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Varicella at sea: a two-year study on cruise ships.
Int Marit Health. 2011; 62(4):254-61.IM

Abstract

BACKGROUND

Being highly contagious by person-to-person transmission, varicella can easily spread within the multinational population of a cruise ship and into communities ashore. The aim of the study was to report the prevalence of varicella infections in a fleet of cruise ships during a two-year period and to discuss measures to prevent and contain shipboard outbreaks.

MATERIAL AND METHODS

All probable varicella cases among passengers and crew on 34 cruise ships were registered for 2 years by the medical facilities onboard. Patients remained isolated until 6 days after rash onset. Susceptible contacts were identified and offered post-exposure prophylaxis. Crew nationality, number of vaccinated contacts, and direct vaccination costs were registered.

RESULTS

During two years 187 varicella cases (36 passengers, 151 crew) were registered and 2,685 varicella vaccinations were administered at an estimated direct vaccination cost of US $ 283,832. Of the 34 ships, only 3 reported no cases of varicella. There were 8 clusters ('outbreaks') of ≥ 5 varicella cases presenting less than 42 days apart, comprising a total of 89 patients. While > 130 nations were represented among the crew, the 151 crew cases came from 26 countries, and 88 (58%) of them came from 5 sub-tropical/tropical countries.

CONCLUSIONS

All cruise vessels must expect to encounter varicella cases or outbreaks onboard every few years. Every varicella case can start an outbreak and thus trigger several time-consuming and expensive containment measures, including isolation and mass vaccination of susceptible contacts. Mandatory pre-contract evidence of varicella immunity from all seafarers or from subgroups according to position or nationality might be worth considering. Seafarers known to be immune to varicella should always carry valid documentation while traveling.

Authors+Show Affiliations

Medical & Public Health Department, Royal Caribbean Cruises Ltd, Miami, Florida, USA.No affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

22544501

Citation

Acevedo, Fabio, et al. "Varicella at Sea: a Two-year Study On Cruise Ships." International Maritime Health, vol. 62, no. 4, 2011, pp. 254-61.
Acevedo F, Diskin AL, Dahl E. Varicella at sea: a two-year study on cruise ships. Int Marit Health. 2011;62(4):254-61.
Acevedo, F., Diskin, A. L., & Dahl, E. (2011). Varicella at sea: a two-year study on cruise ships. International Maritime Health, 62(4), 254-61.
Acevedo F, Diskin AL, Dahl E. Varicella at Sea: a Two-year Study On Cruise Ships. Int Marit Health. 2011;62(4):254-61. PubMed PMID: 22544501.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Varicella at sea: a two-year study on cruise ships. AU - Acevedo,Fabio, AU - Diskin,Arthur L, AU - Dahl,Eilif, PY - 2012/5/1/entrez PY - 2011/1/1/pubmed PY - 2012/8/29/medline SP - 254 EP - 61 JF - International maritime health JO - Int Marit Health VL - 62 IS - 4 N2 - BACKGROUND: Being highly contagious by person-to-person transmission, varicella can easily spread within the multinational population of a cruise ship and into communities ashore. The aim of the study was to report the prevalence of varicella infections in a fleet of cruise ships during a two-year period and to discuss measures to prevent and contain shipboard outbreaks. MATERIAL AND METHODS: All probable varicella cases among passengers and crew on 34 cruise ships were registered for 2 years by the medical facilities onboard. Patients remained isolated until 6 days after rash onset. Susceptible contacts were identified and offered post-exposure prophylaxis. Crew nationality, number of vaccinated contacts, and direct vaccination costs were registered. RESULTS: During two years 187 varicella cases (36 passengers, 151 crew) were registered and 2,685 varicella vaccinations were administered at an estimated direct vaccination cost of US $ 283,832. Of the 34 ships, only 3 reported no cases of varicella. There were 8 clusters ('outbreaks') of ≥ 5 varicella cases presenting less than 42 days apart, comprising a total of 89 patients. While > 130 nations were represented among the crew, the 151 crew cases came from 26 countries, and 88 (58%) of them came from 5 sub-tropical/tropical countries. CONCLUSIONS: All cruise vessels must expect to encounter varicella cases or outbreaks onboard every few years. Every varicella case can start an outbreak and thus trigger several time-consuming and expensive containment measures, including isolation and mass vaccination of susceptible contacts. Mandatory pre-contract evidence of varicella immunity from all seafarers or from subgroups according to position or nationality might be worth considering. Seafarers known to be immune to varicella should always carry valid documentation while traveling. SN - 2081-3252 UR - https://www.unboundmedicine.com/medline/citation/22544501/Varicella_at_sea:_a_two_year_study_on_cruise_ships_ L2 - https://medlineplus.gov/travelershealth.html DB - PRIME DP - Unbound Medicine ER -