1990 - 2000年游轮上的腹泻病：环境卫生项目的影响

Diarrheal disease on cruise ships, 1990-2000: the impact of environmental health programs.

作者信息

Cramer Elaine H, Gu David X, Durbin Randy E

机构信息

National Center for Environmental Health, Centers for Disease Control and Prevention, Chamblee, Georgia, USA.

出版信息

Am J Prev Med. 2003 Apr;24(3):227-33. doi: 10.1016/s0749-3797(02)00644-x.

DOI:10.1016/s0749-3797(02)00644-x

PMID:12657340

Abstract

BACKGROUND

In 1975, the then-Center for Disease Control (CDC) established the Vessel Sanitation Program (VSP) to minimize the risk for diarrheal disease among passengers and crew aboard ships by assisting the cruise ship industry in developing and implementing comprehensive environmental health programs.

OBJECTIVES

To evaluate the relationship between cruise ship sanitation scores and diarrheal disease incidence and outbreaks among cruise ship passengers.

METHODS

Retrospective cohort study of ship inspection and diarrheal disease data from 1990 through 2000 from the National Center for Environmental Health, CDC database, for cruise ships entering the United States.

OUTCOMES

Yearly trends in number of ships inspected, number of inspections conducted, inspection scores, and risks of failing inspections; rates of diarrheal disease among passengers, by inspection year, cruise duration, incidence of outbreaks, and passing- or failing-score status of the associated ship.

RESULTS

From 1990 through 2000, inspection scores gradually increased from a median of 89 in 1990 to 93 in 2000 (p<0.001), with an associated statistically significant 21% increase in likelihood of passing. The total baseline level of diarrhea among passengers was 2.0 cases per cruise (13243/6485), or 23.6 cases per 100,000 passenger-days (13243/56129096). The latter rate declined significantly from 29.2 in 1990 to 16.3 in 2000 (p<0.0001). Diarrheal disease incidence rates among passengers sailing on ships that passed environmental inspections were significantly lower than rates among passengers sailing on ships that failed inspections (21.7 vs 30.1; RR = 1.39; 95% CI: 1.31-1.47). Diarrheal disease outbreak-related illnesses decreased from 4.2 to 3.5 per 100000 passenger-days from 1990-1995 to 1996-2000.

CONCLUSIONS

Environmental sanitation inspections conducted among ships sailing into the United States appear to continue to decrease diarrheal disease rates and outbreaks among passengers.

摘要

背景

1975年，当时的疾病控制中心（CDC）设立了船舶卫生计划（VSP），通过协助邮轮行业制定和实施全面的环境卫生计划，将邮轮上乘客和船员患腹泻病的风险降至最低。

目的

评估邮轮卫生评分与邮轮乘客腹泻病发病率及疫情之间的关系。

方法

对1990年至2000年美国国家环境卫生中心CDC数据库中进入美国的邮轮的船舶检查和腹泻病数据进行回顾性队列研究。

结果

检查的船舶数量、进行的检查次数、检查评分及检查不合格风险的年度趋势；按检查年份、邮轮航行时长、疫情发病率以及相关船舶的及格或不及格评分状况划分的乘客腹泻病发病率。

结果

1990年至2000年，检查评分从中位数89分逐渐提高到2000年的93分（p<0.001），及格可能性相应地在统计学上显著提高了21%。乘客腹泻的总基线水平为每次邮轮航行2.0例（13243/6485），即每100000乘客日23.6例（13243/56129096）。后一发病率从1990年的29.2例显著降至2000年的16.3例（p<0.0001）。通过环境检查的船舶上乘客的腹泻病发病率显著低于未通过检查的船舶上乘客的发病率（21.7对30.1；RR = 1.39；95%CI：1.31 - 1.47）。腹泻病疫情相关疾病从1990 - 1995年的每100000乘客日4.2例降至1996 - 2000年的3.5例。