Cruise Law News : Maritime Lawyer & Attorney : James M. Walker : Walker & O'Neill Law Firm : Admiralty Law, Cruise Ship Accidents & Injuries

For those of you who read Cruise Law News know that I report regularly on the numerous norovirus cases which plague the cruise industry.  I am rather fascinated by the cruise lines' PR departments which always blame norovirus outbreaks on the passengers for bringing the virus aboard, rather than contaminated food and water which infect the passengers.

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."  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.

The question I have always wondered is how does the water become infected with norovirus?

So I was rather exciting after receiving an email yesterday from a kindred spirit from Britain, Mr. Pat Gardiner, who combines a maritime background with a keen interest in zoonotic disease.  Mr. Gardiner referred me to a recent study from Swedish researchers finding a direct correlation between pig effluent and water sources contaminated with norovirus.  Mr. Gardiner agreed to be a guest blogger, and for that my little blog is richer. 

Be sure to read Mr. Gardiner's rather fascinating background at the end of the article.    

Norovirus - Something in the Water - By Pat Gardiner:  

The constant outbreaks of Norovirus on cruise ships are bringing a powerful industry to its knees, quite aside from the distress and risk to the passengers.  Yet, new evidence yesterday suggests the problem may be ashore and entering the ship with the water supply.

Eureka moments do not come from thin air.  They come from relevant, sometimes diverse experience in the right place at the right time.  Few people can have had the delights of a career in Britain’s most successful seaports, retiring early to raise livestock in an area plagued by constant animal epidemics.

The writer has had a ten-year battle with the British authorities over the appalling handling of animal disease spreading to the human population.  Years ago, he noticed an apparent link between the locations of severe animal disease and the schedules of cruise ships. The ships were calling at ports worldwide in areas where pig disease was rife.

Norovirus is a disease shared between humans and pigs.

Few passengers, once on board, give a thought to the source of the water they use to wash and brush their teeth.  Every cruise ship fills with water, before, during and after every voyage at pretty well every port of call. That water comes from the public supply.

So a ship leaving the UK for a cruise to the Norwegian Fjords would take water from the same country as the passengers embarking – Harwich for example. Vessels calling at Harwich were some of the first to encounter norovirus at the same time as the pigs in the area were getting ill. Now, even ferries from the Scottish mainland to the Scottish islands are becoming infected.

For years, the mechanism by which the norovirus reached the ship baffled the writer.

Smuggling of live pigs and bacon sandwiches on board seemed unlikely for passengers bent on a holiday of glamour and luxury.

Then yesterday the ultra clean Swedes provided the missing link. They found norovirus in the sludge intrinsic to their public water system.

We know that pig effluent can contaminate the surface water and the water supply. Incidents are frequent despite the best efforts of everyone. We know that pigs can carry norovirus.  

We also know that, like everyone else, the Swedes have had outbreaks of various pig diseases.

If the water authority do not look for norovirus or do not detect it, the pathogen will be pumped straight into the cruise ship: directly into the ideal environment for spread to a usually elderly population in an enclosed area.

Any vessel calling at, or sailing via, ports in pig farming country is at risk.

It would be grand to think that the writer has repaid the debt of a satisfying career in shipping by helping to solve one of the most damaging problems imaginable, both to shipping and their customers.

Testing the water is cheap and easy, and the ship owners can do it tomorrow.

About Pat Gardiner:

Mr. Gardiner was too modest to provide me with a biography, but I managed to piece together his background from newspapers and information on line. 

Mr Gardiner started out in the maritime shipping business in the 1960's, working for Blue Star Line in Britain.  He rose to the top of the ship and line agencies in Britain's premier port of Felixstowe.  He has enjoyed a long standing relationship with the U.S., which includes working with what is now the U.S. Sealift Command. He managed his own companies (which acted as agent for U.S. Line among others).  He is a well known figure in the U.K. port and shipping business, and also wrote for newspapers about the shipping and port business.  He twice sold his group of successful shipping and freight businesses, and retired from the maritime freight business while he was still in his forties.   

After his retirement, Mr. Gardiner developed an interest in animal health and zoonotic disease.  In the process, he developed an appropriate distrust of the U.K. veterinary services.

He is the author of two blogs - Animal-Epidemics and  Go Self Sufficient.

Mr. Gardiner is a pancreatic cancer survivor.  He also survived a unsuccessful campaign to ruin his reputation by members of the pig farming and vet industries. 

In 2005, Mr. Gardiner drove across the U.S. in 2005 with his wife.  They are pictured above at my favorite vacation destination, a U.S. national park (Grand Canyon).  Mr. Gardiner can be reached at: patgardiner@btinternet.com 

Additional information:

The "Gardiner Hypothesis:"  Mutated Circovirus in pigs, the consequences of being treated with heavy use of antibiotics, is followed by MRSA in pigs and then MRSA and C.Diff epidemics take off in humans. A circovirus mutation in Britain in 1999 was covered up. The resulting epidemics spread first around the UK, then to Canada and from there, most recently, to the United States.

Learn a new word:

"Zoonotic diseases" - diseases caused by infectious agents that can be transmitted between, or are shared by, animals and humans.

Read Other Cruise Law News Blogs About Cruise Ship Norovirus:

Norovirus On Royal Caribbean's Jewel Of The Seas?   

Centers for Disease Control: "Shut Mercury Cruise Ship Down!"

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

U.S. to Block Arrival of Queen Victoria After Norovirus Outbreak?

Cruise Ship Norovirus - Clean the Damn Toilets!

Best in Law Blogs: 

Mr. Gardiner's article won a top 10 award for Best in Law Blogs today as part of Lexblog's 3,000 blogs.

Thanks Pat!  

 Credits:

Photographs          Pat Gardiner

Diagram            Virginia Bioinformatics Institute, Virginia Tech

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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 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?  

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. 

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