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Outbreaks of gastrointestinal disease may occur on board of cruise ships due to the consumption of contaminated water or food, with a fast person-to-person transmission. Epidemiologic investigations carried out by Centers for Disease Control and Prevention in USA, have confirmed that more than 95% of gastroenteritis outbreaks in cruise ships are caused by norovirus (NoV). In March 2011 an outbreak of acute gastroenteritis (AGE) occurred on a cruise ship with 1,224 passengers and 554 crew members that sailed from Rio de Janeiro, Rio de Janeiro State (Southeast, Brazil) to Manaus, Amazonas State (North) and stopovers in Recife, Pernambuco State, and Fortaleza, Ceara State (Northeast) and Belem, Para State (North). Epidemiological data were obtained and seven rectal swab samples were collected and tested for NoV detection and characterization by molecular techniques. A total of 53 persons (42 passengers and 11 crew members) developed AGE, 75.5% of whom were older than 60 years old. The symptoms duration was less than 48 h, most of the patients presenting vomiting (79.2%) and diarrhea (73.6%). Most of the cases varied from mild to moderate and only one patient needed parenteral rehydration. Cases of AGE were recorded in eight of 12 vessel floors, especially in the recreational areas. The seven rectal samples collected were all NoV-positive by RT-PCR and all NoV strains were genogrouped as GII by semi-nested PCR. The quantitative real-time PCR produced a 57.1% NoV positivity rate. The partial nucleotide sequencing classified five (71.4%) of these samples as GII.P4. Our findings highlight the need for continuous viral enteropathogens surveillance including cruise ships considering the increase of this kind of touristic option in Brazil.

Norovirus outbreak in a cruise ship along the Brazilian coast, March 2011