Abstract
An outbreak of coronavirus disease (COVID-19) occurred on the Diamond Princess cruise ship making an international journey, which led to quarantine of the ship at Yokohama Port, Japan. A suspected COVID-19 case was defined as a passenger or crew member who developed a fever or respiratory symptoms, and a confirmed COVID-19 case had laboratory-confirmation of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Between 3 and 9 February 2020, 490 individuals were tested for SARS-CoV-2 and 172 were positive (152 passengers (median age: 70 years; interquartile range (IQR): 64–75; males: 45%) and 20 crew (median age: 40 years; IQR: 35–48.5; males: 80%). Other than the Hong Kong-related index case, symptom onset for the earliest confirmed case was 22 January, 2 days after the cruise ship left port. Attack rates among passengers were similar across the decks, while beverage (3.3%, 2/61) and food service staff (5.7%, 14/245) were most affected. Attack rates tended to increase with age. A comprehensive outbreak response was implemented, including surveillance, provision of essential medical care, food and medicine delivery, isolation, infection prevention and control, sampling and disembarkation.
Highlights
On 7 January 2020, Chinese health officials announced detection of a case with novel coronavirus disease (COVID-19) in Wuhan, China [1,2]
We believe that the findings from our experience are useful to respond to a similar COVID-19 event in an international cruise ship such as that quarantined at California in March 2020 [14] or Nagasaki in April 2020 [15]
The outbreak of COVID-19 had already been reported in Wuhan by mid-January, and so it was possible that more than one COVID-19 case might have been on board the cruise ship
Summary
On 7 January 2020, Chinese health officials announced detection of a case with novel coronavirus disease (COVID-19) in Wuhan, China [1,2]. As the outbreak expanded in Wuhan, there was spillover of COVID-19 cases outside the country. The first COVID-19 cases outside of China were reported in Thailand on 13 January [3]. All World Health Organization (WHO) Regions have domestic cases and the number of cases has been increasing in many countries in Europe and the Americas [4]. Japan detected its first COVID-19 case on 14 January 2020, a Japanese resident who travelled to Wuhan for winter vacation and returned to Japan for work [5]. There were subsequent reports of new cases in Japan both with and without travel history to Wuhan [6]
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