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Coronavirus Disease 2019 (COVID-19) in Americans Aboard the Diamond Princess Cruise Ship.
Clin Infect Dis. 2021 05 18; 72(10):e448-e457.CI

Abstract

BACKGROUND

The Diamond Princess cruise ship was the site of a large outbreak of coronavirus disease 2019 (COVID-19). Of 437 Americans and their travel companions on the ship, 114 (26%) tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).

METHODS

We interviewed 229 American passengers and crew after disembarkation following a ship-based quarantine to identify risk factors for infection and characterize transmission onboard the ship.

RESULTS

The attack rate for passengers in single-person cabins or without infected cabinmates was 18% (58/329), compared with 63% (27/43) for those sharing a cabin with an asymptomatic infected cabinmate, and 81% (25/31) for those with a symptomatic infected cabinmate. Whole genome sequences from specimens from passengers who shared cabins clustered together. Of 66 SARS-CoV-2-positive American travelers with complete symptom information, 14 (21%) were asymptomatic while on the ship. Among SARS-CoV-2-positive Americans, 10 (9%) required intensive care, of whom 7 were ≥70 years.

CONCLUSIONS

Our findings highlight the high risk of SARS-CoV-2 transmission on cruise ships. High rates of SARS-CoV-2 positivity in cabinmates of individuals with asymptomatic infections suggest that triage by symptom status in shared quarters is insufficient to halt transmission. A high rate of intensive care unit admission among older individuals complicates the prospect of future cruise travel during the pandemic, given typical cruise passenger demographics. The magnitude and severe outcomes of this outbreak were major factors contributing to the Centers for Disease Control and Prevention's decision to halt cruise ship travel in US waters in March 2020.

Authors+Show Affiliations

All authors are part of the COVID-19 Cruise Ship Task Force, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.All authors are part of the COVID-19 Cruise Ship Task Force, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.All authors are part of the COVID-19 Cruise Ship Task Force, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.All authors are part of the COVID-19 Cruise Ship Task Force, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.All authors are part of the COVID-19 Cruise Ship Task Force, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.All authors are part of the COVID-19 Cruise Ship Task Force, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.All authors are part of the COVID-19 Cruise Ship Task Force, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.All authors are part of the COVID-19 Cruise Ship Task Force, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.All authors are part of the COVID-19 Cruise Ship Task Force, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.All authors are part of the COVID-19 Cruise Ship Task Force, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.All authors are part of the COVID-19 Cruise Ship Task Force, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.All authors are part of the COVID-19 Cruise Ship Task Force, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.All authors are part of the COVID-19 Cruise Ship Task Force, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.All authors are part of the COVID-19 Cruise Ship Task Force, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.All authors are part of the COVID-19 Cruise Ship Task Force, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.All authors are part of the COVID-19 Cruise Ship Task Force, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.All authors are part of the COVID-19 Cruise Ship Task Force, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.All authors are part of the COVID-19 Cruise Ship Task Force, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.All authors are part of the COVID-19 Cruise Ship Task Force, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.All authors are part of the COVID-19 Cruise Ship Task Force, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.All authors are part of the COVID-19 Cruise Ship Task Force, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.All authors are part of the COVID-19 Cruise Ship Task Force, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.All authors are part of the COVID-19 Cruise Ship Task Force, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.All authors are part of the COVID-19 Cruise Ship Task Force, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.All authors are part of the COVID-19 Cruise Ship Task Force, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.All authors are part of the COVID-19 Cruise Ship Task Force, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.All authors are part of the COVID-19 Cruise Ship Task Force, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.All authors are part of the COVID-19 Cruise Ship Task Force, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.All authors are part of the COVID-19 Cruise Ship Task Force, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.All authors are part of the COVID-19 Cruise Ship Task Force, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.All authors are part of the COVID-19 Cruise Ship Task Force, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.All authors are part of the COVID-19 Cruise Ship Task Force, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.All authors are part of the COVID-19 Cruise Ship Task Force, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.All authors are part of the COVID-19 Cruise Ship Task Force, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.All authors are part of the COVID-19 Cruise Ship Task Force, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32785683

Citation

Plucinski, Mateusz M., et al. "Coronavirus Disease 2019 (COVID-19) in Americans Aboard the Diamond Princess Cruise Ship." Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America, vol. 72, no. 10, 2021, pp. e448-e457.
Plucinski MM, Wallace M, Uehara A, et al. Coronavirus Disease 2019 (COVID-19) in Americans Aboard the Diamond Princess Cruise Ship. Clin Infect Dis. 2021;72(10):e448-e457.
Plucinski, M. M., Wallace, M., Uehara, A., Kurbatova, E. V., Tobolowsky, F. A., Schneider, Z. D., Ishizumi, A., Bozio, C. H., Kobayashi, M., Toda, M., Stewart, A., Wagner, R. L., Moriarty, L. F., Murray, R., Queen, K., Tao, Y., Paden, C., Mauldin, M. R., Zhang, J., ... Friedman, C. R. (2021). Coronavirus Disease 2019 (COVID-19) in Americans Aboard the Diamond Princess Cruise Ship. Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America, 72(10), e448-e457. https://doi.org/10.1093/cid/ciaa1180
Plucinski MM, et al. Coronavirus Disease 2019 (COVID-19) in Americans Aboard the Diamond Princess Cruise Ship. Clin Infect Dis. 2021 05 18;72(10):e448-e457. PubMed PMID: 32785683.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Coronavirus Disease 2019 (COVID-19) in Americans Aboard the Diamond Princess Cruise Ship. AU - Plucinski,Mateusz M, AU - Wallace,Megan, AU - Uehara,Anna, AU - Kurbatova,Ekaterina V, AU - Tobolowsky,Farrell A, AU - Schneider,Zachary D, AU - Ishizumi,Atsuyoshi, AU - Bozio,Catherine H, AU - Kobayashi,Miwako, AU - Toda,Mitsuru, AU - Stewart,Andrea, AU - Wagner,Riley L, AU - Moriarty,Leah F, AU - Murray,Rachel, AU - Queen,Krista, AU - Tao,Ying, AU - Paden,Clinton, AU - Mauldin,Matthew R, AU - Zhang,Jing, AU - Li,Yan, AU - Elkins,Christopher A, AU - Lu,Xiaoyan, AU - Herzig,Carolyn T A, AU - Novak,Ryan, AU - Bower,William, AU - Medley,Alexandra M, AU - Acosta,Anna M, AU - Knust,Barbara, AU - Cantey,Paul T, AU - Pesik,Nicki T, AU - Halsey,Eric S, AU - Cetron,Martin S, AU - Tong,Suxiang, AU - Marston,Barbara J, AU - Friedman,Cindy R, PY - 2020/07/22/received PY - 2020/8/14/pubmed PY - 2021/5/21/medline PY - 2020/8/14/entrez KW - SARS-CoV-2 KW - cruise ship KW - risk factor KW - symptoms KW - whole genome SP - e448 EP - e457 JF - Clinical infectious diseases : an official publication of the Infectious Diseases Society of America JO - Clin Infect Dis VL - 72 IS - 10 N2 - BACKGROUND: The Diamond Princess cruise ship was the site of a large outbreak of coronavirus disease 2019 (COVID-19). Of 437 Americans and their travel companions on the ship, 114 (26%) tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). METHODS: We interviewed 229 American passengers and crew after disembarkation following a ship-based quarantine to identify risk factors for infection and characterize transmission onboard the ship. RESULTS: The attack rate for passengers in single-person cabins or without infected cabinmates was 18% (58/329), compared with 63% (27/43) for those sharing a cabin with an asymptomatic infected cabinmate, and 81% (25/31) for those with a symptomatic infected cabinmate. Whole genome sequences from specimens from passengers who shared cabins clustered together. Of 66 SARS-CoV-2-positive American travelers with complete symptom information, 14 (21%) were asymptomatic while on the ship. Among SARS-CoV-2-positive Americans, 10 (9%) required intensive care, of whom 7 were ≥70 years. CONCLUSIONS: Our findings highlight the high risk of SARS-CoV-2 transmission on cruise ships. High rates of SARS-CoV-2 positivity in cabinmates of individuals with asymptomatic infections suggest that triage by symptom status in shared quarters is insufficient to halt transmission. A high rate of intensive care unit admission among older individuals complicates the prospect of future cruise travel during the pandemic, given typical cruise passenger demographics. The magnitude and severe outcomes of this outbreak were major factors contributing to the Centers for Disease Control and Prevention's decision to halt cruise ship travel in US waters in March 2020. SN - 1537-6591 UR - https://www.unboundmedicine.com/medline/citation/32785683/Coronavirus_Disease_2019__COVID_19__in_Americans_Aboard_the_Diamond_Princess_Cruise_Ship_ L2 - https://academic.oup.com/cid/article-lookup/doi/10.1093/cid/ciaa1180 DB - PRIME DP - Unbound Medicine ER -