Public Health Responses to COVID-19 Outbreaks on Cruise Ships — Worldwide, February–March 2020

Leah F. Moriarty, MPH; Mateusz M. Plucinski, PhD; Barbara J. Marston, MD; Ekaterina V. Kurbatova, MD, PhD; Barbara Knust, DVM; Erin L. Murray, PhD; Nicki Pesik, MD; Dale Rose, PhD; David Fitter, MD; Miwako Kobayashi, MD, PhD; Mitsuru Toda, PhD; Paul T. Canty, MD; Tara Scheuer, MPH; Eric S. Halsey, MD; Nicole J. Cohen, MD; Lauren Stockman, MPH; Debra A. Wadford, PhD; Alexandra M. Medley, DVM; Gary Green, MD; Joanna J. Regan, MD; Kara Tardivel, MD; Stefanie White, MPH; Clive Brown, MD; Christina Morales, PhD; Cynthia Yen, MPH; Beth Wittry, MPH; Amy Freeland, PhD; Sara Naramore, MPH; Ryan T. Novak, PhD; David Daigle, MPH; Michelle Weinberg, MD; Anna Acosta, MD; Carolyn Herzig, PhD; Bryan K Kapella, MD; Kathleen R. Jacobson, MD; Katherine Lamba, MPH; Atsuyoshi Ishizumi, MPH, MSc; John Sarisky, MPH; Erik Svendsen, PhD; Tricia Blocher, MS; Christine Wu, MD; Julia Charles, JD; Riley Wagner, MPH; Andrea Stewart, PhD; Paul S. Mead, MD; Elizabeth Kurylo, MCM; Stefanie Campbell, DVM; Rachel Murray, MPH; Paul Weidle, PharmD; Martin Cetron, MD; Cindy R. Friedman, MD

Disclosures

Morbidity and Mortality Weekly Report. 2020;69(12):347-352. 

In This Article

Abstract and Introduction

Introduction

An estimated 30 million passengers are transported on 272 cruise ships worldwide each year*.[1] Cruise ships bring diverse populations into proximity for many days, facilitating transmission of respiratory illness.[2] SARS-CoV-2, the virus that causes coronavirus disease (COVID-19) was first identified in Wuhan, China, in December 2019 and has since spread worldwide to at least 187 countries and territories. Widespread COVID-19 transmission on cruise ships has been reported as well.[3] Passengers on certain cruise ship voyages might be aged ≥65 years, which places them at greater risk for severe consequences of SARS-CoV-2 infection.[4] During February–March 2020, COVID-19 outbreaks associated with three cruise ship voyages have caused more than 800 laboratory-confirmed cases among passengers and crew, including 10 deaths. Transmission occurred across multiple voyages of several ships. This report describes public health responses to COVID-19 outbreaks on these ships. COVID-19 on cruise ships poses a risk for rapid spread of disease, causing outbreaks in a vulnerable population, and aggressive efforts are required to contain spread. All persons should defer all cruise travel worldwide during the COVID-19 pandemic.

During February 7–23, 2020, the largest cluster of COVID-19 cases outside mainland China occurred on the Diamond Princess cruise ship, which was quarantined in the port of Yokohama, Japan, on February 3.[3] On March 6, cases of COVID-19 were identified in persons on the Grand Princess cruise ship off the coast of California; that ship was subsequently quarantined. By March 17, confirmed cases of COVID-19 had been associated with at least 25 additional cruise ship voyages. On February 21, CDC recommended avoiding travel on cruise ships in Southeast Asia; on March 8, this recommendation was broadened to include deferring all cruise ship travel worldwide for those with underlying health conditions and for persons aged ≥65 years. On March 13, the Cruise Lines International Association announced a 30-day voluntary suspension of cruise operations in the United States.[5] CDC issued a level 3 travel warning on March 17, recommending that all cruise travel be deferred worldwide.

*Not including river cruises.
Warning level 3: avoid non-essential travel due to widespread ongoing transmission: https://wwwnc.cdc.gov/travel/notices/warning/novel-coronavirus-china.

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