Public Health Responses to COVID-19 Outbreaks on Cruise Ships — Worldwide, February–March 2020

• DOI: 10.15585/mmwr.mm6912e3
• Publication Date: 2020-03-23T15:47:43Z
• Authors: Leah F. Moriarty; Mateusz M. Plucinski; Barbara J. Marston; Ekaterina V. Kurb...; Barbara Knust; Erin L. Murray; Nicki Pesik; Dale Rose; David Fitter; Miwako Kobayashi; Mitsuru Toda; Paul T. Canty; Tara Scheuer; Eric S. Halsey; Nicole J. Cohen; Lauren Stockman; Debra A. Wadford; Alexandra M. Medley; Gary Green; Joanna J. Regan; Kara Tardivel; Stefanie White; Clive Brown; Christina Morales; Cynthia Yen; Beth Wittry; Amy Freeland; Sara Naramore; Ryan T. Novak; David Daigle; Michelle Weinberg; Anna Acosta; Carolyn Herzig; Bryan K Kapella; Kathleen R. Jacobson; Katherine Lamba; Atsuyoshi Ishizumi; John Sarisky; Erik Svendsen; Tricia Blocher; Christine Wu; Julia Charles; Riley Wagner; Andrea Stewart; Paul S. Mead; Elizabeth Kurylo; Stefanie Campbell; Rachel Murray; Paul Weidle; Martin Cetron; Cindy R. Friedman; ; ; ; ; Casey Barton Behr...; Adam Bjork; William Bower; Catherine Bozio; Zachary Braden; Mary Catherine Be...; Kevin Chatham-Ste...; Victoria Chu; Barbara Cooper; Kathleen Dooling; Christine Dubray; Emily Curren; Margaret A. Honein; Kathryn Ivey; Jefferson Jones; Melissa Kadzik; Nancy Knight; Mariel Marlow; Audrey McColloch; Robert McDonald; Andrew Klevos; Sarah Poser; Robin A. Rinker; Troy Ritter; Luis Rodriguez; Matthew Ryan; Zachary Schneider; Caitlin Shockey; Jill Shugart; Margaret Silver; Paul W. Smith; Farrell Tobolowsky; Aimee Treffiletti; Megan Wallace; Jonathan Yoder; ; Pennan Barry; Ricardo Berumen; Brooke Bregman; Kevin Campos; Shua Chai; Rosie Glenn-Finer; Hugo Guevara; Jill Hacker; Kristina Hsieh; Mary Kate Morris; Ryan Murphy; Jennifer F. Myers; Tasha Padilla; Chao-Yang Pan; Adam Readhead; Estela Saguar; Maria Salas; Robert E. Snyder; Duc Vugia; James Watt; Cindy Wong; ; Meileen Acosta; Shai Davis; Beatrix Kapuszinsky; Bela Matyas; Glen Miller; Asundep Ntui; Jayleen Richards
• Keywords: Adult; Male; SARS-CoV-2; Pneumonia, Viral; COVID-19; Middle Aged; Global Health; United States; Disease Outbreaks; 3. Good health; Betacoronavirus; 03 medical and health sciences; 0302 clinical medicine; Risk Factors; Public Health Practice; Humans; Female; Full Report; Coronavirus Infections; Travel-Related Illness; Ships; Aged

An estimated 30 million passengers are transported on 272 cruise ships worldwide each year* (1). Cruise ships bring diverse populations into proximity for many days, facilitating transmission of respiratory illness (2). SARS-CoV-2, the virus that causes coronavirus disease (COVID-19) was first identified in Wuhan, China, in December 2019 and has since spread worldwide to at least 187 countries and territories. Widespread COVID-19 transmission on cruise ships has been reported as well (3). Passengers on certain cruise ship voyages might be aged ≥65 years, which places them at greater risk for severe consequences of SARS-CoV-2 infection (4). During February-March 2020, COVID-19 outbreaks associated with three cruise ship voyages have caused more than 800 laboratory-confirmed cases among passengers and crew, including 10 deaths. Transmission occurred across multiple voyages of several ships. This report describes public health responses to COVID-19 outbreaks on these ships. COVID-19 on cruise ships poses a risk for rapid spread of disease, causing outbreaks in a vulnerable population, and aggressive efforts are required to contain spread. All persons should defer all cruise travel worldwide during the COVID-19 pandemic.