Passengers can make a ship sick

Posted by Anita Dunham-Potter On May - 22 - 2006

Yes, you read that headline right: Passengers can make a ship sick.

When most people take a cruise they focus on the fun, the sun and the food. But here’s another thing to think about: sanitation. Poor sanitation can ruin your cruise — ask anyone who’s been felled by a norovirus. And the biggest culprit? Fellow passengers who don’t wash their hands.

Sailor’s enemy

There’s nothing worse than getting sick on your cruise vacation. Seasoned travelers know all too well the importance of watching what they eat and washing their hands: It keeps the bugs at bay. Still, some of our fellow travelers aren’t so vigilant about hand washing, and they put us all at risk.

Poor personal hygiene habits can spread one of travelers’ worst enemies: noroviruses, also known as Norwalk virus and NLV, a group of viruses that can cause severe diarrhea, nausea and vomiting over a 48- to 60-hour period. According to the Centers for Disease Control and Prevention (CDC), noroviruses are highly contagious and can be passed directly from person to person as well as through tainted food and water. While the majority of patients recover with no lasting effects, the illness can be a more serious problem for infants, elderly people and people with weakened immune systems.

The risk of contracting a contagious disease like norovirus illness is particularly high on a cruise ship because passengers mingle in a relatively confined space. For this reason, all cruise ships that dock in the United States and travel to foreign ports undergo regular inspections by the CDC’s Vessel Sanitation Program (VSP). U.S.-based ships that do not make foreign port stops, such as Norwegian Cruise Line’s America fleet, which cruises around the Hawaiian Islands, are given similar inspections under the U.S. Food and Drug Administration’s Interstate Travel Program.

All this inspecting is both reassuring and alarming, and wise travelers take their own precautions against picking up nasty germs at sea.

Sick at sea

In March, Celebrity Cruises had an outbreak of norovirus illness aboard its ship Mercury, with 336 passengers and crew falling ill over a two-week period. The outbreak affected two sailings along the Mexican Riviera.

Celebrity Cruises contacted the CDC to report an elevated incidence of illnesses, as required by law. On the first voyage, which sailed March 17, 14 of 840 crew members (1.67 percent) and 191 of 1,902 passengers (10.04 percent) were afflicted with norovirus illness. Because of the high percentage of sick passengers, VSP staff boarded the ship in Puerto Vallarta and remained aboard for the remainder of the voyage while they conducted an environmental and epidemiological investigation.

VSP staff consulted with onboard medical staff, observed cleaning and disinfection procedures, distributed a survey to passengers and crew to determine the cause of the illness, and made recommendations. The ship’s medical staff reported that at the end of the second voyage, 24 of 844 crew members (2.84 percent) and 107 of 1,986 passengers (5.39 percent) were ill. Over a period of several more weeks, the ship’s crew continued its stepped-up cleaning procedures; even Bibles and poker chips were disinfected. On April 6, medical staff reported that the number of sick passengers and crew had returned to expected levels, i.e., less than 2 percent.

Mercury isn’t the only ship to experience an outbreak of norovirus illness this year. According to CDC records, 1,192 passengers and crew aboard six ships operated by four different cruise lines became infected with norovirus during the first three months of this year. During the same time period in 2005, 1,536 passengers and crew on eight ships operated by five different cruise lines became infected with norovirus.

“Across the board, we’re seeing more norovirus, particularly on longer cruises,” says Dave Forney, chief of the CDC’s Vessel Sanitation Program.

How come?

“Americans are not very good hand washers,” he says.

America’s dirty little secret

Forney is right. Last August, the American Society of Microbiologists commissioned a
survey on the nation’s hand-washing habits
. Observers sent into public restrooms to observe 6,336 adults found that only 82 percent actually washed their hands after using the facilities. Women were more diligent than men: 90 percent of the ladies washed their hands, compared with only 75 percent of the men.

Forney adds that itinerary can affect the incidence of shipboard illness; for example, the CDC has noted special problems with cruises beginning in Mexico. Of particular concern are passengers who have arrived in the country a few days before boarding the ship; the suggestion is that these travelers pick up the virus on land, then bring it onto the ship when they board.

“We suspect that people are probably coming on board with the virus,” Forney says. “On a cruise ship, people are out and about in very public areas, and so we have this depositing of the virus on various surfaces that then would be easily picked up by others.”

Forney advises travelers who are ill to avoid contact with other passengers and to report to the ship’s medical facility immediately. Of course, most passengers don’t want to be quarantined in their cabins, says Forney, so the virus keeps spreading around the ship, creating a sometimes chronic problem.

Inspectors aboard

The cruise lines’ defense against viral and bacterial illnesses is constant vigilance, strict sanitation control and regular disinfection. To keep them on their toes, the CDC conducts unannounced inspections of each ship twice a year. This cooperative effort is the chief reason there aren’t bigger outbreaks of illnesses at sea.

The CDC’s inspections are rigorous. Each inspection takes six to eight hours, depending on the size of the ship and the number of inspectors. The inspectors use a checklist to help evaluate such things as the ship’s water supply, food storage practices and food-preparation areas. Every ship starts with 100 points, then loses points for each infraction.

It doesn’t take much to lose points — anything from cracked tiles to refrigerators that aren’t quite cold enough. Inspection scores from the mid-80s to mid-90s are the most common. Ships scoring 86 points or higher are considered satisfactory; those scoring 85 and below are reinspected within 30 days.

One cruise line stands out for keeping its ships shipshape. Costa Cruises‘ Costa Mediterranea achieved a perfect score of 100 twice in a row this cruise season during unannounced inspections on December 13 and April 9.

“We’re very proud of this achievement,” says Hans Hesselberg, vice president for Hotel Operations for Costa Cruises, who attributes Costa’s success to careful training and a very strict in-house inspection programs — more stringent, in fact, than the CDC’s program. Hesselberg points out that a ship is like a small city: It has a water plan, a sewage plan and a food plan — and all three systems must be inspected regularly or the citizens will suffer.

Ounce of prevention

The CDC believes that noroviruses are becoming more virulent. And while noroviruses worry ship doctors a lot, they are a bigger problem on land than at sea. Last month, for example, an outbreak of norovirus occurred in 11 Chicago-area hospitals and nursing homes, reportedly affecting 536 people.

The statistical reality is that a miniscule percentage of all cruise passengers worldwide have become infected with a norovirus. Still, you don’t want to find yourself in the sick bay, so how can you protect yourself?

Remember what your mother told you: Wash your hands. For best results, the CDC recommends using warm water to moisten your hands before applying soap. Rub your hands together vigorously for at least 20 seconds. It is the soap combined with the scrubbing action that loosens and removes the germs from your hands.

That’s all there is to it: Twenty seconds of insurance that can literally save your health and your cruise.

Do you know how clean your cruise ship is? Travelers can view inspection summaries by visiting the CDC’s Web site, which publishes extensive reviews and vessel sanitation scores.

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