Sailing Off: Cruise Around the World without Getting Sick9 min read
It’s the worst nightmare of cruise lines and cruise ship passengers alike. When an outbreak occurs on a ship full of people, the ship’s staff scrambles to contain it and sanitize, passengers deal with the nasty symptoms of the illness or fear catching it, and the cruise line company’s PR department goes into crisis mode.
According to the Centers for Disease Control and Prevention (CDC), there were nine gastrointestinal illness outbreaks in 2014 and nine thus far in 2015.
The idea of catching the highly-contagious norovirus, let alone on a pricey vacation, may make you shudder: It can cause the sudden onset of severe vomiting and diarrhea that can last up to three days. But, despite the flurry of headlines that take over the news when a norovirus infection strikes on a cruise ship, experts say norovirus isn’t that high on their list of health concerns when we step foot onto a ship.
The facts on norovirus
Norovirus causes your stomach or intestines (or both) to become inflamed, causing stomach pain, nausea, vomiting and diarrhea.
Norovirus is typically spread when people eat food or drink liquids that have been contaminated, as well as through close contact with an infected person. You can also get infected if you touch a surface or object infected with the virus and then touch your nose, mouth or eyes.
The reason it seems like norovirus thrives on cruise ships is due to a lot of shared surfaces – think serving utensils at a buffet – in addition to a lot of people situated in close quarters. Once a person becomes infected through contaminated food, the virus can quickly spread from person to person on the ship through shared food or utensils, by shaking hands and other close contact.
On the other hand, some people can come in contact with norovirus and never get sick.
“Thirty percent of the population lacks the chromosome for norovirus – it’s unable to attack their system, so even if they come in contact with [norovirus], they won’t become symptomatic,” says Ross Klein, the Cruise Junkie and professor at Memorial University of Newfoundland. “So you’ve got a one-third chance of not getting sick based on your genetic makeup.”
If you don’t happen to be a part of that lucky population and do get infected with norovirus, symptoms usually begin 24 to 48 hours after exposure and last one to three days. Most people completely recover without treatment. However, all that vomiting and diarrhea can sometimes leave sufferers dehydrated .
The fight against outbreaks
The fact of the matter is that norovirus is a hearty virus, but that doesn’t mean cruise ships and other establishments simply work to put out fires when there are outbreaks. Cruise lines have protocols in place for most illnesses that could occur on a cruise – preventative protocols and guidelines to follow should an outbreak occur.
According to Royal Caribbean International’s chief medical officer Dr. Art Diskin, there are two common sources for gastrointestinal outbreaks: a group returning from an off ship activity and then it starting on the ship by way of someone not washing their hands after using the bathroom, touching tongs and utensils at the buffet line and not washing hands before eating, or foods that are uncooked or undercooked in a common area.
“We have extensive procedures in place. We have a paradigm I developed for prevention and management. We look at the screening and surveillance, communication, isolation and management,” he says. That paradigm may vary depending on where the cruise ship is traveling to ensure crew members are prepared for any outbreak. For instance, ships traveling to Asia are prepared for MERs and other illnesses that region is known for.
“Norovirus is very hard to kill,” Dr. Diskin says. Ships undergo a thorough cleaning process in order to kill any remnants of the virus. “The ships become very clean places. You will easily kill off the flu viruses and most bacteria on board. They’re designed to kill norovirus – you may not do that 100 percent effectively all of the time, but you will kill the other bacteria. That’s why you see so few outbreaks on board.”
Cruise lines aren’t completely on their own in the fight against outbreaks. The CDC’s Vessel Sanitation Program (VSP) helps the cruise ship industry prevent and control the introduction, transmission and spread of gastrointestinal illnesses on their ships.
This program accomplishes this mission by periodically conducting unannounced sanitation inspections of cruise ships. The program monitors gastrointestinal illnesses, investigates or responds to outbreaks, and trains cruise ship crew members on public health practices. The VSP also provides health education and public health information that is both reliable and current to the industry, travelers, health care providers, state and local health authorities and the media.
Norovirus shouldn’t be your biggest health concern on a cruise
Each year, approximately 22 million people board cruise ships. The number of cruise ship passengers who report outbreaks of gastrointestinal illness only reaches into the low thousands –a tiny percentage when you factor how many people are setting sail.
“People think that because it’s in the news, things like norovirus are the most frequent risk to their health. While it is something to be concerned about, it’s not the most common health risk on a cruise ship,” Klein says.
According to the CDC, 1,766 passengers and crew members reported gastrointestinal illness outbreaks abroad nine cruise ships in 2014. In 2013, the total was 1,505 passengers on nine ships.
“We have more experience with norovirus than anybody because we have a commercial need to not have it [on our ships]. Therefore, norovirus is a relatively miniscule problem,” Dr. Diskin says. “From an illness standpoint, the most common [health risk on a cruise] is respiratory illnesses and that also depends on the time of the year.”
According to Dr. Diskin, people often come onto cruise ships with coughs and colds, spreading them to other passengers by not covering their mouth when they cough or not sneezing into their sleeves.
“There have been very large outbreaks of influenza in the fall and winter on cruises. A cruise ship is like a perfect incubator – people are indoors, socializing, not getting fresh air, spreading influenza on a cruise ship,” Klein explains.
Some people fear seasickness before boarding a cruise ship, but Dr. Diskin says, like norovirus, that isn’t a big health risk.
“There’s very little sea sickness because of the size of the ships and their stabilizers,” he says.
The population on the cruise can impact what health issues arise during a trip.
“On ships with a lot of elderly passengers, we get cardiac issues. The elderly want to be more mobile despite what medical problems they may have,” Dr. Diskin says.
And then there are health issues passengers arguably bring upon themselves.
“Think about what happens on vacation: overindulgence,” Klein says, adding that people tend to gain 5 to 7 pounds during their cruise. Eating too much can cause indigestion and drinking too much alcohol can lead to slips and falls.In fact, when it comes to injuries, slips and falls pose a big risk to passengers’ health.
“We have people who slip and fall on the ship even when it’s not moving. They miss a step on a stairwell or sprain an ankle on a basketball court,” Dr. Diskin says. “There are a lot of minor injuries, things like sprained ankles, lacerations, or stepping on a sea urchin in the ocean at a port.”
But injuries aren’t just an issue on the ship.
“The major injuries we tend to see happen off the ship. People who rent mopeds at port and then go drinking – it has led to a lot of tragedies for cruise ship passengers. You shouldn’t be renting a moped at port and you certainly shouldn’t be drinking while driving them,” Dr. Diskin says.
Healthy prep work you can do
Just like you take the time to carefully plan out your trip and make sure you pack everything you need, it’s also important to prepare for your health for the adventure.
This means making a visit to your doctor or a traveler’s clinic.
“The travel clinic has the vaccines available that are suggested for travel to certain parts of the developing world, including yellow fever and typhoid vaccines, that are not likely to be available through their primary physician,” says Dr. Todd Braun, the chief of Abington-Jefferson Health System’s Division of Infectious Diseases and Traveler’s Clinic.
Some vaccines take two to four weeks to help you become protected from illnesses. Malaria prophylactic medications may also need to be started prior to traveling, he says.
“We offer advice and prescriptions for malaria prevention and traveler’s diarrhea, as well as advice regarding avoidance of contaminated food and water,” Dr. Braun says of visiting traveler’s clinics before a trip.
You may feel like you need to work overtime or fit extra workouts in at the gym before a vacation, but taking time to rest before your trip is important too.
“It’s important that they rest and that they’re well when they come on board. It’s best if they don’t come to the ship when they’re sick,” Dr. Diskin says.
“I would go on a cruise already healthy,” Klein, the “cruise junkie,” says, adding that getting on board tired and worn out can make you susceptible to getting sick.
If you have medical issues, bring your medications, a list of those medications and a summary of your medical history in case you need to make a trip to the ship’s medical facility. In addition to packing prescriptions, make sure you also bring hand sanitizer, sunblock, antacids, and simple over-the-counter medications just in case.
“If people are going to be sailing somewhere there’s a lot of mosquitoes, be aware of preventing mosquito bites,” Dr. Diskin says, noting that mosquitoes can transmit serious diseases. “If you’re going somewhere hot and muggy, bring mosquito repellent along.”
Traveler’s insurance is another important preventative health measure you should take – most basic U.S. insurance plans and Medicare won’t cover medical treatment on a cruise ship or at a port in a different country.
“We recommend that everyone have travel insurance and that you also understand the policy. There can be issues with pre-existing conditions,” Dr. Diskin says.
How to prevent getting hurt or sick
Once you’re on your ship and sailing away, you can protect your health while still enjoying your trip and having fun.
“Wash your hands,” Dr. Diskin warns. Wash your hands every time you use the bathroom, before you eat, especially after touching the serving utensils at the buffet line. “Hand sanitizers aren’t as effective as hand washing – you have to wash your hands.”
And, when it comes to injuries, common sense comes into play.
“You need to know your own limitations. If you’ve been sitting behind a desk for two years and then get on the ship and start playing basketball or another activity you haven’t done in year, you’re putting yourself at risk of getting hurt,” he says.
What happens if you need medical assistance?
Unfortunately, it’s a reality that injuries and illnesses happen. If and when that may happen, passengers have some resources available to them on their ship.
“The modern cruise ship has a pretty extensive and well-stocked medical facility. It’s like going into your local emergency department,” Dr. Diskin says. Typically, ships’ medical facilities consist of one or two doctors and a few nurses capable of performing digital x-rays, blood transfusions, as well as providing passengers experiencing cardiac emergencies with thrombolytic drugs. What they cannot do is perform surgery.
“If we’re at a port with a higher level of care, we’ll get someone critically ill off the ship,” Dr. Diskin says. If the port can’t provide the ill passenger with a higher level of care, they’ll continue on to a port that can. “We try to keep on board until we get to the next appropriate port.”
Just as there are limitations to what medical facilities can do for you depending on the severity of your illness or injury, they are limited in the prescriptions they keep stocked. Because of that, Dr. Diskin recommends bringing any and all prescriptions you need with you on your trip as well as your medication list and medical records.
“If you have complex health issues, you need to check out where that cruise ship draws its physicians from. Choose cruise lines that employ physicians from countries where you trust their medical degrees,” Klein says.