International Centre for Cruise Research
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Centers for Disease Control.  "Outbreak of influenza A infection among travelers - Alaska and the Yukon Territory, May-June 1999," Morbidity and Mortality Weekly Report, 1999, 48, 25, 545...555

Clusters of febrile respiratory illness and associated pneumonia were reported among travellers and tourism workers in Alaska, USA and the Yukon Territory, Canada, during June 1999. As of 29 June 1999, reports of 428 cases of acute respiratory infection (ARI) had been reported among tourists who travelled to Alaska and the Yukon Territory from 22 May through 28 June on 7 separate week-long cruises. Dates of illness onset were known for 386 cases, and for 187 (48%) of these, illness occurred before or within 48 hours after boarding a cruise ship, suggesting that disease transmission occurred during a preceding land-based tour. For the 386 cases, the ARI incidence was 3.8% among 10110 passengers for a 7-day travel itinerary, the attack rate being 5.5 per 1000 passenger-days. 132 (34%) cases met the criteria for influenza-like illness (ILI), which were fever or feverishness with cough or sore throat, and 4 cases were hospitalized for pneumonia. There were no fatalities. 104 cases of ARI were reported among tourism workers. Laboratory evidence, which included rapid influenza A antigen-detection tests and viral cultures from respiratory specimens, implicated influenza A virus as the causative agent.

Centers for Disease Control and Prevention. "Update: influenza activity -- United States, 1997-98 season,"
Morbidity and Mortality Weekly Report, 1997, 46:46 (Nov 21), 1094-8

CDC conducts surveillance for influenza viruses and related disease activity in collaboration with the World Health Organization (WHO), its collaborating laboratories, and state and local health departments. This report summarizes influenza surveillance data in the United States from September 28, 1997, through the week ending November 8, and describes two recent cruise ship outbreaks of influenza. The findings indicate that, during this period, influenza activity in the United States was low and that influenza A predominated.

Centers for Disease Control and Prevention. "Update: outbreaks of cyclosporiasis -- United States and Canada, 1997," Morbidity and Mortality Weekly Report, 1997, 46:23 (June 13), 521-3.

Since April 1997, CDC has received reports of outbreaks of cyclosporiasis in the United States and Canada (1,2). As of June 11, there have been 21 clusters of cases of cyclosporiasis reported from eight states (California, Florida, Maryland, Nebraska, Nevada, New York, Rhode Island, and Texas) and one province in Canada (Ontario). These clusters were associated with events (e.g., receptions, banquets, or time-place-related exposures [meals in the same restaurant on the same day]) that occurred during March 19-May 25 and comprise approximately 140 laboratory-confirmed and 370 clinically defined cases of cyclosporiasis. In addition, four laboratory-confirmed and approximately 220 clinically defined cases have been reported among persons who, during March 29-April 5, were on a cruise ship that departed from Florida. Approximately 70 laboratory-confirmed sporadic cases (i.e., cases not associated with events, the cruise, or recent overseas travel) have been reported in the United States and Canada. The most recent laboratory-confirmed sporadic case occurred in a person who had onset of symptoms on June 3.