Once the records had been reviewed, all unique identifiers associated with outbreaks and case reports were removed, including names, dates buy Antidiabetic Compound Library of birth, gender, countries of origin, job titles and duties on the vessel, vessel names, and cruise line names. Analysis was limited to varicella reports among crew members on cruise ships. Reports from cargo ships were not included since they do not carry trained medical personnel and follow different CDC recommendations

than those given to cruise ships. Passenger varicella cases and contacts were not included, since secondary cases associated with the index case would not be readily identified and only contact management information up to the time of disembarkation would be available. Categorical variables were described using frequencies and percentages, and continuous variables were described using ranges, means, and medians. This investigation was approved as non-research by the CDC Institutional Review Board. During 2005 to 2009, varicella reports comprised 357 (15%) of the total 2,305 maritime illness reports submitted to CDC during that period. Of the varicella reports, 278 (78%) were among cruise ship crew members. They were selleck products predominantly male (80%), their median age was 29 years (range 20–66), and three-quarters

Megestrol Acetate of the ill crew members were residents of Caribbean countries, Indonesia, the Philippines, or India. Excluding 2005, a partial reporting year, varicella was reported more commonly in the spring (28%) and winter (27%) months. During 2009, 94 cases of varicella among cruise ship crew members were reported to CDC Quarantine Stations. By manual review of each case report, 22 varicella clusters were identified. Four of the clusters were excluded because the cases were not considered epidemiologically linked. Therefore, after exclusion, 66/94 (70%) cases among crew members were associated with 18 outbreaks. The remaining 28 cases were considered isolated case reports.

Outbreak response by cruise ships reporting the 18 varicella outbreaks during 2009 included isolation of 66 (100%) of 66 cases, restriction of 66 (26%) of 255 close crew-contacts, and administration of post-exposure vaccine to 522 close contacts and other susceptible crew members (Table 2). No contacts received VZIG. The number of cases per outbreak ranged from 2 to 9. There were a total of 45 first-generation cases (range 1–6 per outbreak), 16 second-generation cases (range 0–4), and five additional-generation cases (range 0–2) (Figure 1). There was a slight but nonsignificant positive correlation between time to reporting and number of second- and additional-generation cases.