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Abstract
Flemmer M, Oldfield EC. "The agony and the ecstasy," American Journal
of Gastroenterology, 2003, 98:9 (Sept), 2098-9
The authors, who are from the
Vessel Sanitation Program of
the Centers for Disease Control and Prevention (CDC), summarize the
recent outbreaks of acute gastroenteritis (AGE), which occurred on five
different cruise ships. Attack rates among passengers ranged from 4% to
13% and among crew members from 0.2% to 3.3%. Subsequent
epidemiological investigations by the CDC suggested that the incidence
was higher, approaching 19-41% of passengers. Overall there were 21
outbreaks of AGE on 17 cruise ships, of which nine were documented to
be due to norovirus, three due to bacterial agents, and nine of unknown
cause. In general, subsequent outbreaks on each cruise ship were of the
identical strain of norovirus by reverse transcriptase polymerase
reaction, which suggests an embedded source. The authors conclude that
in addition to emphasizing basic food and water sanitation measures,
control efforts should include thorough and prompt disinfection of
ships during cruises and isolation of ill crew-members and passengers
for 72 hours.
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