Research – Gastroenteritis outbreaks on cruise ships: contributing factors and thresholds for early outbreak detection

Eurosurveillance

Acute gastroenteritis (AG) is the most frequent disease among travellers and outbreaks are detected among tourists staying in accommodation every year [1], including on cruise ships [2]. The majority (97%) of AG outbreaks that were reported and diagnosed on cruise ships in the United States (US) during 2008–2014 were caused by norovirus [2]. Norovirus gastroenteritis outbreaks often involve person-to-person and environmental transmission [3–9] and have been recognised to have a considerable public health impact and economic burden on the tourism industry [10,11]. In addition to the public health impact and disruption of holidays, consequences include loss of personal travel funds and high ship operation costs [10]. Preventative routine measures include pre-embarkation screening, syndromic surveillance, isolation of symptomatic travellers (i.e. crew members and passengers), environmental and personal hygiene measures, crew education, and instructions to travellers and others about hand washing and symptoms reporting [12,13].