Rapid Risk Assessment: Measles on a cruise ship, Mediterranean Sea
This document assesses the risk associated with a first outbreak of measles on board a cruise ship while docked in port in Civitavecchia, Italy; it also proposes mitigation options, e.g. the containment of the disease.
Executive Summary
ECDC assesses the risk associated with an outbreak of measles on board a cruise ship, Costa Pacifica, while docked in port in Civitavecchia, Italy; the Rapid Risk Assessment also presents mitigation options below to help contain the spread of the disease.
On 27 February, around 40 crew members showed symptoms suspected to be measles. The ship had arrived from Palma de Mallorca, Spain. By 5 March 2014, the ship’s authorities had detected no new measles cases, and no passengers have been reported to have contracted measles.
Since measles is highly contagious, has relatively long incubation period and contagious prior symptoms, it is likely that new cases will appear among the crew, and further transmission may take place. To help mitigate the spread of measles, ECDC proposes the following options:
- If anyone shows symptoms of measles, such as, cough, runny nose, red eyes, fever, and rash is advised to seek medical attention. When presenting with these symptoms, patients should avoid visiting a general practitioner or family doctor, or emergency room to prevent further transmission and instead call medical services for advice first.
- For passengers and crew having disembarked in the past seven days are advised to review their measles vaccinations status. If their vaccination status is ‘unknown’ or ‘unvaccinated’, they should get immediately vaccinated if they left the boat during the past three days (as a prophylactic measure); they should be offered administration of human normal immunoglobulin (HNIG) if they belong to a risk group, e.g. pregnant women or immunocompromised patients and have left the boat in the past six days;
- Passengers and crew on board the ship should be informed about the possibility that they could be exposed to measles during the cruise. They should be asked about any symptoms that could indicate measles and seek medical attention if they show symptoms indicative of measles. Suspected cases should be isolated and disembark if possible.
- Incoming crew and passengers should be informed about the possibility that they could be exposed to measles during the cruise. They should be asked to review their measles vaccinations status. If their vaccination status is ‘unknown’ or ‘unvaccinated’, they should be immediately offered vaccination; they should be offered administration of human normal immunoglobulin (HNIG) if they belong to a risk group, e.g. pregnant women or immunocompromised patients. Priority should be given to children below two years of age as they are likely to be unvaccinated (or not fully vaccinated) and have a higher risk of complications.
The single most effective preventive measure against measles is vaccination with two doses of trivalent measles, mumps and rubella (MMR) vaccine. MMR vaccines are known to be very safe and effective.
