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Bacterial Meningitis outbreak reported on MSC Orchestra

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According to news reports, 4 crew members from MSC Orchestra have been hospitalized in Livorno due to an outbreak of bacterial meningitis. Best wishes to all concerned. Regards, Salacia

 

Source: http://www.agi.it/english-version/italy/elenco-notizie/201210081244-cro-ren1047-msc_crew_meningitis_cases_confirmed_cruise_continues

 

http://www.ansamed.info/ansamed/en/news/regions/tuscany/2012/10/08/Man-fighting-life-meningitis-outbreak-liner_7594571.html

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We just got an e-mail from our travel agent 30 minutes ago that we need to be examined by our doctor. Our doctor needs specifics on the strain of Meningitis involved in order to treat us properly, but neither our travel agent nor MSC were able to provide any details. Now it's after 6 and nobody is picking up the phone anymore.

 

Is there an MSC emergency number we can call to reach someone?

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We just got an e-mail from our travel agent 30 minutes ago that we need to be examined by our doctor. Our doctor needs specifics on the strain of Meningitis involved in order to treat us properly, but neither our travel agent nor MSC were able to provide any details. Now it's after 6 and nobody is picking up the phone anymore.

 

Is there an MSC emergency number we can call to reach someone?

 

Alex, I'm sorry, I can't locate an emergency number, but there must be a number to phone the ship directly and speak with the medical centre on board if necessary. Here is a phone number for MSC in the United States: 1-877.665.4655 - maybe they can offer more information.

 

The news reports indicate that 4 crew members are being treated for bacterial meningitis, but I've found no mention of the particular strain of bacterial meningitis. More information regarding meningitis can be found at the Meningitis Foundation of America website http://www.meningitisfoundationofamerica.org/templates/section-view/18/index.html

 

Best wishes,

Salacia

Edited by Salacia

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Alex, I'm sorry, I can't locate an emergency number, but there must be a number to phone the ship directly and speak with the medical centre on board if necessary. Here is a phone number for MSC in the United States: 1-877.665.4655 - maybe they can offer more information.

 

The news reports indicate that 4 crew members are being treated for bacterial meningitis. More information regarding meningitis can be found at the Meningitis Foundation of America website http://www.meningitisfoundationofamerica.org/templates/section-view/18/index.html

 

Best wishes,

Salacia

 

Hi Salacia,

 

Thank you very much! My wife called the MSC number in the US. They were very nice and and promised to get back to us with more details. According to our doctor, the choice of antibiotic will depend on the exact strain.

 

Very poor showing of MSC Germany to blast out this e-mail that we needed to see a doctor 30 minutes before the office closed and then to be unavailable for further information.

 

According to Auststrian news sites, all passemgers on the Orchestra were put on antibiotics, so one would have expected MSC to make some info on the recommended kind available.

 

Thanks again!

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Yesterday about 5pm local time an announcement of "Charlie Alpha" came over the PA system. Having family in the cruise industry, I have learnt that this means (charlie) security threat (alpha) medical emergency.

 

On shore there was quite a lot of activity (in comparison to previously). We did not depart on schedule and just before dinner around 7pm they announced that a member of the crew was found to have bacterial meningitis. This announcement came first in Italian - and after that it was impossible to hear anything in the other languages. Dinner proceeded as normal. Later at night - a letter (in extremely bad English) was distributed to say that a crew member was found to have bacterial meningitis. We were issued a ciproflaxin 500mg tablet with no explanation of side effects or cautions. I went down to the medical centre to ask - but there everything was quite chaotic.

 

I disembarked on time today (as scheduled - I boarded in Villefranche) but no extra information was given until I received a mail from the travel agent late this afternoon. As stated above - I have been advised to contact my physician - but given no advice about what to do, symptoms to look out for etc.

 

On advice from my doctor I too am trying to get information on the exact strain.

 

Thinking back, I did notice that there were people wearing masks, constantly polishing the railings the last couple of days. I have today learnt that this is usual behaviour when there is some kind of outbreak on a cruiseship.

 

I am crossing my fingers that these 4 cases are the only ones and that the crew in intensive care pull through.

 

Kathleen

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The following is translated from Italian to English...so some context will be lost...

 

Meningitis on Msc Orchestra in Livorno: 2 cases and 2 suspected. The ship allocated to France

 

It left the port of Livorno for the cruise ship France they were recorded at least two cases of meningococcal infection among crew members. On board thousands of people to whom it was administered prophylactically. Before sailing there is who came down out of fear. The official statement of the company

 

LIVORNO. Two cases of meningitis, two other suspected cases. Four crew members aboard the Msc Orchestra cruise ship were hospitalized this afternoon to a hospital in Livorno. The cruise ship, coming from Naples docked earlier today, Sunday, at the Valessini Gate of the port of Livorno where they landed those who, among the 2,200 passengers on board, came up in the city of Livorno.

 

Only in the early afternoon is tripped the alarm. Among the 975 crewmembers, two engine room personnel were hurt, an Indonesian of 32 years and a Filipino by 30. Now both are very severe, hospitalized in intensive care at a hospital in Livorno. One of them is in a coma.

 

Were warned maritime authorities and medical institutions. On Board have risen just doctors who have briefly with both a bacterial meningitis admission immediately Recalling: the arrival at the hospital around 14. It was over: in the late afternoon, another crew member has misheard, symptoms were high fevers and severe headache. And then a fourth. Also for their hospital shelter and rush in the infectious diseases ward.

 

Meanwhile, for passengers proceeding to France was willing prophylaxis, as well as to all the personnel of the ship: an antibiotic Tablet from 500 mg for adults and a syrup for children. For passengers landed at Livorno the maritime health authority considered nonessential prophylaxis. Were administered around 2,800 doses anti-meningitis. This is bacterial meningitis, meningococcal.

 

At 23.15 the ship is divided from the port of Livorno to Villefranche sur Mer, the arrival is scheduled for 7. Before sailing around 40 passengers asked to get off: the fear was too much. Permission granted, has waited a long time to give them time to prepare their cases and get off.

 

THE OFFICIAL RELEASE OF MSC

Today aboard the MSC Orchestra is an established fact that a crew member is suffering from bacterial meningitis. It was therefore disembarked and rushed to a hospital where it is already subjected to appropriate medical care. 3 other crew members with suspect symptoms were also landed and entrusted to health facilities for appropriate investigations and therapies. Purely precautionary purposes in conjunction with maritime health authorities was prepared a cure of antibiotic prophylaxis for all passengers in the previous days. The ship is departing according to plan established to continue her cruise.

 

http://iltirreno.gelocal.it/livorno/cronaca/2012/10/07/news/due-casi-di-meningite-a-bordo-di-una-nave-da-crociera-1.5819849

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Hi Alex. You're very welcome; hope you get the information you need quickly.

 

I'm also concerned for those passengers (and their fellow travellers) that might be on planes or some other mode of public transportation on their way home after the cruise, and are unaware of the outbreak.

 

Shame on any cruise line that doesn't release all the necessary information to the public as soon as possible after an outbreak of a serious contagious illness. -S.

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Hi Kathleen,

 

Thank you, this is very helpful. One of the questions my doctor had was regarding the recommended antibiotic, so knowing the kind you got on the ship is a starting point.

 

BTW, we haven't heard back from the American MSC office yet. In case I find anything out, I'll post it here.

 

Now as you mention them constantly polishing the railings: the night before we disembarked in Livorno, our son touched one of the railings and was told to immediately wash his hands, so they must have used some pretty strong stuff for desinfection.

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MSC Crociere in Italy has also posted updates on their facebookpage:

 

MSC Crociere conferma che a quattro membri dell’equipaggio sbarcati ieri a Livorno, è stata diagnosticata una meningite batterica. Tutti e quattro sono ora ricoverati in ospedale e tenuti sotto stretta osservazione. In accordo con le autorità sanitarie, tutti i passeggeri e tutti i membri dell’equipaggio hanno ricevuto una profilassi antibiotica come misura precauzionale. Al momento non si segnalano altri casi né tra i membri dell’equipaggio né tra i passeggeri. La Divisione Medica di MSC Crociere è a bordo per tenere sotto controllo la situazione e svolgere ulteriori accertamenti. MSC Orchestra è arrivata oggi regolarmente al porto di Villefranche sur Mer, in Francia, e proseguirà regolarmente la sua navigazione verso Valencia, in Spagna. A i passeggeri imbarcati oggi sarà proposta la profilassi antibiotica, come ulteriore misura precauzionale.

MSC Crociere sta facendo tutto il necessario per salvaguardare la salute dei suoi ospiti e di tutti i membri dell’equipaggio.

 

http://www.facebook.com/pages/MSC-Crociere/40909081326

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Italian to English translation (provided by Google) of the statement mentioned previously by Kathleen:

http://www.salastampa.salute.gov.it/attualita/paDettaglioComunicati.jsp?id=3726

The Ministry of Health warned yesterday evening, Sunday, Oct. 7, at 19.55 the French Focal Point for the International Health Regulations of the situation on board the ship MSC ORCHESTRA, where they were found four cases of meningococcal meningitis. And since yesterday the health authorities of the two countries are in constant contact. The cases of the disease were reported from the ship around 16 by the Office of Air and Maritime Health (USMAF) of Livorno. A doctor of 'USMAF spoke on the cruise ship, after reporting illness in two cases of mariners, who were landed and immediately hospitalized at the Hospital of Livorno. The USMAF then gave directions for the isolation and prophylaxis, as provided in these cases, persons in contact with the two seamen, and prophylaxis for all passengers embarked on the same day in Livorno and still on board the ship and for all crew members. Drugs for prophylaxis (2,800 doses) have been found promptly and administered by the ASL responsible for the area. It is of ciprofloxacin and rifampicin. The USMAF has also arranged health surveillance for 7 days for all staff and passengers, and invited the MSC to contact passengers landed in the last seven days, Catania and Naples, to undergo the same prophylaxis. Two other seamen who accused symptoms similar to the first two, were landed and stored in a day. The USMAF of Livorno has warned the episode USMAF Catania and Naples, port of which the ship had stopped a few days earlier.

 

Today, October 8, 4 cases of meningococcal meningitis were confirmed and two of them is surely involved serotype C. Were found in the crew that used to cooking and that, therefore, they should not have had continuous and close contact with passengers. However, we can not exclude a particular aggressiveness of the pathogen that caused the outbreak on the ship, the Ministry of Health has informed all the regions about the possibility that passengers landed in Italy by MSC ORCHESTRA, alerted by the Company naval might address the prevention departments of ASL or your doctor for evaluation of prophylactic treatment indicated. The offices of the Ministry contacted the international health authorities, for the surveillance measures provided for in the case.

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MSC Crociere in Italy has also posted updates on their facebookpage:

 

MSC Crociere conferma che a quattro membri dell’equipaggio sbarcati ieri a Livorno, è stata diagnosticata una meningite batterica. Tutti e quattro sono ora ricoverati in ospedale e tenuti sotto stretta osservazione. In accordo con le autorità sanitarie, tutti i passeggeri e tutti i membri dell’equipaggio hanno ricevuto una profilassi antibiotica come misura precauzionale. Al momento non si segnalano altri casi né tra i membri dell’equipaggio né tra i passeggeri. La Divisione Medica di MSC Crociere è a bordo per tenere sotto controllo la situazione e svolgere ulteriori accertamenti. MSC Orchestra è arrivata oggi regolarmente al porto di Villefranche sur Mer, in Francia, e proseguirà regolarmente la sua navigazione verso Valencia, in Spagna. A i passeggeri imbarcati oggi sarà proposta la profilassi antibiotica, come ulteriore misura precauzionale.

MSC Crociere sta facendo tutto il necessario per salvaguardare la salute dei suoi ospiti e di tutti i membri dell’equipaggio.

 

http://www.facebook.com/pages/MSC-Crociere/40909081326

 

Italian to English translation (again provided by Google)

MSC Cruises confirms that four crew members landed yesterday in Livorno, was diagnosed with bacterial meningitis. All four are now hospitalized and closely monitored. According to health authorities, all passengers and all crew members have received prophylactic antibiotics as a precautionary measure. At the time there were no other cases or among the crew or passengers. The Medical Division of MSC Cruises is on board to control the situation and carry out further investigations. MSC Orchestra is now regularly arrived at the port of Villefranche sur Mer, France, on a regular basis and its navigation to Valencia, Spain. A boarding passengers now will be offered antibiotic prophylaxis, as an additional precautionary measure.

MSC Cruises is doing everything necessary to protect the health of all our guests and crew members.

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According to the following: http://www.salastampa.salute.gov.it/attualita/paDettaglioComunicati.jsp?id=3726

the strain is Meningococcal Serotype C

Let us hope some official source can confirm.

 

Kathleen

 

Thank you, this will be very helpful information for our doctor tomorrow. Based on your earlier information, our doctor prescribed us also the Cipro 500 and for the kids Azithromezin 250, all after 9 pm CET.

 

She said the Cipro is not particularly strong, but does not have any serious side effects either. Normally, stonger antibiotics are needed to treat Meningitis.

 

No word from MSC yet. I hope they are willing to cover the medical bills. Can't be cheap to keep the doctors up so late just because the can't come across with the needed information.

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MSC Cruises is doing everything necessary to protect the health of all our guests and crew members.

 

One has to take this as irony given the way they handle this situation. I really like MSC, but I'm starting to wonder if there is a cultural difference in the way incidents are handled.

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MSC Cruises confirms that four MSC Orchestra crew members disembarked in Livorno, Italy yesterday, Sunday, October 7th, 2012. They have been diagnosed with bacterial meningitis and are receiving appropriate medical treatment in Livorno’s main hospital. No additional crew members or guests have presented with symptoms. All guests and crew were provided with an antibiotic treatment (Ciprofloxacin is the active ingredient) which is easy and safe to take as well as highly effective as a preventative measure. In addition, an MSC Cruises medical taskforce, headed up by Pierfrancesco Lepore, head of MSC Cruises Corporate Medical Services, Specialist in Hygiene and Preventive Medicine, have boarded the ship.

 

MSC Cruises is in close contact with the crew members’ families.

 

The ship is operating normally. Today MSC Orchestra called as planned in Villefranche, France, where guests enjoyed excursions in the region as well as various onboard entertainment activities. MSC Orchestra is now on her way to Valencia as per her planned itinerary.

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MSC Cruises confirms that four MSC Orchestra crew members disembarked in Livorno, Italy yesterday, Sunday, October 7th, 2012. They have been diagnosed with bacterial meningitis and are receiving appropriate medical treatment in Livorno’s main hospital. No additional crew members or guests have presented with symptoms. All guests and crew were provided with an antibiotic treatment (Ciprofloxacin is the active ingredient) which is easy and safe to take as well as highly effective as a preventative measure. In addition, an MSC Cruises medical taskforce, headed up by Pierfrancesco Lepore, head of MSC Cruises Corporate Medical Services, Specialist in Hygiene and Preventive Medicine, have boarded the ship.

 

MSC Cruises is in close contact with the crew members’ families.

 

The ship is operating normally. Today MSC Orchestra called as planned in Villefranche, France, where guests enjoyed excursions in the region as well as various onboard entertainment activities. MSC Orchestra is now on her way to Valencia as per her planned itinerary.

 

Hi MSC Cruises USA,

 

Can you confirm the strain of Meningitis? This is critical information that my doctor needs to determine the appropriate treatment.

 

Thanks!

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MSC Cruises confirms that four MSC Orchestra crew members disembarked in Livorno, Italy yesterday, Sunday, October 7th, 2012. They have been diagnosed with bacterial meningitis and are receiving appropriate medical treatment in Livorno’s main hospital. No additional crew members or guests have presented with symptoms. All guests and crew were provided with an antibiotic treatment (Ciprofloxacin is the active ingredient) which is easy and safe to take as well as highly effective as a preventative measure. In addition, an MSC Cruises medical taskforce, headed up by Pierfrancesco Lepore, head of MSC Cruises Corporate Medical Services, Specialist in Hygiene and Preventive Medicine, have boarded the ship.

 

MSC Cruises is in close contact with the crew members’ families.

 

The ship is operating normally. Today MSC Orchestra called as planned in Villefranche, France, where guests enjoyed excursions in the region as well as various onboard entertainment activities. MSC Orchestra is now on her way to Valencia as per her planned itinerary.

 

MSC Cruises USA, I'm happy to read that there have been no additional cases reported. What is the time period between possible exposure and onset of symptoms? (I've read it is up to 7 days, is that accurate?)

 

Also, what is the time period during which passengers who were on the ship before the outbreak was confirmed was might also have exposed to the illness? Thanks -S.

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As soon as the hospital confirmed on October 7th that the crew members were diagnosed with Neisseria meningitides we took immediate action and put a plan in place. MSC has taken all appropriate measures to ensure our guests health and safety. All guests and crew members were given medicination on October 7th and October 8th.

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As soon as the hospital confirmed on October 7th that the crew members were diagnosed with Neisseria meningitides we took immediate action and put a plan in place. MSC has taken all appropriate measures to ensure our guests health and safety. All guests and crew members were given medicination on October 7th and October 8th.

 

MSC Cruises USA, thanks for your post.

 

I noted with interest that you made no mention of the passengers that disemarked prior to October 7th or 8th, when "medicination" was distributed to passengers and crew. Also noted that several specific questions directed to MSC remain unanswered, or with answered with lack of specificity.

 

Lack of response is not in the best interst of public health, nor is it the best interest of MSC or the cruise industry.

 

With best wishes to those affected,

Salacia

Edited by Salacia

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One has to take this as irony given the way they handle this situation. I really like MSC, but I'm starting to wonder if there is a cultural difference in the way incidents are handled.

 

I also wonder, but there are protocols in place when it comes to contagious diseases, and cultural differences are of little difference: bacteria doesn't discriminate.

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MSC Cruises USA, I'm happy to read that there have been no additional cases reported. What is the time period between possible exposure and onset of symptoms? (I've read it is up to 7 days, is that accurate?)

 

Also, what is the time period during which passengers who were on the ship before the outbreak was confirmed was might also have exposed to the illness? Thanks -S.

 

Lacking a response from MSC, quoted below is the information I found , but I'm unclear as to how the how long the antibiotics must be taken...is one dose sufficient? From what I've read, passengers and crew were given one dose.

Also wondering if ciprofoxacin and rifampicin were the the most available anti-biotics for 2,800 people. (Isn't that the anti-biotics stockpiled in the event of terror attacks? - Not specific to the treatment of bacterial meningitis?) Happy that anti-biotics were availabe in mass quantities, but I do hope that anyone who might have been exposed knows to contact their doctor for assesment.

 

(CNN) -- Doctors distributed antibiotics to passengers aboard an Italian cruise ship after four crew members were diagnosed with bacterial meningitis, Italy's health ministry reported Monday.

All four were taken to hospitals in the Italian port of Livorno after the crew of the MSC Orchestra reported the illnesses, the ministry said. More than 2,800 doses of the antibiotics ciprofloxacin and rifampicin were issued for passengers, and the ministry said passengers who have disembarked in the past week should take similar precautions quoted from http://www.cnn.com/2012/10/08/health/italy-meningitis/index.html

Edited by Salacia

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Good morning Cruise Critic Friends,

 

As a precautionary measure we are reaching out to all guests who sailed on board MSC Orchestra from Oct. 1st on.

 

We understand you are wanting answers to questions asked and we are looking into them and will update you with more information as the day progresses.

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Hi all,

 

To follow up with further inquiries we have provided additional information below.

 

When was medication first given?

All guests on board MSC Orchestra received antibiotic treatment as a precautionary measure as soon as MSC received the diagnosis with bacterial meningitis for the 4 crew members. The treatment was given Sunday evening, October 7th. The embarking guests in Livorno received the treatment the day after, October 8th.

 

Are guests given one dose or is it something they take for several days?

Adults should take ciprofloxacina (500 mg) only once. For guests who have already taken a dose of ciprofloxacina (500 mg), there is no need for follow up action. Pregnant women and those allergic to the treatment should refer directly to their doctor before taking any medication. Children weighing under 66 pounds should be taken to their doctor or local health service where treatment should be administered by a different method.

 

What is the time frame from exposure to onset of symptoms?

Symptoms can appear 7-10 day after contagion.

 

I hope this helps answer your inquiries at this time.

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I may have missed it - what positions did the affected crew hold on the ship cabin stewards, bar staff, kitchen staff what???

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Irishman45,

 

We will need to contact our home office in Italy to confirm the crew members position. We will update you when we receive confirmation, which will most likely be tomorrow morning.

 

Regards,

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I'd like to thank everyone who provided us yesterday with the critical information that our doctor needed, in particular Salacia and Kathleen, but also MSC Cruises USA who stepped in where MSC Germany failed to communicate. Fantastic job of our doctor who stayed in communication with us till 9 pm till we were able to collect some information.

 

We got our prescription of Ciprofoxacin filled yesterday and should be ok.

 

Here are my final thoughts on the case:

I give credit to MSC for informing us rather than trying to cover it up. Nevertheless, sending out an e-mail 30 minutes before their office closed recommending to see a doctor, but not to provide any of the specifics that a doctor needed to assess the situation and then to be unreachable is just not the way to go.

 

Here's what I would have expected (hoping MSC is able to learn for future incidents):

 

- An e-mail that includes all necessary medical information

- including the strain of bacteria, recommended antibiotics, typical symptoms to watch out for

- including the positions that the affected crew members worked in so that the risk of exposure can be assessed

- including the phone number of someone on the medical team who is able to answer specific questions that a patient or doctor may have

 

Thank again,

 

Michael

Edited by Alex71

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Irishman45-

 

The crew members affected by this unfortunate illness worked as a waiter, an assistant waiter and two of the crew worked in the kitchen.

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Irishman45-

 

The crew members affected by this unfortunate illness worked as a waiter, an assistant waiter and two of the crew worked in the kitchen.

 

Do you know which tables they served? We had table 704 in the Ibiscus restaurant.

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Hi Alex71,

 

I would be happy to get that information and let you know as soon as I receive it.

 

That would be great!

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Hi all,

 

To follow up with further inquiries we have provided additional information below.

 

When was medication first given?

All guests on board MSC Orchestra received antibiotic treatment as a precautionary measure as soon as MSC received the diagnosis with bacterial meningitis for the 4 crew members. The treatment was given Sunday evening, October 7th. The embarking guests in Livorno received the treatment the day after, October 8th.

 

Are guests given one dose or is it something they take for several days?

Adults should take ciprofloxacina (500 mg) only once. For guests who have already taken a dose of ciprofloxacina (500 mg), there is no need for follow up action. Pregnant women and those allergic to the treatment should refer directly to their doctor before taking any medication. Children weighing under 66 pounds should be taken to their doctor or local health service where treatment should be administered by a different method.

 

What is the time frame from exposure to onset of symptoms?

Symptoms can appear 7-10 day after contagion.

 

I hope this helps answer your inquiries at this time.

 

MSC Cruises USA, thank you very much for your response.

 

The ill crew members were admitted to hospital in Livorno on Oct 7, which means that they might have contracted bacterial meningitis 7 -10 days prior to the onset of symptoms, according to the information provided.

 

Depending on when the symptoms first appeared (and it must have been prior to Oct.7), those in close contact might have been exposed 10 or more days earlier. So what has been given as the possible exposure time frame appears to be a few days short of the contagion period. If that is correct, more notifications are necessary, not limited to passengers who disembarked the ship one week prior to the hospitalization of those crew members.

 

Thanks again for your reponse and best wishes to the stricken crew members and their loved ones; I am so sorry for their pain. Ciao, -S.

Edited by Salacia

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