Introduction:
The successful management of a cruise ships norovirus outbreak is described to highlight best practices and operational points to improve in the future.

Methods:
In November 2023 an outbreak of AGE was managed on a cruise ship operating in Mediterranean area. A collaboration between Health Port Authority, the company health departments and the onboard outbreak management team was established immediately. A continuous action of testing (biological specimens, environmental surfaces and waters) was conducted in different Mediterranean ports: norovirus was identified as the etiological agent. Epidemiological investigation was carried out (patient questionnaires, layout examinations) but couldn’t identify any point source on board. A list of public health prescriptions has been agreed and implemented on board according to SHIPSAN guidelines¹ and other international reference documents². A benchmark process with review of CDC database of AGE outbreaks cases³ was conducted.

Results:
After the onboard implementation of the measures the epidemic curve shows a dramatic resolution of the outbreak.

Conclusions:
The results demonstrate 1) Effectiveness of SHIPSAN guidelines, 2) Team collaborative working between public health authorities, company health departments and board outbreak management team were key factors for successful outbreak management. 3) All crew collaborated in the implementation of public health measures. Critical issues to work on in the future are the availability and coordination of accredited laboratory testing capacities in different ports, the coordination between public health authorities, ways to check the passenger’s compliance to isolation disposition, the physiological wellbeing of isolated persons and the need of periodical international training simulation on the field.