Infectious disease on cruise ships

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Infectious disease on cruise ships is a hazard associated with cruises. Outbreaks of contagious diseases can spread quickly due to the confined cruise ship environment, reliance on shared spaces, the lack of healthcare facilities, [1] and the large number of passengers and crew members from disparate points of origin.

Contents

Outbreaks of diseases including norovirus, [2] [3] Legionnaire’s, [4] [5] [6] [7] cyclosporiasis, [8] and COVID-19 have all occurred on cruise ships. [9]

Diseases

Respiratory and gastrointestinal diseases are more likely to be communicated on cruise ships. [10]

Norovirus

Norovirus is a virus that can cause gastroenteritis [11] and is also a cause of gastroenteritis on cruise ships. [2] It is typically transmitted from person to person. [12] Symptoms usually last between 1 and 3 days and generally resolve without treatment or long term consequences. The incubation period of the virus averages about 24 hours. [13]

Norovirus outbreaks are often perceived to be associated with cruise ships. According to the American CDC, factors that cause norovirus to be associated with cruise ships include the closer tracking and faster reporting of illnesses on cruise ships compared to those on land; the closer living quarters that increases the amount of interpersonal contact and the turnover of passengers that may bring the viruses on board. [14] Outbreak investigations by the CDC have shown that transmission of norovirus among cruise ship passengers is primarily person-to-person; potable water supplies have not been implicated.[ citation needed ] In a study published in the Journal of the American Medical Association , the CDC reported that, "Perceptions that cruise ships can be luxury breeding grounds for acute gastroenteritis outbreaks don't hold water. A recent CDC report showed that from 2008 to 2014, only 0.18% of more than 73 million cruise passengers and 0.15% of some 28 million crew members reported symptoms of the illness." [15]

Ships docked in port undergo surprise health inspections. In 2009, ships that underwent unannounced inspections by the CDC received an average CDC Vessel Sanitation Program score of approximately 97 out of a total possible 100 points. [16] The minimum passing inspection score is 85. [16] Collaboration with the CDC's Vessel Sanitation Program and the development of Outbreak Prevention and Response Plans has been credited in decreasing the incidence of norovirus outbreaks on ships. [17]

Legionnaires' disease

Legionella , the bacterium which causes Legionnaires' disease, and in particular the most virulent strain, Legionella pneumophila serogroup 1, can cause infections when inhaled as an aerosol or aspirated. [4] 50 passengers across nine cruises in 1994 either contracted Legionnaire's or likely contracted the disease due to exposure to whirlpool spas contaminated with the pathogen. [4]

Enterotoxigenic Escherichia coli

Enterotoxigenic Escherichia coli is a form of E. coli and the leading bacterial cause of diarrhea in the developing world, as well as the most common cause of diarrhea for travelers to those areas. [18] Since 2008 there has been at least one reported incident each year of E. coli on international cruise ships reported to the Vessel Sanitation Program of the Centers for Disease Control, though there were none in 2015. [2] Causes of E. coli infection include the consumption of contaminated food or water contaminated by human waste. [19]

COVID-19

Cases and suspected cases of COVID-19 occurred on cruise ships in early 2020, at the beginning of the COVID-19 pandemic. [10] Authorities across the world turned away ships or quarantined them; cruise operators cancelled some port visits and ultimately suspended global cruise operations. People aboard cruise ships played a role in spreading the disease in some countries.[ citation needed ]

Outbreaks

2020s

Cruise launch yearCruise datesOwner/OperatorShipDiseaseCasesDeathsLocationNotes and References
20202 February - 16 February Princess Cruises Caribbean Princess Norovirus4030No information [20]
202016 February - 1 March Princess Cruises Caribbean Princess Norovirus2590No information [20]
20201 March - 16 March Holland America Line Westerdam Unknown270No information [20]
20207 March - 19 March Royal Caribbean International Grandeur of the Seas Norovirus1050No information [20]
202129 November - 13 December Viking Cruises Viking Sea Vibrio and E. coli1200No information [20]
202228 April - 5 May Seabourn Cruise Line Seabourn Odyssey Unknown200No information [20]
202224 May - 31 May Carnival Cruise Line Carnival Splendor Norovirus800No information [20]
202221 December - 6 January Silversea Cruises Silver Moon Unknown280No information [20]
202229 December - 3 January P&O Cruises MV Arcadia Norovirus940No information [20]
20231 January - 13 April P&O Cruises MV Arcadia NorovirusNo informationNo informationNo information [20]
202316 January - 21 January Royal Caribbean International Brilliance of the Seas NorovirusNo informationNo informationNo information [20]
202328 January - 3 February Royal Caribbean International Jewel of the Seas NorovirusNo informationNo informationNo information [20]
20232 February - 5 March Princess Cruises Ruby Princess NorovirusNo informationNo informationNo information [20]
20236 March - 17 March Celebrity Cruises Celebrity Constellation NorovirusNo informationNo informationNo information [20]
20239 March - 18 March Celebrity Cruises Celebrity Equinox NorovirusNo informationNo informationNo information [20]
202311 March - 23 March Royal Caribbean International Enchantment of the Seas NorovirusNo informationNo informationNo information [20]
202323 March - 31 March Royal Caribbean International Enchantment of the Seas NorovirusNo informationNo informationNo information [20]
202317 March - 1 April Princess Cruises Emerald Princess NorovirusNo informationNo informationNo information [20]
202331 March - 28 April Princess Cruises Grand Princess NorovirusNo informationNo informationNo information [20]
202331 March - 28 April Princess Cruises Grand Princess NorovirusNo informationNo informationNo information [20]
20236 May - 21 May Holland America Nieuw Amsterdam NorovirusNo informationNo informationNo information [20]
202315 May - 25 May Celebrity Cruises Celebrity Summit NorovirusNo informationNo informationNo information [20]
20236 June - 20 June Viking Cruises Viking Neptune NorovirusNo informationNo informationNo informationViking Cruises blamed the outbreak on an Icelandic restaurant visited by some passengers. [21] [20]
20238 October - 13 October Virgin Voyages Scarlet Lady NorovirusNo informationNo informationNo information [20]
20243 January - 12 January Celebrity Cruises Celebrity Constellation NorovirusNo informationNo informationNo information [20]
202422 January - 6 February Cunard Line Queen Victoria Unknown150+No informationNo informationAs of 8 February 2024, the disease had not been identified. [22] [20]

Related Research Articles

<i>Escherichia coli</i> O157:H7 Serotype of the bacteria Escherichia coli

Escherichia coli O157:H7 is a serotype of the bacterial species Escherichia coli and is one of the Shiga-like toxin–producing types of E. coli. It is a cause of disease, typically foodborne illness, through consumption of contaminated and raw food, including raw milk and undercooked ground beef. Infection with this type of pathogenic bacteria may lead to hemorrhagic diarrhea, and to kidney failure; these have been reported to cause the deaths of children younger than five years of age, of elderly patients, and of patients whose immune systems are otherwise compromised.

Pontiac fever is an acute, nonfatal respiratory disease caused by various species of Gram-negative bacteria in the genus Legionella. It causes a mild upper respiratory infection that resembles acute influenza. Pontiac fever resolves spontaneously and often goes undiagnosed. Both Pontiac fever and the more severe Legionnaire's disease may be caused by the same bacteria, but Pontiac fever does not include pneumonia.

<span class="mw-page-title-main">Norovirus</span> Type of viruses that cause gastroenteritis

Norovirus, also known as Norwalk virus and sometimes referred to as the winter vomiting disease, is the most common cause of gastroenteritis. Infection is characterized by non-bloody diarrhea, vomiting, and stomach pain. Fever or headaches may also occur. Symptoms usually develop 12 to 48 hours after being exposed, and recovery typically occurs within one to three days. Complications are uncommon, but may include dehydration, especially in the young, the old, and those with other health problems.

<i>Legionella</i> Pathogenic genus of gram-negative bacteria and the related disease

Legionella is a genus of pathogenic gram-negative bacteria that includes the species L. pneumophila, causing legionellosis including a pneumonia-type illness called Legionnaires' disease and a mild flu-like illness called Pontiac fever.

<span class="mw-page-title-main">Cruise ship</span> Passengers ship used for pleasure voyages

Cruise ships are large passenger ships used mainly for vacationing. Unlike ocean liners, which are used for transport, cruise ships typically embark on round-trip voyages to various ports of call, where passengers may go on tours known as "shore excursions". On "cruises to nowhere" or "nowhere voyages", some cruise ships make two- to three-night round trips without visiting any ports of call.

<span class="mw-page-title-main">Foodborne illness</span> Illness from eating spoiled food

Foodborne illness is any illness resulting from the contamination of food by pathogenic bacteria, viruses, or parasites, as well as prions, and toxins such as aflatoxins in peanuts, poisonous mushrooms, and various species of beans that have not been boiled for at least 10 minutes.

<i>Explorer of the Seas</i> Voyager-class cruise ship operated by Royal Caribbean International

Explorer of the Seas is a Voyager-class cruise ship owned and operated by Royal Caribbean International, completed in 2000. She can accommodate over 3,000 guests, including scientists making use of a built-in atmospheric and oceanographic laboratory operated by the University of Miami's Rosenstiel School of Marine and Atmospheric Science. The lab, with its attendant educational and outreach programs for passengers, was discontinued in 2007.

<span class="mw-page-title-main">Gastroenteritis</span> Inflammation of the stomach and small intestine

Gastroenteritis, also known as infectious diarrhea or simply as gastro, is an inflammation of the gastrointestinal tract including the stomach and intestine. Symptoms may include diarrhea, vomiting, and abdominal pain. Fever, lack of energy, and dehydration may also occur. This typically lasts less than two weeks. Although it is not related to influenza, in the U.S. and U.K., it is sometimes called the "stomach flu".

<i>Diamond Princess</i> (ship) Cruise ship

Diamond Princess is a British-registered cruise ship owned and operated by Princess Cruises. She began operation in March 2004 and primarily cruises in Asia during the northern hemisphere summer and Australia during the southern hemisphere summer. She is a subclassed Grand-class ship, which is also known as a Gem-class ship. Diamond Princess and her sister ship, Sapphire Princess, are the widest subclass of Grand-class ships, as they have a 37.5-metre beam, while all other Grand-class ships have a beam of 36 metres. Diamond Princess and Sapphire Princess were both built in Nagasaki, Japan, by Mitsubishi Industries.

<span class="mw-page-title-main">Waterborne diseases</span> Diseases caused by pathogenic microorganisms transmitted by waters

Waterborne diseases are conditions caused by pathogenic micro-organisms that are transmitted by water. These diseases can be spread while bathing, washing, drinking water, or by eating food exposed to contaminated water. They are a pressing issue in rural areas amongst developing countries all over the world. While diarrhea and vomiting are the most commonly reported symptoms of waterborne illness, other symptoms can include skin, ear, respiratory, or eye problems. Lack of clean water supply, sanitation and hygiene (WASH) are major causes for the spread of waterborne diseases in a community. Therefore, reliable access to clean drinking water and sanitation is the main method to prevent waterborne diseases.

<i>MS Island Princess</i> (2002) Cruise ship

Island Princess is a Coral-class cruise ship for the Princess Cruises line. She is the sister ship to Coral Princess and together they are the only Panamax ships in Princess's fleet. She was constructed at Chantiers de l'Atlantique, France.

<span class="mw-page-title-main">1976 Philadelphia Legionnaires' disease outbreak</span> First occasion of a cluster of a pneumonia cases later identified as Legionnaires disease

The 1976 Legionnaires' disease outbreak, occurring in the late summer in Philadelphia, Pennsylvania, United States was the first occasion in which a cluster of a particular type of pneumonia cases were determined to be caused by the Legionella pneumophila bacteria.

In 2006, there were several outbreaks of foodborne illness from spinach and lettuce contaminated by E. coli O157:H7.

<span class="mw-page-title-main">Legionnaires' disease</span> Form of atypical pneumonia

Legionnaires' disease is a form of atypical pneumonia caused by any species of Legionella bacteria, quite often Legionella pneumophila. Signs and symptoms include cough, shortness of breath, high fever, muscle pains, and headaches. Nausea, vomiting, and diarrhea may also occur. This often begins 2–10 days after exposure.

<span class="mw-page-title-main">2015 Bronx Legionnaires' disease outbreaks</span> Disease outbreaks in New York City, United States

In 2015, there were two outbreaks of Legionnaires' disease in the Bronx, New York City, United States. Between January and August 2015, one hundred and thirty people in New York City were infected with Legionnaires', but the majority of them were in the Bronx.

A toilet plume is the dispersal of microscopic particles as a result of flushing a toilet. Normal use of a toilet by healthy individuals is considered unlikely to be a major health risk. However this dynamic changes if an individual is fighting an illness and currently shedding out a virulent pathogen in their urine, feces or vomitus. There is indirect evidence that specific pathogens such as norovirus or SARS coronavirus could potentially be spread by toilet aerosols, but as of 2015, no direct experimental studies had clearly demonstrated or refuted actual disease transmission from toilet aerosols. It has been hypothesized that dispersal of pathogens may be reduced by closing the toilet lid before flushing, and by using toilets with lower flush energy.

<span class="mw-page-title-main">Food safety in the United States</span>

Food safety in the United States relates to the processing, packaging, and storage of food in a way that prevents food-borne illness within the United States. The beginning of regulation on food safety in the United States started in the early 1900s, when several outbreaks sparked the need for litigation managing food in the food industry. Over the next few decades, the United States created several government agencies in an effort to better understand contaminants in food and to regulate these impurities. Many laws regarding food safety in the United States have been created and amended since the beginning of the 1900s. Food makers and their products are inspected and regulated by the Food and Drug Administration and the Department of Agriculture.

<span class="mw-page-title-main">Milk borne diseases</span>

Milk borne diseases are any diseases caused by consumption of milk or dairy products infected or contaminated by pathogens. Milk borne diseases are one of the recurrent foodborne illnesses—between 1993 and 2012 over 120 outbreaks related to raw milk were recorded in the US with approximately 1,900 illnesses and 140 hospitalisations. With rich nutrients essential for growth and development such as proteins, lipids, carbohydrates, and vitamins in milk, pathogenic microorganisms are well nourished and are capable of rapid cell division and extensive population growth in this favourable environment. Common pathogens include bacteria, viruses, fungi, and parasites and among them, bacterial infection is the leading cause of milk borne diseases.

References

  1. ↑ Zhang, Nan; Miao, Ruosong; Huang, Hong; Chan, Emily Y. Y. (8 December 2016). "Contact infection of infectious disease onboard a cruise ship". Scientific Reports. 6 (1): 38790. doi:10.1038/srep38790. ISSN   2045-2322.
  2. 1 2 3 CDC VSP. "Vessel Sanitation Program – Outbreak Updates for International Cruise Ships". Centers for Disease Control and Prevention. Archived from the original on 10 May 2016. Retrieved 11 February 2024.
  3. ↑ "CDC – Vessel Sanitation Program – Balmoral, April 16, 2016". Cdc.gov. Archived from the original on 14 May 2016. Retrieved 11 February 2024.
  4. 1 2 3 Jernigan, D.B; Hofmann, J; Cetron, M.S; Nuorti, J.P; Fields, B.S; Benson, R.F; Breiman, R.F; Lipman, H.B; Carter, R.J; Genese, C.A; Paul, S.M; Edelstein, P.H; Guerrero, I.C (February 1996). "Outbreak of Legionnaires' disease among cruise ship passengers exposed to a contaminated whirlpool spa". The Lancet. 347 (9000): 494–499. doi:10.1016/s0140-6736(96)91137-x.
  5. ↑ "Cruise-Ship—Associated Legionnaires Disease, November 2003 – May 2004". cdc.gov.
  6. ↑ "EWGLinet Summary Report – December 2006" (PDF). ewgli.org. Archived from the original (PDF) on 27 November 2007.
  7. ↑ "Legionnaires' fear on cruise ship". BBC News . 30 July 2007. Retrieved 15 October 2021.
  8. ↑ Minooee, Arézou; Rickman, Leland S. (1999). "Infectious Diseases on Cruise Ships". Clinical Infectious Diseases. 29 (4): 737–743. ISSN   1058-4838.
  9. ↑ Roe, Teiva (1 August 2020). "Un cas positif de Covid a été détecté sur le paquebot de croisière le Paul Gauguin" . Retrieved 11 February 2024.
  10. 1 2 Tan, Yvette (12 February 2020). "Coronavirus: Are cruise ships really 'floating Petri dishes'?". BBC. Retrieved 11 February 2024.
  11. ↑ Ahmed SM, Hall AJ, Robinson AE, et al. (August 2014). "Global prevalence of norovirus in cases of gastroenteritis: a systematic review and meta-analysis". Lancet Infect Dis. 14 (8): 725–30. doi:10.1016/S1473-3099(14)70767-4. PMC   8006533 . PMID   24981041.
  12. ↑ Moore MD, Goulter RM, Jaykus L (April 2015). "Human Norovirus as a Foodborne Pathogen: Challenges and Developments". Annual Review of Food Science and Technology. 6 (1): 411–33. doi: 10.1146/annurev-food-022814-015643 . PMID   25884284.
  13. ↑ "Norovirus – Chapter 4 – 2020 Yellow Book | Travelers' Health". CDC. Retrieved 2019-10-08.
  14. ↑ "Facts About Noroviruses on Cruise Ships". cdc.gov. 2019-02-07. Retrieved 2019-10-08.
  15. ↑ "Cruise Ship Illness Declines". JAMA. 315 (8): 743. 2016-02-23. doi:10.1001/jama.2016.0733. ISSN   0098-7484.
  16. 1 2 "Vessel Sanitation Program: Advanced Cruise Ship Inspection Search". US Center for Disease Control. Retrieved 15 October 2021.
  17. ↑ "Travel News, Tips, and Guides". USA Today . Retrieved 2019-10-08.
  18. ↑ "WHO | Research and development". WHO. Archived from the original on 8 December 2013.
  19. ↑ "E. Coli Infections". medlineplus.gov. Retrieved 2019-10-08.
  20. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 "Cruise Ship Outbreak Updates | Vessel Sanitation Program | CDC". www.cdc.gov. 8 February 2024. Retrieved 11 February 2024.
  21. ↑ Viswanathan, Giri (11 July 2023). "After years of decline, norovirus outbreaks surge on cruise ships". CNN. Retrieved 13 February 2024.
  22. ↑ Diaz, Johnny (8 February 2024). "C.D.C. Investigating Gastrointestinal Illness on Luxury Cruise Ship". The New York Times. Retrieved 13 February 2024.
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