Systematic Review on Outbreaks of SARS-CoV-2 on Cruise, Navy and Cargo Ships

Abstract

The confined environment of a ship promotes the transmission of the severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) due to close contact among the population on board. The study aims to provide an overview of outbreaks of SARS-CoV-2 on board of cruise, navy or cargo ships, to identify relevant outbreak management techniques, related problems and to derive recommendations for prevention. Four databases were searched. The study selection included reports about seroprevalences or clinically/laboratory confirmed infections of SARS-CoV-2 on board ships between the first of January, 2020 and the end of July, 2020. A total of 37 studies were included of whom 33 reported outbreaks of SARS-CoV-2 on cruise ships (27 studies referred to the Diamond Princess). Two studies considered outbreaks on the Grand Princess, three studies informed about Nile River cruises and one study about the MS Westerdam (mention of multiple outbreaks possible in one study). Additionally, three studies reported outbreaks of SARS-CoV-2 on navy vessels and one study referred to a cargo ship. Problems in handling outbreaks resulted from a high number of asymptomatic infections, transportation issues, challenges in communication or limited access to health care. Responsible operators need to implement infection control measures which should be described in outbreak management plans for ships to prevent transmission risks, including, e.g., education, testing strategies, communication lines, social distancing and hygiene regulations.

A review of COVID-19 transmission dynamics and clinical outcomes on cruise ships worldwide, January to October 2020

“…However, the news citations included in our search were the top results from the Google News search engine, and therefore some cases or reports could have been missed. Reassuringly, a meta-analysis of the scholarly literature by Kordsmeyer et al, which examined four databases over a shorter duration (January–July 2020) was roughly in line with the observations of our search [ 11 ]. In this study, a total of 37 studies were included, of which 33 reported outbreaks of SARS-CoV-2 on cruise ships (27 of these studies referred to the Diamond Princess).…”

“…Previous systematic reviews of the transmission of SARS-CoV-2 and response to COVID-19 outbreaks on cruise ships have been limited to searches of the scholarly literature and, therefore, reported only on a limited number of outbreaks covered in the scientific literature [ 11 ]. Understanding the dynamics of outbreaks on cruise ships and evaluating the non-pharmaceutical interventions that have been successfully or unsuccessfully employed on these ships can inform future prevention research and policies, as well as benefit planning for future outbreaks with similar transmission patterns.…”

Outbreak of SARS-CoV-2 Delta variant on a single liquified natural gas (LNG) vessel, with estimates of vaccine effectiveness

“…Outbreaks of SARS-CoV-2 on various types of ships (cargo, navy, cruise ships) and crew numbers (< 50 in cargo ships to > 1000 in cruise ships) have variable attack rates and mortality even in younger populations. 10 An outbreak with the first strain of SARS-CoV- Although the AR of SARS-CoV-2 Delta strain was high among the vaccinated population aboard the vessel (54%), it was much higher (90%) in the unvaccinated population aboard the South Korean Navy ship. 14 With heightened public health measures and infection control practices, we were able to declare the outbreak over in 26 days.…”

A Historical Review of Military Medical Strategies for Fighting Infectious Diseases: From Battlefields to Global Health

“…Out of these 1331 (27.85%) confirmed and suspected COVID-19 infected subjects, 23 (1.73%) have been hospitalized, 4 (0.3%) needed intensive care, and one died [ 229 ]. Diamond Princess is a cruise ship that started a cruise on 20 January 2020 with approximately 3700 passengers and crew members, during which an outbreak of 712 COVID-19 infected subjects occurred (19.24%, p < 0.0000001 vs. Theodore Roosevelt), with 36 (5%, p = 0.00003448 vs. Theodore Roosevelt) hospitalized, and 13 (1.83%, p = 0.00001793 vs. Theodore Roosevelt) deaths [ 230 ]. The significant difference in the attack rates, higher in the military ship, is probably related to the tighter available spaces for sleeping in the military ship, compared to the more comfortable cabins of the Diamond Princess, where social distancing and isolation are easier to reach, whereas the higher rates of hospitalization and death in the Diamond Princess is probably related to the military being young and in good health.…”