Grandeur of the Seas is Still Sick: Cruise Industry Heading Toward Record Breaking Year for Virus of the Seas

The Centers for Disease Control and Prevention (CDC) has documented passengers sailing on Royal Caribbean's Grandeur of the Seas out of Baltimore have been sickened on two consecutive cruises. 

The CDC website reflects that 97 passengers and 8 crew members on the Grandeur of the Seas became ill with vomiting and diarrhea. It left April 5 for a seven-day cruise and returns to Baltimore today.

Royal Caribbean Cruises notified passengers who will be boarding today to arrive late at the port Grandeur of the Seas - Baltimore - Noro Virusbecause the cruise ship will undergo another round of the so-called "enhanced cleaning."

The Associated Press indicates that Royal Caribbean believes norovirus to be the cause.

As is the situation with virtually all gastrointestinal outbreaks on cruise ships, the CDC has not announced an explanation how the outbreak took place. Contaminated food? Contaminated water? Sick crew members working while ill in the galley or dining rooms? Cruise passengers not washing their hands? (the cruise lines' usual excuse). Your guess is as good as mine.  

This is the second consecutive cruise on the Grandeur with a illness outbreak, The CDC reported that 111  passengers and 6 crew members became ill with norovirus on the Grandeur during its cruise from March 28 to April 5. You can read our report here.

The CDC has documented a total of 8 gastrointestinal illness outbreaks on cruises returning to a U.S. ports so far this year. (There was also a norovirus outbreak aboard the P&O Oriana recently). There were just 9 outbreaks in all of last year. Norovirus is cited as one of the reasons the public has less confidence in the safety and reliability of cruising, especially from people who have never cruised before.

This week we were contacted by many cruise passengers asking whether they could cancel the cruise which leaves today because of the ongoing outbreak. Unfortunately the cruise lines hold all of the cards in cases like this.  Fear of becoming sick is not a legally recognized reason to cancel a cruise and expect a refund. However, it all depends on the goodwill of the cruise line. A FOX News report indicates that the spokesperson for Royal Caribbean, Cynthia Martinez, said "if passengers don't want to take Saturday's cruise, Royal Caribbean staff will help them reschedule." 

You can contact Ms. Martinez on Twitter - @CrisisCommChick / telephone (305) 982-2458 / email cynthiamartinez@rccl.com

Suing a cruise line for compensation when exposed to a gastrointestinal virus is a losing proposition because the CDC does such a poor job trying to determine the cause of the outbreak. In this most recent case the CDC has not determined the type of virus much less how the virus came on the cruise ship.

The last message we received was last night: "I will be traveling on the Grandeur this Saturday as well and our check in time was delayed 4 hours! I will be bringing my own bleach wipes on board. Wish us luck!"

Good luck!

Photo Credit: WBAL Baltimore

Have a thought about this story? Please leave a comment below or join the discussion on our Facebook page.

The Norwegian Star Flunks Sanitation Inspection: Is There a Correlation Between Failed CDC Cruise Ship Inspections And Norovirus?

The first official norovirus outbreak on a cruise ship this year involved the Norwegian Cruise Line (NCL) Norwegian Star

The outbreak occurred during a cruise from January 5-19, 2014. The virus sickened 130 of 2318 cruise passenger (5.61%) and 12 of 1039 crew members (1.15%).  You can read the CDC report here.

The CDC concluded that the virus in question which sickened the 142 or so people was norovirus. This was the "causative factor" in CDC parlance. The CDC can usually figure out the "causative factor" and NCL Norwegian Starmost of the time norovirus is the culprit. But I have never seen a CDC report in the last 10 or 15 years where the CDC figured out how the norovirus came aboard the cruise ship.

The cruise lines always blame the passengers. Sometimes the blame is direct with a cruise line public relations representative pointing the finger at their guests. Sometimes it is more subtle with no blame assessment but in the form of "passengers-need-to-wash-their-hands" type of admonishment. 

Determining the cause of a norovirus outbreak is a scientific process to be made by epidemiologists and doctors, not cruise line PR people.

The CDC is severely limited by the few inspectors and epidemiologists who are assigned to the cruise ships. The cruise lines are also eager to re-load their cruise ships and begin another cruise as soon as possible. Our federal government and the cruise lines work together to keep the cruise industry moving. No one wants to inconvenience the next round of passengers and hold a ship in port. Unfortunately, no one is advocating a more comprehensive (and slower) methodical analysis of data. 

My suggestion is that any time there is an outbreak, the CDC should automatically conduct a sanitation inspection as soon as the ship returns to port pursuant to its vessel sanitation program (VSP). The inspectors should determine whether the cruise ship's food or water supplies are contaminated. Medical literature indicates that many outbreaks are due to noro-laden food or water. Particular attention should be focused on the crew members' medical records, particularly the logs indicating whether food handlers (cooks and waiters) have reported to the ship infirmary with acute Cruise Ship Norovirusgastrointestinal symptoms of cramping, diarrhea and nausea.  

Yes, it will take greater resources from the CDC to accomplish this but it is worth it. The "enhanced cleaning" that takes place after an outbreak is "hit or miss." No one figures out what caused the outbreak. The ship is just pressing everyone to work overtime and spray and wipe everything in sight.

There was no CDC sanitation inspection on January 19th when the Norwegian Star returned to port. I would have liked to see the food handler's medical logs for the preceding two weeks in order to determine whether there were complaints of nausea, diarrhea, cramps, fever and headaches.  How did the cruise line handle the illnesses? Did they log all of the complaints and quarantine the sick crew members?  Did they interview the crew members' cabin mates to determine whether they were ill too?

The Norwegian Star underwent a CDC sanitation inspection on February 16th. The results were disgusting. Many crew members worked while suffering from acute gastrointestinal illnesses, threatening the health of passengers, and then appeared in the ship infirmary after working. The cruise line failed to properly document and log many of the sicknesses and report them to the CDC.  For the January 19th to February 2nd 2014 cruise, the number of sick passengers reached over 2% but the cruise ship did not notify the CDC. Many of the cabin mates of the sick crew members were not interviewed by the ship's medical staff, as required by the CDC protocols.  

The following violation was typical:

"Violation: On 28 January, the medical notes indicated a food worker had an illness onset at 0600 with Cruise Ship Food Handlers - Norovirusfour episodes of diarrhea, abdominal cramps, and a headache, but the AGE surveillance log indicated these symptoms started on 28 January at 1315. On the same day at 1315, this person had their last AGE symptom. There was no documentation indicating how long this person was isolated. This individual had four roommates, but there was no documentation the 48 hour interviews were conducted for three of the four roommates."

The CDC flunked the ship with a score of 82. You can read the CDC report here. In addition to the problems with the sick crew members, parts of the galleys and restaurants were filthy.

Does the CDC employ epidemiologists to study the results of vessel sanitation reports to look for trends to explain why gastrointestinal outbreaks occur?  Correlating the medical records of sick food handlers and their cabin mates with outbreaks may be a good idea. A scientific analysis of medical records and logs of crew members with GI problems would certainly be a better use of time than having to listen to the cruise line always blame the passengers for not not washing their hands. 

 

Photo Credit: Top: Wikipedia / Pjotr Mahhonin; bottom: Centers for Disease Control & Prevention

Disease Outbreak on HAL Veendam

The Centers for Disease Control and Prevention (CDC) report that there has been a disease outbreak on the  M/S Veendam operated by Holland America Line (HAL)

The CDC states that the Veendam cruise ship has returned after a a 14 day cruise from February 8-22, 2014 with 114 of 1273 (8.96%) passengers suffering from norovirus-like symptoms of vomiting and diarrhea. 10 of 575 (1.74%) crew members are reportedly ill.

The CDC has not figured out the type or cause of the disease outbreak.

Veendam Cruise Ship - NorovirusThe CDC has confirmed four disease outbreaks on cruise ships so far this year.

The story was first mentioned by the Cruise Fever blog.

The HAL Veendam was last infected with e-coli last year. You can read about that outbreak here: Gastrointestinal Virus Plagues Passengers Aboard HAL's Veendam Cruise Ship.

The Veendam has experienced problems with cleanliness and Illnesses over the years.

In 2012, this HAL cruise ship flunked a health inspection. That's hard to do. Read our article: Gross! Holland America Line's Veendam Flunks Health Inspection.

The Veendam also sickened 80 and killed one passenger during a gastrointestinal outbreak in November of 2011.

Over the years, HAL has one of the worst records with disease outbreaks.

 

Photo Credit: Wikipedia / Djheini

A Royal Mess: Sick Count Increases to Over 600, Cruise Ends Early

The Centers for Disease Control and Prevention (CDC) has stated that over 600 people have been sickened by the gastrointestinal illness outbreak on the Royal Caribbean Explorer of the Seas, CNN reports.

The Royal Caribbean cruise ship left Cape Liberty, New Jersey on January 21, 2014 for a 10 day cruise through the Caribbean. The ship missed a stop at its private stop in Labadee Haiti after the outbreak. It sailed to San Juan to be cleaned. 

The CDC initially stated that over 300 people (281 passengers and 22 crew members) were ill. (Its official report is here with the new statistics). However, over the weekend we began to hear reports from passengers that the number Royal Caribbean Cruise Explorer of the Seas Norovirusof people suffering from nausea and diarrhea had increased to to over 450 and, now, to over 600. 

CNN quotes a spokeswoman with the CDC that more than 600 people on the ship have become ill, reporting vomiting and diarrhea. The CDC spokeswoman said 564 passengers and 47 crew members reported being ill.

Royal Caribbean is ending the cruise two days early. The cruise line will "use the extra time to sanitize the ship even more thoroughly." 

We have been contacted by guests on this ill fated cruise as well passengers from the prior cruise who became ill. 

Passengers who contacted Royal Caribbean say that the cruise line is not considering refunds of any type.

We previously reported on the incident in our article: Puke Fest Aboard Royal Caribbean's Explorer of the Seas.

There has been no official word from the CDC whether this is in fact norovirus, although the symptoms are consistent with the virus. The cruise lines invariably blame the passengers, but the CDC has never in my experience ever pin-pointed the exact source of an outbreak like this.

NBC News raises the issue whether the outbreak on the Explorer is linked to a nasty new type of norovirus known as the GII 4 Sydney strain which caused an outbreak on the Queen Mary 2.

Join our discussion on Facebook about why norovirus outbreaks occur on cruise ships

 

G.I. Blues: Over 300 Sick on the Celebrity Summit

Celebrity Summit Cruise ShipCruise expert Professor Ross Klein reports that the Centers for Disease Control (CDC) indicates that 307 of 2112 passengers (14.5%) and 14 of 952 crew (1.5%) aboard the Celebrity Summit have reported sick with "gastrointestinal illness."

You can read about the outbreak on the CDC website here.

There is no indication whether the illness is due to norovirus, e-coli or some other virus or bacteria. 

The CDC is working with Health Canada officials as the cruise ship sails in Canada on its way to Bayonne, New Jersey,  The cruise ship will arrival in Bayonne on October 5, 2013.

The CDC will send an epidemiologist and an environmental health officer to meet the ship and conduct an epidemiologic investigation and environmental health assessment, and monitor the sanitation procedures onboard prior to the embarkation of new passengers.

Over 14% of the passengers being sick with gastrointestinal illness is a very high percentage.  

In the past week, we have reported about cruise ship norovirus outbreaks on two Fred Olsen cruise ships, the Black Watch and the Boudicca.

 

Photo Credit: Wikipedia / Yankeesman312

Caribbean Fantasy Flunks Sanitation Inspection - Why Doesn't the CDC Shut Nasty Ships Like This Down?

Professor Ross Klein's website reports that the Caribbean Fantasy, operated by American Cruise Ferries, failed a surprise inspection by the Centers for Disease Control and Prevention last month.  

The Caribbean Fantasy received a failing score of 81. The CDC report is, in a word, gross.

The CDC discovered major problems with the maintenance of the ship's potable water tanks and bunkering system. 

The most disgusting findings were the discovery of "numerous food safety violations" where the ship's American Cruise Ferries Caribbean Fantasystaff used storage lockers to improper store food and galley equipment and utensils.  CDC inspectors found "pests" in the storage lockers which started to be cleaned only during the CDC inspection. 

The CDC found a refrigerator out of order, an oven in the galley out of order, a door to another oven broken, and a dishwasher broken.

Among other disgusting findings by the CDC:

"Multiple condiments and salt and pepper shakers stored among soiled pots and pans."

"Numerous large plastic containers, pots, pans, baking sheets, and coffee carafes were stored as clean but still soiled with food remnants."

"Different sizes of live nymph cockroaches were under the shelves where galley equipment was stored."

Pest management receiving logs had prefilled comments, including "All deliveries free of infestation."

Some "rat guards were not installed."

You can read the report here.  

Earlier this week, we mentioned that the Centers for Disease Control Prevention (CDC), as past of its Vessel Sanitation Program, gave failing scores to two cruise ships following inspections this summer. The cruise ships involved were Regent's Seven Seas Navigator and Un-Cruise Adventures' Safari Endeavour. Both ship flunked the CDC's sanitation inspections.

The Seven Seas Navigator scored a 79 and the Safari Endeavour scored a 81.

These dismal scores of supposedly luxury lines come at a time when the Silver Shadow failed in a highly publicized and spectacular fashion when the CDC caught the crew hiding 15 trolleys of meat, fish, cheese and other perishable items in crew quarters this summer. The CDC concluded that the Silver Shadow intentionally hid food outside of the galley as part of a scheme to obtain high CDC inspection scores.       

Time for the CDC to shut some of these dirty cruise ships down.

 

Photo Credit: acento.com.do

Two More Cruise Ships Flunk CDC Food Sanitation Inspections

Navigator Seven Seas Navigator Cruise ShipThe Centers for Disease Control Prevention (Vessel Sanitation Program) has given failing scores to two cruise ships following inspections this summer.  

The Regent's Seven Seas Navigator and Un-Cruise Adventures' Safari Endeavour flunked the CDC's sanitation inspections. 

Regent's Seven Seas Navigator scored a dismal score of 79.  You can read the report here.  

The Safari Endeavour scored a failing score of 81.  You can read the report here.

These failed scores are even worse than the humiliating failure of the Silver Shadow.

The CDC caught the Silver Shadow cruise ship hiding trolleys of meat, fish, cheese and other perishable items in crew quarters this summer after a surprise inspection. 

CDC Releases Report on Silver Shadow's Disgusting Sanitation Problems

Last week we published an article that Silversea supervisors forced crew members aboard the Silver Shadow to hide trolleys of food in the crew quarters to avoid detection by USPH inspectors: Silver Shadow Fails Sanitation Inspection After Caught Hiding Filthy Conditions from Health Inspectors

Today the Centers for Disease Control (CDC) published its report.

It's damning to Silver Shadow's sanitation practices. Quite frankly, it's worse than I expected. The final score is 82 (it was initially 84). Here's a portion of the report:

Silver Shadow Sanitation CDCSite: Other-Galley Crew Cabins

Violation: An organized effort was made to physically remove over 15 full trolleys of dry foods, spices, canned foods, cooked foods, milk, raw meats, pasteurized eggs, cheeses of all types, baking goods, raw fruits, raw vegetables, and a variety of both hand held and counter model food equipment, pans, dishware and utensils to over 10 individual cabins shared by two or three galley crew members in order to avoid inspection by VSP staff. All the out of temperature potentially hazardous foods were discarded along with most other foods that were not canned or in original containers. The lead VSP inspector poured concentrated chlorine liquid over all the discarded foods as they were dumped into garbage bags to ensure they would not be used again

You can read the report here.

The report contains no photos, but you can see some of the photos we posted last week on our Facebook page.

We also asked crew members from other cruise lines whether cruise ships playing "hide and seek" from the USPH is a common practice in the cruise industry.  Its not a scientific poll, but around 90% of crew members said "yes."  Take a look here.

On Wednesday, Senator Rockefeller oversees another Senate hearing into whether cruise passengers need greater protection from the cruise industry's bad consumer practices.  I'm sure this issue will come up.  I look forward to hearing the cruise industry's response.

 

Silversea Cruises Sanitation Failure: How Many Cruise Lines Play Games with USPH Inspectors?

Last Monday I published an article about the U.S. Centers for Disease Control & Prevention (CDC) failing the Silver Shadow cruise ship following a surprise inspection last month when the ship was calling on Skagway, Alaska. The article is entitled: Silver Shadow Fails Sanitation Inspection After Caught Hiding Filthy Conditions from Health Inspectors

Former Silversea Cruises employees contacted me earlier this year and complained that they were ordered to take trolleys of pots and pans, cutlery and food items from the galley and hide them away from the U.S. public health inspectors in the crew cabins and hallways. We told them to report this practice to the CDC which later boarded, inspected and flunked the Silver Shadow. 

The reaction to the story has been mixed. Passengers who learned of the failed score and the alleged CDC Inspection - Silver Shadow Cruise Ship"hide and seek" tactics of the cruise ship appear to be upset not only with the unsanitary practice but with what they characterize as dishonesty and a lack of transparency by the cruise line. You can see this sentiment in a series of comments on the popular Cruise Critic boards.

Silversea will not respond to inquiries from our firm, but suggests in a PR statement it released that the incident is an aberration, pointing out that the scores on its previous inspections throughout its small fleet of cruise ships have been in the high 90"s and it also recently scored a perfect 100.

This argument, in my opinion at least, seems to be no different than a student caught cheating on a test who defends his failed score by pointing out that he received straight A's on all of the previous tests. The student's dishonesty is surpassed only by his disingenuity.   

The other reaction to the story is that this is "business as usual." This sentiment is being expressed by crew members. We have heard from crew members over the last 20 years who have told us of similar stories of the lengths to which some cruise lines go to obtain a passing USPH score. The comments to our article on Facebook, by crew members at least, are to the effect that this practice is wide spread on other cruise ships. It was back luck that Silversea got caught.

You can see similar comments by crew members about how cruise lines cheat on USPH inspections which were posted to a similar story I wrote in December. 

My Cruise Law News Facebook page has over 60,000 followers, and the majority are crew members from all over the world.  The consensus seems to be that all cruise lines engage in this practice to one extent or the other. I'd like to flush this issue out further. So I will post a simple question on my Facebook page:

Do cruise lines hide pots & pans, galley equipment and food from USPH inspectors?  You can click on the link and see what the crew members have to say about the issue.

Whereas passengers may be disgusted by this practice, I suspect that most crew members will yawn and say that this is business as usual.

July 22, 2013 Update:  CDC just released its official report. It's nasty. Here's our article.  You can read the official CDC report here.

CDC Failed Inspection - Silver Shadow

 

Photo Credit:  Former Silver Shadow crew member.

Disease Breeding Grounds: Three Cruise Ships Fail Health & Sanitary Inspections

Centers for Disease Control - Cruise Ship CDC Cruise Critic is reporting that three cruise ships recently failed inspection by the Centers for Disease Control and Prevention (CDC).

The cruise ships are the Celebrity Summit, Princess Cruises' Golden Princess and the SeaDream II.  

Take a moment and read the actual CDC reports of these ships. They are disgusting.

You can understand how easily norovirus and other gastrointestinal viruses can spread after reading about cooks and food handlers working while they are suffering from acute gastrointestinal symptoms. The monitoring of water treatment on some of these cruise ships is spotty and there was even one ship using a reverse osmosis system (which is suppose to be used only when the ship is underway) that was sucking up nasty water in the ports.    

The report for the Celebrity Summit is here. You will read about several crew members, including food handlers, who were suffering from acute gastrointestinal (referred to as AGE) symptoms but were still working, including handling food. The gastrointestinal surveillance logs were not being completed. There were widespread dirty and greasy conditions with flies and insect droppings in the bars and galleys.

The report for the Golden Princess is here. The Princess Cruises ship also had crew members with acute gastrointestinal symptoms continuing to work throughout the day even though they were Celebrity Summit Cruise Shipobviously ill in the morning.  An assistant buffet steward was suffering from GI problems but worked the buffet from 9:30 Am and did not report to the ship infirmary until 4:00 PM. There were inadequate reports regarding potable water facilities.  The ship had dirty and soiled areas, including the signature Princess restaurant Sabatini's.        

The report for the Sea Dream Yacht Club's Sea Dream II is here. This is the ship that was operating its water system continuously, including at port, and had been doing so for years. There were also dirty and unsanitary conditions noted.

The next time there is a norovirus outbreak and the cruise line instantaneously blames the passengers for not washing their hands, there may be a lot more to the story.

March 27, 2013 Update: In reading cruise expert Professor Ross Klein's website, I realized that Cruise Critic omitted another failed CDC score by the Caribbean Fantasy operated by America Cruise Ferries. You can read the report here. The deficiencies include failing to maintain acute gastrointestinal sickness logs, potable water deficiencies, galley and potwash cleaning shortcomings, and the failure to maintain cleaning equipment in proper order including several dish-washing machines and conveyors which had been not in proper condition for over a year. 

 

Photo Credit:

Celebrity Summit - Wikipedia / Yankeesman312

Norovirus Outbreak on Rhapsody of the Seas in Fiji - Cruise Ship Quarantined

Cruise Norovirus - Rhapsody of the SeasThe Fiji Broadcasting Corporation (FBC) reports that a Royal Caribbean cruise ship berthed at the Suva Wharf in Fiji was quarantined today by authorities following what is described as an outbreak of norovirus. The Health Ministry in Fiji reportedly confirmed 51 cases of the contagious virus on board the Rhapsody of the Seas which is carrying around 2300 passengers and 870 crew.

The FBC states that affected passengers have been isolated and no one is allowed to enter the quarantined area on the ship except the medical response team. 

The cruise ship will leave Fiji for Noumea, New Caledonia later tonight.

Because this outbreak occurred on a cruise ship which did not call on a U.S. port, it will not be reported to the Centers for Disease Control (CDC).

You can get norovirus from an infected person, contaminated food or water, or by touching contaminated surfaces.

The Rhapsody of the Seas experienced a norovirus outbreak the last week of August when 53 of 2,129 passengers (7.19%) experienced vomiting and diarrhea.

October 31, 2012 Update: Cruise ship under quarantine leaves Fiji.

HAL's Veendam Flunks Health Inspection

Below is a CNN video regarding the 16 year old Holland America Line's Veendam cruise ship which failed an inspection conducted by the Centers for Disease Control.

We blogged about this incident last week in our article:

"Gross! Holland America Line's Veendam Flunks Health Inspection."

CNN described the ship conditions as "really gross:"

 

 

Gross! Holland America Line's Veendam Flunks Health Inspection

Dirty Cruise Ship - CDC - Failed InspectionFlies. Dirty and malfunctioning ice machines, refrigerators & dishwashers. More flies. Dust, dirt, food residue, and debris. Flies and more flies. Flies where food is prepared. Flies where food is stored. Ugh. These unsanitary problems are part of a ridiculously long list that the U.S. Centers for Disease documented during a surprise inspection last month aboard the Holland America Line's Veendam cruise ship.

You can read the gross report here.

The inside word is that most "surprise" inspections are not surprises at all.  Most of the time the cruise lines are tipped off and immense pressure is suddenly applied on the crew to bring the ship up to standards. But here, at least, there was no advance warning. And this is what you get.  

The last cruise ship to fail such an inspection was the Monarch of the Seas last December - Dirty Dishes & Fruit Flies Flourish on Royal Caribbean's Oldest Cruise Ship. That was pretty gross too. 

 

Norovirus Update: Celebrity Constellation Cruise Ship is Latest to Join List of Sick Ships

A number of cruisers have been contacting our office asking about a sickness outbreak aboard the Celebrity Cruises' Constellation cruise ship. 

The Centers for Disease Control ("CDC") officially placed the Constellation on its vessel sanitation list of ships with sickness.  The Constellation sailed on January 28th from Fort Lauderdale and returned yesterday, February 11th. 

95 out of 1,992 passengers reported being ill during the voyage (4.77%).  12 crewmembers reported being ill. The sick passengers and crew reported symptoms of vomiting and diarrhea.

Only cruise lines calling on U.S. ports are required to report disease outbreaks to the CDC.  Cruise Celebrity Cruises' Constellation Cruise Ship - Norovirus?lines are required to make the report only when 3% or more of passengers or crew reported symptoms of diarrheal disease to the ships medical staff during the voyage.  Under-reporting occurs regularly because many passengers can't make it away from their toilets due to diarrhea, and some passengers don't want to be confined to their cabins. 

This is the fifth "official" cruise ship sickness outbreak which has found its way onto the CDC database which lists the Celebrity Silhouette, Celebrity Constellation, Royal Caribbean Voyager of the Seas, Princess Cruises' Crown Princess and P & O Cruises Aurora cruse ships.  The CDC data does not include the outbreak on Princess Cruises' Ruby Princess, which we reported on last week

The CDC has confirmed norovirus only on the Crown Princess and Aurora.  It is disappointing that the CDC can't figure out the type of disease on the other ships.  In no cases did the CDC pin-point the cause of the outbreak, to either a virus brought on the cruise ships by a passenger, or unsanitary handling of food by a crew, or infected food and/or water.  If the CDC can't figure out how the outbreak occurred, it seems hard to respond to the problem and eradicate the causative factors.

There has been a lot of criticism on how Celebrity Cruises handled the latest outbreak on the Silhouette.  You can read the comments by passengers here.   

How did Celebrity Cruises handle the outbreak on the Constellation?  If you were on the cruise, please leave her comments below, pro or con.

November 5, 2012 Update:

News sources are reporting that the Constellation suffered another outbreak of norovirus, this time during a 12 day cruise which just returned to Southampton.  BBC reports that 350 passengers became ill with vomiting and nausea. Read our article: Cruise Puke Fest: Norovirus Strikes Celebrity Constellation. if you were ill on that cruise please leave a comment at the end of that article.    

 

Photo credit:  Getty

Dirty Dishes & Fruit Flies Flourish on Royal Caribbean's Oldest Cruise Ship

Cruise Ship - Centers for Disease Control - CDCIn a story widely reported in the national media, the Centers for Disease Control failed Royal Caribbean's Monarch of the Seas after conducting a surprise vessel sanitation inspection last month. 

On November 18, 2011, CDC inspectors boarded the Monarch of the Seas, which is the cruise line's oldest vessel, and found numerous public health risks and violations if the CDC's sanitary standards.

The popular online cruise community, Cruise Critic, first reported on the nasty situation, followed by the USA Today cruise blog, CruiseLog.  

The CDC found a whopping 43 unsanitary conditions and "deficiencies" in the cruise ship's procedures which were in violation of the CDC's Vessel Safety Program (VSP) manual.  Included in the report were the following:

  • Dish-washing equipment in poor condition;
  • Improper cooling temperatures for stored provisions;
  • Improper cooking temperatures for cooked food;
  • Accumulations of food debris in wash and rinse areas;
  • "Clean" plates soiled with food residue;
  • Soiled plates stacked with clean plates;
  • Waiter stations, food preparation counters, slicers, and strainers soiled with dirt and food particles;
  • Live and dead fruit flies on food preperation surfaces throughout the galley; and 
  • Improper procedures for public toilets, shower-head disinfection, and disease outbreak and prevention.   

You can read the complete inspection report here

Cruise Ship Fruit FliesIt is rare for a cruise ship based in the U.S. to fail a CDC inspection.

For a cruise line which spent billions on its gigantic new Genesis class cruise ships the Oasis and the Allure of the Seas, it looks like its oldest cruise the Monarch is showing significant signs of neglect which risk sickening its passengers. 

Anyone who sailed recently on the Monarch care to leave a comment?  

Photo credit: amNY Photo Illustration

 

CruiseLog's Article on Cruise Ship Sickness Misses the Boat

The popular cruise blog written by Gene Sloan for the USA Today newspaper published an article yesterday entitled "Outbreaks of Illness on Cruise Ships at Multiyear Low."

CruiseLog cites statistics from the U.S. Centers for Disease Control ("CDC") of 11 outbreaks of illnesses so far in 2011, down from 14 in 2010 and 15 in 2009.  It concludes that this reflects a "downward trend that began several years ago as the industry increased prevention efforts."

But looking at the data at the CDC website, you can see that the "trend" is actually flat, with 14 to 15  outbreaks reported to the CDC for each the past 3 years (2008, 2009 and 2010).  This year will probably end up with the same number of reported incidents.

There has been an additional outbreak reported to the CDC just since the CruiseLog article was published yesterday.  HAL's Ryndam cruise ship has reported that more than 5% of its passengers reported to the ship's infirmary complaining of vomiting and diarrhea. You can read Cruise Ship Sicknessabout this latest outbreak here.  The cruise ship is returning to Tampa tomorrow.

Unfortunately, there seems to be an outbreak or two over the Christmas and New Year sailing somewhere each year, so we should reasonably expect there to be the usual number (14 to 15) this year as in past years.

My real criticism of the CruiseLog article is not whether the number is actually 15 versus 11.  It is that the article really doesn't explain that the cruise ship outbreaks reported to the CDC are probably less than 50% of the actual number of incidents which occur around the world each year.  Remember that cruise lines do not report sickness outbreaks to the CDC if the cruise does not call on a U.S. port.  This is significant because many cruise lines re-positioned a greater number of their cruise ships to Europe and Asia in recent years compared to five years ago

Although it is difficult to track the incidents outside of the U.S., we have reported on a number of incidents this year. 

For example, in September, norovirus broke out on Celebrity's Eclipse sailing out of Southampton, England. Royal Caribbean's cruise ships sailing out of this U.K. port remained on heightened alert for months.  You will find no mention of this is in the official CDC database.  The cruise lines certainly will never voluntarily disclose this.

In November, we reported on one death and 80 sick passengers on HAL's Veendam which Holland America Line Veendam Cruise Ship Norovirus?experienced a sickness outbreak as the cruise reached in Rio de Janeiro.  

The other issue that the CruiseLog does not explain is the cruise lines report disease outbreaks only when 3% of passengers are afflicted based on the number of ill passengers who appear in the ship infirmary.  This is significantly less than the true number of those afflicted with viral illnesses.  Many sick passengers know that they will be quarantined in their cabins or they simply do not want to wait in the long lines outside of the ship infirmary. 

The Clinical Infectious Disease Journal reported earlier this year that 40% of passengers with a viral infection did not report being sick to the ship medical staff.  If these passengers were included in the sickness count, then the number of CDC reportable cases would surely increase.   

CruiseLog also points to Carnival as not reporting a single outbreak this year.  Does that mean that Carnival has a vaccine against the cruise ship bug?  Hardly.  Consider the following comments by cruise passengers on the CruiseJunkie website about the Carnival Conquest last week:

"From a passenger: There was an outbreak of something vomiting and diarrhea starting on Tuesday of the cruise (4-11 Dec). My husband got sick on Thursday morning and was asked to stay in cabin on isolation. On Friday I came down with vomiting and diarrhea. We were told there were lots of people sick.

Another passenger writes: On our final day at sea suddenly all the crew was wearing gloves and none of the passengers were allowed to get their own plate or food at the buffet.  Everything had to Cruise Ship Norovirusbe served by the staff and they were constantly wiping down everything and making announcements about hygiene.  We asked if something was going on and we were told no however by that night 3 of the seven people in our party were very sick and once we walked in on an employee in the bathroom vomiting very badly.  A casino employee told us that night many of the crew and passengers were very sick. 

When we were getting off the boat Sunday we saw stacks and stacks of mattresses in plastic they were loading on the ship.  We still have people from our group sick and I wish we had been told something.  We received no information and since I was traveling with two children and my seventy year old father I continue to be concerned." 

Families intending to cruise and worried about norovirus should read news sources like CruiseLog with a grain of salt.  There is no empirical evidence that norovirus and other cruise ship sicknesses are on the decline. 

Regarding cruises not calling on a U.S. port, the best sources of information are anecdotal, like cruise community forums and websites not beholden to the cruise lines like Professor Ross Klein's CruiseJunkie.

New Study Reveals Little New About Norovirus on Cruise Ships

The medical journal "Clinical Infectious Diseases" published an article entitled "Disease Transmission and Passenger Behaviors During a High Morbidity Norovirus Outbreak on a Cruise Ship, January 2009."

Of some 1842 passengers on the cruise ship, 1532 (83%) returned questionnaires provided by the researchers.  236 (15%) met the norovirus definition.  

Cruise Ship Norovirus This particular cruise had a passenger vomit in a public area during boarding, as well as 7 other incidents where passengers vomited in public.  The Centers for Disease Control ("CDC") investigators concluded that some sick passengers may have been infected by the vomit (through aerosolized vomit or by touching contaminated surfaces) or they were infected by person-to-person contact, particularly by an ill cabin mate. 

The CDC investigators also concluded that some of the public toilets on the cruise ship were out of hand soap and paper towels and dish washing machines did not do an adequate job sanitizing eating utensils.  These shortcomings might have contributed to the outbreak.

Nothing new with these conclusions.

The two interesting points in my opinion revealed in the study:

Of the 236 ill passengers, 95 (40%) did not report to the infirmary.  We have been told by many passengers on cruises plagued by norovirus that the actual number of sick passengers reported by the cruise lines to the CDC was far less than the actual number of passengers with norovirus.  Cruise lines report only the number of passengers who report to the ship infirmary.  This is a problem we have discussed before - Is Celebrity Cruises Under-Reporting Sicknesses to the CDC?

Perhaps the most interesting statistic is that 62% of ill passengers did not decrease their participation in public activities.  Over 200 passengers ill with norovirus walking around the ship?  Yuck.  This undoubtedly led to the spread of the outbreak.

But most outbreaks of norovirus on cruise ships are no so clear cut.  There appears to be no effort to scientifically determine the source of norovirus outbreaks.  

As we have reported in prior blogs,  the U.S. Food and Drug Administration (FDA) concludes that whereas "person to person" transmission of norovirus has been documented, "norwalk gastroenteritis is transmitted by the fecal-oral route via contaminated water and foods."  The FDA reports that "water is the most common source of outbreaks and may include .  .  . water stored aboard cruise ships."

When will the CDC conduct a recent study analyzing the potable water and food products after an outbreak?  Compare this study with a study by the CDC in 2002 which the CDC "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" and "we identified that eating breakfast at restaurant A on day 2 of the cruise was associated with illness . . ."  Or consider "Characterization of a variant strain of Norwalk virus from a food-borne outbreak of gastroenteritis on a cruise ship in Hawaii" (pin-pointing fruit at a buffet as the likely culprit).
 

Read some of our other articles about cruise ship norovirus:

Cruise Ship Norovirus - Clean the Damn Toilets!

"Cruise Ship Sickness" - Is Norovirus In The Food and Water?

Cruise Ship Norovirus - Something in the Water?

March 24, 2011 Update:  USA Today's CruiseLog has a story today about this study, indicating that the study involved Celebrity Cruises' Mercury cruise ship in January 2009.  As we pointed out in an earlier blog, the CDC investigated outbreaks on the Celebrity Mercury in  January and February 2009. 

The interesting thing about the Mercury was that it experienced four cruises a year later, in 2010, with repeated outbreaks of norovirus until the CDC took the unprecedented step of issuing a no sail order, an event we covered last March: Centers for Disease Control: "Shut Mercury Cruise Ship Down!"   It would have been interesting for the CDC to have studied the cause of the norovirus on this cruise ship for months in early 2010.  Why did this particular cruise ship experience so many problems with norovirus?  Certainly it was not just because a passenger puked on embarkation in January 2009?

Norovirus Update on Celebrity's Mercury Cruise Ship - March 21st Sailing

A local news station in Charleston South Carolina is reporting that passengers aboard the Mercury cruise ship on the March 21st sailing are ill.  The story is entitled  "Five Cases of Norovirus on Celebrity Mercury Cruise Ship."

The article suggests that the information came from the cruise line, although I do not see a quote or a press release from Royal Caribbean / Celebrity.  The article is rather vague, as I'm sure it's more accurate to say that some passengers have norovirus-like symptoms.  Stool samples have to be taken and analyzed ashore before anyone can conclude that norovirus exists. (There is still no official determination regarding the cause of the last round of sickness on the Mercury).  

Mercury Cruise Ship - Celebrity Cruises - Norovirus?If this information is accurate, five cases of gastrointestinal sickness is not particularly significant.  The Centers for Disease Control (CDC) "Vessel Sanitation Program" does not require the data to be reported until at least 2% of the passengers are affected (around 37 passengers).

It is possible that all five passengers were infected before they boarded the cruise ship, because there are reports of norovirus ashore of course.  It is also possible that they contracted a virus after they boarded.

We have received a number of calls and emails asking for information about the Mercury's March 21st sailing.  Here are some suggestions:

The Cruise Critic message board has a posting "People are Sick Again on the Mercury," where there is mention of a small number of passengers who may be ill.  The cruise community message boards are sometimes a good source of information, particularly when the cruise lines are not forthcoming with information.

I have found that the CDC eventually responds to e-mails and telephone calls.  The email for the CDC is cdcinfo@cdc.gov - be sure to include "Celebrity Mercury Cruise Ship - March 21st sailing" in the title of your email.  The telephone number is 800-232-4636.

The PR person at Royal Caribbean who handles crisis management statements, including norovirus outbreaks, is Cynthia Martinez.  Her email is CynthiaMartinez@rccl.com  I would be interested if anyone receives a response. 

We often hear from passengers directly from the cruise ships.  If we hear something, we will update this article.

March 27, 2010 Update:

The Charleston Regional Business Journal reports that the Mercury has only 6 sick passengers -"Celebrity Mercury Sees Huge Dip in Sickness After Extra Cleaning Measures."  Good news for Celebrity Cruises and the next round of passengers who will be sailing this Monday, March 29th. 

 

Credits:

Photograph         Directory of Charleston

Celebrity's Mercury Cruise Ship - Free of Norovirus?

So far, no one is reporting an outbreak of sickness aboard Celebrity Cruises' Mercury cruise ship for its latest - March 21st - sailing.  This is good news after the last three disastrous cruises.

Today's South Carolina Post and Courier newspaper runs the headline "Mercury Appears Free of Norovirus" in which the newspaper reports: "after several days at sea, the Celebrity Mercury seems finally free of a stomach bug that afflicted nearly 1,000 passengers on its previous three voyages Norovirus - Cruise Ship - Contaminated Food, Water - Infected Food Handler? from Charleston." 

The Cruise Critic message boards for the Mercury also seem to suggest that there is not a problem with gastrointestinal sickness, yet.  

The question remains what was the cause of the last illness outbreak on the Mercury?  Was it norovirus?  Was it transmitted due to contaminated water or food?  An infected food handler?  

So far the Centers for Disease Control (CDC) have not said.

Let's hope that the cruise ship passengers do not get sick for the remainder of the cruise.    

If you are on the cruise and know otherwise, let us hear from you.  Otherwise, enjoy your cruise! 

 

Credits:

Chart        Virginia Bioinformatics Institute, Virginia Tech

"Cruise Ship Sickness" - Is Norovirus In The Food and Water?

The Centers for Disease Control (CDC) reports numerous outbreaks of norovirus on cruise ships operated by Celebrity Cruises, Cunard, Holland American Lines, and Royal Caribbean. 

Every time there is an outbreak, the cruise lines blame the passengers who board the cruise ships.  The media picks up in this theme and often reports that the problem is not with the cruise ships but the passengers who board the ships already infected with norovirus.  For example, in a recent article in the New York Times Travel Section "Stomach Bug Hits Cruise Ships," respected journalist Michelle Higgins writes " . . . the contaminated ships have since been disinfected  . . .  but Norovirus - Cruise Ship - Contaminated Water?such measures can’t prevent a sick passenger from coming aboard and infecting others."  Ms. Higgins suggests that " the best defense is simple: wash your hands."

Unfortunately, the issue is not so simple.

According to the U.S. Food and Drug Administration (FDA), whereas "person to person" transmission of norovirus has been documented, "norwalk gastroenteritis is transmitted by the fecal-oral route via contaminated water and foods."

Contaminated Water Supplies On Cruise Ships?

The FDA indicates that contaminated water is one of the most likely causes of norovirus.  The FDA reports that "water is the most common source of outbreaks and may include water from municipal supplies, well, recreational lakes, swimming pools, and water stored aboard cruise ships.

So whereas you always hear reports of extra cleaning of the bathrooms and cabins on infected cruise ships, there is never a mention of whether the potable water is tested and the results of the testing.

Contaminated Food Supplies On Cruise Ships?

In addition to water supplies on cruise ships being a potential source of the virus, food supplies on cruise ships can also sicken the passengers.

The FDA reports that "shellfish and salad ingredients are the foods most often implicated in norwalk outbreaks. Ingestion of raw or insufficiently steamed clams and oysters poses a high risk for infection with Norwalk virus. Foods other than shellfish are contaminated by ill food handlers."

It would be interesting to determine the job positions of the crew members infected with norovirus.  For example, the CDC reports that sixty-nine crew members were reported ill on Celebrity's Mercury and Millennium cruise ships during recent cruises.  How many of these crewmembers were cooks, waiters or food handlers?  

Norovirus - Cruise Ship - Contaminated Food?The issue of eating oysters and other shellfish on cruise ships presents a double whammy.  Cruise ships dump sewage 12 miles from shore, and the fecal material can contaminate shellfish which filter-feed.  Both cruise passengers and people ashore can then be infected by eating contaminated shellfish. 

Uncertainty Regarding Cause of Virus and Transmitting Agent

Although the CDC tries to determine the "causative agent" of the outbreak, this means that they are trying to determine the nature of the pathogen (i.e., whether it is norovirus or some other virus).  But the CDC does not report whether the virus came from a person boarding the cruise ship or, the more likely scenario if the FDA is correct, from contaminated food and water on the cruise ship.

The issue arises where do the cruise lines obtain their potable water?  From U.S. based vendors or from the Caribbean islands?  What testing is done at the ports before the water is brought aboard?  Where do the food products come from?  Is any of the food inspected by the FDA before it is loaded on the cruise ships?  

The CDC reports that around 600 passengers became ill on Celebrity's Mercury cruise ship on the last two cruises alone.  Are we to believe that all 600 people simply failed to wash their hands?  Or is there something in the food and water? 

Cruise lines should be required to publicly report the test results of the cruise ship's water samples, so that the U.S. public can determine the true cause of cruise ship illnesses.

If contaminated water is the culprit, all of the external cleaning of cruise ship surfaces is not going to solve the problem.   

Additional Information: 

Passengers can track the reported outbreaks on the CDC web page which tracks "Outbreak Updates for International Cruise Ships."  Not all norovirus outbreaks are required to be reported to the CDC and the CDC website is incomplete. 

A good source for additional information is found on "Illness Outbreaks on Cruise ships."  We have reported on numerous cases of cruise line illnesses in prior articles

Will the Celebrity Mercury Infect Another Round of Passengers?

Around 450 passengers and crew are sick with nausea, vomiting and diarrhea aboard Celebrity's Mercury as the ill cruise ship completes its inaugural cruise to the Caribbean from the port of Charleston, South Carolina.  The cause of the illness is unknown.  The cruise ship will sail again from Charleston tomorrow, and many new passengers don't want to set foot on the ship.

This is not what the city of Charleston or the thousands of passengers who paid for a relaxing cruise to the Caribbean bargained for.  

The media is focusing on this nauseating story. The Baltimore Sun has an article "More Than 400 Sick Aboard Celebrity Mercury Cruise Ship" (the comments are brutal).  The Consumerist's headline says it all: "Caribbean Cruise Ship Turns Into Diarrhea Nightmare Vessel." 

Cruise Ship Sickness - Norovirus - Pepto Bismol?In ABC News' story "400-Plus Passengers Get Sick on Cruise," the cruise line's PR spokesperson, Cynthia Martinez, says that the ship doctors are giving passengers anti-nausea and diarrhea medication such as Pepto-Bismol . . . "   

Pepto-Bismol?  

The cruise line is in overdrive trying to clean the cruise ship. The web site of a local news station in Charleston carries the story "Mercury Crews Scramble to Clean Cruise Ship."  The ship's crewmembers are "conducting some 'enhanced cleaning,' according to Ms. Martinez. 

"Enhanced cleaning?"  What the heck does that mean?  And what exactly are they cleaning?

The cruise line has not even established the type of pathogen or virus involved and its source.  Large scale sickness like this on a cruise ship can come from numerous sources - such as a contaminated water supply, improperly prepared food, or norovirus in bathrooms. The Norovirus Blog reports that cruise ship norovirus outbreaks are linked to the ship's bathrooms, and we addressed this issue last year in our blog "Cruise Ship Norovirus - Clean the Damn Toilets!"

But so far, there is no indication that norovirus in the ship's bathrooms is the culprit.  If the ship's water supply is contaminated, all of the external cleaning in the world is not going to eradicate the problem.

And at this point, it does not look like the cruise line knows, or at least it is not disclosing the source of the problem to the public or the next 1,800 passengers who are boarding the cruise ship tomorrow.  Instead, the cruise line is implying that its the passengers who are the problem because they are not washing their hands, rather than the ship which is infecting the passengers.    

This week our office has received a number of inquiries from passengers who are frightened to sail on the Mercury tomorrow.  They wonder whether they can cancel their cruise and get their money back.  Unfortunately, the cruise line's lawyers have spent years crafting terms and Celebrity Cruises - Mercury - Sickness - Illnessconditions in the passenger tickets which protect the cruise line, not the consumer.  And if the passenger has travel insurance, the insurance company probably won't pay if the passengers cancel because they are not sick (yet) and the cruise ship will sail again tomorrow, come-hell-or-high-water.    

The cruise line is promising to give sick passengers a voucher "based on the number of days a guest is isolated divided by the total of cruise fare paid."  Huh?  These nice people are sitting on a crapper in their cabins, vomiting into a waste can on their lap.  All they get is a voucher for partial payment for another cruise?  That's a crappy deal, excuse the pun.

What a predicament for these folks.  Tomorrow, the cruise line will unload the 1,800 passengers from the Mercury and load another 1,8000 back on.  And the Mercury will set sail again, this time for a 10 day cruise to Mexico, Belize, the Bahamas, and Key West. 

We wish the passengers luck.

And don't forget to take a large bottle of Pepto-Bismol with you . . .

 

February 25, 2010 Update:

The Washington Post reports that the CDC is confirming the presence of norovirus on the cruise shp.  

Our prior article on the Mercury's history of shipboard illnesses: Stomach Bug Hits Celebrity's Mercury Cruise Ship Again

February 26, 2010 Update:

Celebrity Cruises Postpones Cruise From Charleston After Massive Norovirus Outbreak On Mercury Cruise Ship

March 4, 2010 Update:

The Baltimore Sun reports that "about 55 guests have been treated for gastro-like symptoms" on the Mercury cruise ship.

 

Credits:

Pepto Bismol     Shakespeare's Monkey (fark.com)

Itinerary                Celebrity Cruises  

Stomach Bug Hits Celebrity's Mercury Cruise Ship Again

Sick passengers - Celebrity Mercury Cruise Ship The Associated Press reports that hundreds of passengers have fallen ill with a stomach ailment aboard the cruise ship Mercury, operated by Celebrity Cruises, which is sailing in the Caribbean.

Over 300 of the 1,800 passengers are experiencing upset stomachs, vomiting and diarrhea. Another 25 or so crewmembers are also ill. The Mercury left Charleston, South Carolina on February 15th and this is the first cruise from Charleston.

The PR person for Celebrity / Royal Caribbean stated that the cruise ship's medical facilities were "overwhelmed" and another doctor and nurse boarded the Mercury in St. Kitts.

The cruise line did not report what virus or pathogen was involved, but the cruise ship dropped samples off in Puerto Rico for testing. The ship is scheduled to return to Charleston on Friday.

The Centers for Disease Control (CDC) recorded two outbreaks of gastrointestinal illness on the Celebrity Mercury last year. The CDC investigated outbreaks on the Celebrity Mercury in  January and February 2009.

The CDC has a web page which tracks "Outbreak Updates for International Cruise Ships."

Celebrity's Mercury was in the news just last week when a Hazmat team and ambulances arrived at the port in Baltimore after 6 crewmembers became ill after inhaling fumes while welding on the cruise ship. The crewmembers may have poisoned due to carbon monoxide as reported in the press, although there was no carbon monoxide detected when the cruise ship arrived in port the following day. The cruise ship then repositioned to Charleston for this cruise.

We reported on the incident - Carbon Monoxide Poisoning Reported Aboard Celebrity's Mercury Cruise Ship.  There has been no follow up stories on the cause of the illnesses or the condition of the sick crewmembers.

February 24, 2010 Update:

Will the Celebrity Mercury Infect Another Round of Passengers?

 

Credits:

Artwork          Maxim magazine