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Cruise ship travel in the era of COVID-19: A summary of outbreaks and a model of public health interventions.
Clin Infect Dis. 2021 May 12 [Online ahead of print]CI

Abstract

BACKGROUND

Cruise travel contributed to SARS-CoV-2 transmission when there were relatively few cases in the United States. By March 14, 2020, the Centers for Disease Control and Prevention (CDC) issued a No Sail Order suspending U.S. cruise operations; the last U.S. passenger ship docked on April 16.

METHODS

We analyzed SARS-CoV-2 outbreaks on cruises in U.S. waters or carrying U.S. citizens and used regression models to compare voyage characteristics. We used compartmental models to simulate the potential impact of four interventions (screening for COVID-19 symptoms; viral testing on two days and isolation of positive persons; reduction of passengers by 40%, crew by 20%, and port visits to one) for 7-day and 14-day voyages.

RESULTS

During January 19-April 16, 2020, 89 voyages on 70 ships had known SARS-CoV-2 outbreaks; 16 ships had recurrent outbreaks. There were 1,669 RT-PCR-confirmed SARS-CoV-2 infections and 29 confirmed deaths. Longer voyages were associated with more cases (adjusted incidence rate ratio, 1.10, 95% CI: 1.03-1.17, p < 0.0001). Mathematical models showed that 7-day voyages had about 70% fewer cases than 14-day voyages. On 7-day voyages, the most effective interventions were reducing the number of individuals onboard (43-49% reduction in total infections) and testing passengers and crew (42-43% reduction in total infections). All four interventions reduced transmission by 80%, but no single intervention or combination eliminated transmission. Results were similar for 14-day voyages.

CONCLUSIONS

SARS-CoV-2 outbreaks on cruises were common during January-April 2020. Despite all interventions modeled, cruise travel still poses a significant SARS-CoV-2 transmission risk.

Authors+Show Affiliations

COVID-19 Response Team, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.COVID-19 Response Team, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.COVID-19 Response Team, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.COVID-19 Response Team, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.COVID-19 Response Team, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.COVID-19 Response Team, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.COVID-19 Response Team, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.COVID-19 Response Team, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.COVID-19 Response Team, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.COVID-19 Response Team, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.COVID-19 Response Team, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.COVID-19 Response Team, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.COVID-19 Response Team, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.COVID-19 Response Team, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.COVID-19 Response Team, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.COVID-19 Response Team, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.COVID-19 Response Team, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.COVID-19 Response Team, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.COVID-19 Response Team, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.COVID-19 Response Team, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.COVID-19 Response Team, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.COVID-19 Response Team, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.COVID-19 Response Team, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.COVID-19 Response Team, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

33978720

Citation

Guagliardo, Sarah Anne J., et al. "Cruise Ship Travel in the Era of COVID-19: a Summary of Outbreaks and a Model of Public Health Interventions." Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America, 2021.
Guagliardo SAJ, Prasad PV, Rodriguez A, et al. Cruise ship travel in the era of COVID-19: A summary of outbreaks and a model of public health interventions. Clin Infect Dis. 2021.
Guagliardo, S. A. J., Prasad, P. V., Rodriguez, A., Fukunaga, R., Novak, R. T., Ahart, L., Reynolds, J., Griffin, I., Wiegand, R., Quilter, L. A. S., Morrison, S., Jenkins, K., Wall, H. K., Treffiletti, A., White, S. B., Regan, J., Tardivel, K., Freeland, A., Brown, C., ... Friedman, C. R. (2021). Cruise ship travel in the era of COVID-19: A summary of outbreaks and a model of public health interventions. Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America. https://doi.org/10.1093/cid/ciab433
Guagliardo SAJ, et al. Cruise Ship Travel in the Era of COVID-19: a Summary of Outbreaks and a Model of Public Health Interventions. Clin Infect Dis. 2021 May 12; PubMed PMID: 33978720.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Cruise ship travel in the era of COVID-19: A summary of outbreaks and a model of public health interventions. AU - Guagliardo,Sarah Anne J, AU - Prasad,Pragati V, AU - Rodriguez,Andrea, AU - Fukunaga,Rena, AU - Novak,Ryan T, AU - Ahart,Lauren, AU - Reynolds,Jared, AU - Griffin,Isabel, AU - Wiegand,Ryan, AU - Quilter,Laura A S, AU - Morrison,Stephanie, AU - Jenkins,Keisha, AU - Wall,Hilary K, AU - Treffiletti,Aimee, AU - White,Stefanie B, AU - Regan,Joanna, AU - Tardivel,Kara, AU - Freeland,Amy, AU - Brown,Clive, AU - Wolford,Hannah, AU - Johansson,Michael A, AU - Cetron,Martin S, AU - Slayton,Rachel B, AU - Friedman,Cindy R, Y1 - 2021/05/12/ PY - 2021/03/15/received PY - 2021/5/12/entrez PY - 2021/5/13/pubmed PY - 2021/5/13/medline KW - SARS-CoV-2 KW - cruise ship KW - mathematical modeling KW - outbreaks JF - Clinical infectious diseases : an official publication of the Infectious Diseases Society of America JO - Clin Infect Dis N2 - BACKGROUND: Cruise travel contributed to SARS-CoV-2 transmission when there were relatively few cases in the United States. By March 14, 2020, the Centers for Disease Control and Prevention (CDC) issued a No Sail Order suspending U.S. cruise operations; the last U.S. passenger ship docked on April 16. METHODS: We analyzed SARS-CoV-2 outbreaks on cruises in U.S. waters or carrying U.S. citizens and used regression models to compare voyage characteristics. We used compartmental models to simulate the potential impact of four interventions (screening for COVID-19 symptoms; viral testing on two days and isolation of positive persons; reduction of passengers by 40%, crew by 20%, and port visits to one) for 7-day and 14-day voyages. RESULTS: During January 19-April 16, 2020, 89 voyages on 70 ships had known SARS-CoV-2 outbreaks; 16 ships had recurrent outbreaks. There were 1,669 RT-PCR-confirmed SARS-CoV-2 infections and 29 confirmed deaths. Longer voyages were associated with more cases (adjusted incidence rate ratio, 1.10, 95% CI: 1.03-1.17, p < 0.0001). Mathematical models showed that 7-day voyages had about 70% fewer cases than 14-day voyages. On 7-day voyages, the most effective interventions were reducing the number of individuals onboard (43-49% reduction in total infections) and testing passengers and crew (42-43% reduction in total infections). All four interventions reduced transmission by 80%, but no single intervention or combination eliminated transmission. Results were similar for 14-day voyages. CONCLUSIONS: SARS-CoV-2 outbreaks on cruises were common during January-April 2020. Despite all interventions modeled, cruise travel still poses a significant SARS-CoV-2 transmission risk. SN - 1537-6591 UR - https://www.unboundmedicine.com/medline/citation/33978720/Cruise_ship_travel_in_the_era_of_COVID_19:_A_summary_of_outbreaks_and_a_model_of_public_health_interventions_ L2 - https://academic.oup.com/cid/article-lookup/doi/10.1093/cid/ciab433 DB - PRIME DP - Unbound Medicine ER -
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