Is Your Cruise Ship
by Linda Coffman
When hundreds of cruise passengers
report to the infirmary with similar symptoms, does that necessarily
mean their ship is SICK?
Hardly. But you'd never know that
from news reports about nasty cruise ship diseases
that attack unsuspecting vacationers. CruiseDiva.com would like to
honor CBS News with the Most-Misleading-Headline Award Ever for... "Voyage of
the Sick Docks in NYC"! That one appeared several years ago and
is hard to top, although UK news outlets keep trying with the
use of "vomiting bug" and other equally as distasteful expressions.
Fact vs. Rumor
Let's face the facts first—travel by cruise ship often brings
together large numbers of people from different regions of North
America, as well as other parts of the world. In confined quarters,
certain respiratory and gastrointestinal diseases can quickly spread
from person-to-person contact. In addition, when ships dock and
passengers go ashore, they might be at risk for diseases prevalent
in the ports of call they visit. It is even quite possible that some
passengers who become ill during a cruise were infected prior to
boarding and they were actually "sick" before their
symptoms became apparent.
Wait a minute... before we examine
specific illnesses, let's think about how and when passengers are
likely to be exposed to them. Cruise ships aren't the only places
where large groups of people are likely to get together and
outbreaks of "flu" and the "24-hour stomach bug"
are common in such places as schools, nursing homes, and even
hospitals. According to Princess Cruises, "Statistics have
shown that the chance of contracting Norovirus on land is 1 in 12;
and 1 in 4000 on a cruise ship."
Because respiratory and
gastrointestinal diseases can percolate a few days before their
symptoms strike with a vengeance, it is highly likely that some
passengers bring their "bugs" on board with them. Before
reaching a cruise ship, many—if not most—passengers pass through
airports to board airplanes (with re-circulated, stuffy air) and
they may spend the night in a hotel at their embarkation port and
eat in local restaurants. Each of those places are breeding grounds
While most people are unaware that
they have contracted an illness before embarking, others know they
are sick but go aboard anyway, not acknowledging their illness for
fear of being denied boarding. They might not seek treatment once on
board due to the threat of being confined to their staterooms. These
"alpha passengers" can be the beginning of a ship-board
What To Do
According to the U.S. Center for Disease Control (CDC),
"Anyone who becomes ill while on a cruise ship should seek
medical attention on board and see a health care provider upon
returning home. Ill persons should limit contact with the general
population on board as much as possible to reduce further spread of
disease. People planning cruise ship travel, especially anyone older
than 65 years of age, anyone with acute or chronic illnesses, or
pregnant women should consult with a health care provider prior to
travel for advice and possible preventive medication. Other measures
to prevent the spread of infectious diseases on cruise ships include
frequent hand washing and obtaining appropriate immunizations prior
Two of the most prevalent diseases
that spread through cruise ship populations are Influenza and
In recent studies, influenza infection among travelers is quite
common; hence, it may rank with hepatitis A as one of the most
common vaccine-preventable travelers' diseases. Seasonal epidemics
of influenza generally occur during the winter months on an annual
or near annual basis and can cause disease in all age groups. While
rates of infection are highest among infants, children, and
adolescents, rates of serious illness and death are highest among
persons over 65 years of age and persons of any age who have medical
conditions that place them at high risk for complications from
influenza (e.g., chronic cardiopulmonary disease).
The risk for
exposure to influenza while traveling depends on the time of year
and destination. In the tropics, influenza can occur throughout the
year, while in the temperate regions of the Southern Hemisphere most
activity occurs from April through September. In temperate climates,
travelers can also be exposed to influenza during the summer,
especially when on board a cruise ship with travelers from areas of
the world where influenza viruses are circulating. Influenza
might be, at best, an inconvenience; however, it can lead to
complications, including life-threatening pneumonia, especially
among persons at increased risk for complications. Annual influenza
vaccination is the primary method for preventing influenza and its
These are a group of related viruses that cause acute
gastroenteritis in humans. Norovirus was recently approved as the
official genus name for the group of viruses provisionally described
as "Norwalk-like viruses" or NLV. The incubation
period for norovirus-associated gastroenteritis is usually between
24 and 48 hours, but cases can occur within 12 hours of exposure.
Norovirus infection usually presents as acute-onset vomiting,
diarrhea with abdominal cramps, and nausea. Low-grade fever also
occasionally occurs and vomiting is more common in children.
Dehydration is the most common complication, especially among the
young and elderly, and may require medical attention. Symptoms
generally last 24 to 60 hours. Recovery is usually complete and
there is no evidence of any serious long-term effect.
Highly contagious Noroviruses are
transmitted primarily through the fecal-oral route, either by
consumption of contaminated food or water or by direct
person-to-person spread. During outbreaks of norovirus
gastroenteritis, several modes of transmission have been documented;
for example, initial food borne transmission in a restaurant,
followed by secondary person-to-person transmission to household
Norovirus is often termed the
"cruise ship virus," even thought the vast majority—some
60 percent to 80 percent of outbreaks—occur on land. However, it
is often more unmistakable on cruise ships because all sick
passengers and crewmembers are treated by the same physician, who is
required to prepare a special report for the CDC if an outbreak
affects 2% or more of the passengers or crew. The CDC launches and
investigation if 3% of passengers or crewmembers become ill.
What to do?
First and foremost—WASH
your hands often with hot water and soap. A waterless, sanitizing hand cleaner is also
recommended for times when soap and water aren't available (they are effective and come in travel size bottles).
Some passengers even go so far as to pack disinfectant wipes or a small aerosol can of
germ-killing spray to treat their stateroom
furnishings, bedding, and personal bathrooms before using them.
If you get sick, seek medical
treatment and try not to infect other passengers.
Princess Cruise Line did everything
right—read how they effectively dealt with Norovirus
on Regal Princess in August/September 2003.
for Disease Control & Princess
Pack a Cruise
Travel First Aid Kit and be prepared for small emergencies.
Get CruiseDiva.com's list of what to include.
ship's Sick Bay. You hope you won't need it but it's comforting to
know you can depend on it, if only for a bandage.
Vessel Sanitation Scores—Check out your ship before you
The Centers for Disease Control and
Prevention (CDC) established the Vessel Sanitation Program (VSP) in
1975 as a cooperative endeavor with the cruise vessel industry. The
VSP utilizes a two-prong approach to disease control aboard cruise