Sixteen of the 18 passengers transferred to the U.S. from a cruise ship where there was an outbreak of hantavirus arrived in Omaha, Neb., on Monday for evaluation after disembarking the vessel in Spain’s Canary Islands over the weekend.

Of the 15 U.S. citizens and one dual U.S.-British citizen who arrived in Nebraska, all but one are currently being housed in the National Quarantine Unit. That patient tested positive for the virus and was being housed in the Nebraska Biocontainment Unit, officials said at a Monday news conference. The 15 people in the quarantine unit will continue to be monitored for signs of the illness.

Passengers carry their belongings in plastic bags after being evacuated from the MV Hondius after docking in the Granadilla Port on Sunday in Tenerife, part of the Canary Islands, Spain.

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Nebraska may seem an unlikely location to process these individuals, but it is home to the National Quarantine Unit — the only federally funded quarantine unit in the U.S. — and the separate Nebraska Biocontainment Unit. They are highly specialized facilities located at the University of Nebraska Medical Center (UNMC) and widely considered among the best in the world.

The $1 million, five-room biocontainment unit was dedicated in 2005. It was a joint project with Nebraska Health and Human Services and the UNMC. It is set up to safely provide medical care for patients with highly hazardous and infectious diseases and was used in 2014 to treat two doctors infected with Ebola. The National Quarantine Unit was completed in late 2019. It cost nearly $20 million, according to the Associated Press. Both facilities were used during the COVID-19 epidemic.

“We are prepared for situations exactly like this,” Dr. Michael Ash, CEO of Nebraska Medicine, said in a statement. “Our teams have trained for decades alongside federal and state partners to make sure we can safely provide care while protecting our staff and the broader community. We are proud to support this national effort.”

Two additional U.S. passengers on the cruise ship — a couple, with one showing symptoms of hantavirus — were transferred for monitoring to Emory University Hospital, where another advanced biocontainment facility is located.

When the biocontainment unit was first dedicated more than 20 years ago, the biggest concerns were anthrax attacks and severe acute respiratory syndrome, more commonly known as SARS, Dr. Phil Smith, who spearheaded the efforts at Nebraska Medical Center to create the biocontainment unit, told the AP in 2020. Smith died last year.

A hallway leading to rooms at the Nebraska Biocontainment Unit at the University of Nebraska Medical Center.

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The quarantine unit features 20 negative-pressure rooms designed to keep potentially harmful particles from escaping by maintaining lower air pressure inside than outside the rooms. The single-occupancy rooms provide patients with attached bathrooms, exercise equipment and Wi-Fi, according to the medical center.

“We have protocols in the quarantine unit that provide for safe care of these of these persons, including just all the activities of daily living so that they can … have a comfortable stay but also have it in an area that’s protected and limits spread of the pathogen,” Dr. Michael Wadman, the medical director of the National Quarantine Unit, said at a Friday news conference. 

The biocontainment unit, by contrast, is a patient-care space where people are able to receive medical treatment, Dr. Angela Hewlett, medical director of the biocontainment unit, told reporters Monday.

She emphasized that the facility — which has a 10-bed capacity — operates independently from the quarantine unit and has its own dedicated air-handling system. “We don’t share [it] with any of the rest of the facility,” she said, noting that the unit uses rooftop HEPA filtration and is designed “very differently” from what most people typically imagine in a hospital setting.

One of the rooms in the Nebraska Biocontainment Unit.

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Nebraska Gov. Jim Pillen, speaking at Monday’s news conference, welcomed the recently arrived patients, who are among nearly 150 people from 23 different countries who were aboard the MV Hondius when the illness most commonly transmitted to humans through contact with infected rodents broke out. As of Monday, the World Health Organization has reported at least nine cases of hantavirus, including three deaths.

“We’re glad that you’re here,” Pillen said. “We’re going to ensure that you have the best world-class care possible.”

Pillen also sought to reassure Nebraskans that the facilities are safe and secure: “We’re working diligently to ensure no one leaves the security in an unsecured way at an inappropriate time,” he said. “No one poses a risk to public health, just walking out the front door of the streets of Omaha.”

The hantavirus outbreak on the cruise ship has been identified as the Andes strain of the illness, one that can be spread, though rarely, from person-to-person, according to the Centers for Disease Control and Prevention. It can cause severe respiratory disease, with early flu-like symptoms.

“The Andes variant of this virus does not spread easily, and it requires prolonged, close contact with someone who is already symptomatic,” according to Adm. Brian Christine, the assistant secretary for health at the U.S. Department of Health and Human Services, who spoke at Monday’s news conference. “Even so, we have taken this situation very seriously from the very start.”

“The risk of hantavirus to the general public remains very, very low,” he said.

The full quarantine period for hantavirus is 42 days, Christine said, but he added that the patients would be allowed to go home if they remained asymptomatic.

“Right now, the passengers that are all in the assessment phase — they’re going to be here for at least a few days while we do assessments and the coordination on what happens next,” he said, adding that they had the option to remain in the quarantine facility for the full period, for “the safest and most effective option for them.”