Norovirus Transmission on Cruise Ship

Isakbaeva, Elmira T.; Widdowson, Marc‐Alain; Beard, R. Suzanne; Bulens, Sandra N.; Mullins, James A.; Monroe, Stephan S.; Bresee, Joseph S.; Sassano, Patricia; Cramer, Elaine H.; Glass, Roger I.

doi:10.3201/eid1101.040434

Cited by 152 publications

(105 citation statements)

References 13 publications

(16 reference statements)

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“…Thirteen of these were subsequently excluded because they did not meet the inclusion criteria: five because they were reports of outbreaks on military ships, and eight because data about the location and the characteristics of the outbreak were not available. Twenty-two articles (Morillo et al 2012;Wikswo et al 2011;Vivancos et al 2010;Xerry et al 2009;Boxman et al 2009;Xerry et al 2008;Chimonas et al 2008;Verhoef et al 2008a, b;Takkinen 2006;Koopmans et al 2006;Ferson and Ressler 2005;Isakbaeva et al 2005;Widdowson et al 2004;Gallimore et al 2003;CDC 2002;Minooee and Rickman 1999;McEvoy et al 1996;Koo et al 1996;Herwaldt et al 1994;Khan et al 1994) met the inclusion criteria and were thus included in our review.…”

Section: Resultsmentioning

confidence: 99%

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

et al. 2014

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Noroviruses are recognized as the leading cause of human acute viral gastroenteritis worldwide. The rate of outbreaks on cruise ships has grown significantly in recent years. Given the potentially harmful consequences of outbreaks for passengers and crewmembers and the subsequently high costs for cruise companies, disease outbreaks on cruise ships represent a serious public health issue. The aim of our study was to systematically review published studies related to Norovirus outbreaks on commercial cruise ships. We searched the PubMed and Scopus scientific databases. We included eligible studies published from January 1990 to July 2013 that were written in English and described infectious episodes involving at least two passengers and/or crewmembers on a commercial cruise ship. As a result, 15 studies and seven reviews met the inclusion criteria, describing a total of 127 outbreaks. The majority of the cases were reported in Europe and the USA, affecting <1 to 74 % of the embarked passengers. In the majority of the studies, stool samples and/or serum specimens from ill passengers were collected and tested for laboratory confirmation. Twelve studies reported that an ad-hoc questionnaire was administered. Fifteen studies investigated the possible source of infection which was contaminated food in the majority of cases. Our findings suggest a strong need for the monitoring and implementation of preventive measures in semi-closed communities, such as cruise ships. It would be advisable to strengthen all relevant initiatives in order to improve the detection of, response to and control of Norovirus outbreaks on cruise ships.

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Section: Resultsmentioning

confidence: 99%

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

et al. 2014

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“…This estimate explains why the number of new cases per day continued to increase and why norovirus infection spread to new camps, even after implementation of enhanced hygiene measures. It is tempting to speculate that our fi ndings could be extrapolated to other hygiene measures to explain the typical pattern in several subsequent norovirus outbreaks on cruise ships and in hotels (9,26,27). The estimation procedure for the time course of the reproduction number has several limitations.…”

Section: Discussionmentioning

confidence: 99%

“…Early studies suggested that norovirus outbreaks could be contained by rapid implementation of enhanced hygiene measures, such as washing hands, thoroughly cleaning contaminated surfaces, avoiding contact between sick and healthy persons, and requesting caretakers and cleaning staff to wear gloves and aprons (13)(14)(15)(16). However, in nursing homes or on cruise ships, norovirus can cause consecutive outbreaks, even after implementation of strict hygiene protocols (9,17,18). No quantitative estimates exist of the results of such enhanced hygiene measures on reducing further transmission of norovirus.…”

mentioning

confidence: 99%

“…It can be transmitted through small infectious droplets (aerosols) after a vomiting episode (6,7) and can survive for a very long time in the environment (5,8). Most norovirus outbreaks are seen in settings where clusters of vulnerable, susceptible persons live closely together, such as nursing homes, hospitals, and daycare centers (4), and in settings in which turnover of susceptible persons is high, such as hotels and cruise ships (9,10).…”

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confidence: 99%

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Enhanced Hygiene Measures and Norovirus Transmission during an Outbreak

Heijne¹,

Teunis²,

Morroy³

et al. 2009

Emerg. Infect. Dis.

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Control of norovirus outbreaks relies on enhanced hygiene measures, such as handwashing, surface cleaning, using disposable paper towels, and using separate toilets for sick and well persons. However, little is known about their effectiveness in limiting further spread of norovirus infections. We analyzed norovirus outbreaks in 7 camps at an international scouting jamboree in the Netherlands during 2004. Implementation of hygiene measures coincided with an 84.8% (95% predictive interval 81.2%-86.6%) reduction in reproduction number. This reduction was unexpectedly large but still below the reduction needed to contain a norovirus outbreak. Even more stringent control measures are required to break the chain of transmission of norovirus.G astroenteritis is one of the most common causes of illness (1). Recent fi ndings indicate norovirus is the most common cause of gastroenteritis (2,3). Of all gastroenteritis outbreaks reported in the Netherlands during 2002, 54% were caused by norovirus (4). Norovirus is predominantly transmitted through the fecal-oral route, either indirectly through contaminated food or surfaces or directly from person to person (5). It can be transmitted through small infectious droplets (aerosols) after a vomiting episode (6,7) and can survive for a very long time in the environment (5,8). Most norovirus outbreaks are seen in settings where clusters of vulnerable, susceptible persons live closely together, such as nursing homes, hospitals, and daycare centers (4), and in settings in which turnover of susceptible persons is high, such as hotels and cruise ships (9,10).Norovirus infection can cause serious medical complications, such as dehydration, in persons with underlying illness (11). No antiviral treatment exists for norovirus infection, and although norovirus vaccines are in development (12), none are available yet. Early studies suggested that norovirus outbreaks could be contained by rapid implementation of enhanced hygiene measures, such as washing hands, thoroughly cleaning contaminated surfaces, avoiding contact between sick and healthy persons, and requesting caretakers and cleaning staff to wear gloves and aprons (13-16). However, in nursing homes or on cruise ships, norovirus can cause consecutive outbreaks, even after implementation of strict hygiene protocols (9,17,18). No quantitative estimates exist of the results of such enhanced hygiene measures on reducing further transmission of norovirus. To our knowledge, the effect of enhanced hygiene measures has not been investigated in randomized controlled trials or in statistical analyses of outbreaks.We investigated the effect of enhanced hygiene measures on reducing norovirus transmission during an outbreak. We measured the effectiveness of enhanced hygiene measures as the relative reduction in the reproduction number-defi ned as the average number of secondary cases caused by 1 typical case-in the absence of and after enhanced hygiene measures. The value of this reproduction number provides crucial information about transmissio...

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“…This particularly refers to crewmembers, who are often four per cabins and therefore are more likely to become infected. In the present study, the prevalence of gastroenteritis complaints, which is mainly driven by norovirus [19,22,23], was low. According to the navigation area, the ship is subject to strict health inspections requiring the physician to notify all gastrointestinal infection and to respect cleaning protocols in case of outbreak.…”

Section: Discussionmentioning

confidence: 97%