Gastroenteritis outbreaks on cruise ships: contributing factors and thresholds for early outbreak detection
Open Access
- 9 November 2017
- journal article
- research article
- Published by European Centre for Disease Control and Prevention (ECDC) in Eurosurveillance
- Vol. 22 (45), 16-00576-32
- https://doi.org/10.2807/1560-7917.es.2017.22.45.16-00576
Abstract
When an increased number of acute gastroenteritis (AG) cases is detected among tourists staying at the same accommodation, outbreak management plans must be activated in a timely manner to prevent large outbreaks. Syndromic surveillance data collected between 1 January 2010 and 31 December 2013 by five seagoing cruise ships were analysed to identify attack rate thresholds for early outbreak detection. The overall incidence rate of AG was 2.81 cases per 10,000 traveller-days (95% confidence interval (CI): 0.00–17.60), while the attack rate was 19.37 cases per 10,000 travellers (95% CI: 0.00–127.69). The probability of an outbreak occurring was 11% if 4 per 1,000 passengers reported symptoms within the first 2 days of the voyage, and this increased to 23 % if 5 per 1,000 passengers reported such within the first 3 days. The risk ratio (RR) for outbreak occurrence was 2.35, 5.66 and 8.63 for 1, 2 and 3 days’ delay of symptoms reporting respectively, suggesting a dose–response relationship. Shipping companies’ policies and health authorities’ efforts may consider these thresholds for initiating outbreak response measures based on the number of cases according to day of cruise. Efforts should focus on ensuring travellers report symptoms immediately and comply with isolation measures.Keywords
This publication has 18 references indexed in Scilit:
- Norovirus Disease in the United StatesEmerging Infectious Diseases, 2013
- Actions for prevention and control of health threats related to maritime transport in European UnionTravel Medicine and Infectious Disease, 2013
- Disease Transmission and Passenger Behaviors during a High Morbidity Norovirus Outbreak on a Cruise Ship, January 2009Clinical Infectious Diseases, 2011
- pROC: an open-source package for R and S+ to analyze and compare ROC curvesBMC Bioinformatics, 2011
- Hygiene inspections on passenger ships in Europe - an overviewBMC Public Health, 2010
- Passenger Behaviors Associated With Norovirus Infection On Board a Cruise Ship—Alaska, May to June 2004Journal of Travel Medicine, 2008
- Passenger Behaviors During Norovirus Outbreaks on Cruise ShipsJournal of Travel Medicine, 2008
- Epidemiology of Gastroenteritis on Cruise Ships, 2001–2004American Journal of Preventive Medicine, 2006
- Diarrheal disease on cruise ships, 1990–2000: The impact of environmental health programsAmerican Journal of Preventive Medicine, 2003
- The frequency of a Norwalk-like pattern of illness in outbreaks of acute gastroenteritis.American Journal of Public Health, 1982