Walker, Liz J

Codreanu, Tudor A

Armstrong, Paul K

Goodwin, Samuel

Trewin, Abigail

Spencer, Emma

Colquhoun, Samantha M

Stephens, Dianne

Baird, Robert

Douglas, Nicholas

Cribb, Danielle

Owen, Rhonda

Kelly, Paul

Kirk, Martyn D

2021-09-07

BACKGROUND: Prolonged periods of confined living on a cruise ship increase the risk for respiratory disease transmission. We describe the epidemiology and clinical characteristics of a SARS-CoV-2 outbreak in Australian passengers on the Diamond Princess cruise ship and provide recommendations to mitigate future cruise ship outbreaks. METHODS: We conducted a retrospective cohort study of Australian passengers who travelled on the Diamond Princess from 20 January until 4 February 2020 and were either hospitalised, remained in Japan or repatriated. The main outcome measures included an epidemic curve, demographics, symptoms, clinical and radiological signs, risk factors and length of time to clear infection. RESULTS: Among 223 Australian passengers, 56 were confirmed SARS-CoV-2 positive. Forty-nine cases had data available and of these over 70% had symptoms consistent with COVID-19. Of symptomatic cases, 17% showed signs and symptoms before the ship implemented quarantine and a further two-thirds had symptoms within one incubation period of quarantine commencing. Prior to ship-based quarantine, exposure to a close contact or cabin mate later confirmed SARS-CoV-2 positive was associated with a 3.78 fold (95% CI, 2.24-6.37) higher risk of COVID-19 acquisition compared to non-exposed passengers. Exposure to a positive cabin mate during the ship's quarantine carried a relative risk of 6.18 (95% CI, 1.96-19.46) of developing COVID-19. Persistently asymptomatic cases represented 29% of total cases. The median time to the first of two consecutive negative PCR-based SARS-CoV-2 assays was 13 days for asymptomatic cases and 19 days for symptomatic cases (p = 0.002). CONCLUSION: Ship based quarantine was effective at reducing transmission of SARS-CoV-2 amongst Australian passengers, but the risk of infection was higher if an individual shared a cabin or was a close contact of a confirmed case. Managing COVID-19 in cruise ship passengers is challenging and requires enhanced health measures and access to onshore quarantine and isolation facilities.

Australian Government Department of Health, Canberra, Australian Capital Territory, Australia.

National Centre for Epidemiology and Population Health, The Australian National University, Canberra, Australian Capital Territory, Australia.

National Critical Care and Trauma Response Centre, Darwin, Northern Territory, Australia.

Western Australian Department of Health, Perth, Western Australia, Australia.

Northern Territory Department of Health, Darwin, Northern Territory, Australia.

Territory Pathology, Department of Health, Darwin, Northern Territory, Australia.

Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia.

PLoS One. 2021 Sep 7;16(9):e0255401. doi: 10.1371/journal.pone.0255401. eCollection 2021.

0000-0002-5752-4468

0000-0002-4206-2627

0000-0002-7214-4244

0000-0002-7200-1227

https://pubmed.ncbi.nlm.nih.gov/34492022/?otool=iaurydwlib

https://hdl.handle.net/10137/11875

16

SARS-CoV-2 infections among Australian passengers on the Diamond Princess cruise ship: A retrospective cohort study.

Journal Article

Publication