Eurosurveillance remains in the updated list of the Directory of Open Access Journals (DOAJ). It was first added to the DOAJ on 9 September 2004. Eurosurveillance is also listed in the Securing a Hybrid Environment for Research Preservation and Access / Rights MEtadata for Open archiving (SHERPA/RoMEO) [2], a database which uses a colour‐coding scheme to classify publishers according to their self‐archiving policy and to show the copyright and open access self-archiving policies of academic journals. Eurosurveillance is listed there as a ‘green’ journal, which means that authors can archive pre-print (i.e. pre-refereeing), post-print (i.e. final draft post-refereeing) and archive the publisher's version/PDF.

ESCAIDE participants are invited to the fifth Eurosurveillance scientific seminar on 30 November 2016

Follow Eurosurveillance on Twitter: @Eurosurveillanc

Read our articles on Zika virus infection

Read our articles on mcr-1-mediated colistin resistance

Note of concern published for 'Epidemiological investigation of MERS-CoV spread in a single hospital in South Korea, May to June 2015',

In this issue

Home Eurosurveillance Weekly Release  2003: Volume 7/ Issue 45 Article 3
Back to Table of Contents

Eurosurveillance, Volume 7, Issue 45, 06 November 2003

Citation style for this article: Adak GK, Barker M. Outbreak of norovirus infection on a cruise liner in the Mediterranean. Euro Surveill. 2003;7(45):pii=2321. Available online:

Outbreak of norovirus infection on a cruise liner in the Mediterranean

Bob Adak ( Health Protection Agency Communicable Disease Surveillance Centre, London, and Mike Barker, Hampshire and Isle of Wight Health Protection Unit, Southampton, England

An outbreak of norovirus infection has been reported from a cruise liner owned by a British cruise operator, P&O Cruises. The liner departed from Southampton on England’s south coast for a cruise of the Mediterranean on 20 October 2003 with a complement of nearly 1800 passengers and over 800 crew. The first cases of gastroenteritis among passengers occurred on day 2 of the cruise. A sharp increase in illness was reported to the ship’s medical team on day 6. Over 500 people have been affected since the start of the outbreak, and symptoms include projectile vomiting and diarrhoea, with 86% of patients reporting vomiting. Most of the patients recovered after two days of illness. This epidemiological and clinical pattern is typical of norovirus outbreaks in semi-closed settings such as cruise ships, hotels, schools and healthcare institutions. Norovirus was identified in patient specimens by the medical team on the ship using a commercial enzyme linked immunosorbent assay (ELISA).

P&O Cruises have been working with the Health Protection Unit in Southampton on the implementation of control measures. As the home port for the vessel, Southampton Port Health Services have been kept fully informed of the progress of the outbreak and the control measures employed. The primary responsibility of the Port Health Service is to protect the public health and Port Health and medical officers will board the vessel when she docks to verify that procedures and policies have been correctly implemented in response to the outbreak.

Each year a small number of norovirus outbreaks on cruise ships, particularly ships sailing in the Mediterranean and Caribbean, are reported to health authorities around the world. Norovirus is the commonest cause of gastroenteritis in the developed world, and it has been estimated from population studies in England and the Netherlands that 1-3% of the population will be affected each year (2,3).

  1. Health Protection Agency. Outbreak of norovirus infection on a cruise liner. Commun Dis Rep CDR Wkly 2003; 13 (45): news. (
  2. Infectious Intestinal Disease Study Team. A report of the study of infectious intestinal disease in England. London: The Stationery Office; 2000. (for more information, see [accessed 6 November 2003]
  3. de Wit MA, Koopmans MP, Kortbeek LM, Wannet WJ, Vinje J, van Leusden F, et al. Sensor, a population-based cohort study on gastroenteritis in the Netherlands: incidence and etiology. Am J Epidemiol 2001; 154: 666-74. (abstract available at

back to top

Back to Table of Contents

The publisher’s policy on data collection and use of cookies.

Disclaimer: The opinions expressed by authors contributing to Eurosurveillance do not necessarily reflect the opinions of the European Centre for Disease Prevention and Control (ECDC) or the editorial team or the institutions with which the authors are affiliated. Neither ECDC nor any person acting on behalf of ECDC is responsible for the use that might be made of the information in this journal. The information provided on the Eurosurveillance site is designed to support, not replace, the relationship that exists between a patient/site visitor and his/her physician. Our website does not host any form of commercial advertisement. Except where otherwise stated, all manuscripts published after 1 January 2016 will be published under the Creative Commons Attribution (CC BY) licence. You are free to share and adapt the material, but you must give appropriate credit, provide a link to the licence, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.

Eurosurveillance [ISSN 1560-7917] - ©2007-2016. All rights reserved.

This website is certified by Health On the Net Foundation. Click to verify. This site complies with the HONcode standard for trustworthy health information:
verify here.