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Abstract

Background

Cruise ships provide an ideal setting for transmission of SARS-CoV-2, given the socially dense exposure environment.

Aim

To provide a comprehensive review of COVID-19 outbreaks on cruise ships.

Methods

PubMed was searched for COVID-19 cases associated with cruise ships between January and October 2020. A list of cruise ships with COVID-19 was cross-referenced with the United States Centers for Disease Control and Prevention’s list of cruise ships associated with a COVID-19 case within 14 days of disembarkation. News articles were also searched for epidemiological information. Narratives of COVID-19 outbreaks on ships with over 100 cases are presented.

Results

Seventy-nine ships and 104 unique voyages were associated with COVID-19 cases before 1 October 2020. Nineteen ships had more than one voyage with a case of COVID-19. The median number of cases per ship was three (interquartile range (IQR): 1–17.8), with two notable outliers: the Diamond Princess and the Ruby Princess, which had 712 and 907 cases, respectively. The median attack rate for COVID-19 was 0.2% (IQR: 0.03–1.5), although this distribution was right-skewed with a mean attack rate of 3.7%; 25.9% (27/104) of voyages had at least one COVID-19-associated death. Outbreaks involving only crew occurred later than outbreaks involving guests and crew.

Conclusions

In the absence of mitigation measures, COVID-19 can spread easily on cruise ships in a susceptible population because of the confined space and high-density contact networks. This environment can create superspreader events and facilitate international spread.

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This work is licensed under a Creative Commons Attribution 4.0 International License.
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2022-01-06
2024-11-23
http://instance.metastore.ingenta.com/content/10.2807/1560-7917.ES.2022.27.1.2002113
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A review of COVID-19 transmission dynamics and clinical outcomes on cruise ships worldwide, January to October 2020
<p class="citation"> <span>Citation style for this article:</span> <span class="meta-value authors"> <a href="/search?value1=Kathryn+S+Willebrand&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Willebrand Kathryn S</a>, <a href="/search?value1=Lauren+Pischel&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Pischel Lauren</a>, <a href="/search?value1=Amyn+A+Malik&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Malik Amyn A</a>, <a href="/search?value1=Samuel+M+Jenness&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Jenness Samuel M</a>, <a href="/search?value1=Saad+B+Omer&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Omer Saad B</a></span>. A review of COVID-19 transmission dynamics and clinical outcomes on cruise ships worldwide, January to October 2020. <a href="/content/ecdc">Euro Surveill.</a> 2022;27(1):pii=2002113. <a href="https://doi.org/10.2807/1560-7917.ES.2022.27.1.2002113" title="doi link" target="_blank">https://doi.org/10.2807/1560-7917.ES.2022.27.1.2002113</a> <span class="ES_Article_citation"> <span class="generated">Received</span>: 20 Dec 2020;&nbsp;&nbsp; <span class="generated">Accepted</span>: 18 May 2021 </span> </p>
/content/10.2807/1560-7917.ES.2022.27.1.2002113
/content/10.2807/1560-7917.ES.2022.27.1.2002113
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