title: Cruise ships: high-risk passengers and the global spread of new influenza viruses.
abstract: In 1997, passengers on North American cruises developed acute respiratory illnesses (ARIs); influenza was suspected. We reviewed 1 ship's medical records for 3 cruises: cruise 1 (31 August to 10 September 1997), cruise 2 (11-20 September 1997), and cruise 3 (20-30 September 1997). Medically attended ARI was defined as any 2 of the following symptoms: fever (temperature, > or =37.8 degrees C) or feverishness, sore throat, cough, nasal congestion, chills, myalgia, and arthralgia. During cruise 2, we collected nasopharyngeal swabs for viral culture from people with ARI and surveyed passengers for self-reported ARI (defined as above except feverishness was substituted for fever). The outbreak probably began among Australian passengers on cruise 1 (relative risk, 3.3; 95% confidence interval, 1.89-5.77). Of 1284 passengers on cruise 2, 215 (17%) reported ARI, 994 (77%) were aged > or =65 years, and 336 (26%) had other risk factors for respiratory complications. An influenza strain not previously identified in North America was isolated. We concluded that an "off-season" influenza outbreak occurred among international travelers and crew on board this cruise ship.
authors.affiliation: Divisions of Quarantine, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA.
authors.forename: J M
authors.initials: JM
authors.lastname: Miller
authors.forename: T W
authors.initials: TW
authors.lastname: Tam
authors.forename: S
authors.initials: S
authors.lastname: Maloney
authors.forename: K
authors.initials: K
authors.lastname: Fukuda
authors.forename: N
authors.initials: N
authors.lastname: Cox
authors.forename: J
authors.initials: J
authors.lastname: Hockin
authors.forename: D
authors.initials: D
authors.lastname: Kertesz
authors.forename: A
authors.initials: A
authors.lastname: Klimov
authors.forename: M
authors.initials: M
authors.lastname: Cetron
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D004196:Disease Outbreaks; D005260:Female; D006760:Hospitalization; D006801:Humans; D009980:Influenza A virus / Q000145:classification / Q000302:isolation & purification*; D007251:Influenza, Human / Q000150:complications / Q000453:epidemiology* / Q000635:transmission / Q000821:virology; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012767:Ships; D014195:Travel