The World Health Organization (WHO) has confirmed five hantavirus infections linked to the cruise ship MV Hondius, with cases now identified in five countries as health authorities work to trace and contain the outbreak.
Three people have died since the vessel departed Argentina last month, a Dutch couple and a German national.
The first suspected case was a 70-year-old Dutch man who fell ill on board with fever, headache, abdominal pain and diarrhoea.
He died on 11 April, according to South Africa’s Health Department.
A total of 146 passengers and crew from 23 countries remain on the ship under "strict precautionary measures," operator Oceanwide Expeditions said on Thursday.
The vessel is due to dock in Tenerife in Spain’s Canary Islands around noon local time on Sunday before those on board are flown home.
At least 30 passengers disembarked at Saint Helena in late April, while several critically ill passengers have been air-evacuated to Europe this week.
Three others have arrived in the Netherlands for treatment, including a British national, a 65-year-old German and a 41-year-old Dutch crew member.
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Two are in serious condition, while the third is not currently showing symptoms but remains under medical care.
A British national who fell ill on 27 April is being treated in intensive care at a private hospital in Johannesburg.
He is the second confirmed hantavirus case, and the WHO said his condition is improving.
On Wednesday, WHO Director-General Tedros Adhanom Ghebreyesus said a passenger who returned to Switzerland after leaving the ship had also tested positive and was being treated in Zurich.
In the United Kingdom (UK), the Health Security Agency said two British nationals who left the ship at Saint Helena on 24 April are self-isolating at home as a precaution.
Reports added that the agency is still tracing a seventh person who has not yet returned to the UK, while four others remain on the island.
United States (US) health authorities are monitoring three residents who deboarded and returned home, with no symptoms reported so far.
In Singapore, two men in their 60s are self-isolating and being tested.
Between the two men, reports said, one has a runny nose but is otherwise well, while the other is asymptomatic.
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