Brazilian Public Health Policy for Cruise Ships - A Review of Morbidity and Mortality Rates - 2009/2015

Document Type : Short Communication

Authors

Instituto de Medicina Tropical de São Paulo, Universidade de São Paulo, São Paulo, Brazil

Abstract

Introduction: For 10 years, Brazil has presented a significant flow in cruise ships with 597 011 travelers in 2015. Cruise ships represent a major mass gathering capacity, generating more risk of outbreaks and epidemics. Moreover, visiting several places presents travelers with the possibility of contact with some tropical diseases, which demands the development of specific policies for public health surveillance.
Methods: In this study, case reports on transmissible diseases, accidents and deaths on board of cruise ships in the Brazilian coast during 2009 to 2015 were reviewed and correlated with the development of public health surveillance policies implemented by ANVISA, which established the mandatory communication of infectious diseases in 2009 and of deaths onboard in 2011.
Results: Norovirus was the major etiologic agent of outbreaks, though the rate of outbreak has been declining in recent years. The lethality rate last season was 0.67:100 000, mostly because of preexisting conditions (75%); the remaining cases were caused by accidents. The mandatory reporting of outbreaks and deaths is an important tool in the planning of preventive actions for the safety and health of travelers in Brazil. The continuous evolution of hygiene surveillance may reduce outbreaks; the adoption of transparency policies and fast communication of deaths has contributed to the significant reduction in accidents.
Conclusion: The effectiveness of specific public policies for the safety and security of travelers established for cruise ships in Brazil is indicated by the quantitative reduction in outbreaks and deaths. New destinations such as Cuba and China may adopt the same strategy of surveillance and protection against potential outbreaks of infectious diseases provided by cruise ships.

Keywords

References

CLIA. 2017 Cruise Industry Outlook. https://www.cruising.org/docs/default-source/research/clia-2017-state-of-the-industry.pdf?sfvrsn=0.
Pavli A, Maltezou HC, Papadakis A, et al. Respiratory infections and gastrointestinal illness on a cruise ship: A three-year prospective study. Travel Med Infect Dis. 2016;14(4):389-397. doi:10.1016/j. tmaid.2016.05.019.
Rodriguez-Morales AJ, Schlagenhauf P. Zoonoses and travel medicine: “one world--one health”. Travel Med Infect Dis. 2014;12(6 Pt A):555-556. doi: 10.1016/j.tmaid.2014.11.003.
Kak V. Infections on Cruise Ships. Microbiol Spectr. 2015;3(4). doi: 10.1128/microbiolspec.IOL5-0007-2015.
ABREMAR. Temporada de Navios de Cruzeiros 2015. http://abremar.hospedagemtemporaria.com.br/temporadas-2/.%20Accessed%20August%208,%202016.
Brazil. Brazilian Health Legislation Data Bank 2015. ANVISA. http://portal2.saude.gov.br/saudelegis/LEG_NORMA_PESQ_CONSULTA.CFM. Accessed October 26, 2014.
ANVISA. Temporada de Navios de Cruzeiros. http://www.anvisa.gov.br/hotsite/cruzeiros/industria.html.
Fernandes EG, de Souza PB, de Oliveira ME, et al. Influenza B outbreak on a cruise ship off the Sao Paulo Coast, Brazil. J Travel Med. 2014;21(5):298-303. doi: 10.1111/jtm.12132.
Cruise Ships Season - Anvisa. http://www.anvisa.gov.br/hotsite/cruzeiros/industriaingles.html. Accessed July 24, 2017.
CDC. CDC - Vessel Sanitation Program. http://www.cdc.gov/nceh/vsp/. Accessed March 20, 2016.
Mouchtouri VA, Nichols G, Rachiotis G, et al. State of the art: public health and passenger ships. Int Marit Health. 2010;61(2):49-98.
Marchand C, Merrina F, Gagnayre R, Bouchaud O. A descriptive study of advising practices during travel health consultations in France. J Travel Med. 2017;25(5):582–602. doi:10.1093/jtm/ tax042.
Goeijenbier M, van Genderen P, Ward BJ, Wilder-Smith A, Steffen R, Osterhaus AD. Travellers and influenza: risks and prevention. J Travel Med. 2017;24(1):taw078. doi: 10.1093/jtm/taw078.
Oldenburg M, Herzog J, Püschel K, Harth V. Mortality of German travellers on passenger vessels. J Travel Med. 2016;23(1). doi: 10.1093/jtm/tav003.
Lawson CJ, Dykewicz CA, Molinari NA, Lipman H, Alvarado‐Ramy F. deaths in international travelers arriving in the United States, July 1, 2005 to June 30, 2008. J Travel Med. 2012;19(2):96–103. doi: 10.1111/j.1708-8305.2011.00586.x.
Mitruka K, Felsen CB, Tomianovic D, et al. Measles, rubella, and varicella among the crew of a cruise ship sailing from Florida, United States, 2006. J Travel Med. 2012;19(4):233-237. doi:10.1111/j.1708-8305.2012.00620.x.
International Journal of Travel Medicine and Global Health
Volume 6, Issue 1
Winter 2018
Pages 11-15

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History

  • Receive Date: 29 August 2017
  • Revise Date: 18 September 2017
  • Accept Date: 23 September 2017

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