Passenger behaviors associated with norovirus infection on board a cruise ship - Alaska, May to June 2004
Passenger behaviors associated with norovirus infection on board a cruise ship - Alaska, May to June 2004
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DOI：
10.1111/j.1708-8305.2008.00200.x
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发表时间：
2008-05-01
影响因子：
25.7
通讯作者：
Cramer, Elaine
中科院分区：
文献类型：
--
作者：
Chimonas, Marc-Andre R.;Vaughan, George H.;Cramer, Elaine
背景资料。2004年5月，船舶卫生计划(VSP)调查了在阿拉斯加水域航行的一艘游轮上爆发的诺沃克病毒胃肠炎。目的是找出常见的食物来源，并探索乘客人际传播的行为危险因素。一个病例被定义为24小时内三次或三次以上大便松弛，或两次或两次以下大便松弛并伴有一次或多次呕吐。用逆转录聚合酶链式反应检测受影响乘客的呕吐物和粪便样本中的诺沃克病毒。环境卫生官员根据VSP方案进行了环境调查。关于食物消费和行为危险因素的问卷放在机舱邮箱中(n=2018)。采用多变量Logistic回归的病例对照研究设计，检验危险因素与疾病之间的关系。共有359名乘客(24.1%的受访者)符合病例定义。7份临床标本中有4份诺沃克病毒检测呈阳性。没有发现环境卫生实践中的重大缺陷，也没有发现膳食供应与疾病有关。有患腹泻或呕吐的机友[优势比(OR)：3.40；95%可信区间(CI)=1.80~6.44]和使用被呕吐物污染的女厕所(OR：5.13；95%CI=1.40~18.78)与疾病有关。饭前洗手对疾病有保护作用(OR：0.25；95%CI=0.12~0.54)。即使采取了适当的环境卫生措施，诺沃克病毒在人与人之间的广泛爆发也可能发生在游轮上。预防和控制游轮上诺沃克病毒爆发的计划应该包括阻断人与人之间传播的战略，并强调洗手。
Background. During May 2004, the Vessel Sanitation Program (VSP) investigated an outbreak of norovirus gastroenteritis on board a cruise ship sailing in Alaska waters. The objectives were to identify a common food item source and explore behavioral risk factors for person-to-person transmission among passengers.Methods. A case was defined as three or more episodes of loose stools within 24 hours or two or fewer episodes of loose stools accompanied by one or more episodes of vomiting. Vomitus and stool samples from affected passengers were tested for norovirus by reverse transcriptase-polymerase chain reaction. Environmental health officers performed an environmental investigation following VSP protocol. Questionnaires about food items consumed and behavioral risk factors were placed in cabin mailboxes (n = 2,018). A case-control study design using multivariable logistic regression tested associations between risk factors and disease.Results. A total of 359 passengers (24.1% of respondents) met the case definition. Four of seven clinical specimens tested positive for norovirus. No significant deficiencies in environmental health practices were identified, and no meal servings were associated with disease. Having a cabin mate sick with diarrhea or vomiting [odds ratio (OR): 3.40; 95% confidence interval (CI) = 1.80-6.44] and using a specific women's toilet that was contaminated with vomit (OR: 5.13; 95% CI = 1.40-18.78) were associated with disease. Washing hands before meals was protective (OR: 0.25; 95% CI = 0.12-0.54) against disease.Conclusions. Widespread person-to-person norovirus outbreaks can occur on board cruise ships, even with appropriate environmental health practices. Programs to prevent and control norovirus outbreaks on board cruise ships should involve strategies that disrupt person-to-person spread and emphasize hand washing.