Skip to main content
NCBI home page
Public Health Reports logoLink to Public Health Reports
. 2004 Jul-Aug;119(4):427–434. doi: 10.1016/j.phr.2004.05.007

A review of outbreaks of foodborne disease associated with passenger ships: evidence for risk management.

Roisin M Rooney 1, Elaine H Cramer 1, Stacey Mantha 1, Gordon Nichols 1, Jamie K Bartram 1, Jeffrey M Farber 1, Peter K Benembarek 1
PMCID: PMC1497653  PMID: 15219800

Abstract

OBJECTIVE: Foodborne disease outbreaks on ships are of concern because of their potentially serious health consequences for passengers and crew and high costs to the industry. The authors conducted a review of outbreaks of foodborne diseases associated with passenger ships in the framework of a World Health Organization project on setting guidelines for ship sanitation. METHODS: The authors reviewed data on 50 outbreaks of foodborne disease associated with passenger ships. For each outbreak, data on pathogens/toxins, type of ship, factors contributing to outbreaks, mortality and morbidity, and food vehicles were collected. RESULTS: The findings of this review show that the majority of reported outbreaks were associated with cruise ships and that almost 10,000 people were affected. Salmonella spp were most frequently associated with outbreaks. Foodborne outbreaks due to enterotoxigenic E. coli spp, Shigella spp, noroviruses (formally called Norwalk-like viruses), Vibrio spp, Staphylococcus aureus, Clostridium perfringens, Cyclospora sp, and Trichinella sp also occurred on ships. Factors associated with the outbreaks reviewed include inadequate temperature control, infected food handlers, contaminated raw ingredients, cross-contamination, inadequate heat treatment, and onshore excursions. Seafood was the most common food vehicle implicated in outbreaks. CONCLUSIONS: Many ship-associated outbreaks could have been prevented if measures had been taken to ensure adequate temperature control, avoidance of cross-contamination, reliable food sources, adequate heat treatment, and exclusion of infected food handlers from work.

Full Text

The Full Text of this article is available as a PDF (119.1 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Addiss D. G., Yashuk J. C., Clapp D. E., Blake P. A. Outbreaks of diarrhoeal illness on passenger cruise ships, 1975-85. Epidemiol Infect. 1989 Aug;103(1):63–72. doi: 10.1017/s0950268800030363. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Berkelman R. L., Cohen M. L., Yashuk J., Barrett T., Wells J. G., Blake P. A. Traveler's diarrhea at sea: two multi-pathogen outbreaks caused by food eaten on shore visits. Am J Public Health. 1983 Jul;73(7):770–772. doi: 10.2105/ajph.73.7.770. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Bohnker B., McEwen G., Feeks E., Palombaro J. Explosive outbreak of gastroenteritis on an aircraft carrier: an infectious disease mass casualty situation. Aviat Space Environ Med. 1993 Jul;64(7):648–650. [PubMed] [Google Scholar]
  4. Boyce T. G., Mintz E. D., Greene K. D., Wells J. G., Hockin J. C., Morgan D., Tauxe R. V. Vibrio cholerae O139 Bengal infections among tourists to Southeast Asia: an intercontinental foodborne outbreak. J Infect Dis. 1995 Nov;172(5):1401–1404. doi: 10.1093/infdis/172.5.1401. [DOI] [PubMed] [Google Scholar]
  5. Centers for Disease Control and Prevention (CDC) Outbreaks of gastroenteritis associated with noroviruses on cruise ships--United States, 2002. MMWR Morb Mortal Wkly Rep. 2002 Dec 13;51(49):1112–1115. [PubMed] [Google Scholar]
  6. Corwin A. L., Soderquist R., Edwards M., White A., Beecham J., Mills P., Larasati R. P., Subekti D., Ansari T., Burans J. Shipboard impact of a probable Norwalk virus outbreak from coastal Japan. Am J Trop Med Hyg. 1999 Dec;61(6):898–903. doi: 10.4269/ajtmh.1999.61.898. [DOI] [PubMed] [Google Scholar]
  7. Dannenberg A. L., Yashuk J. C., Feldman R. A. Gastrointestinal illness on passenger cruise ships, 1975-1978. Am J Public Health. 1982 May;72(5):484–488. doi: 10.2105/ajph.72.5.484. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Gunn R. A., Terranova W. A., Greenberg H. B., Yashuk J., Gary G. W., Wells J. G., Taylor P. R., Feldman R. A. Norwalk virus gastroenteritis aboard a cruise ship: an outbreak on five consecutive cruises. Am J Epidemiol. 1980 Dec;112(6):820–827. doi: 10.1093/oxfordjournals.aje.a113054. [DOI] [PubMed] [Google Scholar]
  9. Herwaldt B. L., Lew J. F., Moe C. L., Lewis D. C., Humphrey C. D., Monroe S. S., Pon E. W., Glass R. I. Characterization of a variant strain of Norwalk virus from a food-borne outbreak of gastroenteritis on a cruise ship in Hawaii. J Clin Microbiol. 1994 Apr;32(4):861–866. doi: 10.1128/jcm.32.4.861-866.1994. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Ho M. S., Glass R. I., Monroe S. S., Madore H. P., Stine S., Pinsky P. F., Cubitt D., Ashley C., Caul E. O. Viral gastroenteritis aboard a cruise ship. Lancet. 1989 Oct 21;2(8669):961–965. doi: 10.1016/s0140-6736(89)90964-1. [DOI] [PubMed] [Google Scholar]
  11. Hobbs B. C., Rowe B., Kendall M., Turnbull P. C., Ghosh A. C. Escherichia coli O 27 in adult diarrhoea. J Hyg (Lond) 1976 Dec;77(3):393–400. doi: 10.1017/s0022172400055777. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Koo D., Maloney K., Tauxe R. Epidemiology of diarrheal disease outbreaks on cruise ships, 1986 through 1993. JAMA. 1996 Feb 21;275(7):545–547. [PubMed] [Google Scholar]
  13. Lawrence D. N., Blake P. A., Yashuk J. C., Wells J. G., Creech W. B., Hughes J. H. Vibrio parahaemolyticus gastroenteritis outbreaks aboard two cruise ships. Am J Epidemiol. 1979 Jan;109(1):71–80. doi: 10.1093/oxfordjournals.aje.a112661. [DOI] [PubMed] [Google Scholar]
  14. Lew J. F., Swerdlow D. L., Dance M. E., Griffin P. M., Bopp C. A., Gillenwater M. J., Mercatante T., Glass R. I. An outbreak of shigellosis aboard a cruise ship caused by a multiple-antibiotic-resistant strain of Shigella flexneri. Am J Epidemiol. 1991 Aug 15;134(4):413–420. doi: 10.1093/oxfordjournals.aje.a116103. [DOI] [PubMed] [Google Scholar]
  15. McEvoy M., Blake W., Brown D., Green J., Cartwright R. An outbreak of viral gastroenteritis on a cruise ship. Commun Dis Rep CDR Rev. 1996 Dec 6;6(13):R188–R192. [PubMed] [Google Scholar]
  16. Merson M. H., Hughes J. M., Wood B. T., Yashuk J. C., Wells J. G. Gastrointestinal illness on passenger cruise ships. JAMA. 1975 Feb 17;231(7):723–727. [PubMed] [Google Scholar]
  17. Minooee A., Rickman L. S. Infectious diseases on cruise ships. Clin Infect Dis. 1999 Oct;29(4):737–744. doi: 10.1086/520426. [DOI] [PubMed] [Google Scholar]
  18. Oyofo B. A., Soderquist R., Lesmana M., Subekti D., Tjaniadi P., Fryauff D. J., Corwin A. L., Richie E., Lebron C. Norwalk-like virus and bacterial pathogens associated with cases of gastroenteritis onboard a US Navy ship. Am J Trop Med Hyg. 1999 Dec;61(6):904–908. doi: 10.4269/ajtmh.1999.61.904. [DOI] [PubMed] [Google Scholar]
  19. PARKER W. S. Food-poisoning at sea. Br Med J. 1954 Jul 3;2(4878):22–25. doi: 10.1136/bmj.2.4878.22. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Rooney Roisin M., Bartram Jamie K., Cramer Elaine H., Mantha Stacey, Nichols Gordon, Suraj Rohini, Todd Ewen C. D. A review of outbreaks of waterborne disease associated with ships: evidence for risk management. Public Health Rep. 2004 Jul-Aug;119(4):435–442. doi: 10.1016/j.phr.2004.05.008. [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. Singal M., Schantz P. M., Werner S. B. Trichinosis acquired at sea--report of an outbreak. Am J Trop Med Hyg. 1976 Sep;25(5):675–681. doi: 10.4269/ajtmh.1976.25.675. [DOI] [PubMed] [Google Scholar]
  22. Snyder J. D., Wells J. G., Yashuk J., Puhr N., Blake P. A. Outbreak of invasive Escherichia coli gastroenteritis on a cruise ship. Am J Trop Med Hyg. 1984 Mar;33(2):281–284. doi: 10.4269/ajtmh.1984.33.281. [DOI] [PubMed] [Google Scholar]
  23. Waterman S. H., Demarcus T. A., Wells J. G., Blake P. A. Staphylococcal food poisoning on a cruise ship. Epidemiol Infect. 1987 Oct;99(2):349–353. doi: 10.1017/s0950268800067820. [DOI] [PMC free article] [PubMed] [Google Scholar]

Articles from Public Health Reports are provided here courtesy of SAGE Publications

RESOURCES