cdc cruise ship covid reporting

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• Section 9 - The International Business Traveler

Airplanes & Cruise Ships: Illness & Death Reporting & Public Health Interventions

Cdc yellow book 2024.

Author(s): Alida Gertz, Francisco Alvarado-Ramy

The Centers for Disease Control and Prevention (CDC) has a regulatory mission to protect the public health of the United States by preventing the introduction, transmission, and spread of communicable diseases from foreign countries into and within US states and territories. For diseases of concern that have received special designation by the President of the United States, CDC may issue federal public health orders for quarantine, isolation, and conditional release. Diseases falling under this specific federal public health authority ( Table 8-03 ) include cholera, diphtheria, infectious tuberculosis, measles, plague, smallpox, yellow fever, viral hemorrhagic fevers, severe acute respiratory syndromes (e.g., Middle East respiratory syndrome [MERS], coronavirus disease 2019 [COVID-19]), and influenza due to novel or reemergent viruses that are causing (or have the potential to cause) a pandemic. The list of federally quarantinable diseases can be revised by executive order when a communicable disease becomes a significant public health threat. For more information, see Specific Laws and Regulations Governing the Control of Communicable Diseases .

Table 8-03 Executive Orders specifying diseases for which federal quarantine is authorized

Protecting the public’s health before, during & after travel.

In the United States, CDC conducts public health actions before, during, and after commercial flights and cruise travel to prevent or mitigate the introduction and spread of diseases of public health concern. Many of these actions are carried out by CDC quarantine station personnel working in collaboration with state, tribal, local, and territorial (STLT) public health officers. CDC quarantine stations are located at the 20 ports of entry, including land border crossings, where most travelers arrive to or transit through the United States. See more information on CDC quarantine stations .

Before Travel

In 2007, CDC and the US Department of Homeland Security (DHS) developed a public health Do Not Board (DNB) list to prevent people from boarding commercial aircraft if they are known to have, are suspected of having, or were exposed to a communicable disease of public health concern. A person placed on the DNB list will not be issued a boarding pass for any commercial airline flight originating from or arriving to a US airport.

STLT public health authorities notify CDC when people with communicable diseases of public health concern are at risk of traveling on a commercial flight; they also can recommend to CDC that people who meet certain criteria be added to the DNB list. For more information about the DNB list, see FAQs for Public Health Do Not Board and Lookout Lists .

During Travel

Federal regulations mandate that before arrival, the person in charge of a conveyance destined for a US port of entry must report to the CDC quarantine station of jurisdiction any death or “ill person” among passengers or crew. For the definition of an ill person, see CFR Title 42 §71.21: Report of death or illness and  Box 8-08 .

Airlines, DHS’s US Customs and Border Protection, and emergency medical personnel at arriving airports can each provide CDC quarantine station staff with reports of illness and/or death that occurs during commercial air travel. Most reports of illness or death on commercial, seagoing vessels are received directly from the ship’s medical staff or from a shipping agent. Airline and cruise ship illness and death reports also can originate from other federal partners or STLT health departments.

Box 8-08 Regulatory definition of an "ill traveler" for the purposes of reporting illness on commercial airplanes and ships 1

Fever, 2  plus ≥1 of the following

• Appears obviously unwell (applies to air travelers only)
• Breathing difficulty (or, for maritime travelers, suspected or confirmed pneumonia)
• Bruising or bleeding, new and unexplained, without a history of previous injury
• Consciousness decreased or confusion of recent onset
• Cough, persistent (or, for maritime travelers, cough with bloody sputum)
• Diarrhea, persistent (applies to air travelers only)
• Headache with stiff neck
• Vomiting, persistent (other than air or sea sickness)

Fever for >48 hours

Acute gastroenteritis 3  (applies to maritime travelers only)

Symptoms or other indications of a communicable disease, as the CDC may announce through posting of a notice in the Federal Register.

1 Definition applies to all travelers, including passengers and crew, US citizens and non–US citizens.

2 Measured temperature ≥100.4°F (≥38°C); feels warm to the touch; or provides a history of feeling feverish.

3 Defined as diarrhea (≥3 episodes of loose stools in a 24-hour period or what is above normal for the person) OR vomiting accompanied by ≥1 of the following: ≥1 episode of loose stools in a 24-hour period, abdominal cramps, headache, muscle aches, or fever (temperature ≥100.4°F [≥38°C]).

Air Travel Response

CDC’s goals in responding to reports of illness during air travel are to determine whether the illness poses (or has the potential to pose) a public health threat and to take appropriate public health actions. When responding to reports of illness during air travel, public health officials can either allow ill air passengers to resume travel if their illness does not pose a meaningful public health risk; recommend ill air passengers with a suspected communicable disease seek medical care and delay further commercial travel until noninfectious; or require ill air passengers to be medically evaluated if they are suspected of having a quarantinable communicable disease.

Together with airport and public health response partners (e.g., emergency medical services, public health authorities), CDC staff board arriving airplanes to conduct public health assessments of ill travelers and to make recommendations regarding potentially exposed passengers. Potentially exposed travelers might be asked to provide their contact information before disembarking so that health authorities can follow up and provide additional health information if the ill traveler is diagnosed with a disease of public health concern.

CDC provides guidance to airlines on reporting and managing ill travelers on airplanes at Airline Guidance: Reporting Death/Illness and Airline Guidance: Managing Ill Passengers/Crew .

Cruise Ship Response

For public health responses to ill cruise ship passengers and crew, control measures typically are initiated while the ship is still at sea. CDC quarantine station personnel obtain clinical and epidemiologic information about the ill or deceased person(s), determine public health risk, and provide guidance to the ship’s clinicians about case findings, infection control measures, and contact investigations.

CDC quarantine station personnel might respond by meeting a ship at the port of entry to further investigate or to assist the responding health department with surveillance and control measures. CDC personnel also might provide onsite response for outbreaks or clusters of disease, quarantinable communicable diseases, and some vaccine-preventable diseases (e.g., measles, rubella). CDC’s Vessel Sanitation Program is responsible for responding to reports of acute gastroenteritis on cruise ships.

CDC provides guidance to cruise lines on reporting and managing ill travelers at Cruise Ship Guidance: Reporting Death or Illness on Ships and Cruise Ship Guidance: Disease-specific Management of Ill Passengers/Crew .

After Travel

When a US or foreign public health authority notifies CDC of an illness of public health concern in airplane or cruise ship travelers who have reached their final destination, CDC conducts, or assists STLT health departments in conducting, a public health contact investigation. The primary purpose of the contact investigation is to identify and notify potentially exposed passengers and crew, so they can be offered clinical evaluation, postexposure prophylaxis (when necessary), and health education, including recommended quarantine periods.

Reporting Posttravel Illness

Travelers who become ill at their destination or after returning home should inform their health care providers of where, when, and on what type of conveyances they traveled. Report cases of communicable diseases of public health concern in returning travelers to appropriate public health authorities according to the state’s specific reportable disease requirements.

When a risk for communicable disease transmission during travel is possible, health departments can notify CDC by contacting either the quarantine station with jurisdiction for their region or the CDC Emergency Operations Center (770-488-7100; [email protected] ).

Report cases of travel-associated legionellosis to CDC to [email protected], and cases of acute gastroenteritis associated with cruise travel to  [email protected] .

The following authors contributed to the previous version of this chapter: Rebecca Hall, Kara Tardivel, Robynne Jungerman, Clive Brown

Bibliography

Centers for Disease Control and Prevention. Vessel Sanitation Program operations manual, 2018. Available from:  www.cdc.gov/nceh/vsp/pub/pub.htm .  

Council of State and Territorial Epidemiologists. Cross cutting: border/international health. Available from:  www.cste.org/members/group.aspx?code=BorderInternational .

Criteria for requesting federal travel restrictions for public health purposes, including for viral hemorrhagic fevers. Fed Regist. 2015;80(1640):16400–2. Available from:  www.federalregister.gov/documents/2015/03/27/2015-07118/criteria-for-requesting-federal-travel-restrictions-for-public-health-purposes-including-for-viral .

Foreign quarantine. 42 CFR §71 (2000). Available from:  www.ecfr.gov/current/title-42/chapter-I/subchapter-F/part-71 . 

Interstate quarantine. 42 CFR §70 (2000). Available from:  www.ecfr.gov/current/title-42/chapter-I/subchapter-F/part-70 . 

Jungerman MR, Vonnahme LA, Washburn F, Alvarado-Ramy F. Federal travel restrictions to prevent disease transmission in the United States: An analysis of requested travel restrictions. Travel Med Infect Dis. 2017;18:30–5. 

World Health Organization. Guide to hygiene and sanitation in aviation, 3rd edition. Geneva: The Organization; 2009. Available from:  www.who.int/publications/i/item/9789241547772 .

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The CDC ends COVID reporting on cruise ships. Is this good for public health?

Plus, the who warns of rising covid hospitalizations, ba.2.75 is on the way, monkeypox may be declared a ‘global health emergency,’ and more..

Cruise ship companies are thrilled that the Centers for Disease Control and Prevention ended its COVID-19 monitoring program that tracked how many COVID-19 cases were reported ship-by-ship. On Monday, the constantly updated spreadsheet was gone without a trace, replaced with this notice:

It is hard to make sense of why the CDC would pull back from a detailed monitoring program just as COVID-19 cases are again rising worldwide . (The World Health Organization says cases in Europe have tripled in the last six weeks, and hospitalizations have doubled.)

When the site took down the monitoring page, 93 of the 95 ships reporting to the CDC system had enough COVID-19 cases among passengers and crew to be “under observation” by the CDC. You can see a cached version of the CDC cruise ship monitoring page from July 18 here . Here is a screenshot of that cached dashboard, which shows almost all of the ships reporting COVID-19 data were under observation:

The CDC’s cruise ship status dashboard on July 18, 2022. (CDC)

This is what those colors used to mean:

Cruise lines will report COVID-19 data to the CDC, but the CDC won’t pass that information along to you. Instead, the CDC says, passengers “have the option of contacting their cruise line directly regarding outbreaks occurring on board their ship.” In other words, the CDC will still have the data that could allow the public to see the COVID-19 levels on each ship, but it is up to you now to call the cruise line and ask for it.

The CDC website says the now-closed system “depended upon each cruise line having the same COVID-19 screening testing standards, which may now vary among cruise lines.”

CDC spokesperson Kristen Nordlund emailed an explanation to The Washington Post :

CDC has determined that the cruise industry has access to the necessary tools (e.g., cruise-specific recommendations and guidance, vaccinations, testing instruments, treatment modalities, and non-pharmaceutical interventions) to prevent and mitigate COVID-19 on board.

Cruise lines generally require adult passengers to be vaccinated and provide a recent negative COVID-19 test before boarding. Cruise lines have varied requirements for children.

Andy Bloch, who is a master at turning data into charts, posted this . I link to his Twitter post and his exhaustive charts with one caveat: Even the highest COVID-19 numbers on the ships are still not as high as you will find in some counties and countries.

Yesterday, the CDC ended its opt-in “COVID-19 Program for Cruise Ships” that tracked COVID-19 tests and cases. https://t.co/6Zmvug9xdr They updated the data one last time last night. I’ve been extracting the data and decided to publish it here: https://t.co/hWkL5EXOKy pic.twitter.com/SNDYX4v87G — Andy Bloch (@Andy_Bloch) July 19, 2022

With no pesky COVID-19 data to plant doubts in people’s minds, cruise ship stocks rose fast on Tuesday.

The cruise industry argued that the CDC kept ships under scrutiny that far exceeded any monitoring for concert halls, hotels or convention centers. Earlier this year, the CDC made the reporting program voluntary. But, of course, a key difference is that people don’t live in concert halls for days and go home if they notice sick or reckless people around them.

The CDC’s decision to take down the cruise ship monitoring page also comes just as a new book called “Cabin Fever” by Michael Smith and Jonathan Franklin goes public . It tells the nightmare story of 1,200 passengers and 600 crew stuck on the MS Zaandam when COVID-19 spread through the ship like wildfire during the first weeks of the pandemic’s rage.

WHO warns of COVID hospitalizations rising now, worse to come in a few months

The World Health Organization is warning that the newest variants of omicron are “super infectious” and that COVID-19 hospitalizations, which have doubled across Europe in the last few weeks, will grow worse soon.

Look at these increases from the WHO’s COVID-19 dashboard:

The Associated Press reports :

WHO’s Europe director, Dr. Hans Kluge, described COVID-19 as “a nasty and potentially deadly illness” that people should not underestimate. He said super-infectious relatives of the omicron variant were driving new waves of disease across the continent and that repeat infections could potentially lead to long COVID. “With rising cases, we’re also seeing a rise in hospitalizations, which are only set to increase further in the autumn and winter months,” Kluge said. “This forecast presents a huge challenge to the health workforce in country after country, already under enormous pressure dealing with unrelenting crises since 2020.” Earlier this week, editors of two British medical journals said the country’s National Health Service has never before had so many parts of the system so close to collapsing. Kamran Abbasi, of the BMJ and Alastair McLellan of the Health Service Journal wrote in a joint editorial that the U.K. government was failing to address persistent problems worsened by COVID, including ambulances lining up outside hospitals too overloaded to accept new patients.

We barely understand BA.5 and now BA.2.75 is on the way

A coronavirus variant called BA.5 is now the dominant vaccine-escaping COVID-19 variant to infect people in America. But already, the WHO is tracking what could be the next problem: BA.2.75.

The variant has shown up in 15 countries and is on the move . It has been detected in seven U.S. states, including Washington, California, Illinois, New York, North Carolina, Texas and Wisconsin.

The newest variant has gained the unofficial name “Centaurus,” after a Twitter user got the notion that the endless string variants that contain numbers and not a name are not being taken seriously enough.

Keep in mind that every person who gets infected with COVID-19 becomes a host, a potential incubator for the virus to morph again. So, the danger is not just that COVID-19 will make a person sick or cause long-COVID, but that every new case is a potential birthplace for a new threat.

WHO decides tomorrow if monkeypox is a ‘global health emergency’

At last count, 63 countries had reported 9,200 cases of monkeypox , and the number is growing fast. Now the WHO will hear the latest data and decide whether to declare the outbreak a “global health emergency.” That is the highest alarm that the WHO can sound about a health crisis.

The WHO says most infections have been reported in men of young age who have sex with men. Most of the cases are in or near big cities.

France24 reports :

The normal initial symptoms of monkeypox include a high fever, swollen lymph nodes and a blistery chickenpox-like rash. But the report said that in this outbreak, many cases were not presenting with the classically-described clinical picture. Among the cases who reported at least one symptom, 81 percent presented with a widespread rash on the body, 50 percent presented with fever and 41 percent presented with genital rash.

The WHO says :

Monkeypox is usually considered mild and most people recover within a few weeks without treatment. However, the disease is frequently uncomfortable or painful, and can sometimes lead to complications that require close medical follow-up.

The CDC’s latest state-by-state monkeypox case count shows 1,814 cases , which means cases are increasing by a few hundred daily.

The science behind ice cream headaches

Children sitting in a car in Prayagraj, in the northern Indian state of Uttar Pradesh, eat ice cream on Wednesday, April 13, 2022. (AP Photo/Rajesh Kumar Singh)

Ice cream and popsicles definitely are part of the treatment plan to cure summertime overheating. But when it is as hot as it is now, some of us ravage through our frozen treats to keep them from melting … and then the ice cream headache sets in.

There is a quick cure. But first you have to know what causes ice cream headaches.

Ice cream headaches have a couple of fancier names: cold-stimulus headaches or trigeminal headaches. They are “thought to be caused” by the cold treat touching the roof of your mouth and constricting the blood vessels in the palate. I say “thought to be caused” because there is still a bit of mystery behind them.

Here is the clinical explanation of how brain freezes happen from the University of Melbourne :

When a part of the body gets really cold, the blood vessels in that area will tend to constrict. This is called vasoconstriction , and it minimizes the amount of blood that can flow through that area and be cooled down. You might notice your fingers or toes going pale when you’re out in the cold, and this is exactly why! On the other hand, when your body gets too warm, blood vessels expand to allow more blood to pass through. When the blood vessels near the skin expand, this allows heat to be released and the body to cool down. This is why people can get flushed or red-faced after being in a warm room or exercising . So, when a really cold substance hits the roof of your mouth or the back of your throat, it causes a rapid change of temperature there. And it just so happens that at this location we find the juncture of two very important blood vessels: the internal carotid artery (which is responsible for supplying blood to the inside of the brain), and the anterior cerebral artery (which travels along the front of your brain and sits right on top of the brain tissue) When these arteries are hit with the sudden chill of your rapidly consumed ice cream, they constrict very quickly. The body then compensates for this rapid constriction by sending a bunch of blood there to try warm them back up. This causes them to widen. Scientists think it is this contracting and expanding that triggers pain sensors and creates the sensation of pain.

The Cleveland Clinic advises you to bring the temperature in your mouth back to normal to relieve a brain freeze. But a room temperature drink works best; not something too hot or cold that will just cause more blood vessel reaction. The other treatment, Cleveland Clinic says, is to “try pressing your thumb or tongue against the roof of your mouth.”

By the way, people who suffer migraines may be more likely to have ice cream headaches. There is also some evidence that cold stimulus headaches can touch off a migraine.

Johns Hopkins researchers say one of the unknowns about ice cream headaches is why the pain is not felt in the mouth so much as other parts of the head and face:

The pain, through a quirk of our anatomy, is not felt so much in the mouth as it is “referred” to other areas of the face — behind the eyes and nose, in the forehead or elsewhere.

So, you learned another phrase today, “referred pain.”

We’ll be back tomorrow with a new edition of Covering COVID-19. Are you subscribed? Sign up here  to get it delivered right to your inbox.

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CDC issues next phase of guidance to cruise ship industry

WASHINGTON — The Centers for Disease Control and Prevention on Friday issued new guidance to the cruise ship industry, including the need for Covid-19 vaccinations, a necessary step before passenger voyages can resume.

The new technical instructions, the first update since October, include increasing from weekly to daily reporting frequency of Covid-19 cases and illnesses and implementing routine testing of all crew based on a ship’s Covid-19 status and establishing a plan and timeline for vaccination of crew and port personnel.

“Covid-19 vaccination efforts will be critical in the safe resumption of passenger operations,” the CDC said.

CDC said the next phase of the CDC’s conditional sail order will include simulated voyages to will allow crew and port personnel to practice new Covid-19 operational procedures with volunteers before sailing with passengers.

“CDC is committed to working with the cruise industry and seaport partners to resume cruising when it is safe to do so, following the phased approach outlined” in October’s conditional sail order,” the agency said.

It did not specify a date for the resumption of cruise operations from U.S. ports despite calls from the industry for planning for a phased resumption by the beginning of July. The CDC said it will issue additional guidance before it will allow cruises to resume.

The Cruise Lines International Association, which represents Carnival Corp, Norwegian Cruise Line and Royal Caribbean Cruises and others had pleaded with CDC to issue new guidance, saying in a March 24 statement the “lack of any action by the CDC has effectively banned all sailings in the largest cruise market in the world.” It did not immediately comment on Friday.

The group had said the prior conditional sail order issued in October was “outdated” and “does not reflect the industry’s proven advancements and success operating in other parts of the world, nor the advent of vaccines, and unfairly treats cruises differently. Cruise lines should be treated the same as other travel, tourism, hospitality, and entertainment sectors.”

These are the cruise ships with the best — and worst — sanitation scores so far this year

• The CDC randomly inspects cruise ships to help prevent the spread of stomach viruses. 
• The agency has reported 13 norovirus outbreaks on cruise ships this year.
• These are the cruise ships with the best and worst sanitation report cards in 2023 so far.

There's nothing like a stomach virus to ruin your vacation, as hundreds of cruise ship passengers have unfortunately learned this year.

The Centers for Disease Control and Prevention has reported 13 norovirus outbreaks on cruise ships so far in 2023. The last time the industry's yearly gastrointestinal illness outbreak total was that high was back in 2016 — and it's only July.

For the agency to report a cruise-ship outbreak, 3% or more of passengers or crew members must report symptoms of gastrointestinal illness, such as vomiting and diarrhea, to the ship's medical staff. During the most recent outbreak, a 14-day cruise aboard the Viking Neptune in June, slightly over 13% of passengers (110 of 838) reported being ill with predominant symptoms of abdominal cramps, vomiting, and diarrhea, according to the CDC.

The nasty stomach bug isn't just a cruise-ship problem, though. Norovirus cases have spiked across the United States this year, which some experts say is the result of ending COVID-19 restrictions .

"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 website. "Health officials track illness on cruise ships. So outbreaks are found and reported more quickly on a cruise ship than on land."

To try to help prevent the spread of stomach viruses at sea, the CDC randomly inspects cruise ships and scores them on a scale of 0 to 100 through the Vessel Sanitation Program . Inspection scores of 85 and lower are considered "not satisfactory" by the agency.

Related stories

Most vessels have received scores in the high 90s — only one cruise ship, the MSC Seaside, has failed the CDC's sanitation inspection so far this year. The vessel received an unusually low score of 67 , nearly 20 points below the agency's passing grade.

An MSC Cruises representative told Insider at the time that the cruise line had launched an internal investigation based on the inspector's concerns and taken immediate corrective actions.

"MSC Cruises rigorously adheres to health protocols, and the results of this inspection do not reflect the brand's high standards," the person added.

In the past 10 years, only three other cruise ships have received sanitation scores below 70, CDC records show. Violations can include something as small as not posting a raw-eggs advisory on the omelet station or a single fly hovering in a food area. But before going on your next cruise adventure, it doesn't hurt to check out the ship's most recent sanitation rating.

These are the cruise ships with the highest and lowest sanitation scores so far this year:

The 15 cruise ships with perfect scores of 100

The 15 cruise ships with scores below a 95.

Correction: July 17, 2023 — An earlier version of this story included a photo caption that misstated how many passengers and crew members aboard the Nieuw Amsterdam reported being ill during a May voyage. It was 284 people, not 539.

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Coronavirus Updates

Cdc drops its covid-19 risk advisory for cruise ship travel.

Jonathan Franklin

The Norwegian Gateway cruise ship is moored at PortMiami on Jan. 7 in Miami. The Centers for Disease Control and Prevention dropped its advisory warning Wednesday for cruise travel after more than two years of warning Americans. Joe Raedle/Getty Images hide caption

The Norwegian Gateway cruise ship is moored at PortMiami on Jan. 7 in Miami. The Centers for Disease Control and Prevention dropped its advisory warning Wednesday for cruise travel after more than two years of warning Americans.

The Center for Disease Control and Prevention has lifted its risk advisory for cruise ship travel Wednesday following two years of issuing warnings to travelers about the possibility of contracting COVID-19 onboard a cruise.

In an update posted online, the agency removed its "Cruise Ship Travel Health Notice," a notice that recommended individuals against traveling onboard cruise ships. Three months ago, the CDC increased its travel warnings for cruises to Level 4 — the highest level — following investigations of ships that had COVID outbreaks.

While the CDC has lifted its travel health notice, officials say it's up to the passengers to determine their own health risks before going onboard a cruise ship.

"While cruising will always pose some risk of COVID-19 transmission, travelers will make their own risk assessment when choosing to travel on a cruise ship, much like they do in all other travel settings," the agency said in a statement to NPR.

People should avoid cruise travel regardless of their vaccination status, the CDC says

The agency says it will continue to provide guidance to the cruise ship industry in order for cruise lines to operate in a way that will provide "safer and healthier" environments for crews, passengers and communities.

News of the CDC's decision to remove its travel health notice was praised by the Cruise Lines International Association, the industry's largest trade organization.

"Today's decision by the U.S. Centers for Disease Control and Prevention (CDC) to altogether remove the Travel Health Notice for cruising recognizes the effective public health measures in place on cruise ships and begins to level the playing field, between cruise and similarly situated venues on land, for the first time since March 2020. From the onset of the pandemic, CLIA's cruise line members have prioritized the health and safety of their guests, crew, and the communities they visit and are sailing today with health measures in place that are unmatched by virtually any other commercial setting."

A luxury cruise ship rerouted to the Bahamas over an arrest warrant for unpaid fuel

The CDC emphasizes that travelers should make sure they're up to date with their COVID-19 vaccines before taking a cruise, in addition to following their ship's requirements and recommendations against the virus.

Travelers are urged to check their cruise ship's COVID case levels and vaccination requirements online before traveling, the agency says.

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• CDC COVID-19 guidance

clock This article was published more than  2 years ago

Every U.S. cruise with passengers has coronavirus cases on board

The CDC has opened investigations into 92 ships

Coronavirus cases have been reported on every cruise ship sailing with passengers in U.S. waters.

According to the Centers for Disease Control and Prevention, all 92 ships with passengers have met the threshold for investigation by the public health agency. In every case, the CDC has either started an investigation or has investigated and continues to observe the ship.

The number of ships under investigation had grown sharply in recent days, but it wasn’t until Tuesday’s update, using data submitted by cruise lines Monday, that every ship reached that level.

Last week, the CDC warned all travelers, including those who are vaccinated, to avoid cruise ships. The advice came after the agency said the number of cases skyrocketed from 162 in the first two weeks of December to 5,013 between Dec. 15 and 29.

CDC warns against cruise travel after 5,000 new cases in 2 weeks

“The virus that causes COVID-19 spreads easily between people in close quarters on board ships, and the chance of getting COVID-19 on cruise ships is very high, even if you are fully vaccinated and have received a COVID-19 vaccine booster dose,” the agency cautioned .

Cruise lines are requiring all crew and most, if not all, passengers to be fully vaccinated to sail. Passengers also need proof of a recent negative test before boarding.

In addition to the 92 ships with passengers on board, 18 vessels are in U.S. waters with crew only, according to the CDC. Of those, two have met the threshold for investigation, and three have reported cases but not enough to warrant an investigation. Thirteen crew-only ships have reported no cases, according to the data.

“As part of investigating cruise ships that meet the investigation threshold, CDC will obtain additional information from the cruise ship, such as case exposure histories, details about close contacts, traveler vaccination rates, and medical capacities,” CDC spokeswoman Caitlin Shockey said in an email.

She said the agency would work closely with cruise lines and “consider multiple factors” before moving ships from their current status — yellow — to the more serious red status, in which a ship would return to port right away or delay a sailing. To reach that mark, a ship must have sustained transmission of covid-19 or covid-like illness and the potential for “cases to overwhelm on board medical center resources,” the CDC says .

Cruise passengers on holiday trips deal with outbreaks: ‘We’re sailing on a petri dish’

Since late December, several cruises have been turned away from ports because of passengers or crew on board testing positive. Most have continued on their journeys, even when they were forced to skip the stops they had planned.

On Wednesday, however, Norwegian Cruise Line confirmed it was canceling a nine-day Caribbean voyage on Norwegian Getaway that was scheduled to leave Miami that day. The reason, according to the cruise line: “COVID related circumstances.”

The operator gave the same reason on Tuesday for bringing a ship, Norwegian Pearl, back to Miami after it left for an 11-night Panama Canal trip Monday. According to the Miami Herald , passengers were informed that the trip was ending after an unspecified number of crew tested positive; the company would not provide that number to The Washington Post. The vessel is scheduled to return to Miami on Thursday.

“We will never compromise on health and safety and we will of course, continue to take all appropriate action to ensure everyone’s well-being and to protect public health,” the company said in a statement .

More cruise news

Living at sea: Travelers on a 9-month world cruise are going viral on social media. For some travelers, not even nine months was enough time on a ship; they sold cars, moved out of their homes and prepared to set sail for three years . That plan fell apart, but a 3.5-year version is waiting in the wings.

Passengers beware: It’s not all buffets and dance contests. Crime data reported by cruise lines show that the number of sex crimes has increased compared to previous years. And though man-overboard cases are rare, they are usually deadly .

The more you know: If you’re cruise-curious, here are six tips from a newcomer. Remember that in most cases, extra fees and add-ons will increase the seemingly cheap price of a sailing. And if you happen to get sick , know what to expect on board.

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• Data Summary
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• Addressing AGE on Cruise Ships

Cruise Ship Illness Frequently Asked Questions

• Find answers to common questions about gastrointestinal illness outbreaks, our inspections, and more.
• Note that ships under our jurisdiction are those that have a foreign itinerary, a U.S. port, and more than 13 passengers. Other organizations handle cruise ships outside our jurisdiction.

Norovirus and acute gastroenteritis (AGE)

Why do people associate age (including norovirus) with cruise ships.

Norovirus is a very contagious virus. Close living quarters may increase the amount of group contact. People joining the ship may bring the virus to other passengers and crew. Additionally, health officials track illness on cruise ships. So outbreaks are found and reported more quickly on a cruise ship than on land.

Does CDC address other illnesses on cruise ships?

Yes. Learn more about other common health concerns during cruise travel and what you can do to prevent illness.

The ship I sailed on had a lot of sick passengers or crew. Where can I find more information?

We consider it an outbreak when 3% or more of a ship's passengers or crew report being sick with AGE symptoms. We investigate outbreaks on ships within our jurisdiction. Explore our outbreak information on specific ships .

I think the ship I was on had an outbreak, but I don't see an outbreak posting. Why not?

There could be several reasons why an outbreak isn't posted on our site:

• The number of cases might not have met our threshold for what we can consider an outbreak (3% or more of a ship's passengers or crew report being sick with AGE symptoms).
• The ship might be outside our jurisdiction. Other organizations handle outbreaks outside our jurisdiction.
• People who were sick might not have reported it, so an outbreak could have gone undetected. This is why reporting illness is important.

Public health inspections

How often are ships inspected.

Cruise ships under our jurisdiction are subject to two unannounced inspections each year. We inspect cruise ships to determine how well they are operating and maintaining public health standards (learn more about the eight areas we inspect ). If a ship sails outside of the United States for an extended period, it may not be inspected twice a year, but it will be inspected again when it returns to the United States.

Why isn't the ship I'm looking for in the inspection database?

The ship might not be in the inspection database because it does not meet our criteria for inspection.

The ship could be sailing outside the United States for an extended period (in which case it will be inspected and added in the database when it returns).

How are cruise ships inspections scored?

Cruise ships are scored on a 100-point scale as outlined in our current Vessel Sanitation Program (VSP) Operations Manual .

• Points are deducted when there is a pattern of similar violations or when there is a single, significant violation.
• An 85 or below is a failing score.

We post all inspection scores .

Are ships required to correct violations found during inspections?

Yes. Ships are responsible for correcting all violations. They must correct certain critical violations immediately.

In addition, some violations can be corrected during the inspection, while others may take longer to correct. Each ship submits a corrective action statement describing how violations were corrected.

What happens if a ship fails an inspection?

A failing score indicates violations that the ship is responsible for correcting. Ships that fail inspections are reinspected within a reasonable period.

No-sail recommendation

When would vsp recommend a ship not sail.

People sometimes assume that we will recommend a ship not sail if it fails an inspection. However, we have rarely issued such recommendations.

We may recommend a ship not sail if there are imminent public health risks . Examples of such risks are

• Inability to properly chlorinate potable (drinking) water.
• Inability to keep food within safe temperatures.
• Inadequate facilities for cleaning and sanitizing food equipment.
• Inability to properly dispose of solid or liquid waste.

We may also recommend a ship not sail during an infectious disease outbreak where continuing normal operations could subject newly arriving passengers to disease.

If a cruise line refuses to follow a VSP no-sail recommendation, it can become a no-sail order.

Children and pools

Why can't children who are not toilet trained use pools on cruise ships.

Children who wear any type of diaper, including swim diapers, are not allowed in pools. Swim diapers and swim pants might hold in some solid feces, but they are not leak proof.

The Vessel Sanitation Program helps the cruise ship industry prevent and control the introduction and spread of gastrointestinal illnesses on cruise ships.

For Everyone

Public health.