Tags

Type your tag names separated by a space and hit enter

Passenger behaviors associated with norovirus infection on board a cruise ship--Alaska, May to June 2004.
J Travel Med. 2008 May-Jun; 15(3):177-83.JT

Abstract

BACKGROUND

During May 2004, the Vessel Sanitation Program (VSP) investigated an outbreak of norovirus gastroenteritis on board a cruise ship sailing in Alaska waters. The objectives were to identify a common food item source and explore behavioral risk factors for person-to-person transmission among passengers.

METHODS

A case was defined as three or more episodes of loose stools within 24 hours or two or fewer episodes of loose stools accompanied by one or more episodes of vomiting. Vomitus and stool samples from affected passengers were tested for norovirus by reverse transcriptase-polymerase chain reaction. Environmental health officers performed an environmental investigation following VSP protocol. Questionnaires about food items consumed and behavioral risk factors were placed in cabin mailboxes (n = 2,018). A case-control study design using multivariable logistic regression tested associations between risk factors and disease.

RESULTS

A total of 359 passengers (24.1% of respondents) met the case definition. Four of seven clinical specimens tested positive for norovirus. No significant deficiencies in environmental health practices were identified, and no meal servings were associated with disease. Having a cabin mate sick with diarrhea or vomiting [odds ratio (OR): 3.40; 95% confidence interval (CI) = 1.80-6.44] and using a specific women's toilet that was contaminated with vomit (OR: 5.13; 95% CI = 1.40-18.78) were associated with disease. Washing hands before meals was protective (OR: 0.25; 95% CI = 0.12-0.54) against disease.

CONCLUSIONS

Widespread person-to-person norovirus outbreaks can occur on board cruise ships, even with appropriate environmental health practices. Programs to prevent and control norovirus outbreaks on board cruise ships should involve strategies that disrupt person-to-person spread and emphasize hand washing.

Authors+Show Affiliations

Section of Epidemiology, Division of Public Health, State of Alaska, Anchorage, AK, USA. mchimonas@msn.comNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

18494695

Citation

Chimonas, Marc-Andre R., et al. "Passenger Behaviors Associated With Norovirus Infection On Board a Cruise ship--Alaska, May to June 2004." Journal of Travel Medicine, vol. 15, no. 3, 2008, pp. 177-83.
Chimonas MA, Vaughan GH, Andre Z, et al. Passenger behaviors associated with norovirus infection on board a cruise ship--Alaska, May to June 2004. J Travel Med. 2008;15(3):177-83.
Chimonas, M. A., Vaughan, G. H., Andre, Z., Ames, J. T., Tarling, G. A., Beard, S., Widdowson, M. A., & Cramer, E. (2008). Passenger behaviors associated with norovirus infection on board a cruise ship--Alaska, May to June 2004. Journal of Travel Medicine, 15(3), 177-83. https://doi.org/10.1111/j.1708-8305.2008.00200.x
Chimonas MA, et al. Passenger Behaviors Associated With Norovirus Infection On Board a Cruise ship--Alaska, May to June 2004. J Travel Med. 2008 May-Jun;15(3):177-83. PubMed PMID: 18494695.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Passenger behaviors associated with norovirus infection on board a cruise ship--Alaska, May to June 2004. AU - Chimonas,Marc-Andre R, AU - Vaughan,George H, AU - Andre,Zandra, AU - Ames,Jaret T, AU - Tarling,Grant A, AU - Beard,Suzanne, AU - Widdowson,Marc-Alain, AU - Cramer,Elaine, PY - 2008/5/23/pubmed PY - 2008/6/10/medline PY - 2008/5/23/entrez SP - 177 EP - 83 JF - Journal of travel medicine JO - J Travel Med VL - 15 IS - 3 N2 - BACKGROUND: During May 2004, the Vessel Sanitation Program (VSP) investigated an outbreak of norovirus gastroenteritis on board a cruise ship sailing in Alaska waters. The objectives were to identify a common food item source and explore behavioral risk factors for person-to-person transmission among passengers. METHODS: A case was defined as three or more episodes of loose stools within 24 hours or two or fewer episodes of loose stools accompanied by one or more episodes of vomiting. Vomitus and stool samples from affected passengers were tested for norovirus by reverse transcriptase-polymerase chain reaction. Environmental health officers performed an environmental investigation following VSP protocol. Questionnaires about food items consumed and behavioral risk factors were placed in cabin mailboxes (n = 2,018). A case-control study design using multivariable logistic regression tested associations between risk factors and disease. RESULTS: A total of 359 passengers (24.1% of respondents) met the case definition. Four of seven clinical specimens tested positive for norovirus. No significant deficiencies in environmental health practices were identified, and no meal servings were associated with disease. Having a cabin mate sick with diarrhea or vomiting [odds ratio (OR): 3.40; 95% confidence interval (CI) = 1.80-6.44] and using a specific women's toilet that was contaminated with vomit (OR: 5.13; 95% CI = 1.40-18.78) were associated with disease. Washing hands before meals was protective (OR: 0.25; 95% CI = 0.12-0.54) against disease. CONCLUSIONS: Widespread person-to-person norovirus outbreaks can occur on board cruise ships, even with appropriate environmental health practices. Programs to prevent and control norovirus outbreaks on board cruise ships should involve strategies that disrupt person-to-person spread and emphasize hand washing. SN - 1708-8305 UR - https://www.unboundmedicine.com/medline/citation/18494695/Passenger_behaviors_associated_with_norovirus_infection_on_board_a_cruise_ship__Alaska_May_to_June_2004_ L2 - https://academic.oup.com/jtm/article-lookup/doi/10.1111/j.1708-8305.2008.00200.x DB - PRIME DP - Unbound Medicine ER -