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Mouchtouri VA, Simou E, Soteriades S, Rousou X, Kontouli KM, Kafetsouli D, Kourentis L, Anagnostopoulos L, Hadjichristodoulou C. Systematic literature review and meta-analysis on preventing and controlling norovirus outbreaks on cruise ships, 1990 to 2020: calling for behaviour change strategies of travellers. Euro Surveill 2024; 29:2300345. [PMID: 38456215 PMCID: PMC10986668 DOI: 10.2807/1560-7917.es.2024.29.10.2300345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 11/30/2023] [Indexed: 03/09/2024] Open
Abstract
BackgroundOutbreaks of norovirus gastroenteritis aboard cruise ships may affect a large number of people, debilitate vulnerable travellers, disrupt vacations and cause economic losses to the cruise ship industry.AimWe aimed to identify risk factors for norovirus outbreaks on cruise ships and assess the effectiveness of prevention and control measures.MethodsWe conducted a systematic literature review searching PubMed and Scopus databases as well as grey literature for articles and reports describing norovirus outbreaks on cruise ships between 1990 and 2020. We also performed a meta-analysis of norovirus prevalence in passengers and crew members.ResultsData from 45 outbreaks on 26 cruise ships from 1990 to 2020 were identified in 13 articles and five reports, with a weighted average of prevalence (attack rate) for passengers of 7% (95% confidence interval (CI): 5.00-9.00) and for crew of 2% (95% CI: 0.00-3.00). Person-to-person was the most frequent mode of transmission in 35 of the 45 outbreaks (in 14 the only mode and in 21 as part of multiple transmission routes). Having an ill cabin mate (OR = 38.70; 95% CI: 13.51-110.86) was the most common risk factor. Six outbreak investigations reported poor hygiene, while four reported satisfactory hygiene in the cruise setting. Behavioural risk factors among travellers were investigated in three of the 13 studies.ConclusionsThe findings indicate a need for behavioural interventions to improve personal hygiene, symptom reporting and compliance with isolation measures, and for reconsidering current isolation policies where symptomatic and healthy individuals are isolated in the same cabin.
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Affiliation(s)
- Varvara A Mouchtouri
- HEALTHY SAILING project, Larissa, Greece
- EU SHIPSAN Scientific Association, Larissa, Greece
- Laboratory of Hygiene and Epidemiology, Medical School, University of Thessaly, Larissa, Greece
| | - Evangelia Simou
- Laboratory of Hygiene and Epidemiology, Medical School, University of Thessaly, Larissa, Greece
| | - Soteris Soteriades
- Laboratory of Hygiene and Epidemiology, Medical School, University of Thessaly, Larissa, Greece
| | - Xanthoula Rousou
- Laboratory of Hygiene and Epidemiology, Medical School, University of Thessaly, Larissa, Greece
| | - Katerina Maria Kontouli
- HEALTHY SAILING project, Larissa, Greece
- Laboratory of Hygiene and Epidemiology, Medical School, University of Thessaly, Larissa, Greece
| | - Dimitra Kafetsouli
- Laboratory of Hygiene and Epidemiology, Medical School, University of Thessaly, Larissa, Greece
| | - Leonidas Kourentis
- HEALTHY SAILING project, Larissa, Greece
- EU SHIPSAN Scientific Association, Larissa, Greece
- Laboratory of Hygiene and Epidemiology, Medical School, University of Thessaly, Larissa, Greece
| | - Lemonia Anagnostopoulos
- HEALTHY SAILING project, Larissa, Greece
- Laboratory of Hygiene and Epidemiology, Medical School, University of Thessaly, Larissa, Greece
| | - Christos Hadjichristodoulou
- HEALTHY SAILING project, Larissa, Greece
- EU SHIPSAN Scientific Association, Larissa, Greece
- Laboratory of Hygiene and Epidemiology, Medical School, University of Thessaly, Larissa, Greece
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Küpper T, Apel C, Bertsch D, van der Giet M, van der Giet S, Graß M, Cerfontaine C, Haunolder M, Hundt N, Kühn C, Morrison A, Museo S, Timmermann L, Wernitz K, Jäger J. Analysis of local drinking water for fecal contamination in Solu-Khumbu / Mt. Everest region, Nepal. Int J Hyg Environ Health 2022; 246:114043. [DOI: 10.1016/j.ijheh.2022.114043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Revised: 09/12/2022] [Accepted: 09/21/2022] [Indexed: 11/06/2022]
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Misumi M, Nishiura H. Long-term dynamics of Norovirus transmission in Japan, 2005-2019. PeerJ 2021; 9:e11769. [PMID: 34306831 PMCID: PMC8280881 DOI: 10.7717/peerj.11769] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 06/22/2021] [Indexed: 11/20/2022] Open
Abstract
Norovirus continues to evolve, adjusting its pathogenesis and transmissibility. In the present study, we systematically collected datasets on Norovirus outbreaks in Japan from 2005 to 2019 and analyzed time-dependent changes in the asymptomatic ratio, the probability of virus detection, and the probability of infection given exposure. Reports of 1,728 outbreaks were published, and feces from all involved individuals, including those with asymptomatic infection, were tested for virus in 434 outbreaks. We found that the outbreak size did not markedly change over this period, but the variance in outbreak size increased during the winter (November–April). Assuming that natural history parameters did not vary over time, the asymptomatic ratio, the probability of virus detection, and the probability of infection given exposure were estimated to be 18.6%, 63.3% and 84.5%, respectively. However, a model with time-varying natural history parameters yielded better goodness-of-fit and suggested that the asymptomatic ratio varied by year. The asymptomatic ratio was as high as 25.8% for outbreaks caused by genotype GII.4 noroviruses. We conclude that Norovirus transmissibility has not changed markedly since 2005, and that yearly variation in the asymptomatic ratio could potentially be explained by the circulating dominant genotype.
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Affiliation(s)
- Megumi Misumi
- Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan.,Rumoi City Hospital, Rumoi, Hokkaido, Japan
| | - Hiroshi Nishiura
- Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan.,School of Public Health, Kyoto University, Kyoto, Japan
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Kordsmeyer AC, Mojtahedzadeh N, Heidrich J, Militzer K, von Münster T, Belz L, Jensen HJ, Bakir S, Henning E, Heuser J, Klein A, Sproessel N, Ekkernkamp A, Ehlers L, de Boer J, Kleine-Kampmann S, Dirksen-Fischer M, Plenge-Bönig A, Harth V, Oldenburg M. Systematic Review on Outbreaks of SARS-CoV-2 on Cruise, Navy and Cargo Ships. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:5195. [PMID: 34068311 PMCID: PMC8153346 DOI: 10.3390/ijerph18105195] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 05/07/2021] [Accepted: 05/10/2021] [Indexed: 02/06/2023]
Abstract
The confined environment of a ship promotes the transmission of the severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) due to close contact among the population on board. The study aims to provide an overview of outbreaks of SARS-CoV-2 on board of cruise, navy or cargo ships, to identify relevant outbreak management techniques, related problems and to derive recommendations for prevention. Four databases were searched. The study selection included reports about seroprevalences or clinically/laboratory confirmed infections of SARS-CoV-2 on board ships between the first of January, 2020 and the end of July, 2020. A total of 37 studies were included of whom 33 reported outbreaks of SARS-CoV-2 on cruise ships (27 studies referred to the Diamond Princess). Two studies considered outbreaks on the Grand Princess, three studies informed about Nile River cruises and one study about the MS Westerdam (mention of multiple outbreaks possible in one study). Additionally, three studies reported outbreaks of SARS-CoV-2 on navy vessels and one study referred to a cargo ship. Problems in handling outbreaks resulted from a high number of asymptomatic infections, transportation issues, challenges in communication or limited access to health care. Responsible operators need to implement infection control measures which should be described in outbreak management plans for ships to prevent transmission risks, including, e.g., education, testing strategies, communication lines, social distancing and hygiene regulations.
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Affiliation(s)
- Ann-Christin Kordsmeyer
- Institute for Occupational and Maritime Medicine (ZfAM), University Medical Center Hamburg-Eppendorf (UKE), 20459 Hamburg, Germany; (N.M.); (J.H.); (K.M.); (T.v.M.); (L.B.); (H.-J.J.); (V.H.); (M.O.)
| | - Natascha Mojtahedzadeh
- Institute for Occupational and Maritime Medicine (ZfAM), University Medical Center Hamburg-Eppendorf (UKE), 20459 Hamburg, Germany; (N.M.); (J.H.); (K.M.); (T.v.M.); (L.B.); (H.-J.J.); (V.H.); (M.O.)
| | - Jan Heidrich
- Institute for Occupational and Maritime Medicine (ZfAM), University Medical Center Hamburg-Eppendorf (UKE), 20459 Hamburg, Germany; (N.M.); (J.H.); (K.M.); (T.v.M.); (L.B.); (H.-J.J.); (V.H.); (M.O.)
| | - Kristina Militzer
- Institute for Occupational and Maritime Medicine (ZfAM), University Medical Center Hamburg-Eppendorf (UKE), 20459 Hamburg, Germany; (N.M.); (J.H.); (K.M.); (T.v.M.); (L.B.); (H.-J.J.); (V.H.); (M.O.)
| | - Thomas von Münster
- Institute for Occupational and Maritime Medicine (ZfAM), University Medical Center Hamburg-Eppendorf (UKE), 20459 Hamburg, Germany; (N.M.); (J.H.); (K.M.); (T.v.M.); (L.B.); (H.-J.J.); (V.H.); (M.O.)
| | - Lukas Belz
- Institute for Occupational and Maritime Medicine (ZfAM), University Medical Center Hamburg-Eppendorf (UKE), 20459 Hamburg, Germany; (N.M.); (J.H.); (K.M.); (T.v.M.); (L.B.); (H.-J.J.); (V.H.); (M.O.)
| | - Hans-Joachim Jensen
- Institute for Occupational and Maritime Medicine (ZfAM), University Medical Center Hamburg-Eppendorf (UKE), 20459 Hamburg, Germany; (N.M.); (J.H.); (K.M.); (T.v.M.); (L.B.); (H.-J.J.); (V.H.); (M.O.)
| | - Sinan Bakir
- Department of Trauma and Reconstructive Surgery and Rehabilitative Medicine, Medical University Greifswald, 17475 Greifswald, Germany; (S.B.); (E.H.); (J.H.); (A.K.); (N.S.); (A.E.)
| | - Esther Henning
- Department of Trauma and Reconstructive Surgery and Rehabilitative Medicine, Medical University Greifswald, 17475 Greifswald, Germany; (S.B.); (E.H.); (J.H.); (A.K.); (N.S.); (A.E.)
| | - Julian Heuser
- Department of Trauma and Reconstructive Surgery and Rehabilitative Medicine, Medical University Greifswald, 17475 Greifswald, Germany; (S.B.); (E.H.); (J.H.); (A.K.); (N.S.); (A.E.)
| | - Angelina Klein
- Department of Trauma and Reconstructive Surgery and Rehabilitative Medicine, Medical University Greifswald, 17475 Greifswald, Germany; (S.B.); (E.H.); (J.H.); (A.K.); (N.S.); (A.E.)
| | - Nadine Sproessel
- Department of Trauma and Reconstructive Surgery and Rehabilitative Medicine, Medical University Greifswald, 17475 Greifswald, Germany; (S.B.); (E.H.); (J.H.); (A.K.); (N.S.); (A.E.)
| | - Axel Ekkernkamp
- Department of Trauma and Reconstructive Surgery and Rehabilitative Medicine, Medical University Greifswald, 17475 Greifswald, Germany; (S.B.); (E.H.); (J.H.); (A.K.); (N.S.); (A.E.)
| | - Lena Ehlers
- Hamburg Port Health Center (HPHC), Institute for Hygiene and Environment, 20537 Hamburg, Germany; (L.E.); (J.d.B.); (S.K.-K.); (M.D.-F.)
| | - Jens de Boer
- Hamburg Port Health Center (HPHC), Institute for Hygiene and Environment, 20537 Hamburg, Germany; (L.E.); (J.d.B.); (S.K.-K.); (M.D.-F.)
| | - Scarlett Kleine-Kampmann
- Hamburg Port Health Center (HPHC), Institute for Hygiene and Environment, 20537 Hamburg, Germany; (L.E.); (J.d.B.); (S.K.-K.); (M.D.-F.)
| | - Martin Dirksen-Fischer
- Hamburg Port Health Center (HPHC), Institute for Hygiene and Environment, 20537 Hamburg, Germany; (L.E.); (J.d.B.); (S.K.-K.); (M.D.-F.)
| | - Anita Plenge-Bönig
- Infectious Diseases Surveillance Center, Institute for Hygiene and Environment, 20539 Hamburg, Germany;
| | - Volker Harth
- Institute for Occupational and Maritime Medicine (ZfAM), University Medical Center Hamburg-Eppendorf (UKE), 20459 Hamburg, Germany; (N.M.); (J.H.); (K.M.); (T.v.M.); (L.B.); (H.-J.J.); (V.H.); (M.O.)
| | - Marcus Oldenburg
- Institute for Occupational and Maritime Medicine (ZfAM), University Medical Center Hamburg-Eppendorf (UKE), 20459 Hamburg, Germany; (N.M.); (J.H.); (K.M.); (T.v.M.); (L.B.); (H.-J.J.); (V.H.); (M.O.)
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Li Y, Fan X, Yu G, Wei P, Wang Y, Guo H. An acute gastroenteritis outbreak associated with breakfast contaminated with norovirus by asymptotic food handler at a kindergarten in Shenzhen, China. BMC Infect Dis 2021; 21:54. [PMID: 33435906 PMCID: PMC7802125 DOI: 10.1186/s12879-021-05762-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 01/02/2021] [Indexed: 11/10/2022] Open
Abstract
Background An outbreak of acute gastroenteritis occurred in a kindergarten located Shenzhen City on March 4, 2018. We were invited to investigate to the risk factors associated with this outbreak. Methods We conducted retrospective cohort-studies on three different groups of subjects in order to figure out the difference of incidence of acute gastroenteritis among subjects of different activities on March 2: group one consisted of people who attended the Lantern festival activities; group two consisted of children and employees who ate breakfast and bread provided by the kindergarten; and groups three consisted of children and employees who did not eat breakfast or bread provided by the kindergarten. Fecal, anal swabs, dishware swabs and hand swabs specimens were collected in the study. Bacteria known to cause acute gastroenteritis were cultured. Viruses associated with acute gastroenteritis were tested using real-time PCR. Capsid gene fragment of 557 bp of norovirus was amplified and sequenced. The phylogenetic tree was constructed with MEGA 7.0 using neighbor-joining method based on capsid gene fragment of norovirus. Results A total of 143 suspected cases were identified in this outbreak. Diarrhea happened more often in adults than in children while emesis and bellyache were more frequently found in children than in adults. Higher AGE incidence was observed in group 2, children and employees who had breakfast in the kindergarten on March 2, as well as in group 3, and among employees who eating bread involved in breakfast provided on March 2. Five anal swab specimens were positive for norovirus. All noroviruses belongs to group II.3 and have an identity more than 99%. Conclusion A chef, as an asymptomatic carrier with norovirus, was the infectious resource in this outbreak. He contaminated breakfast food provided on March 2. Although morning check is implemented in kindergartens of China, employees are often excluded in morning check. Our finding highlights the importance of morning check covering employees and periodical training for cooks. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-021-05762-z.
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Affiliation(s)
- Yuan Li
- Shenzhen Bao'an Center for Disease Control and Prevention, Shenzhen, China
| | - Xiangbo Fan
- Hezhou Center for Disease Control and Prevention, Hezhou, China
| | - Guangqing Yu
- Shenzhen Bao'an Center for Disease Control and Prevention, Shenzhen, China
| | - Peinan Wei
- Wuqing Center for Disease Control and Prevention, Tianjin, China
| | - Yong Wang
- Department of Epidemiology, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Hongxiong Guo
- Jiangsu Provincial Center for Disease Control and Prevention, 172 Jiangsu Road, Nanjing, China.
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