COVID-19 Outbreak on a Passenger Ship and Assessment of Response Measures, Greece, 2020

Abstract

ger and 1,606-bed capacity) with 33 crew members sailed from Piraeus, Greece, to Cesme, Turkey, where an additional 350 crew members embarked on March 8, 2020 (1). For 21 days, the ship sailed without any disembarkations or embarkations until the fi rst suspected coronavirus disease (COVID-19) case was reported to the health authority of the Piraeus port on March 28, 2020. We describe results of the outbreak investigation, including risk factors for transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The StudyWe collected data by completing standardized forms through interviews and medical examination of all travelers onboard and by reviewing the ship records and logs. We used descriptive statistics to analyze the study variables and performed univariate and multivariate analyses.In conducting clinical management of cases, we followed guidelines from the Hellenic National Public Health Organization (NPHO) for health measures on travelers and repatriation, which were based on the European Union Healthy Gateways Joint Action advice for management of COVID-19 cases onboard ships (2) (Appendix Table 1, https:// wwwnc.cdc.gov/EID/article/27/7/21-0398-App1. pdf). NPHO and the Piraeus Port Health Authority provided passengers with information about using medical facemasks at all times when outside of their cabins, as well as handwashing, physical distancing, and cleaning and disinfecting cabins; ship offi cers supervised.Food preparation and laundry and cleaning services were halted; travelers were instructed to clean their own cabins and store used linens in plastic bags. Cleaning and disinfection of the terminal was done by a private company under supervision of the Piraeus Port Health Authority, after all travelers disembarked the ship at the port of Piraeus. A catering company provided packaged meals; personal hygiene supplies were also provided (including facemasks and hand sanitizer). Methods and results of the environmental sampling have been published elsewhere (3).We collected oropharyngeal specimens from all travelers onboard. Molecular tests for SARS-CoV-2 detection were performed by using the Cobas SARS-CoV-2 test qualitative assay and the Cobas 6800/8800 System (La Roche, https://www.roche. com). Serologic tests were performed on blood

Interventional Study of Nonpharmaceutical Measures to Prevent COVID-19 Aboard Cruise Ships

“…Masking in different settings (ships, hospitals, communities) might have different effects, however, the effectiveness of masking measures is likely influenced by how strictly those measures are enforced. During the pandemic, an absence of mask-wearing measures resulted in large outbreaks onboard ships ( 8 , 9 ). Our study demonstrated reduced COVID-19 incidence rates because of the protective effect of masking onboard ships.…”

Transoceanic pathogen circulation in the age of sail and steam

“…Recent reports of SARS-CoV-2 transmission on board passenger ships [3,43,54,81] and military ships [47] indicate high attack rates across both vaccinated and unvaccinated populations. Multiple studies suggest that outbreaks could spread broadly across ship populations.…”

Analysis of the on-ship transmission of the COVID-19 mass outbreak on the Republic of Korea Navy amphibious warfare ship

“…'20년 1월 코로나19 판데믹 이후, 전세계적으로 교육시설, 종교시설, 목욕탕 및 음식점 등 다중이용시설, 병원 및 사업장 등 다양한 장소와 경로를 통한 집단 사례 발생이 보고되고 있 다 [3][4]. 코로나19에 의한 다양한 집단 사례 중 선박에서의 코로나19 집단 발병은 일본에서 2020 년 2월 중순 탑승자 700여 명이 감염된 D사의 크루즈선 사례가 있으며, 이후 미국 G사의 크루즈 선, 브라질의 화물선 등의 사례가 보고되었으며 [5][6][7], 특히 항공 모함(aircraft carrier)을 비롯한 군 함에서의 코로나19 집단 사례 [8][9] The adjusted rate ratio was calculated using the Mantel-Haenszel method, which is a weighted average of crude rate ratios from the individual stratumspecific two-by-two tables. 3 Due to the high correlation between age and rank, it was excluded from the calculation of adjusted rate ratio.…”