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Cruise Ship Norovirus Outbreaks

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

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

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

Norovirus outbreaks on cruise ships in 2024

Cruise norovirus outbreaks updates.

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

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

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

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

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

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

CDC cruise ship Norovirus reports

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

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

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

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

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

CDC ship illness outbreak investigations

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

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

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

During an outbreak:

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

Illness outbreaks on cruise ships (annual statistics)

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

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

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

Norovirus Outbreaks 2023 reports

Outbreaks 2022 reports, outbreaks 2020 reports, outbreaks 2019 reports.

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

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

Outbreaks 2018 reports

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

Outbreaks 2017 reports

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

Outbreaks 2016 reports

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

Outbreaks 2015 reports

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

Outbreaks 2014 reports

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

Outbreaks 2013 reports

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

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

Outbreaks 2012 reports

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

Norovirus on cruise ships

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

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

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

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

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

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

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

How to avoid Norovirus on cruise ships?

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

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

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

Cruise ship virus procedures

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

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

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

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

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

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

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

Zika virus on cruise ships

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

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

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

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

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

"Cruise ship virus" politics

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

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

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

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

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

Seasickness on cruise ships

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

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

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

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

How to prevent seasickness on cruise ships (tips)

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

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

During the cruise tips to divert seasickness symptoms include:

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

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

Cruise ship hospital (medical care)

Cruise vessels are not "hospital ships".

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

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

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

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

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

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

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

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

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

Basic medical care on cruise ships

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

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

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

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

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

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

Mercy Ships

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

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

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

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

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

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

MV Africa Mercy

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

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

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

Vessel details include:

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

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

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

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

Nearly 200 people sick in norovirus outbreaks on Royal Caribbean, Princess Cruises ships

Nearly 200 people got sick in norovirus outbreaks on Princess Cruises and Royal Caribbean International ships.

The Centers for Disease Control and Prevention said 94 of the 2,532 guests on Sapphire Princess reported being ill during its April 5 cruise, along with 20 crew members. The round-trip cruise, which left from Los Angeles with stops in Hawaii and the South Pacific, will end on May 7, according to CruiseMapper .

On Royal Caribbean’s Radiance of the Seas, 67 of its 1,993 guests reported being ill in addition to two crew members during a cruise that ended April 22, according to the CDC . The two-week voyage sailed from Tampa, Florida to Los Angeles with stops in countries like Colombia and Panama, according to CruiseMapper .

In both outbreaks, the guests and crew members’ main symptoms were diarrhea and vomiting.

Princess, Royal Caribbean and the ships’ crews implemented heightened cleaning and disinfection measures and isolated those who were sick, among other steps, the health agency said.

"Onboard the most current sailing of Sapphire Princess, there have been a small number of cases of mild gastrointestinal illness among passengers, the cause likely is the common but contagious virus called Norovirus," a Princess spokesperson told USA TODAY in an emailed statement. "At the first sign of an increase in the numbers of passengers reporting to the medical center with gastrointestinal illness, we immediately initiated additional enhanced sanitization procedures to interrupt the person-to-person spread of this virus. Our sanitization program, developed in coordination with the CDC, includes disinfection measures, isolation of ill passengers and communication to passengers about steps they can take to stay well while onboard."

Royal Caribbean did not immediately respond to a request for comment.

The CDC has logged six outbreaks of gastrointestinal illness on cruise ships that met its threshold for public notification since the beginning of the year. Norovirus was listed as the causative agent in five, while one was unknown.

The illness is often associated with cruise ships but outbreaks occur in communities on land as well, according to Dr. Sarah E. Hochman, a hospital epidemiologist and the section chief of infectious diseases at NYU Langone Health’s Tisch Hospital.

“There's not something special or unique about cruise ships,” she said. “It's really any type of congregate setting, but it's also happening out in the community on a much smaller scale among households and household contacts. It just doesn't come to the attention of public health as much as it does for larger congregate settings.”

Hochman said the virus is “incredibly infectious” and congregate settings tend to have many shared surfaces, such as handrails in cruise ship stairwells or elevators. “And so, if you just have one person who's shedding the virus and touches the surface and then someone else touches it and then touches their mouth, that's how it can spread in those types of settings.”

Cruise ship medical facilities: What happens if you get sick or injured (or bitten by a monkey)

Alcohol-based hand sanitizer isn't as effective against norovirus, and Hochman emphasized that washing hands with soap and water “will do a lot to prevent the spread.”

The news comes after more than two dozen Silversea Cruises guests got sick in a gastrointestinal illness outbreak on the luxury line’s Silver Nova ship during a sailing that began in late March.

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

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Avoid Norovirus (and Worse) on a Cruise Ship With These Seven Important Tips

Update:  I wrote this article way back in 2015. Here we are in 2020 faced with a deadly outbreak of coronavirus around the world and what I preached back then is finally becoming mainstream. These common-sense hygiene tips apply even more now than they did five years ago.

I can’t tell you how many times over the last decade I’ve watched in absolute horror as people at a cruise ship dining table reach across to shake hands. What were they thinking? 

Whether coronavirus, norovirus or any human coronavirus, vigilant hygiene on a cruise ship is more important than ever. (Sure, maybe it’s nearly inevitable that a virus will spread on cruise ships as we’ve seen with Diamond Princess and now possibly Grand Princess.)  But you can avoid norovirus and hopefully coronavirus if you are careful. Very careful.

But here are the absolute basic hygiene and common sense rules to follow, written in 2015 and now more than ever if you have not canceled your upcoming cruise. And for any future cruises once coronavirus outbreak has diminished or finally gone. 

If you’d rather not catch norovirus (worse, cornoavirus), here’s what to know.

Being sick aboard a ship used to simply mean seasick. Norovirus, formerly Norwalk virus seems to be in and out of the news year-round. Whether it’s helpful or harmful to sensationalize cruise ship passengers plagued by this gross virus is debateable. (And now we see this with coronavirus.)

Cruise lines issue Code Red, a term used when at least more than five people become ill over five consecutive days. These actual numbers to qualify for a Code Red may vary with each cruise line. According to the CDC, somewhere between 19 and 21 million people in the U.S. contract the norovirus each year. 

Don’t blame the cruise line.

If you think the cruise line is at fault, consider this. In order to board a cruise ship, passengers must complete a health questionnaire that asks if they have had symptoms such as vomiting, diarrhea, fever or sore throat.

Many cruise guests have either flown or driven a great distance and spent a lot of money for their cruise. Do you think anyone might actually not tell the truth on that form? A “yes” answer may required medical exam by the ship’s physician prior to boarding or denial of boarding.

So yes. People lie. And people don’t purchase travel insurance, either. Guess what spreads like wildfire once the ship is underway? Norovirus. Ship’s fault? Not hardly.

What some of the cruise lines do in anticipation of norovirus carriers coming onboard?

Cunard and Holland America Line : No handshaking at any of the “meet the officers” parties. Signs are posted at the ballroom or lounge entrances. If the officers want to avoid norovirus spreading like wildfire on their cruise ship, who am I to question it.

Holland America takes a preemptive strike and for the first three days of every voyage on every ship, none of the passengers can serve themselves at the Lido buffet. Serving utensils are turned with the handles away from the guests and only waiters stationed generously throughout the serving line, can dish up the grub.

What you can do to avoid norovirus on your next cruise?

1. Wash your hands.

This not only helps you to avoid norovirus spreading to others but will also help to fend off the bug for you. 20-seconds of thoroughly scrubbing your hands (slowly sing the Happy Birthday song; it’s about 20-seconds) with hot water is sufficient.

2. Don’t ever touch railings, elevator buttons and certainly not bathroom door handles.

I watch (again in horror) as people slide their hands along staircase railings. Many people do need to hang on to the rail for stability. But others who don’t should not be sliding their hands as they go up and down the stairs. Instead, what I do is hover my hand over the railing so that if I need to grab on, I can.

Any surface that people slide, grab or touch is the enemy. And think about this…your stateroom attendant wear gloves when cleaning your bathroom and probably others, too. Then, without taking off their gloves, open and close your stateroom doors. I never leave my stateroom after it’s been cleaned without using a tissue to touch the door handles. 

3. Stateroom safety and precautions

Wash your hands immediately upon returning to your stateroom. Who knows who might have inadvertently touched the corridor door handle or what you might have accidentally touched en route to your stateroom. Avoid bringing norovirus in your own space.

Those throw pillows and colorful bed scarf? Tell your room steward to remove them. Spray the tv remote and/or keep it in a thin plastic bag. It’ll still work. 

4. Avoid the buffet – depending on your ship’s vigilance

Why? The buffet is a huge contender for spreading norovirus. Before the outbreak is noted by the ship, utensil handles aren’t reversed. When I see people cough into their hands and then grab the serving spoon, I leave the buffet line without hesitation.

5. Use hand sanitizers in addition to thoroughly washing your hands.  

You wash your hands before leaving your stateroom but without realizing it, touch a railing on the stairs or an elevator button. Always use the hand sanitizers. Carry your own, too, because once seated in the dining room, the menus and chair arms can be contaminated.

6. Wash your hands again after ordering your meal in the dining room.

This may sound nuts, but think about it. Someone with a virus sits down to eat in the dining room. This person will not only handle the menu, but most likely grab the bottom of their chair or chair arms to move closer to the table. As soon as I order and hand the menu to the waiter, I push away from the table and go to wash my hands. When I return, I do not put my hands on the underneath of the chair seat and slowly work the chair closer to the table in little hops.

7. Muster drill 

If your ship handles muster drill by lining people up in rows outside on deck under the lifeboats, you do not want to be at the front of the line. Get there early and stand at the very start of the line, with your back to the ship. If you’re at the front, everyone behind you is a potential cougher who doesn’t cover their mouth. 

Sounding paranoid, am I? Yes, a bit. But being sick (or worse now…getting coronavirus) isn’t worth the slight embarrassment of offending someone by not shaking hands or avoiding crowds of people in a confined space. 

Coronavirus, norovirus or any virus – common sense precautions should always be taken.

If it sounds like I’m a bit paranoid, I am. I have friends who have experienced this debilitating bug and it sounds like no fun at all. And it’s no fun for the crew either. When an outbreak or norovirus occurs, there is a 24-hour sanitizing procedure in place every day until it’s under control. No rest for the weary.

The next time you hear or read about an outbreak of norovirus on a cruise ship, realize that it isn’t totally the fault of the ship or the cruise experience. In my opinion, ignorant or self-entitled passengers are the main cause for spreading the illness. While many crew members stationed at restaurants do try to spritz everyone’s hands, they are not policemen/women. Guests sneak past thinking they don’t need it and so it goes.

Of course, even the most cautious of cruisers are prone to the virus. All it takes is one small bit of forgetfulness. But if an ounce of prevention is worth a pound of cure to avoid norovirus and now coronavirus, I’m all for it.

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21 comments.

Hi Phil, Thank you for your comment and I totally understand your (and probably thousands of others) situation. I am not a medical professional, but from what you wrote, if this medical issue was applied to my husband or mother or even sister, I would advise not going to Europe next month. Cruise lines (and airlines) are being extremely lenient with cancellation or rebooking trips so this is a good time to seriously think about contacting either your travel agent if you used one or contacting the air and cruise lines to rebook or cancel your trip. Personally, being in my 60s, I still would not travel abroad until this epidemic runs its course. Just my thoughts. I wish you both a wonderful voyage when you do go and safe and healthy travels ahead for all of us. Thank you again for writing. Sherry

my wife has a compromised immune system because of medication for rheumatoid arthritis. do you know if this is justification for a change of the cruise we are scheduled for this april 9th. it looks like it will be too risky to go to england and france and all i want is to schedule another cruise to where it is safe. probably next winter. if this cannot be done i stand to lose around 6000.00$.

Hi Gary, Thank you for reading the article and taking the time to write your comment. I totally agree. It’s a terrible situation going on right now. Too bad the cruise lines can’t revert back to the days of real brass railings. Sherry

The problem is largely the cruise line’s fault. Brass surfaces kill microbes including norovirus almost immediately on contact. If all the touch surfaces were bare naked brass, not clear coated, as they formerly were on ships before plastic, those surfaces would self-sterilize constantly throughout the day. Those red plastic serving tongs in the picture are the cruise ship’s fault.

Maybe update your post here and push the cruise lines to fix their problem. As I write this, cruise ships are quarantined with coronavirus. Brass or copper touch surfaces would have killed the coronavirus too.

Congratulations, Joyce! You did exactly the right things. It’s really tough to remember all the precautions to take, especially when your eye itches! I can’t imagine being in the same stateroom with someone who comes down with Noro. Good job! Thanks for your comment. Sherry

My husband got sick on a recent cruise, but I did not. I followed the hand washing/sanitizer suggestions. I used a tissue on taps, flush handles, remotes, etc. I also kept my hands away from my mouth, nose, and eyes-which took a conscious effort.

Hi Aida, Congrats on your first family cruise. I would suggest that you talk to your doctor and ask what medications you should bring with you. Aside from meds, I always have some type of Clorox wipes for surfaces and hand-cleaning wipes, too. But your doctor is your best advisor, especially with children.

Have a great time! Sherry

My husband and I will be going on our first cruise with our 2 boys, 13, 7. We are looking forward to it. What can we bring just in case we come down with something?

Hand sanitizer does nothing for norovirus! You must wash with soap and water and cleaning must be done with bleach or Lysol hydrogen peroxide cleaners!

Hi Kimberly, Thank you for your comment. I really think that most times, the ship does above and beyond what it can to prevent a GI issue. It’s people who refuse to wash their hands or don’t use sanitizer that many times are the culprits. I’m glad all worked out well and sorry to hear of your group getting sick. I hope your next cruise is fabulous! Sherry

Thank you for the informative article. Three of my friends and I have just left a cruise ship with a very unpleasant gastrointestinal issue. The morning we left the ship we spoke to several people who were experiencing it as well. I will not name the ship or the cruise line because I feel that they did everything they could to keep everyone safe and healthy. The ship was incredibly clean, washing stations were present at all buffets, crew encouraged people to wash their hands upon entering buffets, and the crew and chefs were highly attentive to everything happening on the ship at all times. I think it’s very possible this illness could have a source other than the ship itself. Having said all of that my friends and I have been inconvenienced and uncomfortable but we have all been able to work upon return and are almost all better now. I’m not terribly upset about it, it’s life. I enjoyed the cruise, I enjoyed the destinations we visited, and a good time was had by all!

Thanks, Maxie! Another way to try to not catch a bug. Sherry

Also, taking a strong probiotic during the cruise, lowers your chances . it prevents the virus doesn’t adhere well to the walls of your intestines.

Thanks for sharing this article about avoiding the norovirus. Hope it is helpful to your readers.

It’s important to note, though, that alcohol-based hand sanitizers actually do NOTHING to prevent the spread of norovirus. Norovirus is different from the common cold/flu in that its cell walls cannot be ruptured by alcohol (the active ingredient in hand sanitizer). The only thing–other than physically removing the virus from your hands via a rigorous scrub with soap and water–that kills norovirus is bleach.

Hand-washing will save you. Hand sanitizer will not.

There’s an old newspaper saying, “if it bleeds, it leads.” So it seems to be with anything related to a cruise issue and the press. Such a shame, too. Thanks for your comment.

Thanks for your comment. Yes, I’ve seen the same disgusting habits at buffets…in hotels, too. Clever idea to sanitize the light switches etc. Wishing you happy and healthy travels!

Hi Patricia,

Thanks for your comment. People simply want to blame someone else, it seems, and a cruise line is a prime target. Every ship really has to be sure that the person at the entrance to the restaurants spritzes everyone’s hands. Sadly, the lotion isn’t sufficient to kill all germs, but it’s better than nothing. Lucky you not getting sick on that cruise!

I totally agree! Except for the movie….yuk! But it does get the point across. Happy, healthy travels!

Excellent article. I’ve had it but on land thankfully and it’s very unpleasant. But in 2011, there was an outbreak on my QM2 cruise. First reported case in Madeira, 2nd November and there were still cases when we returned to Southampton on the 10th. Despite all warnings, there were still far too many people ignoring them. Many would come back in port, not sanitise their hands then head straight for the buffet, also walking past the machines and crew (it wasn’t enforced). I was surrounded by sick people on my deck and was grateful not to catch it. I’m fed up with people blaming the cruise lines when it’s not as if they don’t know what to do to prevent it.

Great article! I am one who usually eats at the buffets and sadly I have seen people actually lick their finger then swipe the serving spoon to get the chopped egg onto their salad plate then stick the spoon back into the eggs. I have notified crew many times when I have seen people literally stick their fingers in something and then taste the sauce. Sickening!! These are adults, not children!!! I travel with Lysol wipes and the first thing I do upon entering my cabin for the first time is wipe the light switches, the phone, the TV remote and the button to flush the toilet.

Using the paper towel to open a community restroom door is something I have always done and something I taught my daughter to do as well. It’s amazing on a ship how many people don’t wash their hands after using the restrooms.

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Updated on March 6, 2020 by Sherry Laskin

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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.

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

By SciTechDaily July 14, 2023

Cruise ships face a surge in Norovirus outbreaks, with the highest number of cases since 2012, highlighting the ongoing challenges of controlling the highly contagious virus in close quarters and underscoring the need for enhanced preventive measures in the cruise industry.

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 .

Norovirus is a highly contagious virus that causes gastroenteritis, characterized by symptoms like severe vomiting, diarrhea, and stomach cramps.

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.

The close quarters and shared facilities on cruise ships facilitate the rapid spread of the virus among passengers and crew.

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.

Outbreaks lead to significant operational disruptions, including isolation of infected individuals, intensive cleaning requirements, and potential trip cancellations, which can incur financial losses and damage the cruise line’s reputation.

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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• Nation & World

Cruise ship passengers infected with Norwalk virus

State health officials have identified the highly contagious Norwalk virus in an outbreak that affected about 220 passengers aboard the Norwegian Cruise...

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HONOLULU — State health officials have identified the highly contagious Norwalk virus in an outbreak that affected about 220 passengers aboard the Norwegian Cruise Lines ship Pride of Hawaii.

Lab tests confirmed the presence of the virus, which causes nausea, vomiting and diarrhea, said Janice Okubo, spokeswoman for the Hawaii Department of Health.

The virus infected about 9 percent of the ship’s 2,500 passengers, according to NCL. The ship returned to Honolulu on Monday morning after its weekly seven-day cruise around the islands.

“It’s one of the common viruses we’ve been seeing on cruise lines,” Okubo said. “Most of the time, people recover.”

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The Health Department has notified NCL of the test results, she said. But a statement from the company sent Monday makes no mention of the Norwalk virus.

“Pride of Hawaii has been carrying out an extensive range of preventive measures on board and does not expect this issue to carry forward into the next cruise,” the statement said.

Passengers who felt sick during the course of the voyage and their cabinmates were asked to remain quarantined in their rooms for 24 hours. NCL said it was giving those passengers a $200 on-ship credit.

The company reported Friday that the outbreak had been confined to just the one ship, and the Pride of Aloha and Pride of America were not affected.

Passengers on the next cruise will be told before boarding that some people had suffered stomach flu symptoms, according to the statement. They will be given the opportunity not to sail if they’re uncomfortable after being told about the illness.

Investigators from the U.S. Food and Drug Administration will handle the outbreak, Okubo said.

Cruise lines usually take measures including keeping passengers isolated and rigorously cleaning surfaces on board, she said.

A field supervisor for the U.S. Food and Drug Administration didn’t immediately return a phone call seeking comment.

The Norwalk virus typically lasts 24 hours, although it may persist for several days. There’s no good way to treat its symptoms besides drinking fluids.

It can become life-threatening for the very old, the frail and the very young if they become dehydrated from the virus.

Additional symptoms include low-grade fever, chills, headache, muscle aches and tiredness.

The virus spreads through food, personal contact and touching of contaminated surfaces.

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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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Watch CBS News

"We made it!" Cruise ship docks after nearly 700 fall ill

Updated on: January 29, 2014 / 4:17 PM EST / CBS/AP

BAYONNE, N.J. -- A cruise ship on which hundreds of passengers and crew members fell ill returned to port Wednesday in New Jersey, with health officials recommending those still showing symptoms to check in at hotels or seek medical care before heading home.

One woman aboard the Explorer of the Seas yelled "We made it!" as the ship docked in Bayonne. Other passengers, with blankets wrapped around them, stood on deck to watch the ship pull in.

The U.S. Centers for Disease Control and Prevention said its latest count puts the number of those sickened at 630 passengers and 54 crew members. The ship, on a 10-day cruise that had to be cut short, was carrying 3,050 passengers.

He said he suffered from vomiting, pain and diarrhea and that his experience was simply "awful."

"It was violent for about 24 hours," Rakowicz told reporters after disembarking. "The first 12, 14 hours of it was really, really bad, and then, well, you never felt better for four days."

But he gave high marks to Royal Caribbean for going "above and beyond" in its response.

Health investigators suspect norovirus, but lab results are not expected until later this week. If norovirus is to blame, it would be one of the largest norovirus outbreaks in last 20 years, the CDC said. A 2006 norovirus outbreak on a Carnival Cruise Lines ship also sickened close to 700.

Norovirus - once known as Norwalk virus - is highly contagious. It can be picked up from an infected person, contaminated food or water or by touching contaminated surfaces. Sometimes mistaken for the stomach flu, the virus causes bouts of vomiting and diarrhea for a few days.

The cruise line said most guests who fell ill were up and about as the ship headed to port.

The CDC said it recommended to Royal Caribbean that people who still have symptoms be housed in nearby hotels or seen at medical facilities before traveling home.

CDC investigators boarded the ship during its U.S. Virgin Islands Port call on Sunday. They said no single food or water source or other origin has been identified.

Royal Caribbean is providing all guests a 50 percent refund of their cruise fares and an additional 50 percent future cruise credit. It's also reimbursing airline change fees and accommodations for guests who had to change plans for traveling home.

Stricken guests who were confined to their staterooms are being provided a credit of one future cruise day for each day of confinement.

After returning to port, the ship will be sanitized and no one will be allowed aboard for a period of more than 24 hours as an extra precaution, the cruise line said.

Explorer of the Seas is on track to depart at its originally scheduled time Friday afternoon on its next cruise, a nine-night trip with port calls in Puerto Rico, St. Thomas, the Dominican Republic and Haiti, a Royal Caribbean spokeswoman said.

More from CBS News

Norovirus outbreak on Royal Caribbean cruise ship sickens 475 passengers

The ship will be cutting its journey short.

The Royal Caribbean Oasis of the Seas cruise ship is cutting its journey short after 475 passengers and crew members have been infected with a norovirus, Royal Caribbean Cruises announced Thursday.

The cruise line initially reported on Thursday that more than 250 passengers had fallen ill.

“We think the right thing to do is to get everyone home early rather than have guests worry about their health ” the cruise line said in a statement, adding that returning early “also gives us more time to completely clean and sanitize the ship before her next sailing.”

Guest and crew members began getting sick when the ship departed the Port Canaveral in Florida on Jan. 6. The ship, originally scheduled for a seven night cruise, made its first stop in Haiti Tuesday where the ship hosted a lunch buffet on land, said Abby Perrin, a passenger on the ship told ABC News. That night, Perrin said she and her mother began experiencing symptoms associated with food poisoning, like vomiting.

The next day, the ship arrived to Jamaica, but passengers said they weren’t allowed to leave the vessel.

Thursday morning, the ship headed for its next scheduled destination in Cozumel, Mexico , but officials canceled the cruise while it was still en route. Now it is on its way back to Florida.

(MORE: Arizona police collect DNA at nursing home where comatose woman gave birth)

“It was pretty upsetting that we weren’t able to get into Jamaica at all,” Perrin said. “Then we were supposed to be in Mexico tomorrow, which we were really excited about, and it turns out we’re going back to Florida instead.”

About three percent of people aboard the ship are affected by the norovirus, according to the cruise company.

Alan Thomas is currently aboard the ship with his spouse and two friends.

(MORE: Meningitis warning follows death of man two days after broadcasting final conscious moments on Facebook Live from New Jersey police station)

“People are still getting sick,” he told ABC News. “At a cafe next to Guest Services last night, there was a kid vomiting in the trash can.”

Thomas shared a video on Twitter of crew members cleaning the ship. He told ABC News that crew members are not allowing guests to serve themselves food or drinks.

Norovirus is a contagious virus that causes vomiting and diarrhea. A person can become infected through having direct contact with another infected person, consuming contaminated food or water, or touching their nose and mouth after touching contaminated surfaces, according to the Centers for Disease Control and Prevention (CDC).

(MORE: New York City Mayor Bill de Blasio unveils health care program for city residents, including undocumented immigrants)

Norovirus is the leading cause of foodborne illness in the U.S., according to CDC.

It is not yet known what caused the outbreak, but most instances of norovirus occur in food service settings like restaurants, according to the CDC.

The Royal Caribbean advertises the Oasis of the Seas as one of the world’s largest ships.

In 2017, about 220 passengers aboard a five-night Royal Caribbean cruise suffered from a gastro-intestinal illness .

All of the current Oasis of the Seas passengers will receive a full refund, Royal Caribbean Cruises said in the statement.

“Our guests sail with us to have great vacations, and we are sorry this cruise fell short,” the statement reads.

The cruise company said the ship is scheduled to return to Florida on Saturday.

ABC News' Julia Jacobo, Rachel Katz and Brendan Rand contributed to this report.

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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 .

Related Articles

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?

Matador Original Series

2024 is already shaping up to be the year of cruise ship norovirus cases.

A nother month, another norovirus outbreak on a cruise ship. On March 12, reports started to surface that 98 passengers and 12 crew members tested positive for the virus on a Holland America Line cruise that left San Diego on February 17, with planned stops in Hawai’i and French Polynesia. It marks the third instance in the first three months of 2024 to be listed on the Centers for Disease Control and Prevention (CDC) tracker .

The cruise industry’s norovirus year started early. The Celebrity Cruises Constellation ship left from Tampa, Florida, on January 3 with planned stops in New Orleans, Belize, and Mexico. Shortly after, 92 of 2,056 guests and eight crew members were reported ill with vomiting and diarrhea during a norovirus outbreak, according to USA Today . Then, in February, more than 150 people were confirmed with norovirus on Cunard Line’s Queen Victoria that departed from England with stops in Florida and San Francisco.

That’s not counting the Norwegian Dawn incident in late February, which was originally reported as cholera but was changed to a “stomach-related illness.” Or, in the words of a Matador editor on the ship, “plenty of cases of stomach-related illnesses. Of the frequent stomach-related illnesses on cruise ships, norovirus is the most common.”

2024 is surely starting strong after what was a breakout year for norovirus in 2023. The CDC, which is the only agency tracking norovirus outbreaks on cruise ships and only follows up on outbreaks on ships that dock in United States ports, recorded the highest disease outbreak incidence rate in 10 years in 2023. That year saw 14 outbreaks that met the public notification threshold, and 13 of those were from norovirus (the other was due to Salmonella and E. Coli).

Norovirus is neither novel nor exceptional. Tens of millions of people get it every year, and the CDC lists it as the “leading cause of vomiting and diarrhea, and foodborne illness in the United States.” It spreads easily, is hard to build immunity against because there are different types of noroviruses, and it’s unknown how long protection lasts even if someone does get antibodies for one particular strain.

It’s easy to pass — especially with raw foods, though norovirus can withstand heat up to 145 degrees Fahrenheit — and hand sanitizer is not super effective. Norovirus can quickly travel from one cook’s unwashed hands to dozens of plates in front of diners.

Diarrhea, vomiting, nausea, and stomach pain are the most common norovirus symptoms, followed by fever, headache, and body aches. It’s often accompanied by stomach or intestine inflammation, or acute gastroenteritis. Symptoms start 12-to-48 hours after exposure, and last for up to three days (though people can stay contagious for longer).

In the grand scheme of things, norovirus is not solely a cruise ship problem. Industry officials are all too eager to point out to the press that an estimated 1 percent of norovirus cases tracked by the CDC are on or from cruise ships. Schools, nursing homes, hospitals, and restaurants make up the vast majority of root sources. But it’s important to put those numbers in perspective.

The total number of cruise passengers in 2023 isn’t available as of writing, but the industry source Cruise Lines International Association (CLIA) forecasted 31.5 million people around the world went on a cruise last year. Numbers from Statista point to just under 12 million American passengers in 2022, the latest year that numbers are available. That amounts to about 3 percent of the US population. So yes, comparatively few norovirus cases are tied to cruises, but that 1 percent of norovirus cases stemming from cruise ships has new meaning when considering the comparatively miniscule number of people who are cruising compared to the number of people going to restaurants, healthcare facilities, and schools.

There’s simply no getting around the fact that the likelihood of getting norovirus is statistically higher on a cruise ship than it is when you go to any random restaurant, classroom, or hospital in the country.

It’s hard to blame cruise ships. People get sick when traveling, and that’s a tale as old as time. Whose responsibility, of course, is harder to pin down, and CLIA makes it pretty clear where the industry stands: “All of the efforts made by cruise ship crews cannot replace the responsibility that rests with each and every individual. Passengers and crew alike must also be committed to keeping themselves, their family and their fellow travelers healthy.”

There’s only so much that one can do. A 2005 study in the journal Emerging Infectious Diseases studies norovirus transmission on a cruise ship that had back-to-back-to-back itineraries. It found that after passengers on the first cruise came down with the illness, the new passengers on the second and third cruises were infected with the same strain of the virus as well as new strains (as determined by genetic sequencing). This is despite the fact that the ship was sanitized before the second boarding. Three more cruises on the ship had higher positive cases than background levels, but stayed below the 3 percent threshold of calling it a big outbreak.

All that’s left to see is whether cruise lines can figure out a way to get ahead of the issue in a year when cruises are undeniably booming with at least 35 around-the-world cruises to choose from.

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Volume 11, Number 1—January 2005

Norovirus Transmission on Cruise Ship

Cite This Article

We describe an investigation of a norovirus gastroenteritis outbreak aboard a cruise ship affecting 6 consecutive cruises and the use of sequence analysis to determine modes of virus transmission. Noroviruses (NoV), are the most common cause of infectious acute gastroenteritis and are transmitted feco-orally through food and water, directly from person to person and by environmental contamination ( 1 ). These viruses are often responsible for protracted outbreaks in closed settings, such as cruise ships, nursing homes, and hospitals ( 2 , 3 ).

On November 20, 2002, cruise ship X recorded an elevated number of persons with acute gastroenteritis symptoms reporting to the ship’s infirmary (84 [4%] of 2,318 passengers) during a 7-day vacation cruise from Florida to the Caribbean. According to federal regulations, when the incidence of acute gastroenteritis among passengers and crew exceeds 3%, an outbreak is defined and requires a formal investigation ( 4 ). The outbreak continued on the subsequent cruise (cruise 2), after which the vessel was removed from service for 1 week of aggressive sanitization. Despite cleaning, gastroenteritis also developed in 192 (8%) of 2,456 passengers and 23 (2.3%) of 999 crew on the following cruise (cruise 3). To determine the source of this continuing outbreak and to better understand the mechanisms of NoV transmission, we began an investigation on cruise 1 and collected stool specimens from persons with gastroenteritis on this cruise and the next 5 cruises.

We surveyed all 2,318 passengers on cruise 1 to determine dates of illness onset, symptoms, cabin locations, activities, and food consumption. We also performed a sanitary inspection of the ship. We suspected that initial infection among passengers on cruise 1 originated from a common food or water source and then continued to spread from person to person. Therefore, we conducted a case-control study with all passengers in whom illness developed early in the cruise (days 3 and 4) after embarkation (defined as day 1) and also with passengers who became ill later (day 5). Controls were systematically selected among passengers who reported no symptoms of gastroenteritis throughout the entire cruise. We continued to monitor the number of cases of acute gastroenteritis on the subsequent 5 cruises and collected fecal specimens from ill persons on all 6 cruises. During our shipboard investigation, we also obtained stool specimens from ill persons in a long-term care facility affected by an outbreak of acute gastroenteritis, in which the index patient was a passenger who returned ill to the facility after disembarking from cruise 1. All stool specimens were tested for NoV by reverse transcription–polymerase chain reaction, as previously described ( 5 ). The positive amplicons were sequenced, and sequences were compared for genetic diversity.

Figure 1 . Number (%) of cases of acute gastroenteritis among 513 passengers and 74 crew by date of symptom onset reported to the infirmary on 6 consecutive cruises of ship X, November 2002–January...

The outbreak began abruptly on day 2 of cruise 1 and continued on cruise 2 with new passengers. Despite sanitization of the ship for 1 week after cruise 2, illness was also reported among passengers on cruise 3 ( Figure 1 ). On the subsequent cruises ( 4 – 6 ), the number of ill persons reporting to the infirmary remained above background levels but below 3%. Of the 2,318 surveyed passengers on cruise 1, 1,276 (55%) returned questionnaires, of these, 212 case-passengers and 265 control-passengers were enrolled in our study. We identified that eating breakfast at restaurant A on day 2 of the cruise was associated with illness among case-passengers with onset of symptoms on day 3 (odds ratio [OR] 4.04, p < 0.01) and that eating dinner at the same restaurant on day 2 was a risk factor for illness among case-passengers who became ill on day 4 (OR 2.8, p < 0.005). We also found that eating dinner at restaurant B aboard ship on day 3 was associated with illness among case-passengers with onset on day 5 (OR 2.3, p < 0.05). Restaurants A and B did not share a galley. Case-passengers with later onset of illness on day 5 were more likely than controls to have a cabin mate in whom gastroenteritis developed on days 3 or 4 (OR 2.01, p = 0.01), which suggests either infection by environmental contamination or by person-to-person spread.

Figure 2 . Phylogram of 9 norovirus sequence types detected in outbreaks on ship X, 4 reference sequences from GenBank, and the Farmington Hills virus. The tree is based on a 277-nucleotide region (region...

Of 55 tested stool specimens from all 6 cruises, 25 (45%) were positive for NoV and belonged to 6 strains ( Table ). Norovirus was detected in at least 1 stool sample from all cruises, except cruise 4, where no stool samples were found positive, and in 2 samples of ill persons from the long-term care facility ( Table ). The genetic sequences detected on cruises 1 and 2 were identical in regions B and C and belonged to a lineage of NoV within genogroup II (GII), cluster 4 ( Figure 2 ), which has been provisionally described as the Farmington Hills strain ( 6 ). Five of the 8 NoV-positive specimens on cruise 3, which sailed after sanitization, contained 3 different sequences (X, Y, and Z). Sequence X was found in 1 sample and was identical to the sequence detected on cruises 1 and 2, which suggested that this strain may have persisted onboard despite cleaning. Sequence Y was found in 3 samples and differed from sequence X by 3 nucleotides (nt) in region C, which suggested that it was the predominant strain and probably newly introduced by passengers or crew at the start of cruise 3. Sequence Z was detected in 1 sample and belonged to the same lineage of NoV as the strain found on cruises 1 and 2 but to a different cluster (cluster 3), which suggested that it was also newly introduced onto cruise 3. Single stool samples from persons on cruises 5 and 6 contained a sequence that differed from the Farmington Hills strain by 3 nt and 1 nt, respectively, which suggested probable continuous reintroductions of closely related viruses aboard the ship. A sequence indistinguishable from that found on cruises 1 and 2 was also detected in stool samples from 2 persons ill in the outbreak that occurred in the long-term care facility, which suggested that virus was possibly introduced by the ill passenger from cruise 1. The environmental inspection of the ship identified no major violations.

Conclusions

We report on a large outbreak of NoV-related gastroenteritis that affected 6 consecutive cruises on 1 ship and recurred despite thorough sanitization after the second cruise. In the past, investigations of shipboard outbreaks of viral gastroenteritis were limited by the lack of adequate molecular methods for detecting and characterizing viruses ( 7 ). In this investigation, epidemiologic analysis suggested an initial foodborne source of infection with subsequent secondary spread from person to person, while molecular analysis provided several new insights into disease transmission. Application of genetic sequencing documented persistence of the same strain onboard between cruises by detecting identical sequences in stool samples from ill passengers before and after 1 week of the vessel’s cleaning. Although these findings suggest that environmental contamination may have helped perpetuate the outbreak, infected crew members could have also been a reservoir of infection between cruises. Molecularly fingerprinting detected viruses confirmed several introductions of new strains aboard, which underscores the difficulty in controlling outbreaks of NoV on cruise ships. Sequence analysis provided evidence that an outbreak of NoV in the care facility was caused by a person returning ill from an outbreak-affected cruise.

Like other outbreaks of viral gastroenteritis on cruise ships ( 3 , 6 , 8 – 11 ), this outbreak affected several hundred people, was transmitted by multiple modes, and recurred on subsequent cruises. Multiple routes of NoV transmission have been documented in other reports, such as that of an outbreak of gastroenteritis among football players, in which initial foodborne transmission of virus and secondary person-to-person spread was demonstrated ( 12 ). Outbreaks of gastroenteritis aboard cruise ships are similar to those in other closed and crowded settings where identifying and interrupting multiple routes of transmission has proved particularly challenging ( 2 , 13 , 14 ).

A limitation of this study was that the investigation on cruise 1 started 7 days after the first cases were reported, and because of logistic constraints, surveying was restricted to passengers in a short period before their disembarkation. Thus, we were unable to investigate risk factors for illness among crew and determine if any of the food-handlers were ill. In addition, poor recall of exposures resulted in a lack of complete data for a detailed evaluation of risk factors. We also did not perform a full investigation on the subsequent cruises because the number of ill persons did not exceed 3%.

Our investigation suggests that efforts to control gastroenteritis outbreaks on cruise ships should address all possible modes of NoV transmission, including foodborne, environmental persistence, and person-to-person spread. Such measures should include extensive disinfection, good food and water handling practices, isolating ill persons, providing paid sick leave for ill crew, and promoting hand-washing with soap and water among passengers and crew. Developing strategies and incentives to dissuade symptomatic passengers from boarding may also minimize opportunities to introduce new strains aboard. Cruise ship outbreaks with <3% of passengers reporting ill should be considered for investigation because they may contribute substantial information on the transmission and epidemiologic characteristics of NoV, which could be used to develop control strategies and prevent future outbreaks on land and at sea.

Dr. Isakbaeva was an officer with the Epidemic Intelligence Service at the Centers for Disease Control and Prevention when this investigation was conducted. She currently serves as a senior adviser in the Department of Infectious Diseases Epidemiology at the Norwegian Institute of Public Health in Oslo, Norway. Her research interests focus on control of communicable diseases.

Acknowledgments

We thank Jaret Ames and Donald Ackerman for their assistance during the investigation; passengers, crew members, and representatives of the cruise line for their support; Susan Adams, Leslie Hadley, Du-Ping Zheng, and Howard White for reverse transcription–polymerase chain reaction testing performed at CDC; Lenee Browne for assistance during the analysis; and Claudia Chesley for excellent editorial comments.

The investigation was funded by CDC and by Bucks County Health Department.

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• Figure 1 .  Number (%) of cases of acute gastroenteritis among 513 passengers and 74 crew by date of symptom onset reported to the infirmary on 6 consecutive cruises of ship X, November...
• Figure 2 .  Phylogram of 9 norovirus sequence types detected in outbreaks on ship X, 4 reference sequences from GenBank, and the Farmington Hills virus. The tree is based on a 277-nucleotide region...
• Table . Results of laboratory testing for norovirus in stool specimens, November 2002–January 2003

DOI: 10.3201/eid1101.040434

Table of Contents – Volume 11, Number 1—January 2005

Please use the form below to submit correspondence to the authors or contact them at the following address:

Marc-Alain Widdowson, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, Mailstop A34, Atlanta, GA 30333, USA; fax: 404-639-4960

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Norwalk virus gastroenteritis aboard a cruise ship: an outbreak on five consecutive cruises

• PMID: 7457473
• DOI: 10.1093/oxfordjournals.aje.a113054

An explosive outbreak of gastroenteritis caused by a parvovirus-like (PVL) agent (Norwalk agent) affected 521 (64%) cruise ship passengers in 1977. The illness was characterized as mild-to-moderate and lasted one to two days. Principal symptoms experienced by ill passengers were nausea, vomiting, and diarrhea; fever was reported for approximately 25% of the patients. The outbreak was compatible with a common-source exposure, but no such exposure was identified. On the next four cruises, passengers experienced a similar gastrointestinal illness, but the outbreaks were less explosive, affected fewer persons, and symptoms appeared milder, on each subsequent cruise. No common source was identified, and person-to-person transmission may have occurred. The etiology of these outbreaks would have remained unknown were it not for the recent development of a specific radioimmunoassay (RIA) for the serologic identification of Norwalk virus and the measurement of antibody titers to the virus. A fourfold or greater rise in serum antibody titers to Norwalk antigen in serum from seven of eight ill passengers and the identification of Norwalk antigen in stool specimens from two ill passengers on the first cruise demonstrated that Norwalk virus caused this outbreak. The symptoms experienced by passengers on the four subsequent cruises suggest that a Norwalk agent probably also caused these outbreaks. In addition, a stool specimen from an ill passenger on cruise 3 contained Norwalk antigen.

• Disease Outbreaks / epidemiology*
• Gastroenteritis / diagnosis
• Gastroenteritis / epidemiology*
• Gastroenteritis / etiology
• Parvoviridae
• Virus Diseases / diagnosis
• Virus Diseases / epidemiology*