Infections and other problems on ferries and cruise ships

Abstract number: S441

Dahl E.

Passenger ships are isolated communities with a high population density, crowded public rooms and living accommodation, shared sanitary facilities, and common water and food supplies. Hence, infectious diseases are easily transmitted aboard. Outbreaks of measles, rubella, varicella, meningococcal meningitis, hepatitis A, Legionnaires' disease, influenza and gastroenteritis among passengers and crew have been reported and are feared both for their health and publicity reasons. However, consequences are usually less serious for ferries, carrying people between two close ports, than for cruise ships. Vessels doing cruises that last weeks to months often visit remote areas with varying sanitation standards, and evacuation may not be possible for days. While ferries often carry no medical personnel, cruise ships as a rule have 1–2 physicians and 1–3 nurses.

Cruise companies emphasize illness prevention through pre-employment medical screening and vaccination programmes for their crew, as well as detailed and rigid ship sanitation procedures. Over one hundred outbreaks of infectious diseases, particularly gastrointestinal disease, were reported to be associated with ships between 1970 and 2000. Despite good performance on health inspections, outbreaks of gastroenteritis per 1000 cruises increased almost tenfold from 2001 to 2004. The increase was mostly attributable to norovirus, and highlights the inability of environmental programmes to fully predict and prevent risk factors common to person-to-person and fomite spread of disease. The much publicised outbreaks and global threats have led the cruise companies to cooperate closely with local, national and international public health authorities – and with each other. These efforts have resulted in detailed protocols on how to deal with every aspect of shipboard sanitation: under normal circumstances, when there is a threat of an outbreak, and during an outbreak. They include mandatory hand disinfection for all persons entering the ship, and strict isolation demands for all cases of gastroenteritis for a minimum of 24 hours after the last symptom. Isolation aboard is difficult and risky. A bedside test to quickly diagnose or rule out norovirus is therefore high on the cruise industry's wish list.

As it is almost impossible for ships to comply with different requirements in each port, it is a pressing international challenge for all port countries to agree on a uniform vessel sanitation programme for passenger ships.

Session Details

Date: 19/04/2008
Time: 00:00-00:00
Session name: 18th European Congress of Clinical Microbiology and Infectious Diseases
Location: Barcelona, Spain
Presentation type:
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