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Norovirus outbreak on cruise ship shows need for increased prevention measures
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Person-to-person transmission of norovirus infection was the likely cause of a high morbidity outbreak on a cruise ship in 2009.
“Incentives to encourage ill passengers to report their illness to ship personnel may help to prevent the introduction of norovirus onto cruise ships and enable more timely interventions, particularly if aggressive sanitation measures are adopted at the first signs of a possible acute gastroenteritis outbreak,” the researchers wrote.
Norovirus infection has caused, on average, 27 outbreaks on cruise ships every year during the past 5 years, according to background information in the study. After a suspected norovirus outbreak on a cruise ship in January 2009, Mary E. Wikswo, MPH, in the division of viral diseases at the National Center for Immunization and Respiratory Diseases at the CDC, and colleagues conducted a retrospective cohort study and examined data on health care-seeking behaviors, hygiene practices and possible norovirus exposures via questionnaires administered after the outbreak began.
Of the 1,532 returned questionnaires, 236 met the case definition of acute gastroenteritis. These passengers were more likely to have witnessed vomiting during boarding (RR=2.8; P=.01) and to have an ill roommate (RR=3; P?.01). Moreover, 40% of ill passengers reported that they did not seek medical care at the cruise ship infirmary.
An increase in hand hygiene practices was reported in more than 90% of passengers after the outbreak. In addition, 11% of well passengers and 38% of ill passengers reported decreased participation in public activities. Twelve of 14 stool samples of ill passengers tested positive for norovirus; five were confirmed as GII.4 Minerva.
“Cruise line personnel should discourage ill passengers from boarding their ships,” Wikswo said in a press release. “Once on board, passengers and crew who become ill should report to the ship’s medical center as soon as possible. These quick actions are crucial in preventing the introduction and spread of norovirus on cruise ships and allow ship personnel to take immediate steps to prevent the spread of illness.”
For more information:
- Wikswo ME. Clin Infect Dis. 2011;doi:10.1093/cid/cir144.
Disclosure: The researchers report no relevant financial disclosures.