Public Health Responses to COVID-19 Outbreaks on Cruise Ships — Worldwide, February–March 2020

Moriarty, Leah F.; Plucinski, Mateusz M.; Marston, Barbara J.; Kurbatova, Ekaterina V.; Knust, Barbara; Murray, Erin L.; Pesik, Nicki; Rose, Dale; Fitter, David; Kobayashi, Miwako; Toda, Mitsuru; Canty, Paul T.; Scheuer, Tara; Halsey, Eric S.; Cohen, Nicole J.; Stockman, Lauren; Wadford, Debra A.; Medley, Alexandra M.; Green, Gary; Regan, Joanna J.; Tardivel, Kara; White, Stefanie; Brown, Clive; Morales, Christina; Yen, Cynthia; Wittry, Beth; Freeland, Amy; Naramore, Sara; Novak, Ryan T.; Daigle, David; Weinberg, Michelle; Acosta, Anna; Herzig, Carolyn; Kapella, Bryan K; Jacobson, Kathleen R.; Lamba, Katherine; Ishizumi, Atsuyoshi; Sarisky, John; Svendsen, Erik; Blocher, Tricia; Wu, Christine; Charles, Julia; Wagner, Riley; Stewart, Andrea; Mead, Paul S.; Kurylo, Elizabeth; Campbell, Stefanie; Murray, Rachel; Weidle, Paul; Cetron, Martin; Friedman, Cindy R.; Behravesh, Casey Barton; Bjork, Adam; Bower, William; Bozio, Catherine; Braden, Zachary; Bertulfo, Mary Catherine; Chatham-Stephens, Kevin; Chu, Victoria; Cooper, Barbara; Dooling, Kathleen; Dubray, Christine; Curren, Emily; Honein, Margaret A.; Ivey, Kathryn; Jones, Jefferson; Kadzik, Melissa; Knight, Nancy; Marlow, Mariel; McColloch, Audrey; McDonald, Robert; Klevos, Andrew; Poser, Sarah; Rinker, Robin A.; Ritter, Troy; Rodriguez, Luis; Ryan, Matthew; Schneider, Zachary; Shockey, Caitlin; Shugart, Jill; Silver, Margaret; Smith, Paul W.; Tobolowsky, Farrell; Treffiletti, Aimee; Wallace, Megan; Yoder, Jonathan; Barry, Pennan; Berumen, Ricardo; Bregman, Brooke; Campos, Kevin; Chai, Shua; Glenn-Finer, Rosie; Guevara, Hugo; Hacker, Jill; Hsieh, Kristina; Morris, Mary Kate; Murphy, Ryan; Myers, Jennifer F.; Padilla, Tasha; Pan, Chao-Yang; Readhead, Adam; Saguar, Estela; Salas, Maria; Snyder, Robert E.; Vugia, Duc; Watt, James; Wong, Cindy; Acosta, Meileen; Davis, Shai; Kapuszinsky, Beatrix; Matyas, Bela; Miller, Glen; Ntui, Asundep; Richards, Jayleen

An estimated 30 million passengers are transported on 272 cruise ships worldwide each year* (1). Cruise ships bring diverse populations into proximity for many days, facilitating transmission of respiratory illness (2). SARS-CoV-2, the virus that causes coronavirus disease (COVID-19) was first identified in Wuhan, China, in December 2019 and has since spread worldwide to at least 187 countries and territories. Widespread COVID-19 transmission on cruise ships has been reported as well (3). Passengers on certain cruise ship voyages might be aged ≥65 years, which places them at greater risk for severe consequences of SARS-CoV-2 infection (4). During February-March 2020, COVID-19 outbreaks associated with three cruise ship voyages have caused more than 800 laboratory-confirmed cases among passengers and crew, including 10 deaths. Transmission occurred across multiple voyages of several ships. This report describes public health responses to COVID-19 outbreaks on these ships. COVID-19 on cruise ships poses a risk for rapid spread of disease, causing outbreaks in a vulnerable population, and aggressive efforts are required to contain spread. All persons should defer all cruise travel worldwide during the COVID-19 pandemic.