Respiratory infections and gastrointestinal illness on a cruise ship: A three-year prospective study.
BACKGROUND
Cruise ships carry a large number of people in confined spaces providing an environment for transmission of infections. The aim of this study is to estimate the incidence of and describe the spectrum of respiratory infections and gastrointestinal illness among passengers and crew of cruise Ship A.


METHODS
The study was carried out from January 2011 to December 2013 on cruise Ship A, including passengers and crew who presented with symptoms suggestive of acute respiratory infection (ARI), influenza-like illness (ILI) and gastrointestinal illness (GI). Advice about preventive measures of respiratory and gastrointestinal infections and influenza vaccination was given to passengers and crew. Data were collected by using one standardized form per patient.


RESULTS
The most common destination was Northern Europe (90.7%). The mean duration of cruise was 10.6 days; 440 passengers and 421 crew members who sought medical attention were studied (mean age 72.6 ± 9.5 and 33 ± 7 years, respectively). ILI, ARI and GI were diagnosed in 32.7%, 15.9%, 17% and 10.9%, 80%, 0.2% of ill passengers and crew, respectively. The association of ARI, ILI and GI incidence in passengers was statistically significant with season, destination and duration of travel; the incidence for all illnesses was higher during winter, for travel to South America and for >14 days (p-value<0.001).


CONCLUSIONS
ARI, ILI and GI continue to pose a burden on cruise travel; therefore pre-travel advice is crucial for passengers and crew regarding respiratory and gastrointestinal infections. Surveillance and implementation of control measures are important for outbreak prevention.
Travel Medicine Office, Hellenic Center for Disease Control and Prevention, Athens, Greece. Electronic address: androulapavli@yahoo.com.
Androula
A
Pavli
Department for Interventions in Health-Care Facilities, Hellenic Center for Disease Control and Prevention, Athens, Greece.
Helena C
HC
Maltezou
Cruise Ships Medical Consultant, Medical Director MMS, United Kingdom.
Antonis
A
Papadakis
Department for Interventions in Health-Care Facilities, Hellenic Center for Disease Control and Prevention, Athens, Greece.
Panagiotis
P
Katerelos
National Kapodistrian University of Athens School of Nursing, Athens, Greece.
Georgios
G
Saroglou
Department of Microbiology, National Kapodistrian University of Athens Medical School, Athens Greece.
Athanasios
A
Tsakris
4th Department of Internal Medicine, Attikon University Hospital, National Kapodistrian University of Athens Medical School, Athens, Greece.
Sotirios
S
Tsiodras
D000208:Acute Disease / Q000453:epidemiology; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004196:Disease Outbreaks / Q000517:prevention & control; D005060:Europe; D005260:Female; D005767:Gastrointestinal Diseases / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D007251:Influenza, Human / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012141:Respiratory Tract Infections / Q000453:epidemiology*; D012767:Ships; D013020:South America; D013997:Time Factors; D014195:Travel; D014611:Vaccination
Acute respiratory infection; Crew; Cruise; Influenza-like illness; Passengers