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 Daily Post in the U.K. reports that a gastrointestinal virus outbreak has delayed the departure of a cruise ship from Liverpool.

The cruise ship involved is the MV Discovery which was scheduled to depart on a Norwegian cruise last night at 6:30 PM but was delayed until 10:30 PM while a "deep clean" was performed. 

I have always been skeptical about how a cruise ship can be disinfected in just 4 hours. 

One passenger, who described being treated like a leper, said: "I was on a ship which had norovirus and in the end it took four days to clean it, so I cannot see how four hours will help."

But a representative of the operating company said that 3 hours was "exactly the amount of time needed."  It's hard to fathom how anyone can say that with a straight face, particularly considering that the type of virus is unknown, the source of the virus is unknown, and the precise location of the virus is always a mystery.  

As usual, the cruise company also blamed the passengers: 

Paul Foster, speaking on behalf of Cruise and Maritime Voyages, said: "It’s one of those things that are brought on board by passengers. I always say a ship cannot get a sore throat."

But that simply not true. There are such things as "sick ships."  Cruise ships and their food and water supplies can become contaminated with a wide variety of viral and bacterial diseases such as Legionnaires Disease, norovirus, e-coli, and unspecified gastrointestinal viruses. In fact, the U.S. Food and Drug Administration ({FDA) and the Centers for Disease Control and Prevention (CDC) state that the most likely source of a norovirus outbreak is contaminated food or water. Yes, a virus can be spread by bad hygiene of either passengers or crew, but usually the source of the outbreaks starts with something like noro-laden food or water.

The Discovery was launched in 1972 and is a 40 year old ship. It was formerly the Island Venture, Island Princess, Hyundai Pungak and Platinum

The cause of any particular outbreak is the business of expert epidemiologists - not cruise CEO's or Cruise Directors who are quick to point the finger at the passengers.  

Photo Credit: Wikipedia / yeldark

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

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

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

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

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

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

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

Photo Credit: Wikipedia / Barek

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A Carnival cruise ship has become the sixth cruise ship this year to flunk a sanitation inspection by the Centers for Disease Control and Prevention (CDC).

The Carnival Fascination failed the surprise inspection with a score of only 84. You can read the report from the CDC here.  It's full of dirty and unsanitary conditions in the galley and food serving areas, as well as problems with the recreational water supplies.

The Fascination had a problem which we are hearing about more often, that is when crew members are experiencing acute gastrointestinal illness but keep working. This substantially increases the chances that they will infect other crew members and the passengers that they come into contact with. The problem is particularly critical when the infected crew are food handlers. 

Five other cruise ships have failed CDC inspections this year.

Two weeks ago we wrote about the Celebrity Summit, the Golden Princess, the Sea Dream Yacht Club's Sea Dream, and the Caribbean Fantasy operated by America Cruise Ferries all of which flunked the CDC inspections. You can read our article: Disease Breeding Grounds: Three Cruise Ships Fail Health & Sanitary Inspections

A week ago, we wrote about another Celebrity Cruises ship, the Celebrity Century, which also failed the inspection.

Read the U.K.'s Daily Mail article:  Carnival Fascination Fails Health Inspection After Dead Flies, Leaking Brown Material and Cockroach 'Nymph' Found on Board

Photo Credit: Wikipedia / Jonathan Schilling

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Those of you who read this blog regularly know that I find lots of information about things that the cruise lines would prefer you not know on Professor Ross Klein's website called CruiseJunkie.com.  A silly name I know, but the information is quite serious if you are interested in accurate information about cruise passengers and crew who disappear under mysterious circumstances, fires and collisions, and disease outbreaks on the high seas.  There is no other credible website like this anywhere which tracks such information in the cruise industry. 

Yesterday Professor Klein's website contained information about a gastrointestinal illness (GI) outbreak aboard the Celebrity Infinity cruise ship. He linked to the CDC Vessel Sanitation website which contained a report that 101 of 2086 passengers (4.84%) and 17 of 927 crew (2.05%) have reported ill with gastrointestinal illness. Two CDC Vessel Sanitation Program environmental health officers and an epidemiologist boarded the ship on arrival in Fort Lauderdale on April 1, 2013 to conduct a targeted environmental health assessment and evaluate the outbreak and response activities. 

But when I clicked on the link to the CDC information, the website said:

"The page you requested cannot be found at this time. It may be temporarily unavailable or it may have been removed."

So what happened?  I don't know. 

Professor Klein questions whether this is a mistake of some sort or whether there is a cover-up at play.

Again I don't know. But I do know after being a lawyer for 30 years that there is a very cozy relationship between the cruise lines and federal agencies like the CDC whose surprise inspections are hardly a surprise. And last year it became obvious that after Congress passed a law requiring the cruise lines to report crimes to the FBI which had to post the data on a Coast Guard website for the public to view, these federal agencies worked behind the scenes with the cruise lines to cover the crime statistics up.  

So what's up with the CDC posting a GI outbreak and then the information disappearing?

Celebrity has had difficulties with its shipboard sanitation this year with the Summit and the Century failing CDC inspections for health and sanitation.  

Is the removal of the report of the outbreak aboard the Celebrity Infinity a mistake or is something else more sinister going on?

I'd like to hear from passengers and crew members whether there was a recent gastrointestinal illness or norovirus outbreak on the Celebrity Infinity?  Please let us know.

Am I being overly-suspicious? Maybe so. But I'd rather be paranoid than a naive sap who looks the other way while another federal agency and a cruise line play games behind the public's back.

April 7 2013 9:30 PM: The CDC report on the Celebrity Infinity has reappeared. Here it is.  Celebrity Cruises has the dubious distinction of 2 failed CDC inspections and a GI outbreak for 2013.

Photo Credit: Celebrity Infinity  - Wikipedia / Yankeesman312

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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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Researchers in Europe, Japan, New Zealand and the U.S. have detected a new variation of norovirus which emerged last year.  The virus was and remains particularly prevalent in the United Kingdom where norovirus sickened over 1,000,000 people.  The virus was tracked back to Australia and has spread to a number of countries,  The U.S. Centers  for Disease Control (CDC) documented the new mutant virus to have entered the U.S. last fall.

The researchers' findings and conclusions are set forth in a publication "Indications For Worldwide Increased Norovirus Activity Associated With Emergence of a New Variant of Genotype II.4, Late 2012." The new virus has been labeled "Sydney 2012."

An article in Bloomberg explains that this virus has posed a problem for cruise lines late last year and will continue to plague the cruise industry this year. In "Sydney Vomiting Bug Poses Risk for Cruise-Line Passengers," Jason Gale explains that "new epidemics of acute gastro often emerge on cruise ships, where control is hindered by close living quarters and shared dining areas." 

Gale writes that cruise ships carrying sick passengers have docked in New York and Florida the past three weeks, "heralding a new wave of infections for which there is no specific treatment or vaccine." The article cites a professor of microbiology in Australia, Peter White, who says: “Cruise ships are almost a sentinel sensing system for norovirus. Norovirus is going to wreak havoc in their cruise industry for the next year while this new strain gets a grip.”

Last month we wrote about Cunard's Queen Mary 2 sailing into New York from the U.K. with several hundred passengers and crew members sickened with norovirus, Princess Cruises' Emerald Princess docking in Fort Lauderdale with over 200 ill passengers and crew, and the Princess Crown Princess arriving in Galveston from Europe with hundreds puking from noro. 

The researchers are quoted saying: “Cruise ship holidays create an environment in which norovirus is easily spread and outbreaks readily occur." Professor White, who identified the new mutation, refers to cruise ship passengers and says: “It’s almost impossible for them to protect themselves against a norovirus outbreak once it occurs. The only way you could do it would be to stay in your cabin the whole time and not go out.”

Photo credit: Bsip/Photoshot/UPPA/Zuma Press via Bloomberg

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ABC News aired a video look tonight at the recent spate of multiple norovirus outbreaks on cruise ships, focusing on the most recent outbreaks spreading to passengers and crew aboard the Queen Mary 2 and the Emerald Princess cruise ships. 

You can read about our articles about the Emerald Princess and the QM 2.

Watch the video below with ABC's Matt Gutman reporting:

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Miami's WSVM Channel 7 television station is bringing us some bad news this Christmas Eve, reporting that passengers aboard a Princess Cruises cruise ship sailing on the high seas are ill with the dreaded norovirus.

According to News Station 7, more than 150 passengers and crew members reportedly caught the norovirus aboard the Emerald Princess.

This is the second Princess cruise ship in a week to report cases of the contagious virus.  The Crown Princess sailed to Galveston with over 100 cruise passengers and crew members ill with norovirus. You can read several comments by passengers criticizing the food serving and hygiene on the cruise ship  

The news station states that crews will sanitize the ship once it docks at Port Everglades on Thursday, whatever that means.

The sick passengers and crew were reportedly confined to their cabins to prevent a further spread of the disease on the 10-day cruise.

As far as cruise ships calling on U.S. ports, Princess Cruises has by far the most gastrointestinal illness outbreaks - with all of the cases involving norovirus.  According to the data collected by the Centers for Disease Control (CDC), of the total number of 15 outbreaks, this is the ninth sailing with an illness outbreak on Princess cruise ships this year alone:

The Crown Princess suffered two outbreaks in January and February; the Ruby Princess in February; the Sun Princess in July; the Dawn Princess in August and September; the Ruby Princess again in October; the Crown Princess again in December; and now the Emerald Princess.  

As year 2012 ends, Princess has experienced more than 50% of the CDC documented gastrointestinal cases. Considering there are 26 cruise lines associated with the Cruise Line International Association, one cruise line having more than 50% of the sicknesses is quite a feat!

Princess' standard operating procedure is to always blame the passengers for bringing the virus aboard.  Let's wait and hear what Princess says this time. Who wants to make a bet that the cruise line PR representatives point the finger at the poor people spending Christmas Eve puking in their staterooms?

Anyone sailing on the Emerald Princess have comments about the latest norovirus outbreak?  

December 26, 2012 Update: The Global Dispatch states:

The Centers for Disease Control and Prevention (CDC) Vessel Sanitation Program team will be boarding Princess Cruises’ “Emerald Princess” as it arrives in Ft. Lauderdale Dec. 27 to investigate an outbreak of yet unknown etiology, which has sickened nearly 200 passengers and crew.

According to health officials, a total of 166 passengers and 30 crew were sickened with the symptoms of diarrhea and vomiting, resembling norovirus. The voyage dates for the cruise were from Dec. 17 to Dec. 27.

The CDC said the cruise ship took the following actions in response to the outbreak to include cleaning and sanitizing, making announcements to notify passengers and crew and to encourage hand hashing, collecting stool samples for laboratory analysis and reporting twice daily to CDC officials.

This outbreak follows a norovirus outbreak reported aboard a “Crown Princess” cruise destined for Galveston, TX. More than 100 passengers and crew were sickened in this outbreak, according to a Chron.com report earlier this week.

Norovirus is a highly contagious illness caused by infection with a virus of the same name. It is often called by other names, such as viral gastroenteritis, stomach flu, and food poisoning.

The symptoms include nausea, vomiting, diarrhea, and some stomach cramping. Sometimes people additionally have a low-grade fever, chills, headache, muscle aches, and a general sense of tiredness. The illness often begins suddenly, and the infected person may feel very sick. In most people, the illness is self-limiting with symptoms lasting for about 1 or 2 days. In general, children experience more vomiting than adults do.

Norovirus is spread person to person particularly in crowded, closed places. Norovirus is typically spread through contaminated food andwater, touching surfaces or objects contaminated with norovirus and then putting your hand or fingers in your mouth and close contact with someone who is vomiting or has diarrhea.

Photo Credit: Wikipedia (Holger.Ellgaard)

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

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

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

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

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

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

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

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

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

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

Photo Credit: Centers for Disease Control

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

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

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

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

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

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

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

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

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

Photo Credit: News Tank

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Newspapers in Germany report that 67 passengers suffered "heavily illness" on a cruise ship last night aboard the Dutch river ship MS Bellriva. Around midnight the passengers began experiencing what is described as "agonizing nausea, diarrhea and vomiting."  

The cruise ship anchored in the district of Wiesbaden Biebrich on the Rhine River.

The newspapers say that the sick passengers were housed in quarantine in a separate area of the ship during the night. That seems quite difficult because the river ship has only three decks. Some passengers were sent to local hospitals in the morning after experiencing cardio-problems.

There were 188 people on board the ship, including 146 passengers. 

The newspaper state that the passengers were stricken with the dreaded norovirus.

50 members of fire rescue departments showed at the shore up to deal with the many ill passengers.

Videos show many medical responders wearing white hazmat suits standing under a sign on the entrance to the cruise ships saying "Welcome Aboard."   

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

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

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

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

According to the U.S. Food and Drug Administration (FDA), whereas "person to person" transmission of norovirus has been documented, "norwalk gastroenteritis is transmitted by the fecal-oral route via contaminated water and foods." The FDA indicates that contaminated water is one of the most likely causes of norovirus. The FDA reports that "water is the most common source of outbreaks and may include water from municipal supplies, well, recreational lakes, swimming pools, and water stored aboard cruise ships."

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

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

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

Art credit: Chan Lowe / Sun Sentinel

Chart Credit: Friends of the Earth

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Photo credit: 

Bill Hearne - top photos of Voyager of the Seas

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

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

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

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

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

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

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

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

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

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

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

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

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

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

We blogged about this incident last week in our article:

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

CNN described the ship conditions as "really gross:"

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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 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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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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The Centers for Disease Control ("CDC") report that 118 of the 2,730 passengers aboard the Celebrity Solstice cruise ship have reported to the ship's medical facility with vomiting, diarrhea and other symptoms of gastrointestinal illness.

The Solstice is currently on a 14 day cruise and will return to Fort Lauderdale on December 11, 2011.

Pursuant to the CDC Vessel Sanitation Program, environmental health officers and an epidemiologist will board the cruise ship, once it returns to Fort Lauderdale tomorrow, in order assess the outbreak and the cruise line's response activities.

It has been our experience over the years that the "official" CDC numbers of ill passengers and crewmembers is usually less than the true number of those afflicted with viral illnesses.  This is because 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.  Often, sick crewmembers are pressed to work notwithstanding their sicknesses.  

We wrote about the problem of under reporting last year when the Celebrity Mercury experienced a prolonged outbreak of norovirus: Is Celebrity Cruises Under-Reporting Sicknesses to the CDC?

This is not the first time the Solstice has experienced an outbreak this year.  In January and February, there were norovirus outbreaks on the Solstice with one passenger dying due to exposure to the virus. 

Celebrity Cruises has experienced other bouts of widespread illnesses in 2011.  Over 100 passengers became sick on the Millennium in May of this year. 

Not all gastrointestinal outbreaks are documented with the CDC.  The cruise lines do not have to report the outbreaks when the cruise ship does not call on a U.S. port.  In September, norovirus broke out on Celebrity's Eclipse sailing out of Southampton, England.  You will find no mention of it in the official CDC database.

Earlier this week, we discussed Is there a Cure for the Cruise Ship Virus?

If you were on the Solstice and have something to add to this story, please leave a comment below.  Was the sickness more widespread than reported?  How did the cruise line handle the situation?   

Photo credit:  Examiner

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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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The Centers for Disease Control and Prevention (CDC) has listed Royal Caribbean's Radiance of the Seas as the first cruise ship in 2011 to suffer gastrointestinal illness affecting more than 2% of the vessel's passengers.

The CDC's Vessel Sanitation Program website has indicated that 150 of 2336 (6.42%) of the Royal Caribbean passengers reported being ill during the cruise on the Radiance from January 3 - 8, 2011.  The CDC information on the Radiance can be seen here. 

Tampa Local 13-News station has the headline "Sick Cruise Ship Docked at Tampa Port," indicating that vacationers on board suffered from vomiting and diarrhea. The illnesses will delay the ship from returning to sea later today. The station indicates that the cruise ship's departure will be delayed approximately five hours, until 9:30 p.m., "so crews can sanitize the vessel."

The cruise line is advising cruise passengers who have recently experienced gastrointestinal illness should reschedule their cruise.  The CDC is reporting that the cruise line's response to the outbreak is "increased cleaning and disinfection procedures." 

The CDC at this point has not determined whether norovirus is causing the outbreak, nor the source of the "causative factor."  If norovirus is involved, most outbreaks of norovirus are from food and water, not by person to person contact as the cruise lines claim. 

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."

When stories like this occur, the cruise lines blame the passengers and tell them to wash their hands. The cruise ships then spray cleaning fluids everywhere.  But no one ever reveals whether the ship's food and water have been tested and the results of the tests.

The Radiance of the Seas had norovirus outbreaks before.  One passenger took this video of nasty looking tap water on the Radiance on a prior cruise.  An equally disgusting video of brown water on a Carnival cruise ship is here.  

But the winner of the gross-cruise-tap-water award goes to Carnival and is shown here.

Does anyone have video for this cruise?

Were you on the cruise?  How did Royal Caribbean handle the situation?

January 8, 2010 Update:

Passengers on the cruise arre beginning to leave comments, below, that the ice may have been contaminated, that this was a "vacation from hell," and there were way more than 150 passenger  sick.  A few passengers say they still had a great time . . .  

Photo credit:   Tampa's 13-News Station

Video credit:  ABC News

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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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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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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. 

• Comments (4)

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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