March 18, 2006

Commentary from the Food Safety Network

On November 5, 2005, somewhere off the coast of Somalia, passengers aboard Seabourn Cruise Lines' Spirit awoke to captain Sven Erik Pedersen announcing over the ship's PA system, "Stay inside, we're under attack." Pirates in two small boats were outside firing at the luxury cruise liner.

On December 10, 2005, somewhere near the Bahamas, a 59-year-old Canadian woman presumably fell overboard Royal Caribbean International's Jewel of the Seas. Her body was never recovered.

And then there's norovirus -- a far greater threat to passenger safety.

As Mary Lu Abbott notes in a recent Los Angeles Times article, these incidents have some people asking: "Are cruise ships safe?"

More than eleven million people thought so in 2005.

But falls overboard and pirate attacks aside, the cruise ship industry has for years been plagued by scrutiny concerning passenger safety.

Just as students and families head out on spring break, a study published in the American Journal of Preventative Medicine reports that outbreaks of gastroenteritis (vomiting, diarrhea) on cruise ships sailing into the United States have increased almost ten fold from 2001 to 2004 -- most likely attributable to noroviruses.

On an average seven-day cruise the expected incidence of gastroenteritis has increased from two cases between 1990 and 2000, to three cases between 2001 and 2004.

But you never hear about two or even three passengers falling ill.

Large cruise ship outbreaks demonstrate just how easily gastrointestinal viruses like norovirus spread from person-to-person within closed environments.

Last week two outbreaks of gastroenteritis aboard luxury liners made headlines in Florida. And while identification of the causative agent is pending, the likely cause is norovirus. On the Cunard Lines ship Queen Mary 2, over 100 people developed gastroenteritis on her voyage to Los Angeles. At the same time, over 250 people were affected on Royal Caribbean's, Explorer of the Seas seven-night journey to Belize, Mexico and the Cayman Islands. The only thing sick passengers explored were the insides of bathrooms.

"Normally the cruises are great," said Explorer of the Seas passenger Joe Clifford, who spent more than $10,000 for his family to go on the cruise. "This time it wasn't."

This week as many as 100 passengers fell ill as a second Royal Caribbean ship Grandeur of the Seas, was struck with illness after it left the Port of Tampa. In addition to bouts of vomiting and diarrhea, those who were ill experienced a three-hour wait at the ship's infirmary, were prohibited from leaving the ship at port calls, and told to stay in their cabin. Some vacation.

Dave Forney, chief of the Vessel Sanitation Program of the U.S. Centers for Disease Control and Prevention (CDC), was quoted as saying, "The reason you hear about norovirus on cruise ships is because they are required to report every incidence of gastrointestinal illness. Nowhere else in the public health system of the United States is norovirus a reportable illness."

Established in 1975 as a cooperative activity with the cruise industry, the Vessel Sanitation Program helps to minimize the risk for gastrointestinal illness among passengers visiting U.S. ports.

Cruise ships like Queen Mary 2 and Explorer of the Seas are subject to unannounced, twice yearly inspections, both of which are paid for by the ships' owners. To pass the inspection a ship must score 86 or above, out of a possible 100. And unlike many counties across North America that have yet to make restaurant inspection reports publicly available, all cruise ship inspection scores and reports are published online (

According to the study published in the American Journal of Preventative Medicine, annual inspections scores have increased from a median of 89 in 1990 to 95 in 2004 despite the bad press. So why is it that we're still reading about the cruise ship illness?

If we are to believe the cruise ship spokespeople, passengers are bringing the virus on board and transmitting it through direct contact and through what the ships call "high-touch" areas (doorknobs, elevator buttons, railings).
CDC concurs.

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