A SARS-CoV-2 Omicron outbreak among crew members on a cruise ship in Germany in early 2022.

BACKGROUND: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) outbreaks on cruise ships have rarely been investigated. In early 2022, we were informed about a SARS-CoV-2 outbreak on a cruise ship calling Port of Hamburg after 10 infections among crew members were detected. We conducted an outbreak investigation in collaboration between ship owners, the ship physician and Hamburg's Institute for Hygiene and Environment, to identify risk factors and to achieve containment. The aim was to identify risk factors for SARS-CoV-2 infection and SARS-CoV-2 variants in a cohort of 165 crew members. MATERIALS AND METHODS: For this purpose, we collected data on age, sex, nationality, boarding-time, cabin use (single/shared), work place, and vaccination status of the study participants. Cases were defined as individuals who tested SARS-CoV-2 positive at least once in daily screenings during the outbreak period (10 days) by polymerase chain reaction or antigen test. We investigated risk factors for infection by descriptive, univariable and multivariable analysis. We performed whole genome sequencing to identify SARS-CoV-2 variants. RESULTS: We verified 103 SARS-CoV-2 positive cases (attack rate [AR] 62.4%); 39/41 sequenced samples were BA.2.3 Omicron subtype, one BA.1 and one BA.1.1. Among boostered crew members, AR was 38% vs. 65% among those vaccinated once or twice. Among those who stayed < 30 days on board, AR was 31% vs. 72% among those staying on board longer. Among Europeans, the AR was 53% vs. 71% in non- -Europeans. Adjusting for age and sex, cases were more likely to have received no booster vaccine (odds ratio [OR]: 2.66, 95% confidence interval [CI]: 0.99-7.13), to have spent more time on board (≥ 30 days, OR: 6.36, 95% CI: 2.81-14.40 vs. < 30 days) and to have a non-European nationality (OR: 2.14, 95% CI: 1.08-4.27). The outbreak stopped shortly after offboard isolation of cases. CONCLUSIONS: This investigation confirms the importance of a booster vaccine against COVID-19. Longer stays onboard could facilitate social mixing. Further studies could investigate the impact of social, cultural/ behavioural patterns and public health access on the infection risk. Physical distancing together with screening and isolation can contain SARS-CoV-2 outbreaks on cruise ships.

[Prevention and management of COVID-19 outbreaks on merchant ships]. / Prävention und Management von COVID-19-Ausbrüchen auf Handelsschiffen: Technische, organisatorische und persönliche Schutzmaßnahmen zur Risikominimierung in einem besonderen Arbeitsumfeld.

BACKGROUND: A pandemic is a particular medical challenge for seafarers traveling without a physician on board. At the same time the global fight against the coronavirus disease 2019 (COVID-19) pandemic has to rely on resilient merchant shipping in order to maintain the flow of goods. For infection prevention and management on board, those responsible need a portfolio of protective measures that can be used on ships. RESEARCH QUESTIONS: The overview examines the question of which technical, organizational and personal protective measures can be used on a merchant ship in order to prevent or cope with COVID-19 outbreaks on board. MATERIAL AND METHODS: Guidelines, information and occupational health and safety standards from the maritime setting, but also from many other work areas, were examined in order to facilitate a variable use by those responsible (e.g. according to ship size, equipment, weather, operating status, work requirements, contact with external persons, medical problems). RESULTS: A handout was compiled that contains specific technical, organizational and personal protective measures for crews, explaining their use in a maritime context. Possible safety barriers, options to combine them and an appropriate timing are explained in a target group-oriented manner. CONCLUSION: A great variety of protective measures derived from occupational medical literature and the experience of the port medical service in Hamburg can also be implemented on the high seas. In pandemic times, merchant ships should be equipped with foresight (e.g. with rapid diagnostic tests) and those responsible should be authorized to use effective infection control measures adapted to the situation on board. Seafarers should receive priority vaccination offers regardless of their national origin.

[Air and maritime transport during the COVID-19 pandemic in Germany: challenges for the public health service]. / Flug- und Schiffsverkehr während der COVID-19-Pandemie in Deutschland: Herausforderungen für den Öffentlichen Gesundheitsdienst.

COVID-19 has been challenging our society since January 2020. Due to global travel, the new coronavirus has rapidly spread worldwide. This article aims to provide an overview of the challenges in implementing measures in the air and maritime transport sector from the perspective of the German Public Health Service (Öffentlicher Gesundheitsdienst, ÖGD). Significant events and measures for air and maritime transport between January and August 2020 were selected. Lessons learned are discussed.During the COVID-19 pandemic, the ÖGD has been operating in a field of tension between the dynamics of scientific knowledge, political decision-making, social acceptance and consent.There are specific challenges at points of entry such as airports and seaports. These include staff shortages and the need to implement measures with a high organisational effort at very short notice such as health authority passenger checks carried out on aircraft, the establishment of test centres at points of entry and control of compliance with quarantine measures. Aggravating the situation, passenger lists, which are necessary for effective contact tracing, are often not available or incomplete. There is also a lack of digital tools for contact tracing but also, for example, the exchange of personal data within the ÖGD. Further difficulties in outbreak management arise from the cramped conditions on board ships and from the potential psychological stress on crew members and passengers, which have not yet been sufficiently considered.In view of all these challenges, it is paramount to strengthen the German Public Health Service in general and at points of entry and to intensify the exchange between the national, federal state and local levels.