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.

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 contact cases traced.

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.

Three passengers - a Dutch couple and a German woman - have died after travelling on the vessel. Two of them are confirmed to have had the virus.

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.

In its statement early on Monday, the US Department of Health and Human Services said all 17 US citizens on the flight "will undergo clinical assessment" at a medical facility in Nebraska.

Seven other US passengers had already returned and are being monitored in their home states.

A British national who resides in the US was evacuated along with the 17 American passengers.

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.

There were five French nationals sailing on board the vessel.

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.

Two other British nationals with confirmed cases are now being treated in the Netherlands and South Africa.

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.

The Spanish minister also revealed that one of the police officers involved in the ongoing repatriation operation had died of cardiac arrest.

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.

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.

An Irish Air Corps jet is bringing home the two Irish passengers from MV Hondius.

The Merseyside site was last used to isolate those arriving from China at the start of the Covid pandemic.

After being flown to a medical centre in Nebraska, some will be allowed to "self-isolate" in their home states.

The passengers landed in the UK on Sunday and none have reported symptoms, but they will will be monitored in hospital for 72 hours.

The first US presidential visit to China in almost 10 years will test a fragile tariff truce.