Gastroenteritis outbreaks on cruise ships: are sanitation inspection scores a true index of risk?
Abstract
Background: The utility of cruise ship sanitation scores as indicators of future gastroenteritis outbreak was
investigated by means of a 5-year review of inspection scores and outbreaks of gastroenteritis as reported
under the Vessel Sanitation Programme of the United States Public Health Centers for Disease Control.
Materials and methods: Between 2012 and 2017 a total of 1197 inspections were published online, with
a mean score of 95.7 out of 100. During the same interval there were 50 separate outbreaks of acute
gastroenteritis.
Results: No significant difference was found between pre-outbreak inspection scores, mean 96.4, and
inspections that were not followed by an outbreak, mean 95.1 (z = 0.81, p = 0.42).
Conclusions: This study shows that the current format of the inspection audits carried out under the Vessel
Sanitation Programme generates scores that have no prognostic value with regard to future outbreaks of
gastroenteritis on board cruise ships.
Keywords: acute gastroenteritisoutbreakVessel Sanitation ProgrammeUnited States Centres for Disease Control and Preventioncruise shipsnorovirus
References
- Freeland AL, Vaughan GH, Banerjee SN. Acute Gastroenteritis on Cruise Ships - United States, 2008-2014. MMWR Morb Mortal Wkly Rep. 2016; 65(1): 1–5.
- Vessel Sanitation Program. 2011 Operations Manual. Atlanta, GA: US Department of Health and Human Services, CDC, Vessel Sanitation Program; 2011. https://www.cdc.gov/nceh/vsp/operationsmanual/OPSManual2011.pdf (accessed 06/September/2018).
- Vessel Sanitation Program. Outbreak Updates for International Cruise Ships. https://www.cdc.gov/nceh/vsp/surv/gilist.htm (accessed 06/September/2018).
- Vessel Sanitation Program. Advanced Cruise Ship Inspection Search. https://wwwn.cdc.gov/InspectionQueryTool/InspectionSearch.aspx (accessed 06/September/2018).
- Vessel Sanitation Program. Health Education and Public Information. https://www.cdc.gov/nceh/vsp/desc/about_information.htm (accessed 06/September/2018).
- Mann-Whitney U test. https://en.wikipedia.org/wiki/Mann-Whitney_U_test (accessed 06/September/2018).
- Handbook of Parametric and Nonparametric Statistical Procedures, 3rd edition. Sheskin DJ, Chapman & Hall/CRC, Boca Raton, 2004.
- Glass RI, Parashar UD, Estes MK. Norovirus gastroenteritis. N Engl J Med. 2009; 361(18): 1776–1785.
- Hall AJ, Lopman BA, Payne DC, et al. Norovirus disease in the United States. Emerg Infect Dis. 2013; 19(8): 1198–1205.
- Centers for Disease Control and Prevention. Norovirus Worldwide. https://www.cdc.gov/nceh/vsp/desc/about_inspections.htm (accessed 06/September/2018).
- Mounts AW, Ando T, Koopmans M, et al. Cold weather seasonality of gastroenteritis associated with Norwalk-like viruses. J Infect Dis. 2000; 181 Suppl 2: S284–S287.
- NHS choices. Norovirus (vomiting bug). . https://www.nhs.uk/conditions/norovirus (accessed 06/September/2018).
- Kirby AE, Streby A, Moe CL. Vomiting as a symptom and transmission risk in norovirus illness: evidence from human challenge studies. PLoS One. 2016; 11(4): e0143759.
- Greer AL, Drews SJ, Fisman DN. Why "winter" vomiting disease? Seasonality, hydrology, and Norovirus epidemiology in Toronto, Canada. Ecohealth. 2009; 6(2): 192–199.
- Centers for Disease Control and Prevention. Norovirus. Transmission. https://www.cdc.gov/norovirus/about/transmission.html (accessed 06/September/2018).
- Vessel Sanitation Program. Inspections. Periodic Operational Sanitation Inspections. https://www.cdc.gov/nceh/vsp/desc/about_inspections.htm (accessed 06/September/2018).
