Infectious disease on cruise ships

Infectious disease on cruise ships is a hazard associated with cruises. Outbreaks of contagious diseases can spread quickly due to the confined cruise ship environment, reliance on shared spaces, the lack of healthcare facilities,[1] and the large number of passengers and crew members from disparate points of origin.

Outbreaks of diseases including norovirus,[2][3] Legionnaire’s,[4][5][6][7] cyclosporiasis,[8] and COVID-19 have all occurred on cruise ships.[9]

## Diseases

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Respiratory and gastrointestinal diseases are more likely to be communicated on cruise ships.[10]

### Norovirus

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Norovirus is a virus that can cause gastroenteritis[11] and is also a cause of gastroenteritis on cruise ships.[2] It is typically transmitted from person to person.[12] Symptoms usually last between 1 and 3 days and generally resolve without treatment or long term consequences. The incubation period of the virus averages about 24 hours.[13]

Norovirus outbreaks are often perceived to be associated with cruise ships. According to the American CDC, factors that cause norovirus to be associated with cruise ships include the closer tracking and faster reporting of illnesses on cruise ships compared to those on land; the closer living quarters that increases the amount of interpersonal contact and the turnover of passengers that may bring the viruses on board.[14] Outbreak investigations by the CDC have shown that transmission of norovirus among cruise ship passengers is primarily person-to-person; potable water supplies have not been implicated.[citation needed] In a study published in the Journal of the American Medical Association, the CDC reported that, "Perceptions that cruise ships can be luxury breeding grounds for acute gastroenteritis outbreaks don't hold water. A recent CDC report showed that from 2008 to 2014, only 0.18% of more than 73 million cruise passengers and 0.15% of some 28 million crew members reported symptoms of the illness."[15]

Ships docked in port undergo surprise health inspections. In 2009, ships that underwent unannounced inspections by the CDC received an average CDC Vessel Sanitation Program score of approximately 97 out of a total possible 100 points.[16] The minimum passing inspection score is 85.[16] Collaboration with the CDC's Vessel Sanitation Program and the development of Outbreak Prevention and Response Plans has been credited in decreasing the incidence of norovirus outbreaks on ships.[17]

### Legionnaires' disease

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Legionella, the bacterium which causes Legionnaires' disease, and in particular the most virulent strain, Legionella pneumophila serogroup 1, can cause infections when inhaled as an aerosol or aspirated.[4] 50 passengers across nine cruises in 1994 either contracted Legionnaire's or likely contracted the disease due to exposure to whirlpool spas contaminated with the pathogen.[4]

### Enterotoxigenic Escherichia coli

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Enterotoxigenic Escherichia coli is a form of E. coli and the leading bacterial cause of diarrhea in the developing world, as well as the most common cause of diarrhea for travelers to those areas.[18] Since 2008 there has been at least one reported incident each year of E. coli on international cruise ships reported to the Vessel Sanitation Program of the Centers for Disease Control, though there were none in 2015.[2] Causes of E. coli infection include the consumption of contaminated food or water contaminated by human waste.[19]

### COVID-19

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Main article: COVID-19 pandemic on cruise ships

Cases and suspected cases of COVID-19 occurred on cruise ships in early 2020, at the beginning of the COVID-19 pandemic.[10] Authorities across the world turned away ships or quarantined them; cruise operators cancelled some port visits and ultimately suspended global cruise operations. People aboard cruise ships played a role in spreading the disease in some countries.[citation needed]

## Outbreaks

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### 2020s

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Cruise launch year  | Cruise dates  | Owner/Operator  | Ship  | Disease  | Cases  | Deaths  | Location  | Notes and References

|
|
|
|
|
|
|
|

2020  | 2 February - 16 February  | Princess Cruises | Caribbean Princess | Norovirus  | 403  | 0  | No information  | [20]
2020  | 16 February - 1 March  | Princess Cruises | Caribbean Princess | Norovirus  | 259  | 0  | No information  | [20]
2020  | 1 March - 16 March  | Holland America Line | Westerdam | Unknown  | 27  | 0  | No information  | [20]
2020  | 7 March - 19 March  | Royal Caribbean International | Grandeur of the Seas | Norovirus  | 105  | 0  | No information  | [20]
2021  | 29 November - 13 December  | Viking Cruises | Viking Sea | Vibrio and E. coli | 120  | 0  | No information  | [20]
2022  | 28 April - 5 May  | Seabourn Cruise Line | Seabourn Odyssey | Unknown  | 20  | 0  | No information  | [20]
2022  | 24 May - 31 May  | Carnival Cruise Line | Carnival Splendor | Norovirus  | 80  | 0  | No information  | [20]
2022  | 21 December - 6 January  | Silversea Cruises | Silver Moon | Unknown  | 28  | 0  | No information  | [20]
2022  | 29 December - 3 January  | P&O Cruises | MV Arcadia | Norovirus  | 94  | 0  | No information  | [20]
2023  | 1 January - 13 April  | P&O Cruises | MV Arcadia | Norovirus  | No information  | No information  | No information  | [20]
2023  | 16 January - 21 January  | Royal Caribbean International | Brilliance of the Seas | Norovirus  | No information  | No information  | No information  | [20]
2023  | 28 January - 3 February  | Royal Caribbean International | Jewel of the Seas | Norovirus  | No information  | No information  | No information  | [20]
2023  | 2 February - 5 March  | Princess Cruises | Ruby Princess | Norovirus  | No information  | No information  | No information  | [20]
2023  | 6 March - 17 March  | Celebrity Cruises | Celebrity Constellation | Norovirus  | No information  | No information  | No information  | [20]
2023  | 9 March - 18 March  | Celebrity Cruises | Celebrity Equinox | Norovirus  | No information  | No information  | No information  | [20]
2023  | 11 March - 23 March  | Royal Caribbean International | Enchantment of the Seas | Norovirus  | No information  | No information  | No information  | [20]
2023  | 23 March - 31 March  | Royal Caribbean International | Enchantment of the Seas | Norovirus  | No information  | No information  | No information  | [20]
2023  | 17 March - 1 April  | Princess Cruises | Emerald Princess | Norovirus  | No information  | No information  | No information  | [20]
2023  | 31 March - 28 April  | Princess Cruises | Grand Princess | Norovirus  | No information  | No information  | No information  | [20]
2023  | 31 March - 28 April  | Princess Cruises | Grand Princess | Norovirus  | No information  | No information  | No information  | [20]
2023  | 6 May - 21 May  | Holland America | Nieuw Amsterdam | Norovirus  | No information  | No information  | No information  | [20]
2023  | 15 May - 25 May  | Celebrity Cruises | Celebrity Summit | Norovirus  | No information  | No information  | No information  | [20]
2023  | 6 June - 20 June  | Viking Cruises | Viking Neptune | Norovirus  | No information  | No information  | No information  | Viking Cruises blamed the outbreak on an Icelandic restaurant visited by some passengers.[21][20]
2023  | 8 October - 13 October  | Virgin Voyages | Scarlet Lady | Norovirus  | No information  | No information  | No information  | [20]
2024  | 3 January - 12 January  | Celebrity Cruises | Celebrity Constellation | Norovirus  | No information  | No information  | No information  | [20]
2024  | 22 January - 6 February  | Cunard Line | Queen Victoria | Unknown  | 150+  | No information  | No information  | As of 8 February 2024, the disease had not been identified.[22][20]

## References

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1. ^ Zhang, Nan; Miao, Ruosong; Huang, Hong; Chan, Emily Y. Y. (8 December 2016). "Contact infection of infectious disease onboard a cruise ship". Scientific Reports. 6 (1): 38790. doi:10.1038/srep38790. ISSN 2045-2322. PMC 5144015.
2. ^ a b c CDC VSP. "Vessel Sanitation Program – Outbreak Updates for International Cruise Ships". Centers for Disease Control and Prevention. Archived from the original on 10 May 2016. Retrieved 11 February 2024.
3. ^ "CDC – Vessel Sanitation Program – Balmoral, April 16, 2016". Cdc.gov. Archived from the original on 14 May 2016. Retrieved 11 February 2024.
4. ^ a b c Jernigan, D.B; Hofmann, J; Cetron, M.S; Nuorti, J.P; Fields, B.S; Benson, R.F; Breiman, R.F; Lipman, H.B; Carter, R.J; Genese, C.A; Paul, S.M; Edelstein, P.H; Guerrero, I.C (February 1996). "Outbreak of Legionnaires' disease among cruise ship passengers exposed to a contaminated whirlpool spa". The Lancet. 347 (9000): 494–499\. doi:10.1016/s0140-6736(96)91137-x.
5. ^ "Cruise-Ship—Associated Legionnaires Disease, November 2003 – May 2004". cdc.gov.
6. ^ "EWGLinet Summary Report – December 2006" (PDF). ewgli.org. Archived from the original (PDF) on 27 November 2007.
7. ^ "Legionnaires' fear on cruise ship". BBC News. 30 July 2007. Retrieved 15 October 2021.
8. ^ Minooee, Arézou; Rickman, Leland S. (1999). "Infectious Diseases on Cruise Ships". Clinical Infectious Diseases. 29 (4): 737–743\. ISSN 1058-4838.
9. ^ Roe, Teiva (1 August 2020). "Un cas positif de Covid a été détecté sur le paquebot de croisière le Paul Gauguin". Retrieved 11 February 2024.
10. ^ a b Tan, Yvette (12 February 2020). "Coronavirus: Are cruise ships really 'floating Petri dishes'?". BBC. Retrieved 11 February 2024.
11. ^ Ahmed SM, Hall AJ, Robinson AE, et al. (August 2014). "Global prevalence of norovirus in cases of gastroenteritis: a systematic review and meta-analysis". Lancet Infect Dis. 14 (8): 725–30\. doi:10.1016/S1473-3099(14)70767-4. PMC 8006533. PMID 24981041.
12. ^ Moore MD, Goulter RM, Jaykus L (April 2015). "Human Norovirus as a Foodborne Pathogen: Challenges and Developments". Annual Review of Food Science and Technology. 6 (1): 411–33\. doi:10.1146/annurev-food-022814-015643. PMID 25884284.
13. ^ "Norovirus – Chapter 4 – 2020 Yellow Book | Travelers' Health". CDC. Retrieved 2019-10-08.
14. ^ "Facts About Noroviruses on Cruise Ships". cdc.gov. 2019-02-07. Retrieved 2019-10-08.
15. ^ "Cruise Ship Illness Declines". JAMA. 315 (8): 743. 2016-02-23. doi:10.1001/jama.2016.0733. ISSN 0098-7484.
16. ^ a b "Vessel Sanitation Program: Advanced Cruise Ship Inspection Search". US Center for Disease Control. Retrieved 15 October 2021.
17. ^ "Travel News, Tips, and Guides". USA Today. Retrieved 2019-10-08.
18. ^ "WHO | Research and development". WHO. Archived from the original on 8 December 2013.
19. ^ "E. Coli Infections". medlineplus.gov. Retrieved 2019-10-08.
20. ^ a b c d e f g h i j k l m n o p q r s t u v w x y z "Cruise Ship Outbreak Updates | Vessel Sanitation Program | CDC". www.cdc.gov. 8 February 2024. Retrieved 11 February 2024.
21. ^ Viswanathan, Giri (11 July 2023). "After years of decline, norovirus outbreaks surge on cruise ships". CNN. Retrieved 13 February 2024.
22. ^ Diaz, Johnny (8 February 2024). "C.D.C. Investigating Gastrointestinal Illness on Luxury Cruise Ship". The New York Times. Retrieved 13 February 2024.