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Abstract

Background

Outbreaks of norovirus gastroenteritis aboard cruise ships may affect a large number of people, debilitate vulnerable travellers, disrupt vacations and cause economic losses to the cruise ship industry.

Aim

We aimed to identify risk factors for norovirus outbreaks on cruise ships and assess the effectiveness of prevention and control measures.

Methods

We conducted a systematic literature review searching PubMed and Scopus databases as well as grey literature for articles and reports describing norovirus outbreaks on cruise ships between 1990 and 2020. We also performed a meta-analysis of norovirus prevalence in passengers and crew members.

Results

Data from 45 outbreaks on 26 cruise ships from 1990 to 2020 were identified in 13 articles and five reports, with a weighted average of prevalence (attack rate) for passengers of 7% (95% confidence interval (CI): 5.00–9.00) and for crew of 2% (95% CI: 0.00–3.00). Person-to-person was the most frequent mode of transmission in 35 of the 45 outbreaks (in 14 the only mode and in 21 as part of multiple transmission routes). Having an ill cabin mate (OR = 38.70; 95% CI: 13.51–110.86) was the most common risk factor. Six outbreak investigations reported poor hygiene, while four reported satisfactory hygiene in the cruise setting. Behavioural risk factors among travellers were investigated in three of the 13 studies.

Conclusions

The findings indicate a need for behavioural interventions to improve personal hygiene, symptom reporting and compliance with isolation measures, and for reconsidering current isolation policies where symptomatic and healthy individuals are isolated in the same cabin.

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This work is licensed under a Creative Commons Attribution 4.0 International License.
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2024-03-07
2024-12-21
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Systematic literature review and meta-analysis on preventing and controlling norovirus outbreaks on cruise ships, 1990 to 2020: calling for behaviour change strategies of travellers
<p class="citation"> <span>Citation style for this article:</span> <span class="meta-value authors"> <a href="/search?value1=Varvara+A+Mouchtouri&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Mouchtouri Varvara A</a>, <a href="/search?value1=Evangelia+Simou&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Simou Evangelia</a>, <a href="/search?value1=Soteris+Soteriades&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Soteriades Soteris</a>, <a href="/search?value1=Xanthoula+Rousou&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Rousou Xanthoula</a>, <a href="/search?value1=Katerina+Maria+Kontouli&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Kontouli Katerina Maria</a>, <a href="/search?value1=Dimitra+Kafetsouli&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Kafetsouli Dimitra</a>, <a href="/search?value1=Leonidas+Kourentis&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Kourentis Leonidas</a>, <a href="/search?value1=Lemonia+Anagnostopoulos&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Anagnostopoulos Lemonia</a>, <a href="/search?value1=Christos+Hadjichristodoulou&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Hadjichristodoulou Christos</a></span>. Systematic literature review and meta-analysis on preventing and controlling norovirus outbreaks on cruise ships, 1990 to 2020: calling for behaviour change strategies of travellers. <a href="/content/ecdc">Euro Surveill.</a> 2024;29(10):pii=2300345. <a href="https://doi.org/10.2807/1560-7917.ES.2024.29.10.2300345" title="doi link" target="_blank">https://doi.org/10.2807/1560-7917.ES.2024.29.10.2300345</a> <span class="ES_Article_citation"> <span class="generated">Received</span>: 05 Jul 2023;&nbsp;&nbsp; <span class="generated">Accepted</span>: 30 Nov 2023 </span> </p>
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