Individual cruise ship investigations have been posted on the CDC VSP’s Web site www.cdc.gov/nceh/vsp.
Passenger Behaviors During Norovirus Outbreaks on Cruise Ships
Version of Record online: 20 MAY 2008
© 2008 International Society of Travel Medicine
Journal of Travel Medicine
Volume 15, Issue 3, pages 172–176, May/June 2008
How to Cite
Neri, A. J., Cramer, E. H., Vaughan, G. H., Vinjé, J. and Mainzer, H. M. (2008), Passenger Behaviors During Norovirus Outbreaks on Cruise Ships. Journal of Travel Medicine, 15: 172–176. doi: 10.1111/j.1708-8305.2008.00199.x
Some findings of this paper, along with other investigation findings, were presented at the following meetings: National Environmental Public Health Conference, December 2006, and 56th Annual Epidemic Intelligence Service Conference, April 2007.
- Issue online: 20 MAY 2008
- Version of Record online: 20 MAY 2008
Background Norovirus causes a majority of outbreaks of gastrointestinal (GI) illness on cruise ships calling on the United States. Control measures include patient isolation, hand washing, and facility closure. Little is known about the behaviors and practices of people who have become ill with norovirus GI illness compared to those who remained well during an outbreak.
Methods Passenger surveys were distributed during three cruise ship outbreaks caused by norovirus. Surveys inquired about illness symptoms, ill contacts, illness reporting status, hand sanitation beliefs and practices, and availability of public hand sanitizer. A case was a passenger reporting three or more episodes of loose stool in a 24-hour period, three or more episodes of vomiting in a 24-hour period, or one or more episodes each of loose stool and vomiting in a 24-hour period. Controls reported that they were not ill during the cruise.
Results In total, 1,323 responses were compared. All ships had passengers who were ill prior to embarkation. Most cases delayed or did not report their illness to the ship’s infirmary because they did not believe it was serious (43%–70% of responses). Cases were less likely to believe that isolation was effective in preventing disease spread [Mann–Whitney–Wilcoxon (MWW) p value <0.0001]. Cases were less likely to believe that hand washing or hand sanitizer are effective means of preventing disease spread (MWW p values 0.002 and 0.04, respectively), wash their hands after restroom use (MWW p value 0.02), or believe that hand sanitizer was available for public use prior to/after knowing about an outbreak (MWW p values 0.002 and 0.03, respectively).
Conclusions Prevention and control of norovirus GI illness may be improved by routine screening of embarking passengers, education about GI illness and its impact on public health, a focus on improving hand-washing practices, and identification of public hand sanitizer dispensing locations.