Letter to the editor: Measles on the cruise ship: links with virus spreading into an emergency department in Southern Italy

Abstract

Recently, Lanini et al. described an outbreak of measles that occurred on a ship cruising the western Mediterranean Sea, involving 27 cases among crew members and passengers between 20 February and 1 March 2014 [1]. Cases originated from different countries, six were from Italy. As highlighted by the authors, at the time of their preliminary report, the number of cases among passengers was likely to be underestimated, given that the incubation time for measles ranges from seven to 18 days, and the mean passenger time on board is seven days. Since the time on board is not long enough to develop symptoms in a susceptible exposed person, passengers might develop the diseases only after returning to their home country [1].

Authors’ reply: Measles on the cruise ship: links with virus spreading into an emergency department in Southern Italy

“…We thank Cozza et al for their letter in response to our paper [1]. The letter is a timely report and a good opportunity to provide additional information about the outbreak and share some general considerations.…”

“…Seven of the 29 confirmed cases developed symptoms at home after returning from the cruise. These cases included a young child (passenger) from Lazio, a young child (passenger) from Umbria, an adult passenger from Sardinia who needed admission to an intensive care unit, two cases from Lecce (an adult passenger and a crew member), an adult passenger from Bari, and the teenage passenger from Brindisi reported by Cozza et al [1].…”

“…Cozza et al raised another interesting issue with relevant public health implications: the contact tracing investigation pointed out that 12 of all 32 potential measles cases from Puglia were associated with exposure to measles within an emergency department [1]. Media news report that the Department of Health in Spain is investigating a large, still ongoing, measles outbreak in Catalonia, with about 102 cases in the first three months of 2014 [3].…”

Extensive Nosocomial Transmission of Measles Originating in Cruise Ship Passenger, Sardinia, Italy, 2014

“…The remaining 56 cases include 28 primary cases (crew and passengers) and 28 secondary cases; 39 of 56 case-patients were Italian and 17 were of foreign origin. One other secondary outbreak linked to the cruise ship has been reported ( 2 ). …”

“…Measles virus genotype B3 was identified in 7 cases, and phylogenetic analysis showed that viral sequences were identical to each other and to those obtained from the cruise ship outbreak ( 2 , 4 ) (measles nucleotide surveillance [MeaNS] database accession nos. 62563, 62564, 67009, 67016, 62565, 67017, and 67020).…”