Passengers aboard the MV Hondius, a cruise ship hit by a hantavirus outbreak that has killed three people, have started leaving the vessel, according to The Associated Press. The first evacuation flight, carrying Spanish nationals, departed the Canary Islands on Sunday, Spanish health authorities confirmed. Those passengers face quarantine upon arrival in Madrid.

The outbreak, which has drawn international attention, has not produced additional symptomatic cases among the more than 140 people on board, according to Spain's health ministry, the World Health Organization, and cruise operator Oceanwide Expeditions. However, the deaths have prompted swift action from U.S. and Spanish officials.

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The U.S. Centers for Disease Control and Prevention (CDC) has dispatched a team of epidemiologists and medical professionals to the Canary Islands to assess the situation. Once the ship docks in Tenerife, the CDC will conduct exposure risk evaluations for every American passenger and recommend monitoring levels, the agency said.

A State Department spokesperson confirmed that the U.S. is coordinating with the CDC, the Department of Health and Human Services, and Spanish authorities to arrange a repatriation flight for Americans. “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.

At least four states—Arizona, Virginia, California, and Georgia—are monitoring residents who were on the MV Hondius. This follows a pattern of state-level tracking after disease outbreaks on cruise ships, similar to recent norovirus outbreaks on other vessels.

The CDC has activated its lowest emergency level for hantavirus, reflecting the limited risk of widespread transmission, as reported in a separate update. The WHO has downplayed pandemic concerns, stating the outbreak is contained to the ship.

Hantavirus, which has no cure and requires supportive care, is typically spread through rodent droppings. The outbreak on the MV Hondius has raised questions about sanitation protocols on cruise ships, especially given the vessel's remote itinerary.

Oceanwide Expeditions has not commented on potential changes to future voyages. The crew remains on board as the evacuation continues, with all passengers expected to be cleared within days.