May 4, 2011 (CIDRAP News) – Alaskan quarantine officials yesterday issued a reminder to cruise and cargo ship operators to quickly report on-board illnesses and disease outbreaks, which they said are sometimes slow to come to the attention of health authorities.
In a state epidemiology bulletin, members of the Anchorage office of the US Centers for Disease Control and Prevention's (CDC's) Quarantine and Border Services Health Branch wrote that some maritime disease outbreaks are not reported to state and federal agencies in Alaska until after they are large and well underway.
Shahrokh Roohi, RN, MPH, lead author of the report and regional officer in charge of the office, told CIDRAP News that early disease reporting can allow health officials to do more to respond to outbreaks, such as providing prophylactic medication, conducting contact tracing, and providing guidance. He added that cruise and cargo ship travel is unique, because travelers are in close quarters for a relatively long period of time, which not only affects disease-spread dynamics but also provides healthcare workers more opportunities for intervention.
He said the group's report is a timely reminder for cruise ships that will be traveling to Alaska, because the cruise season is just starting. Alaska is the nation's top cruise ship destination, and the state has 21 maritime ports of call. The cruise season, which peaks in July and August and runs through September, brings about 1 million visitors a year to Alaska.
Maritime disease reporting is required by law, and underreporting is an ongoing problem in Alaska and other states, the authors noted. Federal quarantine laws require that carriers to US ports immediately report passenger or crew members who have a fever of 100° F or higher accompanied by rash, swollen glands, or jaundice for more than 24 hours. They must also report diarrheal illnesses, which are also reported separately to the CDC Vessel Sanitation Program.
Ships are asked to report other types of febrile conditions, including those accompanied by breathing difficulty, cough of longer than 2 weeks with bloody sputum, headache with neck stiffness, reduced consciousness level, or unexplained bleeding.
Roohi said issuing the reminder provides an opportunity to note the successes that ship medical officials have achieved in disease reporting, but also to advise them that more can be done to improve the process. For example, he said early notice about shipboard disease outbreaks can also facilitate the help of state medical experts in making a presumptive diagnosis or advising when to implement precautions against airborne pathogens.
Quarantine officials are monitoring the status of Europe's measles outbreaks, which could pose a risk to cruise ship passengers, given that as many as 50 different nationalities could be on board any one ship and that the disease transmits easily, Roohi said.
Early notification about suspected measles cases is another example of a trigger that could enhance and speed the public health response, he said, commenting, "We can make an impact by providing vaccine during the 3- to 6-day window for vaccine prophylaxis."
May 3 Alaska Department of Health report