard cruise ships, together with portable molecular diagnostic tools, may further strengthen preparedness and rapid response capacities [156,157].
In this regard, cruise itineraries involve multiple countries and health jurisdictions, making coordinated surveillance systems and information-sharing mechanisms essential [49]. The COVID-19 pandemic demonstrated both the vulnerability of cruise ships to infectious disease outbreaks and the importance of international collaboration in implementing effective control measures [69,120].
Future challenges include the effects of climate change and the expansion of maritime tourism into ecologically sensitive regions. Changes in temperature, precipitation patterns, and ecosystems may alter the distribution of vectors and reservoirs, increasing the risk of zoonotic disease transmission [158]. In addition, growing ecotourism activities may increase human exposure to wildlife and natural habitats [159,160,161].
Strengthening preparedness for future zoonotic threats will require integrated surveillance systems supported by multidisciplinary research, molecular technologies, digital surveillance tools, and international collaboration [162,163,164]. The effective implementation of the One Health approach will contribute to safer, more sustainable, and more resilient maritime tourism in the face of emerging global health challenges.
Table 1. Ecology and diversity of animal reservoirs of Hantavirus and other zoonotic viruses relevant to international cruise ships.
Table 1. Ecology and diversity of animal reservoirs of Hantavirus and other zoonotic viruses relevant to international cruise ships.
Viral disease/group Main reservoir(s) Vector/transmission Relevance to maritime tourism and cruises Main geographic regions Key preventive measures References
Hantaviruses (Seoul virus, Andes virus, Sin Nombre virus) Wild and peri-urban rodents (Rattus, Oligoryzomys, Peromyscus) Aerosolized rodent excreta Rodent infestations in ports, ships, warehouses, and coastal infrastructure facilitate exposure risk Americas, Asia, Europe Rodent control, sanitation, food protection, surveillance [9,74,165,166,167,168,169]
Dengue virus Humans, non-human primates Aedes aegypti, Aedes albopictus High transmission risk in tropical ports and coastal destinations visited by cruises Caribbean, Latin America, Southeast Asia Vector control, repellents, traveler education [170,171,172,173]
Chikungunya virus Humans, non-human primates Aedes mosquitoes Expanding arboviral threat linked to global mobility and climate change Caribbean, Indian Ocean, Asia Mosquito bite prevention, surveillance [174,175,176]
Zika virus Humans, non-human primates Aedes mosquitoes Risk during tropical excursions and ecotourism activities Latin America, Caribbean, Pacific Vector control, reproductive health counseling [176,177,178,179]
Yellow fever virus Non-human primates Haemagogus spp., Aedes spp. Relevant during jungle excursions in endemic regions South America, Africa Vaccination, mosquito prevention [81,83,84,180,181]
Avian influenza viruses Migratory birds, poultry Respiratory/environmental exposure Migratory routes connect coastal ecosystems and ports Asia, Europe, Africa Wildlife surveillance, biosecurity [182,183,184]
Coronaviruses (including SARS-related viruses) Bats and intermediate mammals Respiratory transmission Cruise ships are highly vulnerable to rapid respiratory spread Global Ventilation, surveillance, vaccination [71,185,186,187]
Nipah virus Fruit bats (Pteropus spp.) Direct exposure, contaminated food Ecotourism and wildlife interaction increase spillover risk Southeast Asia Avoid wildlife exposure, hygiene [188,189,190,191]
Rabies and lyssaviruses Bats, dogs, wild mammals Animal bites/saliva Wildlife exposure during excursions and ecotourism Latin America, Africa, Asia Vaccination, avoidance of animal contact [192,193,194,195,196,197]
Orthopoxviruses (including mpox-related viruses) Rodents and wild mammals Direct contact Emerging concern in wildlife-tourism interfaces Africa and globally connected regions Hygiene, surveillance, traveler awareness [198,199,200,201,202]
Table 2. One Health framework for preventing, detecting, and responding to zoonotic viral threats associated with international cruise travel.
Table 2. One Health framework for preventing, detecting, and responding to zoonotic viral threats associated with international cruise travel.
Phase or operational setting Principal risks and considerations Recommended measures Primary stakeholders
Itinerary planning and pre-voyage risk assessment Travel to endemic regions, tropical ports, remote islands, forests, caves, wetlands, and other wildlife interfaces; limited medical and evacuation capacity in remote destinations. Assess the epidemiological and ecological situation at all destinations; identify areas with active zoonotic or vector-borne disease transmission; evaluate medical referral, evacuation, laboratory, and communication capacities; establish contingency plans before departure. Cruise operators; itinerary planners; maritime medical teams; port authorities; travel-medicine specialists; public health agencies.
Pre-embarkation assessment of passengers and crew Advanced age, pregnancy, immunosuppression, chronic cardiovascular or respiratory disease, incomplete vaccination, and recent exposure in endemic areas may increase the risk of infection or severe outcomes. Obtain relevant medical and recent travel histories; provide destination-specific counseling; update indicated vaccinations; educate travelers about mosquito bites, wildlife contact, rodent-contaminated environments, food safety, and early symptom reporting. Travel-medicine providers; healthcare professionals; cruise medical services; passengers and crew.
Provisioning, loading, and port operations Introduction of rodents, mosquitoes, contaminated cargo, food, or other biological hazards through ports, warehouses, provisioning areas, and stored goods. Inspect cargo and provisioning areas; maintain food protection and waste controls; seal potential rodent entry points; implement trapping, pest management, and vector surveillance programs; coordinate inspections between vessels and ports. Cruise operators; port health authorities; pest-control personnel; food-safety services; veterinary and environmental authorities.
Routine onboard prevention and environmental management Rodent infestation, mosquito breeding, contaminated surfaces or food, inadequate waste handling, and delayed recognition of febrile illness. Conduct scheduled inspections and environmental monitoring; ensure safe food storage and preparation; manage waste appropriately; eliminate vector-breeding sites; maintain adequate sanitation; document pest sightings and corrective actions. Ship management; environmental health officers; food handlers; housekeeping and maintenance personnel; pest-control services.
Shore excursions and ecotourism activities Exposure to rodent excreta, mosquitoes, bats, wild birds, non-human primates, and other wildlife in rural, jungle, cave, wetland, island, or peri-urban environments. Perform excursion-specific risk assessments; avoid entering visibly rodent-infested or poorly ventilated enclosed spaces; prevent direct contact with wildlife; use repellents and protective clothing; ensure qualified guides and mechanisms for recording relevant exposures. Excursion operators; local guides; cruise staff; passengers; destination health and environmental authorities.
Onboard syndromic surveillance Early manifestations of hantavirus and other zoonotic viral infections may be nonspecific and resemble influenza, COVID-19, or other acute febrile illnesses. Monitor fever, myalgia, headache, respiratory symptoms, rash, bleeding manifestations, and gastrointestinal symptoms; maintain accessible medical reporting systems; review cases for common itineraries, excursions, accommodations, or exposures; use telemedicine when necessary. Ship physicians and nurses; epidemiological surveillance personnel; passengers and crew; shoreside medical support.
Management of a suspected zoonotic viral infection Rapid clinical deterioration, uncertain transmission route, diagnostic limitations at sea, and possible exposure of close contacts. Isolate the patient when person-to-person transmission cannot be ruled out; provide supportive care and appropriate personal protective equipment; collect appropriate clinical specimens; notify the captain, cruise operator, and destination port; arrange laboratory testing and medical evacuation when indicated. Ship medical team; cruise operator; port health authorities; receiving hospitals; reference laboratories.
Investigation of a cluster or outbreak A common environmental exposure, multiple shore-based exposures, onboard transmission, or infection acquired before embarkation may produce similar temporal patterns. Develop a line list and exposure timeline; classify cases and contacts; conduct contact tracing; investigate cabins, food storage areas, waste systems, excursions, and potential animal or vector exposures; undertake molecular testing and genomic sequencing when available. National public health agencies; WHO and other international organizations; reference laboratories; cruise operators; veterinary and environmental investigators.
Port arrival, evacuation, and cross-border coordination Multiple jurisdictions, delays in notification, limited isolation capacity, and the international dispersal of passengers and crew may complicate containment efforts. Establish advance communication with the receiving port; coordinate safe disembarkation and medical referral; share standardized epidemiological and laboratory information; apply International Health Regulations procedures; ensure continuity of care and contact follow-up across countries. Port health authorities; national focal points; immigration and transport authorities; hospitals; cruise operators; international organizations.
Post-disembarkation surveillance and follow-up Symptoms may develop after passengers or crew return home, obscuring the relationship with the cruise or a shared exposure. Provide written advice regarding incubation periods, warning symptoms, and where to seek care; retain passenger and crew contact information; notify relevant national authorities; monitor high-risk contacts for the pathogen-specific period; communicate final investigation findings internationally. Cruise operators; passengers and crew; national surveillance systems; healthcare providers; public health authorities.
Long-term One Health preparedness Climate change, urbanization, altered reservoir and vector distributions, expanding ecotourism, and incomplete integration of human, animal, and environmental surveillance. Integrate human case surveillance with rodent, mosquito, bird, and other wildlife monitoring; wastewater and surface monitoring; and environmental monitoring; strengthen portable diagnostics, genomics, data sharing, multidisciplinary training, simulation exercises, and international research collaboration. Public health, veterinary, wildlife, environmental, maritime, laboratory, and travel-medicine sectors; cruise industry; academic institutions.
WHO, World Health Organization. Measures should be tailored to the itinerary, local epidemiology, suspected pathogen, transmission pathway, traveler characteristics, and available maritime and port health resources.

Limitations

This review has several limitations. First, it is narrative rather than systematic, and source selection may therefore be subject to publication and selection bias. Second, cruise-specific evidence on zoonotic viruses and animal reservoirs remains scarce, heterogeneous, and largely based on case reports, outbreak investigations, surveillance reports, and extrapolation from ports or terrestrial tourism settings. Third, underdiagnosis and inconsistent reporting may underestimate the true burden. Finally, evidence concerning the M/V Hondius outbreak and other emerging events continues to evolve, limiting definitive conclusions regarding exposure sources, transmission pathways, and the effectiveness of specific preventive measures.

Conclusions

Maritime tourism and the global expansion of international cruise ships have generated new epidemiological scenarios for the emergence and dissemination of viral zoonoses associated with animal reservoirs and vectors. The constant interaction among passengers, crews, coastal ecosystems, and wildlife favors complex transmission interfaces, in which viruses such as hantavirus, dengue, chikungunya, Zika, yellow fever, and avian influenza pose growing threats to global public health. Factors such as overcrowding, international mobility, ecotourism, and climate change increase the risk of transcontinental introduction and spread of emerging pathogens in maritime environments.
Peri-urban rodents, bats, migratory birds and other animal reservoirs play a fundamental role in the ecological dynamics of multiple zoonotic viruses relevant to cruise ships and coastal tourist destinations. Likewise, climate change, accelerated urbanization, and environmental alteration are altering the geographical distribution of vectors and hosts, thereby favoring the emergence of new epidemiological risks in previously non-endemic regions.
The implementation of comprehensive prevention and biosecurity strategies is essential to reduce the impact of these infectious threats. Rodent and vector control programs, environmental sanitation, epidemiological surveillance, health education, and clinical preparation on board are fundamental pillars for strengthening maritime health security. In this context, the One Health approach emerges as an indispensable tool for integrating human, animal, and environmental surveillance in complex maritime scenarios.
Finally, strengthening international cooperation, molecular monitoring of emerging pathogens, and preparedness for future zoonoses will be decisive in ensuring safer, more resilient, and more sustainable maritime tourism in the face of the global epidemiological challenges of the 21st century.

Author Contributions

Conceptualization, D.K.B.-A. and A.J.R.-M.; methodology, D.K.B.-A., J.L.B.-A. and A.J.R.-M.; resources, I.C.S.R., L.Z. and A.J.R.-M.; writing—original draft preparation, D.K.B.-A., J.L.B.-A., I.C.S.R., L.Z., and A.J.R.-M.; writing—review and editing, D.K.B.-A., J.L.B.-A., I.C.S.R., L.Z., and A.J.R.-M.; supervision, D.K.B.-A., J.L.B.-A., I.C.S.R., L.Z., and A.J.R.-M. All authors have read and agreed to the published version of the manuscript.

Funding

The current article processing charges (publication fees) were funded by the Faculty of Health Sciences, Universidad Tecnológica Centroamericana (UNITEC), Tegucigalpa, MDC, Honduras, Central America (granted to Zambrano).

Institutional Review Board Statement

Not applicable.

Data Availability Statement

No new data were created or analyzed in this study.

Acknowledgments

This article has been registered in the Research Proposal Registration of the Coordination of Scientific Integrity and Surveillance of Universidad Cientifica del Sur, Lima, Peru. This article is part of the project titled “Caracterización de la epidemiología y carga para la salud pública de enfermedades infecciosas emergentes y re-emergentes en Colombia y Latinoamérica” (Characterization of the epidemiology and public health burden of emerging and re-emerging infectious diseases in Colombia and Latin America), Código: PE005, of the Institución Universitaria Visión de las Américas.

Conflicts of Interest

The authors declare that they have no conflicts of interest.

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