What is tricky, highly contagious and bound to cause diarrhea and vomiting? If you answered “norovirus,” you would be correct. But what is it, and why is it often associated with sailing?
There have been many news reports of norovirus cases on ships, making it appear to an unsuspecting public that cruise ships are dirty or that you may get sick while sailing. I’m here to set the record straight.
Find out why norovirus is mislabeled as cruise ship disease, what cruise lines are doing to reduce the spread on board and whether you should be concerned about it on your next trip.
What is cruise ship norovirus?
Norovirus is the most common of several viruses that cause acute gastrointestinal illness or acute gastroenteritis. Symptoms may include diarrhea and vomiting, as well as stomach cramps, headaches, muscle aches and fever – an unpleasant experience anytime but especially when you’re on holiday.
Norovirus is highly contagious and spreads when you touch a contaminated surface and put your fingers in or near your mouth, such as when you eat without washing your hands. It is also spread through contaminated food, sometimes called “food poisoning,” although there are many bacteria that can cause foodborne illness. You may also hear it commonly referred to as the stomach bug or stomach flu, despite the fact that noroviruses are not the same as flu viruses.
How does norovirus spread on cruise ships?
What causes norovirus on cruise ships, anyway? Norovirus spreads easily in close quarters, such as those found on cruise ships. Although it can spread from one person to another, on ships, it is often passed when passengers fail to wash their hands after coming into contact with high-affected areas, such as handrails, elevator buttons and serving dishes in onboard buffets.
Infected passengers who don’t wash their hands after coughing, sneezing or using the toilet are the reason those areas are contaminated in the first place. To avoid both spreading your germs and picking up germs from others, wash your hands regularly, especially before you eat, for at least 20 seconds with soap and warm water, making sure to scrub your nails and between your fingers.
Contaminated food is also a factor, but is less common on ships, where crews are carefully trained to follow health and safety guidelines for sanitation. Standards used by the US Centers for Disease Control and Prevention. (See the next section for more.)
What are cruise ships doing to prevent norovirus outbreaks on board?
Cruise lines employ staff dedicated to keeping public areas and high-impact areas clean. Galley staff and waiters receive extensive training in food safety and handling.
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Lines also screen passengers for symptoms of illness upon boarding. They are asking passengers who feel ill during their journey to report symptoms to the medical center and keep themselves in their cabins.
On ships where outbreaks occur, crews thoroughly clean the ship after passengers disembark and before the next voyage begins. In cases where the outbreak is severe, subsequent sailings may be canceled to allow for complete sanitation.
Additionally, the CDC’s Vessel Sanitation Program, which began in the 1970s, subjects all vessels carrying 13 or more people to random, unannounced inspections if they wish to call US ports.
As part of this process, ships are required to comply with strict health and safety regulations that cover everything from the cleaning of high-impact areas to the way food is stored in fridges, freezers and boats.
VSP inspectors board vessels and conduct thorough inspections to ensure compliance – and standards are high. A score of less than 86 out of 100 is considered a failure. You can find a list of the most recent inspection scores and a list of violations for each vessel on the VSP website.
Should you be worried about getting norovirus on a cruise?
The short answer is no. Cruise ships are responsible for some of the smallest numbers of norovirus cases each year in the U.S. Most cases develop in restaurants, schools, hospitals and nursing homes.
However, you are more likely to hear about ship outbreaks because ships are required to report cases while other organizations are not.
“Health officials are tracking illness on cruise ships,” the CDC says on its VSP norovirus FAQ page. “Thus outbreaks are detected and reported more quickly on a cruise ship than on land.”
In a study of acute gastroenteritis cases from 2006 to 2019 (before the COVID-19 shutdown of the travel industry), the CDC found that the number of cases on cruise ships decreased over those 14 years. It also noted that the number of incidents tends to be higher on larger ships and voyages of a week or more.
“The rate of … illness on cruise ships decreased between 2006-2019 for passengers and crew,” the report said. That’s good news for cruisers.
During that time, approximately 127 million passengers traveled on 252 ships under the VSP regime. Of the 127 million cruise passengers, 26,450 reported gastrointestinal symptoms while on board. It sounds like a huge number, but it amounts to only 0.02% (two hundred and a half 1%) of the cruises in all those 14 years, and the total number of cases decreased from 4,507 in 2006 to 1,201 in 2019.
If you’d like to check the details of the outbreak, you can find a detailed list of ships that have had outbreaks of acute gastroenteritis (most of which are caused by norovirus), listed by year, about halfway down the CDC’s outbreak page.
For more information on how to stay healthy on board, visit TPG’s article on how to avoid getting sick on a cruise.
Why are there so many reports of cruise norovirus in the news?
The simple answer is that cruise ships are required to report cases of acute gastroenteritis to the CDC, even if the numbers are low. In contrast, some organizations are not.
Specifically, each ship’s medical staff must submit a report containing the number of sick passengers within 24 to 36 hours of the ship’s arrival at a US port from a foreign port, even if there are no cases of gastrointestinal illness. They must also submit reports if 2% or more of the passengers and crew are ill and the ship is scheduled to visit a US port within 15 days. If the number reaches 3% or more, cases must be reported to the CDC even if the vessel is not scheduled to call at a US port within the next 15 days.
That means norovirus data on cruise ships is more readily available than other organizations. It’s easy to make the numbers of norovirus cases sound scary, but context is important. For example, 100 incidents on one ship may seem like a lot, but on a ship like the Oasis of the Seas, which carries more than 5,400 passengers, 100 incidents is only about 2% of the people on board.
Bottom line
Should you be worried about catching norovirus or another gastrointestinal illness while on a cruise? The CDC says that cruises account for some of the lowest case numbers in the US every year.
Your chances of finding yourself locked in your room and holding the toilet for a week are slim when you’re on a cruise, especially if you take sensible precautions like washing your hands and not sharing drinks, dishes and other germ-spreading items.
Got a lot of questions about sailing? TPG has the answers:
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