Cruise Ship AGE Publications

At a glance

Find selected publications related to acute gastroenteritis (AGE) and cruise ships.

Photo of a cruise ship on a magazine

List of publications

Spotlight‎

Gastrointestinal illness can spread quickly in closed and semienclosed environments, such as cruise ships. However, rates on passenger cruise ships have significantly decreased over time. Read highlights from our publication.

Lee S, Edens C, Ritter T, Rodriguez LO, Tardivel L, Kozak-Muizniek NA, et al. Two outbreaks of Legionnaires disease associated with outdoor hot tubs for private use — two cruise ships, November 2022–July 2024. MMWR 2024;73:950-4.

Rodriguez L, Jenkins K, Jean-Louis M. Resources for healthy cruising. [commentary] J Environ Health. 2024;86(7):38-9.

Crisp C, Jenkins K, Dunn I, Kupper A, Johnson J, White S, et al. Notes from the field: cruise ship norovirus outbreak associated with person-to-person transmission — United States jurisdiction, January 2023. MMWR. 2023;72(30):833-4. (Moritz E, Rodriguez L)

Jenkins KA, Vaughan GH Jr, Rodriguez LO, Freeland A. Acute gastroenteritis on cruise ships — Maritime Illness Database and Reporting System, United States, 2006–2019. MMWR Surv. Summ. 2021;70(6):1–9.

Park G, Ng T, Freeland AL, Marconi VC, Boom JA, Staat MA, et al. CrAssphage as a novel tool to detect human fecal contamination on environmental surfaces and hands. Emerg Infect Dis. 2020;26(8):1731-9. (Treffiletti A)

Rispens JR, Freeland A, Wittry B, Kramer A, Barclay L, Vinjé J, et al. Notes from the field: Multiple cruise ship outbreaks of norovirus associated with frozen fruits and berries—United States, 2019. MMWR. 2020;69(16):501-2. (Treffiletti A, Houston K)

Freeland AL, Vaughan GH Jr, Banerjee SN. Acute gastroenteritis on cruise ships—United States, 2008–2014. MMWR. 2016;65(1):1–5.

Park GW, Lee D, Treffiletti A, Hrsak M, Shugart J, Vinjé J. Evaluation of a new environmental sampling protocol for detection of human norovirus on inanimate surfaces. Appl Environ Microbiol. 2015;81(17):5987–92.

Centers for Disease Control and Prevention. Notes from the field: Emergence of new norovirus strain GII.4 Sydney—United States, 2012. MMWR. 2013;62(3):55.

Wikswo ME, Cortes J, Hall AJ, Vaughan G, Howard C, Gregoricus N, Cramer EH. Disease transmission and passenger behaviors during a high morbidity norovirus outbreak on a cruise ship, January 2009. Clin Infect Dis. 2011;52(9):1116-22.

Hall AJ, Vinjé J, Lopman B, Park GW, Yen C, Gregoricus N, et al. Updated norovirus outbreak management and disease prevention guidelines. MMWR. 2011;60(RR03);1-15.

Chimonas MA, Vaughan GH, Andre Z, Ames JT, Tarling GA, Beard S, et al. Passenger behaviors associated with norovirus infection on board a cruise ship–Alaska, May to June 2004. J Travel Med. 2008;15(3):177-83

Neri AJ, Cramer EH, Vaughan GH, Vinjé J, Mainzer HM. Passenger behaviors during norovirus outbreaks on cruise ships. J Travel Med. 2008;15(3):172-6.

Cramer EH, Blanton C, Otto, Charles, Vessel Sanitation Program Environmental Health Inspection Team. Shipshape: Sanitation inspections on cruise ships, 1990–2005, Vessel Sanitation Program, Centers for Disease Control and Prevention. J Environ Health, 70(7):15-23.

Cramer EH, Blanton C, Browne L, Vaughan G, Bopp C, Forney D. Epidemiology of gastroenteritis on cruise ships, 2001-2004: the impact of noroviruses. Am J Prev Med. 2006;30(3):252-7.

Isakbaeva ET, Widdowson M-A, Beard RS, Bulens SN, Mullins J, Monroe SS, et al. Norovirus transmission on cruise ship. Emerg Infect Dis. 2005:154-7.

Widdowson M-A, Cramer EH, Hadley L, Bresee JS, Beard RS, Bulens SN, et al. Outbreaks of acute gastroenteritis on cruise ships and on land: identification of a predominant circulating strain of norovirus – United States 2002. J Infect Dis. 2004;190(1):27-36.

Cramer EH, Gu DX, Durbin RE, Vessel Sanitation Program Environmental Health Inspection Team. Diarrheal disease on cruise ships, 1990–2000: the impact of environmental health programs. Am J Prev Med. 2003;24(3):227-33.

Centers for Disease Control and Prevention. Outbreaks of gastroenteritis associated with noroviruses on cruise ships — United States, 2002 — United States, 2002. MMWR. 2002;51(49):1112-5.

Herwaldt BL, Lew JF, Moe CL, Lewis DC, Humphrey CD, Monroe SS, et al. Characterization of a variant strain of Norwalk virus from a food-borne outbreak of gastroenteritis on a cruise ship in Hawaii. J Clin Microbiol. 1994;4:861-6.

Khan AS, Moe CL, Glass RI, Monroe SS, Estes MK, Chapman LK, et al. Norwalk virus-associated gastroenteritis traced to ice consumption aboard a cruise ship in Hawaii: comparison and application of molecular method-based assays. J Clin Microbiol. 1994;2:318-22.

Centers for Disease Control and Prevention. Outbreak of Shigella flexneri 2a infections on a cruise ship. MMWR. 1994;43(35):657.

Lew JF, Swerdlow DL, Dance ME, Griffin PM, Bopp CA, Gillenwater MJ, et al. An outbreak of shigellosis aboard a cruise ship caused by a multiple-antibiotic-resistant strain of Shigella flexneri. Am J Epidemiol. 1991;134(4):413-20.

Merson MH, Tenney JH, Meyers JD, Wood BT, Wells JG, Rymzo W, et al. Shigellosis at sea: an outbreak aboard a passenger cruise ship. Am J Epidemiol. 1975;101:165-75.

Nguyen, CH, Qualls NL, O'Toole TE. A cost-effectiveness analysis of the Vessel Sanitation Program. Atlanta: Centers for Disease Control and Prevention, U.S. Public Health Service 1989.

Ho MS, Glass RI, Monroe SS, Madore HP, Stine S, Pinsky PF, et al. Viral gastroenteritis aboard a cruise ship. Lancet. 1989 Oct 21;2(8669):961-5.

Addiss DG, Yashuk JC, Clapp DE, Blake PA. Outbreaks of diarrhoeal illness on passenger cruise ships, 1975-85. Epidemiol Infect. 1989;103(1):63-72.

Centers for Disease Control and Prevention. Vessel sanitation scores. MMWR 1988;37(7):114-7.

Sawyer LA, Murphy JJ, Kaplan JE, Pinsky PF, Chacon D, Walmsley S, et al. 25- to 30-nm virus particle associated with a hospital outbreak of acute gastroenteritis with evidence for airborne transmission. Am J Epidemiol. 1988;127:1261-71.

Centers for Disease Control and Prevention. Gastroenteritis outbreaks on two Caribbean cruise ships. MMWR 1986;35(23):383-4.

Centers for Disease Control and Prevention. Staphylococcal food poisoning on a cruise ship. MMWR. 1983;32(22):294-5.

Dannenberg AL, Yashuk JC, Feldman RA. Gastrointestinal illness on passenger cruise ships, 1975-1978. Am J Publ Health. 1982;72:484-8.

Gunn RA, Terranova WA, Greenberg HB, Yashuk J, Gary GW, Wells JG, et al. Norwalk virus gastroenteritis aboard a cruise ship: an outbreak of five consecutive cruises. Am J Epidemiol. 1980;1122:820-7.

Merson MH, Hughes JM, Wood BT, Yashuk JC, Wells JG. Gastrointestinal illness on passenger cruise ships. JAMA. 1975;723-7.