Transmission of SARS-CoV-2 Associated with Cruise Ship Travel: A Systematic Review
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Abstract
Background: Maritime and river travel may be associated with respiratory viral spread via infected passengers and/or crew and potentially through other transmission routes. The transmission models of SARS-CoV-2 associated with cruise ship travel are based on transmission dynamics of other respiratory viruses. We aimed to provide a summary and evaluation of relevant data on SARS-CoV-2 transmission aboard cruise ships, report policy implications, and highlight research gaps. Methods: We searched four electronic databases (up to 26 May 2022) and included studies on SARS-CoV-2 transmission aboard cruise ships. The quality of the studies was assessed based on five criteria, and relevant findings were reported. Results: We included 23 papers on onboard SARS-CoV-2 transmission (with 15 reports on different aspects of the outbreak on Diamond Princess and nine reports on other international cruises), 2 environmental studies, and 1 systematic review. Three articles presented data on both international cruises and the Diamond Princess. The quality of evidence from most studies was low to very low. Index case definitions were heterogeneous. The proportion of traced contacts ranged from 0.19 to 100%. Studies that followed up >80% of passengers and crew reported attack rates (AR) up to 59%. The presence of a distinct dose–response relationship was demonstrated by findings of increased ARs in multi-person cabins. Two studies performed viral cultures with eight positive results. Genomic sequencing and phylogenetic analyses were performed in individuals from three cruises. Two environmental studies reported PCR-positive samples (cycle threshold range 26.21–39.00). In one study, no infectious virus was isolated from any of the 76 environmental samples. Conclusion: Our review suggests that crowding and multiple persons per cabin were associated with an increased risk of transmission on cruise ships. Variations in design, methodology, and case ascertainment limit comparisons across studies and quantification of transmission risk. Standardized guidelines for conducting and reporting studies on cruise ships of acute respiratory infection transmission should be developed.
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SciScore for 10.1101/2021.10.11.21264724: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Ethics not detected. Sex as a biological variable not detected. Randomization Studies can be observational, including case series, ecological, or prospective; or interventional, including randomized trials and clinical reports, outbreak reports, case-control studies, experimental studies, and non-predictive modeling. Blinding not detected. Power Analysis not detected. Table 2: Resources
Software and Algorithms Sentences Resources Search Strategy: We will search the following electronic databases: LitCovid and the WHO COVID-19 from inception, and medRxiv and Google Scholar databases from January 2020. Google Scholarsuggested: (Google Scholar, RRID:SCR_008878)As important new data accumulates, we will produce a … SciScore for 10.1101/2021.10.11.21264724: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Ethics not detected. Sex as a biological variable not detected. Randomization Studies can be observational, including case series, ecological, or prospective; or interventional, including randomized trials and clinical reports, outbreak reports, case-control studies, experimental studies, and non-predictive modeling. Blinding not detected. Power Analysis not detected. Table 2: Resources
Software and Algorithms Sentences Resources Search Strategy: We will search the following electronic databases: LitCovid and the WHO COVID-19 from inception, and medRxiv and Google Scholar databases from January 2020. Google Scholarsuggested: (Google Scholar, RRID:SCR_008878)As important new data accumulates, we will produce a report as an individual rapid review and aim to make all our work available by depositing the review findings on the Oxford Research Archive. Oxford Research Archivesuggested: NoneResults from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).
Results from LimitationRecognizer: An explicit section about the limitations of the techniques employed in this study was not found. We encourage authors to address study limitations.Results from TrialIdentifier: No clinical trial numbers were referenced.
Results from Barzooka: We did not find any issues relating to the usage of bar graphs.
Results from JetFighter: We did not find any issues relating to colormaps.
Results from rtransparent:- Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
- Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
- No protocol registration statement was detected.
Results from scite Reference Check: We found no unreliable references.
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