An Unusual Cause for Concern? A Hantavirus outbreak associated with a cruise ship

May 26, 2026 girlymicro General, Microbiology (Clinical), Science Communication cruise, epidemiology, global health, hantavirus, health, Infection Prevention and Control, news, Outbreak, public health, public-health, virology, zoonosis

Content warning – this one is long, and is heavier on the detail than usual. It kind of needed to be as people have died. However, if you want the Cliff Notes version, no, there is no need to panic as Hantavirus is not going to be the cause of the next pandemic.

Everyone seems to be talking about Hantavirus right now, well they were, now people are also talking about Ebola and meningitis. It does rather feel like the infectious disease of the week right now. Despite a lot of effort by scientists and healthcare professionals there seems to be an appetite for panic linked to this. It is worth knowing that although Hantavirus is considered to be a high consequence infectious disease (HCID), that is mainly because it is linked to a potentially severe outcome for an individual if infection is confirmed, rather than potential for wide scale spread.

As I’m being asked about this by everyone from cab drivers to healthcare professionals, and faced with panicked social media commentary about whether this is going to be another pandemic, I thought I should share some of the information that is out there in order to support the ‘don’t panic’ key messaging. I think it is important to note, however, that I am not a Hantavirus expert, just your standard infection prevention and control professional, but having studied zoology in a previous life I couldn’t miss the opportunity to talk about a zoonotic (linked to spread from animals) infection.

What is the current scenario?

The cruise ship (MV Hondius) that is making headlines departed from Ushuaia, Argentina, on April 1, 2026, and traveled across the South Atlantic Ocean, stopping at several remote locations that including excursions and the opportunity for passengers to get off the ship, standard cruise fare but with more unusual destinations. These included Antarctica, South Georgia Island, Tristan da Cunha, Saint Helena, and Ascension Island.

The ship itself carried 147 people (86 passengers and 61 crew) from 23 different countries, so small for a cruise but still a sizable mix of people to have in one space.

BBC News – Three dead in suspected virus outbreak on Atlantic cruise ship – BBC News
https://www.bbc.co.uk/news/articles/cy0294829ndo

The extent of their contact with wildlife before or during the expedition is either unknown or disputed, although there are plenty of rumours linked to bird watching etc. The importance of all of which will become apparent when we talk more about the virus and it’s standard transmission routes.

It is also worth noting, that unlike many cruises which have a curcular route with all passengers embarking and disembarking at the same point, with this cruise a number of passengers departed at various points as part of planned departures, therefore dissemination of some people involved had already occurred before any clinical symptoms were understood.

Headlines began to appear linked to a possible outbreak onboard in early May, with the outbreak developing, and more information gradually becoming available, as so often happens during any outbreak situation.

What are Hantaviruses?

First let’s start with the fact that Hantaviruses are very different from the viruses that we have seen causing pandemics over the last century. Although all three are RNA viruses, Hantaviruses are different in structure, transmission and disease presentation to both coronaviruses and influenza viruses. They demonstrates low comparative rates of mutation and very limited person to person spread, so the same epidemiological principles do not apply.

Hantaviruses are RNA viruses that are part of the genus Orthohantavirus. They were named after the Hanta river in South Korea in 1978 (originally called the Hantaan virus) and consist of a family of viruses rather than one single disease, with over 20 species known. As a viral group they have since been split into Old World Hantaviruses and New World Hantaviruses, with viruses found to circulate not just within rodents but also within moles, shrews and other animals. They circulate asymptomatically within their natural zoonotic reservoirs without causing symptomatic infection. When humans are exposed, and infection caused, it is typically due to spread from their normal reservoir with exposure due to interaction with bodily fluids, such as dried urine and droppings.

https://www.ecdc.europa.eu/en/infectious-disease-topics/hantavirus-infection/factsheet-orthohantavirus-infections

Different Hantavirus species are associated with different animal reservoirs and their associated geographical territories, as well as leading to different clinical presentations in human infection. Old World Hantaviruses are linked with hemorrhagic fever with renal syndrome (HFRS) and are geographically associated with Africa, Asia, and Europe. New World Hantaviruses are associated with hantavirus cardiopulmonary syndrome (HCPS) have a geographical and have a distribution across the Americas, sometimes also called hantavirus pulmonary syndrome (HPS). As the cruise exposure focus is mostly linked to South America, due to both cruise stops and clinical HCPS presentation, the main animal reservoirs of interest are:

Long-tailed Pygmy Rice Rat (Oligoryzomys longicaudatus)
Pygmy Rice Rats (Oligoryzomys species)
Vesper Mice (Calomys species)

Although there have been a number of cases in the current cluster confirmed as positive for the Andes virus, for context, in Europe (according to ECDC), just under 1,900 cases were recorded in 2023 across all different strains/species of Hantavirus. In the Americas, 8 countries reported 229 cases in 2025. There are, therefore, cases of Hantavirus infection detected annually across the globe, and although not huge numbers the impacts on individuals can be significant. The number of cases that are currently being observed linked to the cruise are therefore considered to be an outbreak, but the risk is mainly due to how individuals that will need to be repatriated to their native countries will be managed and how to ensure the best possible outcomes for those exposed.

What are Zoonotic infections?

A zoonosis (or zoonotic infection) is an infectious disease that can jump from a non-human animal to humans. Traditionally it will have no, or limited, ongoing human to human spread. Transmission can be:

Direct – touching, petting, biting, leading to direct contamination by saliva, blood, urine, or other bodily fluids
Indirect – exposure to saliva, blood, urine, or other bodily fluids via indirect routes such as contamination linked to food, contaminated environments where animal reservoirs live (soil, water etc), contaminated objects
Vector borne – not linked to Hantaviruses, but for other organisms can be spread linked to insect carriage and transmission via insect bites

I’ve talked about the fact that Hantaviruses have animal reservoirs. But which animal, depends on the Hantavirus species, which then impacts where there is a risk of acquisition, as you can’t be exposed if the animal doesn’t live there.

Old World Hantavirus animal reservoirs:

Apodemus (Wood Mice / Field Mice) – Dobrava-Belgrade virus (DOBV)/Hantaan virus (HTNV)
Rattus (Rats) – Seoul virus (SEOV)
Myodes (Bank Voles) – Puumala virus (PUUV)
Microtus (Voles) – Tula Virus (TULV)

New World Hantavirus animal reservoirs:

Deer Mouse (Peromyscus maniculatus) – Sin Nombre virus (SNV)
White-footed Mouse (Peromyscus leucopus) – New York virus (NYV)
Cotton Rat (Sigmodon hispidus) – Black Creek Canal virus (BCCV)
Marsh Rice Rat (Oryzomys palustris) – Bayou virus (BAYV)
Long-tailed Pygmy Rice Rat (Oligoryzomys longicaudatus) – Andes virus (ANDV)
Pygmy Rice Rats (Oligoryzomys species) – Andes virus (ANDV)
Vesper Mice (Calomys species) – Laguna Negra virus (LNV)

The cruise had been visiting remote wildlife areas, so a passenger could have come into contact with the virus then, or before boarding the ship, as the incubation period is prolongued. This can make contact tracing and understanding the epidemiology more challenging, at least initially, and it is possible that the initial transmission event will never be well understood. The animal reservoir associated with the identified Andes virus, the causative agent of the outbreak, long-tailed pygmy rice rat (Oligoryzomys longicaudatus) and Pygmy Rice Rats (Oligoryzomys species) which can help to pin down broad areas, but not precise transmission route.

Transmission

Transmission linked to zoonotic infection happens in two main ways, transmission within the animal reservoir where infection is usually without any symptoms (asymptomatic), and exposure to humans to the virus circulating within the animal reservoir.

Within the animal reservoir transmission can be linked to moments like aggressive acts, such as biting and scratching where saliva or bodily fluids may be transferred. This is probably one of the primary mechanisms. Animals may also share environments leading to close contact, such as sharing nests, and viral transmission can be linked to exposure in close quarters.

This transmission linked to close contact is also an unusual feature of the Andes Hantavirus and can occur in humans and not just within the animal reservoir. Even so, human to human transmission is relatively rare, but can occur when individuals have prolongued close contact with someone who is symptomatic, especially if exchange of bodily fluids can occur via kissing or other close contact. There is also believed to be an airborne transmission route for the Andes virus, although the route by which this occurs is not well understood. This is addition to the transmission routes from the animal reservoirs that can be due to a number of exposure routes:

The initial clinical presentation of the 70-year-old Dutch passenger, who developed a fever, headache, and diarrhea day 6 of the cruise, five full days after boarding, and who then died on day 11. This timeline means the passenger is unlikely to have acquired Hantavirus onboard as the minimum Hantavirus incubation is believed to be 7 days, meaning that the exposure was likely to have occurred before the passengers even boarded the ship. Ongoing transmission onboard is therefore unlikely to have been point source from an animal exposure, and is more likely to have been linked to close contact of human passengers.

Clinical presentation

Initial presentation of HCPS is pretty generic, and could easily be hard to recognise as Hantavirus infection without a string travel or exposure history. The prodrome phase, or early onset phase is usually 1 – 5 days long and can occur 4-42 days after exposure. Symptoms can be confused with many other viral illnesses and include:

High fever, chills, and profound fatigue
Severe myalgia (muscle aches), particularly in large muscle groups like the thighs and back
Prominent gastrointestinal symptoms: nausea, vomiting, diarrhea, and abdominal pain
Headaches and dizziness

One to two days after the initial phase patients can enter a cardiopulmonary phase where patients can become critically unwell:

Rapidly progressive dyspnea (shortness of breath) and hypoxia
Noncardiogenic pulmonary edema (fluid in the lungs) and coughing
Hypotension, tachycardia, and cardiogenic shock
Potential myocardial depression and acute metabolic acidosis

Vial P, Ferrés M, Vial C et al.
Hantavirus in humans: a review of clinical aspects and management
The Lancet Infectious Diseases, 2023; 23, e371-e382

This is different to the progression of HFRS, which typically has five phases:

Febrile Phase (3–7 Days)
Hypotensive Phase (Hours to 2 Days)
Oliguric Phase (3–7 Days)
Diuretic / Polyuric Phase (Days to Weeks)
Convalescent Phase (Weeks to 6 Months)

The initial febrile phase is still pretty non-specific in terms of presentation, but tends to include high fever, chills, intense headache, severe backache, and abdominal pain. Mortality rates vary by causative species, but range from 1 – 15%.

Transmission control

Within the UK, Hantavirus infection caused by Andes virus is classified as a high consequence infectious disease (HCID). HCIDs are defined based on the following criteria:

Requires an enhanced individual, population and system response to ensure it is managed effectively, efficiently and safely
Acute infectious disease
Typically has a high case-fatality rate
May not have effective prophylaxis or treatment
Often difficult to recognise and detect rapidly
Ability to spread in the community and within healthcare settings

Interestingly, only the Andes Hantavirus is listed as a HCID, due to the risk of airborne human to human transmission. Once an HCID is confirmed or highly probable based on a combination of exposure history, symptoms, and diagnostic testing outcomes, the patient will be transferred by specialist transport teams to a designated HCID Treatment Center or High-Level Isolation Unit (HLIU). There are 7 adult and 5 paediatric Airborne HCID Treatment Centres in England, all of whom will hold specialist isolation facilities.

Early diagnosis of Hantavirus infection can be difficult, especially within the first 72 hours of symptoms, before the virus can be accurately detected in body secretions and excretions. Repeat diagnostic testing is often done 72 hours after symptom onset. As the initial presentation is fairly generic, it can take some time to realise what additional testing is required, and a good travel and activity history is key to informing diagnostic steps.

Within the UK, diagnostic testing options include:

Serology (Blood Tests): This is the primary diagnostic method. Laboratories use Enzyme-Linked Immunosorbent Assays (ELISA) or immunoblot assays to detect hantavirus-specific Immunoglobulin M (IgM) which looks for recent infection and IgG antibodies which looks for more established immune response, both by testing blood serum samples.
Molecular Testing (RT-PCR): Reverse transcription-polymerase chain reaction (RT-PCR) is used to detect hantavirus viral RNA in acute blood or blood samples during the viraemic phase, when the virus is present within the blood stream.

Internationally, one of the challenges for control in this specific outbreak, was that this wasn’t a point source exposure where everyone is incubating according to the same time frame, as people left the ship at different times, and were also isolating onboard the ship over different time periods based on the level of contact with the initially cases. This made initial components of contact tracing challenging, which then led to further possible exposures as some of the initial passengers returned to their home countries before the extent of the outbreak was understood.

Clinical management

There is no specific antiviral treatment option for Hantavirus so management focuses on supportive therapy, respiratory support (often in intensive care), fluid management, and for HFRS dialysis. Among patients who have severe respiratory symptoms as part of HCPS, the case fatality rate has been estimated to be approximately 38%.

As part of the follow up for this current outbreak, UK nationals, once repatriated have been taken to an isolation facility where they will be kept for up to 72 hours and initial clinical review and testing will be undertaken. As part of this clinical teams will then assess whether contacts who are not displaying symptoms can isolate at home or at another suitable location based on their living arrangements. Exposed individuals are generally being advised to self-isolate for up to 45 days from their last known exposure, but this self-isolation is voluntary. During the isolation period clinical networks will maintain daily contact to check for potential symptoms and undertake regular testing.

The World Health Organization (WHO) has recommended a 42-day quarantine period for the cruise passengers from their last exposure, although within the UK this has been extended to 45 days. Cases are managed, if symptoms develop using the following case definitions:

Confirmed Case: A patient with positive PCR testing for hantavirus in clinical samples, combined with travel on the MV Hondius from 1 April 2026 or contact with a passenger within 45 days of symptom onset.
Probable Case: A patient with compatible symptoms (e.g., fever, respiratory distress) and no other identified pathogen, linked by travel or close contact to the MV Hondius outbreak.
Possible/Suspected Case: A patient with compatible symptoms and no other identified pathogen, who had contact with a MV Hondius passenger within 45 days of symptom onset.

Previous outbreaks

Although all of this information seems rather intense and it is easy to see why the new media are trying to make a big story out of it, apart from those exposed we do need to put this outbreak into context. Outbreaks of Hantavirus happen with relative frequency, probably more than we know as diagnosis can be difficult identification may be underestimated, and some local outbreaks are probably under reported. To help demonstrate this I’ve put together a list of previous, easy to find, outbreaks along with their case numbers:

Argentina Regional Outbreak (Late 2025 – Early 2026)
- Cases: A spike in localized regional cases with the NEJM reporting 34 cases from a single event.
- Deaths: Up to 20 deaths.
Germany Voles-Linked Surge (2025)
- Cases: 55 cases in the first half of the year (predominantly in Bavaria)
- Driven by an ecological spike in the local bank vole population.
Brazil Farmland Outbreak (September 2022)
- Cases: 22 cases.
- Deaths: 10 deaths.
- Traced to wood and rice mice exposure on agricultural properties.
Episodic Outbreaks in Los Santos, Panama (2022)
- Cases: 29 cases recorded over nine months.
- 16 manifested as severe HCPS; no fatalities reported.
Argentina Andes Outbreak (2018)
- Cases: 34 confirmed cases.
- Deaths: 11 deaths.
- Someone sick with ANDV attended a birthday party with 100 people; 5 people who were seated close to the individual later developed symptoms
Yosemite National Park, USA (2012)
- Cases: 10 confirmed cases.
- Deaths: 3 deaths.
- Contracted by visitors staying in signature tent cabins infested with deer mice.
Chili (1997 – 1998)
- Cases: 25 cases were officially recognized as part of the primary outbreak wave from July 1997 to January 1998.
- When expanding the surveillance period from October 1995 through January 22, 1998, a total of 33 cases were confirmed nationwide
- Epidemiologists verified human-to-human transmission across two out of three family clusters identified during the outbreak
The Korean War Epidemic (1950–1953)
- Cases: 3,000+ UN soldiers infected.
- The landmark historical event that first clinically defined Hantavirus Hemorrhagic Fever with Renal Syndrome (HFRS)

What is currently happening with this outbreak?

As this post has taken me a couple of weeks to pull together, I thought it was worth ending with the latest update I have available from the European Centre for Disease Prevention and Control (ECDC) on 24 May. At this point 12 cases have been reported in total, including 10 confirmed and 2 probable cases. One new case and no new deaths have been reported since the previous update (unclear when the last update was).

The cruise ship M/V Hondius has had all passengers and crew disembarked and is currently docked in Rotterdam, the Netherlands, undergoing sanitation procedure.

https://www.nejm.org/doi/full/10.1056/NEJMc2606496

Do I need to be concerned?

The short answer is no, I don’t believe so and neither do many people who are far more expert than I that you will hear write and talk on this subject. This scenario has got me thinking though, if this outbreak hadn’t impacted European and US passengers whether we would have even heard about this outbreak at all. As you’ve seen in the outbreak section, Hantavirus outbreaks are not that uncommon. Was it because of passenger social media that it made headlines, because the cruise industry is big business, or because it impacted audiences because they saw passengers as being ‘like them’ and worrying that they too could be impacted on a holiday?

I think, whatever the reason, that this should be used as a wake up call for all of us to realise that infection diseases are global, and that we ignore infections that we don’t consider to impact ‘us’ at our risk. With global travel, with climate change, with changes in health surveillance due to certain US policies, the old way of looking at infectious diseases may not be fit for purpose. Too much of the world is in pandemic denial, and just doesn’t want to think about infection risk. We either experience coverage that induces panic, or ostriching where we don’t talk about it at all. Neither of these approaches are going to lead to the best outcomes or knowledge sharing in the face of a changing infection landscape. What needs to happen is for global networks to be built, for infrastructure to be invested in, and for communication to occur in a way that supports surveillance and knowledge acquisition. I don’t believe that Hantavirus is a risk for developing a new pandemic, but if we don’t take the time we have available to invest in planning, we won’t be as prepared for the next outbreak that could be.

Reading you might find interesting

https://asm.org/articles/2026/may/how-does-andes-hantavirus-spread-between-people?fbclid=Iwb21leAR_9pVleHRuA2FlbQIxMQBzcnRjBmFwcF9pZAwzNTA2ODU1MzE3MjgAAR5YsP6VyODOW7LaM47kpl__ECZ7fgHiAcPymHPd5HvAKzUj6GHfYSQgSpw5SA_aem_YWdncwDbsPWxAcsw50hsWWdn6Odm&brid=YWdncwHt62falu6GnVxUGBdWXpcB

Curr Treat Options Infect Dis. 2020 Oct 29;12(4):410–421. doi: 10.1007/s40506-020-00236-3

What is hantavirus? How is it transmitted and what are the symptoms?

BBC News – Hantavirus may have spread between passengers on cruise ship, WHO says – BBC News
https://www.bbc.co.uk/news/articles/cm2p186gyp2o

BBC News – Cruise passengers tell of life on board stranded ship after hantavirus outbreak – BBC News
https://www.bbc.co.uk/news/articles/clype7ededzo

BBC News – Hantavirus: Race to trace passengers who left MV Hondius at St Helena – BBC News
https://www.bbc.co.uk/news/articles/cnvpzgn26edo

BBC News – Hantavirus strain that spreads between humans found in cruise ship passengers – BBC News
https://www.bbc.co.uk/news/articles/ce8pypvjx1ko

BBC News – Britons on hantavirus cruise ship face 45 days of self-isolation – BBC News
https://www.bbc.co.uk/news/articles/c9wepl8we90o

BBC News – British passengers on virus-hit cruise ship to isolate on Wirral – BBC News
https://www.bbc.co.uk/news/articles/c2029r42w8wo

BBC News – Tourist hotspot at ‘end of the world’ denies causing hantavirus outbreak
https://www.bbc.co.uk/news/articles/cx21ej471g2o

https://www.england.nhs.uk/long-read/ipc-measures-asymptomatic-contacts-cases-hantavirus-healthcare-settings/

All opinions in this blog are my own

The Next Chapter: Don’t Open That Door! A Microbiologist’s Guide to Infection in Movies and TV

March 27, 2026March 27, 2026 girlymicro General, Healthcare Science, Microbiology (Clinical), Science Communication, Writing Writing, books, infection, science-fiction, movies, film, TV, Outbreak, book writing, horror, Thriller, Superhero

You may have noticed that I’ve been a little poor at keeping up with the Girlymicrobiologist site admin, and missing the odd weekly blog post. This isn’t because I’ve been slacking, honest, it’s more because I may have become a little distracted by a new project. I promise to get back on top of things soon, but in the meantime I thought I owed you an update.

Many of you have been kind enough to support last years project, which was a book aimed at supporting people to engage with research and research degrees, and I couldn’t be more grateful for your cheer leading. This new project, however, in the words of Monty Python could be described as ‘and now for something completely different’. It couldn’t be further from a book about academic study. This one is all about something else I love passionately, movies and TV.

I finished and launched the last book last October, and to be honest it hadn’t occurred to me, prior to letting it go into the wild, that I would write anything else till my retirement – when I’m planning to write some pathology based murder mysteries. It was never the plan to do something again, at least so soon. Frankly though, my brain tends to disrupt all my best laid plans, and ideas come meaning I just can’t help myself but get swept up. I’m blaming Ian McKellen inspiring me to ‘practice any art’.

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Despite having no plans to do more, I have to say that I really enjoyed writing the first book, and I found the process of being able to write in a different way very fulfilling. I love writing this blog, and the first book is based on a lot of the pieces I have written for here, but it was nice to see them come together and take on a new and different life of their own. I also enjoyed mixing up the writing of something on a single theme with writing blogs on different topics for here, although I did rely a lot on Dr Claire Walker bringing together many guest blogs to allow me some writing time. It was lovely to see what those guest blogs brought to the site, and I really enjoyed seeing how including those voices really makes this feel even more like a community space. Without realising it, I think I caught ‘the bug’. Now, I’ve always enjoyed writing, this is my happy space, but I had never seen myself as an author, having held a book I’d written in my hands though, I can see how it could become a little addictive.

As I was sitting watching horror movies as part of my post release recovery, and researching for my 2025 Halloween post, I suddenly realised what I’d like to do next. I really wanted to write about some duel loves of mine, movies and TV plus infection.

Halloween 2025: Let’s talk all things vampirism and infection

Without any expectation of writing another book, all of a sudden I had a structure in my mind, and Don’t Open That Door had began…

You all know how much I am a movie and TV buff, everything from guilty pleasure reality TV, like The Secret Lives of Mormon Wives, to documentaries, and all genre of film (with the exception of torture porn horror movies, I’m a Blumhouse girlie). Whilst enjoying some down time with Mr Girlymicro, I realised how widely infection is featured in all kinds of different genera settings, some of it was actually pretty good, whilst some of it was really poor. So the first step was to do a whole bunch of research about what kind of examples were out there, by hitting up a bunch of different lists that have been collated by others, internet searches, and sourcing opinions from my movie loving friends. All of which led to the creation of a list of 138 options that needed a review to see if if they were actually linked to infection, and if they were infection based….was the infection content any good.

If you follow me (Girlymicro) on Instagram, you will have probably seen a number of stories that I’ve posted recently linked to movies I’ve been watching with some Infection Prevention and Control/micro commentary:

These have come about whilst I’ve been watching the 138 films/series with Mr Girlymicro to decide which ones make the cut to be included. I’ve watched some awesome films, some like Sinners, weren’t based on infection so couldn’t be included. I have also watched some truly bad movies, I even gave Resident Evil another go, and have spared you all by making sure that it is not included on the list. One of the considerations was that, even if the science wasn’t dreadful, I haven’t included anything that I or Rotten Tomatoes include as being truly horrible. I’m not just saving you on this, but also myself, as I’m having to watch included examples many times as part of the writing. I also felt it was really important to cover infections linked to viral, fungal, parasitic, and bacterial causes, just because they behave so differently and the interventions needed are so different. So the final list for inclusion involves movies and TV series that sit across infectious agents, although viruses are more represented than any other cause.

There are plenty of horror movies on the list, purely because they represent A LOT of the infection genera, but I was surprised at how many options there were outside of horror movies. I also tried to mix up certifications where I could, so that there are some options that everyone might enjoy.

Not everything could be included however, and there were also some exclusion criteria that impacted what I could include. Exclusion criteria included factors such as availability – no point including things that people can’t access, language options – I sadly only speak English so it needed at least English subtitles, and most importantly not based on real life events – this is about fiction.

For inclusion examples also needed to have infection as a central theme. This meant that health dramas could not be included as they only feature infection in some episodes, but at some point I do really want to write something that compares different medical dramas (House, New Amsterdam, Holby City etc) and maybe do a ranking scale….let me know if you think that would be a fun blog post.

The reason it felt timely to talk about this today, is that the Biomedical Scientist magazine has been kind enough to do a whole feature on what the new book will look like, with a bit more detail, and some examples of what chapters will look like. It dropped on the 27th March and you can check it out the link here: https://thebiomedicalscientist.net/2026/03/24/infections-films. Also, how awesome is the art work they’ve done, can’t say enough how awesome The Red Dress are.

Whilst writing the article for the Biomedical Scientist and watching the example movies, I couldn’t happen but note how many weird and wonderful things are included as part of the science representation. Things that in my scientific career I rarely if ever encounter, but seem to crop up time and time again in Hollywood depictions of scientific life. I’m collating these for one of the final chapters in the book called ‘Science House of Horrors’ as I find them a bit fascinating. I’ve included some of the ones in the Biomedical Scientist article that I noticed, as well as those sent through as responses from social media, but I’d love to know if you have any others that I should include.

There are other opportunities to get involved though, I have 23 films and series examples, but there is room in the book to cover 25. I’m really keen to get other examples that include fungi, but if there is just something brilliant I haven’t included please let me know. There will also be a chapter called ‘Hall of Fame’ that covers both amazing movies that just don’t have enough infection in them to be included, or ones that were great but not quite as good an example of an infection characteristic as the ones already included. There is also the ‘Hall of Shame’ for examples, such as the TV series The Rain and Resident Evil, where the science is so bad that it is note worthy in itself.

Anyone who drops me an email to elaine@girlymicrobiologist.com and inputs into the House of Horrors, volunteers film examples I’ve missed, or suggests contenders for the ‘Hall of Fame’ or ‘Hall of Shame’, will get their name included in the list of contributors at the back of the book. Science takes a village, so does pulling together a book, and I’m really keen that this feels like it comes from our community. I hope you enjoy the article and I can’t wait to hear from you about your suggestions.

All opinions in this blog are my own

Infection Representation in Popular Culture: Why infection and infection risks, as discussed in movies and TV, may matter more than you think

November 11, 2024 girlymicro General, Microbiology (Clinical), Science Communication Contagion, covid, covid-19, epidemic, film, fungi, health, IMDB, infection, infection movies, Last of Us, movies, Outbreak, pandemic, parasites, public engagement, Rise of Planet of the Apes, The Strain, TV, virus

It has not been a great week for science, with many of us being concerned about how the presence of a vaccine denier on the successful ticket to the white house will impact public health initiatives and the quality of science communication in general. I’ve been thinking a lot about how we got here and how, even more than previously, embedding good science into mediums that are routinely accessed by the majority, will be crucial in ensuring the reach of accurate science communication when some of the more standard public health routes are bound to suffer in the coming years.

I think it will be a surprise to none of you that I am a bit of a lover of TV and movies, we’ve also covered a number of book reviews linked to this blog, and I like nothing better than snuggling down with a good book and a cup of Darjeeling. What does any of this have to do with anything? Infection, infection control, and science in general is a huge chunk of my every day, but this isn’t the case for everyone, or even most people. Many people are passive absorbers, meaning that they may not search out information but take on board when they encounter it when going about their lives. This means that the quality of what they encounter may be hugely variable, depending on how and where this happens. I’ve previously talked about the quality of the science in some of the books I enjoy, including the News Flesh series, as well as posting last week about how infection control is represented the Alien movies for Halloween. These are fun posts to do, but it made me think of the most popular movies that are linked to infection out there. How good is the science they represent? and by doing this better, could we support science literacy in general?

IMDB list of Top 25 Virus/Pandemic/Epidemic/Infection Movies

In order to think about this more detail I hit the Internet Movie Database (IMDB) which contains all kinds of lists, including a top 25 of Virus/Pandemic/Epidemic/Infection Movies (https://www.imdb.com/list/ls094715071/)

Outbreak (1995)
Contagion (2011)
Carriers (2009)
Twelve Monkeys (1995)
The Crazies (2010)
28 Days Later (2002)
28 Weeks Later (2007)
I Am Legend (2007)
[Rec] (2007)
Doomsday (2008)
World War Z (2013)
Snowpiercer (2013) (Girlymicro comment – I don’t know that this should count as it’s linked to climate change)
Train to Busan (2016)
Resident Evil (2002)
Mimic (1997) (Girlymicro comment – I don’t know that this should count as its linked to biocontrol…)
Blindness (2008) (Girlymicro comment – I don’t know that this should count as its more Day of the Triffids than infection)
The Invasion (2007)
It Comes at Night (2017)
A Quiet Place (2018) (Girlymicro comment – I don’t know that this should count as it’s an alien invasion film)
Bird Box (2018) (Girlymicro comment – I don’t know that this should count as it’s an unknown enemy film that does not appear to be linked to infection)
Land of the Dead (2005)
Rise of the Planet of the Apes (2011)
The Happening (2008) (Girlymicro comment – I don’t know that this should count as it’s pheromones/intoxication rather than infection)
Dawn of the Dead (2004)
The Last of Us (2023)

Now, I have only seen 16/25 of these, Mr Girlymicro has seen 22/25, so between us we have most of these, so hopefully I’ll be to comment from a position of knowledge on a fair few of these. Before we even start however, as you can see from my commentary on this list, the poor science starts early during the classification of some of these as infection movies, even before we start to talk about the science content of the movie/show itself. Firstly, let’s look at the name of the list = Top 25 Virus/Pandemic/Epidemic/Infection Movies and how it related to the actual definition.

The CDC defines an epidemic as:

An increase, often sudden, in the number of cases of a disease above what is normally expected in a specific population and area.

An outbreak, which carries the same definition as an epidemic, but is often used for a more limited geographic area.

The CDC suggests epidemics occur when an agent and susceptible hosts are present in adequate numbers, and the agent can be effectively conveyed from a source to the susceptible hosts. Whereas a pandemic refers to an epidemic that has spread over several countries or continents, usually affecting a large number of people. The starting epidemic is usually due to a combination of factors including:

A recent increase in amount or virulence of the agent,

The recent introduction of the agent into a setting where it has not been before,

An enhanced mode of transmission so that more susceptible persons are exposed,

A change in the susceptibility of the host response to the agent, and/or

Factors that increase host exposure or involve introduction through new portals of entry

So you can see from the above that a number of movies on this list don’t actually count under the terms linked with to the title. Some of them are alien invasion, some of them are climate change related, and one is even on the topic of bioremediation. Yet there they are on the list.

For some of the others, I’ve already covered their concept during my Zombie post, so I’m not going to go through these in this blog, but focus instead on the ones that fulfill the epidemic based criteria. That said, give me a shout if you’d like a more in-depth zombie comparison post as Train to Busan is an awesome movie, and I’ll accept any excuse to re-watch it.

Let’s start at the very beginning

The first film on the list is Outbreak, a film that came out in 1995, with a description of ‘A team of Army doctors struggle to find a cure for the deadly Motaba virus that was transported from Africa to North America by a white-headed Capuchin monkey and is now spreading quickly throughout a small California town.’

This movie has an amazing cast, but I have to say I don’t want any of them in my team if it came to trying to lock down a high risk infection from an unknown source (vector). In terms of the escape monkey component. You’d think that it is far fetched, and if you’d asked me yesterday I would have said just that, but just today on BBC News there was a story on 43 escaped monkeys from a research lab in the US. So far fetched it may be, but not unheard of, in the case of vector escape.

Even if the vector component may not be quite as unlikely as I’d previously thought, I’d like to say that the rest of the practice in this is highly suspect at times. That said, I do have to admit, that I once went to a talk by a scientist who was looking for viral transmission sources of haemorrhagic fevers in Africa. They showed pictures of the table where they performed autopsies on found deceased animals in the jungle, under the same canopy as the table where they then sat down for dinner. So, as much as the way that high consequence infectious diseases (Ebola etc) are not portrayed as accurately as I’d like, maybe this is a movie of its time, as was that lecture. I really want to enjoy this movie, as it so defined how many of us had our first introduction to outbreaks and what they could mean, but almost 30 years on I don’t think I could recommend the scientific accuracy it portrays. The fact that this is still the top rated movie does not bode well for our scientific literacy hopes.

What a difference a decade makes

Almost 15 years after Outbreak, Contagion was released in 2011. This was the first of the infection movies on this list that I saw after I’d started working within Infection Prevention and Control. Contagion is described as ‘Healthcare professionals, government officials and everyday people find themselves in the midst of a pandemic as the CDC works to find a cure.’ I remember going to see this with a scientist friend and whooping out loud at the explanation of an R0, it gave me so much joy I was shushed by someone else in the cinema, to my ongoing shame.

The CDC defines an R0 as ‘The basic reproduction number (R 0), also called the basic reproduction ratio or rate or the basic reproductive rate, is an epidemiological metric used to describe the contagiousness or transmissibility of infectious agents.’ So, see if you share my joy at how the movie explains what this is, in a way that is so much more approachable than the CDC definition:

This film is not perfect, I clearly remember losing my mind about the glove use at one point, and SPOILER ALERT, it was that poor glove use that meant I was OK with one of the characters dying, but the underlying science is well explained and some of the approaches to containment and vaccination are definitely well routed in evidence. The differences in the quality of embedded science between Outbreak and Contagion are highly noticeable. Part of me wonders if some of the drivers for this heightened quality is linked to awareness of the topic due to the 2009 Swine Flu pandemic, or whether this was part of a wider shift towards improved factual grounding in these kinds of movies.

When talking to Mr Girlymicro about this movie, whilst writing this post, he has pointed out that despite my enjoyment he found it an act of ultimate depression which he will not be watching again, and that was when he watched it before the pandemic. It may therefore be, something that triggered my science joy may, in fact, be too depressing or triggering for other reasons to equate to true enjoyment for the general public. This may be an example of something that could risk being dis-engaging by being too close to the truth, despite being second on the IMDB list. Especially in a post pandemic world, this is a line that may prove difficult to walk and prove to be a barrier to movies and TV on this topic being commissioned in the short to medium term.

A completely different movie about primates

Still on viruses and re-visiting our primate theme from Outbreak comes Rise of the Planet of the Apes , which was also a 2011 release. It came out the same year as Contagion, and in the same discussion as Mr Girlymicro stated he would not re-watch that movie, for all the accuracy of it’s science, he would watch Rise repeatedly, and I can testify that in fact he has. Rise has the following description ‘A substance designed to help the brain repair itself gives advanced intelligence to a chimpanzee who leads an ape uprising.’ This is a really interesting addition to the category, as the pandemic aspects of it are mainly actually addressed in the closing credits which demonstrate how a pandemic can spread across the globe, with the film very much focused on the human (and primate) story behind the build up.

This film utilises a viral vector to try to address and revert brain abnormalities linked to Alzheimer’s, with a scientist desperately trying to find a cure for his father, whilst undertaking clinical trials on primates. Now, the clinical trial aspects of this film could not be further from the reality, and any scientist caught undertaking clinical trials and then sneaking the medication to treat their father would at best be fired and at worst been imprisoned. Somehow, because of the focus on the relationships rather than the science, the bad science in this movie bothers me significantly less than that represented in Outbreak, possibly because it feels deliberately portrayed as more like science fiction than science fact. There are some aspects of science to this one that I find interesting and like. The idea of a vaccine or medication behaving differently across species barriers is something that is interesting and could be deeply seated in evidence based plot-lines. I am aware, in this age of post truth and vaccine denial, having a film that focuses on how a vaccine or treatment could end life as we know it may not play into the goals I’m wishing to achieve using popular culture.

Let’s not forget about fungi

In recent years there’s been a rise in the quality of TV and the amount of choice has exploded, especially on streaming and other services. The switch to being able to film big budget TV over shorter film equivalents has provided storytellers with the capacity to really explore bigger and more complex tales that may not have been possible in under 3 hours.

This is last and most recent entry onto the IMDB list and is also the only TV entrant. It is our first step away from the world of viruses, into the world of mycology and all things fungal. The Last of Us came out in 2023, although it’s based on a computer game that was released in 2013. The series is set ‘after a global pandemic destroys civilization, a hardened survivor takes charge of a 14-year-old girl who may be humanity’s last hope.’ This is therefore a great combination of the way different mediums impact popular culture. The plot asks big questions about how far you would go to get a cure for the world, how much is one persons life versus the possible saving of mankind. It’s a real homage to the power that vaccination could hold to impact the world, and how when one isn’t available how desperately people might act in the search for a cure. This is the only entry on the list that came about post pandemic, and I think it is because of that (despite being a parallel to the game) that really resonates on where that desperation comes from, and despite the current vaccine back lash, shows how different outcomes could be.

The very first scenes of the series are a flashback interview from before the pandemic where a scientist talks about what they think the next bit pandemic will be, and I have to say the whole scene brings me unacceptable levels of science joy.

Anyway, this one played so much into my particular ball park that I worked with Liv Gaskill at ID Transmission on a series of articles that talked about the science behind both the Last of Us computer game and the resulting TV series, which pretty closely followed the same plot. This four part series was a real joy to be involved with and so I’m hoping that you might enjoy them too:

https://www.idtransmission.com/understanding/tlou-tales–episode-1-the-culprit-of-humanitys-downfall

https://www.idtransmission.com/understanding/tlou-tales–episode-2-the-devil-is-in-the-details

https://www.idtransmission.com/understanding/tlou-tales–episode-3-the-realities-of-the-last-of-us

https://www.idtransmission.com/understanding/tlou-tales–episode-4-living-with-the-living-dead

I wonder if fungi will be increasingly represented in this genre a) due to the success of The Last of Us and b) as viruses feel a little too close to home these days and so the fungal world might feel like a safer sand box to play around in. This could provide a safe way to have accurate science portrayal, alongside entertainment, as the real prospect of a fungal pandemic is thankfully pretty small.

A shocking oversight

We’ve reached the end of the list, but not the end of the blog post as I want to address an appalling over sight on the IMDB list, and that is the omission of The Strain on the list. This is also a TV series, where season 1 was released in 2014, covered a series of 3 books, and ran for 4 seasons. The series is described as ‘A mysterious viral outbreak with hallmarks of an ancient and evil strain of vampirism ravages the city of New York.’

The strain – episode one, season one

There are many reasons why I love this series (and at some point I should do a vampirism and infection blog to include things like Ultraviolet) is that some of the main characters are epidemiologists linked to the CDC and so some of the science exposition as part of the job based discussions is very pleasing. The other reason I like this series is there is a definite bait and switch, in terms of the causative agent, with all the initial dialogue being linked to your standard viral outbreak, with a gradual reveal that the culprit is actually a parasite. This adds a layer of interest as the approaches to dealing with transmission really start to reflect this, and provide an interesting change as the characters are also forced to pivot and discuss the differences. So, the use of a non-viral infection is not as unique as some of the coverage of The Last of Us may imply. That said, the general science outside of the epidemiology in this definitely becomes more to serve the horror plot than feasibility as time progresses.

Where are the bacteria?

You’ve survived ~3000 words of outbreak talk, covering viruses, fungi and even parasites. You may however be struck by the lack of bacterial cause in any of these listings. I’ve been thinking about this whilst I’ve been writing this blog and I’ve come up with a few thoughts as to why this might be the case:

Too close to home – many people have experienced bacterial infections themselves in their loved ones, sometimes with tragic consequences. It may be hard to therefore suspend belief enough to enjoy the offering. I wonder if this will be true to an extent for viruses now, or whether popular culture will be a safe way to explore collective trauma linked to the pandemic
Too slow – one of the features of many of the scenarios in these movies and shows is that the impact to fast and significant. This an important aspect of making events have real risk and in raising tensions. If accurately portrayed bacterial infections may be too slow in their impact OR the deterioration is so quick there is insufficient time for viewer engagement
Not dramatic enough – bacterial transmission (as described by R0) are not going to be as dramatic as their viral counterparts, so if you subscribe to ‘go big or go home’ this transmission route is probably not the one to drive a sprawling plot-line forward
Too commonly encountered – there are 101 medical shows which have bacterial infections and their consequences featured and so they may be too close to a different genre
The science is pretty hard to get right – as people are more familiar with the topic the less story flexibility there is and the greater the need to not be too jarring for those you are trying to engage. At least in the UK, many people will have been taught about Typhoid Mary and the John Snow Cholera outbreak, and so may have some familiarity. It may also be that these also make people think of the past, and this is not the feel many of these properties are trying to evoke.

So maybe bacteria are a harder sell, although I’d be intrigued to throw a little antibiotic resistance into the mix, or some bacterial toxin related drama and then see what cool things could be done as a result. Maybe that might be my future project 🙂 Let me know if you think that there is a bacterial based film/series that I’ve missed.

All opinions in this blog are my own