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Norovirus Breaks Out on Cruise


100 passengers catch terrible cruise bug

Wikimedia/Citking

Cruises are supposed to be fancy and luxurious, or at the very least a way for people who are afraid of flying to take a decent vacation. But recent trips haven't been going well for all passengers, especially the 105 vacationers who were sickened by a norovirus outbreak on a Royal Caribbean cruise this week.

The 915-foot Vision of the Seas departed from Port Everglades, Fla., on February 25 for an 11-day tour including stops at Barbados, Grenada, and Aruba. According to The Inquisitr, the ship was carrying 772 crewmembers and 1,991 passengers.

Norovirus is the most common form of gastrointestinal illness. It typically spreads from person to person contact and sickens more than 300 million people every year. Its relative commonness doesn't make it much more pleasant, though, as common symptoms include nausea, diarrhea, vomiting, and abdominal pain. Second-tier symptoms include fever, weakness, and muscles aches.

In an attempt to take control of the spread of the illness, infected passengers were given nonprescription medication and the ship was cleaned more thoroughly than normal.

“At Royal Caribbean International we have high health standards for all our guests and crew,” Royal Caribbean said in a statement. "During the sailing, we conduct enhanced cleaning on board the ship, to help prevent the spread of the illness.”

The cause of the outbreak has not been determined, but when the ship docked in Port Everglades on Friday it was given an intensive cleaning to prevent carrying the illness on its next cruise. The Vision of the Seas left on its next scheduled cruise on Friday afternoon.


What is Norovirus?

Norovirus is a highly contagious virus that spreads very easily and quickly. You can get infected if you touch your nose or mouth after touching an infected object or surface or by consuming contaminated food or water. Norovirus is the leading cause of foodborne illness, but other germs and chemicals can also cause food poisoning.

Norovirus Symptoms

According to Lawrence, you might have a mild illness with watery diarrhea and a fever or more intense symptoms. These include:

“Symptoms usually last for 2-3 days and recovery is usually quick,” Lawrence says.

Around 20 million people get norovirus each year in the U.S. Infected food workers cause about 70% of reported norovirus outbreaks, while cruise ships account for only 1% of cases. However, cruise ship outbreaks get more media attention, and norovirus has even been called “cruise ship virus”.


Cruise Norovirus outbreaks, Coronavirus updates

Norovirus on ships is spread through contaminated water, foods and surfaces (public restrooms, railings, doorknobs, handles, board games-cards-puzzles-toys, etc). Norovirus withstands chlorine, prolonged exposure outside the body, as well as temperature extremes. Like a virus, Norwalk can't be effectively treated with antibiotics, making it extremely difficult to eliminate in closed environments - like cruise vessels.

Norovirus may incubate up to 48 hours before the symptoms appear. This makes difficult to restrict an outbreak. Noro symptoms include nausea, vomiting (kids more than adults, abdominal cramps, diarrhea, general weakness, low fever, headache, muscle aches. The illness could last up to 5 days (depending on the person's age, general health, and severity of the exposure to the virus. Recovered patients can still spread the virus for up to 2 weeks.

Quarantining the ill passengers and crew to their cabins is mandatory (at least for 48 hours) to slow the outbreak's spread. Failing to comply with the crew's orders results in fines or even discharge from the ship.

CruiseMapper's Norovirus survey is based on official data from CDC.gov (USA's "Centers for Disease Control and Prevention"). CDC's "Vessel Sanitation Program" assists the cruise tourism industry to prevent and control the transmission and spread of gastrointestinal illnesses (Norovirus, ETEC) on passenger ships calling on US seaports.

This program operates under the authority of the Public Health Service Act (fda.gov, "Quarantine and Inspection Regulations to Control Communicable Diseases"). CDC sanitation inspections on passenger ships are conducted twice a year. Scores of 86 are considered passing. Among the issues that CDC health inspectors usually find on board and report are:

  • food debris
  • dead insects
  • insect droppings
  • records indicating crewmembers (including cooks and galley staff) working while sick (suffering from gastrointestinal disorders or with acute gastroenteritis/AGE symptoms)
  • cracked/corroded equipment
  • soiled cutting boards
  • food served undercooked
  • lack of safety instruction signs.

CDC cruise ship Norovirus reports

Cruise ship outbreaks are reported (posted on the CDC website) when the illness incident meets the following criteria:

  • The ship falls within the purview of the Vessel Sanitation Program (VSP). This means if it carries 13+ passengers and has a foreign cruise itinerary with US ports of call in it. Keep in mind, that most departures are from US-based home ports.
  • The ship cruise itinerary length is between 3 and 21 days,
  • The ship carries 100+ passengers.
  • The percentage of infected passengers or crew (cases reported to the ship's med staff) during the cruise is 3% or more. This means small outbreaks on cruise ships will not be reported to the CDC.

CDC cruise ship inspection fees are payable by the shipowner. Fees are based on the vessel's size. VSP doesn't charge fees for consultations related to shipping facilities renovations or new ships. Inspection fees are as follow:

  • Small ships (under 3000 GT / gross tons) pay USD 1500 per inspection.
  • Small ships (between 3000-15000 GT) pay USD 3000 per inspection.
  • Medium ships (between 15000-30000 GT) pay USD 6000 per inspection.
  • Large ships (between 30000-60000 GT) pay USD 9000 per inspection.
  • Extra-large ships (between 60000-120000 GT) pay USD 12000 per inspection.
  • Mega-liners (above 120000 GT) pay USD 18000 per inspection.

Note: When the itinerary doesn't include US cruise ports, the ship is not required to report to CDC, thus no official illness outbreak report would be issued.

CDC ship illness outbreak investigations

VSP (abbrev "Vessel Sanitation Program") monitors CDC's observations on illness patterns for GI (gastrointestinal) outbreaks on passenger shipping vessels (ferries and cruise ships).

  • VSP conducts outbreak investigations only in cases with 3% or more passengers or crew reported sick with GI symptoms. VSP may also conduct outbreak investigations in cases of unusual GI illness patterns (even if the rate is less than 3%).
  • VSP conducts outbreak investigations only on vessels visiting ports in the USA or which are within 15 days of arriving at a US port.
  • When an outbreak occurs, VSP asks for ship logs and infirmary records of reported GI cases (symptoms and timing) and illness distribution (among passengers/crew, during each day of the cruise).
  • VSP staff usually boards the vessel for epidemiological assessment, interviews, distribution and analysis of illness questionnaires, monitoring cleaning procedures.
  • Lab investigations - the ship's med staff often collects stool, vomit, blood specimens, which then send to land-based labs to confirm the illness cause.

During the onboard illness outbreak, VSP requires from the cruise company to activate the "Outbreak Prevention and Response Plan" (vessel's response to illness cases). During an outbreak are:

  • Cleaning and disinfection frequencies are Increased.
  • Self-service buffets are stopped.
  • All infected (pax/crew) are quarantined to their staterooms/cabins
  • Clinical specimens are collected for analysis.
  • Daily updates are provided to VSP (cases counts and measures reports)
  • All passengers and crew are alerted of the illness.
  • Upon boarding on the next scheduled cruise, passengers are notified about the previous voyage's outbreak.
  • Occasionally, VSP requires the company to notify port authorities and also to perform cleaning and disinfection in cruise port terminal buildings.

Illness outbreaks on cruise ships (annual statistics)

The following statistics show the number of cruise ship illness outbreaks in recent years. You can compare the number of reports (CDC and news media sources) and the total number of infected (passengers and crew).

1556 (of which 1440 pax, 116 crew)

1177 (of which 1099 pax, 78 crew)

2535 (of which 2450 pax, 85 crew)

2504 (of which 2378 pax, 126 crew)

2570 (of which 2458 pax, 112 crew)

3530 (of which 3354 pax, 205 crew)

2385 (of which 2249 pax, 136 crew)

5542 (of which 5079 pax, 463 crew)

1971 (of which 1834 pax, 137 crew)

7101 (of which 6799 pax, 302 crew)

4197 (of which 3800 pax, 397 crew)

3743 (of which 3465 pax, 278 crew)

4577 (of which 4228 pax, 349 crew)

7215 (of which 6567 pax, 648 crew)

4674 (of which 4110 pax, 564 crew)

3675 (of which 3189 pax, 486 crew)

3556 (of which 3159 pax, 397 crew)

3530 (of which 3211 pax, 319 crew)

In 2014, Time Magazine published the article "The 13 Worst Norovirus Outbreaks on Cruise Ships". In it, the overall winner was Princess Cruises with 5 epidemic illness outbreaks:

  • Coral Princess (February 2009, infected 271)
  • Crown Princess (January 2010, infected 396)
  • Crown Princess (February 2012, infected 363)
  • Sun Princess (July 2012, infected 216)
  • Ruby Princess (March 2013, infected 276)

Cruise ship virus outbreaks 2019 reports

In the following table, you can see all 2019-reported Norovirus outbreaks on cruise ships. The listed statistical data is based on CDC or news media reports. It shows the number of sick passengers and crew (with the respective percentage to all), along with the corresponding CDC report pages (if available) as outgoing links.

Note: When the itinerary doesn't include US cruise ports, the ship is not required to report to CDC, thus no official illness report would be issued.

(Nov 8-24) 16day Panama Canal (Miami to Los Angeles)

passengers 127 / 3602 (3,5%), crew 6 / 1769 (0,3%)

(Oct 3-13) 10day Canada and New England (Montreal to NYC)

passengers 70 / 2251 (3,1%), crew 10 / 610 (1,6%)

(Sept 28 - Oct 12) 14day Caribbean from NYC

passengers 72 / 2166 (3,3%), crew 8 / 612 (1,3%)

(Sept 5-23) 18day Transatlantic Rostock to NYC

passengers 117 / 2055 (5,7%), crew 8 / 610 (1,3%)

(Sept 7-14) 7day Caribbean from Miami

passengers 17 / 3241 (0,5%), crew 35 / 1158 (3%)

(Mar 18-Apr 5) 18day Panama Canal (Callao-Lima to NYC)

passengers 36 / 1066 (3,4%), crew 4 / 763 (0,5%)

(Feb 8-18) 10day Panama Canal from Fort Lauderdale

passengers 101 / 2193 (4,6%), crew 9 / 905 (1%)

(Feb 7-14) 7day Cuba from Miami

passengers 36 / 904 (4%), crew 1 / 461 (0,2%)

(Jan 18-28) 10day Caribbean from San Juan (Puerto Rico)

passengers 31 / 925 (3,4%), crew 0 / 455 (0%)

(Jan 6-13) 7day Caribbean from Port Canaveral

passengers 561 / 6285 (8,9%), crew 31 / 2169 (1,5%)

(Dec 13-Jan 3) 21day Panama Canal from Los Angeles to Miami

passengers 28 / 917 (3,1%), crew 5 / 449 (1,1%)

Cruise ship virus outbreaks 2018 reports

In 2018, the number of reported illness outbreaks on cruise ships was 15. The total number of infected was 1177 (of those 1099 passengers and 78 crew).

(Nov 3-18) 15day Panama Canal from San Diego to Fort Lauderdale

passengers 60 / 1285 (4,7%), crew 8 / 599 (1,3%)

(Sept 22-29) 7day Mediterranean from Palma de Mallorca (Spain)

(Sept 1-12) 11day USA and Canada (Chicago to Toronto)

(Sept 15-22) 7day Northern Europe from Hamburg Germany

(June 20-30) 10day Alaska from Seward AK to Vancouver BC

passengers 38 / 652 (5,8%), crew 0 / 457

(June 18 - July 2) 14day Alaska from Seattle WA

passengers 95 / 1472 (6,5%), crew 18 / 591 (3,1%)

(May 10-24) 14day Transpacific from Tokyo to Seward AK

passengers 28 / 327 (8,6%), crew 8 / 290 (2,8%)

(April 17 - May 2) 15day Panama Canal cruise from San Diego to Fort Lauderdale

passengers 111 / 2140 (5,2%), crew 7 / 970 (0,7%)

(Feb 21 - Mar 9) 16day Panama Canal cruise from Valparaiso-Santiago to Fort Lauderdale

passengers 65 / 1901 (3,4%), crew 9 / 968 (0,9%)

(Jan 25 - Feb 8) 14day repositioning from South America to USA (Puntarenas Costa Rica to San Diego CA)

passengers 20 / 663 (3%), crew 2 / 458 (0,4%)

(Jan 9-24) 15day Panama Canal (Los Angeles to Fort Lauderdale)

passengers 71 / 2181 (3,3%), crew 7 / 898 (0,8%)

(Jan 2-11) 9day Florida and Bahamas from Baltimore MD

(Dec 21 - Jan 4) 14day New Zealand roundtrip from Brisbane Australia

Outbreaks 2017 reports

In 2017, the number of reported illness outbreaks on cruise ships was 21. The total number of infected was 2535 (of those 2450 passengers and 85 crew).

(Dec 11-16) 5day Caribbean from Fort Lauderdale

passengers 310 / 4160 (7,5%), crew 22 / 1398 (1,6%)

(Nov 23 - Dec 7) 14day Singapore to Sydney Australia

(Nov 17-27) 10day Caribbean from Fort Lauderdale

passengers 173 / 3034 (5,7%), crew 3 / 1240 (0,2%)

(Nov 4-11) 7day Bahamas from NYC New York

(Oct 30 - Nov 11) 12day Australia to New Zealand (Sydney to Auckland)

(Oct 25 - Nov 8) 14day repositioning from Canada to Florida (Quebec City to Fort Lauderdale)

passengers 184 / 2957 (6,2%), crew 12 / 1172 (1%)

passengers 13 / 57 (22,8%), crew 1 / 30 (3,3%)

(July 31 - Aug 10) 10day New Caledonia and Vanuatu from Brisbane Quensland

(July 22-29) 7day Alaska from Vancouver Canada

passengers 73 / 2210 (3,3%), crew 4 / 869 (0,5%)

(July 30 - Aug 6) 7day Alaska from Vancouver to Seward

passengers 82 / 2143 (3,8%), crew 5 / 790 (0,6%)

(July 23-30) 7day Alaska from Seward AK to Vancouver Canada

passengers 138 / 2086 (6,6%), crew 4 / 803 (0,5%)

(July 12-1 9) 7day Alaska from Vancouver Canada

passengers 68 / 1480 (4,6%), crew 1 / 610 (0,2%)

(June 15-24) 10day Mediterranean from Venice to Civitavecchia-Rome

(March 8-18) 10day Caribbean and Panama Canal roundtrip from Fort Lauderdale

passengers 157 / 2016 (7,8%), crew 25 / 881 (2,8%)

(Jan 8 - Apr 7) 90day "World Cruise" roundtrip from Brisbane Australia

  • (Jan 22 - Feb 2) 12day Papua New Guinea from Brisbane QLD
  • (Feb 2 - 16) 14day Australia to New Zealand from Brisbane

Outbreaks 2016 reports

In 2016, the number of reported illness outbreaks on cruise ships was 23. The total number of infected was 2504 (of those 2378 passengers and 126 crew).

(Dec 10-18) 9day Australia cruise from Adelaide to Fremantle-Perth

(Nov 3-18) 16day Transatlantic cruise from Rome-Civitavecchia to Tampa Florida

(Oct 16-23) 7day Cuba cruise from Miami

(Apr 27 - May 1) 4day Bahamas from Miami

(Apr 16 - May 20) 34day Transatlantic roundtrip to USA and Canada from Southampton England (UK)

(Mar 20 - Apr 3) 14day Caribbean from Miami

(Mar 12 - 22) 10day Caribbean from NYC New York

(Mar 8 - 22) 14day South Pacific Islands from Melbourne Australia

(Mar 3 - 21) 18day South America from Valparaiso-Santiago to Fort Lauderdale

(Feb 21 - Mar 5) 13day Caribbean from Port Canaveral

(Feb 21 - Mar 4) 12day Caribbean from Cape Liberty (New Jersey, NYC)

(Princess Cruises / Oceania Cruises) Ocean Princess / Oceania Sirena

(Feb 13 - Mar 7) 23day South America repositioning from Valparaiso to Miami

(Feb 12 - 22) 10day Caribbean roundtrip from Miami FL

(Jan 8 - 18) 10day Mexico Riviera roundtrip from Los Angeles CA

Outbreaks 2015 reports

In 2015, the number of reported illness outbreaks on cruise ships was 23. The total number of infected was 2570 (of those 2458 passengers and 112 crew).

(Dec 16 - 28) 12day Christmas Cruise round-trip from Sydney Australia

    60 passengers and crew (or 4% of all

(Dec 20 - 27) 7day Mexican Riviera round-trip from San Diego CA

(Dec 13 - 20) 7day Caribbean round-trip from Houston Texas

(Dec 2 - 16) 14day Australia to New Zealand, round-trip from Sydney NSW

(18 Nov - 2 Dec) 14day Transatlantic from Barcelona to Miami FL

(29 April - 14 May) 15day Hawaii from San Francisco CA

(21 Apr - 7 May) 16day South America (through Panama Canal) from Callao Peru to New York City NY

(17 Apr - 1 May) 14day Caribbean from Fort Lauderdale

(Alaska repositioning, Apr 12 - 27) 15day Panama Canal transit from Fort Lauderdale to Los Angeles

(Royal Caribbean / Marella Cruises)

(30 Mar - 14 Apr) 15day Panama Canal transition cruise from Fort Lauderdale to San Diego

(29 Mar - 13 Apr) 15day Panama Canal transit from Ft Lauderdale to San Diego

(13-23 Feb) 10day Caribbean from Fort Lauderdale

Outbreaks 2014 reports

In 2014, the number of reported illness outbreaks on cruise ships was 17. The total number of infected was 3559 (of those 3354 passengers and 205 crew).

(5-12 Apr) 7day California from Los Angeles

(Princess Cruises / P&O Australia) Dawn Princess / Pacific Explorer

(18 Oct - 16 Nov) New Zealand from Melbourne

(28 Mar - 5 Apr) 8day Baltimore to Bahamas

(2-28 Mar) 26day Amazon/South America from Rio de Janeiro to Ft Lauderdale

(8-22 Feb) Panama Canal from San Diego to Fort Lauderdale

(25 Jan - 1 Feb) 7day Caribbean from Houston TX

(21-27 Jan) 10day Caribbean from NYC (Cape Liberty / Bayonne NJ)

(5-19 Jan) 7day Mexican Riviera from LA

Outbreaks 2013 reports

In 2013, the number of reported illness outbreaks on cruise ships was 22. The total number of infected was 2385 (of those 2249 passengers and 136 crew).

    According to CDC, in 2013 from Norovirus and similar GI (gastrointestinal) illnesses suffered a total of 1409 passengers (which is 7,5% of all passengers on the inspected cruise vessels) and 96 crew/staff members (which is 1,2% of all). With nearly 12 million cruisers departing from USA and Canada ports in 2013, the Norovirus infection rate is

25 Sept - 7 Oct (Black Sea cruise)

  • On Oct 5, 90+ passengers with Norovirus symptoms were taken to Burgas Municipal hospital
  • crew (na)

Grand Turk was bypassed as call port by several ships due to a gastrointestinal outbreak there. The cruise terminal was temporarily closed (March 26 through April 4) - according to the port schedule, there were no arrivals after March 13, 2013. The list of lines/ships that skipped the island:

Grand Turk authorities didn't find the cause of the illness. The cruise terminal and the near area were thoroughly cleaned and sanitized.

itinerary changes included:

  • adding a sea day
  • rerouting ships or extending port stays in Puerto Rico and the Bahamas
  • all pre-booked Grand Turk excursions and port taxes were fully refunded in the form of OBC.

affected voyages / changes

  1. Mar16 / to San Juan
  2. Mar17 / to San Juan
  3. Mar31 / to Nassau
  4. Mar30 / to Nassau
  5. Mar30 / to San Juan
  6. Apr1 / to Freeport

Outbreaks 2012 reports

In 2012, the number of reported illness outbreaks on cruise ships was 34. The total number of infected was 5542 (of those 5079 passengers and 463 crew).

  • 28 Jan - 4 Feb
  • 4-9 Feb
  • passengers 364 / 3103 (11,7%)
  • crew 32 / 1168 (2,7%)
  • passengers 288 / 3078 (9,4%)
  • crew 75 / 1178 (6,4%)

(Princess Cruises / P&O Australia) Dawn Princess / Pacific Explorer

  • passengers 129 / 3147 (4,1%)
  • crew 9 / 1179 (0,8%)
  • passengers 149 / 2971 (5%)
  • crew 14 / 1177 (1,2%)

"When you are sick with norovirus, you can shed billions of virus particles in your vomit and poop. It only takes a few of these particles to make someone sick," the CDC explains.

The illness spreads rapidly if you eat food or drink liquids that are contaminated with the virus, touch contaminated surfaces or objects and then touch your mouth, or have direct contact with an infected person, such as by caring for them or sharing food or utensils with them.

The CDC notes that while people often associate cruise ships with norovirus, acute gastrointestinal illness is relatively infrequent on cruise ships. However, the close living quarters on the ship increases the risk of transmission.


Eye-opening images expose the SECRET life of a cruise ship officer.

The SECRET life of a cruise ship officer

Norovirus: How to prevent catching the virus

According to the Centers for Disease Control and Prevention: &ldquoNorovirus is a very contagious virus. You can get norovirus from an infected person, from contaminated food or water, or by touching contaminated surfaces.

&ldquoThe virus causes your stomach or intestines or both to get inflamed (acute gastroenteritis). This leads you to have stomach pain, nausea, and diarrhoea and to throw up.&rdquo

Macfarlane also revealed in his book a disgusting trick that some cruise ship chefs use to trick passengers. He explained that wealthier passengers enjoyed eating the very dangerous pufferfish.

Normally &ldquothe chefs dissect out the gall bladder to remove the toxins - but leave a tiny bit of the bile duct intact so the diners feel the buzz of poison on their lips as they swallow,&rdquo he said.

However, to cut corners and limit dangers, the chef on his ship &ldquojust dabs a bit of mouth ulcer cream on what&rsquos left. Ready-made tingle with far less risk of sudden death and a lawsuit.&rdquo

Another employee told MacFarlane: &ldquoIt&rsquos a win-win situation. The passengers think they&rsquore dying when in fact they&rsquore just cleaning up cold sores.&rdquo

In Japan, pufferfish are called fugu and must be carefully cleaned and prepared by a specially trained chef.


Cruise secrets: Ex ship crew reveals vile truth of what happens when norovirus breaks out

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Cruise tips: Expert advises how to avoid norovirus during trip

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Cruise ship holidays are something many Britons are keen to enjoy at least once in their lives. While such voyages are undeniably a time to have a lot of fun, there are still risks with cruises. One potential problem onboard a cruise is norovirus.

Related articles

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A former cruise ship crew member has revealed the drama that ensues onboard cruises when it&rsquos feared norovirus has struck.

Brian David Bruns wrote in his book Cruise Confidential: &ldquoDespite all [the] extreme effort at maintaining extraordinary cleanliness, outbreaks of norovirus did occur.

&ldquoThe reason was simple and unpleasant to hear: the unwashed masses brought it aboard and perpetuated it amongst themselves,

&ldquoAnyone who suffered the flu-like symptoms simply did not wash properly.&rdquo

Cruise: One potential problem on board a cruise is norovirus (Image: Getty Images)

Cruise: "Hundreds of employees&rsquo lives were turned upside-down with brutal special cleaning duties" (Image: Getty Images)

So what happened if the cruise line feared norovirus was a risk onboard the ship?

Buns explained: &ldquoIf an outbreak was feared, literally hundreds of employees&rsquo lives were turned upside-down with brutal special cleaning duties.

&ldquoNomadic packs wandered the hallways, bleaching every doorknob, handrail, and wall a hand could possible touch, and very button on every elevator, coffee machine, and video game.

&ldquoIn the dining rooms, we bleached the trays, the menus, the saltshakers, the ketchup bottles, the toothpick holders the sneeze-guards, the everything.&rdquo

Related articles

Bruns described the atmosphere onboard the cruise ship at such times as a &ldquofloating madhouse.&rdquo

He penned: &ldquoDuring outbreaks we lived in a floating madhouse of buckets, mops, cloths, and for the lucky few, ruler gloves.

&ldquoThe system was formalised, exact and even had a name: The Three Bucket System.

&ldquoWe used different coloured buckets for clean water, dirtied water and bleach solution.

Cruise: &ldquoAnyone who suffered the flu-like symptoms simply did not wash properly&rdquo (Image: Getty Images)

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&ldquoEvery waiter stayed extra late to double-wash the silverware and polish the glasses twice.&rdquo

The ex cruise ship crew worker also revealed how ill passengers had to be for the ship to report the outbreak.

&ldquoCruise ships had a certain ratio of sick calls to passenger count they had to maintain.

&ldquoWhen too many folks complained of illness, the ship was required to report it to the port authorities who reported it to the Centers for Disease Control.

&ldquoThe percentage of sick warranting a report was actually quite low, but when they were almost five thousand people aboard even seven percent looked like a helluva lot of sick people.

&ldquoIf too many were ill, the ship was forbidden to dock.&rdquo

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Cruise: &ldquoCruise ships had a certain ratio of sick calls to passenger count they had to maintain" (Image: Getty Images)

Sometimes news of an outbreak was music to the crews&rsquo ears. &ldquoIf an employee called in sick his or her roommate was forced into quarantine with them for two days, whether sick or not,&rdquo wrote Bruns.

&ldquoIt was extremely common for crew members, already taxed to the point of exhaustion, to claim illness just to get a full night&rsquos sleep.&rdquo

According to the NHS, the main symptoms of Norovirus appear within one to two days of infection, and include:


Cruise ship nightmare: After measles, norovirus outbreaks, why does anyone still set sail?

I took my 5-year-old to see the live-action version of "The Lion King" last weekend. While we were waiting for the film to begin, we were subjected to a commercial for Disney's cruise line, sold as a family-friendly excursion with your favorite Disney characters. My son, of course, was ready to go tomorrow. I didn't have the heart to tell him that, as my child, he's never getting on one of those things.

I know plenty of people love cruises. The convenience of seeing a variety of places without having to plan them individually the all-inclusive meals the variety of entertainment options and for those with kids, the special activities provided for youngsters. I get it. But as an individual trained in microbiology and infectious diseases, what I see when contemplating such an excursion is the potential to be trapped with thousands of others in a confined space, suffering from gastrointestinal aliments like norovirus and E. coli, respiratory infections including influenza and chickenpox, or, as a recent Scientology cruise demonstrated, measles. And that just doesn't sound like a fun vacation to me.

Granted, I could become ill via any type of travel, or even via a staycation with my kindergartener. But cruise ships take those risks of background infection and amplify them.

This is hardly a secret: Just this week it was reported that inspectors from the Centers for Disease Control and Prevention gave the Carnival ship “Fantasy” one of the company’s worst ever sanitation inspection reports. (The Carnival Corp. & PLC made close to $19 billion in full revenues in 2018.)

Granted, I could become ill via any type of travel, or even via a staycation with my kindergartener. But cruise ships take those risks of background infection and amplify them due to the constant shared quarters of travelers onboard. The ships are notoriously difficult to clean when a case of norovirus is diagnosed. And norovirus is so infectious that it's almost impossible to avoid in close quarters — a mere 10 viral particles is enough to make someone sick. I've suffered through a travel-related norovirus illness alone in a hotel before and it was horrible. I can't even imagine how much worse it would have been if I was sharing that tiny room (and that nasty virus) with my family.

While norovirus is the key cruise ship pathogen, other stomach bugs can proliferate as well. Among the violations reported on Carnival’s “Fantasy,” for example, included “brown water discharged from two shower hoses in the medical center.” The medical center! The main pool gutters on the 855-foot ship were also not functioning correctly: “There was a visible film on the top of the water, and there was excessive visible debris floating on the water.”

And inspectors observed a general lack of attention to food safety throughout, including deficiencies “related to food equipment and facilities, protection of food and clean items, handling of waste and soiled items, food employee knowledge, and food employee managerial control.” Utensils for the buffets were stored in soiled water, or dirty ones were added in with clean utensils water was leaking onto containers of vegetables sneeze guards were missing or improperly used breads with visible fly contamination were reused and on and on.


What happens when norovirus breaks out on a cruise ship?

If you are in the unfortunate and uncommon situation where there is a Norovirus outbreak on-board your cruise ship, you may notice staff cleaning with much more intensity than before. While generally this just involves members of the crew using stronger cleaning agents and paying more attention to surfaces in general, it may also impact you further as certain facilities may be closed for a period of time while they are deep cleaned. Buffet restaurants may be staffed by servers instead of being self-serve, information on precautionary methods may be displayed and other guests on your nightly dinner table may instead be quarantined if they are hit with symptoms themselves.

The best thing to do if your cruise ship suffers an outbreak is to simply be vigilant. Wash your hands frequently and use any anti-bacterial stations that you pass when entering a restaurant at every possible opportunity. If you do show signs of any symptoms, visit the ship’s doctor. Don’t hide hoping to avoid quarantine – it’s an unfortunate necessary and will do you good in the long run.

However it’s not something you should worry about at all. Outbreaks of norovirus are rare on cruise ships, and when they do strike they only affect a very small percentage of passengers.


Royal Caribbean Norovirus Outbreak Sickens 475 Passengers

Norovirus outbreaks increase during the winter months because more people are together indoors. But some venues, such as nursing homes, schools, and cruise ships, can be struck by this virus at any time. A norovirus outbreak on a Royal Caribbean cruise ship has sickened 475 passengers.

The cruise was cut short. It was supposed to be a seven day cruise, leaving Port Canaveral in Florida on January 6, 2019. Apparently, passengers started getting sick after eating a cruise ship-sponsored lunch buffet in Haiti, which was the first stop. The ship is heading back to port. The company plans to clean and sanitize the vessel before its next trip.

Norovirus is a contagious virus that causes symptoms of vomiting, nausea, stomach pain, and diarrhea. Some people may experience fever, headache, and body aches. Symptoms have a short onset time. People can start getting sick within a few hours of exposure to the pathogen. And most people recover on their own without medical treatment.

According to the Centers for Disease Control and Prevention (CDC), 129,678 passengers were sickened on cruise ships from 2008 to 2014. That seems like a large number, but just 10% of those illnesses were norovirus. And the number of people on those cruses was 74,000,000.

That CDC report states that close living quarters increase the amount of contact between ill persons and people who are healthy. In addition, people joining the ship during a cruise can bring the virus aboard.

If you are planning to take a cruise, you can visit the CDC’s Green Sheet Report on their Vessel Sanitation Program to see the scores of various ships from different lines. They also list the ships that scored 100, or a perfect score, on various dates.

The best way to prevent a norovirus outbreak is to stay home from work and school (and vacations) when you are sick with a vomiting or diarrheal illness. There is no vaccine against this virus. Practicing proper hand hygiene is crucial. Soap and water are better than hand sanitizers when washing your hands.


Cruise Lines With the Most Virus Outbreaks in 2017

Royal Caribbean grabbed headlines in December after more than 500 people fell ill on two of the company's cruise ships. While it may seem like an alarming number of individuals, it's actually a very small percentage of the total passengers aboard the ships. Royal Caribbean isn't the only offender&mdashplenty of other cruise lines have experienced notable outbreaks. As of November 27, a total of 10 other incidents happened in 2017, according to data from the Centers for Disease Control and Prevention.

In order for the outbreak to be documented by the CDC, the ship has to be sailing internationally and meet other criteria, including being on a voyage between 3-21 days and carrying at least 100 passengers. Additionally, at least 3 percent of passengers or crew have to report symptoms of diarrheal disease to the medical staff aboard the ship.

Among the 10 documented incidents, seven were caused by the norovirus&mdashcommonly referred to as the stomach bug. It's a contagious virus that causes diarrhea, throwing up, and nausea, and sometimes a fever and body aches.

The first documented incident of 2017 happened aboard the Princess Cruises's Coral Princess ship. During a voyage in early March, a total of 182 passengers and crew fell ill. Later in the month, another 24 individuals got sick while traveling on Oceania Cruises's Regatta ship.

Holland America was hit especially hard in 2017. In less than a month's time span, the cruise line had five outbreaks among various ships, which led to a total of 462 passengers and crew getting hit by the stomach bug. Although these events almost always gain widespread attention, it's important to note that only 1 percent of all norovirus outbreaks occur on cruise ships.

The CDC also documented three other incidents however, rather than norovirus, the cause was C. perfringens enterotoxin in one case, and is unknown in two of the other incidents. C. perfringens is a bacterium commonly found in raw meat and poultry. It's responsible for nearly 1 million foodborne illness cases every year, according to the CDC.

Honeymoon vacation turns into a nightmare when 10 family members catch a norovirus while abroad seven-day cruise to the Bahamas https://t.co/qr5lveHhei pic.twitter.com/XTbFntssRg

&mdash ABC News (@ABC) November 15, 2017

Globally, more than 685 million cases of norovirus are reported each year. Despite the media attention, outbreaks are not more prevalent than they were in the 1990s or 2000s, National Geographic reports.

"It makes the news during these cruises because there are a great number of people who are in confined space and very susceptible to infection because it is so easily spread," John R. Palisano, a microbiologist at Sewanee: The University of the South in Tennessee, told National Geographic.


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