Maritime illness and death reporting and public health response, United States, 2010–2014

Abstract

Background Deaths and certain illnesses onboard ships arriving at US ports are required to be reported to the US Centers for Disease Control and Prevention (CDC), and notifications of certain illnesses are requested. Methods We performed a descriptive analysis of required maritime illness and death reports of presumptive diagnoses and requested notifications to CDC’s Division of Global Migration and Quarantine, which manages CDC’s Quarantine Stations, from January 2010 to December 2014. Results CDC Quarantine Stations received 2891 individual maritime case reports: 76.8% (2221/2891) illness reports, and 23.2% (670/2891) death reports. The most frequent individual illness reported was varicella (35.9%, 797/2221) and the most frequently reported causes of death were cardiovascular- or pulmonary-related conditions (79.6%, 533/670). There were 7695 cases of influenza-like illness received within aggregate notifications. CDC coordinated 63 contact investigations with partners to identify 972 contacts; 88.0% (855/972) were notified. There was documentation of 6.5% (19/293) receiving post-exposure prophylaxis. Three pertussis contacts were identified as secondary cases; and one tuberculosis contact was diagnosed with active tuberculosis. Conclusion These data provide a picture of US maritime illness and death reporting and response. Varicella reports are the most frequent individual disease reports received. Contact investigations identified few cases of disease transmission.

A Systematic Review for Vaccine-Preventable Diseases on Ships: Evidence for Cross-Border Transmission and for Pre-Employment Immunization Need

“…Records of reported deaths in the US revealed five deaths due to meningitis/meningococcal disease, three of them were among passengers [11].…”

“…The International Medical Guide for Ships (IMGS) recommends immunization of susceptible crew members after diagnosis of the first case of varicella on board a ship, as a measure to prevent an outbreak, but not as a routine precautionary measure. In the US, varicella is the most frequent VPDs reported on ships and one death of varicella pneumonia was reported in 2015 [11,25]. As a regular pre-employment condition, IMGS requires immunization for diphtheria and tetanus for every seagoing person, while for hepatitis A and hepatitis B for any crew member assigned to medical care duties [47].…”

“…Outbreaks of norovirus and influenza, as well as food and waterborne disease, are well documented [7,8,9,10]. In recent years, outbreaks of diseases, which could be prevented by routine vaccines (e.g., measles, rubella, and varicella) have also been reported on ships [11,12]. This is not surprising as both crew and passengers originate from diverse countries with variable vaccine schedules and coverage.…”

Maritime varicella illness and death reporting, U.S., 2010–2015

“…The Centers for Disease Control and Prevention’s (CDC) Division of Global Migration and Quarantine (DGMQ) has jurisdiction over measures to prevent the entry and spread of communicable diseases that arrive through U.S. ports of entry. Ships arriving at a U.S. port of entry are required to report any shipboard deaths, suspected or confirmed cases of quarantinable diseases, and illness signs and symptoms of public health interest (e.g., fever with skin rash) among passengers or crews to the DGMQ Quarantine Station at or nearest the U.S. port of arrival [1–3].…”

“…Varicella, commonly known as chickenpox, is one of the most commonly reported communicable diseases on maritime vessels, comprising 35% of maritime illness reports submitted to DGMQ from 2010 to 2014 [3–5]. Varicella is caused by the varicella-zoster virus (VZV) and is characterized by a generalized, pruritic maculopapular vesicular rash that lasts up to a week.…”