cruise ship illness outbreaks

Many crew positions do not require direct contact with passengers. Outbreaks of influenza and other respiratory viral diseases can occur at any time of the year among cruise ship passengers. During the most recent outbreak, a 14-day cruise onboard the Viking Neptune in June, slightly over 13% of passengers (110 of 838) reported being ill with predominant symptoms of abdominal. Passengers can work in collaboration with cruise lines to promote onboard public health by frequently washing their hands, promptly reporting AGE illness symptoms, and isolating themselves from other persons immediately after illness onset. Respiratory specimens should ideally be collected within 3 to 4 days of illness onset. This report uses MIDRS data to describe the incidence rates of AGE illness onboard passenger cruise ships that travel from foreign countries by ship size, voyage length, and regional U.S. ports of call for arrival. Caribbean Islands: FPR, ISC, MAY, NYA, PPR, SJO, SJU, STC, STT. Update: Influenza activity United States, 1997-98 season. Ships should carry a sufficient quantity of PPE, such as face masks, N95 respirators, and disposable gloves, for use in controlling the spread of influenza or other diseases. Rates (total population, passengers, and crew) were mapped using quartile breaks as cut points to measure the variability around the median rate. Health care providers should consider discussing the importance of good personal hygiene and proper handwashing during clinical examinations with patients, especially those planning to take a cruise. In addition to higher rates, these findings also indicate that AGE outbreaks are more frequent on voyages lasting >7 days among passengers and 67 days among crew. Specific management should include early identification and isolation of crew members and passengers with ILI, encouraging good respiratory hygiene and cough etiquette, use of influenza antiviral medications for treatment of people with suspected or confirmed influenza, and use of antiviral chemoprophylaxis during influenza outbreaks, if indicated, for high-risk people exposed to influenza. Holland America's the Nieuw Amsterdam, which set sail on May 6, is among a string of 11 cruise ships to report gastrointestinal illness onboard this year, according to the Centers for Disease Control and Prevention. Vaccination of passengers, especially those at high risk for influenza complications, is recommended at least 2 weeks before cruise ship travel, if influenza vaccine is available and the person has not already been vaccinated with the current years vaccine. Passengers and crew members who may have been exposed to a person suspected of having influenza should monitor their health for 4 to 5 days after the exposure. 5 Illnesses You Can Get on a Cruise Ship (Besides COVID) Plus, tips on how to avoid getting sick while at sea and ports of call By Rachel Nania and Nicole Gill Council, AARP En espaol March 17, 2023 Continued surveillance provides an opportunity for VSP to work collaboratively with cruise lines to reduce the risk for AGE transmission onboard and mitigate possible transmission to local communities. Overall, AGE incidence rates were highest among cruise ships visiting ports in California (San Diego, Los Angeles, San Pedro, and San Francisco), Alaska (Whittier and Seward), Texas (Houston and Galveston), New York (Brooklyn and New York City), Florida (Fort Lauderdale), and Louisiana (New Orleans) (Figure 2). Saving Lives, Protecting People, https://www.cdc.gov/norovirus/trends-outbreaks/worldwide.html, https://www.cdc.gov/nceh/vsp/desc/about_inspections.htm, https://www.cdc.gov/nceh/vsp/desc/about_investigations.htm, https://www.who.int/news-room/fact-sheets/detail/diarrhoeal-disease, https://www.cdc.gov/nceh/vsp/docs/vsp_construction_guidelines_2018-508.pdf, https://doi.org/10.1016/j.pop.2013.05.006, https://doi.org/10.1017/S0950268800030363, https://doi.org/10.1016/S0749-3797(02)00644-X, https://www.cdc.gov/nceh/vsp/surv/gilist.htm, https://doi.org/10.1017/S0950268812000234, https://doi.org/10.1111/j.1708-8305.2008.00199.x, https://doi.org/10.1016/j.amepre.2005.10.027, Centers for Disease Control and Prevention, U.S. Department of Health & Human Services. CDC is not responsible for Section 508 compliance (accessibility) on other federal or private website. Federal regulation 42 (CFR Section 71.41 General Provisions, Foreign Quarantine Requirements Upon Arrival at U.S. People with underlying chronic medical conditions can experience exacerbation of those conditions with influenza. Where sinks are available, ships should ensure that supplies for handwashing (i.e., soap, disposable towels) are consistently available. CDC is not responsible for Section 508 compliance (accessibility) on other federal or private website. By clicking Sign up, you agree to receive marketing emails from Insider In the early 1970s, cruise ships experienced an excessive number of gastrointestinal disease outbreaks, which led CDC to establish VSP in 1975 (4). Gastrointestinal Illness Surveillance. Ships should ensure availability of conveniently located dispensers of alcohol-based hand sanitizer. Vessel Sanitation Program 2011 Operations manual. More than 100 Viking cruise passengers fall ill in norovirus outbreak AGE incidence rates among crew increased in 2010, 2013, and 2016 for all ship sizes (Figure 7). During 20062019, VSP received 18,040 (48.4%) 24-hour routine reports, 18,606 (49.9%) 4-hour update reports, and 612 (1.6%) special reports (2% and 3% AGE reports). The findings in this report also indicate that AGE incidence rates are higher on cruises lasting >7 days and that rates vary by regional port location. Abbreviation: GRT = gross registered tons. Hall AJ, Wikswo ME, Manikonda K, Roberts VA, Yoder JS, Gould LH. As a result, many crew members have limited interaction with passengers by using only crew designated areas and interact with the same crew members for the length of their contracts. VSP monitors cases of AGE illness among passengers and crew sailing on cruise ships carrying 13 passengers and within 15 days of arrival at a U.S. port from a foreign port of call. It's not that the kitchen crew isn't following food safety guidelines. Provide tissues and access to soap and water and ask the sick person to: Cover his or her mouth and nose with a tissue (or face mask) when coughing or sneezing. When stratified by voyage length, a greater percentage of cruise ships anchoring in California had voyages lasting 35 days. Used gloves should be discarded in the trash and should not be washed or saved for reuse. Linking to a non-federal website does not constitute an endorsement by CDC or any of its employees of the sponsors or the information and products presented on the website. Of the 156 passenger-associated outbreaks, 63% occurred during 20062012; for crew, 50% occurred during 20142019 (Figure 10). Learn how VSP tracks cases of gastrointestinal illness. VSP obtains its operating funds through user fees paid by the cruise lines after ships undergo unannounced environmental health inspections. Second, the estimated incidence for voyages lasting 37 days might be biased because exposure to norovirus on these shorter voyages might result in symptoms occurring after the voyage has ended, leading to underreporting of AGE cases. Close living quarters may increase the amount of group contact. The majority of ships traveling to ports in California and the Southeast region were on voyages lasting 35 days (52% and 51.9%, respectively); 67 days for ships anchoring in the South region (47.0%); 810 days for ships visiting ports in the Northwest (88.8%), Caribbean Islands (70.1%), and Northeast (68.7%) regions; and 1121 days for ports in the Hawaiian Islands (97.0%) (Figure 5). Each year, new cruise ships are built to accommodate the growing number of cruisers (17). The CDC has logged 13 outbreaks on cruise ships that met its threshold for public notification so far this year, more than any year between 2017 and 2019. Until 2001, ship masters reported the number of diarrheal illnesses by radio or telephone to CDCs VSP 24 hours before arrival at a U.S. port. The Cruise Ships With the Best and Worst Sanitation Scores in 2023 Vega E, Barclay L, Gregoricus N, Shirley SH, Lee D, Vinj J. Genotypic and epidemiologic trends of norovirus outbreaks in the United States, 2009 to 2013. Disease transmission and passenger behaviors during a high morbidity Norovirus outbreak on a cruise ship, January 2009. VSP is authorized under the Public Health Service Act (42 U.S.C. the date of publication. * Per 100,000 travel days (defined as the sum of passengers/crew cases of the total number of voyage days). Health and Human Services. endorsement of these organizations or their programs by CDC or the U.S. Outbreaks of AGE illness commonly occur in crowded living accommodations or communities where persons are crowded together and can spread quickly in semienclosed environments, such as cruise ships. In addition to implementation of ship inspections, cruise ship industry practices, such as hygiene standards, availability of hand hygiene stations in public areas throughout the ship, and health screening of passengers and crew before embarkation, also have likely contributed to the trend of declining AGE incidence rates. Early detection, prevention, and control of influenza are important, not only to protect the health of travelers on cruise ships, but also to avoid spread of disease into home communities by disembarking sick passengers and crew members. Final voyage AGE case counts are not required to be reported to MIDRS, likely leading to an underestimation of the actual incidence of AGE illness and limiting accurate trend analysis, which can hamper efforts to improve public health interventions and policies to reduce disease transmission. AGE illness is highly contagious and can be transmitted quickly within vessels. AGE incidence rates decreased during this time. Epidemiology of gastroenteritis on cruise ships, 2001-2004. Additional research and evaluation are needed to determine possible causal relations between delayed reporting of AGE illness to ship medical personnel and demographic characteristics of traveling passengers. This document provides guidance for cruise ships originating from, or stopping in, the United States to help prevent, diagnose, and medically manage influenza-like illness (ILI). US Department of Health and Human Services. Remain isolated in their cabins or quarters until at least 24 hours after resolution of fever without the use of fever-reducing medications. Washington, DC: Cruise Line International Association; 2019. This conversion might result in character translation or format errors in the HTML version. Ship inspections were implemented in 1975 to ensure a higher level of shipboard sanitation to protect the health of the travelling public, including crew members who typically spend several months at a time onboard a cruise ship. This finding might be attributed to changes in the AGE case definition. Improper use or handling of PPE can increase disease transmission risk. Explore our resources for investigating and responding to outbreaks on cruise ships. Surveillance Summaries / September 24, 2021 / 70(6);119, Keisha A. Jenkins, DrPH1; George H. Vaughan Jr., MPH2; Luis O. Rodriguez, MS1; Amy Freeland, PhD1 (View author affiliations), Views equals page views plus PDF downloads. Outbreak of influenza A infection among travelersAlaska and the Yukon Territory, May-June 1999. Sick travelers should be advised to seek healthcare if they are at high risk of developing severe illness from influenza or if they are concerned about their illness. MIDRS data do not reflect final AGE case counts at the time of disembarkation because ships are not required to report final voyage case counts for passengers and crew. Southeast (all ports in FL, GA, and SC): CHA, JAX, KWE, MAN, MIA, NPF, PBF, PCF, PEN, PEV, SAV, SFL, SPF, TAM, VBF, WPB. Commercial maritime travel is characterized by the movement of large numbers of people in closed and semi-closed settings. Cruise Ship Illness: Why Are Ships So Prone to Norovirus Outbreaks? In a statement to The Washington Post, the Cruise Lines International Association said that gastrointestinal illness outbreaks on cruise ships are "quite rare" compared to those on land. This means if it carries 13+ passengers and has a foreign cruise itinerary with US ports of call in it. Differences in findings might be due to the time frame in which the studies were conducted and correlation with the emergence of new norovirus strains (14,19). South (all ports on Gulf of Mexico, excluding FL): BRT, CCT, FTP, FTX, GAL, GMS, HOU, MAL, NOL, PAT, PIT. Ports with <20 reports were considered unstable and no data are presented. 1. Learn more about illnesses and outbreaks reported to VSP and find information about outbreaks of gastrointestinal illness on cruise . California: ACA, CAT, LAX, LBC, MCA, SAC, SBC, SDC, SFO, SPC. Approximately 37.0% had voyages lasting 35 days and 32.9% had voyages lasting 810 days. Continue to practice respiratory hygiene, cough etiquette, and hand hygiene after returning to work, because respiratory viruses can continue to be shed for several days after fever resolves. In 2019, nearly 15 million people took cruises in the US, while that number. If the ship will not be arriving imminently at a US seaport, CDC quarantine officials will provide guidance to cruise ship officials regarding management and isolation of the sick person or people and recommendations for other passengers and crew members. Interpretation: This report is the first detailed summary of surveillance data from MIDRS during 20062019. Users are referred to the electronic PDF version (https://www.cdc.gov/mmwr) Among crew, incidence rates were significantly higher for extra-large ships compared with other ship sizes and voyages lasting 67 days. Dannenberg AL, Yashuk JC, Feldman RA. Stomach Virus Spreads Through Cruise Ships at Fastest Pace in Years During influenza outbreaks, in addition to routine cleaning and disinfection strategies, cruise ships may consider more frequent cleaning of commonly touched surfaces such as handrails, countertops, and doorknobs. Outbreak updates for international cruise ships: vessel sanitation program 2011. A total of 122 passenger outbreaks occurred on cruise ships visiting ports in the Southeast (44.3%), California (20.1%), and Northeast (17.5%) regions (Table 3). Acute gastroenteritis. Centers for Disease Control and Prevention, The cruise industry shut down during the pandemic. Linking to a non-federal website does not constitute an endorsement by CDC or any of its employees of the sponsors or the information and products presented on the website. Vessel Sanitation Program | VSP | CDC A total of 117 (75%) outbreaks occurred among passengers on voyages lasting 1121 days; for crew, 10 (63%) of 16 outbreaks occurred on voyages lasting 37 days (Table 3). Signs and symptoms of influenza include acute onset of some or all of these signs and symptoms: fever or feeling feverish, chills, cough, sore throat, runny or stuffy nose, muscle or body aches, headache, fatigue (tiredness), and sometimes diarrhea or vomiting. AGE incidence rate trends for passengers and crew were analyzed in relation to ship size and, during 20062019, rates showed a decreasing trend among extra-large, mega, and super-mega ships. Cruise ships: high-risk passengers and the global spread of new influenza viruses. ** Northwest (WA, OR, AK): ADK, AKU, ANC, AOR, ATT, BAK, BWA, COR, DHA, EFC, FHW, GLB, HAK, HNS, HOM, IAK, JNU, KIS, KOD, KTN, MET, NOM, PAN, POR, PTB, SEA, SGY, SIT, SWD, VDZ, WAI, WRG, WTR, YAK; Hawaiian Islands, Guam, American Samoa, Saipan: GUA, HIL, HNL, KAH, KAU, KON, LAH, MAU, PAS, SAI, SAM; California: ACA, CAT, LAX, LBC, MCA, SAC, SBC, SDC, SFO, SPC; South (all ports on Gulf of Mexico, excluding FL): BRT, CCT, FTP, FTX, GAL, GMS, HOU, MAL, NOL, PAT, PIT; Northeast (all states north of and including NC): ABN, AMD, ANY, AVA, BAL, BAR, BAT, BNJ, BNY, BOO, BOS, BUF, CHI, CLY, CMA, CME, COH, DET, DMN, EME, ERI, GMA, GNY, HOL, JOL, KNY, MAC, MAR, MCI, MIL, MVY, NOR, NRI, NYC, OGS, OMA, OSW, PEJ, PHL, PHM, PME, PNH, PNY, PRI, PVM, RCK, RHI, RNY, SMA, SMI, STP, SYN, TCM, TNY, TRA, WDE, WNC, WPN, WRI, WVA, WYN, YRK; Southeast (all ports in FL, GA, and SC): CHA, JAX, KWE, MAN, MIA, NPF, PBF, PCF, PEN, PEV, SAV, SFL, SPF, TAM, VBF, WPB; Caribbean Islands: FPR, ISC, MAY, NYA, PPR, SJO, SJU, STC, STT. Atlanta, Georgia: US Department of Health and Human Services, CDC, National Center for Environmental Health; 2018. Maintain a distance of 6 feet from the sick person while interviewing, escorting, or providing other assistance. Find a cruise ship's inspection report. In 2017, U.S. passengers accounted for 46% of global cruise ship travelers (26.8 million passengers), and the number of transit passengers visiting U.S. ports increased by 8% from 2016 to 2017 (5.6 million passengers) (20). A single oral dose of baloxavir is equivalent to 5 days of twice daily oral oseltamivir; however, baloxavir is not recommended for pregnant women, lactating mothers, or people with severe influenza, including hospitalized patients, because of the lack of data in these groups. Percentages might not total 100% because of rounding. That's the same as the number reported in the whole of 2018. Acute Gastroenteritis . Outbreaks of influenza or ILI (exceeding 1.380 cases per 1,000 traveler days) among passengers or crew members, Hospitalization (ashore or at sea) caused by, or suspected to be associated with, influenza or ILI onboard the vessel. The revised case definition was first published in the 2000 VSP Operations Manual and became fully operational in 2001 (8). Like other affected cruise ships, Holland America told the CDC it has increased cleaning and disinfection procedures to deal with the outbreak and has sent stool samples to a lab to determine the cause. Cruise ship management and medical staff need to be flexible in identifying and caring for people with ILI. Among passengers, AGE incidence rates increased significantly with increasing ship size and voyages lasting more than 7 days, whereas for crew members, rates were significantly higher for mega (26.7 per 100,000 travel-days) and super-mega (29.2 per 100,000 travel days) ships compared with the smaller ship sizes and voyages >5 days compared with 35 day voyages (Table 2). People joining the ship may bring the virus to other passengers and crew. Incidence rates among passengers were higher on mega and super-mega ships and voyages lasting >7 days. Healthcare providers should understand the advantages and limitations of influenza tests, and proper interpretation of negative results of rapid influenza diagnostic tests (antigen detection tests). CDCs Vessel Sanitation Program (VSP) is responsible for conducting public health inspections and monitoring acute gastroenteritis (AGE) illness on cruise ships entering the United States after visiting a foreign port. An inspection score lower than 86 is considered unsatisfactory and subjects the ship to an unannounced reinspection. Cruise ships under VSP jurisdiction are required to submit a standardized AGE report (24-hour report) of case counts for passengers and crew 2436 hours before arrival at a U.S. port after traveling internationally. VSP declares an outbreak when 3% or more of the passengers or crew on a voyage report AGE symptom to the ships medical staff. Regional AGE incidence rates were mapped using natural breaks as cut points, and port-specific AGE incidence rates (total population, passengers, and crew) were mapped using quartile breaks as cut points to examine the variability around the median rate. Cruise Ship Illness: How to Protect Yourself Surfaces contaminated by the respiratory secretions of a sick person (e.g., in the sick persons living quarters or work area, and in isolation rooms) should also be cleaned. A Celebrity Summit cruise ship is docked in Portland Harbor on Tuesday, June 25, 2019, Shawn Patrick Ouellette/Getty Images Nearly 200 people were sickened with norovirus on the Celebrity Summit cruise ship in May. Acute respiratory illness among cruise-ship passengersAsia. 213, or over 10%, of passengers and 35, or 4%, of crew on the Nieuw Amsterdam have been reported sick during the voyage that lasts until May 21, mostly with diarrhea and vomiting. Cruise Ship Travel | CDC Yellow Book 2024 Cramer EH, Gu DX, Durbin RE. Acute Gastroenteritis on Cruise Ships Maritime Illness Database and Reporting System, United States, 20062019. Cruise Ship Illness: How to Protect Yourself Cruise Tips Staying Safe Cruise Ship Illness: How to Protect Yourself Find out how you can protect yourself from cruise ship illness. If the cumulative number of AGE cases changes after submission of the 24-hour report, a 4-hour update report must be submitted no less than 4 hours before the ship arrives at the U.S. port. The cruise industry is back in full swing after shutting down during the COVID pandemic. For crew members, rates were significantly higher on extra-large ships (19.8 per 100,000 travel-days) compared with small and large ships and on voyages lasting 67 days. Outbreak of 2009 pandemic influenza A (H1N1) on a Peruvian Navy ship June-July 2009. The most frequently reported cruise ship outbreaks involve GI infections (e.g., norovirus), respiratory infections (e.g., coronavirus disease 2019 [COVID-19], influenza), and other vaccine-preventable diseases (VPDs), such as varicella.

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