Norovirus Outbreaks on Commercial Cruise Ships: A Systematic Review and New Targets for the Public Health Agenda

Bert, Fabrizio; Scaioli, Giacomo; Gualano, Maria Rosaria; Passi, S.; Specchia, Maria Lucia; Cadeddu, Chiara; Viglianchino, C.; Siliquini, Roberta

doi:10.1007/s12560-014-9145-5

Cited by 62 publications

(51 citation statements)

References 27 publications

(20 reference statements)

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“…With approximately 25 million passengers annually across the world and growing, almost one million full-time equivalent jobs with $38 billion in wage and salaries and over $100 billion economic impact worldwide, the cruise industry has an influence on the lives of people in terms of recreation and employment. 1 Unfortunately, the environment on cruise ships has the ingredients of a ‘perfect storm’ for outbreaks, with common food and drink, shared spaces for most activities and a semi-closed environment [ 5 , 16 ]. The economic disincentive for passengers and crew to report illness may also play a role in complicating control of outbreaks [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

Quantifying the relative effects of environmental and direct transmission of norovirus

Towers¹,

Chen²,

Cruz³

et al. 2018

R. Soc. open sci.

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Norovirus is a common cause of outbreaks of acute gastroenteritis in health- and child-care settings, with serial outbreaks also frequently observed aboard cruise ships. The relative contributions of environmental and direct person-to-person transmission of norovirus have hitherto not been quantified. We employ a novel mathematical model of norovirus transmission, and fit the model to daily incidence data from a major norovirus outbreak on a cruise ship, and examine the relative efficacy of potential control strategies aimed at reducing environmental and/or direct transmission. The reproduction number for environmental and direct transmission combined is R0tot=7.2 [6.1,9.5], and of environmental transmission alone is R0environ=1.6 [0.9,2.6]. Direct transmission is overwhelmingly due to passenger-to-passenger contacts, but crew can act as a reservoir of infection from cruise to cruise. This is the first quantification of the relative roles of environmental and direct transmission of norovirus. While environmental transmission has the potential to maintain a sustained series of outbreaks aboard a cruise ship in the absence of strict sanitation practices, direct transmission dominates. We find that intensive promotion of good hand washing practices may prevent outbreaks. Isolation of ill passengers and cleaning are beneficial, but appear to be less efficacious at outbreak control.

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Section: Introductionmentioning

confidence: 99%

Quantifying the relative effects of environmental and direct transmission of norovirus

Towers¹,

Chen²,

Cruz³

et al. 2018

R. Soc. open sci.

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“…N oroviruses are responsible for approximately half of all cases of gastroenteritis worldwide. Their low infectious dose, ability to persist in an infectious state in the environment, and resistance to many commonly used cleaning agents have led to many disease outbreaks that have proved very difficult to contain (1,2). The virus is spread directly via the fecal-oral route but also from touching contaminated surfaces, which has recently been found to be more significant than originally thought in the spread of many diseases (3).…”

mentioning

confidence: 99%

Inactivation of Murine Norovirus on a Range of Copper Alloy Surfaces Is Accompanied by Loss of Capsid Integrity

Warnes

Summersgill

Keevil

2015

Appl Environ Microbiol

103

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Norovirus is one of the most common causes of acute viral gastroenteritis. The virus is spread via the fecal-oral route, most commonly from infected food and water, but several outbreaks have originated from contamination of surfaces with infectious virus. In this study, a close surrogate of human norovirus causing gastrointestinal disease in mice, murine norovirus type 1 (MNV-1), retained infectivity for more than 2 weeks following contact with a range of surface materials, including Teflon (polytetrafluoroethylene [PTFE]), polyvinyl chloride (PVC), ceramic tiles, glass, silicone rubber, and stainless steel. Persistence was slightly prolonged on ceramic surfaces. A previous study in our laboratory observed that dry copper and copper alloy surfaces rapidly inactivated MNV-1 and destroyed the viral genome. In this new study, we have observed that a relatively small change in the percentage of copper, between 70 and 80% in copper nickels and 60 and 70% in brasses, had a significant influence on the ability of the alloy to inactivate norovirus. Nickel alone did not affect virus, but zinc did have some antiviral effect, which was synergistic with copper and resulted in an increased efficacy of brasses with lower percentages of copper. Electron microscopy of purified MNV-1 that had been exposed to copper and stainless steel surfaces suggested that a massive breakdown of the viral capsid had occurred on copper. In addition, MNV-1 that had been exposed to copper and treated with RNase demonstrated a reduction in viral gene copy number. This suggests that capsid integrity is compromised upon contact with copper, allowing copper ion access to the viral genome. N oroviruses are responsible for approximately half of all cases of gastroenteritis worldwide. Their low infectious dose, ability to persist in an infectious state in the environment, and resistance to many commonly used cleaning agents have led to many disease outbreaks that have proved very difficult to contain (1, 2). The virus is spread directly via the fecal-oral route but also from touching contaminated surfaces, which has recently been found to be more significant than originally thought in the spread of many diseases (3). Ineffective cleaning agents may leave on surfaces residual virus particles which can initiate an infection (4). Norovirus disease is usually self-limiting, with symptoms lasting a few days, but can be more serious in severely ill or immunocompromised individuals, especially if the causative agent is one of the emerging recombinant strains, including GII.g/GII.12, which appeared in 2008 and has enhanced virulence and severity of clinical symptoms. Asymptomatic carriage and extended virus shedding also increase the risk of transmission (5, 6). A recent study of a large waterborne outbreak in Nokia, Finland, also observed that norovirus exposure may result in long-term health effects, which can persist for 15 months after the initial infection (7). This may mean that the considerable public health costs incurred in initial outbreaks, estimate...

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“…All cases were managed by the medical staff according to the cruise ship guidance in terms of exclusion and isolation of patients [34] and implementation of environmental disinfection [15]. These measures prevented the development of a GI outbreak [39].…”

Section: Discussionmentioning

confidence: 99%

Respiratory infections and gastrointestinal illness on a cruise ship: A three-year prospective study

Pavli

Maltezou

Papadakis³

et al. 2016

Travel Medicine and Infectious Disease

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Norovirus Outbreaks on Commercial Cruise Ships: A Systematic Review and New Targets for the Public Health Agenda

Cited by 62 publications

References 27 publications

Quantifying the relative effects of environmental and direct transmission of norovirus

Quantifying the relative effects of environmental and direct transmission of norovirus

Inactivation of Murine Norovirus on a Range of Copper Alloy Surfaces Is Accompanied by Loss of Capsid Integrity

Respiratory infections and gastrointestinal illness on a cruise ship: A three-year prospective study

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