norovirus on cruise ship may 2023

More than 175 people fall ill in Celebrity Cruises norovirus outbreak

More than 175 people got sick with norovirus during a recent Celebrity Cruises’ sailing, the Centers for Disease Control and Prevention said.

The agency said 152 of the Celebrity Summit ship’s 2,144 passengers, as well as 25 crew members, reported being ill during its May 15 voyage, according to its website . Their main symptoms were diarrhea, vomiting, abdominal cramps and headache.

"The health and safety of our guests, crew and communities we visit are our top priority," a Celebrity spokesperson said in an emailed statement. "To maintain the highest levels of health onboard our ships, we implement rigorous safety and cleaning procedures, many far exceeding public health guidelines. Combined, these efforts allow us to maintain some of the lowest levels of community spread."

The cruise line and ship’s crew implemented heightened “cleaning and disinfection procedures according to the ship’s outbreak prevention and response plan,” notified guests and encouraged practicing good hand hygiene and reporting illness, according to the agency. They also provided reports of gastrointestinal illness cases to the CDC’s Vessel Sanitation Program twice a day during the outbreak investigation, among other steps.

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The incident marks the third norovirus outbreak on Celebrity ships the CDC has posted this year. The line previously saw outbreaks on its Celebrity Equinox and Celebrity Constellation vessels in March. On Celebrity Equinox, 136 passengers and crew reported being ill, while 96 did so on Celebrity Constellation.

Gastrointestinal illness at sea plummeted during the COVID-19 pandemic, but cases have ticked up again as the industry has rebounded.

While norovirus is frequently associated with cruise ships, Ben Lopman, a professor of epidemiology at Emory University’s Rollins School of Public Health, told USA TODAY in February that those represent a "tiny minority of norovirus outbreaks.” The vast majority take place in health care settings like nursing homes, he said.

Nathan Diller is a consumer travel reporter for USA TODAY based in Nashville. You can reach him at [email protected].

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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.

Stomach viruses are back up on cruise ships, with hundreds falling ill

The cdc has already reported 12 outbreaks of gastrointestinal illness on cruises this year.

This story has been updated.

As cruise passengers return to the seas in force following a pandemic lull, an unwelcome side effect is also back: outbreaks of gastrointestinal illness.

According to the Centers for Disease Control and Prevention, so far this year there have been 12 outbreaks of vomiting and diarrhea that have reached the threshold for public notification on cruise ships visiting U.S. ports. The tally has already exceeded each yearly total number of outbreaks reported from 2017 to 2019.

Norovirus has been identified as the culprit in five of the 2023 cases; the others are all classified as unknown. The CDC did not immediately provide responses to questions about the increase in cases this year.

In a May outbreak, aboard Holland America Line’s Nieuw Amsterdam, 213 passengers and 35 crew reported being ill. That represents almost 11 percent of guests and about 4 percent of workers.

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“Incidence of mild gastrointestinal illness among guests onboard Nieuw Amsterdam are suspected to be the common but highly contagious Norovirus, which is typically transmitted through close contact with unwell people and includes touching shared items,” Holland America Line said in an emailed statement. “The cases have been mostly mild and quickly resolving.”

The CDC says crew on the ship, which can carry more than 2,100 passengers, increased cleaning and disinfection procedures and collected stool specimens to send to a lab to confirm the cause.

According to a CDC norovirus tracking network that uses information from 14 states, there were 735 outbreaks reported from August through April 23. There were 907 during the same period of the 2021-2022 norovirus season. Norovirus causes 19 million to 21 million illnesses on average every year in the United States, the agency says .

Outbreaks of gastrointestinal illness plummeted during the pandemic, which shut down the cruise industry for more than a year and forced a slow return with multiple health precautions in place. There were no reported cases in 2020, followed by one in 2021 and four last year.

William Schaffner, a professor of infectious diseases at the Vanderbilt University School of Medicine in Nashville, told The Washington Post last year that the lower number of cruises, reduced concentration of passengers and coronavirus precautions were all factors in the drop in cases.

“The more rigorous we are with all of these hygienic measures, there’s spillover to other infectious agents,” he said.

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Health authorities say cruise passengers should wash their hands often and leave the area if they see someone get sick. If people are sick before a cruise, they should ask about alternative options and ask a doctor whether it’s safe to sail.

The Cruise Lines International Association says incidents of gastrointestinal illness are “quite rare” on ships, pointing to the millions who get sick every year on land. The group said in a statement that crew members clean and sanitize using practices developed with public health authorities, including the CDC.

“All of the efforts made by cruise ship crews cannot replace the responsibility that rests with each and every individual,” the association said. “Passengers and crew alike must also be committed to keeping themselves, their family and their fellow travelers healthy.”

Through its Vessel Sanitation Program , the CDC inspects cruise ships, monitors illness, trains crew and provides public health information. The agency releases information on outbreaks when 3 percent or more of passengers or crew report symptoms to medical staff on board.

“Norovirus can be especially challenging to control on cruise ships because of the close living quarters, shared dining areas, and rapid turnover of passengers,” the CDC says. “When the ship docks, norovirus can be brought on board in contaminated food or water or by passengers who were infected while ashore.”

Because norovirus can linger on surfaces and resists many common disinfectants, it can result in outbreaks on back-to-back cruises. Still, the agency says that norovirus on cruise ships only account for 1 percent of reported outbreaks of the illness and notes that “acute gastrointestinal illness is relatively infrequent” on ships.

“Health officials track illness on cruise ships,” the CDC says . “So outbreaks are found and reported more quickly on a cruise ship than on land.”

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177 sickened with norovirus on the Celebrity Summit. Gastrointestinal illness outbreaks on ships are on the rise this year.

• Nearly 200 people were sickened with norovirus on the Celebrity Summit cruise ship in May.
• It was the 12th CDC-reported outbreak of a gastrointestinal illness onboard a cruise ship this year.
• Five outbreaks were confirmed to be norovirus, a fast-spreading bug that causes diarrhea and dehydration.

More than 175 people felt more than seasickness onboard a Celebrity Cruise ship last month.

Twenty-five crew members and 152 of the 2,144 passengers onboard the May 15 to May 25, 2023 voyage of the Celebrity Summit reported norovirus symptoms , according to a notice issued by the Centers for Disease Control and Prevention.

Norovirus, often called the stomach flu, can quickly spread via particles from vomit and poop, through contaminated surfaces, tainted food and water, and contact with people who have the virus.

Related stories

It is also notoriously difficult to contain.

"If you get norovirus illness, you can shed billions of norovirus particles that you can't see without a microscope," according to the CDC. "It only takes a few norovirus particles to make you and other people sick."

Washing your hands is the gold standard to prevent the spread

Washing your hands with water and soap after you use the restroom or change a diaper and before you prepare food or eat is the best way to avoid spreading norovirus.

Hand sanitizer, the CDC notes, "does not work well against norovirus."

(Insider has great guides on prevention , disinfection , and treatment. Spoiler alert: There's no antiviral for norovirus. You must ride it out, isolate, and keep hydrated.)

The 'cruise ship disease'?

Norovirus is sometimes known as the "cruise ship disease" because it can spread quickly in close quarters, like a cruise ship, dorm rooms, or a nursing home.

In response, Celebrity increased cleaning and sanitation, notified guests, encouraged reporting symptoms and good hygiene, and sent stool samples to the CDC for testing, among other protocols.

It is the 12th such CDC-reported outbreak of a gastrointestinal illness on a cruise ship in 2023 : five of the 12 are known to be norovirus, though the CDC notes that "acute gastrointestinal illness is relatively infrequent on cruise ships" and the rate of acute gastroenteritis decreased between 2006 and 2019 . 

However, with the rebound of the cruise industry , it does look like there's been an uptick in GI illness on ships compared to 2019 — before the cruise industry was briefly shut down due to COVID-19 — when there were 10 outbreaks reported for the entire year versus 12 reported outbreaks in the first five months 0f 2023. Celebrity did not immediately respond to Insider's request for comment.

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Norovirus outbreaks surging on cruise ships this year

By Emily Mae Czachor

July 12, 2023 / 10:33 AM EDT / CBS News

Norovirus outbreaks spiked on cruise ships this year, with data showing more outbreaks happened between January and June than over the course of any other full calendar year in the last decade. Thirteen norovirus outbreaks have been reported on cruises so far in 2023, according to the  U.S. Centers for Disease Control and Prevention , which keeps a record of annual case counts dating back to 1994. 

The most recent outbreak hit passengers and crew members on board a Viking Cruises trip from Iceland that docked in New York on June 20. More than 13% of passengers on the Viking Neptune — 110 of 838 in total — reported being ill while onboard, according to the CDC. Nine crew members reported being ill as well. Health officials at the CDC determined that norovirus caused the outbreak after Viking Cruises collected and sent specimens to the agency's laboratory for testing.

Those cases in June came after multiple norovirus outbreaks in previous months that affected a range of cruise lines. 

In May, two outbreaks were reported on voyages led by Celebrity Cruises and Holland America. In March, Celebrity Cruises reported two norovirus outbreaks, as did Royal Caribbean International and Princess Cruises. Princess Cruises reported its first outbreak of the year in February, and Royal Caribbean International reported two the previous month. P&O Cruises also reported an outbreak on its Arcadia cruise ship this year.

The CDC's tally of norovirus outbreaks so far confirmed on cruise ships in 2023 is already higher than any annual outbreak tallies since 2012, when the health agency recorded 16 outbreaks. 

Symptoms of norovirus

Norovirus is a highly contagious virus that causes acute gastroenteritis, which is inflammation in the stomach or intestines, according to the CDC . Health officials say norovirus is the most common cause of vomiting and diarrhea as well as the most common type of foodborne illness .

Norovirus is often referred to as a "stomach bug" or "stomach flu" (although it is not a form of flu). It causes a variety of symptoms including nausea, vomiting, diarrhea and stomach pain. People infected with the virus may also have headaches, fevers and body aches, and are at risk of dehydration.

The virus spreads easily and is typically contracted when someone accidentally ingests tiny particles of vomit or feces from someone who is infected with it. The CDC writes that people who are infected "can shed billions of norovirus particles that you can't see without a microscope," and exposure to just a few norovirus particles can make someone sick. 

Symptoms typically emerge within 12 to 48 hours of being exposed. Most people get better after a few days, but severe cases may require hospitalization.

Studies have shown that norovirus can continue to spread for two weeks or more after an infected person stops having symptoms of the illness, according to the CDC.

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Emily Mae Czachor is a reporter and news editor at CBSNews.com. She covers breaking news, often focusing on crime and extreme weather. Emily Mae has previously written for outlets including the Los Angeles Times, BuzzFeed and Newsweek.

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Norovirus Outbreaks on Cruise Ships: How to Avoid Getting Sick on Vacation

• There have been 13 norovirus outbreaks on cruise ships in 2023.
• Experts note that the highly congested environment, as well as the fact that people have not been exposed to as many illnesses due to the COVID-19 pandemic, are likely the reason for the increased norovirus numbers.
• Experts recommend maintaining proper hygiene habits and contacting the ship’s medical facility as soon as you don’t feel well in order to avoid spreading illnesses while at sea.

Multiple cruise lines are experiencing norovirus outbreaks.

There have currently been 13 norovirus outbreaks on cruise ships in 2023. The most recent outbreak occurred on a Viking Cruises ship, which traveled from Iceland and docked in New York City. About 13% of its passengers and several crew members became ill with the virus while on board.

With more than 31 million passengers worldwide expected to set sail this year, experts told Health that these highly-congested environments—along with the fact that people have not been exposed to a normal amount of illnesses due to the pandemic—could be the reasons for the increased numbers.

“Loosening of restrictions after the COVID-19 pandemic makes us more susceptible to picking up viruses after several years in seclusion,” Sanjiv Shah, MD, MPH , an infectious disease specialist and chief medical officer for MetroPlusHealth, New York City’s public health insurance program, told Health.

“Children who have been able to avoid the virus during the pandemic are now being exposed to viruses that tend to peak during the school year,” he said. “While norovirus is higher this year, the numbers are not a big outlier compared to pre-pandemic levels.”

Getty Images / Michael Dunning

What Is Norovirus?

Norovirus is the most common cause of gastroenteritis and foodborne illness . Though people often call it the “ stomach flu ,” it has nothing to do with flu, Brian Labus, PhD, MPH, REHS , an expert in infectious diseases, told Health .

“You have to swallow the virus to get sick,” Labus, an assistant professor in the Department of Epidemiology and Biostatistics at the UNLV School of Public Health, said. “That can be through consuming contaminated food or touching a contaminated surface and then touching your mouth or not washing your hands before you eat.”

Norovirus, which causes inflammation of the stomach or intestines, typically causes diarrhea , vomiting, nausea, and stomach pain Bernadette Boden-Albala, DrPH, MPH , director and founding dean of the Program in Public Health at the University of California Irvine told Health . Other symptoms can include fever, headache, and body aches.

Typically, norovirus lasts for one to three days, though you can spread the illness for a few days after.

“Infected people spread the virus widely and make it difficult for public health officials to contain the virus,” Boden-Albala said.

Why the Number of Norovirus Outbreaks Increased

The exact cause for the increase in the number of norovirus cases is not clear, but the increasing demand for cruises could be one explanation for the rise in reported cases, said Labus.

During COVID, the options for cruises were limited, but now that restrictions have been lifted , more people are deciding to take that cruise they had been putting off.

People also are more likely to get sick now since pandemic restrictions have been lifted. For the past few years, people have not been exposed to as many common viruses and illnesses and now that exposure is rising, illnesses are bound to rise as well.

It also is possible the numbers for norovirus on cruise ships appear more alarming than they truly are.

On cruise ships, health officials are legally required to track any illnesses that occur, while this same reporting is not required on land. For this reason, the Centers for Disease Control and Prevention note that outbreaks are reported more frequently on sea than on land.

“The risk of getting norovirus each year is about 1 in 15 [but] a cruise passenger has about a 1 in 5,500 risk of getting norovirus,” Sally Andrews, vice president of strategic communications and public affairs for the Cruise Lines International Association told Health .

Environments Where Norovirus Spreads Quickly

According to Shah, norovirus spreads rapidly anywhere there are large groups of people, like school classrooms, family gatherings, and weddings.

Cruise ships in particular have many of the conditions that make people susceptible to norovirus—close quarters, enclosed spaces, communal dining, and high turnover of passengers.

“The virus is often associated with cruise travel simply because health officials are required to track illnesses on ships,” Shah said. “The CDC estimates only about 1% of annual U.S. norovirus cases happen on cruise ships. Rates are much higher in schools, nursing homes, hospitals, and restaurants, which collectively account for about 91% of cases.”

Minji Kang, MD, an assistant professor and infectious disease specialist in the Department of Internal Medicine at UT Southwestern Medical Center added that norovirus can also be brought onboard by contaminated food or water, or passengers who were infected while ashore.

Yes, Cruise Ships Have Strategies to Prevent Outbreaks

Because norovirus outbreaks can flare up in the close quarters of a ship, the cruise industry has had norovirus prevention programs in place for nearly 20 years, Labus said. “They have the right chemicals needed to control it and the plans and training for how to use them appropriately.”

Cruise ships also have plans for how to deal with ill guests to ensure that they are not infecting other passengers, he said. “It’s important to let the ship’s medical staff know if you are sick so that they can protect the rest of the passengers.”

According to the American College of Emergency Physicians (ACEP), every cruise ship must have a place to isolate any passengers who have a contagious disease. This step helps them minimize the risk of spreading the disease to others.

What’s more, the CDC has established a rigorous Vessel Sanitation Program (VSP) to help prevent the overall spread of illnesses on cruise ships. Not only do they inspect a cruise ship’s medical center, but they also monitor their portable water systems, dining rooms, housekeeping procedures, heating, ventilation, air conditioning (HVAC) systems, and more.

If a cruise ship does not do well on its inspection—or gets an 85% or lower—it cannot set sail until it corrects the issues.

Staying Healthy While on a Cruise

While there have been 13 outbreaks of norovirus on cruise ships this year, Labus explained that not every cruise passenger is going to be exposed to the virus. Still, taking certain steps to prevent the likelihood of getting sick is never a bad idea.

“The most important measure to prevent the spread of norovirus is to wash your hands with soap and water for at least 20 seconds,” said Kang. “This should be done before eating and drinking, brushing one’s teeth, and after going to the bathroom, touching high-hand contact surfaces, and taking care of a sick person.”

She noted that hand sanitizers do not work well against norovirus and that they are not a substitute for handwashing.

For extra peace of mind, you can also research your cruise line prior to booking.

To see how your specific cruise line performed on its VSP inspections, you can visit the CDC website and search their portal. This site also lists any corrective actions taken to remedy any issues. You can even look for cruise lines that have scored a perfect 100.

If you do happen to get sick while on a cruise, Boden-Albala recommends that you follow CDC guidelines and report your illness to the ship’s medical facility as soon as possible. “[You also should] rest and drink plenty of water to rebuild your immunity system and prevent dehydration.”

Even though you may be tempted to conceal your illness, you would be doing a great disservice to the other passengers and the crew on the cruise by keeping it a secret.

“While staying in your cabin [for a day or two] may not make for the best vacation,” Shah said, “it’s important to take precautions to avoid infecting others.”

Centers for Disease Control and Prevention. Outbreak updates for international cruise ships .

Cruise Lines International Association. State of the cruise industry 2023 .

Centers for Disease Control and Prevention. Symptoms of norovirus .

Centers for Disease Control and Prevention. Facts about noroviruses on cruise ships .

Cruise Lines International Association. Norovirus on cruise ships .

American College of Emergency Physicians. Healthcare guidelines for cruise ship medical facilities .

Centers for Disease Control and Prevention. Vessel sanitation program: inspection infographic .

Centers for Disease Control and Prevention. Advanced cruise ship inspection search .

Centers for Disease Control and Prevention. Cruise ship inspection scored 100 .

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Norovirus Cases Are Rising on Cruises. Here’s How You Can Stay Safe

Keep hands clean as stomach bug cases rise.

Larry Bleiberg,

Just as travel has begun to bounce back after the pandemic, cruise ship passengers are facing another threat to their vacation: norovirus .

Thirteen ships so far this year have reported outbreaks of the highly contagious stomach bug, the most since 2012, according to the  U.S. Centers for Disease Control and Prevention (CDC) . Nearly 1,700 passengers have come down with the virus, which causes vomiting, nausea, diarrhea and stomach pain. Not only does it take the joy out of vacation, keeping passengers confined to their stateroom, but for older travelers, there’s a concern of dehydration, doctors say.

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The  bug thrives in crowded conditions  and is spread through food and by touching contaminated surfaces. The easiest way to avoid the ailment is to wash your hands with soap and water after using the bathroom, before eating and after touching surfaces touched by others.

Samuel Mathis, M.D., an assistant professor in the University of Texas Medical Branch Department of Family Medicine, says the resilient virus can live for days and there are plenty of places for it to linger on cruise ships: “Door handles, stairway banisters, tongs for food at the buffet, things that a lot of people touch that aren’t cleaned between each use.”

And washing your own hands isn’t enough. Mathis says older passengers and others traveling with family face a risk from others in their party. For example, if grandchildren aren’t careful hand-washers, they can easily infect their grandparents and others.

Mathis, who works in Galveston, Texas, a cruise port, has seen passengers with norovirus. He says that while the virus itself is uncomfortable, it isn’t typically dangerous. “The biggest risk for almost everyone — but especially for seniors — is actually the risk of dehydration: losing all that fluid through nausea, vomiting and diarrhea.”

Symptoms of dehydration  include extreme thirst, lack of urination and dizziness when standing, Mathis says.

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If passengers come down with a stomach bug, they should contact the ship’s medical clinic, which will monitor for dehydration. In addition, they should stay in their cabin away from people until they are symptom-free for at least 24 hours, Mathis says. “That can be really rough because you’re missing your cruise.”

The most recent norovirus outbreak was reported on the  Viking Neptune  cruise ship. During its June 6 to June 20 voyage, 110 of the ship’s 838 passengers, or 13.1 percent, were infected. In addition, nine of the 455 crew members were infected.

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“We believe the gastrointestinal illness originated from a shoreside restaurant in Iceland where a group of guests dined during their free time,” the cruise line said in a statement. After docking in New York, the ship was thoroughly cleaned and disinfected, and continued its scheduled sailings.

The CDC regularly inspects cruise ships and monitors the number of outbreaks. This year, norovirus also has been reported on cruises operated by Royal Caribbean International, Celebrity Cruises, Princess Cruises, Holland America and P&O Cruises. The worst year for norovirus was 2006, when 32 ships reported infections, according to the CDC.

Cruise experts say several factors may be contributing to the rise in cases. For one, cruising has soared this year, with the number of passengers expected to surpass the total that sailed in 2019, according to the Cruise Lines International Association.

Letting down their guard

Ashley Kosciolek, senior cruise writer at The Points Guy, a consumer travel website, says that after years of COVID-related precautions, passengers may have let their guard down. 

“People are just so happy to be back, but they’ve gotten a little lax with hygiene. I personally have seen lots of people using the women’s room and not washing their hands. I don’t know if it’s subconscious rebellion or if they don’t realize what could happen.”

Kosciolek says she has made it a practice to wash her hands before going to the buffet, and then washing them again before she eats, since buffet implements aren’t sanitized after each passenger touches them.

Mathis says it might even make sense for passengers to avoid the buffet and dine only at their ship’s sit-down restaurants.

That said, the chances of catching the bug on a cruise ship aren’t particularly high. According to the  Cruise Lines Industry Association , the risk each year of getting laboratory-confirmed norovirus during a ship outbreak is about 1 in 5,500. The most common settings for norovirus aren’t even at sea. Over half of all cases originate in long-term health care facilities, according to the CDC, while less than 1 percent of all norovirus cases come from cruise ships.

Kosciolek notes that while cruise ships are required to report outbreaks, many land-based cases go unreported. “It is easy for someone who has never cruised to see these news reports and say, ‘Oh my goodness, I’m never going to cruise because I’m going to get sick.’ ”

Likewise, Mathis says vacationers shouldn’t let the fear of norovirus keep them from taking a vacation.

“I do not suggest that people don’t go on cruises. When proper safety precautions are taken, cruises are fantastic opportunities for individuals to relax, to spend time with friends or family and meet new people. It really just comes down to recognizing there are risks.”

Virginia native Larry Bleiberg is president of the Society of American Travel Writers, a frequent contributor to  BBC Travel  and the creator of  CivilRightsTravel.com .​​

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Surge at Sea: Alarming Increase of Norovirus Outbreaks on Cruise Ships

By SciTechDaily July 14, 2023

The allure of the open sea, captivating itineraries, and the luxurious promise of a carefree escape have long made cruising a popular choice for vacationers. However, this industry’s lustrous appeal has recently been overshadowed by a surge in outbreaks of a particularly stubborn and contagious pathogen — Norovirus.

Since the start of this year, an unsettling trend has emerged. According to data compiled by the Centers for Disease Control and Prevention (CDC), there have been 13 outbreaks across six different cruise lines. This alarming number marks the highest incidence of such outbreaks since 2012 when there were 16 across eight lines over the entire year.

In light of these recent developments, it’s imperative to explore and understand the nature of Norovirus — what it is, why it’s a recurring issue aboard cruise ships, and its impact on the cruise industry. This article aims to shed light on these matters, unpacking the complexities of the problem, and highlighting the steps that are being taken to address it.

The recent surge in Norovirus outbreaks underscores the necessity of vigilance and proper understanding of this issue, both for those planning a dream vacation at sea and for those in the cruise industry itself. Together, we can work towards ensuring that cruise ships remain a place of relaxation and enjoyment, rather than a breeding ground for this troublesome virus .

What is Norovirus?

Norovirus, sometimes referred to as the “winter vomiting bug,” is a highly contagious virus that causes gastroenteritis, an inflammation of the stomach and intestines. Named after Norwalk, Ohio, where the first outbreak was identified in 1968, norovirus can lead to severe vomiting, diarrhea, stomach cramps, and, in certain cases, even more serious consequences such as severe dehydration.

The virus is commonly spread through direct contact with an infected person, consuming contaminated food or water, or touching surfaces or objects contaminated with the virus. One of the main challenges in containing norovirus is its ability to survive on various surfaces for a significant amount of time, making it easy to pick up unknowingly.

Why is Norovirus a problem on Cruise Ships?

Highly contagious in close quarters.

The design and operation of cruise ships often involve large groups of people living in close proximity, sharing dining areas, entertainment spaces, and public restrooms. This makes it easy for norovirus to spread rapidly from person to person.

Quick and Vast Outbreaks

When a single case of norovirus appears on a cruise ship, it can quickly become an outbreak affecting hundreds or even thousands of people. This can happen incredibly quickly due to the confined nature of a cruise ship and the frequency of close interactions among passengers and crew.

Contaminated Food and Water

Cruise ships are known for their vast buffets and dining options. This presents an opportunity for the virus to spread if food or water becomes contaminated, either by an infected person or through improper handling and storage.

Difficulty in Proper Sanitation

While cruise ships have strict sanitation practices, the resilience of norovirus complicates matters. The virus can survive for days on surfaces and is resistant to many common disinfectants, making it challenging to eliminate once an outbreak has occurred.

Interruption of Planned Activities

A norovirus outbreak can cause significant disruption to the planned activities and itineraries of a cruise. Infected individuals must be isolated, common areas may need to be closed for cleaning, and in severe cases, the ship may even have to return to port.

The Impact of Norovirus on Cruise Industry

Cruise lines have had to invest heavily in cleaning and sanitation protocols, disease detection methods, and passenger education to combat the threat of norovirus. In many instances, outbreaks have led to public relations challenges, decreased passenger satisfaction, and financial losses due to trip cancellations and medical costs.

Moreover, the cruise industry often finds itself under scrutiny following an outbreak, which can affect the public’s perception and willingness to book cruises, ultimately impacting the industry’s bottom line.

The threat of norovirus on cruise ships is a serious issue that has both health and economic impacts. The confined environment of a cruise ship, combined with the virus’s highly contagious nature, creates a significant challenge. It’s crucial for cruise lines, passengers, and health officials to remain vigilant, proactive, and informed to prevent and contain potential norovirus outbreaks.

While the industry has made strides in improving sanitation protocols and disease prevention measures, the threat of norovirus remains a considerable concern that must be continuously addressed to ensure the safety and well-being of all passengers at sea.

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2 comments on "surge at sea: alarming increase of norovirus outbreaks on cruise ships".

Pay tons of money to be crammed onto a petri dish and no way off, no thanks. Then once you are on board its more $$$ for anything.

I might enjoy a cruise in a small ship with a few people, but having done a trip on a large ship many years ago I found all the hobnobbing with hundreds of other people to be psychologically scream-making ! Far too many humans in one place – no amount of luxury things would compensate for the horror of that, let alone worrying about a virus. So no thanks !

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Cruise lines battle norovirus outbreaks, affecting crews, hundreds of passengers. Here's what to know

In all, about 1,700 people reported being sick with norovirus aboard a cruise ship between January and June of this year. 

By Monica Galarza and Marissa Bagg • Published July 13, 2023 • Updated on July 13, 2023 at 6:49 pm

The Centers for Disease Control and Prevention is reporting the highest number of norovirus outbreaks in over a decade and it is impacting hundreds of passengers and crew members onboard some of the most prominent cruise lines.

In the first six months ending in June, cruise lines have reported 13 separate outbreaks to the CDC. It’s the most number of reported norovirus outbreaks on cruise ships since 2012.

And this year’s outbreaks represent the highest number since cruises began sailing again in the summer of 2021 after being suspended due to COVID-19.

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One local expert says it’s in part because more people are cruising. 

“The hundreds of thousands, if not millions of people that have already gone on cruises without incident. It’s a very small number and it’s there’s nothing to be concerned about,” said Steward Chiron, a cruise expert. “I would not think twice about going on a cruise. I would not think twice about going on a cruise or traveling anywhere.”

Celebrity, Royal Caribbean International, Holland America, Princess and P&O were among the Royal Caribbean and Carnival lines affected.

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So if you're planning to set sail this summer, here's everything you need to know about the norovirus.

What is norovirus?

According to the CDC, norovirus is the leading cause of vomiting, diarrhea, and foodborne illness in the United States.

It's also not a one-and-done virus. You can get norovirus illness many times in your life because there are many different types of noroviruses and one type may not protect you against the others.

It is possible, however, to develop protection against specific types, but it's not known exactly how long protection lasts.

This may explain why so many people of all ages get infected during norovirus outbreaks.

According to the CDC, your likelihood of getting a norovirus infection is also determined in part by your genes.

How does norovirus spread?

Because people of all ages can get sick with norovirus, it can spread easily and quickly.

The CDC says norovirus can be spread by:

• Having direct contact with someone with norovirus, such as by caring for them, sharing food or eating utensils with them, or eating food handled by them.
• Eating food or drinking liquids that are contaminated with norovirus.
• Touching surfaces or objects contaminated with norovirus and then putting your unwashed fingers in your mouth.

You are at your most contagious when you have  symptoms  of norovirus illness, especially vomiting or during the first few days after you feel better.

But studies have shown that you can still spread norovirus for two weeks or more after you feel better.

According to Mayo Clinic , norovirus most often spreads in closed and crowded environments, such as hospitals, nursing homes, child care centers, schools and cruise ships.

But it can also spread through contaminated food, water or through sick people and contaminated surfaces.

What are the symptoms of norovirus?

According to the CDC, the most common symptoms of norovirus are diarrhea, vomiting, nausea and stomach pain.

You may, however, experience fevers, headaches, and body aches.

Symptoms usually last one to three days and most people recover, according to the Mayo Clinic.

How do you treat norovirus?

There is no specific medicine to treat people with norovirus illness.

If you have norovirus illness, the CDC recommends you drink plenty of liquids to replace fluid lost from vomiting and diarrhea and help prevent dehydration.

Sports drinks and other drinks without caffeine or alcohol can help with mild dehydration, but these drinks may not replace important nutrients and minerals.

It is important to note that antibiotic drugs will not help treat norovirus infections because they fight bacteria, not viruses.

When was the most recent norovirus outbreak on a cruise ship?

The CDC's latest report of a norovirus outbreak happened on Viking Neptune, a cruise ship owned by Switzerland-based Viking Cruises, during a voyage from June 6 to June 20.

According to the CDC, 110 of 838 passengers and nine of the 455 crew members reported feeling ill during the trip.

The following ships saw outbreaks so far in 2023: Celebrity Summit, Nieuw Amsterdam, Grand Princess, Emerald Princess, Enchantment of the Seas, Celebrity Equinox, Celebrity Constellation, Ruby Princess, Viking Neptune, Jewel of the Seas, Brilliance of the Seas, Arcadia.

What can I do to prevent contracting norovirus?

The key to preventing norovirus , and most other illnesses is simply washing your hands well.

Norovirus is very contagious, but you can take steps to stop it from spreading.

Wash your hands often with soap and water for at least 20 seconds, especially:

• After using the toilet or changing diapers.
• Before eating, preparing, or handling food.
• Before giving yourself or someone else medicine.

It is important to continue washing your hands often even after you feel better.

Chiron says cruise lines try to keep ships clean and limit some interactions. 

“What they do is they reduce the person-to-person interactions. So when you go to the buffet for example for breakfast or lunch. Instead of serving yourself a gloved crew member will do it for you,” said Chiron.

When on board, if you see someone with norovirus symptoms, you’re urged to leave the area and alert a crew member. 

Norovirus can be found in your vomit or feces (poop) even before you start feeling sick. The virus can also stay in your poop for two weeks or more after you feel better and you can still spread norovirus during that time.

Hand sanitizer does not work well against norovirus. You can use hand sanitizers in addition to hand washing, but hand sanitizer is not a substitute for handwashing.

This article tagged under:

How common is norovirus on cruise ships? Here’s why you shouldn’t worry

What's sneaky, super contagious and bound to cause diarrhea and vomiting? If you answered "norovirus," you'd be correct. But what is it, and why is it often associated with cruises?

An excessive number of news reports exist for norovirus cases on ships, making it seem to the unsuspecting public that cruise vessels are dirty or you're likely to get sick if you sail . I'm here to set the record straight.

Find out why norovirus is unfairly labeled a cruise ship illness, what cruise lines do to minimize onboard spread and whether you should be worried about it on your next voyage.

For more cruise news, guides and tips, sign up for TPG's cruise newsletter .

What is cruise ship norovirus?

Norovirus is the most common of several viruses that cause severe gastrointestinal illness or acute gastroenteritis. Symptoms may include diarrhea and vomiting, as well as abdominal cramping, headaches, muscle aches and fever — an unpleasant experience any time but especially when you're on vacation.

Norovirus is highly contagious and spreads when you touch a contaminated surface and then put your fingers in or near your mouth, such as when eating without washing your hands. It's also frequently spread through contaminated food, sometimes earning it the nickname "food poisoning," even though there are many pathogens that can cause foodborne illnesses. You might also hear it generically called a stomach bug or the stomach flu despite the fact that noroviruses are not the same as flu viruses.

How does norovirus spread on cruise ships?

What causes norovirus on cruise ships, anyway? Norovirus spreads easily in close quarters, such as those found on cruise ships. Although it can spread from person-to-person contact, on vessels, it's most commonly passed when passengers fail to wash their hands after coming in contact with high-touch areas, such as handrails, elevator buttons and serving utensils in the onboard buffets.

Infected passengers who don't wash their hands after coughing, sneezing or using the restroom are the reason those surfaces become contaminated in the first place. To avoid both spreading your own germs and picking up the germs of others, wash your hands frequently, especially before eating, for at least 20 seconds with soap and warm water, making sure to scrub around your fingernails and between your fingers.

Contaminated food is also a cause, but it's not as common on ships, where the staff is meticulously trained to follow health and safety guidelines for sanitation. Standards are enforced by the U.S. Centers for Disease Control and Prevention. (See the next section for more.)

What do cruise ships do to prevent norovirus outbreaks on board?

Cruise lines employ crews dedicated to keeping public areas and high-touch surfaces clean. Galley crews and waiters receive extensive training on food safety and handling.

Lines also screen passengers for signs of illness at embarkation. They ask passengers who feel ill during their cruises to report symptoms to the medical center and keep themselves isolated in their cabins.

On ships where outbreaks occur, the crew conducts a deep cleaning of the ship after passengers have disembarked and before the next sailing begins. In cases where outbreaks are particularly severe, subsequent sailings could be canceled to allow for more thorough sanitization.

Additionally, the CDC's Vessel Sanitation Program, implemented in the 1970s, subjects all passenger ships carrying 13 or more people to random, unannounced inspections if they wish to call on ports in the United States.

As part of the program, ships are required to adhere to stringent health and safety protocols that dictate everything from the cleaning of high-touch areas to how food is stored in freezers, refrigerators and galleys.

VSP inspectors board ships and conduct thorough checks to ensure compliance, and the standards are high. A score of less than 86 out of 100 is considered failing. You can find a list of the most recent inspection scores and lists of violations for each ship on the VSP website .

Should you worry about getting norovirus on a cruise?

The short answer is no. "People often associate cruise ships with acute gastrointestinal illnesses, such as norovirus, but acute gastrointestinal illness is relatively infrequent on cruise ships," the CDC says on its " Facts About Noroviruses on Cruise Ships " page.

Based on the math, you have less chance of catching a gastrointestinal illness on a ship than at many places you're likely to visit on land.

The CDC estimates only about 1% of all annual U.S. norovirus cases happen on cruise ships. The numbers are greatest in nursing homes, hospitals, schools and restaurants, which collectively account for about 91% of cases.

In a study of acute gastroenteritis cases from 2006 to 2019 (before the cruise industry's COVID-19 shutdown), the CDC found that the number of cases on ships decreased over those 14 years. It also noted that the number of cases tends to be higher on larger ships and on voyages of a week or longer.

"The rate of … illness on cruise ships decreased during 2006-2019 for passengers and crew," the report says. That's good news for cruisers.

During that time frame, approximately 127 million passengers sailed on the 252 cruise ships under VSP jurisdiction. Of those 127 million cruisers, 26,450 reported symptoms of gastrointestinal illness while on board. It sounds like a large number, but it amounts to just 0.02% (two one-hundredths of one percent) of cruisers throughout those 14 years, with the total number of cases decreasing from 4,507 in 2006 to 1,201 in 2019.

If you'd like to check out the outbreak information, you can find a detailed list of ships that have had acute gastroenteritis outbreaks (many of which were caused by norovirus), listed by year, about halfway down the CDC's outbreak page .

For more details on how to keep yourself healthy on board, visit TPG's story on how to avoid getting sick on a cruise .

Why are there so many cruise norovirus reports on the news?

The simple answer is that cruise ships are required to report cases of acute gastroenteritis to the CDC, even when the numbers are low. In contrast, other entities — schools, nursing homes, hospitals and restaurants — are not.

"Health officials track illness on cruise ships. So outbreaks are found and reported more quickly on a cruise ship than on land," reads the CDC's facts page .

Specifically, the medical staff from each cruise ship must submit a report with the number of ill passengers within 24 to 36 hours of its arrival at a U.S. port from a foreign port, even when no cases of gastrointestinal illness are present. They must also submit reports if 2% or more of the passengers and crew become ill and the ship is scheduled to visit a U.S. port within 15 days. If the number hits 3% or more, cases must be reported to the CDC even if the ship is not scheduled to call on a U.S. port within the next 15 days.

That means data for norovirus on cruise ships is more readily available than for other entities. It's easy to make norovirus case numbers sound alarming, but context matters. For example, 100 cases on a single ship might seem like a lot, but on a vessel like Oasis of the Seas, which carries more than 5,400 passengers, 100 cases are only about 2% of the onboard population.

Bottom line

Should you be worried about catching norovirus or another gastrointestinal illness when you cruise? The CDC says cruises account for some of the lowest case numbers in the U.S. annually.

Your chances of finding yourself confined to your room and hunched over a toilet for a week are slim when you sail, especially if you take common-sense precautions like washing your hands and not sharing drinks, utensils and other items that easily spread germs.

Have more cruise questions? TPG has answers:

• Are cruises safe? Here's what you need to know before you sail
• Packing for a cruise? These items aren't allowed on board
• Man overboard: Cruise ship overboards and how they happen
• What is baked Alaska, and why is it paraded around cruise ships?
• What are the largest cruise ships in the world?
• Gentlemen hosts: These men cruise to make sure single ladies have a great time
• What is the Jones Act and how does it affect cruise ships?
• What is a lido deck on a cruise ship?
• What's a cruise cabin guarantee and will it save you money?
• What's the difference between a cruise ship concierge and a butler?

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Nearly 30 Silversea Cruise passengers sickened by outbreak on board

28 passengers and one crew member fell ill with stomach bug on luxury silver nova cruise liner, the cdc reported.

5 things you didn’t know about traveling on cruise ships

Passengers expecting outstanding cuisine aboard a luxury Silversea cruise liner spent much of their vacation in the ship's bathrooms with a gastrointestinal virus, the Centers for Disease Control and Prevention (CDC) said Monday.

At least 28 passengers and one crew member among the Silver Nova's 633 passengers fell ill during their 16-day Easter-themed cruise that set sail in Callao, Peru, the agency said. 

They all reported the same primary symptom: diarrhea. 

DISNEY CRUISE LINE PASSENGER RESCUED BY US COAST GUARD AFTER EMERGENCY OFF PUERTO RICO

Of the 633 passengers aboard the Silversea's Silver Nova, 28 fell ill during a 16-day cruise from Peru this month, the CDC wrote in a press release. (Photo by Gerard Bottino/SOPA Images/LightRocket via Getty Images)

The cause of the outbreak is still unknown, but the agency noted that noroviruses are typically caused by eating contaminated food or drinking contaminated water. 

The Silver Nova, the cruise company's newest liner introduced in 2023, boasts butler service for each suite and a ratio of one crew member for every 1.3 guests. 

Workers aboard the ship aim to show guests "outstanding gastronomy," according to the Silversea website. At the end of last year, "Top Chef's" Nina Compton joined its staff, and offered personal cooking lessons to passengers. 

Sick passengers were quarantined in their rooms, the CDC said. Other passengers were notified, and crew members "increased cleaning and disinfection procedures."  

FLORIDA MAN BELIEVES SON IS ALIVE AFTER JUMPING OFF CRUISE SHIP: REPORT

The primary symptom reported by sick passengers was diarrhea, the CDC said. Crew members "increased cleaning and disinfection procedures" and quarantined sick passengers to quell the outbreak. (iStock)

"The health and safety of our guests, crew and communities we visit are our top priority," a spokesperson for Silversea Cruises told the New York Post.  

Prices for the voyage, which ended on April 16, started at $11,700 for a double-occupancy room, according to CruiseMapper. 

SEARCH FOR MISSING SOUTH CAROLINA CRUISE PASSENGER COMPLICATED BY JUNGLE TERRAIN AS FAMILY DEMANDS US HELP

Prices for the voyage started at $11,700 for a double-occupancy room according to CruiseMapper. The Silver Nova, the newest introduction to the cruise company's fleet, boasts a luxury experience and "outstanding gastronomy." (Photo by Gerard Bottino/SOPA Images/LightRocket via Getty Images)

The Post reported that the Silversea outbreak was the fourth this year, including one that saw 130 people struck with diarrhea and vomiting and another that saw 104 passengers fall ill on a Holland America liner . 

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The CDC reported 14 cruise ship outbreaks in 2023.

Christina Coulter is a U.S. and World reporter for Fox News Digital. Email story tips to [email protected] .

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• Gastrointestinal illness/Norovirus affects 28 passengers on...

Gastrointestinal illness/Norovirus affects 28 passengers on Silversea's ship Silver Nova

An outbreak of gastrointestinal illness affected over two dozen passengers aboard a Silversea Cruises voyage.

According to the CDC/Centers for Disease Control and Prevention, 28 out of the 633 guests aboard Silver Nova ship reported symptoms of illness, including one crew member. The primary symptom reported was diarrhea, although the CDC has labeled the causative agent as unknown.

Silversea promptly informed both guests and crew about the outbreak through announcements, urging them to report any cases and maintain proper hand hygiene. Additionally, the cruise line isolated affected individuals and implemented rigorous cleaning and disinfection protocols.

The cruise commenced in Callao-Lima) (Peru) on March 31st and is scheduled to end in Fort Lauderdale (Florida USA) on April 16th.

For more Silver Nova incidents and accidents see the ship's CruiseMinus page .

Notes from the Field: Cruise Ship Norovirus Outbreak Associated with Person-to-Person Transmission — United States Jurisdiction, January 2023

Weekly / July 28, 2023 / 72(30);833–834

Carolyn A. Crisp, PhD 1 ,2 ; Keisha A. Jenkins, DrPH 2 ; Ian Dunn, MPH 3 ; Andrew Kupper, MPH 2 ; Jona Johnson, PhD 2 ; Stefanie White, MPH 2 ; Erin D. Moritz, PhD 2 ; Luis O. Rodriguez, MS 2 ( View author affiliations )

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CDC’s Vessel Sanitation Program (VSP) monitors cases of acute gastroenteritis (AGE) on board cruise ships traveling to a U.S. port ( 1 ). Persons who have ≥3 loose stools (or more than normal for that person) within a 24-hour period or vomiting plus one other sign or symptom (e.g., fever, diarrhea, bloody stool, myalgia, abdominal cramps, or headache) meet the case definition for reportable AGE ( 2 ). When the percentage of passengers or crew members with AGE is ≥2% and the ship is due to arrive at a U.S. port within 15 days, the Maritime Illness Disease Reporting System alerts VSP and activates an investigation ( 1 ). During the first week of January 2023, VSP was notified of cases of AGE affecting >2% of passengers on board a ship that had completed three voyages in Europe and was within 15 days of arriving at a U.S. port (voyage 4)* ( Figure ). Ship medical crew members submitted stool samples from ill travelers for testing. All samples tested positive for norovirus genotype II. While the ship was sailing to a U.S. port, VSP monitored AGE cases on board and reviewed case data. By mid-January, passenger AGE prevalence reached 3.4%.

Investigation and Outcomes

During mid-January 2023, VSP’s outbreak team boarded the ship to conduct an epidemiological and environmental investigation. The investigation focused on exposure sources and routes of transmission. Occupational and social behaviors of crew members were evaluated because the epidemic curve (Figure) suggested that the index case occurred in a crew member during voyage 1 who developed symptoms after embarking, likely leading to transmission among other crew members (voyage 2), and then to passengers (voyage 3). After the investigation, VSP continued to monitor the ship (voyage 5) until it left U.S. jurisdiction. This activity was reviewed by CDC and was conducted consistent with applicable federal law and CDC policy. †

Among 410 reported cases during November 2022–January 2023 (voyages 1–5), 356 (87%) occurred in passengers and 54 (13%) in crew members. The index case likely occurred in a food and beverage crew member sailing on a crew-only voyage (voyage 1). In general, crew members with AGE reported to onboard medical personnel in a timely manner and were isolated until 48 hours after symptoms subsided. Crew member transmission was followed by passenger transmission on voyages 3, 4, and 5. Vomiting and diarrhea were the predominant symptoms among cases. Approximately 70% of crew members with AGE interacted with passengers (i.e., housekeeping and food and beverage services). VSP partnered with the United States Agency for Toxic Substances and Disease Registry’s Geospatial Research, Analysis, and Services Program to create four-dimensional visual models of the ship. These models helped visualize continued norovirus transmission and sources of potential exposure (e.g., contaminated surfaces in cabins of persons with AGE and high-touch surfaces in common areas).

Preliminary Conclusions and Actions

During this investigation, VSP used surveillance data and environmental and spatial analyses to improve field responses and quickly identify sources of norovirus exposure and transmission. Public health response to maritime AGE outbreaks involves robust and timely monitoring of AGE cases and collaborations with cruise companies. To prevent illness transmission across voyages, cruise ship personnel and travelers should always maintain proper hand hygiene and sanitation practices, and passengers and crew members should immediately isolate and report illness symptoms to the ship medical center ( 3 ). Cruise companies are encouraged to conduct frequent norovirus trainings for crew members, especially those with limited experience working with the cruise company (e.g., those who have served fewer than three contract terms).

Acknowledgments

Crew members and representatives of the cruise line; CDC’s National Calicivirus Laboratory; the Agency for Toxic Substances and Disease Registry’s Geospatial Research, Analysis, and Services Program; Vessel Sanitation Program members; Water, Food, and Environmental Health Services Branch, National Center for Environmental Health, CDC.

Corresponding author: Carolyn A. Crisp, [email protected] .

1 Epidemic Intelligence Service, CDC; 2 Division of Environmental Health Science and Practice, National Center for Environmental Health, CDC; 3 Geospatial Research, Analysis, and Services Program, Agency for Toxic Substances and Disease Registry, Atlanta, Georgia.

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.

* Voyage 1 (early November 2022), voyage 2 (early November–mid-December 2022), voyage 3 (mid-to-late December 2022), voyage 4 (late December 2022–early January 2023) and voyage 5 (began in early January and lasted ≥30 days); the ship made port in the United States during mid-January 2023.

† 45 C.F.R. part 46, 21 C.F.R. part 56; 42 U.S.C. Sect. 241(d); 5 U.S.C. Sect. 552a; 44 U.S.C. Sect. 3501 et seq.

• Jenkins KA, Vaughan GH Jr, Rodriguez LO, Freeland A. Acute gastroenteritis on cruise ships—Maritime Illness Database and Reporting System, United States, 2006–2019. MMWR Surveill Summ 2021;70(No. SS-6):1–19. https://doi.org/10.15585/mmwr.ss7006a1 PMID:34555008
• Freeland AL, Vaughan GH Jr, Banerjee SN. Acute gastroenteritis on cruise ships—United States, 2008–2014. MMWR Morb Mortal Wkly Rep 2016;65:1–5. https://doi.org/10.15585/mmwr.mm6501a1 PMID:26766396
• CDC. Vessel sanitation program: illness prevention resources. Atlanta, GA: US Department of Health and Human Services, CDC; 2022. https://www.cdc.gov/nceh/vsp/healthy.htm

FIGURE . Cases of acute gastroenteritis (N = 410),* by illness onset date † — Cruise ship A, five voyages, November 2022–January 2023 §

* Cases occurred among 356 passengers and 54 crew members.

† Index case likely occurred on November 8, 2022.

§ Voyage 5 was a world voyage that lasted ≥30 days.

Suggested citation for this article: Crisp CA, Jenkins KA, Dunn I, et al. Notes from the Field: Cruise Ship Norovirus Outbreak Associated with Person-to-Person Transmission — United States Jurisdiction, January 2023. MMWR Morb Mortal Wkly Rep 2023;72:833–834. DOI: http://dx.doi.org/10.15585/mmwr.mm7230a5 .

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All HTML versions of MMWR articles are generated from final proofs through an automated process. This conversion might result in character translation or format errors in the HTML version. Users are referred to the electronic PDF version ( https://www.cdc.gov/mmwr ) and/or the original MMWR paper copy for printable versions of official text, figures, and tables.

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Nearly 30 silverseas cruise passengers fall ill with diarrhea at sea.

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This vacation stinks.

Nearly 30 people aboard a luxury cruise liner known for its phenomenal cuisine have fallen ill thanks to a gastrointestinal outbreak that swept through the ship.

At least 28 of the Silver Nova ship’s 633 guests and one of its crew members reported feeling sick during their 16-day voyage from Peru, the Centers for Disease Control and Prevention  said Monday.

The group all reported one main symptom: diarrhea.

The cause of the outbreak — which has impacted roughly 5% of the ship’s passenger population — is still unknown, but the CDC notes that norovirus outbreaks are primarily caused by eating contaminated food or drinking contaminated water.

The Silver Nova is Silversea Cruises’ newest liner and among its most luxurious.

Introduced in 2023, the Silver Nova boasts butler service for every suite, one crew member for every 1.3 guests and “outstanding gastronomy” — it even welcomed “Top Chef’s” Nina Compton to its ranks at the end of last year.

The ship includes multiple kitchens, grills and even an interactive space where guests can cook with Compton.

To quell the spread of the stomach bug, Silversea Cruises reportedly quarantined its impacted passengers and crew member and “increased cleaning and disinfection procedures,” the CDC said.

“The health and safety of our guests, crew, and the communities we visit are our top priority,” a spokesperson for Silversea Cruises told The Post in a statement.

“To maintain an environment that supports the highest levels of health and safety onboard our ships, we implement rigorous cleaning procedures, many of which far exceed public health guidelines.”

The outbreak was reported one day before the “Easter” themed cruise was scheduled to end.

The 11-deck cruise ship started its journey in Callao-Lima, Peru, on March 31 and is set to end on April 16.

Prices for the 16-day excursion started at $11,700 for a double occupancy room, according to CruiseMapper.

The Silversea Cruises outbreak marks the fourth this year — including one that saw 104 become infected aboard a Holland America Line ship and more than 130 people on Cunard Cruise Line’s Queen Victoria struck down by a bout of diarrhea and vomiting in February .

Norovirus was the cause of the three preceding outbreaks.

In 2023, the CDC logged a jaw-dropping 14 cruise ship outbreaks.

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Nearly 30 Cruise Ship Passengers In US Mysteriously Fall Ill With Diarrhoea

The "easter-themed" cruise began in peru on march 31 and ended in fort lauderdale, florida, on tuesday..

The cruise ship quarantined its impacted passengers.

Nearly 30 passengers on a luxury cruise ship got sick in a gastrointestinal illness outbreak despite Silversea Cruises being known for its phenomenal cuisine, as per a report in the New York Post . The Centers for Disease Control and Prevention announced on Monday that during the 16-day journey from Peru, at least 28 of the Silver Nova's 633 passengers and one member of the crew reported feeling ill.

The CDC added that the main symptom was diarrhoea. Although the exact source of the outbreak, which has affected about 5 per cent of the passengers on board, is still unknown, the CDC stated that contaminated food or water is the main cause of norovirus outbreaks.

The cruise ship made announcements informing both staff and guests about the outbreak and urged them to report instances and adopt "good hand hygiene." In addition, Silversea reportedly quarantined its impacted passengers and increased cleaning and disinfection procedures. 

"The health and safety of our guests, crew, and the communities we visit are our top priority. To maintain an environment that supports the highest levels of health and safety onboard our ships, we implement rigorous cleaning procedures, many of which far exceed public health guidelines," a spokesperson for Silversea Cruises told The Post in a statement. The "Easter-themed" cruise began in Peru on March 31 and ended in Fort Lauderdale, Florida, on Tuesday.

According to CruiseMapper, the starting price for a double occupancy room on the 16-day adventure was $11,700.

In February, several passengers on board Cunard Cruise Line in the US were struck down with vomiting and diarrhoea, CDC said. According to the press note, at least 123 passengers and 16 crew members travelling on the Queen Victoria reported falling ill since the voyage set off on January 22 from Florida. 

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The cause of the gastrointestinal illness was not known, health officials said, but they added that the main symptoms among those on board the vessel included diarrhoea and vomiting. 

This came weeks after passengers on board a Florida-based cruise ship came down with an unknown illness. Passengers on the cruise ship reported symptoms of gastroenteritis, or the stomach flu, after setting off from Jacksonville. One passenger, Miranda Hill said her bout of illness was so bad that she started hurling blue vomit. "My throw up was bright blue and I have never eaten anything blue and every time I look up blue throw up, it has to deal with a poisoning," she said.  

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