Brazilian Public Health Policy for Cruise Ships - A Review of Morbidity and Mortality Rates - 2009/2015

Introduction: For 10 years, Brazil has presented a significant flow in cruise ships with 597 011 travelers in 2015. Cruise ships represent a major mass gathering capacity, generating more risk of outbreaks and epidemics. Moreover, visiting several places presents travelers with the possibility of contact with some tropical diseases, which demands the development of specific policies for public health surveillance. Methods: In this study, case reports on transmissible diseases, accidents and deaths on board of cruise ships in the Brazilian coast during 2009 to 2015 were reviewed and correlated with the development of public health surveillance policies implemented by ANVISA, which established the mandatory communication of infectious diseases in 2009 and of deaths onboard in 2011. Results: Norovirus was the major etiologic agent of outbreaks, though the rate of outbreak has been declining in recent years. The lethality rate last season was 0.67:100 000, mostly because of preexisting conditions (75%); the remaining cases were caused by accidents. The mandatory reporting of outbreaks and deaths is an important tool in the planning of preventive actions for the safety and health of travelers in Brazil. The continuous evolution of hygiene surveillance may reduce outbreaks; the adoption of transparency policies and fast communication of deaths has contributed to the significant reduction in accidents. Conclusion: The effectiveness of specific public policies for the safety and security of travelers established for cruise ships in Brazil is indicated by the quantitative reduction in outbreaks and deaths. New destinations such as Cuba and China may adopt the same strategy of surveillance and protection against potential outbreaks of infectious diseases provided by cruise ships.