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Isakbaeva, E. T.;  Widdowson, M. A.;  Beard, R. S.;  Bulens, S. N.;  Mullins, J.;  Monroe, S. S.;  Bresee, J.;  Sassano, P.;  Cramer, E. H.;  and Glass, R. I.  "Norovirus transmission on cruise ship,"  Emerging Infectious Diseases, 2005, 11:1, 154-157

A large outbreak of Norovirus gastroenteritis among passengers and crew of a cruise ship travelling from Florida (USA) to the Caribbean is described. A total of 513 passengers and 74 crew members reported acute gastroenteritis on 6 consecutive cruises during November 2002-January 2003, despite one week sanitation of the ship after cruise 2. Epidemiological investigation revealed that the disease was transmitted through food, person-to-person contact or environmental contamination. Of the 55 tested faecal samples from all 6 cruises, 25 (45%) were positive for Norovirus and belonged to 6 strains. It is suggested that efforts to control gastroenteritis outbreaks on cruise ships should address all possible modes of Norovirus transmission, including foodborne, environmental persistence and person-to-person spread.