• Cruise Control: Reducing Your Risk for Noroviruses

    Image for Norwalk Virus article The Centers for Disease Control (CDC) and the Cruise Lines International Association (CLIA) have been working together for decades to ensure your cruising experience is a safe, healthy, and enjoyable one. So, why are there disease outbreaks? Sources in the cruising industry blame it on the increased popularity of cruising. More people, more ships, more destinations, and less vessel “downtime” between trips can set the stage for a norovirus outbreak. But, that does not mean your ship needs to sail without you. Here are some tips for a safe and healthy cruising adventure.

    Defining Noroviruses

    Noroviruses are actually quite common and are rarely deadly or life-threatening. The original norovirus strain discovered was named after an outbreak of gastroenteritis in a school in Norwalk, Ohio in 1968. You may be familiar with the term Norwalk virus or Norwalk-like virus. They are all considered noroviruses. The gastroenteritis caused by noroviruses are mild, self-limiting, but highly contagious diseases characterized by nausea, vomiting, diarrhea, and abdominal pain. Muscle aches and low-grade fever may also occur. Symptoms of noroviruses typically develop within 1-2 days of exposure and may last from one day to one week.
    Water is a common source of outbreaks of the noroviruses. This may include water from municipal supplies, wells, recreational lakes, swimming pools, and water stored aboard cruise ships. The noroviruses are transmitted by the oral-fecal route, directly from person-to-person, through ingestion of contaminated water and foods, or through contact with a surface that has been contaminated.
    Shellfish are the foods often implicated in norovirus outbreaks. Ingestion of raw or insufficiently steamed clams and oysters that were harvested in sewage-polluted water poses a high risk of infection. Foods other than shellfish can be contaminated when washed in water that contains the virus or by food handlers carrying the virus.

    The Cruise Connection

    The CDC and the cruise ship industry worked together to form a Vessel Sanitation Program (VSP). This program helps prevent and control the transmission and spread of gastrointestinal illnesses on cruise ships.
    Noroviruses are very common, so what is the connection to disease outbreaks on cruises? Close living quarters may increase the amount of person to person contact. New passengers arriving on the ship can also transmit the virus to existing passengers and crew members. The CDC performs unannounced ship inspections which results in outbreaks being discovered and reported. Sometimes this can inflate outbreak numbers to make it look like cruise ships have more infections than on land.
    The good news is that the VSP found a decrease in sanitation violations from 1990-2005. This means the cruise ship industry is working hard to keep things safe for travelers.

    Reducing Your Risk of Infection

    There are some measures you can take to reduce your risk of getting sick during your cruise.

    Before the Trip

    • Check the history of the cruise ship you are planning to take (for example, any previous outbreaks or failed inspections).
    • If you have a chronic illness, ask your doctor if it is safe for you to go.
    • Check the Travelers Health page at the CDC website for updated travel notices. These notices inform travelers of disease outbreaks and their locations.

    Once Onboard

    • Wash your hands thoroughly and often with soap and warm water, particularly before eating, preparing food, and after using the bathroom.
    • Avoid other passengers who are ill.
    • Avoid foods that may have been washed in contaminated water.
    • Go to the infirmary if you have symptoms of an infection.

    If You Get Sick

    Seek medical attention immediately. All cases of suspected noroviruses should be reported to the ship’s medical staff.
    The most common complication of noroviruses is dehydration. Drink plenty of bottled water, clear liquids such as defizzed ginger ale or decaffeinated colas, fruit juices, or decaffeinated teas or broth made from safe drinking water.
    If you become extremely sick and dehydrated, you may need a special rehydration solution. This is best obtained from the ship’s medical staff, but it may be available in a dry mix, which can be purchased in a drug store before you leave home. (Ask your doctor about this before you go). Very severe cases may require a hospital admission so that you can receive hydration and electrolytes through an IV.
    Get as much rest as you can and stay calm. Gastroenteritis is an uncomfortable, but not usually serious illness, which will usually resolve itself within a few days. If you become ill onboard, you may be isolated from the rest of the passengers, or you may be asked to disembark at the next port. This is done for your own protection, as well as the protection of the other passengers on the ship. It may not be the end to your vacation that you had envisioned, but it will be in everyone's best interest. Remember, new ships sail every day. Once you are feeling better, you can be on the next one!


    Centers for Disease Control http://www.cdc.gov

    Cruise Lines International Association http://www.cruising.org


    Communicable Disease Control Unit http://www.gov.mb.ca

    Health Canada http://www.hc-sc.gc.ca/index%5Fe.html


    Cramer EH, Blanton CJ, Otto C. Shipshape: sanitation inspections on cruise ships, 1990-2005, Vessel Sanitation Program, Centers for Disease Control and Prevention. J Environ Health. 2008;70(7):15-21.

    Cruising Tips. Centers for Disease Control and Prevention website. Available at: http://www.cdc.gov/nceh/vsp/pub/CruisingTips/cruisingtips.htm. Updated September 17, 2009. Accessed January 23, 2013.

    Facts About Noroviruses on Cruise Ships. Centers for Disease Control and Prevention website. Available at: http://www.cdc.gov/nceh/vsp/pub/Norovirus/Norovirus.htm. Updated September 18, 2012. Accessed January 23, 2013.

    Outbreaks of gastroenteritis associated with noroviruses on cruise ships—United States, 2002. Centers for Disease Control and Prevention website. Available at: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5149a2.htm. Accessed January 23, 2013..

    Travel Notices. Centers for Disease Control and Prevention website. Available at: http://wwwnc.cdc.gov/travel/. Updated January 16, 2013. Accessed January 23, 2013.

    Vessel Sanitation Program. Centers for Disease Control and Prevention website. Available at: http://www.cdc.gov/nceh/vsp/default.htm. Updated November 1, 2012. Accessed January 23, 2013.

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