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Management and control of varicella on cruise ships: a collaborative approach to promoting public health.
J Travel Med. 2012 Jul; 19(4):226-32.JT

Abstract

BACKGROUND

In most years varicella is the vaccine-preventable disease most frequently reported to Centers for Disease Control and Prevention (CDC) by cruise ships. Since 2005, CDC has received numerous isolated case reports of varicella among crew members and has investigated varicella outbreaks aboard vessels sailing into and from US seaports.

METHODS

CDC investigators reviewed electronic varicella case reports from 2005 to 2009 and outbreak reports from 2009 to characterize the response and control efforts implemented by cruise ships in accordance with CDC protocols. Outbreak reports from 2009 were manually reviewed for details of case identification, contact investigations, isolation and restriction of cases and contacts, respectively, and number of contacts administered varicella vaccine post-exposure by cruise lines.

RESULTS

During 2005 to 2009, cruise ships reported 278 cases of varicella to CDC among predominantly male (80%) crew members, three-quarters of whom were residents of Caribbean countries, Indonesia, the Philippines, or India, and whose median age was 29 years. Cases were more commonly reported during spring and winter months. During 2009, cruise ships reported 94 varicella cases among crew members of which 66 (70%) were associated with 18 reported varicella outbreaks. Outbreak response included isolation of 66 (100%) of 66 cases, restriction of 66 (26%) of 255 crew-contacts, and administration of post-exposure vaccine to 522 close contacts and other susceptible crew members per standard CDC recommendations.

DISCUSSION

Most cases reported to CDC during 2005 to 2009 were among non-US resident crew members. Overall, cruise lines sailing into North America have the onboard capability to manage varicella cases and outbreaks and appear responsive to CDC recommendations. Cruise lines should continue to implement CDC-recommended response protocols to curtail outbreaks rapidly and should consider whether pre-placement varicella immunity screening and vaccination of crew members is a cost-effective option for their respective fleet operations.

Links

Publisher Full Text (DOI)

Authors+Show Affiliations

Cramer EH
Division of Global Migration and Quarantine, Quarantine and Border Health Services Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA.
Slaten DD
No affiliation info available
Guerreiro A
No affiliation info available
Robbins D
No affiliation info available
Ganzon A
No affiliation info available

MeSH

AdultAgedCenters for Disease Control and Prevention, U.S.ChickenpoxChickenpox VaccineDisease OutbreaksFemaleHumansMaleMiddle AgedNaval MedicineNorth AmericaPractice Guidelines as TopicPublic HealthShipsTravelUnited StatesYoung Adult

Pub Type(s)

Journal Article

Language

eng

PubMed ID

22776383

Citation

Cramer, Elaine H., et al. "Management and Control of Varicella On Cruise Ships: a Collaborative Approach to Promoting Public Health." Journal of Travel Medicine, vol. 19, no. 4, 2012, pp. 226-32.
Cramer EH, Slaten DD, Guerreiro A, et al. Management and control of varicella on cruise ships: a collaborative approach to promoting public health. J Travel Med. 2012;19(4):226-32.
Cramer, E. H., Slaten, D. D., Guerreiro, A., Robbins, D., & Ganzon, A. (2012). Management and control of varicella on cruise ships: a collaborative approach to promoting public health. Journal of Travel Medicine, 19(4), 226-32. https://doi.org/10.1111/j.1708-8305.2012.00621.x
Cramer EH, et al. Management and Control of Varicella On Cruise Ships: a Collaborative Approach to Promoting Public Health. J Travel Med. 2012;19(4):226-32. PubMed PMID: 22776383.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Management and control of varicella on cruise ships: a collaborative approach to promoting public health. AU - Cramer,Elaine H, AU - Slaten,Douglas D, AU - Guerreiro,Adriane, AU - Robbins,Danisha, AU - Ganzon,Andrew, PY - 2012/7/11/entrez PY - 2012/7/11/pubmed PY - 2013/5/29/medline SP - 226 EP - 32 JF - Journal of travel medicine JO - J Travel Med VL - 19 IS - 4 N2 - BACKGROUND: In most years varicella is the vaccine-preventable disease most frequently reported to Centers for Disease Control and Prevention (CDC) by cruise ships. Since 2005, CDC has received numerous isolated case reports of varicella among crew members and has investigated varicella outbreaks aboard vessels sailing into and from US seaports. METHODS: CDC investigators reviewed electronic varicella case reports from 2005 to 2009 and outbreak reports from 2009 to characterize the response and control efforts implemented by cruise ships in accordance with CDC protocols. Outbreak reports from 2009 were manually reviewed for details of case identification, contact investigations, isolation and restriction of cases and contacts, respectively, and number of contacts administered varicella vaccine post-exposure by cruise lines. RESULTS: During 2005 to 2009, cruise ships reported 278 cases of varicella to CDC among predominantly male (80%) crew members, three-quarters of whom were residents of Caribbean countries, Indonesia, the Philippines, or India, and whose median age was 29 years. Cases were more commonly reported during spring and winter months. During 2009, cruise ships reported 94 varicella cases among crew members of which 66 (70%) were associated with 18 reported varicella outbreaks. Outbreak response included isolation of 66 (100%) of 66 cases, restriction of 66 (26%) of 255 crew-contacts, and administration of post-exposure vaccine to 522 close contacts and other susceptible crew members per standard CDC recommendations. DISCUSSION: Most cases reported to CDC during 2005 to 2009 were among non-US resident crew members. Overall, cruise lines sailing into North America have the onboard capability to manage varicella cases and outbreaks and appear responsive to CDC recommendations. Cruise lines should continue to implement CDC-recommended response protocols to curtail outbreaks rapidly and should consider whether pre-placement varicella immunity screening and vaccination of crew members is a cost-effective option for their respective fleet operations. SN - 1708-8305 UR - https://www.unboundmedicine.com/medline/citation/22776383/full_citation DB - PRIME DP - Unbound Medicine ER -