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Piloting a syndromic diagnostic testing system on board a cruise ship: Assessing system performance in a passenger ship environment
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):A16
KEYWORDS
ABSTRACT
Introduction:
Infectious disease point-of-care (POC) testing on passenger ships traditionally targets few pathogens; with syndromic surveillance it can facilitate rapid diagnosis, treatment and outbreak management1,2. Syndromic diagnostic testing systems exist to rapidly identify multiple pathogens simultaneously3. This study aimed to assess one system’s performance for detecting respiratory/gastrointestinal pathogens among cruise travellers, also considering suitability for passenger ships.
Methods:
Clinical samples were collected from crew/passengers travelling onboard a cruise ship during July 2023 who displayed respiratory/gastrointestinal symptoms. Two nasal swabs were obtained from each patient. One nasal swab was analyzed onboard using the QIAstat-Dx-Analyzer (Respiratory SARS-CoV-2 panel detects 20+ viral/bacterial pathogens; Gastrointestinal 2 panel detects multiple viral/bacterial/parasitic pathogens)4,5. To validate results against a reference method, the other nasal swab was analyzed at the University of Thessaly’s Laboratory of Hygiene and Epidemiology using the VIASURE Respiratory Panel III RT-PCR Detection Kit, CE-IVD.
Results:
During the study period, no travellers reported gastrointestinal symptoms while 25 reported respiratory symptoms. Fifty nasal samples (two per patient) were collected, with 14 travellers positive for respiratory pathogens via QIAstat-Dx Respiratory SARS-CoV-2 Panel. The reference method yielded the same results for positivity and pathogen type in 13/14 samples with comparable viral loads. In one sample QIAstat-Dx detected two pathogens (Corona OC43/HKU1) while the reference method confirmed only one pathogen (Corona OC43) with highest viral load. Sensitivity, specificity, positive and negative predictive values of the QIAstat-Dx Respiratory SARS-CoV-2 Panel were 100%.
Conclusions:
Ship medical personnel considered the QIAstat-Dx-Analyzer compatible with the medical facility’s workflow. Sample collection and results interpretation were considered simple. High sensitivity/specificity, ability to differentiate between multiple respiratory pathogens, short time to results and minimal training requirements are considered benefits of this type of system. Study limitations affecting generalizability include the small number of respiratory samples and lack of gastrointestinal samples collected for assessment.
Infectious disease point-of-care (POC) testing on passenger ships traditionally targets few pathogens; with syndromic surveillance it can facilitate rapid diagnosis, treatment and outbreak management1,2. Syndromic diagnostic testing systems exist to rapidly identify multiple pathogens simultaneously3. This study aimed to assess one system’s performance for detecting respiratory/gastrointestinal pathogens among cruise travellers, also considering suitability for passenger ships.
Methods:
Clinical samples were collected from crew/passengers travelling onboard a cruise ship during July 2023 who displayed respiratory/gastrointestinal symptoms. Two nasal swabs were obtained from each patient. One nasal swab was analyzed onboard using the QIAstat-Dx-Analyzer (Respiratory SARS-CoV-2 panel detects 20+ viral/bacterial pathogens; Gastrointestinal 2 panel detects multiple viral/bacterial/parasitic pathogens)4,5. To validate results against a reference method, the other nasal swab was analyzed at the University of Thessaly’s Laboratory of Hygiene and Epidemiology using the VIASURE Respiratory Panel III RT-PCR Detection Kit, CE-IVD.
Results:
During the study period, no travellers reported gastrointestinal symptoms while 25 reported respiratory symptoms. Fifty nasal samples (two per patient) were collected, with 14 travellers positive for respiratory pathogens via QIAstat-Dx Respiratory SARS-CoV-2 Panel. The reference method yielded the same results for positivity and pathogen type in 13/14 samples with comparable viral loads. In one sample QIAstat-Dx detected two pathogens (Corona OC43/HKU1) while the reference method confirmed only one pathogen (Corona OC43) with highest viral load. Sensitivity, specificity, positive and negative predictive values of the QIAstat-Dx Respiratory SARS-CoV-2 Panel were 100%.
Conclusions:
Ship medical personnel considered the QIAstat-Dx-Analyzer compatible with the medical facility’s workflow. Sample collection and results interpretation were considered simple. High sensitivity/specificity, ability to differentiate between multiple respiratory pathogens, short time to results and minimal training requirements are considered benefits of this type of system. Study limitations affecting generalizability include the small number of respiratory samples and lack of gastrointestinal samples collected for assessment.
ACKNOWLEDGEMENTS
We would like to thank the HEALTHY SAILING project consortium. We would also like to thank the participating cruise line, particularly the management, ship officers and ship medical staff. We would also like to thank SB BioAnalytica.
CONFLICTS OF INTEREST
There are no conflicts of interest to declare. The commercial company (QIAGEN/SB BioAnalytica) was in no way involved in sample collection, storage or transport. During the study period, the commercial company had no access to the clinical samples.
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). The commercial company (QIAGEN/SB BioAnalytica) provided 60 QIAstat-Dx panel assays to implement during the pilot-test for the duration of the study. QIAGEN/SB BioAnalytica installed the QIAstat-Dx Analyzer system on board the cruise ship, providing training to the ship’s medical personnel on use of the system, sample preparation, processing, interpretation and troubleshooting.
ETHICAL APPROVAL AND INFORMED CONSENT
The HEALTHY SAILING project has received approval from the University of Thessaly Research Ethics Board (Protocol Nr. 59 / 19.09.2022). Under this framework, the study protocol was submitted to the University of Thessaly Research Ethics Board. Ethical considerations were in accordance with the cruise line’s policy for clinical specimen collection from passengers and crew members for health and safety purposes. Information on the study was made available and written consent was obtained from study participants for examination of specimens at the University of Thessaly’s Laboratory of Hygiene and Epidemiology, through information letters and consent forms.
REFERENCES (5)
1.
Bouricha M, Samad MA, Levy PY, Raoult D, Drancourt M. Point‐of‐Care Syndrome‐Based, Rapid Diagnosis of Infections on Commercial Ships. Journal of travel medicine. 2013;21(1):12-16.
2.
Carter JT. Point of Care Tests at Sea. Journal of travel medicine. 2014;21(1):4-5.
4.
QIAGEN. QIAstat-Dx Gastrointestinal Panel 2 Instructions for Use (Handbook). Accessed 7 February 2024. https://www.qiagen.com/de/reso....
5.
QIAGEN. QIAstat-Dx Respiratory SARS-CoV-2 Panel. Accessed 7 February 2024. https://www.qiagen.com/de-us/a....
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