钻石公主号游轮上美国乘客中的2019冠状病毒病（COVID-19）

Coronavirus Disease 2019 (COVID-19) in Americans Aboard the Diamond Princess Cruise Ship.

作者信息

Plucinski Mateusz M, Wallace Megan, Uehara Anna, Kurbatova Ekaterina V, Tobolowsky Farrell A, Schneider Zachary D, Ishizumi Atsuyoshi, Bozio Catherine H, Kobayashi Miwako, Toda Mitsuru, Stewart Andrea, Wagner Riley L, Moriarty Leah F, Murray Rachel, Queen Krista, Tao Ying, Paden Clinton, Mauldin Matthew R, Zhang Jing, Li Yan, Elkins Christopher A, Lu Xiaoyan, Herzig Carolyn T A, Novak Ryan, Bower William, Medley Alexandra M, Acosta Anna M, Knust Barbara, Cantey Paul T, Pesik Nicki T, Halsey Eric S, Cetron Martin S, Tong Suxiang, Marston Barbara J, Friedman Cindy R

机构信息

All authors are part of the COVID-19 Cruise Ship Task Force, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.

出版信息

Clin Infect Dis. 2021 May 18;72(10):e448-e457. doi: 10.1093/cid/ciaa1180.

DOI:10.1093/cid/ciaa1180

PMID:32785683

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7454359/

Abstract

BACKGROUND

The Diamond Princess cruise ship was the site of a large outbreak of coronavirus disease 2019 (COVID-19). Of 437 Americans and their travel companions on the ship, 114 (26%) tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).

METHODS

We interviewed 229 American passengers and crew after disembarkation following a ship-based quarantine to identify risk factors for infection and characterize transmission onboard the ship.

RESULTS

The attack rate for passengers in single-person cabins or without infected cabinmates was 18% (58/329), compared with 63% (27/43) for those sharing a cabin with an asymptomatic infected cabinmate, and 81% (25/31) for those with a symptomatic infected cabinmate. Whole genome sequences from specimens from passengers who shared cabins clustered together. Of 66 SARS-CoV-2-positive American travelers with complete symptom information, 14 (21%) were asymptomatic while on the ship. Among SARS-CoV-2-positive Americans, 10 (9%) required intensive care, of whom 7 were ≥70 years.

CONCLUSIONS

Our findings highlight the high risk of SARS-CoV-2 transmission on cruise ships. High rates of SARS-CoV-2 positivity in cabinmates of individuals with asymptomatic infections suggest that triage by symptom status in shared quarters is insufficient to halt transmission. A high rate of intensive care unit admission among older individuals complicates the prospect of future cruise travel during the pandemic, given typical cruise passenger demographics. The magnitude and severe outcomes of this outbreak were major factors contributing to the Centers for Disease Control and Prevention's decision to halt cruise ship travel in US waters in March 2020.

摘要

背景

“钻石公主”号游轮是2019年冠状病毒病（COVID-19）大规模暴发的场所。在船上的437名美国乘客及其旅行同伴中，114人（26%）严重急性呼吸综合征冠状病毒2（SARS-CoV-2）检测呈阳性。

方法

在基于船只的隔离结束后，我们对229名美国乘客和船员进行了登船后的访谈，以确定感染的危险因素，并描述船上的传播情况。

结果

单人舱或没有感染室友的乘客感染率为18%（58/329），与无症状感染室友同住一室的乘客感染率为63%（27/43），与有症状感染室友同住一室的乘客感染率为81%（25/31）。同住一室的乘客样本的全基因组序列聚集在一起。在66名有完整症状信息的SARS-CoV-2阳性美国旅行者中，14人（21%）在船上时无症状。在SARS-CoV-2阳性的美国人中，10人（9%）需要重症监护，其中7人年龄≥70岁。

结论

我们的研究结果凸显了游轮上SARS-CoV-2传播的高风险。无症状感染者的室友中SARS-CoV-2阳性率很高，这表明在共享空间中根据症状状态进行分流不足以阻止传播。鉴于典型的邮轮乘客人口统计学特征，在疫情大流行期间，老年人入住重症监护病房的比例很高，这使未来邮轮旅行的前景变得复杂。此次疫情的规模和严重后果是导致疾病控制与预防中心在2020年3月决定暂停美国水域邮轮旅行的主要因素。