An American and a French national who have returned to their home countries having left a cruise ship hit by a deadly outbreak of hantavirus have tested positive, authorities say.
In total seven cases of hantavirus linked to the MV Hondius have been confirmed, with two other cases suspected, the World Health Organization *WHO) said on Monday.
The US health department said a second American national on the repatriation flight had also shown mild symptoms, adding that both passengers had travelled back in "biocontainment units out of an abundance of caution".
French Health Minister Stéphanie Rist said a woman was isolating in Paris and her health was deteriorating, with 22 contacts traced.
Three passengers have died after travelling on the ship, two of whom were confirmed to have had the virus.
The WHO said the person who is believed to have been the first to be infected in the outbreak died before he could be tested.
Two other British nationals with confirmed cases are currently being treated in the Netherlands and South Africa.
Hantaviruses are usually carried by rodents, but human transmission of the Andes strain - which the World Health Organization (WHO) believes was contracted by some of the Dutch ship's passengers while in South America - is possible.
Symptoms can include fever, extreme fatigue, muscle aches, stomach pain, vomiting, diarrhoea and shortness of breath.
Officials say the risk of a major outbreak is very low.
More than 90 passengers of the MV Hondius ship, currently docked in Spain's Canary Islands, are being repatriated.
In its latest update from Tenerife on Monday, Spanish officials said 54 passengers and crew were still on board the ship. Spanish Health Minister Mónica García said six of those were passengers: four Australians, one Briton and one New Zealander.
Some 22 people would disembark the ship to fly to the Netherlands on Monday, she said - including the Australians who had been expected to be flown home directly but whose plane could not be guaranteed to arrive on time.
The MV Hondius was then expected to leave for the Netherlands later on Monday, she said.
In its statement early on Monday, the US Department of Health and Human Services said all 17 US citizens on Sunday's flight would undergo "clinical assessment" at a medical facility in Nebraska. A British national living in the US was also repatriated alongside them.
Seven other US passengers had already returned home and were being monitored in their home states.
Before the American case was confirmed, WHO head Tedros Adhanom Ghebreyesus warned that the decision by the US not to follow his organisation's guidelines over the hantavirus outbreak "may have risks".
The WHO has recommended 42 days of isolation for those leaving the MV Hondius.
But Dr Jay Bhattacharya, the acting head of the US Centers for Disease Control (CDC) said he did not want to cause public panic, insisting that human-to-human transmission was rare and it should not be treated like the Covid virus.
Cruise ship passengers were pictured wearing blue gowns, bouffant caps, and medical face masks as they disembarked on Sunday at the port of Grandilla de Abona in Tenerife.
On Sunday, a plane carrying 20 British nationals arrived in the UK.
The passengers flew into Manchester Airport on a chartered flight from Tenerife and were taken to Arrowe Park Hospital in Wirral, Merseyside, to isolate for 72 hours. None of them have reported symptoms.
In Spain, 14 Spaniards flown to Madrid now face mandatory quarantine at a military hospital. Another two evacuation flights are scheduled for Monday afternoon.
A separate flight with 26 passengers and crew - including eight Dutch nationals - arrived in the Netherlands on Sunday.
Earlier on Monday, Ukraine said four of its citizens would remain on board the MV Hondius as part of the crew to ensure the ship's transfer to the Netherlands. Upon arrival, the foreign ministry said, they would be expected to quarantine at a medical facility.
Another Ukrainian national was expected to leave the ship as part of the partial crew evacuation on a flight to the Netherlands.
At present, no signs of illness have been recorded among the Ukrainians, the ministry added.
In a video message released on Monday by Oceanwide Expeditions, which operates the MV Hondius, the captain said the crew's thoughts were "with the ones that are now longer with us".
Jan Dobrogowski also said that "the past few weeks have been extremely challenging to us all", while praising the patience, discipline and kindness shown on board the vessel.
During her update, the Spanish health minister also said that one of the police officers involved in the ongoing repatriation operation had died of cardiac arrest.
An elderly Dutch man was the first passenger who died on board the MV Hondius on 11 April. He had earlier developed symptoms - but is considered a probable case as no tests have been carried out.
His wife - a 69-year-old woman - left the ship on the island of St Helena on 24 April and flew to South Africa. She died two days later in a clinic in Johannesburg.
A German woman died on board the cruise ship on 2 May.
The two women are both confirmed cases.
The MV Hondius departed Argentina's southern city of Ushuaia on 1 April, and is currently docked at the port of Grandilla, southern Tenerife.
