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

The last several articles on this blog have involved gastrointestinal (G.I.) virus outbreaks on cruise ships.

The cruise ships involved are Holland American Lines’ Volendam and Veendam, (HAL ships, historically, are the most likely to be contaminated with norovirus), the Discovery cruise ship which was held up in Liverpool for what the cruise lines describe as “enhanced cleaning,” and most recently the Celebrity Millennium which arrived in Alaska with a bunch of sick passengers who went ashore and coughed all over the city of Seward.

These ships join the list of other sick cruise ships this year. There are seven official reports of G.I. cases so far this year documented by the U.S. Centers for Disease Control and Prevention (CDC). But the list is incomplete. The CDC requires cruise lines to report outbreaks only when a certain percentage (more than 3%) of the passengers become ill. If the cruise ship does not call upon a U.S. port, then the CDC has no jurisdiction and there is no obligation to report any G.I. cases to the U.S. federal government.

Most countries around the world don't require reporting of cruise G.I. cases. So when you read the CDC database of G.I. outbreaks on cruise ships, remember that this is only those cruises which dock at a U.S. port and where at least 3% of the passenger report to the infirmary.

My partners at my law firm ask me why I blog about G.I. cases because our firm rarely handles such cases. Why don’t we handle G.I. cases? For a couple of reasons:

It is usually impossible to prove where the virus originated. The CDC and the Food and Drug Administration (FDA) concluded long ago that most norovirus outbreaks are due to contaminated food and water. No, not due to the dirty hands of the cruise passengers as the cruise lines want you to believe, but noro-laden food or contaminated water.

But general propositions are no help in a particular case. The CDC makes no real effort to pinpoint the epicenter of the outbreak on the cruise ship.

The CDC usually can figure out the causative agent (i.e., noro, e-coli, etc.) but that’s where the federal agency’s inquiry ends. The CDC has but a few hours to board the cruise ship and conduct its investigation once the ship returns to a U.S port. It does not have the time or the resources to perform a full blown epidemiology assessment during the limited time the ship is in port.

Was the water well used to irrigate the potatoes or lettuce which were loaded onto the cruise ship contaminated by noro-infected swine feces that leeched into the well supplies? You will never know because no one is doing any investigation to find out.

The cruise lines don’t want such sophisticated analysis either, because the most likely cause of norovirus outbreaks is not bad passenger hygiene but contaminated food and water. It’s bad for cruise business for an official U.S. agency to point the finger at contaminated water or infected food, or to conclude that food handlers worked while infected with noro and, in turn, contaminated 150 plates of salad consumed by the passengers.

Illnesses due to e-coli or norovirus are nasty. You’re afraid that you are going to die and then you’re afraid that you’re not going to die, the joke goes. But it’s no joke. Sick passengers do die, particularly elderly passengers with suppressed immune system and especially those who are ignored by the ship doctors or those who receive bad care while on the cruise ship.

The rights of ill or dying passenger infected with norovirus on cruise ships are limited. The Death on the High Seas Act (DOHSA) prohibits the recovery of damages for elderly retirees. Their deaths are financially meaningless if they become sick during a cruise and then later die either on or off of the cruise ship. Cruise lines love DOHSA. Also, sick passengers who receive bad medical care by the ship doctors usually have no recourse against the cruise lines because the ship doctors are legally considered to be “independent contractors” for whom the cruise lines have no responsibility. And neither the cruise lines nor the CDC or FDA are trying to find out where the norovirus came from in the first place.

Cruise lines are cutting back on the testing of water, placing increasing demands on its crew members who often work while sick, hiding dirty galley equipment from CDC inspectors, and pushing their ships and staff past reasonable limits leaving little time and resources to maintain a clean and hygienic environment. 

It’s easier for the cruise lines to blame the passengers for poor hygiene and then stand behind the CDC’s and FDA’s indifference and archaic laws like DOHSA which have insulated the cruise industry from the consequences of their negligence and recklessness for decades.

In a nutshell, we don’t handle G.I. virus cases because the deck is stacked against the cruise passenger. Cruise passengers typically don’t know when they board a noro-infected ship that they have few rights and that the cruise line will blame them if they get sick. We blog about the problem because it is an insight into the way which the cruise industry operates its business and treats its customers.

The cruise lines say that the “health and safety of cruise passengers are its highest priorities.” That’s not true. We prefer that the cruise passengers understand that before they walk up the gangway into a noro-contaminated ship.

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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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The Centers for Disease Control and Prevention (CDC) reports that sixty (60) of the 1237 passengers (4.85%) aboard the HAL Veendam cruise ship exhibited symptoms such as diarrhea, nausea and vomiting during the last cruise.

Ten (10) of the 574 crew members (1.74%) also reported ill with gastrointestinal illness.

You can read the report here. 

The ship sailed from April 13 to May 4, 2013.

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

Last year, 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 last decade HAL's cruise ships have experienced the most gastrointestinal illnesses and the Veendam has the third most outbreaks of the hundreds of cruise ships operating out of the U.S.  The only other cruise ships with a worse records are the Ryndam and the Amsterdam, both HAL ships. Read about the problem here.    

Photo Credit:  Wikipedia / Djheini

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According to the Centers for Disease Control and Prevention (CDC), another Celebrity Cruises ship flunked a surprise inspection.

The Celebrity Century failed the CDC inspection, receiving a score of only 78.

Last week we reported that another Celebrity cruise ship, the Summit scored, flunked an inspection with a score of only 81. Three other cruise ships received failing scores as well.  So far this year there have been five cruise ships with failing grades. Read our article: Disease Breeding Grounds: Three Cruise Ships Fail Health & Sanitary Inspections.

The most disturbing finding was not just that the Century was dirty with contaminated food debris, but that crew members worked while ill with gastrointestinal sicknesses. Several of the ill ship employees worked in the galleys or interacted with passengers while ill.  The other cruise ships who flunked the inspections earlier this year also had ill crew members who worked with food and around passengers as well.  

These findings are significant because the cruise lines always blame the passengers when there are norovirus outbreaks and accuse the quests of not washing their hands.  The outbreaks may be due to ill employees who may be contaminating the food and infecting passengers.  

You can read the report of the Century here. 

The report indicates that two cruise ship cook worked while ill before reporting to the ship's medical infirmary.  A sick hair stylist worked all day around passengers before going to the medical center. And an ill gift shop attendant worked before going to the medical center and continued working after he was suppose to be in isolation.

A particularly disgusting finding was that the toilet intended for galley workers was found locked when the galley was in service, and when the inspectors opened the door, the bathroom had no toilet paper.

And you wonder why there are norovirus outbreaks on cruise ships?

Leave a comment below or join the discussion on our Facebook page.

Photo Credit: Celebrity Century Cruise Ship - Wikipedia / Emesbe

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CBS (Miami) reports today that  a Royal Caribbean cruise ship arrived back in Port Everglades this morning with an outbreak of norovirus on board

The cruise line has not responded to requests for information, but passengers aboard the Vision of the Seas complained about vomiting and diarrhea. Passengers said more than 200 passengers had to be quarantined due to the outbreak.

“It’s been a hell of an experience,” said passenger Johny Celaire, of the 11-day cruise.  The captain reportedly announced there had been an outbreak of the norovirus on board shortly after the cruise ship departed.

CBS reports that one cruise passenger, Joan Webber was not  quarantined even though her husband was ill.  She is concerned that other passengers infected with the virus will take taxi cabs to hotels and airports where others could be exposed.

“There are people flying out today that are going on an aircraft that have diarrhea so bad they don’t know how they are going to get back up to Canada,” Webber said. “I’m surprised we didn’t go and have the health department talk to us.”

CBS further reports that Celaire said Royal Caribbean’s customer service reps added insult to injury when they called to inquire about the situation.

“She said to me if you had washed your hands you’d be okay,” Celaire said. “I said, ‘How the hell do you know if I didn’t wash my hands?’”

Blaming the passengers is a common ploy by the cruise lines even though the Centers for Disease Control (CDC) state that the most likely cause of norovirus outbreaks is contaminated food or water. 

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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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A newspaper in the U.K. reports on the grave illness suffered by a 18 year old college student in England which left her fighting for her life.  

Chelsea-Rose Cartwright, photo left, developed septicemia from a virus she caught while on a cruise in the Mediterranean. Septicemia is a severe blood infection that can lead to organ failure and death. It often begins with chills, high fever, rapid breathing, and/or a rapid heart rate.  

Ms. Cartwright planned to be a bridesmaid at her father’s wedding during the cruise in November of last year. But she spent most of her time in a cabin with a fever. After she got off the cruise ship, she spent over a month in hospital. She underwent two 6 pint blood transfusions.

Her condition was so critical that her family thought that she would die. Ms. Cartwright's mother said “She could barely talk and could not walk. Her condition got worse and it got so bad at one stage we feared we may lose her.”

Ms. Cartwright became ill on a P&O cruise ship based in Southampton. 

She will be recovering in the hospital for another month.

Her mother stated to the newspaper that she is considering making an official complaint about how P&O staff cared for her daughter aboard the cruise ship.

Photo credit: Facebook

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A Galveston television station reports that a Princess Cruises' ship, sailing from Venice, Italy with a final destination in Galveston, has stricken nearly one cruise passengers with the dreaded norovirus.

KHOU states that the 20-day cruise turned out to be the "trip from hell" for dozens of passengers who fell ill. Ninety six passengers and six crew members on the Crown Princess became ill with the highly contagious norovirus.

With passengers stricken with nausea, vomiting and diarrhea, a spokesperson for Princess Cruises responded that the cruise line took "extra precautions" with sanitation such as disinfecting "high-touch surfaces like railings, door handles and elevator buttons, encouraging passengers to use correct hand washing procedures and enhancing this with the use of hand sanitizing gels placed throughout the ship." 

Like all other of the many cruise norovirus cases, there will be no effort to scientifically determine the cause of the outbreak and try and track it down to either hand-to-hand contact from a passenger or crew member or from contaminated food or water.  Yes the enhanced cleaning is appropriate but won't do too much good if the nasty bug is in the food and/or water.  

The Crown Princess cruise ship left Venice on December 2, 2012 and is scheduled to arrive in Galveston on Saturday.

The Crown Princess experienced several bouts of norovirus earlier this year resulting in hundreds sick and one cruise to be cut short.

The first outbreak struck on the ship's January 28, 2012 cruise cruise and again on the February 4, 2012 cruise with several hundred passengers and crew members becoming ill. After the second outbreak Princess brought the ship back to Fort Lauderdale two days early for an “enhanced cleansing protocol.”

The Crown Princess also had some nasty noro outbreaks in December 2011 which you can read about here and here.

Anyone with info about this latest outbreak please leave a comment below. Or please leave a comment on our facebook page about this story.

December 22, 2012 Update: I am informed that there was a "red alert" for disease outbreak aboard the Crown Princess throughout the Atlantic crossing.  The cruise ship is now in Galveston (as you can see from the ship's bridge cam) and the CDC will board.  If you were on the cruise, how do you think the cruise line handled the outbreak?  Is around 100 sick passengers an accurate number of guests affected by the norovirus?  

Don't forget to read: "Why Do the Cruise Lines Always Blame the Passengers When Norovirus Breaks Out?"

Photo credit:

Top: AP via Fox News

Middle: WPTV

Bottom: Princess Cruises

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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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Yesterday we received an email from a cruise passenger planning to board the Celebrity Constellation, indicating that embarkation would be delayed several hours today because of a norovirus outbreak on the cruise ship.

Today news outlets are reporting that there has been a large outbreak of the dreaded disease on this ship. BBC reports that Celebrity Cruises' Constellation arrived in Southampton at 06:00 GMT at the end of a 12-night cruise. The local port health authority said about 350 passengers had fallen ill with norovirus and were exhibiting vomiting and diarrhea. 

Its departure has been delayed until 20:00 while "deep cleaning" takes place. Of course this type of cleaning is not much good if there is contaminated food or water or a sick crew member in the galley or waiting on tables. 

The BBC report further reports that around 2,200 passengers and 900 crew members had been on a wine cruise around the coasts of France and Spain. Passenger David Mattey said his holiday had been "completely ruined" when he went down with severe vomiting and diarrhea. He said: "The sanitation on that ship is bad."

The U.K.'s Daily Echo mentions that passenger Mattey was bed bound for seven days, and had to go to the medical center several times for an intravenous drip to rehydrate his body. Mattey told the newspaper: “For elderly people to go down with something like this is horrendous. I have never suffered from anything like it before I still feel very weak and I am relieved I am home.”

Celebrity Cruises is quoted telling the newspaper that only "a small number of guests" were affected by the virus. The 350 sickened passengers as reported by the BBC is a very high number to become sick.

This outbreak does not have to be reported to the Centers for Disease Control (CDC) because the cruise ship does not call on a U.S. port. The last outbreak affecting this ship which was reported to the CDC occurred in February this year. 

The last outbreak reported about a Royal Caribbean / Celebrity cruise ship was last month and involved the Rhapsody of the Seas.

The cruise ships ported out of Southampton have experienced problems with norovirus outbreaks in the past which you can read about here and here. 

How did the cruise line handle this latest outbreak? 

Photo credit: Wikimedia Commons (Megadri).

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The U.K.'s Daily Echo reports today that twenty-five ill cruise passengers (and their family members) who sailed aboard the Independence of the Seas filed a lawsuit against the Miami based cruise line, Royal Caribbean Cruises, claiming that the dirty ship conditions and unsanitary galley and food led them to become ill.

The newspaper states that in addition to the unsanitary shipboard conditions, the Royal Caribbean cruise ship had insufficient medical facilities and staff to deal with disease outbreaks during cruises.

The lawsuit is described in the newspaper article as including complaints of "flies in their bathrooms, a waiter blowing (his) nose on a napkin that was then placed on a table and an outbreak of illness so severe there were often ambulances waiting for passengers in the ports they visited."

There is no mention where the lawsuit was filed or the name of the passengers' lawyers, but it appears that the case was filed in England. The passengers are seeking £500,000 in compensation from the cruise line. The Independence of the Seas sailed from Southampton England.

The affected passengers sailed on five different cruises over the course of a seven month period from December 2010 through June 2011.  In the U.S. courts, cruise lines like Royal Caribbean have successfully enforced a one year limitations period.  There appears to be a longer limitations period in which to file suit in the U.K.

Royal Caribbean denied the allegations of under-cooked food and poor galley hygiene, stating that it delivered “extremely high” health standards for its guests. During the time period in question, "the ship, Independence of the Seas, sailed on 15 cruises, welcoming over 67,000 guests."

Although the cruise line is down-playing the allegations, the fact of the matter is that Royal Caribbean had a problem with norovirus on this cruise ship notwithstanding its attempts at "enhanced cleaning."  It should be pointed out that if the cruise line really carried some 67,000 passengers in this six month period, it collected well over £100,000,000 as well.    

The last norovirus outbreak we reported on which occurred on the Independence  of the Seas was in March 2012.

The cruise lines always blame the passengers for not washing their hands, but there is far more to the story than pointing the finger at the guests. 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 also 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." 

Consider a couple of our articles regarding this subject: 

Cruise Ship Norovirus - Clean the Damn Toilets!

Cruise Ship Bathrooms, Norovirus and Medical Care

It will be interesting how this case turns out! 

Photo credits:

Drawing - Maxim Magazine

Independence of the Seas - Echo Daily

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The 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.

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When passengers fall victim to norovirus while cruising, cruise lines typically blame the passengers for bringing the virus aboard and sickening the ship and crew. But if this Canadian news report is correct, its looks like the table has been turned on one cruise line which allegedly sickened people ashore in the port of Halifax with the dreaded "cruise ship virus."

According to CTV News, the Carnival Glory which stopped in Halifax about two weeks ago is the suspected source of an outbreak that shut down two restaurants on the waterfront this week. Two waterfront restaurants, The Bicycle Thief and Ristorante a Mano, had to close after at least 26 staff and customers became ill with what appears to be the norovirus. 

Other business owners complained that Carnival cruise passengers came through their shops and sickened the employees and customers.  

Some locals commented that they intended to avoid waterfront businesses out of fear that the virus from the cruise passengers might infect them.

We commented on the puke fest on the Carnival in a prior blog.  

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A puke fest is underway on the Carnival Glory cruise ship, with passengers taking to the message boards at Cruise Critic to comment that passengers are suffering from diarrhea and other norovirus-like symptoms,

The message board states that Carnival prepared a letter to passengers this weekend that passengers on the prior cruise experienced norovirus sickness. Several passengers are stating that the current cruise has been plagued by norovirus as well.  Some comments mention the strong smell of vomit in public areas of the cruise ship.  

One passenger comments that the Centers for Disease control (CDC) came onto the Glory on August 9th.  

There has been no official determination by the CDC yet. According to the CDC, cruise line calling on U.S. ports are required to report the total number of gastrointestinal (GI) illness cases evaluated by the medical staff when the GI illness count exceeds 2% of the total number of passengers or crew on board.

Last year there were 14 official cases of norovirus on cruise ships.

The usual debate is taking place about where the virus comes from, how it's spread and how the cruise lines is handling the outbreak.   The cruise industry bristles at the label "cruise ship virus" and always blames the passengers for not washing their hands and spreading the virus. The fact of the matter is that no one is conducting a scientific analysis to determine the origin of the virus notwithstanding the CDC's findings that the most common cause of norovirus on cruise ships in contaminated food or water.  

Some people are commenting that Carnival is doing a good job dealing with the outbreak, while others are saying that the cruise line is not disclosing the true number of affected passengers to avoid an official determination that the outbreak is norovirus related.

The last norovirus involved the Sun Princess during a July  8 - 21st sailing.  

Augyst 13, 2012 Update: The CDC says that the type of virus is "unknown."   This is the ninth gastrointestinal outbreak aboard a cruise ship calling on a U.S. port this year. 

Photo credit: Mark Davis via Wikimedia

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The Sun Sentinel newspaper in Fort Lauderdale reports that passengers aboard the Island Princess cruise ship are experiencing symptoms of gastrointestinal illness, according to a spokesperson for the Centers for Disease Control ("CDC"). 

The Princess cruise ship is scheduled to return to Port Everglades this morning after sailing a 10 night Panama Canal cruise.

The newspaper reports that the incident is not yet an official “outbreak" which occurs only when at least three percent of passengers experience symptoms such as of the illness, which include vomiting and diarrhea.

There are 1,970 passengers aboard the Island Princess. 

Several Princess cruise ships have experienced problems with norovirus this year, Including the Ruby Princess and the Crown Princess.  

If you were ill on this cruise or have observations regarding how Princess dealt with the issue, please leave a comment below. 

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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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A reader of Cruise Law News in the U.K. alerted me to an article in the Daily Echo that one of Royal Caribbean's cruise ships based in the U.K. has been hit with a break out of norovirus: 

"Thousands of holidaymakers due to set sail on board a Southampton-based cruise ship were hit by delays yesterday after norovirus hit 117 passengers and three crew on the liner’s previous cruise.

They were delayed boarding Royal Caribbean ship Independence of the Seas until 3pm so that her cabins and the cruise terminal could be sanitized.

She set sail just after her scheduled 7 PM departure."

Were you on this cruise?  How did the cruise line handle the outbreak?  

Please leave a comment below.

March 7, 2012 Update:

Professor Ross Klein's website has this quote from a passenger:

"We have just returned today 06.03.12 from an 11 day cruise on Independence of the Seas.  We were asked to check in late (15.30), by email.  We were left standing in corridors, the check in lounge and even outside for about three hours. They kept apologising for the delay over and over again.

While we were on the ship the staff were constantly sanatizing all handrails chairs and tables, the shops were sprayed every night.  Each time someone entered the toilet a voice would say"Stop don't forget to wash your hands."  When you sat down to dinner then someone would announce that we were on a high state of alert for Norovirus and to please wash your hands. We were handed wipes each time you entered a venue. We were not allowed to put condiments on our food the waiters etc had to do it for you. They even had to put the milk in you coffee and handed you sugar packets with tongs. We felt like lepers and it spoiled the whole holiday.

must say that the crew had to work extra hard but they always had a smile for us, but they must all be shattered."

Photo credit:  Daily Echo

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A reader of Cruise Law News in Brazil has informed us that a crewmember of the Armonia cruise ship, operated by MSC Cruises, died yesterday after being admitted to the hospital in serious condition.

A newspaper in Brazil (G1 in Sao Paulo) reports that a local woman, Fabiana Pasquarelli, age 30, was taken from the MSC cruise ship and was eventually admitted to the intensive care unit of Hospital Ana Costa.

The deceased crewmember worked as a waitress and was taken to the hospital on Wednesday with a fever and cough and was apparently diagnosed with pneumonia.  

There is also speculation that she may have died of swine flu.

Five other crewmembers are also sick and have been under observation in the hospital since Friday. 

The cruise line said that passengers are disembarking the cruise ship today and new passengers will board.

If you have information about this incident, please leave a message below.  

February 18, 2012 Update:  Passengers from the cruise ship have also been hospitalized in serious condition.

Another Brazilian newspaper, A Tribuna, has an account and reports that the diagnosis is unclear although it is the result of an infectious process.  

Ms. Pasquarelli died of an acute respiratory failure after being placed on a ventilator.  

February 19, 2012 Update:

A newspaper in Brazil states that seven people of the ten passengers and crew from the cruise ship were released from the hospital. Three remain hospitalized.  The hospital ran tests to determine the type of infection that caused the sickness.

Five crewmembers have contacted us, wishing to remain anonymous, complaining that Ms. Pasquarelli's medical treatment was delayed.  Read comments below.

February 21, 2012 Update:

A spokesperson for MSC left a comment below.

Also, a newspaper in Buenos Aires reports that heath authorities in Uruguay were on board the MSC cruise ship, which docked this morning at the main port in Montevideo after fears of a flu outbreak. The ship is expected to arrive to Buenos Aires tomorrow.  Osvaldo Fabacchi, the head of Port Administration in Montevideo, stated that “at present the cause of the crew member’s death has not been confirmed. The autopsy has yet to be carried out in order to determine and confirm the cause of death.”

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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 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

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In a responsible step to sanitize its cruise ship following an outbreak of what appears to be norovirus, Princess Cruises decided to end the current cruise of its Crown Princess cruise ship after consulting with the Centers for Disease Control (CDC). 

Nearly 400 passengers and crew on the last cruise became sick due to gastrointestinal illness, which is suspected to be norovirus as we reported over the weekend.   The current cruise out of Fort Lauderdale has seen 114 passengers and 59 crew members become ill, continuing an outbreak that began last week. 

Princess states that it will offer full refunds to the over 3,000 cruise passengers on the current cruise.  It will also assist the passengers in arranging flights home from Ft. Lauderdale.  Princess is providing hotel accommodations for affected passengers, if needed, and will provide all passengers a 25% cruise credit toward a future cruise.

Compare this proactive move to the debacle Celebrity Cruises faced in 2010 when four consecutive sailing of the Celebrity Mercury where hit by norovirus.  Celebrity kept reloading the cruise ship and sickening subsequent passengers until the CDC ordered the Celebrity Mercury to be shut down.

It's nice to see the cruise lines act responsibly like this.  The official statement from Princess is below:

Princess Cruises' Statement on Gastrointestinal Illness Aboard Crown Princess - February 7, 2012

The increased incidence of gastrointestinal illness that occurred during the previous cruise of Crown Princess has reappeared on the current voyage which departed Saturday, February 4, despite rigorous sanitization measures.

In consultation with the US Centers for Disease Control (CDC), who has informed us that there are widespread outbreaks of Norovirus occurring in the US, it was agreed that the best course of action to stop the spread of the illness is for the ship to undergo a two-day extensive sanitization. To accomplish this, Crown Princess is now returning to Fort Lauderdale where the cruise will end on Thursday, Feb. 9. The ship was scheduled to return on Saturday, Feb. 11.

We sincerely regret having to cut short our passengers’ cruise vacations because of this highly-unusual situation. We will, of course, be refunding their cruise fare, arranging flights home, including covering change fees if air was not booked through Princess, providing hotel accommodation if necessary, and offering a 25% future cruise credit.

Crown Princess departed February 4 on its scheduled Southern Caribbean cruise after a comprehensive disinfection of all cabins and public areas, which was overseen by the CDC together with our public health, medical and onboard departments.

On the current sailing 114 passengers (3.70% out of 3,078) and 59 crew (5.01% of 1,178) have reported gastrointestinal illness. On the previous cruise, 364 passengers (11.73% of 3,103) and 30 crew (2.57% of 1,168) were affected.

At the first sign of increased cases of gastrointestinal illness, we immediately initiated additional enhanced sanitation procedures to interrupt the spread of illness for both passengers and crew members. Our sanitation program has been developed in coordination with the CDC and includes such measures as disinfection of high-touch surfaces; encouraging correct hand washing procedures and enhancing this with the use of hand sanitizing gels placed throughout the ship; isolating ill passengers and crew in cabins until non-contagious; encouraging passengers to use their own cabin’s bathroom facilities; and providing regular verbal and written communication to passengers about steps they can take to stay well while onboard.

The enhanced disinfection of the ship in Fort Lauderdale will include bringing aboard additional cleaning crew to assist with a thorough sanitization of all public spaces and surfaces including soft furnishing and carpets, railings, door handles and the like. The staterooms will be sanitized multiple times before making up the rooms with fresh linens and towels on Saturday morning, just prior to passenger embarkation.

We continue to work closely with the CDC to determine the cause of the illness, which is suspected to be the easily-transmitted Norovirus, which is so widespread that only the common cold is reported more frequently.

Following this additional sanitization of Crown Princess, we expect that the next cruise on February 11 will depart as scheduled.

The current seven-day Caribbean sailing of the ship was scheduled to visit Curacao and Aruba, but we regret that the early return to Fort Lauderdale has necessitated cancellation of these calls.

# # #

What is Norovirus?

Norovirus is so widespread that only the common cold is reported more frequently. The CDC estimates that there are 23 million land-based Norovirus cases each year in the U.S., affecting one in 12 people, or 8% of the population. In contrast, the number of cruise passengers affected is .028% of the 8 million cruising population, or 1 in 3,600 of those who vacation aboard ships. Symptoms of Norovirus include mild stomach upset with vomiting and diarrhea, usually lasting between one and three days. The illness generally resolves without treatment or long-term consequences.

Health officials recommend that the best way cruise passengers can protect themselves from getting ill is to wash their hands frequently and thoroughly.

Further information about Norovirus is available through the below links to the CDC and Cruise Lines International Association (CLIA).

http://www.cdc.gov/nceh/vsp/pub/norovirus/Norovirus.htm
http://www.cruising.org/regulatory/cruise-industry-policies/vessel-sanitation

Contact: Karen Candy (661) 753-1540 Julie Benson (661) 753-1530
kcandy@princesscruises.com jbenson@princesscruises.com

Photo credit:  Wikimedia Commons (Cliff)
 

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ABC News reports tonight that over 30 cruise passengers were suffering from sickness when the Celebrity Silhouette cruise ship called on St. Maarten today.

Over the last few days, at least four cruise ships have suffered from outbreaks of illness, including norovirus: the Oasis of the Seas and the Voyager of the Seas (both operated by Royal Caribbean Cruises) and the Crown Princess and the Ruby Princess (operated by Princess Cruises).

If you have information about the illness aboard the Silhouette, please leave a comment below.

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While reports of five hundred sick passengers aboard two of Princess Cruises' ships sailing to Fort Lauderdale (Ruby Princess and Crown Princess) dominate the news here in South Florida, a newspaper in New Orleans is reporting that over 200 passengers were stricken with norovirus on a Royal Caribbean cruise ship this weekend.

This means around 700 people on these three cruise ships are battling diarrhea and vomiting.

The norovirus outbreak aboard Royal Caribbean's Voyager of the Seas caused delay of the cruise ship's departure from New Orleans   According to WDSU.com, 20 of the over 200 affected passengers on the ship were quarantined in the port as a result of their illness.

The delay was around two hours Saturday evening as cleaning crews tried to sanitize the cruise ship.  It is impossible to adequately sanitize a ship this large in such a short turn around, assuming the norovirus is not in the cruise ship's food or water.

Yesterday we reported on norovirus outbreaks on the Ruby Princess and Crown Princess.

Last year, there were 14 sickness outbreaks on cruise ships calling on U.S. ports.  So far, in the first five weeks of this year, there are already five outbreaks.

With the Costa Concordia disaster and several other overboards, deaths and shipboard rapes, the cruise industry is off to a rough start in 2012.

Were you on the Voyager of the Seas?  Please leave a comment below and let us know how the cruise line handled the outbreak. 

November 11, 20122 Update:  Passengers report a large norovirus outbreak on the Voyager of the Seas as it sailed to Australia.

November 23, 2012 Update: The norovirus continues to infect unsuspecting passengers aboard the Voyager of the Seas in Australia. This time throughout the November 5 tp 23, 2012 18-night sailing returning to Sydney.

Photo credit: Kerry Maloney  / NOLA.com / Times Picayune

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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 about 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 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 be 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.

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Afraid of your cruise vacation ruined by a nasty bout of diarrhea and vomiting?

There may be hope for you.   

WebMD and a few other medical journals report that there have been promising results from the tests of an experimental vaccine designed to prevent infection and symptoms associated with  norovirus.

WebMD explains that researchers sprayed the experimental vaccine in the noses of 47 volunteers. They also sprayed a "placebo vaccine in the noses of 43 other volunteers."  The study participants all swallowed a large dose of the norovirus (yuck).

About two-thirds of those who got the placebo vaccine developed gastrointestinal symptoms such as diarrhea and vomiting.  However, only a third of the participants who received the real vaccine developed  symptoms.

The researcher behind the experiment, Dr. Robert Atmar, a professor of medicine and molecular virology at the Baylor College of Medicine, said that the results are very promising, but it will be a few more years of research before the vaccine can be offered to the public.

Although commonly referred to as the "cruise ship virus," the virus also affects nursing homes, hospitals and restaurants.   Over the years, the cruise industry's trade organization, Cruise Lines International Association ("CLIA"), has tried to disassociate itself from this nasty virus.  It often writes to newspapers complaining when norovirus is described in such nautical terms.

When nororvirus breaks out on a cruise ship, you will usually hear the cruise lines and pro-cruise line publications stating that the cruise ship has been subjected to "enhanced cleaning,' whatever that means.  Cruise Critic ran an article earlier this year with a title "Norovirus is NOT a 'Cruise Ship' Virus."   The article showed a couple of photographs of crewmembers spraying down tables, chairs and even the roulette wheel.  Many topical solutions sprayed like this are not effective in killing the virus.  If a towel is contaminated, the wiping down of everything in sight spreads the virus everywhere. 

You will never hear the cruise lines or industry publications mention that the norovirus may not be spread from person-to-person, but  have been transmitted by 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.

Whatever the source of the virus on cruise ships, it is encouraging that there are doctors researching a vaccine against this dreaded sickness. 

For other articles about noro virus on cruise ships, consider reading: 

Cruise Ship Norovirus - Clean the Damn Toilets!

Cruise Ship Norovirus - Something in the Water? 

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

100 Norovirus Victims On Sapphire Princess Cruise Ship - Princess Cruises Blames Passengers

Photo credits:

Top:  Reuters via Mail Online

Middle & Bottom:  CruiseCritic

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The Southern Daily Echo newspaper in Southampton England is reporting that the Celebrity Eclipse cruise ship was delayed for “enhanced sanitation” after dozens of passengers returning to Southampton from a 11 night eastern Mediterranean cruise had been struck down by norovirus.

Sick passengers disembarking the cruise ship at the city's terminal reported seeing “people walking around in Ghostbusters suits” ready to disinfect the vessel and the terminal.

Cruise ship norovirus cases often take several sailings before the virus runs its course.  Perhaps the Eclipse needs a major cleaning and spray down.  But "enhanced cleaning" may or may not help, depending on whether the virus is passed hand-to-hand between crew and passengers or passenger to passenger - or is contained in contaminated food or water. 

If you were on the Eclipse, please leave a comment below about how the cruise line handled the situation.  We would be interested in hearing from passengers on the ship now whether additional passengers have been sickened or whether everyone is well and enjoying the cruise.

Photo credit:  UK Telegraph

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Courthouse News Service reports that a lawsuit has been filed against Celebrity Cruises for the death of a father of eight after he died from incompetent medical care for norovirus he contracted during a vacation cruise aboard the Celebrity Solstice. 

The lawsuit alleges that Joseph Gavigan Jr., from Orleans, Massachusetts, embarked the Solstice cruise ship in January of this year in Fort Lauderdale, Florida.  During the cruise, a norovirus outbreak occurred and Mr. Gavigan contracted the illness.

The lawsuit alleges that Celebrity failed to take adequate precautions to screen passengers and crewmembers, failed to sanitize and disinfect the cruise ship and disinfect plates, cups, food trays, utensils, ice machines and drinking fountains, failed to quarantine infected passengers and crewmembers and failed to warn Mr. Gavigan about the virus. 

The lawsuit also alleges that Celebrity provided negligent medical care to Mr. Gavigan, and negligently selected the cruise ship medical staff who held themselves out as agents of the cruise line.

A copy of the lawsuit is available on line and can be viewed here.  The lawsuit was filed by attorney Keith Brais, a very experienced maritime lawyer who used to be a defense lawyer for Celebrity Cruises and other cruise lines.  

The Centers for Decease Control and Prevention reports that 118 cruise passengers and 10 crewmembers reported ill during the voyage.  You can read more about the CDC's report for this voyage aboard the Solstice here.  

The popular on line community Cruise Critic contains Celebrity's official press statement about the norovirus outbreaks (which preceded Mr. Gavigan's cruise) as well as the accounts of unhappy cruisers some of whom felt that the medical staff was incompetent and the cruise line was trying to cover-up and down-play the outbreaks. 

An on line obituary indicates that Mr. Gavigan, nicknamed "Junior," is survived by 21 grandchildren and 17 great grandchildren in addition to his 8 children and companion.

Photo credit:  Dockray & Thomas Funeral Home

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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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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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A reader of our blog informs us that Royal Caribbean's Jewel of the Seas continues to infect cruise passengers with norovirus. 

The reader referred us to the Harwich and Manningtree Standard and Daily Gazette newspapers in Norwich U.K. which report that Royal Caribbean passengers continue to be struck by a highly-contagious virus for the second time in a month. The cruise line again delayed the departure a few hours yesterday so that they crew could try some extra cleaning to deal with the problem.

The reader commented:

"Obviously the last attempt didn't work, so why should this? I would have expected that by now, the source and specific nature of the virus would have been found, thus allowing effective treatment to be carried out before the ship sails. However, since I have not heard otherwise, I assume it has sailed again last evening, with a new set of unsuspecting guests . . .  How can the port authority in Harwich allow this to happen?"

Royal Caribbean's PR people crafted the following statement: "At Royal Caribbean International, we have high health standards for all our guests and crew."

We reported on the last norovirus outbreak on the Jewel of the Seas - Norovirus On Royal Caribbean's Jewel Of The Seas?   45 passengers commented on the story and described poor food handling, cleaning, and medical procedures on the Royal Caribbean cruise ship.  

Have you sailed on the Jewel of the Seas recently?  How is the cruise line handling the situation? 

Please leave a comment below.  

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Cruises.co.uk reports today that norovirus has broken out aboard Royal Caribbean's Jewel of the Seas cruise ship. 

The website reports that passengers due to sail on June 12,  2010 have been informed to arrive late as embarkation will start to take place from 4:30pm.  The cruise ship will apparently undergo what the cruise line calls an "enhanced sanitizing" on Saturday.

The Jewel of the Seas had widespread sickness (diarrhea and vomiting) last March, but the Center for Disease Control (CDC) could not determine the type of pathogen.  You can read the CDC analysis here.

The CDC database for cruise ship norovirus outbreaks is here.

For prior blog articles about cruise ship norovirus, read them here. 

Royal Caribbean's cruise ship, the Constellation, operated by its subsidiary Celebrity Cruises also sickened passengers and crew just two weeks ago.  164 passengers and 29 crewmembers developed a norovirus infection, according to Cruise.co.uk.  You will not find this officially reported to the CDC because cruise ships are not required to report outbreaks of sicknesses when the cruise ship does not call on a U.S. port. 

Royal Caribbean's PR crisis manager Cynthia Martinez issued a statement that the Constellation would be delayed so that the ship would undergo a "thorough cleaning and sanitizing." 

This sounds good but what does this mean?   As we mentioned 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." 

So how does a cruise ship go about a "thorough cleaning" when the cruise lines has not determined whether the source of the norovirus is infected food or water?  How do you perform an "enhanced sanitizing" of food or water?

Royal Caribbean's PR department refused to respond to a request for a statement or a comment on the latest sicknesses to Cruise Law News (CLN). 

If you are disembarking from the Jewel of the Seas or the Constellation, please leave a note below and provide us with your thoughts on how the cruise line handled the outbreak.  

June 12th Update:

Newspapers in Harwich are reporting that 398 passengers and 30 crew fell ill with norovirus while on board the Jewel of the Seas.  A company PR release states that boarding today will be delayed until 3:00 p.m. for what the cruise line states is "extensive," "thorough" and "enhanced" sanitizing.  But health officials have not identified the source of the norovirus as either contaminated food or water, unsanitary crew members, or infected passengers.  So what will additional cleaning for 2 or 3 hours accomplish?

Passengers are beginning to leave interesting comments below, pointing out that the method of serving passengers is likely causing the norovirus to spread . . .   

June 26, 2010 Update:

Royal Caribbean is violating U.K. law by sailing without completely sanitizing the contaminated cruise ship.  Some very astute readers are leaving insightful comments below, regarding the potential causes of the virus and the cruise line's shortcommings.  Be sure to read the comments at the bottom. 

June 25, 2010 Update:

The norovirus continues:  Jewel of the Seas Remains Contaminated with Norovirus

Credits:

Photograph of cleaner                telegraph.co.uk 

Photograph Jewel of the Seas                 w:User:Dave souza at Wikipedia

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A Seattle news station King5.com reports today that norovirus sickened 100 people on Princess Cruises' Sapphire Princess cruise ship based in Seattle. 

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 from municipal supplies, well, recreational lakes, swimming pools, and water stored aboard cruise ships."

But Julie Benson (right), the PR person for Princess Cruises, blamed passengers for probably carrying Norovirus on board the cruise ship.

Of course, there is no proof of this.  Ms. Benson is just a PR person and a script reader - not a doctor, scientist or epidemiologist.  It is part of the cruise industry's play book to always blame the passengers for bringing norovirus aboard.  It is far more likely - according to the FDA - that there is contaminated food or water on the cruise ship.  How did Ms. Benson figure out that the passengers brought the virus aboard, rather than poor hygiene by the crew or infected food or water?  The outbreak has not even been investigated by the Centers for Disease Control (CDC).

The CDC database for cruise ship norovirus outbreaks is here. 

Blame-the-passengers is just the script that poor Ms. Benson has to read.

Passengers suffered through norovirus on several cruises on the the Grand Princess just last month.  You can read about those cases here and here.  One of the problems with Princess is that the cruise line charges passengers around a $100 just for a nurse to come to the cabin when a passenger is infected with norovirus.  Some passengers didn't report their illnesses to avoid the excessive charges for "medical treatment."  At the same time, Princess didn't  try to sanitize cabins where no one reported an illness, as reported by this passenger.  This may have led to additional outbreaks on the next cruise.  

The passenger also thought that the public toilets on the cruise ships may be a problem.  Disease experts have inspected toilets on cruise ships in the past, with disgusting results: Cruise Ship Norovirus - Clean the Damn Toilets!  

Lawyers in the U.K. are suing the cruise line for improper cleaning procedures aboard the Grand Princess.  The litigation is being handled by U.K. lawyers, Irwin Mitchell which specializes in travel law in England.  The firm is demanding that passengers are informed of health risks on the cruise ship in advance of it sailing and given the choice of continuing their holiday, choosing an alternative or getting their money back.  According to the Guardian newspaper, the Irwin Mitchell lawyers criticized that Princess is only devoting two hours for "extra cleaning:"

"The fact that this liner has been allowed to set sail again so quickly is astounding given the reports of such widespread illness on the preceding cruise .  .  .  For maximum effect this would normally have taken at least two days. I struggle to see how a fully effective deep-clean of such a large ship could be achieved in a few short hours."

For other articles about the cruise ship sickness, norovirus, in general read here.    

Were you aboard the Sapphire Princess or Grand Princess during these recent norovirus outbreaks?  Were more passengers and crew infected than reported?  How did the cruise line handle the problem?  Please leave your comments below. 

Don't forget to watch the video below:  

June 8, 2010 Update:

AOL Travel published an article "Sick Ship in Europe and Alaska" about the Sapphire Princess as well as Celebrity's Constellation, where norovirus infected at least 204 passengers and 34 crew members.  A comment by one reader: "What they don't tell you is Norovirus is often a food-borne illness. Food is cruise line's stock and trade. They don't want you to know that it may be coming from the kitchen!"

Credits:

Video          King5.com

 Julie Benson              Twitter.com

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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).  

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

• Comments

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 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

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At 8:00 p.m. this evening, Celebrity Cruises' Mercury cruise ship will sail for an eight day cruise to the Caribbean.

The Mercury has been called the "sickest sea at sea."  Even ABC's Good Morning America posed the question: Celebrity Mercury - Sickest Ship At Sea - Can Cruise Ship Be Cured? 

Local South Carolina ABC affiliate WCIV News - 4 is optimistic that the cruise ship has been thoroughly cleaned over the past 72 hours after the Centers for Disease Control (CDC) issued a rare "no-sail" advisory.  The ABC affiliate reports that "officials are now confident the ship is safe."

But I would not be so sure.  Gastro-intestinal illnesses can be caused by contaminated food or water, from fecal-oral transmission from crew member to passenger, or from sick passengers who come aboard and infect others.

And the CDC has not determined the cause of the last sickness outbreak.  The CDC report for the Celebrity Mercury's March 8th -19th sailing indicates that the "causative" agent for the widespread illnesses is "unknown."

Not sure I would set sail on a "sick" cruise ship where the CDC can't exclude contaminated food or water or ill crew members as the causes. 

Let's cross our fingers and hope another round of passengers don't find themselves confined to their cabins.  

March 22, 2010 Update:

According to USA Today, only 1,076 passengers are cruising on the Mercury (which is about 60% full).  Around 800 passengers canceled and obtained what is described as a full refund.

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The Centers for Disease Control (CDC) reports that 406 of the 1829 passengers (22.1%) aboard Celebrity's Mercury cruise ship have reported fever, vomiting, and/or diarrhea.  These CDC statistics are based entirely on the information provided by the cruise line.

In the past week, we have received information from crew members that although they were sick, they were required to continue working.  This raises the issue whether the cruise line is not reporting all ill crew members to the CDC.

We just received the following comment from a passenger, who suggests that you can't trust the official CDC numbers:  

"We just got back from this cruise March 18th (one day early) and we were ready to come home. Don't believe the official count of sickness on this boat, I became ill on the second night out around 2 AM. At around 8 AM, my wife called for medical attention and was told they would be to see us in our cabin. We waited. At 5 PM, my wife called medical again and were told they had no record of our calling earlier but the medical crew was on its way around the ship and they would be to our cabin soon. As of today, March 19th., no one from medical has seen me yet unless they saw me passing in the hallways. I heard of many others who were sick and were not seen as well.

My suggestion if you decide to go, carry your own medication with you and be prepared to quarantine yourself to protect others while you are sick if you do get sick. Room service is good."
 

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The Celebrity Mercury cruise ship returned to port in Charleston South Carolina today with over 400 sick passengers.  The Centers for Disease Control (CDC) reports that 406 of the 1829 passengers (22.1%) have reported fever, vomiting, and/or diarrhea.

Unlike the last two cruises where the CDC determined that norovirus caused the outbreak, the CDC has not yet determined the cause of the outbreak.  This is probably one of the reasons that the CDC issues a "no travel" advisory for the sick cruise ship.

The traveling public is faced with a cruise line who blames passengers for not washing their hands - the CDC who does not know what the pathogen is or where it's coming from - and the ugly likelihood that the vessel's food, water, crew or public surfaces could be contaminated.

We have been inundated with calls and emails from concerned Americans who are scheduled to travel on the Mercury over the course of the next several months.  We also have heard from crew members, including some crew members who complain that although they are sick they are required to keep working.  Some of the work includes changing linens, serving food and delivering ice.  Very disturbing information. 

There is a lot of pressure on crew members to keep outbreaks secret.  We recently ran across a blog from a former crew member who wrote:

I worked on a cruise ship at the beginning of 2001 and we had a lengthy norovirus outbreak - interestingly, the ship did not make the CDC list for that year. Perhaps because we were far away in South America? Or perhaps it was because we were instructed to deny, deny, deny when any passenger asked: No sir, you're mistaken - the dining rooms are all closed because all the guests are off on tour...not sick in their beds along with half the staff. (Yeah, I was never able to look anyone in the eye and say that.) I never got it, thank God .  .  . "

Here is a recent video from the AP: 

Were you on the last cruise?  Do you have photographs, video or information which may help explain what is happening on the Mercury?  

Let us hear from you.

Credits:

Video      AP

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ABC's Good Morning America (GMA) discusses Celebrity Cruises' sick cruise ship, the Mercury, in this morning's program. 

The Mercury has been hit with three continuous outbreaks of sickness which has plagued hundreds of passengers.  We have covered the outbreaks in prior articles. 

GMA begins its show by describing the Mercury as the "cruise ship which just can't seem to be cleaned."

The video contains the caption - "Sickest Ship at Sea - Can Cruise Ship Be Cured?" and explains how norovirus can thrive on cruise ships.

The GMA video is below.  One passenger askes: "Why do you keep on letting people on this ship when people continuously get sick?"

ABC interviewed its senior health and medical editor Dr. Richard Besser to explain the norovirus and how passengers are infected on cruise ships: 

"The norovirus is highly contagious and its symptoms include nausea, vomiting, diarrhea, cramps and chills, Besser said.

The illness typically lasts 12 to 72 hours and usually occurs in places where people are in close quarters, such as schools, hospitals, nursing homes and cruise ships, according to Besser. It is the leading cause of foodborne outbreaks of diarrheal disease, accounting for more than 50 percent of these outbreaks

It spreads through food, water, contaminated surfaces and person-to-person contact, Besser said. He added that the reason it could be so hard to get rid of on a cruise ship is because people can also bring it on board and it can live on surfaces for more than a week.

Cruise ships often visit places that have poor sanitation, so passengers can easily catch it from a restaurant they visited at a port, Besser explained.

Additionally, the infection dose of norovirus is very low, Besser said. It takes only 10 particles of the virus to make you stick, as opposed to the 100,000 particles of salmonella you would have to be exposed to in order to get sick."

The Mercury returns to Charleston tomorrow.  The CDC issued a "no sail" advisory for the sick ship.  It will undergo another round of "enhaced cleaning" - as the cruise line calls it. 

Credits:

Video              ABC Good Morning America

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The Centers for Disease Control (CDC) has issued a rare no-sail advisory for Celebrity Cruises' Mercury cruise ship.  The CDC has instructed Celebrity not to sail the sick cruise ship until Sunday in order to permit its inspectors to investigate the ongoing outbreaks of gastrointestinal illness. 

Over the course of the last month, hundreds of passengers have become sick on the Mercury over the course of its last three sailings. 

According to CNN, members of the CDC's Vessel Sanitation Program (VSP) boarded the cruise ship looking for causes of the latest wave of illness.

Although the CDC determined that norovirus was the cause of the outbreaks for the first two sailings, the CDC could not determine the type of pathogen for the latest outbreak on the Mercury.

A no-sail advisory is an extreme step.  Its like a city inspector shutting down a dirty restaurant for code violations which pose a health hazard to the city residents. 

The Mercury has been a sailing nightmare for the past month.  First, a half dozen crew members were sickened in what the cruise line thought was carbon monoxide poisoning -  Carbon Monoxide Poisoning Reported Aboard Celebrity's Mercury Cruise Ship - when the cruise ship returned to port in Baltimore.  After the ship was re-positioned to South Carolina, all cruises have been plagued by what many call "cruise ship sickness."

The Mercury is an old ship and Royal Caribbean / Celebrity will be selling it later this year. 

For a chronology of the diseased ship, read our blogs over the past month regarding the Mercury.

March 16, 2010 Update:

USA Today reports: "Celebrity to Offer Full Refunds to Passengers on Delayed Mercury Cruise"

Credits:

Cruise Cleaners              Telegraph.co.uk  "Cruises: Norovirus Questions & Answers" 

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Celebrity Cruises' disastrous string of "diarrhea-cruises" out of South Carolina continues with the cruise line's decision to return the Mercury to port in Charleston a day early.

USA Today's Cruise Log reports that sickness has marred three straight voyages in "Celebrity to End Cruise Out of Charleston Early as Outbreak Continues."  Royal Caribbean indicates that 342 of the 1,829 passengers on the cruise ship became ill since the cruise began.  The article mentions that the cruise ship will skip its scheduled stop in Tortola British Virgin Islands and head straight back to the U.S.  The cruise ship will arrive in Charleston on Thursday.

This is now the third cruise on the Mercury where passengers have become sickened with a gastrointestinal sickness.  

The USA Today article reads not unlike the typical cruise line press release - mentioning that norovirus is the most common cause of stomach illness in the U.S. and breaks out regularly in schools, nursing homes, and hospitals.  But the article does not inquire into the specific cause of this outbreak, nor question why three straight cruises have sickened passengers.

The report from the Centers for Disease Control (CDC) on the Mercury's last cruise does not even contain a conclusion regarding the "causative agent" for the sickness and is a week out of date.  If the CDC can't pinpoint the type of virus or pathogen from last week's cruise - why does anyone think that another round of "top-to-bottom" cleaning will make a difference?  

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 from municipal supplies, well, recreational lakes, swimming pools, and water stored aboard cruise ships."

What are the test results of the cruise ship's water supplies?  The Mercury is one of Celebrity's oldest cruise ships, and is scheduled to leave the Royal Caribbean - Celebrity fleet later this year. Is there something wrong with this ship?  Is this a sick ship?

For prior articles:

Stomach Bug Hits Celebrity's Mercury Cruise Ship Again

Will the Celebrity Mercury Infect Another Round of Passengers?

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

Can Sick Cruise Ships Cause Norovirus Outbreaks in Ports?

Additional Passengers Sickened on Mercury Cruise Ship

Celebrity Cruises' Mercury Returns to Port with 182 Sick Passengers - Sailing Postponed

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

Here is a statement from Celebrity Cruises / Royal Caribbean issued today:

During Celebrity Mercury’s current sailing, a number of guests onboard experienced a gastrointestinal illness, thought to be a norovirus.  Over the course of the sailing, crew onboard has been conducting enhanced cleaning, to help prevent the spread of the illness. 

While there was a decline in the spread of the illness during the sailing, in an abundance of caution, and in order to prevent additional guests and crew from becoming ill, we have decided to bypass Celebrity Mercury’s port of call today to Tortola, British Virgin Islands, and return to Charleston a day earlier than originally scheduled.  Celebrity Mercury will now arrive in Charleston early Thursday morning.  The enhanced cleaning of the ship, all of which is being done in close coordination with the U.S. Centers for Disease Control and Prevention, will continue until the ship arrives in Charleston.

“I would like to apologize for the inconvenience this modified itinerary will cause our guests currently on Celebrity Mercury,” said Daniel Hanrahan, president and chief executive officer of Celebrity Cruises.  “I have made this decision to delay the sailing because we want to maintain our high health standards onboard our ships, while providing our guests with the best cruise experience possible.  The extra time we are taking to sanitize the ship will help prevent any additional guests from becoming ill.”

March 15, 2010 Update:

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

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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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The Centers for Disease Control (CDC) reports that Celebrity Cruises' Mercury cruise ship has returned to Charleston, South Carolina with 182 ill passengers. 

According to its web page "Investigation Update on the Mercury,"  t'he CDC reports 182 of 1749 passengers (10.41%) are ill with diarrhea and vomiting, and 14 of the 850 crew (1.65%) are sick.

With the sick passengers disembarking, another 1,800 passengers are boarding.  (I wonder whether the cruise ine discloses to the new passengers which cabins had sick passengers in them?) 

The Mercury has experienced more than its fair share of problems in the last month.  There was a report of carbon monoxide poisoning on February 13th when the cruise ship returned to Baltimore.  After the ship re-positioned to Charleston, its inaugural cruise from that port resulted in over 400 passengers coming down with the dreaded norovirus. 

The ship was delayed a day until February 26th for what the cruise line calls "enhanced cleaning," and we questioned "Will the Celebrity Mercury Infect Another Round of Passengers?"

Now close to 200 people another passengers and crew have fallen ill.   

The most troubling information is that the CDC reports that the "causative factor" (i.e., whats causing the sickness) is "unknown." 

Norovirus can be caused by sick passengers coming aboard, or sick crewmembers greeting the passengers or, more concerning, infected food and/or water supplies.  The cruise supporters always blame the passengers for not washing their hands - which may be the case.  But the issue whether there is a problem with the cruise ship cannot be excluded.  Many people refer to norovirus as the "cruise ship sickness."

If the potable water or food have norovirus particles, all of the external cleaning in the world is not going to make a difference.  It only takes a few fecal particles in the food, drinking water or shower.

USA Today reports that the Mercury's departure today is delayed for another round of "enhanced cleaning."  

But without determining the "causative factor" and determining whether the passengers, the crewmembers, or the food and water supplies are spreading the virus - it seems like the cruise line is shooting into the dark.

Stay tuned. 

Health Tips: @OrlandoChris has some helpful precautions to help prevent the spread of the infection.

Credits:

Cruise desserts     nbnpress.com

• Comments

A headline in the NoroBlog intrigued me - "Cruise Ships Causing Norovirus Outbreaks in Ports?" - indicating that norovirus is "often associated with cruise ship sickness."  The article also raises the question whether cruise ships can infect the local port communities. 

The cruise industry's PR people have been fighting the connection between norovirus and "cruise ship sickness" for many years.

Last week the cruise industry's trade organization, Cruise Line International Association (CLIA), wrote a letter to the Daytona Beach News Journal complaining that a writer made a connection between the virus and cruise ships and concluded that this is an illness that happens "often" on cruise ships.

CLIA's letter to the editor stated: "the overwhelming majority of norovirus outbreaks take place at land-based locations, such as schools, day care centers, hospitals and nursing homes."  The one comment to the letter, from a passenger on the norovirus infected Queen Victoria cruise ships, dismissed the letter as "more cover-up from the cruise spokes people."

CLIA has made the "its-a-lot-worse-ashore" argument before.  But arguing that it has a better record than day care centers and nursing homes seems counter-productive to the cruise line's image.  Of course day care centers with a million kids who have not mastered the art of going to the toilet and washing their hands and then wipe their runny noses all over the toys are going to be a hotbed of viruses.  And anyone entering a nursing home filled with incontinent geriatrics can instantly smell feces entering the facility.

The Food Poison Journal (affiliated with the Noroblog) reports that "outbreaks of gastrointestinal illness, and norovirus in particular, are not new to the cruise industry.  In fact, the phenomenon prompted the CDC to create and oversee a "vessel sanitation program (VSP)." 

Arguing against the label "cruise ship sickness" is a waste of time.  The real debate should be whether sick cruise ships pose a health hazard to the local port communities.

In the past six weeks, the United States considered blocking the arrival of the Queen Victoria because of a norovirus outbreak - U.S. to Block Arrival of Queen Victoria After Norovirus Outbreak?  - and a week earlier the U.K. considered impounding the Balmoral cruise ship because of a similar outbreak -  "Cursed Cruise Ship" Balmoral At Risk of Being Impounded As Hundreds More Suffer Vomiting Bug.

The South Carolina Post and Courier ran an interesting article "Norovirus Confirmed Aboard Mercury" which reported on the concern that the Celebrity Mercury cruise ship - with over 400 norovirus infected passengers - could infect people living in Charleston.  

The newspaper reports that Katie Zimmerman, a project manager with the Coastal Conservation League, received frantic calls and e-mails from residents concerned not only about infected passengers entering the city but also about trash from the ship entering local waters.

Cruise ships like the Mercury can dump completely untreated sewage 12 miles offshore.  Although the article concludes that waste from the Mercury poses no risk to marine life or people who eat local seafood, there is a risk of contaminated water infecting shellfish which filter-feed. 

In this day and age, it is barbaric to think that hundreds of CLIA cruise ships routinely dump human waste into the sea.  Cruise lines dump waste because they register their cruise ships outside of U.S. jurisdiction in places like Liberia and Panama which don't care what the cruise lines do. 

The thought of a cruise ship like the Mercury dumping hundreds of thousands of gallons of norovirus infected feces just 12 miles offshore South Carolina is particularly disgusting. 

Even the worst run child care facilities and nursing homes don't do that.

Credits:      

Sick cruise passenger           Bill Mahler's Food Poison Blog

Cruise Cleaners              Telegraph.co.uk  "Cruises: Norovirus Questions & Answers" 

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The departure of Celebrity Cruises' Mercury cruise ship, scheduled for today, has been delayed so that the cruise line can make a last ditch effort to try and kill the norovirus which sickened over 20% of the passengers and crew during its last cruise. 

Celebrity is offering vouchers to accommodate the passengers or staying overnight in Charleston.

The ship is now scheduled to depart on Saturday at 5 PM.

A large number of newspapers and blogs are covering the plight of the sick cruise ship.  The highly respected Food Poison Blog by super-lawyer Bill Mahler covers the problem in an article "Over 400 Sickened with Norovirus on Cruise."  NPR (my favorite) has even gotten involved with a story entitled "Stomach Flu Hits Caribbean Cruise Ship."

Celebrity Cruises president Daniel Hanrahan issued a statement: "I would like to apologize for the inconvenience this delay will cause our guests on Celebrity Mercury's next sailing . . . the extra time we are taking to sanitize the ship will help prevent any illness from affecting the next cruise."

Let's hope so.

February 27, 2010 Update:

Passengers who live more than a 2 hour drive from Charleston arte staying in area hotels paid by the cruise line, and credited $50 for expenses incurred.  According to the Post and Courier, the cruise's itinerary was shortened by a day, with a call in Key West canceled. Passengers who sail today will be given on-board credit for two-days worth of their fare and a 25 percent discount on future Celebrity cruise bookings

Read other Cruise Law News articles regarding the sick Mercury cruise ship.

Interested in other cruise - norovirus articles?  consider reading:

Cruise Ship Norovirus - Clean the Damn Toilets! 

Cruise Ship Bathrooms, Norovirus and Medical Care

"Cursed Cruise Ship" Balmoral At Risk of Being Impounded As Hundreds More Suffer Vomiting Bug

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

Credits:

Mercury cruise ship and passengers             AP (Mic Smith) via Washington Post 

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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." 

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 conditions 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  

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CruiseCritic reports that a passenger whose husband died after contracting Legionnaires' Disease during a cruise aboard Fred Olsen Lines' Black Watch (who would name a cruise ship, Black Watch?) received a settlement after three years of litigation.

Audrey Heath, from the U.K. sailed with her husband, Robert Heath, on the Fred Olsen cruise ship when a number of passengers were affected by the illness while onboard. The cruise line ended the cruise early, Mr. Heath went to see his local doctor, who performed no tests, and sent Mr. Heath home with antibiotics. He died at home the next day.

An inquest ruled that the cruise line exposed Mr. Heath to Legionnaires' Disease, and his doctors failed to provide appropriate medical treatment or admit him to a hospital.  Following the decree relating his death to Legionnaires aboard the cruise ship - the cruise line and shoreside doctors agreed to a settlement. 

Ms. Heath received a £70k settlement (a little over $100,000), a small amount for wrongful death by U.S. standards. 

The Fred Olsen Lines are in the press quite a bit for many cases of norovirus, which also can be traced to improper cleaning protocols on the cruise ships.

We have written about Legionnaires' Disease in prior blogs:

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

Former Royal Caribbean Cruise Ship Captain Dies of Legionnaire's Disease After Sailing on Liberty of the Seas
 

Credits:

Black Watch cruise ship photograph                   Milford Haven Port Authority website

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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

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