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

The Centers for Disease Control and Prevention (CDC) reports the Celebrity Millennium cruise ship sailed to Seward, Alaska last Friday, May 10th, with an elevated number of passengers and crew with a gastrointestinal illness.  164 of its 1,963 passengers and 30 of its 935 crew members experienced the gastro-illness.

The CDC states that the "causative agent" (type of pathogen) is "unknown," although at least one newspaper, the Seward City News, states that the sickness outbreak is believed to be caused by norovirus.

Comments to the newspaper complained about cruise passengers coughing and hacking in public and the locals having to be on higher alert to wash their hands when cruise ships come into port.  

Photo Credit: Wikimedia / Captain-Tucker

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A Canadian news source, CBC News, reports that cruise passengers on a 31-day Holland America Line (HAL) cruise returning to Vancouver suffered from the ill effects of a norovirus outbreak. 

The outbreak involved HAL's Volendam.  The cruise line, which has experienced more gastrointestinal outbreaks than any other cruise line in the last decade, drained its pools and hot tubs and emptied its libraries to try and contain the spread of the norovirus outbreak.

HAL reported 28 guests and one crew member (2.37 % of the total 1,222 people on board) were sick over the course of the cruise. At three percent, Health Canada could launch a full investigation but will not because the reported cases did not reach this percentage.

One passenger told CBC that the problem appeared worse to those onboard than just the reported cases: "It had to be quite high, because it seemed like you would never sit at a table at dinner without someone having had it." 

After a few hours of cleaning, the cruise ship sailed on a week-long cruise to Alaska at 5 p.m. on the same day it returned to Vancouver

Yesterday we reported on another HAL disease outbreak on the Veendam. 

The last time we reported on the Volendam, the article involved a crew member fatality when a cable to a lifeboat snapped.

Photo Credit: Wikipedia / Barek

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Thursday night a news station in West Palm Beach, Florida is airing an expose into passengers who are sickened on cruise ships.

WPTV - 5 aired a teaser video tonight entitled Cruise Ship Workers are Breaking the Rules, and Making Passengers Sick.

It sounds like the TV station will take a look at the outbreak of gastrointestinal viruses which have plagued the cruise industry over the years. It promises to reveal the cruise lines with the most problems (i.e., Princess Cruises and Holland America Line).

Cruise lines always blame the passengers for not washing their hands, and the passengers usually blame the cruise lines for having unsanitary ships.  Meanwhile no one is conducting a scientific analysis to determine exactly where the virus originated.  

I will be watching tomorrow night at 11:00 PM.   

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Yesterday I mentioned that over one hundred people are sick with norovirus aboard the Crown Princess cruise ship which will be arriving in Galveston tomorrow at the end of a 20 day cruise from Italy.  This is the third outbreak of noro on this particular Princess cruise ship this year.

According to the Food & Drug Administration (FDA), although there are cases of noro illness transmitted by hand-to-hand contact, the most likely cause of a norovirus outbreak is contaminated water.  Contaminated food is also a likely culprit.

But if you study the last one hundred cruise ship norovirus cases, one thing is certain - the cruise line will always blame the passengers for bringing the virus aboard.

The New York Times just published a short (three sentence) article about the latest norovirus outbreak on the Princess ship. The newspaper reports that Princess is again pointing its finger at its passengers:

"A spokeswoman for Princess Cruises says more than 100 passengers and crew members contracted a stomach virus on one of its ships, the Crown Princess. The illness struck during a Venetian cruise due to end Saturday at Galveston. The spokeswoman said the cruise line suspects the virus was brought on board by passengers." 

If the cruise lines don't flat out accuse the passengers of being the problem, there will always be an implication that the passengers must not have washed their hands.

The amazing thing about the cruise industry is the frenzy activity when the ships come to port. A tremendous amount of provisions are brought aboard at every port, literally hundreds of thousands of pounds of beef, chicken, pork, fish and shellfish as well as every fruit and vegetable under the sun. Hundreds of thousands of gallons of water are pumped into the ship. The crew members get on and off the ship and of course the passengers do as well.

Was the food and/or water served to passengers on the ship contaminated? Did the passengers or crew eat contaminated food ashore?  Were the hands of a crew member involved in food preparation infected?

Proving exactly how the virus appears on a cruise ship is a difficult scientific process. But no one is engaged in such testing.  Yes, the Centers for Disease Control (CDC) test to determine whether the gastrointestinal illness is due to noro or e-coli, but that's where the testing stops.

So the public is left with the blame game.  The Crown Princess has not even arrived at the port of Galveston where the CDC inspectors are awaiting. But Princess is already telling the New York Times that its contaminated ship is the fault of unidentified guests and their dirty hands.     

Photo Credit: Centers for Disease Control

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U.K. and Australian newspapers don't mince words. Unlike the U. S. media which may politely refer to nasty norovirus outbreak on a cruise ship as a "stomach bug," the U.K. press and an Australian newspaper are using some choice words to describe a vomiting virus which has swept through P&O's Oriana cruise ship, sickening many hundreds of passengers.

The P&O crew taped off areas of the ship "like a crime scene" while passengers said the liner reeked of vomit, the British tabloid The Sun reports.  Reports of 300 to 400 ill passengers have come from on board the cruise ship. "There might be a riot because the captain and crew refuse to listen. We'll refuse to disembark unless we get some answers. It's been a cruise to hell," British passenger Dave Stringer, 57, told The Sun as mentions in its article Fury Over Cruise Ship Vomit Hell.

It seems that P&O is blaming the passengers for allegedly bringing the virus aboard and then spreading it by not washing their hands - which is the cruise industry's usual defense to a sick ship.

The London Evening Standard reports that the cruise line appears to be involved in a cover-up:

"A spokeswoman for P&O's parent company Carnival said there had been 'an incidence of a mild gastrointestinal illness' among the passengers.

She added that as of today, of 1,843 passengers, 'the number of passengers with active symptoms is six.'

But passenger Paul Gilman, 62, told the Daily Mail: "It has been outrageous from start to finish. People were falling like flies, yet the crew were trying to insist everything was fine.

'Everyone is saying, this is a plague ship. It's a living nightmare.'"

The Oriana returns to Southampton today where, after "enhanced cleaning" takes place, the ship will re-rack with another 1,800 passengers for a holiday cruise.  Stay tuned for more vomit-cruise-from-hell stories.

Photo Credit: News Tank

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The Centers for Disease Control (CDC) reports that 10% of the passengers aboard Holland America Line's Amsterdam cruise ship were sickened by a disease on the ship. It is not yet known whether the disease was norovirus or due to some other causative agent. 

The Amsterdam was in port in San Diego yesterday after a long cruise starting in Sydney Australia on November 11 and arriving in San Diego on December 5, 2012. 81 of 791 passengers became ill. This turns out to be 10.24% of all passengers (assuming all passengers reported their illness and the cruise line accurately reported the outbreak to the CDC). This is an extremely high percentage of affected passengers.

The cruise line's PR department down-played the outbreak saying "a number of guests reported to the infirmary with a common type of gastrointestinal illness."  The popular cruise site Cruise Critic (owned by Expedia travel company) shrugged the illness off as due to a "stomach bug" and repeated HAL's advice to passengers for "extra hand washing."

As usual, there is no discussion regarding the most likely cause of the outbreak. Cruise lines like HAL like to blame the passengers and suggest that they brought the virus aboard and it was then spread because other passengers didn't wash their hands. If this is viral based, due to norovirus, or due to e-coli infection, the real culprit is probably contaminated food or water.

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."

Most of the affected passengers reportedly became symptomatic after the cruise ship left its last port of call (Hilo, Hawaii) on November 29th. Are we to believe that suddenly 10% of the passengers suddenly stopped washing their hands? Or is it more likely that contaminated food or water introduced at the last port of call were the culprit?

The Friends of the Environment (FOE) has an interesting article that the problem is not sick passengers affecting the cruise ship, but sick ships affecting the passengers. FOE tracked the top 12 cruise ships with the most gastrointestinal outbreaks from 2000 to the present, based on the CDC data.

Out of the top 12 sickest ships, HAL operates 5 of them and has the top three sickest ships. HAL's Amsterdam is number 2. The Ryndam is number 1. The Veendam, which recently flunked a CDC health inspection (you can read about the filthy ship here and here), is number 3. The other HAL cruise ships which made the top 12 sickest list are the Volendam (no. 9) and the Zaandam (No. 11).  

Art credit: Chan Lowe / Sun Sentinel

Chart Credit: Friends of the Earth

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The Voyager of the Seas has returned to Australia today after a 18 night cruise.  Like the previous cruise, this cruise aboard the Voyager ended with the cruise ship arriving in port with what appears to be hundreds of cruise passengers infected with norovirus.

We are beginning to receive emails from passengers who were sickened during the cruise (see comments below) and observed "many incidences we saw of poor food handling and personal hygiene practices of both crew members and passengers."

A newspaper in Australia has an article about the problem facing passengers: "Gastro Outbreak Hits Voyager of the Seas Passengers in Sydney Harbour." The article states that the boarding of the "mega liner Voyager of the Seas was thrown into chaos today following an outbreak of a gastrointestinal illness thought to be noro virus." The article mentions that, according to Royal Caribbean, around 135 passengers already aboard the ship were struck by the illness but disembarked in Sydney.

One passenger who contacted us said that around 150 cabins were quarantined which would suggest that Royal Caribbean may have underestimated the number of sick guests.  

According to the newspaper, the lines of passengers at the cruise terminal stretched hundred of meters as frustrated cruisers were left waiting for hours under the sun - many unaware of the cause of the delay. The passengers were required to complete detailed medical forms before they board, but quite frankly it should be the cruise line completing forms detailing the sickness of the cruise ship.  

A cruise line spokeswoman denied any connection between the long lines and the norovirus and blamed "thousands of passengers disregarding allocated staggered boarding times."

Many passengers were upset that the cruise line kept them in the dark. Some others were handed at the port an "information sheet" in which Royal Caribbean said those ill had been limited to ''a small percentage of guests.''

What is missing from the newspaper article is the fact that there was a massive outbreak of norovirus on this cruise ship during the prior cruise. No newspapers in Australia reported on the disease outbreak and the cruise line kept mum too. You can read about the prior cruise and the problem with norovirus in our article: "Norovirus Outbreak on Royal Caribbean's Voyager of the Seas?"

One passenger, Steve, wrote to us displeased that Royal Caribbean had not disclosed that there was norovirus on the cruise ship when he boarded on February 5th: 

"In hindsight if we had been made fully aware through official channels that there was an outbreak on the ship, we would have probably gone home as the last thing I needed was to catch a bout of Norovirus. There needs to be a lot more honesty and openness in this industry, as too many people are vulnerable and gullible when it comes to trusting these big cruise companies who profess to have our best interests at heart. Never again RCCL!" 

If you were on the cruise, please leave us a comment about how the cruise line handled the situation, or leave us a comment on our facebook page.

Any New Zealanders on the cruise? There is a news reporter from New Zealand who would like to speak with you. Please email me at jim@cruiselaw.com and I will place you in contact with the reporter.

Anyone with photos, either of the "enhanced cleaning" or crew members wearing protective clothing, etc.? Send us your photos to jim@cruiselaw.com 

November 24, 2012 Update: New Zealand newspaper picks up the story: "Sickness Stalks Luxury Superliner"  As usual, no one in the media raises the issue of the cause of the outbreak. Contaminated food or water? Sick crew members? Or infected passengers coming aboard?  

Photo credit: 

Bill Hearne - top photos of Voyager of the Seas

Australia's Daily Telegraph - bottom photo of Royal Caribbean letter 

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A number of people have contacted us, including one passenger "Nancy" from Australia, complaining about a recent, major norovirus outbreak on the Voyager of the Seas.  She writes:

"The Voyager of Seas has relocated to Asia Pacific region husband and I sailed on the relocation cruise from Singapore 22nd Oct 2012 to Fremantle Australia. There was Norovirus outbreak around 800 passengers affected undetermined number with chest infection, one Norovirus victim airlifted . . . The ships doctor was swamped with sick passengers couldn't cope turned people away untreated. Cabins were sanitized once during the 14 night cruise and measures taken to fight the infection cabins sanitized as we left the ship ,very hard to fight when there are 3000+ people in one place." 

Nancy also commented on the absence of any mention of the disease outbreak: "The outbreak didn't rate a mention on TV or news papers ($$ damaging to tourist trade)." (The image of the Voyager of the Seas to the left was from an earlier norovirus outbreak when the ship was sailing out of New Orleans in February). 

Another person commented:  "My Mother just went on the Singapore to Perth cruise & many people were quarantined . My Mother got sick the last few days of cruise & is still recovering, vomiting diarrhea etc. . . Virus of the Sea Ship . . ."    

Passenger Nancy appeared sympathetic to the cruise line and thought the outbreak may have been due to the failure of the passengers to wash their hands.

Like most outbreaks, it does not appear that any effort will be made to establish the real cause of the outbreak (i.e., a sick passenger brought the virus aboard, or food and water were contaminated, or a sick crew member spread the virus).

The last norovirus reported to the U.S. Centers for Disease Control (CDC) involving the Voyager of the Seas was earlier this year on a January 28 to February 4, 2012 sailing. 

Royal Caribbean and sister cruise line Celebrity have experienced recent problems with norovirus outbreaks - the Celebrity Constellation sailing out of Southampton reportedly had 350 passengers stricken with norovirus last week, and the Rhapsody of the Seas was quarantined last month while in port in Fiji due to the port's concern that sick cruise passengers may infect the local community.  The U.S. media typically does not mention these type of outbreaks. 

Neither of these latest outbreaks were reported to the CDC because the ships did not call on a U.S. port. 

Can anyone else on the cruise verify the outbreak and comment on how the cruise line handled it?  

Please leave a comment below or follow the discussion on our facebook page about the outbreak.

November 23, 2012 Update: Norovirus Continues to Sicken Cruise Passenger on Latest Cruise

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Princess Cruises' Ruby Princess cruise ship experienced a norovirus outbreak with the Centers for Disease Control (CDC) reporting that 129 passengers 9 crewmembers suffered gastrointestinal illness.

The Ruby Princess was on a 7 day cruise from February 26 to March 4, 2012 out of Fort Lauderdale. 

The Ruby Princess suffered another outbreak last month, although the prior sickness was not reported or investigated by the CDC.

The cruise industry has struggled with gastrointestinal outbreaks this year, some outbreaks reported by the CDC, some not, with Princess Cruises and the Royal Caribbean/Celebrity ships leading the cruise puke fest.

Here is a list of cases I have reported on just this year:

Princess' Ruby Princess Royal Caribbean's Independence of the Seas Celebrity' Constellation

Princess' Crown Princess (two sailings) Celebrity's Silhouette 

Royal Caribbean's Voyager of the Seas

Princess' Ruby Princess 

P & O Aurora.

There has been a sick cruise ship virtually every week this year. 

Only cruise ships calling on U.S. ports are required to report sickness outbreaks to the CDC.  Cruise line 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. Crewmembers often work while sick.

Photo credit:  bottom - cheezburger.com

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Multiple news sources are reporting that an U.S passenger died aboard Holland America Line's Veendam cruise ship that arrived in Rio de Janeiro yesterday.

HAL's Veendam is also the same cruise ship on which approximated 80 passengers fell ill, according to the state-run Brazilian news agency, Agencia Brasil.  The agency refers to the cruise passengers as suffering from "gastro-enteritis."  It is unknown whether there is a norovirus outbreak. 

Forensic doctors are investigating the death of the American passenger.  A CNN article reports that the cruise ship doctors told police that the woman was "elderly and suffered from diabetes and hypertension."  (So much for the confidentiality of a patient's medical information.) 

The Veendam left New York 36 days ago for a South America cruise. The Veendam had stopped earlier in the cruise at ports in Chile, Argentina and Uruguay before reaching Rio de Janeiro.

November 23, 2011 Update: 

HAL claims that the death and the illness of some 80 passengers are unrelated.  HAL issued a statement to Noticias de Cruceros that the passenger died due to a heart condition which had nothing to do with the  gastrointestinal ilnesses.  It's amazing how cruise line PR people suddenly become epidemiologists when someone dies on their cruise ship. 

But a local newspaper in Brazil, Clarin, has the following account (translated):

An American, 61, died of a suspected food poisoning on a luxury cruise ship which arrived in Rio de Janeiro, from Chile, Argentina and Uruguay, in which 86 other passengers had symptoms such as cramps and vomiting, reported Brazilian authorities, in what is thought to be an outbreak of gastroenteritis due to consumption of bad food and poor hygiene.

The Holland America liner MS Veendam, carrying 1259 passengers, arrived in Rio de Janeiro and was quarantined to be subjected to investigations by the Brazilian Federal Police and the National Health Surveillance Agency (ANVISA) .

Tourism Secretary de Janeiro, Ronald Azaro, said that 79 people have contracted some sort of infection on the trip. When the November 6 cruise departed from Valparaiso, Chile, ANVISA received a warning symptoms of some passengers.  He went to Argentina and Uruguay, having started the journey in New York, USA, with stops in Panama and Colombia, according to the Brazilian press.

The official said the Brazilian Federal Police took over the investigation into the death of the American, identified as Dorothy Philips, age 61, occurred on board as the ship was in the Maua Pier in the city of Rio. 

Sources told the Brazilian media crew that the crew issued a red alert three days ago to take care with hygiene and some food. For now, the pool and the library of the cruise were closed. 

According to the NASS report released last month, 27% of cruise ships passing through the Brazilian coast have health problems than those permitted by the rules in Brazil. Among the problems, according to an official report collection are inadequate food and lack of water conditions offered to passengers. 

ANVISA recalled thatpassengers on the same boat, in March this year, experienced gastroenteritis cruising to  Brazil. At least 43 passengers had symptoms in Belem, capital of Amazon state of Pará.

Photo credit:  Michael Penn / Juneau Empire 

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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.  

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?

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