Hantavirus begins with rodents and people usually catch it by inhaling tiny particles from the urine, droppings or saliva of infected mice and rats. The disease is rare, but when it does take hold it can become severe very quickly.
The latest cases have come from the MV Hondius cruise ship, which sailed from Argentina a month ago.
Three people have died following an outbreak onboard.
The incident has drawn attention back to a virus that health officials have monitored for decades.
How the virus differs by region
In the United States (US), most cases are linked to the Sin Nombre virus carried by deer mice.
In South America, the Andes strain is the only type known to allow limited person-to-person transmission. That distinction matters when outbreaks occur in enclosed settings like ships.
US data from the Centers for Disease Control and Prevention (CDC) shows 890 cases reported between 1993 and 2023.Of those, 309 people died, a fatality rate above 34 percent.
New Mexico recorded the most deaths with 54, followed by Colorado with 45, Arizona with 32, California with 24 and Washington with 20.
Cases have appeared in nearly every state, though numbers are lower in the east.
More than 94 percent occurred west of the Mississippi River, and over 60 percent of patients were male.
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Of the 890 cases, 859 developed hantavirus cardiopulmonary syndrome, the severe form that attacks the lungs.
What to watch for
Symptoms usually start one to eight weeks after exposure. They often look like flu at first, with fever, fatigue and muscle aches in the thighs, hips and back.
Headaches, chills, dizziness, nausea, vomiting, diarrhoea and abdominal pain are also common.
If the illness progresses, fluid can build up in the lungs. This leads to coughing, shortness of breath and, in severe cases, respiratory failure and shock.
Health officials say the condition can deteriorate quickly once breathing problems begin, which is why early medical care is important.
No vaccine yet, prevention is key
There is no widely available vaccine for the hantavirus strains that cause pulmonary syndrome in the Americas.
Prevention focuses on avoiding contact with rodents and their waste.
Public health guidance stresses rodent control, careful cleaning of infested areas with protective equipment, and seeking medical help early.
Vaccines exist in parts of Asia for strains linked to hemorrhagic fever with renal syndrome, but they are not approved in the US and do not protect against North American strains.
Experimental candidates are in early development, but health experts say a wide rollout remains years away.
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