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Acute gastroenteritis in large passenger vessels
1
Laboratory of Hygiene and Epidemiology, Faculty of Medicine, University of Thessaly, Larissa, Greece
2
Healthy Sailing Project, Greece
3
EU SHIPSAN Scientific Association, Larissa, Greece
Publication date: 2025-12-05
Popul. Med. 2025;7(Supplement 1):A15
KEYWORDS
ABSTRACT
Introduction:
Acute gastroenteritis (AG) is a commonly reported illness among ship travellers, with cruise ship literature focused largely on AG1,2. This systematic review aimed to understand risk factors and effectiveness of control measures for acute gastroenteritis on large passenger ships.
Methods:
Conducted according to PRISMA 2020, peer-reviewed articles reporting infectious disease events linked to passenger ships and seaports worldwide were eligible. Gastroenteritis events were defined as: 1) norovirus described by authors as an outbreak; 2) salmonella/shigella/other pathogen with one or more cases in passengers or crew. Articles had to describe infection frequency with at least one case laboratory-confirmed. PubMed, Scopus and Cochrane Library were searched. Articles published after June 2019 (referring to norovirus) and between January 2000 – March 2023 (referring to any other pathogen) were included.
Results:
The review identified 14 eligible publications3-16. We analyzed 14 events (11 single pathogen, three multi-pathogen) among 14 ships (12 cruise, one food banquet cruise, one dinner ferry) on 18 voyages (11 events on single voyages, three events on consecutive/multiple voyages)3,5-10,12. Foodborne transmission (or presumed) was identified in 10 events, with most events published before 20053,6-10,12; risk factors included consuming food onboard (seven events), ashore (three events), harvesting practices and possible cross-contamination during rapid cooling. Waterborne transmission was reported in four events published before 20043,5. Presumed outbreak sources including contaminated water bunkered in overseas ports (three events) and brief water treatment system failures (two events). Six events reported control measures; removing implicated food sources, buffet cessation, excluding symptomatic/infected crew from duty were reported as effective6,12.
Conclusions:
Foodborne and waterborne outbreaks in the literature have not been widely reported in recent years, likely due to rigorous hygiene standards implemented onboard over the last two decades. However, even with declines in reported outbreaks, food and water safety measures must be vigilantly maintained onboard large passenger ships.
Acute gastroenteritis (AG) is a commonly reported illness among ship travellers, with cruise ship literature focused largely on AG1,2. This systematic review aimed to understand risk factors and effectiveness of control measures for acute gastroenteritis on large passenger ships.
Methods:
Conducted according to PRISMA 2020, peer-reviewed articles reporting infectious disease events linked to passenger ships and seaports worldwide were eligible. Gastroenteritis events were defined as: 1) norovirus described by authors as an outbreak; 2) salmonella/shigella/other pathogen with one or more cases in passengers or crew. Articles had to describe infection frequency with at least one case laboratory-confirmed. PubMed, Scopus and Cochrane Library were searched. Articles published after June 2019 (referring to norovirus) and between January 2000 – March 2023 (referring to any other pathogen) were included.
Results:
The review identified 14 eligible publications3-16. We analyzed 14 events (11 single pathogen, three multi-pathogen) among 14 ships (12 cruise, one food banquet cruise, one dinner ferry) on 18 voyages (11 events on single voyages, three events on consecutive/multiple voyages)3,5-10,12. Foodborne transmission (or presumed) was identified in 10 events, with most events published before 20053,6-10,12; risk factors included consuming food onboard (seven events), ashore (three events), harvesting practices and possible cross-contamination during rapid cooling. Waterborne transmission was reported in four events published before 20043,5. Presumed outbreak sources including contaminated water bunkered in overseas ports (three events) and brief water treatment system failures (two events). Six events reported control measures; removing implicated food sources, buffet cessation, excluding symptomatic/infected crew from duty were reported as effective6,12.
Conclusions:
Foodborne and waterborne outbreaks in the literature have not been widely reported in recent years, likely due to rigorous hygiene standards implemented onboard over the last two decades. However, even with declines in reported outbreaks, food and water safety measures must be vigilantly maintained onboard large passenger ships.
ACKNOWLEDGEMENTS
We would like to thank the HEALTHY SAILING project consortium.
CONFLICTS OF INTEREST
None declared.
FUNDING
HEALTHY SAILING project has received funding from the European Union’s Horizon Europe Framework Programme (HORIZON) under Grant Agreement number 101069764. Funded by the European Union. Views and opinions expressed are however those of the author(s) only and do not necessarily reflect those of the European Union or the European Climate, Infrastructure and Environment Executive Agency (CINEA). Neither the European Union nor the granting authority can be held responsible for them. This work was funded by UK Research and Innovation (UKRI) under the UK government’s Horizon Europe funding guarantee [grant number 10040786], [grant number 10040720]. This work has received funding from the Swiss State Secretariat for Education, Research and Innovation (SERI).
ETHICAL APPROVAL AND INFORMED CONSENT
Ethical approval and informed consent were not required for this study.
REFERENCES (16)
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