Lawsuit: Passenger Contracts Legionnaires' Disease on Royal Caribbean's Majesty of the Seas

Majesty of the SeasA passenger from Ohio who sailed aboard the Majesty of the Seas last November and developed Legionnaires' disease has filed suit against Royal Caribbean. The passenger alleges that only after he boarded the cruise ship in Miami, and the ship had set sail, did the cruise line notify him, via a notice placed under his door, that Legionella had been discovered in the ship's water system on prior cruises.       

Legionnaires' disease is one of the most serious diseases a passenger can contract on a cruise ship. Legionnaires’ disease is a severe pneumonia caused by inhalation or possibly aspiration of warm, aerosolized water containing Legionella organisms. According to the Centers for Disease Control (CDC), contaminated ships’ whirlpool spas and potable water supply systems are the most commonly implicated sources of shipboard Legionella outbreaks. Symptoms include a cough, shortness of breath, high fever, muscle aches and headache. Although prompt antibiotic treatment can kill the bacteria, 5% to 30% of people infected with Legionella will die from the infection.  

After the cruise ended on November 13, 2015, Royal Caribbean sent an email to the disembarking passengers, stating that they may have been exposed to Legionella during the cruise. It stated that if passengers become ill, they should seek medical attention and undergo testing for Legionella. 

Royal Caribbean stated that two passengers had been confirmed to be infected with Legionnaires' disease from the cruise ship, and that one person was possibly infected. One person was infected during a cruise in July 2015 and one other person was infected during a cruise in October 2015. The email stated that Royal Caribbean had shut down the whirlpools on the ship after it confirmed the first case of Legionnaires' disease associated with the July sailing. The cruise line claimed that it treated the ship's water supplies with extra chlorine (the email mentions "two rounds of treatment with chlorine"), but water samples taken from showers confirmed the presence of Legionella.

Royal Caribbean also sent the email to those people who had booked cruises on the Majesty on future dates, advising that the risk of illness is "low but not zero" and suggesting to future cruisers that they may want to reschedule their cruises for a later date depending on their individual risk factors.       

A few days after returning home, the passenger began experiencing symptoms consistent with Legionnaires' disease. He visited his doctor on an urgent basis and he was immediately hospitalized. His lawsuit lists kidney, heart and pulmonary failure among other complications which he suffered as a result of the disease which he contracted on the cruise ship. 

The lawsuit alleges that Royal Caribbean was on actual notice of Legionella on its ship but notified the passengers only after Majesty sailed and was at sea. In addition to alleging that the cruise line was negligent, the lawsuit states that the cruise line "acted with deliberate and wanton recklessness" in refusing to advise passengers of the Legionella prior to the cruise. Royal Caribbean, the lawsuit alleges, acted in "callous disregard" of the dangers to the passenger's health in order to promote its economic interests.

The lawsuit seeks punitive damages, in addition to compensatory damages, due to the cruise line's intentional misconduct.  

The lawsuit was filed by Miami maritime lawyer Domingo Rodriquez

There was a discussion regarding Legionnaires' disease and this particular cruise last year on the Cruise Critic boards. If the comments are accurate, some of the passengers apparently were not notified of the Legionella on the ship during the cruise but were notified only after the cruise was over. At least one person commenting said that he sailed on the cruise ending November 13, 2015 but never received an email from the cruise line. One poster mentioned that a family member who was on the cruise was allegedly admitted to the hospital with Legionnaires' Disease. She stated at the time: "we did not get the email about the ship being contaminated until the afternoon of Nov. 13, after we had just gotten off the ship . . . This was very irresponsible and unethical on Royal Caribbean's part."  

In my opinion, it is outrageous that Royal Caribbean kept sailing the Majesty if it knew that the ship's water supply was still contaminated with Legionella after multiple "extra-chlorine" treatments. It is Legionellaprobable that some of the passengers or crew members would become sick because, obviously, passengers are going to shower during cruises. Unfortunately, we have seen this cruise line take the "show-must-go-on" attitude to extremes over the years, whether it is recklessly sailing into hurricanes or repeatedly exposing its passengers to noro virus on successive cruises.

There have been a number cases of Legionnaires' disease on cruise ships over the years. The most infamous case involved the Horizon cruise ship operated by Royal Caribbean's sister cruise line, Celebrity Cruises (before it was purchased by Royal Caribbean), back in 1994.

Following a deadly shipboard outbreak which caused Celebrity to cancel cruises and fly passengers back from Bermuda, passengers sued Celebrity alleging that the company defrauded them by refusing to disclose that Legionella was present on the cruise ship. An Associated Press writer wrote that: "on Saturday passengers on the cruise ship Horizon were told the risk of contracting Legionnaires' disease on board was low. On Tuesday they were hustled off the ship in Bermuda as a precaution." (Numerous passengers were nonetheless infected). The AP quoted passengers as saying at the time: "everyone is entitled to a worry-free vacation and this has been anything but that" and "the people who operate this line should be chastised" and "what they did to the passengers is unconscionable."

Celebrity subsequently sued the manufacturer of the ship's pool and whirlpool equipment, alleging that extensive press coverage of the disease outbreak stigmatized the company, thus hurting its reputation and reducing its profits. Celebrity obtained a $193 million verdict, although an appellate court subsequently reduced the verdict.

Regarding the recent outbreak, if Royal Caribbean was uncertain whether the Majesty of the Seas still had Legionella in its water system, merely warning future passengers that the risk of illness was "low" but not canceling cruises was, at a minimum, irresponsible. Not informing passengers who cruised on the ship of the disease until after they sailed is truly reprehensible conduct. 

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Photo credit: Top -  CC-BY-SA-3.0/Matt H. Wade at Wikipedia; bottom - By CDC (PHIL #1187) - CDC Public Health Image Library, Public Domain.

Legionella Royal Caribbean Email

Legionella Royal Caribbean Email

 

Outbreak on the Silver Spirit Found to be Caused by E. Coli

A gastrointestinal sickness outbreak on the Silver Shadow in March was found by the Centers for Disease Control and Prevention (CDC) to be caused by Enterotoxigenic E. coli (ETEC).

The outbreak occurred during a cruise from March 3 - 21, 2016. The outbreak sickened 37 people according to the CDC report on the incident. The CDC concluded that 24 of 388 (6.19%) passengers and 13 of 366 (3.55%) crew members fell ill due to the disease.

Outbreak News Today said that "according to the Centers for Disease Control and Prevention (CDC), Silver SpiritETEC is a major bacterial cause of diarrhea among travelers and children in the developing world. ETEC is increasingly recognized as an important cause of foodborne illness in developed nations, such as the United States. Infection occurs when a person eats food, or drinks water or ice contaminated with ETEC bacteria. Human or animal wastes (e.g., feces) are the ultimate source of ETEC contamination."

Silversea Cruises was last in the news several years ago when the USPH caught crew members hiding perishable food and galley equipment in crew quarters on the Silver Shadow and flunked the cruise line. CNN covered the scandal. You can see the video here

The Silver Shadow failed another USPH inspection last year as well. 

The Silver Spirit, on the other hand, has always scored highly by the USPH (93-100) in the last 6 years, and it scored a 98 during the last inspection in January. However, in a lawsuit filed by a Silversea crew member (aboard the Silver Spirit and Silver Wind) in 2011, the crew member alleged that his employment as a bartender was terminated after he complained that he was required to fill expensive, premium top-shelf brand liquor bottles with cheaper brands and to fill empty expensive French champagne bottles with cheaper Italian sparkling wines. The case is Marin Asenov v. Silversea Cruises, Ltd., Case No. 0:11 CV 62360 WJZ. You can read the allegations in the lawsuit here.   

Photo credit: This image photographed by Brian Burnell with permission was uploaded to Commons by George Hutchinson. CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=15252523

P&O Oceana Flunks CDC Sanitation Inspection

P&O OceanaA month ago, a crew member aboard the P&O Oceana notified me that the cruise ship failed a sanitation inspection by the enters for Disease Control and Prevention (CDC) while the ship was in port in Charleston, South Carolina.  Oceana received a score of 82; 85 or lower is considered a failure.

I have been checking the CDC's online inspection scores since then. I have been asking the CDC when it will release its report on the Oceana.

The report was finally released today. You can read the report here. The report indicated that several back-flow prevention devices, to prevent the contamination of potable water, did not have test results and appeared not to be tested. The ship's Riviera swimming pool and Crystal whirlpool did not have adequate levels of chlorinated and bromine, failed to have hair and lint strainers / filters and were not disinfected. The inspector closed the recreational water facilities on the ship.   

The report also revealed that a food handler had an onset of Acute Gastroenteritis (AGE) and exhibited symptoms at 9:00 A.M. in the morning but did did not report to the medical center until 11:20 A.M. A review of the crew member's work history indicated that this crew member worked, notwithstanding his illness, from 7:30 A.M. until 10:30 A.M.

The ship's galley appeared dirty. There were comments like "the tile grout in this area was soiled and in disrepair."  "The deck below under counter refrigerator . . . had a significant buildup of more than a week's accumulation of food debris, dirt, equipment parts, and what appeared to be insect remains." Food service equipment was broken or out of service and many operational ovens and ice-makers were overflowing their drip pans and/or leaking onto the floor.

Oceana has not prepared a "corrective action report" in response to the failed score, as required by the CDC.

In an era when cruise lines are quick to blame every single norovirus outbreak on the passengers, this CDC report provides an insight into how deficient water sanitation and disgusting food handling practices by a cruise line can jeopardize the health of the traveling public.  

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April 4, 2016 Update: The CDC vessel sanitation inspectors inspected the P&O Oriana in February.  Although the cruise ship passed with a score of 90, there were several significant sanitation problems including dirty and out of service galley equipment.  Also food handlers working while ill with gastrointeritis: "A Chef de Partie experienced onset of GI symptoms on 20 January 2016 at 6:45 am. This crew member worked from 7 am to 11 am, took lunch at the crew mess, then returned to work from 1 pm to 5 pm. The chef reported his symptoms to the medical center at 6 pm."   You can read the report here

April 5, 2016 Update:  Cruise Law News was quoted today in the Southampton's Daily  Echo and the U.K.'s Daily Mail.  

Fortune magazine also covered the story, writing that it "raises questions about the industry’s squeaky-clean image, and indeed, that there may be more unreported cases that were either ignored or dismissed by the sickened passengers or the cruise lines themselves."

April 6, 2016 Update:  FoxNews covers the story today - Health inspectors find cockroaches, 'potentially hazardous' food aboard two luxury cruise ships.  The Cruise Line International Association (CLIA) interjects the blame-the-passenger-wash-your-hands excuse but ignores the fact that crew members were handling food while contagious and the ship's galley was found to be unsanitary and potentially hazardous to the guests' health. 

Photo credit: Piergiuliano Chesi, CC BY 3.0, commons / wikimedia.

CDC: 137 Sick with Norovirus on Norwegian Gem

Norwegian GemEarlier this week, we reported that health officials banned the Norwegian Gem from calling on St. Maarten because a number of passengers were ill with a gastrointestinal illness. The NCL cruise ship then sailed on to Tortola where it called on the port there.

The Centers for Disease Control and Prevention (CDC) is now officially reporting that 128 of 2,882 cruise passengers (4.44%) and 7 of 1,100 of crew members (0.64%) on the Gem have been ill during the cruise with norovirus. 

Although it was suggested on the cruise ship that the cause of the outbreak may be contaminated water, there has been no information released to the public confirming or excluding this possible cause. Norovirus is primarily a food-borne disease. Outbreak News Today correctly states that "norovirus is typically spread through contaminated food and water, touching surfaces or objects contaminated with norovirus and then putting your hand or fingers in your mouth and close contact with someone who is vomiting or has diarrhea."

Unfortunately, the CDC has limited resources and does not attempt to conduct an epidemiology assessment regarding the source of the norovirus outbreak.    

Photo credit: Corgi5623 at English Wikipedia, CC BY-SA 3.0.       

Another Gastrointestinal Outbreak on Leading GI-Outbreak Cruise Line, Princess Cruises

Ocean PrincessThe Centers for Disease Control and Prevention (CDC) reported that there is a gastrointestinal outbreak on the Ocean Princess cruise ship, with 43 of 603 (7.13%) of passengers ill during the cruise and 5 of 387 (1.29%) crew members sick.

The Princess cruise ship is currently sailing on a February 13 - March 7, 2016 itinerary. The cruise ship is scheduled to go into dry dock on March 7th. 

Princess has 50% of the four cruise ship norovirus that meet the CDC's criteria so far this year. This should be no surprise to anyone who follows gastrointestinal outbreaks on cruise ships.

As I pointed out in my last article about a gastrointestinal outbreak on a Princess cruise ship (the Crown Princess), during the six year period from 2010 to the current date, Princess Cruises experienced the most norovirus outbreaks on its cruise ships calling on a U.S. port, according to the CDC. Including this most recent outbreak, Princess has reported twenty (20) cases to the CDC during this time period.

In contrast, Carnival cruise lines reported just two (2) cases during the same time period.

Celebrity Cruises reported 15 cases (and Royal Caribbean reported 9). HAL also reported a high number (12) during the 2010 to 2016 time period. Cunard reported 4; NCL -3; Oceania - 3; and Crystal - 2. 

Anyone have an explanation why there have been 10 times as many CDC-reported GI outbreaks on Princess cruise ships compared to Carnival cruise line ships?

 Photo Credit: Pjotr Mahhonin - CC0, Wikipedia

Pukefest on the Crown Princess - Why Does Princess Cruise Have So Many Norovirus Outbreaks?

The first norovirus outbreak on a cruise ship calling on a U.S. port this year has been reported to the Centers for Disease Control and Prevention (CDC). And, no surprise to anyone that follows cruise ship outbreaks, it involved a Princess Cruises cruise ship. 

The Crown Princess just returned to Los Angeles following a two week cruise from January 3 - 18, 2016. 180 of the 3,060 passengers (5,88 %) aboard the cruise ship were sick with symptoms of vomiting and diarrhea. 24 of 1,168 crew members (2.05%) became ill with gastrointestinal symptoms which the CDC confirmed were due to norovirus.  You can read the CDC report here.

During the six year period from 2010 to the current date, Princess Cruises experienced the most Princess Cruise Ship Norovirus Outbreaknorovirus outbreaks on its cruise ships calling on a U.S. port, according to the CDC. Princess reported nineteen (19) cases to the CDC during this time period. Carnival cruise lines reported just two (2) cases during the same time period.  

Celebrity Cruises reported 15 cases (and Royal Caribbean reported 9).  HAL also reported a high nummber (12) during the 2010 to 2016 time period.

Cunard reported 4; NCL -3; Oceania - 3; and Crystal - 2.  

The Crown Princess alone has suffered through five (5) norovirus outbreaks since 2010 to the present. Before the current outbreak, the last outbreak on the Crown Princess was from October 18 to November 16, 2014. Prior to that, it was February 5 to 12, 2014. It also experienced back-to-back outbreaks from January 29 to February 4, 2012 and February 4 to February 9, 2012 (photo above).

The Crown Princess alone experienced two and one-half time more norovirus outbreaks that the entire fleet of Carnival cruise lines from 2010 to the present!

So why is Princess Cruises far more prone to norovirus outbreaks than Carnival cruise lines, for example?

The cruise industry always blames the passengers for bringing the virus aboard, rather than its food handlers, or contaminated food or water. So are Princess Cruises customers the sickest and the least hygienic cruisers around? Do they wash their hands the least of any cruisers?  That seems like a absurd argument to make.

Is there a correlation between the age of the cruise ships and gastrointestinal outbreaks?  Are different food sources and food handling techniques a more reasonable explanation?  How about different sanitation procedures?  I'm not sure. The CDC doesn't have time to determine the source of the norovirus outbreak (sick food handlers versus contaminated food or water or a sick passenger) so it is of no help.  

But blaming the passengers when one cruise line (and one cruise ship in particular) has far more gastrointestinal outbreaks than its competitors is certainly not the answer.  

CDC Expands Zika Travel Warning

Zika VirusThe U.S. Centers for Disease Control and Prevention (CDC) added eight (8) more destinations to its recent Zika virus travel alert yesterday.

In addition to the 14 countries already on the CDC list (Brazil, Colombia, El Salvador, French Guiana, Guatemala, Haiti , Honduras, Martinique, Mexico, Panama, Puerto Rico, Paraguay, Suriname, and Venezuela), the CDC added these 8 more countries:

Barbados, Bolivia, Ecuador, Guadeloupe, St. Martin, Guyana, Cape Verde, and Samoa.

The Center for Infectious Disease Research and Policy (CIDRAP) states that the move to add countries where a traveler could be injected "follows the CDC's initial Jan 15 travel advisory recommending that pregnant women and those trying to become pregnant consider postponing travel to countries where Zika virus is circulating, and if they must travel to the destinations they should follow strict steps to avoid mosquito bites."

As we explained in our first article, there is a risk of to pregnant women of having a baby with a small, underdeveloped heads (microcephaly).

This latest development comes at a time when "three travellers who returned to the UK from South and Central America have been diagnosed with the Zika virus."

So far, we have heard of some cruise lines which are cruising to one of the countries subject to the CDC warning are refusing pregnant women to cancel their cruises.  We do not know whether those travel insurance companies are providing coverage when a pregnant cruiser cancels and submits a claim.

The CDC's Recommendations for Pregnant Women Considering Travel to an Area of Zika Virus Transmission

Because there is neither a vaccine nor prophylactic medications available to prevent Zika virus infection, CDC recommends that all pregnant women consider postponing travel to areas where Zika virus transmission is ongoing. If a pregnant woman travels to an area with Zika virus transmission, she should be advised to strictly follow steps to avoid mosquito bites. Mosquitoes that spread Zika virus bite both indoors and outdoors, mostly during the daytime; therefore, it is important to ensure protection from mosquitoes throughout the entire day. Mosquito prevention strategies include wearing long-sleeved shirts and long pants, using U.S. Environmental Protection Agency (EPA - registered insect repellents, using permethrin-treated clothing and gear, and staying and sleeping in screened-in or air-conditioned rooms. When used as directed on the product label, insect repellents containing DEET, picaridin, and IR3535 are safe for pregnant women. Further guidelines for using insect repellents are available online (http://wwwnc.cdc.gov/travel/page/avoid-bug-bites).

January 26, 2016 Update: The CDC added  the United States Virgin Islands and the Dominican Republic to the list of destinations with Zika virus disease outbreaks.

Photo Credit: "Aedes aegypti CDC-Gathany" by James Gathany - PHIL, CDC. Licensed under Public Domain via Commons Wikipedia

Are Cruise Lines Warning Pregnant Passengers of the Zika Virus?

ZIKA VirusThe New York Times published an article yesterday that should alarm women who are pregnant and thinking about taking a cruise calling on ports in the Caribbean or South America or Central America. CDC May Warn Pregnant Women Against Travel to Countries With Zika Virus written by science and health reporter Donald G. McNeil Jr., says that test results from the CDC seems to establish a link between the mosquito-borne virus and Brazil’s rise in babies born with abnormally underdeveloped heads (microcephaly).

According to Helen Bramswell, an infectious diseases and public health reporter from STAT News, there have been  "at least 3,530 cases of microcephaly and 46 deaths in Brazil since the increasing number of cases was recognized last October. The country saw fewer than 200 cases of microcephaly annually over the previous five years." 

The CDC is thinking about issuing a warning for pregnant travelers against travel to Brazil, as well as other Latin American and Caribbean countries where the virus has spread.  According to the Times, the virus has been located in 14 countries in the Western Hemisphere: Brazil, Colombia, El Salvador, French Guiana, Guatemala, Haiti , Honduras, Martinique, Mexico, Panama, Puerto Rico, Paraguay, Suriname, and Venezuela.   

The Times spoke to corporate communications representatives of Carnival. Princess and Royal Caribbean cruise lines who reportedly denied knowing anything about the Zika virus and directed inquiries to their trade association, the Cruise Line International Association.  CLIA suggestions include the same general things suggested to prevent the infection with the chikungunya virus - using mosquito repellents and wearing protective clothes.

According to Caribbean 360, the Zika virus was first detected in humans about 40 years ago in Uganda. It is spread by the same Aedes aegypti mosquito as dengue and chikunguya. The disease was first identified in the South Americas less than two years ago and has spread rapidly across South and Central America.

January 15 2016 Update: It's Official. U.S. issues travel alert over Zika virus in Latin America, Caribbean.

January 16 2016 Update: CDC alert for Zika virus may curb Caribbean 'babymoon' vacations. "The CDC had been urging all travelers visiting areas of Latin America and the Caribbean to take extra precautions against mosquito bites to avoid contracting the virus. But officials upgraded the warning late Friday to a Level 2 travel notice and are now advising pregnant w.men and women trying to become pregnant to consider avoiding travel to the affected areas out of concern that Zika may cause a catastrophic birth defect called microcephaly.

"We likely will see a significant decline in trips by women who are pregnant or trying to conceive to these regions in light of the apparent link between the virus and birth defects,"

CBS Pregnant women warned about Zika virus

Photo Credit: "Aedes aegypti CDC-Gathany" by James Gathany, CDC, licensed under Public Domain via Commons / Wikipedia.

Bahama Mama Flunks CDC Sanitation Inspection

Bahamas MamaThe  Bahama Mama cruise ferry, operated by Balearia Bahamas Express, recently failed a bi-annual sanitation and health  inspection conducted by the Centers for Disease Control and Prevention (CDC).

I first read about the Bahama Mama flunking the CDC inspection in an article by Theresa Norton Masek in Travel Pulse titled Bahama Mama Ferry Fails CDC Inspection.

The official CDC report chronicles a disgusting list of filthy conditions (with the requisite dead flies and crawling insects) on the ship as well as disturbing failures to comply with health procedures designed to avoid food contamination. The report indicates that the ship did not even have acute gastroenteritis surveillance logs for each voyage, although there were ill crew members on the ship.

You can read the report here.

The ship has not complied with the CDC and submitted a corrective action report. 

The ship sails between Port Everglades and Freeport, Bahamas. 

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Photo credit: Vicens Gimenez / © Vicens Gimenez via Sun Sentinel

Noro on the Princess Cruises' Star Princess

News sources in Hawaii are reporting that dozens of Princess cruise ship passengers have been quarantined on Maui after a norovirus outbreak.

Newspapers are saying that Princess Cruises' Star Princess is ported at Lahaina. According to the local health department, around 30 people are quarantined in their rooms. Health officials report that the virus originated in San Francisco. 

Princess Cruises notified the Centers for Disease Control and Prevention (CDC).  

There is no official CDC information  because there is no need for the CDC to make a report to the public unless 3% or more of the cruise passengers or crew are ill. 

This week 8 Canadian doctors published a blockbuster article confirming that norovirus can be transmitted in an airborne form.

Unfortunately, given the short time that cruise ship are in port, no health officials ever determine whether the outbreak is caused by contaminated food and / or water versus a sick food handler versus poor hygiene practices by the cruise ship or passengers. I expect the cruise line will still publicly blame the passengers, whatever the true cause. 

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Star Princess Noro Virus

Photo Credit: Jim Walker in Seattle

 

Norovirus Spreads by Air on Cruise Ships

Researchers in Canada have concluded that norovirus can spread by air, according to a publication in the highly respected Clinical Infectious Diseases.

Eight doctors participated in a study of norovirus and determined that norovirus can be transmitted in an airborne form. They published an article titled "Detection and Quantification of Airborne Norovirus During Outbreaks in Healthcare Facilities."  

Researchers collected air samples (about 3 feet away from the sick patients) and then tested areas Norovirusfurther away, such as by the door of patient rooms and down at nursing stations.

"Airborne noroviruses were identified at six of the eight facilities included in the study. These germs were found in 54 percent of the sick patients' rooms. They were also found in 38 percent of the hallways leading to these rooms and at 50 percent of the nursing stations."

A reporter for HealthDay News / U.S. News and World Report wrote an article titled 'Cruise Ship' Norovirus Bug Can Spread by Air, Study Finds, saying that "notorious bugs that have infected scores of people and ruined countless cruise ship vacations -- can spread through the air and infect people several feet away, according to new research."

"The measures applied in hospital settings are only designed to limit direct contact with infected patients," the study's leader, Caroline Duchaine, a professor at Universite Laval's Faculty of Science and Engineering in Quebec, Canada, said in a university news release."

The medical experts concluded that rules need to be reviewed to take into account the possibility of airborne transmission of noroviruses. She suggested the use of "mobile air-filtration units" or the "wearing of respiratory protection around patients with gastroenteritis" should be considered. 

The news article said that concentrations of norovirus "ranged from 13 to 2,350 particles per cubic meter of air."  As few as  20 norovirus particles can infect someone.

The cruise industry's lobbying team at the Cruise Line International Association (CLIA) has been lecturing the public for decades that passengers not washing their hands is usually the cause of the virus' spread. I have always thought that blaming the passengers was malarkey.

Now we have reliable information that norovirus can spread in the air. It can easily be blown throughout the ship by the cruise ship's air-conditioning.  

I wonder how CLIA will spin this new clinical study?

Silver Shadow Fails CDC Sanitation Inspection Again

The Centers for Disease Control and Prevention (CDC) flunked Silversea's luxury cruise ship, the Silver Shadow, for unsanitary conditions. 

The Silversea cruise ship received a failing score of only 82. The inspectors determined the ship had improper medical protocols for crew members with acute gastroenteritis. The inspectors found 40 unsanitary conditions such as improper temperatures for stored food, improper sneeze guards at the ship's buffet stations, and unsanitary whirlpools.  

Incredibly, Silversea refused to submit a corrective action report.

Two years ago, this cruise ship engaged in an intentional, calculated scheme to hide food and galley equipment in crew cabins.Crew members on the ship alerted our firm that they (galley workers) were being ordered by their supervisors to take trolleys of perishable foods (eggs, fish & cheese) to the crew quarters and hide the food from inspectors during bi-annual CDC inspections. We advised the "whistle-blower" crew members to notify the CDC. As a result of a surprise inspection, the CDC discovered that the cruise line hid "over 15 full trolleys" of food and food equipment, pans, dishware and utensils to "over 10 individual cabins"  in order to avoid scrutiny of vessel sanitation inspectors. It flunked Silversea with a score of 82.

We were interviewed by CNN regarding Silversea's scam.

We found Silversea Cruises to have acted deliberately and unethically. It was obviously not committed to safe food practices, a conclusion which is reinforced by this latest series of violations.

Unfortunately, the CDC can't enter significant sanctions against renegade cruise lines like this even when the cruise ships intentionally violate CDC sanitation protocols. Our government should impose meaningful monetary sanctions and shut cruise ships down when they threaten the health of passengers. 

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The CNN video of the last CDC failed score is below:

 

Whooping Cough Outbreak on the Voyager of the Seas?

Whooping CoughThe operator of a fan Voyager of the Seas Facebook page (not operated by the cruise line) posted the following:

"If you where on the Voyager of the Seas relocation cruise from Singapore to Sydney cruise and you have a really bad cough, then I suggest you got and see a Doctor as you may have Whooping cough . . . "

A large number of passengers have posted comments in response to this post. Many passengers on the cruise say that they are ill.  Many people say that they are having their blood drawn and are seeing doctors to have their throats swabbed. Others say that it has been confirmed that they have been diagnosed with whooping cough.

Passengers complain that they have hear nothing from Royal Caribbean. One person who heard back from the cruise line remarked: "I've heard from RC and they told me they are not compelled to notify all passengers . . . "

Whooping cough, also known as "pertussisis," is a highly contagious respiratory disease caused by the bacterium bordetella pertussis.

Pertussis is known for uncontrollable, violent coughing which often makes it hard to breathe. Pertussis most commonly affects infants and young children. It can be fatal, especially in babies less than 1 year of age.

The best way to protect against pertussis is immunization.

Voyager of the Seas

Photo Credit: Antimicrobe.org / Wikipedia (Corgi5623)

Did the Freedom of the Seas Fail a USPH Sanitation Inspection?

On November 27, 2014, I received a communication directly from a Royal Caribbean crew member indicating that the United States Public Health (USPH) conducted a surprise health inspection of the Freedom of the Seas on November 23rd. The crew member said that the USPH flunked the cruise ship for being unsanitary.  

The crew member, who is still working on the ship and wishes to remain anonymous, said that the USPH gave Royal Caribbean a failing score of "84" (85 or below is a failing grade).

A failed USPH score is a big thing. Only two major U.S. based cruise ships (the Ocean PrincessFruit Flies and Silver Discoverer) failed such an inspection this year. It's embarrassing to the cruise line. It has sometimes ended a F&B (food & beverage) manager's career.  

Since communicating with the crew member, I have checked the Centers for Disease Control and Prevention (USPH) database daily for the official report.

Today, the CDC report was finally released. To my surprise, the official score was an "86," one point above failing.  So what happened between November 23rd and today?

The crew member's account of the inspection seems credible to me. The crew member indicated that there was a great deal of controversy over the failed inspection when the government inspectors left the ship. The crew member mentioned particular aspects of the failed inspection. I tend to believe the account.

Did the inspectors reconsider and change the score after leaving the ship? If so, why? Was this a good faith reconsideration and recalculation based on objective criteria? Or were there behind-the-scenes shenanigans and arm-twisting that resulted in the score being changed to a passing score? There can be no doubt that Royal Caribbean has a cozy relationship with the federal agencies; it routinely hires from the CDC, USPH, FBI and USCG.

So what does the official report say? Here are a few of the findings:

  • Two crew members working with symptomatic acute gastroenteritis;
  • Improper cooling logs for food, risking illness;
  • Cases of food stored on heavily soiled decks;
  • Trolley with plates stored in elevator lobby;
  • Food soil in Sorrentos galley; and
  • Live fruit flies in Windjammer buffet, Chops galley, Windjammer pot wash, Sorrentos bussing station, Cafe Promenade bar, Diamond Lounge buffet, and Crown Viking bar.

The last cruise ship I recall flunking a USPH inspection for fruit flies was the old Monarch of the Seas

If the Freedom's score was not really a "F," it sure sounds like a solid "D-."  

 

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Photo Credit: Batzner Pest Management

Liberty of the Seas & Legionnaires' Disease - Disease of the Seas?

The Miami Herald reports today that a tourist from the U.K. who died from Legionnaires' disease had previously sailed on a seven-day Caribbean cruise on Royal Caribbean's Liberty of the Seas.  

The newspaper identifies the English cruise passenger as Mr. Tore Myhra. 

Previously, there was speculation that Mr. Myhra may have contracted the disease at a local hotel here in Miami, the luxurious Epic Hotel & Residences.  However, the U.S. Center for Disease Control ("CDC") said that the hotel was not implicated in his death because another person who died of the same strain of Legionella had not stayed at the hotel. 

The Herald's article today raises the issue whether Mr. Myhra was exposed to Legionella on the Royal Caribbean cruise ship.  The newspaper quotes the medical examiner's report that Mr. Myhra became sick on the cruise ship and suffered "nausea, vomiting, diarrhea, respiratory difficulty and dry cough.''

The newspaper reports that when the Liberty of the Seas ship returned to port in Miami on October 31st, Mr. Myhra was taken to Jackson Memorial Hospital. His symptoms worsened and he died of "Legionella pneumophila pneumonia" on November 1st at the hospital. 

Royal Caribbean's PR spokesperson, Cynthia Martinez, is quoted as saying that the cruise ship "reacted quickly" to the report of the Legionnaires' case.  It is less than clear what this means, because the cruise ship kept the sick passenger on the ship and did not request a medevac with the Coast Guard.

The Herald also interviewed a spokesman from the Center for Disease Control.  The newspaper reports that the CDC has investigated "five or six cases of Legionnaires' disease aboard cruise ships going in and out of South Florida in the past three months."

The CDC representative appears to be assisting the cruise line in damage control, based on the CDC's quotes in the newspaper: 

"All appropriate steps have been taken.'' 

"Cruise ships are very aggressive in responding to such outbreaks." 

Cruising is "a very safe endeavor.''

The CDC refused to identify the cruise ships where passengers contracted Legionnaires' disease, which is unfortunate because this should be public information. The obvious question remains - did the Liberty of the Seas have prior cases of Legionella?

It makes me nervous when a Federal agency acts like a cheerleader for the cruise lines while refusing to disclose public information regarding which cruise ships may have Legionella.

UPDATE:

The South Florida Business Journal has an excellent article today "Legionnaire's May Be Linked to Ship."  The articles refers to comments posted on the popular CruiseCritic site that a passenger on the Liberty of the Seas had been diagnosed with Legionnaire's, so the H20 Zone and hot tubs were closed . . .

 Liberty of the Seas

Cruise Ship - Legionella Information:

Legionnaires' Disease During Cruise Linked to Water Supply

Legionnaires' Disease Is Cited in Cruise Death On Celebrity Cruise Ship

CDC: What is Legionnaires' disease?

 

 

Credits:

Legionella cells                     scienceblogs.com

Legionella in lungs               nalcoeurope.com

Liberty of the Seas                hassocka5489 (via wikemedia commons)