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From Princess Cruises:

Treating a Princess Norovirus Outbreak

9/4/03 -- Onboard the August 18, 2003 sailing of Princess Cruises' ship Regal Princess, which concluded in New York on Tuesday, September 2, there was an increased incidence of gastrointestinal illness among the passengers. This illness was confirmed through laboratory testing to be caused by Norovirus (also known as Norwalk Virus), which is a common but highly contagious illness that is easily transmitted from person-to-person. Over the full course of the voyage, a cumulative total of 302 passengers (20%) and 45 crew members (7%) reported ill with the virus. Princess began extensive measures to interrupt the spread of the virus when it was noticed on the third day of the cruise.

Regal Princess has now completed an extensive sanitation process over the last three days, and the ship has been thoroughly cleaned and is now ready for its next cruise departing this afternoon. CDC's Vessel Sanitation Chief Dave Forney has expressed satisfaction with Princess' response procedures and disinfection measures, and feels that the ship is safe for embarking passengers. He was quoted in the press yesterday as saying Princess' protocols are "top notch," and that "they notified the CDC well before they were required to do so." Throughout this sanitizing process, we have been working closely with the CDC, who are supportive of the measures we implemented.

Regal Princess had arrived one day earlier than scheduled into New York in order to conduct this thorough sanitization. While we regretted shortening the previous cruise by one day, we did so as the health and well-being of our passengers and crew is our highest priority. Conducting this intensive cleaning without passengers onboard was the most effective way to stop transmission of this common but contagious virus, which we believe was brought aboard by an ill passenger in Copenhagen. There was no increase in gastrointestinal incidences during the previous cruise.

The additional time in New York gave us extra days to conduct a full sanitation of the vessel, and this was concluded successfully last night. The ship's crew, in an addition to an 18-member specially-trained sanitation team, and 25 members of an outside sanitation company worked to disinfect all areas of the ship, including all passenger and crew areas. Some of these measures included:

  • Public areas including passenger and crew cabins were either "fogged," or sprayed with an effective sanitizing solution designed to kill Norovirus
  • Contact surfaces were wiped clean with the sanitizing solution
  • Linens and food utensils were disinfected
  • Carpets through the ship were shampooed with the disinfectant solution
  • The passenger terminal was sanitized by a fully-trained local sanitation team after the passengers departed on Tuesday
  • The motorcoaches used to transport the passengers back to the airport on Tuesday were fully sanitized

Our intensive measures are credited with reducing the number of passengers who reported unwell each day on the previous sailing. When the ship arrived in New York, only two passengers were still unwell, and those passengers stayed aboard the ship overnight and departed for home yesterday. We sincerely regretted any disruption to our passengers' vacation plans and are pleased that, under the circumstances, the large majority of our guests were understanding of the situation and pleased with our crew's efforts to continue to provide an enjoyable cruise experience. The previously ill crew members aboard Regal Princess have completely recovered.

Passengers embarking the ship today were notified through their travel agents last week that there was an increased incidence of gastrointestinal virus, identified as Norovirus, onboard the ship, and invited them to contact us with their concerns. In the event some of the passengers did not receive this information, they are being provided with details upon check-in, and we have Princess medical and hotel staff standing by during embarkation to answer any questions.

The ship is sailing today close to its capacity of 1,590 passengers with 679 crew members. The Regal Princess departs New York at 5 pm on a 10-day cruise through New England and Eastern Canada, calling at Newport, Boston, Bar Harbor, St. John's, Halifax, Quebec and Montreal.

What Happened on the Previous Sailing:
At the onset of the increased incidence of gastrointestinal illness, which occurred on the third day of the cruise, we immediately intensified sanitation efforts onboard Regal Princess to minimize transmission to other passengers. Princess collaborated with local and international public health agencies and initiated an extensive sanitation program onboard in association with the U.S. Centers for Disease Control and Prevention (CDC), U.K. Port Health Authorities and Health Canada, to interrupt the spread of this virus.

As a result of our efforts, we saw a decline in the number of passengers who reported unwell each day, and the majority of people affected by the illness recovered quickly and completely within 12-24 hours. As the cruise concludes, we're pleased that our efforts to contain the illness were successful, and there are only two remaining ill passengers who are recovering onboard and are expected to depart for home on Wednesday, September 3.

The pattern of the spread of illness suggests that the virus was most likely introduced onto the ship in Copenhagen by a passenger with the illness. Land based Norovirus outbreaks are common and have been occurring recently throughout Europe and North America. Under the circumstances, we decided to conduct a special, comprehensive sanitation of the ship without any passengers onboard, and to proceed directly to New York to accomplish this sanitization process and minimize the risk of any further transmission. This necessitated a cancellation of two ports -- Qaqortoq in Greenland, and St. John's in Newfoundland, and the ship arrived one day early in New York.

The ship departed Copenhagen August 18 and sailed on a 16-day Northern Europe/Atlantic crossing itinerary, arriving in New York on September 2. The ship carried 1,528 passengers and 679 crew members. Over the course of the voyage, 301 passengers and 45 crew were affected.

What Princess did to contain the illness:
The safety and comfort of our passengers and crew is always Princess' number one priority. As is currently standard procedure across our fleet, all the ship's passengers were provided with a health notice advising of the increased activity of the Norovirus worldwide and the precautionary measures to avoid contraction and spread. We enhanced the already intensive measures onboard Regal Princess to contain this illness, which included sanitation of every aspect of the ship.

* Two of Princess' Senior Public Health Officers joined Regal Princess, and two special sanitation teams created by Princess to support its vessels in a situation such as this were mobilized on the ship. A third sanitation team joined the ship to further assist. The team members have been specially trained in sanitizing routines using disinfectant agents and supplemented the efforts already being implemented by the ship.

* Passengers and crew were provided with regular health advisories alerting them to an increased incidence of gastrointestinal illness, along with measures to minimize the risk of infection such as washing hands frequently and thoroughly, avoid touching the mouth, avoiding use of the buffet area if symptomatic, and reporting to the medical center if any symptoms are experienced.

Examples of sanitation measures undertaken onboard Regal Princess included:

  • Using a powerful sanitation solution to regularly clean all food and beverage areas of the galley, affected passenger cabins, public restrooms and all surfaces in the ship's public areas (e.g. handrails, door knobs, elevator buttons) including soft furnishings, multiple times each day

  • Suspension of all galley tours

  • Slot machines and casino furnishings were sanitized several times daily

  • Gym equipment was sanitized regularly

  • Public restroom doors were propped open to reduce risks of unwitting door handle contamination

  • Bar snacks were offered in single servings only

  • All dishwashers were being checked hourly to ensure they were operating at a temperature of 165F or above

* Passengers who reported to the medical center with symptoms were treated, without charge. Passengers who were unwell were asked to isolate themselves in their stateroom until non-contagious and comply with the doctor's instructions. Unwell passengers were also asked not to proceed ashore, and any shore excursion costs were refunded.

* Room service was provided to affected passengers and every effort was made to make them as comfortable as possible.

* As drinking large amounts of clear fluids is helpful for diarrhea, we provided complimentary bottled water to affected passengers.

What is Norovirus?
Norovirus is an extremely common and highly
contagious virus which causes gastroenteritis (an inflammation of the stomach and the intestines). Symptoms of Norovirus include nausea, vomiting and watery diarrhea; some people may also experience headache, mild fever and abdominal cramps. It is sometimes known as the "24-hour stomach bug." Symptoms usually last between one and three days and generally resolve without treatment or long-term consequences. The incubation period of the virus averages about 24 hours, and people infected with the illness typically remain contagious for 72 hours after they have recovered.

Norovirus is spread by direct person-to-person contact. As the viral particles are able to survive for long periods in the environment, the illness can be spread through contact with surfaces such as hand rails, door knobs and elevator buttons, or by sharing food, water or eating utensils.

Norovirus is not an upper respiratory virus such as the flu, and only the common cold is reported more frequently. The CDC estimates that Norovirus is the causative agent of some 23 million cases of gastroenteritis in the USA annually, however the vast majority of all outbreaks occur on land. Statistics have shown that the chance of contracting Norovirus on land is 1 in 12; and 1 in 4000 on a cruise ship.

Source: Princess Cruises

More... Is Your Cruise Ship Sick? Separate the facts from fiction.

Pack a Cruise Travel First Aid Kit and be prepared for small emergencies. Get's list of what to include.

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CDC Vessel Sanitation Scores—Check out your ship before you sail.

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 ships:

  • Prevent the introduction, transmission or spread of communicable diseases into the United States through established public health policies and procedures.
  • Assist the cruise ship industry in the development and implementation of comprehensive sanitation programs to protect the health of passengers and crew members aboard cruise vessels.

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