cruise ship cannot dock due to virus

Cruise ship barred from docking in Mauritius amid outbreak of stomach illness

Officials in the island nation of Mauritius blocked a Norwegian Cruise Line ship from docking there Sunday after more than a dozen passengers were stricken with a stomach illness.

Around 15 passengers aboard the Norwegian Dawn remain in isolation because of an undisclosed "health risk" and are undergoing testing, according to the Mauritius Ports Authority .

"The decision not to allow the cruise ship access to the quay was taken in order to avoid any health risks," the authority said in a statement.

The sick guests “experienced mild symptoms of a stomach-related illness,” Norwegian Cruise Line said in a statement Sunday. The cause of the outbreak has not been released.

“Due to additional testing being required by local authorities before being allowed entry, the government of Mauritius has delayed disembarkation for the current cruise and embarkation for the next cruise by two days,” the Norwegian statement said.

It’s expected that the ship will be allowed to dock Tuesday, the cruise line said, after results of tests conducted Sunday become available.

The Norwegian Dawn has more than 2,100 passengers and 1,000 crew on board. About 2,000 of those travelers were set to complete their journey on Sunday by disembarking in Mauritius, in the Indian Ocean just east of Madagascar, the Ports Authority said. Then more than 2,200 new passengers were scheduled to board.

The authority said that the passengers who were due to start their cruise Sunday would not be able to do so that day and that they would have to be relocated to available hotels.

Norwegian Cruise Line said the ship's "management team met with local authorities to confirm precautions and actions were being taken to ensure the wellbeing of all on board."

Gastrointestinal illnesses are often identified on cruise ships for a few reasons , according to the Centers for Disease Control and Prevention: The ships' close living quarters make it easier for viruses to spread, and the regular addition of new passengers creates opportunities to introduce illness. However, because public health officials track illness cases on cruise ships, such outbreaks may also be reported more often than ones on land.

Last month, an outbreak of norovirus — a common stomach bug that causes vomiting and diarrhea — sickened 92 passengers and eight crew members on a Celebrity Cruises ship.

David K. Li is a senior breaking news reporter for NBC News Digital.

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Thousands stranded on Norwegian Dawn cruise ship hit by possible cholera outbreak

By Haley Ott

Updated on: February 27, 2024 / 8:54 AM EST / CBS News

A Norwegian cruise ship with over 2,000 passengers and 1,000 crew on board was given permission to dock in Mauritius on Tuesday after being denied permission over fears of a potential cholera outbreak on board. At least 15 people on the cruise ship Norwegian Dawn were isolated and samples were taken for testing on Sunday, according to a statement from the Port of Mauritius. The test results came in on Tuesday, the Reuters news agency reported.

People on board the ship developed mild stomach symptoms after visiting South Africa for a couple days in mid-February, CBS News partner network BBC News reported.

"The health and safety of passengers as well as that of the country as a whole are of the utmost importance to the authorities," the port authority of Mauritius said. Officials there decided to block the ship "to avoid any health risks."

There have been a number of cholera outbreaks in southern African countries over the last few months, the BBC reported. Since January 2023, over 3,000 people in the region have died from cholera and 188,000 have been infected, according to the BBC.

Cholera, an infection that causes severe diarrhea and dehydration, is rare in the developed world, but it is almost always fatal if left untreated. It is among the deadliest diseases in the world.

There are 2,184 passengers on the Norwegian Dawn along with 1,026 crew members. About 2,000 of those passengers would have completed their trip and disembarked in Port Louis, while 2,279 new passengers were expected to board the ship, Reuters reported.

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Haley Ott is the CBS News Digital international reporter, based in the CBS News London bureau.

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Norovirus outbreaks on cruise ships surge to decade-high levels: How to avoid the stomach bug

In 2023, a decade-high number of cruise ships have reported an unwelcome passenger on board: norovirus.

Outbreaks of the stomach bug have surged on cruise ships this year, reaching the highest levels seen in 10 years. Since January 2023, there have been 13 confirmed norovirus outbreaks on cruise ships under U.S. jurisdiction — that's more outbreaks in six months than there have been during any full year since 2012, according to data from the U.S. Centers for Disease Control and Prevention .

After a lull during the COVID-19 pandemic, cases of the highly contagious virus that causes diarrhea and vomiting, aka stomach flu, spiked this winter and spring on land. As post-pandemic travel surges and millions of Americans return to cruise ships, an increasing number of cruise lines are reporting outbreaks at sea.

Norovirus outbreaks on cruise ships

Most recently, a norovirus outbreak in June on the Viking Neptune sickened 110 passengers (over 13% of the ship's guests) and nine crew members with vomiting, diarrhea and abdominal cramps, according to the CDC . The CDC has tracked outbreaks of gastrointestinal illness on cruise ships through its Vessel Sanitation Program (VSP) since 1994.

Several weeks prior, a Celebrity Summit cruise ship reported an outbreak of norovirus that sickened more than 150 passengers and 25 crew members, per the CDC . It was the third norovirus outbreak on a Celebrity Cruises vessel this year. Another popular cruise line, Royal Caribbean International, has reported four outbreaks since January.

Cruise ships are required to report cases of gastrointestinal illness to the CDC before arriving at any U.S. port, and the CDC will notify the public about outbreaks if they meet certain criteria, including: the ship is carrying 100 or more passengers, the voyage is three to 21 days long, and 3% or more of passengers or crew report symptoms, per the CDC .

The number of outbreaks in the first six months of 2023 is higher than the yearly total during every year since 2012, when there were 16 outbreaks on cruise ships reported to the CDC.

Norovirus can spread year-round, but it tends to have a wintertime seasonality and peak during the colder months. Outbreaks are most common between November and April, TODAY.com previously reported.

"It's a virus we typically see all throughout spring, so it’s not unusual to be see cases in April and May, (and) we are continuing to see many cases now," Dr. Luis Ostrosky, an infectious disease specialist at UTHealth Houston and Memorial Hermann in Houston, tells TODAY.com.

However, as travel surges this summer, travel-related illnesses are expected to surge, as well. “I think our travel frenzy after COVID is partially fueling this continued spread (of norovirus),” says Ostrosky.

What should people know about norovirus and how to avoid getting sick on cruise ships this summer?

Norovirus symptoms and treatment

The most common symptoms of norovirus are vomiting, nausea, diarrhea and abdominal pain, Dr. Albert Ko, infectious disease physician and professor of public health, epidemiology and medicine at Yale School of Public Health, tells TODAY.com.

Less commonly, norovirus may cause a headache, muscle aches, or a low-grade fever — symptoms usually develop within one to two days after exposure to the virus,  per the CDC .

In the vast majority of people, norovirus symptoms will last several days and resolve on their own.

There’s no specific treatment or antiviral for norovirus, according to Ostrosky, but most cases can be managed at home with supportive care like hydration and rest. Sick people should also isolate until their symptoms resolve, the experts emphasize.

Some people are at higher risk of developing severe norovirus symptoms — these include infants, the elderly, and people with compromised immune systems, Ostrosky noted.

How does norovirus spread?

Norovirus is highly contagious and can spread directly through sick people and contaminated surfaces, food, or drinks.

Transmission often occurs when tiny virus particles in feces or vomit from an infected person end up in another person's mouth through direct contact or by touching contaminated surfaces and putting unwashed hands in the mouth or nose, TODAY .com previously reported .

Norovirus can also get into food before, during or after preparation, and it's the top germ causing foodborne illness in the U.S., per the CDC . Virus particles can contaminate drinking water that isn't treated properly or pools when people poop in the water.

It only takes a small number of virus particles for norovirus to spread, which is why norovirus causes so many explosive outbreaks, Ko previously told TODAY.com.

Exposure to less than 100 norovirus particles can make someone sick, and infected people typically shed billions of particles, according to the CDC.

Most people are infectious from symptom onset until about two or three days after recovering, but some people can remain contagious for weeks, Ko notes. People can get infected with norovirus multiple times in their lifetime.

Is norovirus common on cruise ships?

Certain environments are more conducive to the virus spreading. According to the CDC , the most common settings for norovirus outbreaks are health care facilities, restaurants or catered events, schools, day cares and, of course, cruise ships.

Cruise ships are often associated with norovirus because of the enclosed spaces, close living quarters, communal dining and high turnover of passengers, experts note. That said, outbreaks of acute gastrointestinal illnesses are relatively infrequent on cruise ships compared to settings on land, the CDC notes .

How to avoid norovirus on a cruise

Hand hygiene is key to prevent the spread of the highly contagious virus — but the way you clean your hands matters, experts note. It has to be with soap and water, because alcohol-based hand sanitizers are not effective against norovirus.

“Norovirus is one of the few viruses that doesn’t get deactivated by alcohol. You actually need to use soap and water to physically destroy it and remove it from your hands,” Ostrosky previously told TODAY.com.

It's important to wash your hands with soap and clean water frequently, but especially after using the bathroom or changing diapers, before eating and before touching your face.

Surfaces or objects that are contaminated with norovirus can be cleaned with a high-level disinfectant like bleach, per Ostrosky.

On cruise ships, avoid sick people if you can. Passengers who experience norovirus symptoms like vomiting and diarrhea should notify staff and follow recommended precautions, per the CDC .

Caroline Kee is a health reporter at TODAY based in New York City.

CDC: Avoid Cruise Travel, Even If You're Vaccinated, Due to COVID Risk

The agency updated its travel health notice for cruise ships to a level 4, the highest risk level on the cdc's threat scale, by staff • published december 30, 2021 • updated on december 30, 2021 at 2:07 pm.

The U.S. Centers for Disease Control and Prevention is advising people to avoid traveling on cruise ships, regardless of vaccination status, due to the high risk of COVID-19 infection onboard ships.

The agency increased its travel warning for cruise ships from a Level 3 to a Level 4, its highest level. The advisory comes as the number of ships under investigation by the CDC for possible COVID-19 outbreaks continue to rise while new cases of infection in the U.S. soar to their highest level on record, with over 265,000 per day on average.

The CDC cautioned that even fully vaccinated travelers may be at risk for getting and spreading COVID-19, noting that the virus spreads easily between people in close quarters, making the chances of getting infected on board a cruise ship very high, even if you are fully vaccinated and have received a booster.

"It is especially important that travelers who are at an  increased risk of severe illness  from COVID-19 avoid travel on cruise ships, including river cruises, worldwide, regardless of vaccination status," the CDC said.

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Its updated guidance stresses that those who are not fully vaccinated or boosted should not embark on a cruise trip. Unvaccinated passengers or those who have not received the second dose of a two-shot regimen, like those required for the Pfizer and Moderna vaccines, are now also being asked to self-quarantine for a full five days after cruise travel.

The CDC said Wednesday 88 vessels are now either under investigation or observation, but it did not specify how many COVID-19 cases have been reported. Four other vessels are also being monitored by the CDC as well.

Cruise lines have not announced any plans to halt cruising. And the CDC did not say whether it planned to extend the expiration date of a set of rules that cruises must follow to sail during the pandemic. The regulation, called a conditional sailing order, is scheduled to expire on Jan. 15 to become a voluntary program.

Most lines require adult passengers to show proof of vaccination against COVID-19. Cruise ships are allowed to relax measures such as mask use if at least 95% of passengers and 95% of crew are fully vaccinated.

None of the ships so far appear to have so many cases that they would overwhelm medical resources on board and require a return to port. But some have been denied entry at some foreign ports.

Several Florida-based ships have reported outbreaks. The Carnival Freedom was denied entry to Aruba and Bonaire after an undisclosed number of passengers and crew aboard caught the virus.

Some cruise ships have not been allowed to disembark in Mexican ports due to cases reported, bringing to memory the early days of the pandemic when cruise lines negotiated docking plans as ships were being turned away by officials worried about the virus’s spread.

The Mexican government  said  Tuesday it would allow cruise ships with reported coronavirus cases to dock. The country's Health Department said passengers or crew who show no symptoms will be allowed to come ashore normally, while those with symptoms or a positive virus test will be quarantined or given medical care.

This is a breaking news update. Please check back for updates.

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Cases Rise, Criticism Mounts, but Ships Keep Cruising

One day after the C.D.C. advised against all travel on cruise ships, thousands of cruisers partied like it was 2019. But worries about onboard policies — and frustration over quarantines — are rising.

By Ceylan Yeginsu

On the fourth day of a seven-day Mexican Riviera cruise, Jesse Suphan and other passengers onboard the Carnival Cruise Line’s Panorama were denied entry at the port of Puerto Vallarta, because of the number of onboard coronavirus cases. That was the first Mr. Suphan heard about the virus spreading on the ship.

“The captain announced that five people had tested positive for Covid and were quarantining,” Mr. Suphan, a 39-year-old revenue cycle manager, recalled in a telephone interview. “But, then, talking to the crew, they told me there were between 100 and 150 crew members who also tested positive, but the captain didn’t mention that.”

Two days later, the Centers for Disease Control and Prevention told Americans to avoid travel on cruise ships, regardless of their vaccination status. The advisory, the agency’s highest coronavirus warning , came in response to a surge in cases in recent weeks, caused by the spread of the contagious Omicron variant.

But even as case numbers rise, and criticism mounts about the safety of cruising and over cruise line protocols in reporting cases to passengers, ships keep sailing and guests keep embarking, adamant that the onboard environment is safe because of stringent health and safety requirements, including pre-departure testing and vaccine mandates.

Consider the New Year’s Eve festivities held on ships around the world. One day after the C.D.C. announcement, as dozens of crew members and other passengers were confined to small cabins, infected and quarantined, thousands of revelers packed into ship bars, casinos and deck venues, partying like it was 2019.

Harvey Freid, 56, recently returned from a 17-day sailing to Antarctica, during which one positive case was reported. But Mr. Freid, an avid cruiser, is undeterred and is scheduled to go on a Caribbean cruise in late January.

“The cruise ships do a very good job of handling Covid, and I think it’s safer than my building in Miami and most places that I go on land, because people are vaccinated and cases are quickly identified and isolated,” he said.

On Wednesday, Royal Caribbean and Norwegian Cruise Line canceled several voyages in response to the growing number of coronavirus cases onboard some of their ships.

The cruise industry’s trade group, Cruise Lines International Association, called the C.D.C.’s warning “perplexing,” and said that cases identified on ships “consistently make up a slim minority of the total population on board — far fewer than on land.”

“No setting can be immune from this virus — however, it is also the case that cruises provide one of the highest levels of demonstrated mitigation against the virus,” the group said in a statement.

But some passengers are starting to question the effectiveness of health and safety protocols, and say they aren’t being informed of the full extent of coronavirus cases on board. They say they learn of the positive cases only after returning home and would have been able to make more informed decisions about their behavior and participation in activities, if they had been made more aware.

When Mr. Suphan booked his vacation, he felt confident that Carnival had good protocols in place, which included pre-departure testing and requiring vaccines for all crew and most passengers. But as the ship sailed, Mr. Suphan was surprised by the number of people he met who said they had been exempted from the vaccine mandate. He said there were not enough crew members to enforce indoor mask rules for more than 3,000 passengers on board.

Carnival said only a small number of passengers had been exempted from the vaccination requirement, but did not specify how many.

Mr. Suphan was also struck, he said, when a crew member told him that several infected crew were isolating on board when the ship departed from Long Beach.

“The fact that they had infected staff on board when the cruise left Long Beach means that they knew there was the possibility of more cases coming up after we left,” Mr. Suphan said. “But they still continued with the cruise so they could take everyone’s money. It feels like a cash grab to maintain payments.”

Carnival said four asymptomatic crew members were in quarantine when the cruise departed, while others had been taken off the ship.

Reporting positive cases

Most major cruise lines do not publicly announce the number of coronavirus cases on board their ships, but they are required to submit daily figures to the C.D.C. Currently, the agency is monitoring more than 90 cruise ships, because of reported cases that have reached the agency’s threshold for an investigation. (An investigation is undertaken when a certain number of cases is reported among a percentage of passengers.)

Carnival has denied that the number of infected crew was as high as 100 on Mr. Suphan’s sailing, but has not disclosed the total number of people who tested positive. On Dec. 28, when the cruise was denied entry to port, the Jalisco state health ministry said 69 cases had been detected among the ship’s 1,450 crew members. That day, Christine Duffy, the Carnival president, called into the ship and briefed guests on the situation. Passengers said she did not give updated figures for positive cases, which many found concerning.

Chris Chiames, chief communication officer for Carnival, said the company takes its responsibility for public health “very seriously” and has implemented protocols that exceed C.D.C. guidance since restarting operations in the United States in June.

“The extreme majority of the crew who test positive are asymptomatic and detected through the random testing protocol, and they and their close contacts are put into isolation or quarantine,” Mr. Chiames said. “None have required escalated medical attention or hospitalization, and we have also moved most crew off the ship to complete their isolation or quarantine.”

Carnival declined to comment on its policies for reporting daily cases to passengers onboard its ships, but Mr. Chiames said, “the additional complications caused by the fast-spreading Omicron variant will require us to evaluate how to communicate moving forward.”

Testing positive

For many, the idea of testing positive for the coronavirus on a cruise ship conjures up the horrors of the major outbreaks in the early stages of the pandemic, when thousands of people were confined to their rooms for endless days while the pandemic raged through the ships.

The health and safety protocols that allowed U.S. cruise ships to restart operations in June have helped cruise lines contain the virus and avoid large outbreaks, and until now, many of the small percentage of guests who tested positive during sailings have been satisfied with the handling of their cases. Some even received complimentary food and champagne to their rooms and were flown home by charter plane.

But since more contagious variants like Delta and Omicron have emerged, causing cases to increase among passengers and crew, guests have started to complain about quarantine conditions.

Richard Lewis, the chairman and chief executive of Savile Row Travel group, recently caught the coronavirus during two back-to-back Caribbean cruises with his family on board Celebrity Apex. It was his first cruise during the pandemic and initially, the protocols met his expectations and the experience felt relatively normal.

On day two of the cruise, the captain announced that there were two coronavirus cases on board the ship, which Mr. Lewis appreciated for keeping him informed. But there were no further announcements for the remainder of the week. That is when both he and his family started noticing changes.

“The staff were masking up a heck of a lot more, social distancing was being enforced between passengers and things did not seem right,” he said. “As we moved into the second week, some of the staff we became friends with disappeared and we found out they had gone into isolation. Then I started developing symptoms and tested positive and that’s when it became a nightmare.”

Mr. Lewis was moved from his “concierge class infinite veranda cabin” room to a standard cabin allotted for quarantines, which he said had a slightly oversized porthole and no fresh air. He had been under the impression that he could quarantine in his own room, saying the cruise line encourages people to book bigger rooms in the event that they will have to isolate.

Celebrity Cruises said its policy from day one was to move coronavirus-positive guests to a quarantine zone. Those identified as close contacts are permitted to isolate in their state rooms for 24 hours while they are tested and await results.

“Even the food was hideous,” Mr. Lewis said, sharing a picture of fried eggs, hash browns and bacon strips in a takeout container. ‘The first two meals were cold and appeared to have come from the crew canteen. It was only after I kicked up a fuss that I was allowed to order from the regular room service menu.”

That day, the captain announced that there were five coronavirus cases on board, but when Mr. Lewis pressed the doctor who visited him, he says he was told there were 16 cases.

“I know the cruise industry has suffered and I’m so supportive of getting travel back to normality, but there’s a serious lack of transparency and covering things up, and hiding them away is not going to help people make informed decisions,” Mr. Lewis said. Royal Caribbean Group, which owns Celebrity Cruises, said that passenger and crew members are informed when a threshold of virus cases has been met or exceeded.

“Publishing a dashboard of daily cases to all persons onboard is a less meaningful public-health mitigation measure than reinforcing continuous adherence to our industry-leading health and safety protocols, which has resulted in lower prevalence rates onboard than those found shoreside,” the company said in a statement.

Milly Parkinson, 28, developed coronavirus symptoms one day after returning from an eight-night Caribbean cruise with friends on board Royal Caribbean’s Odyssey of the Seas. While more than 50 people tested positive for the virus on board the ship, Royal Caribbean, like most cruise companies, does not require passengers to test before disembarking at their final destination.

“I took a test because I had symptoms, but think of all the people who were asymptomatic who just walked off the ship straight into the grocery store, a restaurant or a nightclub,” Ms. Parkinson said.

“We booked the cruise because we were convinced it would be a fun, safe bubble of vaccinated people,” she said. “But who were we kidding? There’s no place to escape Omicron.”

Follow New York Times Travel on Instagram , Twitter and Facebook . And sign up for our weekly Travel Dispatch newsletter to receive expert tips on traveling smarter and inspiration for your next vacation. Dreaming up a future getaway or just armchair traveling? Check out our 52 Places list for 2021 .

Ceylan Yeginsu is a London-based reporter. She joined The Times in 2013, and was previously a correspondent in Turkey covering politics, the migrant crisis, the Kurdish conflict, and the rise of Islamic State extremism in Syria and the region. More about Ceylan Yeginsu

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Cruise Ships With Possible COVID-19 Cases Have No Places To Dock

A cruise ship with dozens of sick passengers is steaming towards south Florida, where local officials don't want it to dock. It's one of several ships with nowhere to go.

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Cruise Ship Norovirus Outbreaks

Here are listed latest cruise ship Norovirus outbreaks on passenger ships, with information what is and how to avoid Norovirus on cruise ships, CDC reports, and news updates.

From the following links, you can skip the intro and jump directly to illness outbreaks in 2024 , 2023 , 2022 , 2020 , 2019 , 2018 , 2017 , 2016 , 2015 , 2014 , 2013 , 2012 , also read about Zika virus , Seasickness , Hospital (shipboard infirmary) and Mercy Ships (hospital ship Africa Mercy) .

Note: The following CruiseMapper link provides information on Coronavirus/COVID outbreaks on cruise ships .

Norovirus outbreaks on cruise ships in 2024

Cruise norovirus outbreaks updates.

Norovirus on ships is spread through contaminated water, foods and surfaces (public restrooms, railings, doorknobs, handles, board games-cards-puzzles-toys, etc). Norovirus withstands chlorine, prolonged exposure outside the body, as well as temperature extremes. Like a virus, Norwalk can't be effectively treated with antibiotics, making it extremely difficult to eliminate in closed environments - like cruise vessels.

Norovirus may incubate up to 48 hours before the symptoms appear. This makes it difficult to restrict an outbreak. Noro symptoms include nausea, vomiting (kids more than adults, abdominal cramps, diarrhea, general weakness, low fever, headache, muscle aches. The illness could last up to 5 days (depending on the person's age, general health, and severity of the exposure to the virus. Recovered patients can still spread the virus for up to 2 weeks.

Quarantining the ill passengers and crew to their cabins is mandatory (at least for 48 hours) to slow the outbreak's spread. Failing to comply with the crew's orders results in fines or even discharge from the ship.

CruiseMapper's Norovirus survey is based on official data from CDC.gov (USA's "Centers for Disease Control and Prevention"). CDC's "Vessel Sanitation Program" assists the cruise tourism industry in preventing and controlling the transmission and spread of gastrointestinal illnesses (Norovirus, ETEC) on passenger ships calling on US seaports.

This program operates under the authority of the Public Health Service Act (fda.gov, "Quarantine and Inspection Regulations to Control Communicable Diseases"). CDC sanitation inspections on passenger ships are conducted twice a year. Scores of 86 are considered passing. Among the issues that CDC health inspectors usually find on board and report are:

• food debris
• dead insects
• insect droppings
• records indicating crewmembers (including cooks and galley staff) working while sick (suffering from gastrointestinal disorders or with acute gastroenteritis/AGE symptoms)
• cracked/corroded equipment
• soiled cutting boards
• food served undercooked
• lack of safety instruction signs.

CDC cruise ship Norovirus reports

Cruise ship outbreaks are reported (posted on the CDC website) when the illness incident meets the following criteria:

• The ship falls within the purview of the Vessel Sanitation Program (VSP). This means if it carries 13+ passengers and has a foreign cruise itinerary with US ports of call in it. Keep in mind, that most departures are from US-based home ports.
• The ship cruise itinerary length is between 3 and 21 days,
• The ship carries 100+ passengers.
• The percentage of infected passengers or crew (cases reported to the ship's med staff) during the cruise is 3% or more. This means small outbreaks on cruise ships will not be reported to the CDC.

CDC cruise ship inspection fees are payable by the shipowner. Fees are based on the vessel's size. VSP doesn't charge fees for consultations related to shipping facilities renovations or new ships. Inspection fees are as follows.

• Small ships (under 3000 GT/gross tons) pay USD 1500 per inspection.
• Small ships (between 3000-15000 GT) pay USD 3000 per inspection.
• Medium ships (between 15000-30000 GT) pay USD 6000 per inspection.
• Large ships (between 30000-60000 GT) pay USD 9000 per inspection.
• Extra-large ships (between 60000-120000 GT) pay USD 12000 per inspection.
• Mega-liners (above 120000 GT) pay USD 18000 per inspection.

Note: When the itinerary doesn't include US cruise ports, the ship is not required to report to CDC, thus no official illness outbreak report would be issued.

CDC ship illness outbreak investigations

VSP (abbrev "Vessel Sanitation Program") monitors CDC's observations on illness patterns for GI (gastrointestinal) outbreaks on passenger shipping vessels ( ferries and cruise ships ).

• VSP conducts outbreak investigations only in cases with 3% or more passengers or crew reported sick with GI symptoms. VSP may also conduct outbreak investigations in cases of unusual GI illness patterns (even if the rate is less than 3%).
• VSP conducts outbreak investigations only on vessels visiting ports in the USA or which are within 15 days of arriving at a US port.
• When an outbreak occurs, VSP asks for ship logs and infirmary records of reported GI cases (symptoms and timing) and illness distribution (among passengers/crew, during each day of the cruise).
• VSP staff usually boards the vessel for epidemiological assessment, interviews, distribution and analysis of illness questionnaires, monitoring cleaning procedures.
• Lab investigations - the onboard med staff often collects stool, vomit, blood specimens, which are then sent to land-based labs to confirm the illness cause.

During the onboard illness outbreak, VSP requires the cruise company to activate the "Outbreak Prevention and Response Plan" (vessel's response to illness cases).

During an outbreak:

• Cleaning and disinfection frequencies are Increased.
• Self-service buffets are stopped.
• All infected (pax/crew) are quarantined to their staterooms/cabins
• Clinical specimens are collected for analysis.
• Daily updates are provided to VSP (cases counts and measures reports)
• All passengers and crew are alerted of the illness.
• Upon boarding on the next scheduled cruise, passengers are notified about the previous voyage's outbreak.
• Occasionally, VSP requires the company to notify port authorities and also to perform cleaning and disinfection in cruise port terminal buildings.

Illness outbreaks on cruise ships (annual statistics)

The following statistics show the number of cruise ship illness outbreaks in recent years. You can compare the number of reports (CDC and news media sources) and the total number of infected (passengers and crew).

In 2014, Time Magazine published the article "The 13 Worst Norovirus Outbreaks on Cruise Ships". In it, the overall winner was Princess Cruises with 5 epidemic illness outbreaks:

• Coral Princess (February 2009, infected 271)
• Crown Princess (January 2010, infected 396)
• Crown Princess (February 2012, infected 363)
• Sun Princess (July 2012, infected 216)
• Ruby Princess (March 2013, infected 276)

Norovirus outbreaks 2023 reports

Norovirus outbreaks 2022 reports, norovirus outbreaks 2020 reports, outbreaks 2019 reports.

In the following table, you can see all 2019-reported Norovirus outbreaks on cruise ships. The listed statistical data is based on CDC or news media reports. It shows the number of sick passengers and crew (with the respective percentage to all), along with the corresponding CDC report pages (if available) as outgoing links.

Note: When the itinerary doesn't include US cruise ports, the ship is not required to report to CDC, thus no official illness report would be issued.

Outbreaks 2018 reports

In 2018, the number of reported illness outbreaks on cruise ships was 15. The total number of infected was 1177 (of those 1099 passengers and 78 crew).

Outbreaks 2017 reports

In 2017, the number of reported illness outbreaks on cruise ships was 21. The total number of infected was 2535 (of those 2450 passengers and 85 crew).

Outbreaks 2016 reports

In 2016, the number of reported illness outbreaks on cruise ships was 23. The total number of infected was 2504 (of those 2378 passengers and 126 crew).

Outbreaks 2015 reports

In 2015, the number of reported illness outbreaks on cruise ships was 23. The total number of infected was 2570 (of those 2458 passengers and 112 crew).

Outbreaks 2014 reports

In 2014, the number of reported illness outbreaks on cruise ships was 17. The total number of infected was 3559 (of those 3354 passengers and 205 crew).

Outbreaks 2013 reports

In 2013, the number of reported illness outbreaks on cruise ships was 22. The total number of infected was 2385 (of those 2249 passengers and 136 crew).

• According to CDC, in 2013 from Norovirus and similar GI (gastrointestinal) illnesses suffered a total of 1409 passengers (which is 7,5% of all passengers on the inspected cruise vessels) and 96 crew/staff members (which is 1,2% of all). With nearly 12 million cruisers departing from USA and Canada ports in 2013, the Norovirus infection rate is ~0,01% of all passengers.
• It should be noted, that in the past years on many CDC inspections was concluded the Noro virus illness source was off the ship.

Outbreaks 2012 reports

In 2012, the number of reported illness outbreaks on cruise ships was 34. The total number of infected was 5542 (of those 5079 passengers and 463 crew).

Norovirus on cruise ships

All important things you should know about the "cruise virus".

Why do Norovirus incidents happen on cruise ships? There are more than 21 million US cases reported annually, of which 1 mill related to kids. Outbreaks happen mostly during winter months and mainly in more crowded places with close quarters. Among those are schools, hospitals, nursing homes, dormitories, prisons, big resorts, bigger passenger ships (including cruise ferries ). Norovirus is often branded as "cruise ship virus" simply because on ships health officials are required to report every gastrointestinal illness incident. This means Norovirus outbreaks are reported more quickly on ships than on land. Just for comparison, the virus can afflict as many as 3000 people per day in only one big city, which is about the passenger capacity of a typical modern cruiser.

What is Norovirus infection? It's a very common, highly contagious, ruthlessly efficient and uncomfortably bad virus affecting the stomach and large intestines. Often called "stomach flu" (the med term is "Gastroenteritis") the infection results in massive vomiting and diarrhea. Sickness outbreaks are considered as such if the percentage of infected people is over 3%. The virus is not seasonal and usually not serious (in medical terms). It hits 1 in 5 people annually and is the cause of ~50% of all foodborne illness outbreaks in the USA and for ~90% of all non-bacterial gastroenteritis worldwide.

The virus is named after an outbreak in Norwalk (OH, USA). Numerous studies confirm that a quick application of hand sanitizer doesn't kill the Norovirus. It takes about 30 sec of hard rubbing with hot water and soap (including under the nails) to wash it. This virus also mutates (changing its strains). As to its efficiency - a mere 20 particles are enough to get you.

What causes Norovirus on cruise vessels is mainly contaminated food/water. When it comes to ships, it spreads mostly through physical contact with sick people or handling contaminated objects. This includes sharing food/utensils and poor hygiene (not washing hands after bathroom use). The virus also spreads fecally, so you can catch it into the onboard laundry, or while changing diapers, etc. However, many passengers likely can blame a sick crewmember for the virus. According to a survey based on 170 inspection records on ships that docked in Florida ports in 2012, on 59 cruises violations of the required illness reporting laws were reported. A total of 130 crew had gotten sick on those voyages and didn't report their illness in the required time period.

The symptoms are nausea, vomiting, diarrhea, indigestion, abdominal cramps. Also possible are mild fever and headache. It takes 1-2 days for the symptoms to appear. The illness lasts 1 to 4 days, but some people (especially elderly) may be contagious for up to 2 weeks after recovery.

What is the treatment? What to do if you got it? Obviously, the first thing is to go to the ship's infirmary (medical center) and contact the doctor. You should drink plenty of water as dehydration is a side-effect of the illness. There is no real treatment for Norovirus - you just wait it out. A few years ago an experimental Norovirus vaccine (applied as nasal spray) was developed by the "Center for Infectious Diseases and Vaccinology" (Arizona State University). The new vaccine generates a good immune response.

How to avoid Norovirus on cruise ships?

• Wash your hands often (hot water and soap), especially before/after eating and after using the bathroom
• Limit physical contacts as much as possible, pack some extra soap, a personal disinfectant (Lysol, Pepto-Bismol), oral rehydration sachets and treatments for diarrhea
• Avoid eating uncooked food (including salads and sandwiches) and food that cannot be washed (unless it can be peeled or shelled), drink only bottled liquids (preferably without ice), don't share drinks/utensils.
• Drink lots of water.
• Compensation for cruise illness. By contract, cruise lines are not required to compensate passengers who fall ill on cruises. However, they will compensate you if the itinerary was altered/canceled due to an illness outbreak. The deal may include up to 50% refund, up to 50% FCC (future cruise booking discount) or an option to cancel for a full refund plus reimbursement of airline change fees. If you have travel insurance, it covers cancellation due to illness. If you've been infected on the ship, it could also cover medical expenses and to compensate you for all days you're not on the ship before the cruise end.

The following "health advisory" list of recommended actions is often issued during gastrointestinal illness outbreak or on embarkation day (of the next scheduled voyage). It has important suggestions on how to avoid spreading the cruise ship virus infection.

• It is critical that excellent standards of personal hygiene are maintained by all on board, as well as avoiding touching surfaces, such as handrails, door handles, elevator buttons, walls.
• Report any observed evidence of vomiting or diarrhea that you may encounter on the ship.
• Ensure that you minimize direct contact with others during this time, such as handshakes, etc.
• Avoid touching your mouth.
• Wash your hands frequently and thoroughly with soap for at least 20 sec and rinse them well under running water. Ensure that you follow this procedure every time you use the WC, after coughing or sneezing, and before eating, drinking or smoking.
• Attempt to always use your own cabin toilet facilities.
• In addition to hand washing, also use the alcohol hand gels provided where available, and in particular before eating in the self-serve buffet restaurant and outdoor food outlets.
• Should you experience any symptoms of vomiting or diarrhea, return to your cabin and immediately report to the Medical Center or Front Office (Reception, if the infirmary is busy) by dialling 999.

Cruise ship virus procedures

What do they do about it? What actions do lines/operators/CDC actually take in response to a Norovirus cruise outbreak?

An "illness outbreak" is considered when 3% or more of all passengers report symptoms to the ship's med staff. In such cases, the CDC requires cruise lines to file a medical report.

The hotel staff is required to implement special cleaning and disinfection procedures for sanitizing the whole ship. To do that, they use stronger solvents, like Microbac, chlorine bleach, hydrogen peroxide. The Lido Deck's bistro/buffet service switches to manned stations. Often, salt-pepper shakers are taken off the tables. The crew starts offering precautionary tips. Sick passengers and crew are quarantined in their rooms, typically for at least 2 days. When Norovirus outbreaks can't be contained, cruise lines might also pull the ship out of service for a few days for sanitizing.

The CDC's "Vessel Sanitation Program" is for monitoring illness outbreaks on passenger ships carrying 100 or more guests on sailings from 3 to 21 days in length. The ship's medical staff is required by the CDC to maintain illness counts for each itinerary involving a stop at a US cruise port and to give CDC the number of all passengers/crew, plus the number of reported diarrhea cases during that voyage. This is done 24 hrs prior to arrival at any US port of call from a foreign port. And they file such reports even if the "illness number" is zero. This protocol only confirms that the CDC knows everything about it.

Other possible actions and results are red level ("Code Red") cleaning. The boarding/embarkation of new passengers is often delayed to permit more extensive disinfection of public areas and the cabins. Usually, a pre-embarkation health advisory is distributed to all boarding passengers. Additional med staff is sent to the ship in port to assist the disembarkation of infected passengers. Another possibility is the cruise ship to cancel all the itinerary's foreign ports of call and to return to its US home-port before the end of the voyage.

Some cruise lines offer hand-sanitizer dispensers near the ship's restaurants, Lido/pool deck areas and other more crowded public spaces in their effort to keep a lid on sickness outbreaks.

In February 2020, the shipowner cruise company Lindblad Expeditions announced the "Premium Purity" program with a shipwide cleaning system based on ACT CleanCoat technology. The program was rolled out fleetwide after a year trial. The innovative ship cleaning process is based on photocatalytic antibacterial spray that when activated by light kills viruses, bacteria, airborne microbes, mould. The disinfecting product and technology were developed by the Danish company ACT Global AS ( Copenhagen ). The spray is chemical-free, odourless, transparent and can be applied to all surfaces.

Zika virus on cruise ships

Zika virus (aka ZIKV) is a Flavivirus - from the genus of the viruses named West Nile, dengue, tick-borne encephalitis, yellow fever. These plus several other viruses may cause encephalitis (acute brain inflammation). In humans, Zika virus causes the Zika fever which is known to occur only within some equatorial regions. In 2014, Zika spread across the Pacific Ocean to French Polynesia, and soon to Easter Island. In 2015, Zika virus reached Central America, the Caribbean, and South America. In South America were recorded several pandemic outbreaks.

The most severe outbreaks were reported in Brazil, with an alarming surge in newborns with microcephaly. If the mother is infected, the virus may cause microcephaly in newborns. This is a neurodevelopmental disorder - babies are born with an underdeveloped head.

Generally, Zika is a mosquito-borne virus spread by Aedes aegypti (aka "yellow fever mosquito") and Aedes albopictus (aka "Asian tiger mosquito"). However, it became "cruise virus" since the decease can also result from intrauterine (contraceptive device), sexual intercourse, blood transfusion, lab exposure, organ/tissue transplantation, breast milk transmission.

In January 2016, the CDC issued travel guidance on affected countries and suggested using enhanced precautions and even postponing travel. Guidelines (specifically for pregnant women) were issued as well. Similar travel warnings were issued by other health agencies and governments. The CDC list of potentially dangerous for travel countries included (alphabetically) Barbados, Bolivia, Brazil, Cape Verde, Colombia, Ecuador, French Guiana, Guadeloupe, Guatemala, Guyana, Haiti, Honduras, Martinique, Mexico, Panama, Puerto Rico, Paraguay, Salvador, Samoa, St Maarten, Suriname, Venezuela.

Cruise lines should warn their pregnant passengers of the virus. Cruise ships publish daily health and safety instructions to their passengers on how to avoid mosquito bites. Zika symptoms are fever, skin rash, pain in joints, conjunctivitis (pink eye). It typically lasts from a few days to a week. For now, the illness cannot be prevented by drugs or vaccines.

"Cruise ship virus" politics

Virus outbreaks on cruise ships are actually not that uncommon. Such viral/bacterial outbreak incidents affect the vacation experience of thousands of people, being packed up in a floating resort for many days on end. In confined spaces with frequent passenger turnover (like big capacity cruise ships), it is easy for diseases to spread - whether food- or air-borne, or otherwise. However, there's a tendency to cover up the severity of this issue.

Some of the world's most famous passenger ships are listed in the virus outbreak statistics, yet one hears so little of it in mass media news. And there is no surprise in that since the "cruise illness" news are nothing but bad publicity for the companies - which is bad for a prosperous multi-billion dollar sea travel vacation business. All major cruise line companies will do their best to keep quiet about virus outbreaks on their ships. There are passenger testimonials about quarantined ships and how badly guests have been treated by the line. Virus outbreak news speaks of a lack of proper hygiene control, badly trained staff, bad ship management. The whole responsibility goes to the shipowner (cruise line company) and its management.

Major (in some cases epidemic) illness outbreaks are among the "biggies" that can bring down the brand's reputation on the market. Cruise illness issues often result in lower booking rates and cheaper prices - which is bad for the business.

So it comes as no surprise that when CDC reports an illness outbreak on some vessel, big media sources do not immediately (or ever) respond to the news. You may hear about it on your local radio station, or on your local cable operator, but not necessarily on ABC, CNN, and often not even on Yahoo and MSN news online. It's not about the passengers' health (never been) - it's about the big money that rules our world.

So keep your hands clean, keep your mind clear, always hope for the best. Bad, if meant to happen, will happen anyway, and nothing can change it.

Seasickness on cruise ships

Seasickness is physical disorientation as a result of conflicting signals received by the brain from different body senses. Our inner ear senses the ship's irregular motion, which our eyes can't see because the floor and walls are stable. Depending on individual balance, our ability to adjust to motions varies, so not everyone experiences seasickness.

Seasickness is one of the most common "cruise illnesses". Passengers sensitive to nausea or motion sickness should consult their doctors for medical recommendations prior to departure. Drugs (like Dramamine) are effective against seasickness. At the cruise ship's Infirmary, and also at Reception Desk is provided (free of charge) Meclizine. Know that the bigger the vessel the more stable it is. Also, motion in midship-located areas (including staterooms) is highly reduced in comparison to forward and aft areas.

Seasickness manifests in different ways and is always a result of the body's attempt to correct for the conflicting inputs received from its senses. Common symptoms are cold sweat, dizziness, drowsiness, headache, nausea. When such symptoms are noticed, passengers should take precautions to prevent intensifying the disorientation. The harder the symptoms, the longer the recovery.

If seasickness symptoms are accompanied by diarrhea or fever, passengers should immediately seek medical treatment for Norovirus and avoid spreading the illness to others.

How to prevent seasickness on cruise ships (tips)

Passengers prone to motion sickness are more likely to suffer seasickness. The following prevention tips can minimize discomfort, so before the cruise:

• choose more sheltered routes (clam waters). Open sea and ocean waters are rough and have larger swells, thus river cruises are among your best choices.
• Choose a large liner as larger vessels are more stable and motions are minimized.
• Book centralized/midship stateroom and/or middle deck cabin, where motions are less noticeable.
• Get a good sleep before the voyage - an energetic, well-rested body adjusts easier to new conditions.

During the cruise tips to divert seasickness symptoms include:

• Get involved in onboard activities - this will occupy your mind while the inner ear adjusts to equilibrium changes.
• Avoid napping or lying down - when the body is horizontal, the ship's motion is more pronounced.
• Avoid eating unknown foods - you don't know how your stomach may react to new food/ingredients. Avoid alcohol and acidic-fatty-spicy foods. Stay well-hydrated by drinking plenty of water.
• Walk around to adjust the body's equilibrium to the ship's motion. When on open decks, focus on the horizon to give your eyes and body similar inputs about any tilting or other motion. Depending on the symptoms' severity, it may take several hours.
• Often get fresh air, take deep breaths, keep your lungs clear.
• Some herbal remedies (in tablets or teas) also can ease the symptoms, including ginger and peppermint. Their efficacy varies by person, and are best used together with other prevention methods.

Search for medical assistance - consult the ship's physician if no actions provide relief.

Cruise ship hospital (medical care)

Cruise vessels are not "hospital ships".

Hospital ships are designated as floating medical facilities (hospitals).

Most hospital ships are navy vessels (operated by military forces) which are specifically built for use in war zones.

Attacking a hospital ship is considered a war crime, but enemy forces have the right to board them for inspections.

As of 2018, hospital ships have Brazil (6), China (5), Russia (6), USA (2), Spain (2), and India-Indonesia-Peru-Vietnam (x1).

The navies of USA, UK, Australia, China, France, Italy, Spain, Argentina, and Japan have some classes of military ships fitted with onboard hospitals.

For passengers with health concerns, medical care on cruise ships is a vital part of their travel planning. Most cruise vessels are equipped with either basic infirmary (a small clinic) or larger hospital where sick or injured passengers are treated and cared for by contractor physicians and nurses on 24-hour duty.

Shipboard hospitals as facilities and equipment vary by cruise line and vessel. Clinic's size usually depends on the ship's capacity (passengers plus crew). Generally, bigger and newer ships offer larger and better-equipped medical facilities and are served by bigger infirmary staff.

The ship's medical personnel are independent contractors. This is for limiting the cruise company's liability. There are no internationally specified regulations governing ship infirmaries and medical staffing. Each company has its own standards provided for its passengers' healthcare.

For finding the Infirmary you can use the ship deck plans . On most vessels, the medical facilities are located midship on a lower deck (for easier access and better stability) and usually among other crew facilities. Every passenger stateroom has the Infirmary's number - posted or by the cabin's phone.

Basic medical care on cruise ships

A cruise ship's medical facility can treat only passengers experiencing minor health issues - seasickness, scrapes, sunburns, etc. More severe medical emergencies can't be handled on the ship and usually require medevacs. Coast guard helicopter teams fly to the ship, hoist the passenger (accompanied by a spouse/relative and a crew nurse) and fly them to the nearest land hospital.

Infirmary's equipment and med supplies provide only emergency response and basic treatments in order to stabilize the passenger until transferred ashore.

In cases of severe emergencies, passengers with life-threatening illnesses or injuries are evacuated off the ship - either by boat (if in or near seaport) or by rescue helicopter dispatched from nearest coast guard or other station. In some cases, nearby ships with better medical facilities may assist.

Both emergency and basic care are available on the ship 24 hours a day. All treatments are paid. Outside regular opening hours fees are higher.

Like inland hospitals, medical treatments at sea are pricey. However, unlike on land, most basic travel insurance policies don't cover medical treatments on cruise ships as they are not from the patient's primary caregiver. Purchasing cruise travel insurance with health coverage (medical clauses) is highly recommended.

Shipboard medical service fees vary and are usually set by medical practitioners. General consultations incur costs similar to home visits. Prescription medications or other treatments cost extra. In most cruise ship hospitals, some supplies and medications are provided to passengers and crew for free - like aspirin, seasickness pills, small bandages.

Mercy Ships

"Mercy Ships" is a charity accredited by Better Business Bureau. It operates hospital ships since 1978 and also has currently the world's largest hospital ship (excluding navy vessels) - MV Africa Mercy.

The organization provides free humanitarian aid worldwide, including health care, community development, and health education projects, mental health, agriculture, and water development programs in mainly developing countries in Africa, Caribbean, South America, Oceania.

The organization's headquarters are in Garden Valley (Texas USA), with another 16 offices worldwide - in UK, Spain, Canada, Germany, France, Denmark, Switzerland, Belgium, Holland, Sweden, Norway, South Africa, Australia, New Zealand, South Korea.

Financial support and supplies are mainly through donations from medical companies (medications, supplies, equipment), corporations (fuel, food, building supplies), governments (port fees, drydock costs), general public and also by the crew (all volunteers on a rotational basis). The crew serves with short-term (2 weeks to 2 years) and long-term (min 2 years) contracts. Volunteer crew members occupy both medical (surgeons, dentists, nurses) and general jobs (deckhands, seamen, engineers, machinists, electricians, teachers, cooks, welders, plumbers, agriculturalists.

The crew on Mercy Ships pay all costs associated with their service - fees, travel expenses, passports, insurance, personal expenses.

As 95 of the world's top 100 largest megapolises are port cities, "hospital ships" could provide healthcare very quickly and more efficiently to large numbers of people.

MV Africa Mercy

MV Africa Mercy is a converted former rail ferry (1980-built as "Dronning Ingrid") drydock-refitted in 2007 at Cammell Laird shipyard (Hebburn, England).

The ship project started in March 1999 with the vessel's acquisition through a donation from Balcraig Foundation (UK), which purchased the boat for US$6,5 million.

Ferry's train deck was reconstructed and converted into a hospital. Project's total cost was over USD 62 million.

Vessel details include:

• Volume/GT tonnage 16572 tons
• LOA length 152 m (499 ft )
• Width 23,7 m (78 ft)
• Draft 6 m (20 ft)
• Powerplant 4x BW main engines plus diesel generators
• Propulsion two shafts with controllable pitch propellers
• Speed 19 Kn/35 kph/22 mph
• Passenger capacity 484
• Crew capacity 450
• Fleet of 28 vehicles (used in land-based operations)
• Annual drydock maintenance and refurbishment are done in Durban (South Africa).

As for facilities and amenities, the hospital ship has 5 operating rooms, Intensive Care Unit, an ophthalmic unit, CT scanner, X-Ray, labs, recovery ward (82 beds), a daycare center, a school (for all ages), library, launderette, convenience store, restaurant, gymnasium, shops, Starbucks Cafe (donated), satellite communications.

Africa Mercy has a total of 126 staterooms for the staff/crew. They are located on upper decks and include cabins for families, couples and single cabins.

Land-based operations ("Field Service") include mobile clinics providing screening for potential surgery patients, healthcare, dental care, also mental health programs, infrastructure projects.

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Norovirus outbreaks linked to 2 cruise ships with over 150 infected

A total of 161 passengers have reported falling ill during voyages on princess cruises' sapphire princess and royal caribbean international's radiance of the seas.

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The Centers for Disease Control and Prevention are investigating two seemingly separate outbreaks of Norovirus linked to U.S. cruise ships.

Cases have been linked to Princess Cruises' Sapphire Princess and Royal Caribbean International's Radiance of the Seas.

The CDC's Vessel Sanitation Program (VSP) is tracking the "very contagious" outbreaks following reports of passengers in distress .

CARNIVAL FREEDOM PASSENGER ONBOARD DURING FIRE RECOUNTS 'DANGEROUS, TERRIFYING' EXPERIENCE

The Radiance of the Seas, a Royal Caribbean cruise ship, is pictured docked at a port in Seward, Alaska. (iStock)

Approximately 67 out of 1,993 passengers on the Radiance of the Seas reported falling ill during its voyage from Tampa to Los Angeles between Apr. 8 and 22. An additional two crew members also reported illness . 

The predominant symptoms reported from those affected by the Norovirus were diarrhea and vomiting.

WORRIED THE CRUISE SHIP WILL LEAVE WITHOUT YOU? KEEP THESE THINGS IN MIND

A view of the sign at the Center for Disease Control headquarters is seen in Atlanta, Georgia. (Nathan Posner/Anadolu Agency via Getty Images / Getty Images)

Approximately 94 of 2,532 passengers on the Sapphire Princess reported similar symptoms during its voyage from Los Angeles into the South Pacific that began Apr. 5 and is scheduled to conclude on May 7.

An additional 20 members of the 1,066 crew reported symptoms as well.

Fox Business reached out to both Princess Cruises and Royal Caribbean International for comment on the situation but did not receive a response.

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This photo shows the Sapphire Princess cruise ship, operated by Princess Cruises, docked at the Marina Cruise center in Singapore. (ROSLAN RAHMAN/AFP via Getty Images / Getty Images)

"Norovirus is a very contagious virus that causes vomiting and diarrhea. Anyone can get infected and sick with Norovirus," the CDC states on its website. "Norovirus is sometimes called the 'stomach flu' or 'stomach bug.' However, norovirus illness is not related to the flu, which is caused by influenza virus."

One of the biggest health risks posed by Norovirus infection is dehydration — the CDC recommends those infected drink plenty of liquids to aid recovering.

The CDC's Vessel Sanitation Program requires cruise lines to report and document cases of illness on their ships in order to facilitate coordinated responses in case of emergency.

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Mauritius Stops Norwegian Cruise Line Ship From Docking, Cites Health Risk

FILE PHOTO: The cruise ship of the Norwegian Cruise Line 'Norwegian Dawn" (L) departs the Royal Naval Dockyard July 16, 2013 near the port of Hamilton, Bermuda. REUTERS/Gary Cameron/File Photo

By Villen Anganan

PORT LOUIS (Reuters) -Mauritius stopped a ship belonging to Norwegian Cruise Line Holdings from docking at its ports due to what it said was a health risk and took samples from about 15 passengers who were in isolation on board, its port authority said on Sunday.

The Norwegian Dawn had been scheduled to dock in Port Louis on Sunday, but since it had not gone to Reunion Island, it arrived in Port Louis a day earlier, the Mauritius Ports Authority said in a statement.

"The decision not to allow the cruise ship access to the quay was taken in order to avoid any health risks," the authority said.

"The health and safety of passengers as well as that of the country as a whole are of the utmost to the authorities," it added, without giving any details about the nature of the health risk.

A spokesperson for the U.S.-headquartered Norwegian Cruise Line said in a statement that during the ship's trip to South Africa on Feb. 13, some passengers had experienced mild symptoms of a stomach-related illness.

Once in Port Louis, the ship's management worked with Mauritian authorities to make sure precautions were in place and all on board were okay, the spokesperson said.

The port authority said its test results would be known in 48 hours.

Officials at Mauritius' health ministry were not immediately reachable for comment.

The ship has 2,184 passengers and 1,026 crew members. Of these, about 2,000 passengers would have disembarked in Port Louis after completing their cruise while another 2,279 new passengers had been expected to board the ship, the port authority said.

"Passengers who were due to board the 'Norwegian Dawn' and begin their cruise from Mauritius today will not be able to do so due to potential health risks," it said.

Those who were disembarking or joining the cruise will now do so on Feb. 27, the Norwegian Cruise Line spokesperson said.

Tourism is one of the major drivers of Mauritius' economy.

(Reporting by Villen Anganan; Writing by George Obulutsa, Editing by Emelia Sithole-Matarise)

Copyright 2024 Thomson Reuters .

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Public Health Responses to COVID-19 Outbreaks on Cruise Ships — Worldwide, February–March 2020

Weekly / March 27, 2020 / 69(12);347-352

On March 23, 2020, this report was posted online as an MMWR Early Release.

Please note: This report has been corrected .

Leah F. Moriarty, MPH 1 ; Mateusz M. Plucinski, PhD 1 ; Barbara J. Marston, MD 1 ; Ekaterina V. Kurbatova, MD, PhD 1 ; Barbara Knust, DVM 1 ; Erin L. Murray, PhD 2 ; Nicki Pesik, MD 1 ; Dale Rose, PhD 1 ; David Fitter, MD 1 ; Miwako Kobayashi, MD, PhD 1 ; Mitsuru Toda, PhD 1 ; start highlight Paul T. Cantey, MD 1 ; end highlight Tara Scheuer, MPH 3 ; Eric S. Halsey, MD 1 ; Nicole J. Cohen, MD 1 ; Lauren Stockman, MPH 2 ; Debra A. Wadford, PhD 2 ; Alexandra M. Medley, DVM 1 ,4 ; Gary Green, MD 5 ; Joanna J. Regan, MD 1 ; Kara Tardivel, MD 1 ; Stefanie White, MPH 1 ; start highlight Clive Brown, MD 1 ; end highlight Christina Morales, PhD 2 ; Cynthia Yen, MPH 2 ; Beth Wittry, MPH 1 ; Amy Freeland, PhD 1 ; Sara Naramore, MPH 3 ; Ryan T. Novak, PhD 1 ; David Daigle, MPH 1 ; Michelle Weinberg, MD 1 ; Anna Acosta, MD 1 ; Carolyn Herzig, PhD 1 ; Bryan K Kapella, MD 1 ; Kathleen R. Jacobson, MD 2 ; Katherine Lamba, MPH 2 ; Atsuyoshi Ishizumi, MPH, MSc 1 ; John Sarisky, MPH 1 ; Erik Svendsen, PhD 1 ; Tricia Blocher, MS 2 ; Christine Wu, MD 3 ; Julia Charles, JD 1 ; Riley Wagner, MPH 1 ; Andrea Stewart, PhD 1 ; Paul S. Mead, MD 1 ; Elizabeth Kurylo, MCM 1 ; Stefanie Campbell, DVM 1 ; Rachel Murray, MPH 1 ; Paul Weidle, PharmD 1 ; Martin Cetron, MD 1 ; Cindy R. Friedman, MD 1 ; CDC Cruise Ship Response Team; California Department of Public Health COVID-19 Team; Solano County COVID-19 Team ( View author affiliations )

What is already known about this topic?

Cruise ships are often settings for outbreaks of infectious diseases because of their closed environment and contact between travelers from many countries.

What is added by this report?

More than 800 cases of laboratory-confirmed COVID-19 cases occurred during outbreaks on three cruise ship voyages, and cases linked to several additional cruises have been reported across the United States. Transmission occurred across multiple voyages from ship to ship by crew members; both crew members and passengers were affected; 10 deaths associated with cruise ships have been reported to date.

What are the implications for public health practice?

Outbreaks of COVID-19 on cruise ships pose a risk for rapid spread of disease beyond the voyage. Aggressive efforts are required to contain spread. All persons should defer all cruise travel worldwide during the COVID-19 pandemic.

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An estimated 30 million passengers are transported on 272 cruise ships worldwide each year* ( 1 ). Cruise ships bring diverse populations into proximity for many days, facilitating transmission of respiratory illness ( 2 ). SARS-CoV-2, the virus that causes coronavirus disease (COVID-19) was first identified in Wuhan, China, in December 2019 and has since spread worldwide to at least 187 countries and territories. Widespread COVID-19 transmission on cruise ships has been reported as well ( 3 ). Passengers on certain cruise ship voyages might be aged ≥65 years, which places them at greater risk for severe consequences of SARS-CoV-2 infection ( 4 ). During February–March 2020, COVID-19 outbreaks associated with three cruise ship voyages have caused more than 800 laboratory-confirmed cases among passengers and crew, including 10 deaths. Transmission occurred across multiple voyages of several ships. This report describes public health responses to COVID-19 outbreaks on these ships. COVID-19 on cruise ships poses a risk for rapid spread of disease, causing outbreaks in a vulnerable population, and aggressive efforts are required to contain spread. All persons should defer all cruise travel worldwide during the COVID-19 pandemic.

During February 7–23, 2020, the largest cluster of COVID-19 cases outside mainland China occurred on the Diamond Princess cruise ship, which was quarantined in the port of Yokohama, Japan, on February 3 ( 3 ). On March 6, cases of COVID-19 were identified in persons on the Grand Princess cruise ship off the coast of California; that ship was subsequently quarantined. By March 17, confirmed cases of COVID-19 had been associated with at least 25 additional cruise ship voyages. On February 21, CDC recommended avoiding travel on cruise ships in Southeast Asia; on March 8, this recommendation was broadened to include deferring all cruise ship travel worldwide for those with underlying health conditions and for persons aged ≥65 years. On March 13, the Cruise Lines International Association announced a 30-day voluntary suspension of cruise operations in the United States ( 5 ). CDC issued a level 3 travel warning on March 17, recommending that all cruise travel be deferred worldwide. †

Diamond Princess

On January 20, 2020, the Diamond Princess cruise ship departed Yokohama, Japan, carrying approximately 3,700 passengers and crew ( Table ). On January 25, a symptomatic passenger departed the ship in Hong Kong, where he was evaluated; testing confirmed SARS-CoV-2 infection. On February 3, the ship returned to Japan, after making six stops in three countries. Japanese authorities were notified of the COVID-19 diagnosis in the passenger who disembarked in Hong Kong, and the ship was quarantined. Information about social distancing and monitoring of symptoms was communicated to passengers. On February 5, passengers were quarantined in their cabins; crew continued to work and, therefore, could not be isolated in their cabins ( 6 ). Initially, travelers with fever or respiratory symptoms and their close contacts were tested for SARS-CoV-2 by reverse transcription–polymerase chain reaction (RT-PCR). All those with positive test results were disembarked and hospitalized. Testing was later expanded to support a phased disembarkation of passengers, prioritizing testing of older persons, those with underlying medical conditions, and those in internal cabins with no access to the outdoors. During February 16–23, nearly 1,000 persons were repatriated by air to their home countries, including 329 persons who returned to the United States and entered quarantine or isolation. § , ¶

The remaining passengers who had negative SARS-CoV-2 RT-PCR test results,** no respiratory symptoms, and no close contact with a person with a confirmed case of COVID-19 completed a 14-day ship-based quarantine before disembarkation. Those passengers who had close contact with a person with a confirmed case completed land-based quarantine, with duration determined by date of last contact. After disembarkation of all passengers, crew members either completed a 14-day ship-based quarantine, were repatriated to and managed in their home country, or completed a 14-day land-based quarantine in Japan.

Overall, 111 (25.9%) of 428 U.S. citizens and legal residents did not join repatriation flights either because they had been hospitalized in Japan or for other reasons. To mitigate SARS-CoV-2 importation into the United States, CDC used temporary “Do Not Board” restrictions ( 7 ) to prevent commercial airline travel to the United States, †† and the U.S. Departments of State and Homeland Security restricted travel to the United States for non-U.S. travelers.

Among 3,711 Diamond Princess passengers and crew, 712 (19.2%) had positive test results for SARS-CoV-2 ( Figure 1 ). Of these, 331 (46.5%) were asymptomatic at the time of testing. Among 381 symptomatic patients, 37 (9.7%) required intensive care, and nine (1.3%) died ( 8 ). Infections also occurred among three Japanese responders, including one nurse, one quarantine officer, and one administrative officer ( 9 ). As of March 13, among 428 U.S. passengers and crew, 107 (25.0%) had positive test results for COVID-19; 11 U.S. passengers remain hospitalized in Japan (median age = 75 years), including seven in serious condition (median age = 76 years).

Grand Princess

During February 11–21, 2020, the Grand Princess cruise ship sailed roundtrip from San Francisco, California, making four stops in Mexico (voyage A). Most of the 1,111 crew and 68 passengers from voyage A remained on board for a second voyage that departed San Francisco on February 21 (voyage B), with a planned return on March 7 (Table). On March 4, a clinician in California reported two patients with COVID-19 symptoms who had traveled on voyage A, one of whom had positive test results for SARS-CoV-2. CDC notified the cruise line, which began cancelling group activities on voyage B. More than 20 additional cases of COVID-19 among persons who did not travel on voyage B have been identified from Grand Princess voyage A, the majority in California. One death has been reported. On March 5, a response team was transported by helicopter to the ship to collect specimens from 45 passengers and crew with respiratory symptoms for SARS-CoV-2 testing; 21 (46.7%), including two passengers and 19 crew, had positive test results. Passengers and symptomatic crew members were asked to self-quarantine in their cabins, and room service replaced public dining until disembarkation. Following docking in Oakland, California, on March 8, passengers and crew were transferred to land-based sites for a 14-day quarantine period or isolation. Persons requiring medical attention for other conditions or for symptoms consistent with COVID-19 were evaluated, tested for SARS-CoV-2 infection, and hospitalized if indicated. During land-based quarantine in the United States, all persons were offered SARS-CoV-2 testing. As of March 21, of 469 persons with available test results, 78 (16.6%) had positive test results for SARS-CoV-2. Repatriation flights for foreign nationals were organized by several governments in coordination with U.S. federal and California state government agencies. Following disinfection of the vessel according to guidance from CDC’s Vessel Sanitation Program, remaining foreign nationals will complete quarantine on board. The quarantine will be managed by the cruise company, with technical assistance provided by public health experts.

On February 21, five crew members from voyage A transferred to three other ships with a combined 13,317 passengers on board. No-sail orders §§ were issued by CDC for these ships until medical logs were reviewed and the crew members tested negative for SARS-CoV-2.

Additional Ships

The Diamond Princess and Grand Princess had more than 800 total COVID-19 cases, including 10 deaths. During February 3–March 13, in the United States, approximately 200 cases of COVID-19 were confirmed among returned cruise travelers from multiple ship voyages, including the Diamond Princess and Grand Princess, accounting for approximately 17% of total reported U.S. cases at the time ( 10 ). Cases linked with cruise travel have been reported to CDC in at least 15 states. Since February, multiple international cruises have been implicated in reports of COVID-19 cases, including at least 60 cases in the United States from Nile River cruises in Egypt ( Figure 2 ). Secondary community-acquired cases linked to returned passengers on cruises have also been reported (CDC, unpublished data, 2020).

Public health responses to COVID-19 outbreaks on cruise ships were aimed at limiting transmission among passengers and crew, preventing exportation of COVID-19 to other communities, and assuring the safety of travelers and responders. These responses required the coordination of stakeholders across multiple sectors, including U.S. Government departments and agencies, foreign ministries of health, foreign embassies, state and local public health departments, hospitals, laboratories, and cruise ship companies. At the time of the Diamond Princess outbreak, it became apparent that passengers disembarking from cruise ships could be a source of community transmission. Therefore, aggressive efforts to contain transmission on board and prevent further transmission upon disembarkation and repatriation were instituted. These efforts included travel restrictions applied to persons, movement restrictions applied to ships, infection prevention and control measures, (e.g., use of personal protective equipment for medical and cleaning staff), disinfection of the cabins of persons with suspected COVID-19, provision of communication materials, notification of state health departments, and investigation of contacts of cases identified among U.S. returned travelers.

Cruise ships are often settings for outbreaks of infectious diseases because of their closed environment, contact between travelers from many countries, and crew transfers between ships. On the Diamond Princess, transmission largely occurred among passengers before quarantine was implemented, whereas crew infections peaked after quarantine ( 6 ). On the Grand Princess, crew members were likely infected on voyage A and then transmitted SARS-CoV-2 to passengers on voyage B. The results of testing of passengers and crew on board the Diamond Princess demonstrated a high proportion (46.5%) of asymptomatic infections at the time of testing. Available statistical models of the Diamond Princess outbreak suggest that 17.9% of infected persons never developed symptoms ( 9 ). A high proportion of asymptomatic infections could partially explain the high attack rate among cruise ship passengers and crew. SARS-CoV-2 RNA was identified on a variety of surfaces in cabins of both symptomatic and asymptomatic infected passengers up to 17 days after cabins were vacated on the Diamond Princess but before disinfection procedures had been conducted (Takuya Yamagishi, National Institute of Infectious Diseases, personal communication, 2020). Although these data cannot be used to determine whether transmission occurred from contaminated surfaces, further study of fomite transmission of SARS-CoV-2 aboard cruise ships is warranted.

During the initial stages of the COVID-19 pandemic, the Diamond Princess was the setting of the largest outbreak outside mainland China. Many other cruise ships have since been implicated in SARS-CoV-2 transmission. Factors that facilitate spread on cruise ships might include mingling of travelers from multiple geographic regions and the closed nature of a cruise ship environment. This is particularly concerning for older passengers, who are at increased risk for serious complications of COVID-19 ( 4 ). The Grand Princess was an example of perpetuation of transmission from crew members across multiple consecutive voyages and the potential introduction of the virus to passengers and crew on other ships. Public health responses to cruise ship outbreaks require extensive resources. Temporary suspension of cruise ship travel during the current phase of the COVID-19 pandemic has been partially implemented by cruise lines through voluntary suspensions of operations, and by CDC through its unprecedented use of travel notices and warnings for conveyances to limit disease transmission ( 5 ).

Acknowledgments

Staff members responding to COVID-19 outbreaks on cruise ships; Japan’s Ministry of Health, Labour and Welfare; California Department of Public Health; cruise ship passengers; Princess Cruises; Christina Armantas, Matthew Bacinskas, Cynthia Bernas, Brandon Brown, Teal Bullick, Lyndsey Chaille, Martin Cilnis, Gail Cooksey, Ydelita Gonzales, Christopher Kilonzo, Chun Kim, Ruth Lopez, Dominick Morales, Chris Preas, Kyle Rizzo, Hilary Rosen, Sarah Rutschmann, Maria Vu, California Department of Public Health, Richmond and Sacramento; Ben Gammon, Ted Selby, Solano County Public Health; Medic Ambulance Service; NorthBay HealthCare; Sutter Solano Medical Center; Kaiser Permanente Vallejo Medical Center; Kaiser Permanente Vacaville Medical Center start highlight ; field teams at repatriation sites; National Institute of Infectious Diseases, Japan end highlight .

CDC Cruise Ship Response Team

Casey Barton Behravesh, CDC; Adam Bjork, CDC; William Bower, CDC; Catherine Bozio, CDC; Zachary Braden, CDC; Mary Catherine Bertulfo, CDC; Kevin Chatham-Stephens, CDC; Victoria Chu, CDC; Barbara Cooper, CDC; Kathleen Dooling, CDC; Christine Dubray, CDC; Emily Curren, CDC; Margaret A. Honein, CDC; Kathryn Ivey, CDC; Jefferson Jones, CDC; Melissa Kadzik, CDC; Nancy Knight, CDC; Mariel Marlow, CDC; Audrey McColloch, CDC; Robert McDonald, CDC; Andrew Klevos, CDC; Sarah Poser, CDC; Robin A. Rinker, CDC; Troy Ritter, CDC; Luis Rodriguez, CDC; Matthew Ryan, CDC; Zachary Schneider, CDC; Caitlin Shockey, CDC; Jill Shugart, CDC; Margaret Silver, CDC; Paul W. Smith, CDC; Farrell Tobolowsky, CDC; Aimee Treffiletti, CDC; Megan Wallace, CDC; Jonathan Yoder, CDC.

California Department of Public Health COVID-19 Team

Pennan Barry, California Department of Public Health; Ricardo Berumen, III, California Department of Public Health; Brooke Bregman, California Department of Public Health; Kevin Campos, California Department of Public Health; Shua Chai, California Department of Public Health; Rosie Glenn-Finer, California Department of Public Health; Hugo Guevara, California Department of Public Health; Jill Hacker, California Department of Public Health; Kristina Hsieh, California Department of Public Health; Mary Kate Morris, California Department of Public Health; Ryan Murphy, California Department of Public Health; Jennifer F. Myers, California Department of Public Health; Tasha Padilla, California Department of Public Health; Chao-Yang Pan, California Department of Public Health; Adam Readhead, California Department of Public Health; Estela Saguar, California Department of Public Health; Maria Salas, California Department of Public Health; Robert E. Snyder, California Department of Public Health; Duc Vugia, California Department of Public Health; James Watt, California Department of Public Health; Cindy Wong, California Department of Public Health.

Solano County COVID-19 Team

Meileen Acosta, Solano County Department of Public Health; Shai Davis, Solano County Department of Public Health; Beatrix Kapuszinsky, Solano County Department of Public Health; Bela Matyas, Solano County Department of Public Health; Glen Miller, Solano County Department of Public Health; Asundep Ntui, Solano County Department of Public Health; Jayleen Richards, Solano County Department of Public Health.

Corresponding author: Leah F. Moriarty, [email protected] , 770-488-7100.

1 CDC COVID-19 Response Team; 2 California Department of Public Health; 3 Solano Public Health, Fairfield, California; 4 Epidemic Intelligence Service, CDC; 5 Sutter Medical Group of the Redwoods, Santa Rosa, California.

All authors have completed and submitted the International Committee of Medical Journal Editors form for disclosure of potential conflicts of interest. No potential conflicts of interest were disclosed.

* Not including river cruises.

† Warning level 3: avoid non-essential travel due to widespread ongoing transmission: https://wwwnc.cdc.gov/travel/notices/warning/novel-coronavirus-china .

§ Quarantine was used for persons who were exposed; isolation was used for persons who had positive test results for SARS-CoV-2.

¶ Movement for one person with resolved COVID-19 was not restricted.

** Based on Japanese testing procedures, which at the time included taking one oropharyngeal swab.

†† Travel restrictions were lifted when persons had either completed a 14-day monitoring period without symptoms or had met clinical criteria for release from isolation. https://japan2.usembassy.gov/pdfs/alert-20200227-diamond-princess.pdf pdf icon external icon .

§§ CDC has the authority to institute a no-sail order to prevent ships from sailing when it is reasonably believed that continuing normal operations might subject newly arriving passengers to disease.

• Cruise Lines International Association. 2019 cruise trends & industry outlook. Washington, DC: Cruise Line International Association; 2019. https://cruising.org/news-and-research/-/media/CLIA/Research/CLIA-2019-State-of-the-Industry.pdf pdf icon external icon
• Millman AJ, Kornylo Duong K, Lafond K, Green NM, Lippold SA, Jhung MA. Influenza outbreaks among passengers and crew on two cruise ships: a recent account of preparedness and response to an ever-present challenge. J Travel Med 2015;22:306–11. CrossRef external icon PubMed external icon
• World Health Organization. Coronavirus disease (COVID-2019) situation reports. Geneva, Switzerland: World Health Organization; 2020. https://www.who.int/emergencies/diseases/novel-coronavirus-2019/situation-reports/ external icon
• CDC COVID-19 Response Team. Severe outcomes among patients with coronavirus disease 2019 (COVID-19)—United States, February 12–March 16, 2020. MMWR Morb Mortal Wkly Rep 2020. Epub March 18, 2020. CrossRef external icon
• Cruise Lines International Association. CLIA announces voluntary suspension in U.S. cruise operations. Washington, DC: Cruise Line International Association; 2020. https://cruising.org:443/news-and-research/press-room/2020/march/clia-covid-19-toolkit external icon
• Kakimoto K, Kamiya H, Yamagishi T, Matsui T, Suzuki M, Wakita T. Initial investigation of transmission of COVID-19 among crew members during quarantine of a cruise ship—Yokohama, Japan, February 2020. MMWR Morb Mortal Wkly Rep 2020;69:312–3. CrossRef external icon PubMed external icon
• Vonnahme LA, Jungerman MR, Gulati RK, Illig P, Alvarado-Ramy F. Federal travel restrictions for persons with higher-risk exposures to communicable diseases of public health concern. Emerg Infect Dis 2017;23:S108–13. CrossRef external icon PubMed external icon
• Ministry of Health, Labour and Welfare. About new coronavirus infections [Japanese]. Tokyo, Japan: Ministry of Health, Labour and Welfare; 2020. https://www.mhlw.go.jp/stf/seisakunitsuite/bunya/0000164708_00001.html external icon
• Mizumoto, K., Kagaya, K., Zarebski, A. and Chowell, G. Estimating the asymptomatic proportion of coronavirus disease 2019 (COVID-19) cases on board the Diamond Princess cruise ship, Yokohama, Japan, 2020. Eurosurveillance 2020;25. CrossRef external icon
• CDC. Coronavirus disease 2019 (COVID-19): cases in U.S. Atlanta, GA: US Department of Health and Human Services, CDC; 2020. https://www.cdc.gov/coronavirus/2019-ncov/cases-in-us.html

Abbreviation: N/A = not applicable.

FIGURE 1 . Cumulative number of confirmed coronavirus disease 2019 (COVID-19) cases* by date of detection — Diamond Princess cruise ship, Yokohama, Japan, February 3–March 16, 2020

Source: World Health Organization (WHO) coronavirus disease (COVID-2019) situation reports. https://www.who.int/emergencies/diseases/novel-coronavirus-2019/situation-reports/ external icon .

* Decline in cumulative number of cases on February 13 and February 25 due to correction by WHO for cases that had been counted twice.

FIGURE 2 . Cruise ships with coronavirus disease 2019 (COVID-19) cases requiring public health responses — worldwide, January–March 2020

Suggested citation for this article: Moriarty LF, Plucinski MM, Marston BJ, et al. Public Health Responses to COVID-19 Outbreaks on Cruise Ships — Worldwide, February–March 2020. MMWR Morb Mortal Wkly Rep 2020;69:347-352. DOI: http://dx.doi.org/10.15585/mmwr.mm6912e3 external icon .

MMWR and Morbidity and Mortality Weekly Report are service marks of the U.S. Department of Health and Human Services. Use of trade names and commercial sources is for identification only and does not imply endorsement by the U.S. Department of Health and Human Services. References to non-CDC sites on the Internet are provided as a service to MMWR readers and do not constitute or imply endorsement of these organizations or their programs by CDC or the U.S. Department of Health and Human Services. CDC is not responsible for the content of pages found at these sites. URL addresses listed in MMWR were current as of the date of publication.

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Cruise ship refused port over virus fears to dock in Cambodia – operator

MS Westerdam has been turned away by five countries over coronavirus fears, though it says it has no sick passengers

Cambodia has agreed to let a cruise ship that has been turned away by five countries over fears that someone aboard may have the coronavirus to dock and disembark its passengers, the ship’s operator has said.

The MS Westerdam, which has 1,455 passengers and 802 crew on board, will dock at the Cambodian sea port of Sihanoukville on Thursday, Holland America Line said.

The ship – which says it has no sick passengers – has been turned away from Thailand , Japan, Taiwan, Guam and the Philippines, prompting fears prior to Wednesday’s announcement that it could run out of food as it searched for a port.

“We will immediately begin making our way to Sihanoukville in Cambodia,” Westerdam captain Vincent Smit told passengers. “There will be a brief health inspection on board by the Cambodian authorities which will take place at anchor just before we arrive.” The ship is expected to arrive in Cambodia at about 7am (0000 GMT) on Thursday, he said.

Crew members staged a farewell ceremony for passengers on Wednesday morning, singing to the tune of the 1979 hit We Are Family by Sister Sledge.

Stephen Hansen, a Canadian on board the Westerdam with his wife, said they had joined the ship on 16 January in Singapore and were originally scheduled to get off in Yokohama, its intended final destination.

“Passengers are OK but anxious for a resolution,” Hansen told the Guardian in a message before the Cambodia decision was announced. “If it goes on much longer the ship will run low on food, fuel and medications.

“Day-to-day life onboard is still pretty typical for a cruise. There are no restrictions on movement, eats etc. Generally the mood is still OK but each new rejection/disappointment brings increased frustration and anxiety.”

Hansen, from Vancouver, said the crew were doing an “amazing job trying to keep life normal and passengers happy. A few passengers have become angry and are venting on social media but I think most are trusting that it will all work out OK soon.”

“That said, this has become a political issue and our governments need to step in our behalf. Maybe they already are but we have no news of that.”

There are no confirmed cases of the virus onboard the Westerdam, but it stopped in Hong Kong less than two weeks ago, which is within the incubation period of the virus.

The passengers include 650 from the US, 271 from Canada, 127 from the UK and 91 from the Netherlands, with smaller numbers of people from Australia, Germany, China and other countries.

Officials in Japan, meanwhile, said another 39 people onboard the Diamond Princess cruise liner had been diagnosed with the virus, with one quarantine officer also infected, bringing the total number of cases to 175.

In all, Japan has confirmed 203 cases, prompting South Korea on Tuesday to “strongly advise” its citizens not to travel to Japan and several other countries in Asia.

The Diamond Princess, which is docked in Yokohama, south of Tokyo, will remain quarantined until at least 19 February, although media reports said plans were being made to remove older passengers and those with chronic health conditions not connected to the virus before then. Officials said it would take time to work out where they could be sent. About 3,700 people are onboard the cruise ship, which usually has a crew of 1,100 and a passenger capacity of 2,670.

“Out of 53 new test results, 39 people were found positive,” Japan’s health minister, Katsunobu Kato, told reporters, adding that four passengers diagnosed earlier were in a serious condition. Kato said in parliament that he wanted to expand testing to all passengers and crew onboard, and that authorities could muster resources to do more than 1,000 tests a day.

The ship has been in quarantine since arriving off the Japanese coast early last week after the virus was detected in a former passenger who got off the ship last month in Hong Kong.

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Royal Caribbean cancels all cruises to popular destination due to gang violence

G lobal cruise line operator Royal Caribbean has extended its cancellation of ship stops to Labadee, Haiti, due to ongoing violence in the region, the company announced.

Royal Caribbean cruises to Labadee will be canceled until at least September, according to a report from Royal Caribbean blog . Guests who booked cruises for summer and early fall are being notified by the company of the changes. Some trips have been replaced with another port or sea day while others have been canceled and refunded.

In March, Royal Caribbean announced it would suspend visits to Labadee through the end of May.

“We have not had any security concerns; this was done out of abundance of caution,” Jonathon Fishman, director of corporate and incident communications for The Royal Caribbean Group, told the Miami Herald .

Labadee is a private beach resort located on the northern coast of Haiti, which maintains sovereignty over the 260-acre area but leased it to Royal Caribbean in 1985. The exclusive resort is fenced off from Haiti and has its own security.

Haiti, in recent months, has been overwhelmed by civil unrest and violent gangs, which has forced the closing of the country’s main international airports, burnings of police stations and prison raids. About 2,500 people were killed or injured by gang violence in Haiti from January to March, according to the United Nations Integrated Office .

Haitian Prime Minster Ariel Henry in March announced he would resign from his position as the country works to establish a transitional presidential council.

©2024 Advance Local Media LLC. Visit cleveland.com. Distributed by Tribune Content Agency, LLC.

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Three-day party cruise ends in tragedy after passenger dies

An australian man is said to have fallen overboard in the early hours of monday morning.

Olivia Burke

A three-day party cruise has ended in tragedy after a passenger fell overboard just hours before it was due to dock.

Staff on P&O Cruise's 'Pacific Adventure' ship, which had been brimming with Elvis fans who were enjoying a mini-break on the water 'dedicated to The King', alerted authorities about the incident shortly after 4am on Monday (6 May).

New South Wales Police were informed that an Australian man was missing after falling from the vessel 10 nautical miles off Sydney Heads in the early hours.

The P&O ship was supposed to dock in Sydney Harbour at 6am that morning after a three-day party which had been jam-packed with 'themed parties, karaoke and trivia' for fans of the rock and roll legend.

Instead, the Pacific Adventure was left lingering in the area for a number of hours as a massive sea and air search was launched for the missing bloke, who is reported to have fallen from the seventh deck.

Some of the 2,600 passengers who were onboard the cruise for three-days of Elvis -themed fun claimed that they were enveloped by confusion as the hunt for the passenger was launched.

Speaking to the Daily Mail, one man said: "They didn’t tell us what was happening. They told us that there was a man overboard and that’s it. We weren’t told what his name was and what age he might have been."

Another added: "There was zero communication from staff. We don’t know what happened.

"It happened at 4am and there was an alert that went out letting us know that a guy went overboard."

Officials then announced that a man's body had been pulled from the water at 10.30am on Monday morning, after rescue teams had been forced to battle through 'very rocky and windy' conditions .

NSW Police Marine Commander Joseph McNulty had earlier said that he had been hopeful that they would locate the passenger safely, as one of the three emergency life rings that had been flung from the ship had not been retrieved.

Rescuers remained optimistic that the unidentified male may have been able to cling onto it, however, swells which reached up to 5 metres were also hampering the search efforts throughout Monday.

Teams searched a 60-square-nautical-mile area and used infrared technology in the hopes of tracking the man's heat signature, while another nearby cruise ship also joined in the search.

Tragically, the man's lifeless body was later found.

P&O did not comment on how the fatal incident unfolded, saying that police were preparing a report for the coroner while staff onboard had been supporting the family of the victim.

A spokeswoman added: "'Our crew and guests faced a challenging and tragic day. We thank our guests for their patience and understanding."

The tragedy came the morning after another passenger on the three-day party cruise suffered a ' medical episode ' and was forced to be medically evacuated for treatment.

LADbible have contacted P&O for further comment.

Topics:  Cruise Ship , Travel , News , World News , Australia

Olivia is a journalist at LADbible Group with more than five years of experience and has worked for a number of top publishers, including News UK. She also enjoys writing food reviews (as well as the eating part). She is a stereotypical reality TV addict, but still finds time for a serious documentary.

@ livburke_

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Rough seas or smooth sailing? The cruise industry is booming despite environmental concerns

by Frédéric Dimanche and Kelley A. McClinchey, The Conversation

Cruise ship season is officially underway in British Columbia. The season kicked off with the arrival of Norwegian Bliss on April 3—the first of 318 ships that are scheduled to dock in Victoria this year. Victoria saw a record 970,000 passengers arrive in 2023, with more expected in 2024.

The cruise industry was badly hit by the suspension of cruise operations due to the COVID-19 pandemic in 2020. Fueled by heavy consumer demand and industry innovation, cruising has made a comeback. It is now one of the fastest-growing sectors, rebounding even faster than international tourism.

While many predicted a difficult recovery , a recent industry report shows a remarkable post-pandemic rebound . Two million more people went on cruises in 2023 versus 2019, with demand predicted to top 35 million in 2024.

But environmental issues plague the sector's revival. Are they an indication of rough seas ahead? Or will a responsive industry mean smooth sailing?

Cruising has long been criticized for being Janus-faced : on the surface, cruises are convenient, exciting holidays with reputed economic benefits. But lurking underneath are its negative environmental and social impacts .

Unprecedented growth

Newly constructed mega-ships are part of the industry's unprecedented growth. Royal Caribbean's Icon of the Seas is the largest cruise ship in the world , with 18 decks, 5,600 passengers and 2,350 crew.

MSC World Europa with 6,700 passengers and 2,100 crew, P&O Arvia with 5,200 passengers and 1,800 crew, and Costa Smeralda with 6,600 passengers and 1,500 crew also claim mega-ship status.

Those sailing to and from Alaska via Victoria will be some of the estimated 700,000 passengers departing Seattle on massive ships three sport fields in length.

Baby boomers represent less than 25 percent of cruise clientele. Gen X, Millennials and Gen Z have more interest than ever in cruising, with these younger markets being targeted as the future of cruise passengers.

The Cruise Lines International Association asserts that 82 percent of those who have cruised will cruise again . To entice first-timers and meet the needs of repeat cruisers, companies are offering new itineraries and onboard activities, from simulated skydiving and bumper cars to pickleball and lawn bowling.

Solo cruise travel is also on the rise, and multi-generational family cruise travel is flourishing, explaining the extensive variety of cabin classes, activities and restaurants available on newly constructed and retrofitted ships.

However, only a few cruise ports are large enough to dock mega ships. Cruise lines are responding by offering off-beat experiences and catering more to the distinct desires of travelers.

In doing so, there is a move towards smaller vessels and luxury liners , river cruises and expedition cruising . Leveraging lesser-known ports that can only be accessed via compact luxury ships offers more mission-driven, catered experiences for the eco-minded traveler.

Cruising and environmental costs

Cruise ship visitors are known to negatively impact Marine World Heritage sites. While most sites regulate ballast water and wastewater discharge, there are concerns about ship air emissions and wildlife interactions .

Cruise ship journeys along Canada's west coast, for example, are leaving behind a trail of toxic waste . A study by environmental organization Friends of the Earth concluded that a cruise tourist generates eight times more carbon emissions per day than a land tourist in Seattle.

Also, a rise in expedition cruising means more negative impacts (long-haul flights to farther ports, less destination management in fragile ecosystems, last chance tourism ) and a rise in carbon dioxide emissions.

Toxic air pollutants from cruise ships around ports are higher than pre-pandemic levels, leaving Europe's port cities "choking on air pollution ." Last year, Europe's 218 cruise ships emitted as much sulfur oxides as one billion cars—a high number, considering the introduction of the International Maritime Organization's sulfur cap in 2020 .

Rough seas ahead or smooth sailing?

Royal Caribbean said its Icon of the Seas is designed to operate 24 percent more efficiently than the international standard for new ships. International Maritime Organization regulations must be 30 percent more energy-efficient than those built in 2014.

But despite the industry using liquefied natural gas instead of heavy fuel oil and electric shore power to turn off diesel engines when docking, industry critics still claim the cruise sector is greenwashing . As a result, some cities like Amsterdam, Barcelona and Venice are limiting or banning cruise ships .

Environmental critiques remain strong, especially for polar expeditions . The industry must respond and increase sustainability efforts , but their measures remain reactive (i.e., merely meeting international regulations) rather than proactive. In addition, by sailing their ships under flags of convenience , cruise companies evade taxes and demonstrate an unwillingness to abide by a nation's environmental, health and labor regulations.

In any case, environmental concerns are escalating along with the industry. Travel agents and industry figures are aware of these impacts and should help promote cruise lines that demonstrate a commitment to sustainable practices.

Local residents need to expect more from port authorities and local governments in order to cope with cruise tourism . Cruise consumers should recognize the environmental costs of cruising, and demand accountability and transparency from cruise lines.

Provided by The Conversation

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Ukraine-Russia war: Latest updates

Ask our military analysts or international correspondents a question on the Ukraine war in the box below.

Thursday 9 May 2024 09:18, UK

• Putin: We want to avoid global confrontation, but nuclear forces ready if needed  
• Home Office expels Russian diplomat who was 'undeclared military intelligence officer'
• Dominic Waghorn: Russia may have crossed the line - but UK move to expel attache increases risk of dangerous escalation
• Ed Conway : Russian oil still seeping into UK - the reasons why sanctions are not working

Ask a question or make a comment

Vladimir Putin used his Victory Day speech this morning to warn that Russia's combat forces were "always ready".

But he admitted the country was going through a "difficult period".

You can watch a segment from his speech here:

We aren't bringing you live updates today, but here is the main story this morning.

Vladimir Putin has just finished speaking at Russia's annual Second World War victory parade.

The president, now in his fifth term, said that Russia will do all it could to avoid a global confrontation, amid rising rhetoric about a face-off with NATO.

Mr Putin, however, said it would not allow any nation or alliance to threaten Russia.

As he's said multiple times since he invaded Ukraine, the Russian leader warned the West that his nuclear forces were always at a state of combat readiness. 

He was addressing scores of troops in Moscow's Red Square - here are the best images from the Russian capital... 

Thanks for following our live coverage, we'll be back soon with more live updates. 

Kosovo's foreign minister has said her country is convinced Russia must lose the war in Ukraine for conflict not to spread further in Europe.

Donika Gervalla-Schwarz said her young nation's support for Ukraine was unconditional - despite Kyiv not having recognised Kosovo's independence.

Ms Gervalla-Schwarzd her small Balkan nation, which declared its independence from Serbia in 2008, is repeatedly reminded of the aggressive intentions of both Serbia and its ally Russia.

"Ukraine hasn't recognised the Republic of Kosovo as a state, but we really believe that we know exactly what Ukraine is going through," she told The Associated Press in an interview.

"And we know that there is only one solution, not only for Ukraine, but for Europe," she said.

"It can only be Russia to lose the war and Ukraine to win this war. Otherwise, Europe should prepare for other conflicts in our continent."

The people of Kosovo were the targets of war crimes and other atrocities by Serbia's security forces in the 1990s, an experience that led Kosovo to seek independence.

"While Kosovo is a small state with very modest possibilities to help, we have tried to be very helpful with Ukraine and have not hesitated to show our unconditional support and sympathy to the people and to the state of Ukraine," Ms Gervalla-Schwarz said.

Lord Cameron has called the UK's measures on a Russian defence attache "an unequivocal message" to Moscow. 

The foreign secretary was replying to James Cleverly's post on X in which he said the Home Office expelled a Russian defence attache as part of a series of measures against the country.

Other measures in the package include removing the diplomatic premises status from several Russian owned properties in the UK and capping the amount of time Russian diplomats can spend in the UK.

Budapest is once again raising eyebrows across the world's biggest military alliance as it pledges to defy a NATO initiative. 

The alliance's long-term plan to support Ukraine militarily was agreed in April, but was dubbed a "crazy mission" by Hungary's foreign minister today. 

Under the plans, NATO would take over some coordination work from a US-led coalition known as the Ramstein group.

Discussing the plans today, Peter Szijjarto said: "Hungary will stay out of NATO's crazy mission despite all the pressure."

Relations between Budapest and NATO have soured because of Hungary's foot-dragging over the ratification of Sweden's NATO accession - finally passed by Budapest in March - and also over nationalist Prime Minister Viktor Orban's close ties with Moscow. 

The Russian embassy in London has said there will be "an appropriate response" after Britain expelled a Russian defence attache.

The embassy said the restrictions that had been imposed were done under a "groundless and ridiculous pretext", according to Russian state news agency TASS.

It comes after Russian foreign ministry spokeswoman Maria Zakharova was reported as telling journalists that the Kremlin will respond appropriately following the expulsion.

Dominic Waghorn, international affairs editor

It's always assumed defence attaches play some kind of role gatherling intelligence and that is generally tolerated by their host countries. 

They could be gathering data about weapons production for instance or ship building but there is a line they are expected not to cross. 

The assumption here is that the Russians have broken the rules of the game.

But the British government will have thought long and hard before expelling the Russian. It doesn't come without cost.

In their day jobs defence attaches play a crucial role in liaising with their hosts.  That can be very important in terms of avoiding misunderstandings that could lead to unnecessary and dangerous escalation. 

Losing Russia’s defence attache in London deprives the UK of one more line of liaison at a time when clear understanding and clarification could be essential to avoiding deepening conflict.

That is not ideal at a time of war. 

What is not clear is how much these moves are connected specifically to the conduct of the Russians involved or should they actually be seen more as another chapter in the diplomatic war underway between Russia and the UK.

The UK has undoubtedly weakened Russia's ability to spy in the UK and gather intelligence but these measures will also affect Britain's ability to predict and avoid potential escalation. 

That will be made even worse if Russia, as may be expected, responds with like-for-like retaliation

Seven people have been injured by Russian shelling in eastern Kharkiv, according to the region's governor.

Oleg Synegubov said among those wounded was an eight-year-old girl and three boys, two aged 14 and the other 15. 

"Two [of the] boys are in serious condition, [the other] boy and [the] girl are in average condition," he said. 

One 55-year-old civilian of unspecified gender was also hospitalised. 

Two women had minor injuries. 

Defence Secretary Grant Shapps has offered his thoughts on the expulsion of a Russian defence attache the government has accused of being an undeclared military intelligence officer. 

"Today we've expelled Russia's defence attache who has been working as an intelligence officer for Putin in the UK," he said on X. 

"We will not tolerate Putin’s efforts to undermine our nation and democracy and will continue to stand up for freedom here and in Ukraine."

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