Abstract
A measles outbreak occurred in February 2014 on a ship cruising the western Mediterranean Sea. Overall 27 cases were reported: 21 crew members, four passengers.For two cases the status crew or passenger was unknown. Genotype B3 was identified. Because of different nationalities of cases and persons on board,the event qualified as a cross-border health threat. The Italian Ministry of Health coordinated rapid response.Alerts were posted through the Early Warning and Response System.
Highlights
A measles outbreak occurred in February 2014 on a ship cruising the western Mediterranean Sea
After being informed of the outbreak, the Ministry of Health (MoH) immediately alerted all regional health authorities in Italy by email to ensure timely reporting of measles cases, to request that information about recent travel on the involved cruise ship be collected from all reported cases and that biological samples be sent for genotyping to the national reference laboratory at the Istituto Superiore di Sanità (ISS) in Rome
In the outbreak investigation we used a case definition based on the European Union (EU) 2012 case definition [2] for classification of measles cases: clinical criteria were restricted to fever and rash and an epidemiologic link was defined as having been aboard the cruise ship after 1 January 2014 or having been in contact with a case linked to the cruise ship outbreak
Summary
27 measles cases were identified: 24 through the Italian surveillance system (21 crew members, four passengers, two cases not specified whether crew or passenger); two cases were reported directly to the Italian MoH (both passengers) and one case (a passenger) was reported by the Austrian Ministry of Health via the EU’s Early Warning and Response System (EWRS). On 27 February, 968 crew members aged 26-36 years (median: 30) were on board, 153 (16%) were women. They originated from four continents: the majority were from Asia (688; 71%) and Europe (206; 21%), 68 (7%) came from South America and the Caribbean and 5. A request for immediate support to the public health offices on shore followed when they realised that isolation of suspected cases and their contacts could not be managed on board. Symptomatic passengers and their close contacts were disembarked and either hospitalised or put in isolation to prevent further transmission. Nine crew members were hospitalised at the INMI Spallanzani and 56 were quarantined in Figure 2 Flowchart of case management for symptomatic crew members and their close contacts, measles outbreak on cruise ship, Italy, 27 February–1 March 2014
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