title: Management and control of varicella on cruise ships: a collaborative approach to promoting public health.
abstract: BACKGROUND
  In most years varicella is the vaccine-preventable disease most frequently reported to Centers for Disease Control and Prevention (CDC) by cruise ships. Since 2005, CDC has received numerous isolated case reports of varicella among crew members and has investigated varicella outbreaks aboard vessels sailing into and from US seaports.
  
  
  METHODS
  CDC investigators reviewed electronic varicella case reports from 2005 to 2009 and outbreak reports from 2009 to characterize the response and control efforts implemented by cruise ships in accordance with CDC protocols. Outbreak reports from 2009 were manually reviewed for details of case identification, contact investigations, isolation and restriction of cases and contacts, respectively, and number of contacts administered varicella vaccine post-exposure by cruise lines.
  
  
  RESULTS
  During 2005 to 2009, cruise ships reported 278 cases of varicella to CDC among predominantly male (80%) crew members, three-quarters of whom were residents of Caribbean countries, Indonesia, the Philippines, or India, and whose median age was 29 years. Cases were more commonly reported during spring and winter months. During 2009, cruise ships reported 94 varicella cases among crew members of which 66 (70%) were associated with 18 reported varicella outbreaks. Outbreak response included isolation of 66 (100%) of 66 cases, restriction of 66 (26%) of 255 crew-contacts, and administration of post-exposure vaccine to 522 close contacts and other susceptible crew members per standard CDC recommendations.
  
  
  CONCLUSIONS
  Most cases reported to CDC during 2005 to 2009 were among non-US resident crew members. Overall, cruise lines sailing into North America have the onboard capability to manage varicella cases and outbreaks and appear responsive to CDC recommendations. Cruise lines should continue to implement CDC-recommended response protocols to curtail outbreaks rapidly and should consider whether pre-placement varicella immunity screening and vaccination of crew members is a cost-effective option for their respective fleet operations.
authors: Division of Global Migration and Quarantine, Quarantine and Border Health Services Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA.
authors: Elaine H
authors: EH
authors: Cramer
authors: Douglas D
authors: DD
authors: Slaten
authors: Adriane
authors: A
authors: Guerreiro
authors: Danisha
authors: D
authors: Robbins
authors: Andrew
authors: A
authors: Ganzon
mesh_terms: D000328:Adult; D000368:Aged; D002487:Centers for Disease Control and Prevention, U.S.; D002644:Chickenpox / Q000453:epidemiology / Q000517:prevention & control*; D019433:Chickenpox Vaccine; D004196:Disease Outbreaks / Q000517:prevention & control*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009326:Naval Medicine; D009656:North America / Q000453:epidemiology; D017410:Practice Guidelines as Topic; D011634:Public Health; D012767:Ships; D014195:Travel; D014481:United States; D055815:Young Adult
chemical_list: D019433:Chickenpox Vaccine