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The Healthy Crew, Clean Vessel, and Set Departure Date Triad: Successful Control of Outbreaks of COVID-19 On Board Four Cargo Vessels

Published online by Cambridge University Press:  09 July 2021

Tudor A. Codreanu*
Affiliation:
State Health Incident Coordination Centre, Department of Health Western Australia, Perth, Western Australia, Australia Disaster Preparedness and Management Unit, Divisional Commander, Complex Medical Deployments, Australian Medical Assistance Team – Western Australia, Australia
Nevada Pingault
Affiliation:
Public Health Emergency Operations Centre, Department of Health Western Australia, Perth, Western Australia, Australia COVID-Net, Australian Government Department of Health, Perth, Western Australia, Australia
Edmond O’Loughlin
Affiliation:
School of Medicine, University of Western Australia, Perth, Western Australia, Australia
Paul K. Armstrong
Affiliation:
Public Health Emergency Operations Centre, Department of Health Western Australia, Perth, Western Australia, Australia
Benjamin Scalley
Affiliation:
Public Health Emergency Operations Centre, Department of Health Western Australia, Perth, Western Australia, Australia
*
Correspondence: Tudor A. Codreanu, PhD State Health Incident Coordination Centre Department of Health 189 Royal Street, 6000 PerthWestern Australia, Australia E-mail: Tudor.Codreanu@health.wa.gov.au

Abstract

Background:

A variety of infectious diseases can cause outbreaks on board vessels, with both health and economic effects. Internationally, Coronavirus Disease 2019 (COVID-19) outbreaks have occurred on numerous cruise and cargo vessels and the containment measures, travel restrictions, and border closures continue to make it increasingly difficult for ship operators world-wide to be granted pratique, effect crew changes, and conduct trade. An effective outbreak management strategy is essential to achieve the outcome triad – healthy crew, clean vessel, and set departure date – while maintaining the safety of the on-shore workers and broader community and minimizing disruption to trade. This report describes the principles of COVID-19 outbreak responses on four cargo vessels, including the successful use of one vessel as a quarantine facility.

Methods:

Established principles of management and the experiences of COVID-19 outbreaks on cruise ships elsewhere informed a health-lead, multi-agency, strict 14-day quarantine (Q) regime based on: population density reduction on board; crew segregation; vessel cleaning and sanitation; infection risk zones, access, and control measures; health monitoring; case identification and management; food preparation and delivery; waste management control; communication; and welfare and security.

Findings:

Sixty-five crew were diagnosed with Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) infection (range 2-25; attack rate 10%-81%; 15 asymptomatic). No deaths were recorded, and only one crew was hospitalized for COVID-19-related symptoms but did not require intensive care support. Catering crew were among the cases on three vessels. All non-essential crew (n-EC) and most of the cases were disembarked. During the vessel’s Q period, no further cases were diagnosed on board, and no crew became symptomatic after completion of Q. The outbreak response duration was 15-17 days from initial decision.

No serious health issues were reported, no response staff became infected, and only two Q protocol breaches occurred among crew.

Interpretation:

Despite increasing risk of outbreaks on cargo vessels, maritime trade and crew exchanges must continue. The potential consequences of COVID-19 outbreaks to human life and to trade necessitate a balanced response. The principles described can offer health, financial, operational, and safety advantages.

Type
Special Report
Copyright
© The Author(s), 2021. Published by Cambridge University Press on behalf of the World Association for Disaster and Emergency Medicine

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References

McCarter, Y. Infectious disease outbreaks on cruise ships. Clin Microbiol Newsl. 2009;31(21):161168.CrossRefGoogle Scholar
World Health Organization. Promoting Public Health Measures in Response to COVID-19 on Cargo Ships and Fishing Vessels. Geneva, Switzerland: WHO; 2020.Google Scholar
Kak, V. Infections on cruise ships. Microbiol Spectrum. 2015;3(4):IOL50007.10.1128/microbiolspec.IOL5-0007-2015CrossRefGoogle ScholarPubMed
Zhang, N, Miao, R, Huang, H, Chan, EYY. Contact infection of infectious disease on-board a cruise ship. Sci Rep. 2016;6(1):38790.CrossRefGoogle Scholar
Bert, F, Scaioli, G, Gualano, MR, et al. Norovirus outbreaks on commercial cruise ships: a systematic review and new targets for the Public Health agenda. Food Environ Virol. 2014;6(2):6774.CrossRefGoogle ScholarPubMed
Gonzaga, VE, Ramos, M, Maves, RC, Freeman, R, Montgomery, JM. Concurrent outbreak of norovirus genotype I and enterotoxigenic Escherichia coli on a US Navy ship following a visit to Lima, Peru. PLoS One. 2011;6(6):e20822.CrossRefGoogle ScholarPubMed
Philip, CC, Lou Ann, BM, Jeffrey, KG. Cruise ship environmental hygiene and the risk of norovirus infection outbreaks: an objective assessment of 56 vessels over 3 years. Clin Infect Dis. 2009;49(9):13121317.Google Scholar
Chimonas, MA, Vaughan, GF, Andre, Z, et al. Passenger behaviors associated with norovirus infection on board a cruise ship - Alaska, May to June 2004. J Travel Med. 2008;15(3):177183.CrossRefGoogle Scholar
Verhoef, L, Depoortere, E, Boxman, I, et al. Emergence of new norovirus variants on spring cruise ships and prediction of winter epidemics. Emerg Infect Dis. 2008;14(2):238243.CrossRefGoogle ScholarPubMed
Isakbaeva, ET, Widdowson, MA, Beard, RS, et al. Norovirus transmission on cruise ship. Emerg Infect Dis. 2005;11(1):154158.CrossRefGoogle ScholarPubMed
Rooney, RM, Cramer, EH, Mantha, S, et al. A review of outbreaks of foodborne disease associated with passenger ships: evidence for risk management. Public Health Rep. 2004;119(4):427434.CrossRefGoogle ScholarPubMed
Widdowson, MA, Cramer Elaine, H, Hadley, L, et al. Outbreaks of acute gastroenteritis on cruise ships and on land: identification of a predominant circulating strain of norovirus - United States, 2002. J Infect Dis. 2004;190(1):2736.CrossRefGoogle ScholarPubMed
Tibor, F, Scott, AT, Nouansy, W, Weiming, Z, Mekibib, A, Xi, J. Homologous versus heterologous immune responses to Norwalk-like viruses among crew members after acute gastroenteritis outbreaks on two US Navy vessels. J Infect Dis. 2003;187(2):187193.Google Scholar
Dancer, SJ. Controlling hospital-acquired infection: focus on the role of the environment and new technologies for decontamination. (1098-6618 [Electronic]).Google Scholar
Marshall, CA, Morris, E, Unwin, N. An epidemiological study of rates of illness in passengers and crew at a busy Caribbean cruise port. BMC Public Health. 2016;16(1):314316.CrossRefGoogle Scholar
Millman, AJ, Kornylo Duong, K, Lafond, K, Green, NM, Lippold, SA, Jhung, MA. Influenza outbreaks among passengers and crew on two cruise ships: a recent account of preparedness and response to an ever-present challenge. J Travel Med. 2015;22(5):306311.CrossRefGoogle Scholar
Adam, JK, Varan, AK, Kao, AS, McDonald, EC, Waterman, SH. Fatal influenza outbreak aboard a sport fishing vessel in San Diego, California. Travel Med Infect Dis. 2014;13(1):102103.CrossRefGoogle ScholarPubMed
Khaokham, CB, Selent, M, Loustalot, FV, et al. Seroepidemiologic investigation of an outbreak of pandemic influenza A H1N1 2009 aboard a US Navy vessel - San Diego, 2009. Influenza Other Respir Viruses. 2013;7(5):791798.CrossRefGoogle Scholar
Tarabbo, M, Lapa, D, Castilletti, C, et al. Retrospective investigation of an influenza A/H1N1pdm outbreak in an Italian military ship cruising in the Mediterranean Sea, May-September 2009. PLoS One. 2011;6(1):e15933.CrossRefGoogle Scholar
Ward, KA, Armstrong, P, McAnulty, JM, Iwasenko, JM, Dwyer, DE. Outbreaks of pandemic (H1N1) 2009 and seasonal influenza A (H3N2) on cruise ship. Emerg Infect Dis. 2010;16(11):17311737.CrossRefGoogle ScholarPubMed
Brotherton, JML, Delpech, VC, Gilbert, GL, et al. A large outbreak of influenza A and B on a cruise ship causing widespread morbidity. Epidemiol Infect. 2003;130(2):263271.CrossRefGoogle Scholar
Mouchtouri, VA, Rudge, JW. Legionnaires’ disease in hotels and passenger ships: a systematic review of evidence, sources, and contributing factors. (1708-8305 [Electronic]).Google Scholar
Managing water quality on board passenger vessels to ensure passenger and crew safety. Perspect Public Health. 2019;139(2):7074.CrossRefGoogle Scholar
Minooee, A, Rickman, LS. Infectious diseases on cruise ships. Clin Infect Dis. 1999;29(4):737744.CrossRefGoogle ScholarPubMed
Lanini, S, Capobianchi, MR, Puro, V, et al. Measles outbreak on a cruise ship in the western Mediterranean, February 2014, preliminary report. Euro Surveill. 2014;19(10):20735.CrossRefGoogle ScholarPubMed
Pilbara Port Authority. Port of Port Hedland: Pilbara Port Authority; 2020. https://www.pilbaraports.com.au/ports/port-of-port-hedland. Accessed January 2021.Google Scholar
Schlaich, CC, Oldenburg, M, Maike, M, Lamshöft, MM. Estimating the risk of communicable diseases aboard cargo ships. J Travel Med. 2009;16(6):402406.CrossRefGoogle ScholarPubMed
Miller, JM, Tam, TW, Maloney, S, et al. Cruise ships: high-risk passengers and the global spread of new influenza viruses. Clin Infect Dis. 2000;31(2):433438.CrossRefGoogle ScholarPubMed
Jerome, C, Howard, LA, Uzel, E, Androulidakis, JR. Rapid first-stage tests of on-ship infection. WMU J Marit Affairs. 2017;16(1):8998.CrossRefGoogle Scholar
World Health Organization. Guide to Ship Sanitation: Global Reference on Health Requirements for Ship Construction and Operation. Geneva, Switzerland: WHO; 2011.Google Scholar
World Health Organization. Guidelines for Drinking-Water Quality. Geneva, Switzerland: WHO; 2017.Google Scholar
World Health Organization. Handbook for Inspection of Ships and Issuance of Ship Sanitation Certificates. Geneva, Switzerland: WHO; 2011.Google Scholar
World Health Organization. Handbook for Management of Public Health Events On Board Ships. Geneva, Switzerland: WHO; 2016.Google Scholar
World Health Organization. International Health Regulations. Geneva, Switzerland: WHO; 2005.Google Scholar
EU SHIPSAN Act Joint Action. European Manual for Hygiene Standards and Communicable Disease Surveillance on Passenger Ships. Larissa, Greece: European Commission Directorate General for Health and Food Safety; 2016.Google Scholar
UK Government. The Public Health (Ships) Regulations 1979. London, England: Public Health, England and Wales; 1979.Google Scholar
UK Government. The Public Health (Ships) (Amendment) (England) Regulations 2007. London, England: Public Health England; 2007.Google Scholar
Scottish Government. The Public Health (Ships) (Scotland) Amendment Regulations 2007. Edinburgh, Scotland: Public Health Scotland; 2007.Google Scholar
Mallapati, S. What the cruise-ship outbreaks reveal about COVID-19. Nature. 2020;580(18).CrossRefGoogle Scholar
Mizumoto, K, Chowell, G. Transmission potential of the novel coronavirus (COVID-19) on-board the Diamond Princess cruise ship. Infect Dis Model. 2020;5:264270.Google Scholar
Moriarty, L, Plucinski, MM, Marston, BJ, et al. Public Health responses to COVID-19 outbreaks on cruise ships. MMWR Morb Mortal Wkly Rep. 2020;69(12):347352.CrossRefGoogle ScholarPubMed
World Health Organization. WHO Announces COVID-19 Outbreak a Pandemic. Geneva, Switzerland: WHO; 2020.Google Scholar
World Health Organization. Operational Considerations for Managing COVID-19 Cases/Outbreak On Board Ships. Geneva, Switzerland: WHO; 2020.Google Scholar
McLeod, MA, Baker, M, Wilson, N, Kelly, H, Kiedrzynski, T, Kool, JL. Protective effect of maritime quarantine in South Pacific jurisdictions, 1918-19 influenza pandemic. Emerg Infect Dis. 2008;14(3):468470.CrossRefGoogle ScholarPubMed
Rocklöv, J, Sjödin, H, Wilder-Smith, A. COVID-19 outbreak on the Diamond Princess cruise ship: estimating the epidemic potential and effectiveness of public health countermeasures. J Travel Med. 2020;27(3).CrossRefGoogle Scholar
Japanese National Institute of Infectious Disease. Field Brief: Diamond Princess COVID-19 Cases, 20 Feb Update. Tokyo, Japan: NIID; 2020.Google Scholar
Sehdev, PS. The origin of quarantine. Clin Infect Dis. 2002;35(9):10711072.CrossRefGoogle ScholarPubMed
Takeuchi, I. COVID-19 first stage in Japan: how we treat ‘Diamond Princess Cruise Ship’ with 3700 passengers? Acute Med Surg. 2020;7(1):e506.CrossRefGoogle ScholarPubMed
Tabata, S, Imai, K, Kawano, S, et al. Clinical characteristics of COVID-19 in 104 people with SARS-CoV-2 infection on the Diamond Princess cruise ship: a retrospective analysis. Lancet Infect Dis. 2020;20(9):10431050.CrossRefGoogle ScholarPubMed
Nakazawa, E, Ino, H, Akabayashi, A. Chronology of COVID-19 cases on the Diamond Princess cruise ship and ethical considerations: a report from Japan. Disaster Med Public Health Prep. 2020;14(4):506513.CrossRefGoogle ScholarPubMed
Mizumoto, K, Kagaya, K, Zarebski, A, Chowell, G. Estimating the asymptomatic proportion of coronavirus disease 2019 (COVID-19) cases on board the Diamond Princess cruise ship, Yokohama, Japan, 2020. Euro Surveill. 2020;25(10).CrossRefGoogle Scholar
Hirotsu, Y, Maejima, M, Nakajima, M, Mochizuki, H, Omata, M. Environmental cleaning is effective for the eradication of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in contaminated hospital rooms: a patient from the Diamond Princess cruise ship. Infect Control Hosp Epidemiol. 2020;41(9):11051106.CrossRefGoogle ScholarPubMed
Kakimoto, K, Kamiya, H, Yamagishi, T, Matsui, T, Suzuki, M, Wakita, T. Initial investigation of transmission of COVID-19 among crew members during quarantine of a cruise ship - Yokohama, Japan, February 2020. MMWR Morb Mortal Wkly Rep. 2020;20(11):312313.CrossRefGoogle Scholar
Dahl, E. Coronavirus (COVID-19) outbreak on the cruise ship Diamond Princess. Int Marit Health. 2020;71(1):58.CrossRefGoogle ScholarPubMed
US Centers for Disease Control and Prevention. Coronavirus Disease 2019. Atlanta, Georgia USA: US Centers for Disease Control and Prevention (CDC); 2020.Google Scholar
Australian Government Department of Agriculture, Water and Environment. Pratique. Canberra, Australia: Department of Agriculture, Water and Environment (DAWE); 2020.Google Scholar
International Maritime Organization. 400,000 Seafarers Stuck at Sea as Crew Change Crisis Deepens. London, England: International Maritime Organization (IMO); 2020.Google Scholar
International Labour Organization. End the Plight of Stranded Seafarers. Geneva, Switzerland: International Labour Organization (ILO); 2020.Google Scholar
Government of Western Australia Department of Health. Australian Medical Assistance Team WA (AUSMAT WA). Perth, Western Australia: Government of Western Australia Department of Health; 2020.Google Scholar
International Maritime Organization. Principles of Minimum Safe Manning. London, England: International Maritime Organization (IMO); 2011.Google Scholar
Australian Maritime Safety Authority. Definition of Safe Manning. Braddon, Australian Capital Territory: Australian Maritime Safety Authority (AMSA); 2020.Google Scholar
Lee-Archer, P, von Ungern-Sternberg, BS. Pediatric anesthetic implications of COVID-19: a review of current literature. Paediatr Anaesth. 2020;30(6):136141.CrossRefGoogle ScholarPubMed
van Doremalen, N, Bushmaker, T, Morris, DH, et al. Aerosol and surface stability of SARS-CoV-2 as compared with SARS-CoV-1. NJEM. 2020;382(16):15641567.CrossRefGoogle ScholarPubMed
Australian Government Department of Health. Public Summary: Diversey Australia Pty Ltd - Oxivir FIVE16 - Disinfectant, Hospital Grade. Canberra, Australia: Australian Government Department of Health; 2017.Google Scholar
Australian Government Department of Health. Coronavirus Disease (COVID-19): Environmental Cleaning and Disinfection Principles for COVID-19. Canberra, Australia: Australian Government Department of Health; 2020.Google Scholar
Communicable Diseases Network Australia. Coronavirus Disease 2019 (COVID-19). Canberra, Australia: Communicable Diseases Network Australia (CDNA); 2020.Google Scholar
National Association of Testing Authorities. About NATA. Sydney, Australia: National Association of Testing Authorities (NATA), Australia; 2020.Google Scholar
National Oceanic and Atmospheric Administration. What is Seaspeak? Washington, DC USA: National Oceanic and Atmospheric Administration (NOAA); 2020.Google Scholar
International Maritime Organization. International Convention for the Safety of Life at Sea (SOLAS), 1974, as amended. Paris, France: International Maritime Organization (IMO); 1974.Google Scholar
Codreanu, TA, Ngeh, S, Trewin, A, Armstrong, PK. Successful control of an onboard COVID-19 outbreak using the cruise ship as a quarantine facility, Western Australia, Australia. Emerg Infect Dis. 2021;27(5):12791287.CrossRefGoogle ScholarPubMed
Centers for Disease Control and Prevention. Laundry and Bedding: Guidelines for Environmental Infection Control in Health Care Facilities. Atlanta, Georgia USA: Centers for Disease Control and Prevention (CDC); 2015.Google Scholar
Hedley, K. WA Premier blindsided by news sick passengers still on cruise ship refusing to leave Freo. WA Today. Perth, Western Australia: Nine Publishing; 2020. https://www.watoday.com.au/national/western-australia/wa-premier-blindsided-by-news-sick-passengers-still-on-cruise-ship-refusing-to-leave-freo-20200401-p54g2k.html. Accessed November 2020.Google Scholar
9News. Coronavirus: WA’s Port Hedland COVID-19 cluster grows. Perth, Western Australia; 2020. https://www.9news.com.au/videos/health/coronavirus-w-as-port-hedland-covid-19-cluster-grows/ckfmcbhb200230gs7d1svupku. Accessed November 2020.Google Scholar
Laschon, E, Gubana, B, Carmody, J. Coronavirus outbreak on live export ship Al Kuwait docked in Fremantle as six test positive for COVID-19. ABC News; 2020. https://www.abc.net.au/news/2020-05-26/coronavirus-outbreak-on-live-export-ship-al-kuwait-in-fremantle/12287006. Accessed November 2020.Google Scholar
Ramsey, M. Government maps COVID-stricken Al Messilah’s exit from Fremantle. Perth Now; 2020 https://www.perthnow.com.au/news/coronavirus/coronavirus-crisis-wa-government-maps-covid-stricken-al-messilahs-exit-from-fremantle-ng-b881700164z. Accessed November 2020.Google Scholar
Law, P. Coronavirus: Crew on Key Integrity in Geraldton and Al Messilah ships in Fremantle infected with COVID-19. The West Australian; 2020. https://thewest.com.au/news/coronavirus/coronavirus-crew-on-key-integrity-in-geraldton-and-al-messilah-ships-in-fremantle-infected-with-covid-19-ng-b881696059z. Accessed November 2020.Google Scholar
Tardivel, K, White, SB, Duong, KK. Travel by Air, Land & Sea: Cruise Ship Travel. Yellow Book. Atlanta, Georgia USA: Centers for Disease Control and Prevention (CDC); 2019.Google Scholar
Hu, Y, Sun, J, Dai, Z, et al. Prevalence and severity of corona virus disease 2019 (COVID-19): a systematic review and meta-analysis. J Clin Virol. 2020;127:104371.CrossRefGoogle ScholarPubMed
Regli, A, von Ungern-Sternberg, BS. Fit testing of N95 or P2 masks to protect health care workers. Medical Journal Australia. 2020;213(7):293295.CrossRefGoogle ScholarPubMed
Boyce, JM. Modern technologies for improving cleaning and disinfection of environmental surfaces in hospitals. Antimicrob Resist Infect Control. 2016;5(1):10.CrossRefGoogle ScholarPubMed
Rutala, WA, Weber, DJ. Disinfectants used for environmental disinfection and new room decontamination technology. (1527-3296 [Electronic]).Google Scholar
Triandis, CH. Interpersonal Behaviour. Monterey, California USA: Brooks Cole; 1977.Google Scholar
Karadeli, AS. The Challenges of Covid-19 Quarantine. Hamburg, Germany: European Security and Defence; 2020.Google Scholar
Higgins, J, Deeks, J, DG. A. “Special Topics in Statistics: Confidence Intervals When No Events Are Observed.” In: Higgins J, Green S, (eds). Cochrane Handbook for Systematic Reviews of Interventions Ver 5.1.0. London, England: Cochrane Statistical Methods Group; 2011.Google Scholar