According to the Centers for Disease Control and Prevention (CDC), 73 people have reported sick, with symptoms of vomiting and diarrhea, on Holland America’s Zaandam during a cruise through Alaska.

58 of all passengers (3.94% of 1,472) and 15 of all crew members (2.54% of 591) have reported ill to the ship infirmary during the cruise which started on June 18, 2018.  The HAL cruise ship stopped in Juneau yesterday and plans on additional stops in Alaska before returning to Seattle on July 2nd.

Several newspapers report that the outbreak is due to norovirus, although the CDC indicates that the HAL Zaandamcausative agent is currently “unknown.”

Holland America Line experienced 19 cases of GI sicknesses reported to the CDC since 2010. Only Princess Cruises suffered more norovirus/GI cases which were reported to the CDC during this time period. Last year, HAL suffered norovirus outbreaks on the Nieuw Amsterdam, and two outbreaks each on the Volendam and the Noordam.

Cruise ships on non-U.S. itineraries do not have to report GI outbreaks. We have previously mentioned gastrointestinal outbreaks during cruises which do not include a U.S. port, including an outbreak on the Veendam which sailed to a port in Greece last November.

Update: This afternoon I received the following email from a passenger:

“Your latest article about Holland America caught my attention.

I must admit that I am shocked that here on board there is nothing being done regarding standard sanitation before eating. On Princess there is always someone present to give you a plate after you wash your hands or use the sanitation lotion. Here on the Westerdam there is nothing being done.

I don’t see any passengers using any cleaning methods before eating. Therefore your article doesn’t surprise me. Carnival needs to use Princess as an example and get Holland America to improve. I hope this information helps and maybe something can change.

On another note, last week we were sailing in glacier Bay and all paper napkins and straws should be prohibited as they do on Princess but I caught Holland America using them and I quickly reported this to a ranger on board who was shocked.

From my point of view Holland America is lowering their standards and it’s a shame.”

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Photo credit: Barek – commons / wikimedia.

Hidden Foor and Galley Equipment Cruise ShipsToday, the Centers for Disease Control and Prevention (CDC) finally issued a report regarding the United States Public Health Inspection (USPH) inspection of the Carnival Vista which took place six weeks ago, on December 2, 2017.  The USPH sanitation inspection resulted in a failing score of only 79.  Any score of 85 or lower is a failing score according to the U.S. Vessel Sanitation Program (VSP).

Most significantly, the sanitation inspectors found that the Carnival crew members were caught hiding perishable food and galley equipment in crew quarters. The report stated that "an organized effort was made to physically move several containers and trolleys of food equipment, utensils, spices, potentially hazardous food items, raw produce, and decorations to a crew cabin hallway and a crew cabin in order to avoid inspection by VSP staff."

The USPH concluded that crew members moved trolleys filled with lexan boxes of perishable food and galley equipment in order to hide the items from the inspectors. Included on the trolleys were lexan boxes filled with butter, buttermilk, whipping cream, raw salmon, raw lamb and other meats. Inspectors discovered a skillet of lasagna near a crew member bed. Mixed with this food in the lexan boxes were galley machine equipment and batteries, among other items. Flies were found in some food containers.  

In addition, the inspectors found incomplete and/or inaccurate acute gastrointeritis logs, soiled lexan boxes and galley equipment, incorrect time control labels, and raw meat and fish contaminating salad Hidden Foor and Galley Equipment Cruise Shipsitems.  

This is not the first time that crew members were caught hiding food and galley equipment. In 2013, crew members on the Silver Shadow hid food, dirty pots & pans and cooking equipment from U.S. health inspectors. The Silversea cruise ship eventually received a failing score of 82. CNN aired a special on the story. Photographs of this practice are to the left, above left and lower left. 

Over the years, we have heard from thousands of crew members from around the world about the tremendous amount of effort they spend trying to get the cruise ships ready for USPH Inspections. USPH inspections in theory are suppose to be unannounced, but in reality they are rarely a surprise, crew members tell us. Cruise lines routinely hire people in a supervisory position from federal agencies like the USPH, FBI and Coast Guard. In turn, the cruise lines sometimes receive a head’s up from their friends in the federal government when the ship will be met by a team of USPH inspectors.

When a USPH inspection is about to happen, the food and beverage workers will literally work 18 to 24 hours on the days right before the cruise ship arrives in the port where the inspection will take place. There are certain types of baking pans and sheets used everyday for frying greasy food which are extremely difficult to get clean and probably won’t pass inspection. There are hundreds of these pots and pans which the crew try and clean in the pot wash room but it’s difficult to get them all spotless. So what happens is that the galley cleaners are sometimes instructed to rack the pans and sheets in large trolleys and then hide the trolleys down in the crew quarters.

When the USPH inspection is truly a surprise, crew members tell us that there is often a mad scramble to dump everything dirty into lexan boxes and cartons and then stash the stuff in crew members Hidden Foor and Galley Equipment Cruise Shipscabins and corridors on the crew-only areas on the lower decks. 

A bad USPH score is a kiss of death for a cruise ship F&B department head and his supervisors. Ships cut corners to pass inspections.

Over the years, many crew members send us photos of the food and equipment which they are ordered to hide in the crew quarters (photo right from the MSC Poesia).  

What I can only conclude from the report regarding the Carnival Vista is that the USPH inspection was in fact a surprise inspection that caught Carnival doing what it and other cruise lines regularly do – hiding food and galley equipment from sanitation inspectors. 

You can see additional photographs of this practice from the from the Silver Shadow here.    

In addition to the Carnival Vista, the Carnival Breeze also officially flunked its USPH inspection which took place five weeks ago. Last month, we were tipped off of the failed inspection score of only 77 by crew members and we published the news on December 11, 2017.  The official CDC report was finally published today and the Vista did in fact receive a failing score of only 77.

There was a long list of unsanitary conditions found by the inspectors on the Carnival Breeze. Inspectors documented 25 red garbage bins which were "full and overflowing with food waste in the provision corridor on top of wooden pallets and directly outside a lift labeled for food."  Most troubling was evidence that crew members on the Carnival Breeze were working even though the medical records indicate that they were suffering from signs of acute gastroenteritis (this was also the situation with the Vista). Meanwhile, food handlers aboard the Vista who did not work while ill with gastrointestinal symptoms were disciplined on several occasions for not working. 

As I stated in Are Failed USPH Cruise Ship Sanitation Inspections Really Rare?, approximately 20 cruise ships have  Hidden Foor and Galley Equipment Cruise Shipsfailed USPH inspections in the last four years. 

Neither the Vista nor the Breeze submitted corrective action reports, indicating that they have corrected the deficiencies noted by the USPH inspectors last month. 

It’s discouraging that the USPH does not promptly publish reports when a cruise ship fails an inspection. As I previously stated, It seems disconcerting that if the CDC is really concerned about preventing disease on cruise ships, that it would sit on reports of potential public health hazards on several cruise ships for well over a month.

Photo credits: Anonymous crew members aboard the Silver Shadow and MSC Poesia.

The Miami Herald covered the story earlier this afternoon – Inspectors caught Carnival crew hiding dirty conditions. It’s their third ship to fail.

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Its been a tough month for Royal Caribbean. More than 200 passengers became ill and five had to be hospitalized after an outbreak on the Ovation of the Seas during a two-week cruise between Sydney and Singapore, according to the Washington Post.

Local newspapers in South Florida are reporting today that the Independence of the Seas which left Port Everglades on Monday, for a Caribbean cruise, and returned to Fort Lauderdale this morning with at least 332 passengers sickened by a norovirus outbreak.

A cruise travel writer, @CruiseNiche, was on the cruise and posted photos on Twitter about the widespread gastrointestinal outbreak.

Independence of the Seas NoroNBC News reports that over 500 Royal Caribbean passengers have been sickened on these two cruises alone.

Last month, there was a gastrointestinal outbreak on the Anthem of the Seas. Royal Caribbean confirmed that “were a total of 98 reported cases of gastro-intestinal illness symptoms, which represents 1.9 percent of the 4,905 guests and crew onboard.”

The CDC’s Vessel Sanitation Plan requires cruise ships to send a separate notification when the GI illness count exceeds 2% of the total number of passengers or crew onboard. Cruise ship outbreak updates are posted on the CDC website only when 3% or more of the passengers and crew report symptoms to the ship infirmary during the cruise. Because there were less than than 2% of the passengers and crew members reported ill during the cruise, the CDC will not list the outbreak on its official cruise ship Outbreak Updates page.

There was also a norovirus outbreak on the Anthem of the Seas at the end of February and early March 2016 which was reported to the CDC.

Norovirus outbreaks are typically caused by contaminated food or water, according to the CDC and the FDA, although most cruise lines automatically blame their passengers for bringing the virus aboard the ship and/or spreading the outbreak by not washing their hands.

From my view, hand-washing can’t hurt, but it won’t help if the food is contaminated by an ill food handler or waiter. And of course, washing your hands won’t protect you if you contract norovirus via airborne transmission. Three years ago, in an article titled Norovirus Spreads by Air on Cruise Ships, I discussed that researchers have concluded that norovirus can spread by air, according to a publication in the highly respected Clinical Infectious Diseases. This is an issue which the cruise lines have never acknowledged.

As we have said in prior articles, don’t call us if you get sick on a cruise. Establishing where the virus came from, or that the cruise line was negligent, is virtually impossible to prove, especially since the CDC conducts no epidemiological analysis and sometimes can’t even figure out the source of the outbreak.

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Photo credit: @CruiseNiche

Independence of the Seas

HAL VeendamA passenger sailing on a Holland America Line (HAL) cruise ship near Greece contacted me today, stating that a number of guests are experiencing gastrointestinal symptoms:

"I’m currently on MS Veendam. Left Fort Lauderdale on October 20th and due to return to Fort Lauderdale on December 8th. Currently docked in Souda, Greece. Leaving at 5:00 pm less than an hour from now. Souda port terminal has WiFi.

Noro started about four days ago. We did pick up passengers in Barcelona and some of them are sick now and seem to have gotten sick shortly after boarding from what I understand. One day there were 29 passengers and two crew sick . . .  Yesterday …  only four new cases and no crew sick anymore. 

Ship is cleaning, isolating and taking precautions including not allowing passengers to handle food which is good."

It is currently unknown whether the gastrointestinal outbreak is in fact due to norovirus (or-coli or some other more exotic virus) because there will be no testing of the affected passenger’s stools. 

In the last week, we have written about GI outbreaks which included the Crown Princess, which called on a U.S. port and had to report the outbreak to the U.S. Centers for Disease Control and Prevention (CDC). The Anthem of the Seas was experienced a similar outbreak affected many dozens of guests (around 100 people). The Anthem did not meet the percentage of guests who reported their symptoms to the ship infirmary, and therefore there is no official CDC report.  The Celebrity Solstice was also reportedly hit with an aggressive GI outbreak while sailing around Australia, according to news accounts. 

Holland America Line experienced 18 cases of GI sicknesses reported to the CDC since 2010. Only Princess Cruises suffered more norovirus/GI cases which were reported to the CDC during this time period. HAL suffered norovirus outbreaks on the Nieuw Amsterdam, and two outbreaks each on the Volendam and the Noordam this year.

Cruise ships on non-U.S. itineraries do not have to report GI outbreaks. 

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Photo credit: Fletcher6 – CC BY 3.0, commons / wikimedia.

A local news station in Philadelphia reports on a recent gastrointestinal outbreak on the Royal Caribbean Anthem of the Seas.

ABC-6 reports that a family from Philadelphia returned from a 7-night cruise aboar the Anthem which departed Cape Liberty, New Jersey on Saturday, November 4th. The news stations reports that on the second day of the seven day cruise, "rumors of the virus started circulating . . . and started to spread fast. Workers could be seen spraying the narrow hallways, but it was apparently spreading like wildfire." 

A newlywed woman and her husband and several of her family members became ill with symptoms of a gastrointestinal virus. 

The family complained to the news stations that "some hand sanitizing stations … didn’t have any Royal Caribbean Norovirussanitizer available to us, there were out of soap at certain sinks, there were no sanitizing stations at the elevators . . the ship’s managers (didn’t take) enough measures to stop the spread of the virus, which is not airborne but rather comes from personal touch with others or germs left on surfaces."

Royal Caribbeaan confirmed that "were a total of 98 reported cases of gastro-intestinal illness symptoms, which represents 1.9 percent of the 4,905 guests and crew onboard." 

The CDC’s Vessel Sanitation Plan requires cruise ships to send a separate notification when the GI illness count exceeds 2% of the total number of passengers or crew onboard. Cruise ship outbreak updates are posted on the CDC website only when 3% or more of the passengers and crew report symptoms to the ship informary during the cruise.

Because there were less than than 2% of the passengers and crew members reported ill during the cruise, the CDC will not list the outbreak on its official cruise ship Outbreak Updates page.

A couple of take-aways from this article. First, how many passengers did not dislose their symptoms to the ship doctor?

Secondly, there is no indication that the outbreak is related to norovirus, which cannot be confirmed until there is scientific analysis of the infected passengers’ stool samples, which will not be done because the CDC is not involved.

Thirdly, the local news station is wrong that GI virus outbreaks can’t occur through airborne transmission. Two years ago, in an article titled Norovirus Spreads by Air on Cruise Ships, I discussed that researchers have concluded that norovirus can spread by air, according to a publication in the highly respected Clinical Infectious Diseases.

Finally, don’t call us if you get sick on a cruise. Establising where the virus came from, or that the cruise line was negligent, is virtually impossible to prove, especially since the CDC conducts no epidemiological analysis and sometimes can’t even figure out the source of the outbreak

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Read: Gastrointestinal Outbreak on the Crown Princess, Again.

http://6abc.com/video/embed/?pid=2643100

The Centers for Disease Control (CDC) reports that there was a gastrointestinal outbreak on the Crown Princess during its recent cruise, from October 25th to November 8, 2017. The Princess cruise ship departed Quebec, Canada on October 25th for a two-week cruise to Canadian and U.S. ports. The cruise ship arrived in Fort Lauderdale, Florida on November 8th and will begin its Caribbean season.

According to the CDC report, 184 passengers and 12 crew members became ill with gastro-like symptoms which included diarrhea.  

During the period from 2010 to the current date, Princess Cruises experienced the most outbreaks on iCrown Princess Princess Cruises Norovirusts cruise ships calling on U.S. ports, according to the CDC. Princess reported twenty-one (21) cases to the CDC during this time period.

The Crown Princess alone has suffered through six (6) norovirus outbreaks since 2010 to the present. Before the current GI outbreak, the last norovirus outbreak on the Crown Princess was from January 3 – 18, 2016 and, before that, from October 18 to November 16, 2014. Earlier, there was a norovirus and e-coli outbreak from February 5 to 12, 2014. It also experienced back-to-back norovirus outbreaks from January 29 to February 4, 2012 and February 4 to February 9, 2012 (photo right).

The cruise line with the second most outbreaks is Holland America Line with 18 cases of GI sicknesses reported to the CDC since 2010. HAL suffered norovirus outbreaks on the Nieuw Amsterdam, and two outbreaks each on the Volendam and the Noordam this year.  

So why is Princess Cruises far more prone to norovirus outbreaks than Carnival cruise lines, for example? The cruise industry always blames the passengers for bringing the virus aboard, rather than its food handlers, or contaminated food or water. So are Princess Cruises customers the sickest and the least hygienic cruisers around? Are guests of HAL the second most unhygienic cruisers? Do they wash their hands the least of any cruisers? This seems like absurd arguments to make.

Is there a correlation between the age of the cruise ships and gastrointestinal outbreaks? Are different food sources and food handling techniques a more reasonable explanation? How about different sanitation procedures? 

The CDC doesn’t have time to determine the source of the norovirus outbreak (sick food handlers versus contaminated food or water or a sick passenger) so it is of no help. The CDC has not even determined the type of virus involved in the most recent outbreak on the Crown Princess.  

But blaming the passengers when one cruise line (and one cruise ship in particular) has far more gastrointestinal outbreaks than its competitors is certainly not the answer.

Whoever is to blame, the crew members, of course, always pay the price, by having to wipe and scrub and spray everything in sight for long 16+ hour days to try to disinfect a ship longer than three football fields.

Irrespective of the blame-game, don’t call us if you get sick on a cruise. Proving where the virus came from, or that the cruise line was negligent, is virtually impossible to prove, especially since the CDC conducts no epidemiological analysis and sometimes can’t even figure out whether the outbreak is due to norovirus, e-coli or something as exotic as shigella sonnei or cyclospora cayetanensis

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Read: Why Do the Cruise Lines Always Blame the Passengers When Norovirus Breaks Out?

Oceania Crew Members Pay the Price When Norovirus Hits.

Photo credit: WPTV (2012 noro outbreak); Royal Caribbean crew members (anonymous crew member).

Coral PrincessThe Coral Princess arrived in Fort Lauderdale this weekend with 157 of 2,016 cruise passengers aboard the Princess Cruises’ ship stricken with nausea/vomiting and diarrhea which the Centers for Disease Control and Prevention (CDC) suspect are symptoms related to norovirus.

The noro-infected passengers comprise 7.79% of the total passenger population on the ship. 25 of 881 (2.84%) crew members are also infected.

The CDC was unable to conclude where the norovirus came from. I am not aware of a single instance when the CDC has pinpointed the cause of a cruise ship disease outbreak. Unfortunately, the public is often left with the "blame game" of wondering whether the cruise ship food or water was contaminated (which the CDC and FDA generally say are the most likely causes of gastrointestinal outbreaks), or the outbreak was caused by a sick galley worker, or was brought aboard by sick passengers, and then spread because of inadequate hygiene and poor cleaning procedures.

Several years ago, Time magazine published an article titled 13 Worst Norovirus Outbreaks on Cruise Ships. The overall winner of Time’s top 13 list was Princess Cruises which had five outbreaks on its brand alone: Crown Princess (January 2010) with 396 ill; Crown Princess (February 2012) – 363; Ruby Princess (March 2013) – 276; Coral Princess (February 2009) – 271; and Sun Princess (July 2012) – 216.

The last norovirus outbreak involving the Coral Princess was in April 2015.

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Photo credit: Roy Luck – CC BY 2.0, commons / wikimedia.

Hat tip to the popular Crew Center blog which first covered the outbreak. 

HAL's OosterdamPassengers aboard a Holland America Line (HAL) cruise ship have fallen ill with symptoms consistent with norovirus on an approximately two week trans-Atlantic cruise that departed from Civitevecchia, Italy on November 3rd and arrived today in Tampa, Florida.  

According to the Centers for Disease Control and Prevention (CDC), the November 3 – 18 cruise aboard the Oosterdam sickened 86 of 1,843 passengers (4.67%) and 18 of 796 crew members (2.26%) who exhibited symptoms of vomiting and diarrhea. 

The link to the CDC about this outbreak is here. There has been no official determination of the cause of the outbreak although norovirus is suspected.

According to the CDC and the FDA, the most common cause of norovirus is contaminated food or water. Of course, like land-based restaurants, ill food handlers often transmit the virus. Passengers can also obviously bring the disease aboard which can spread due to unhygienic conditions caused either by the passengers and/or the cruise line.

Before there can be a scientific determination as to the actual cause of the outbreak, there must first be a serious epidemiology assessment of the ship which the CDC rarely performs due to the quick turn-around of the cruise ship. Unfortunately, in this case HAL immediately argued that norovirus is allegedly "circulating throughout North America and can be easily transmitted if personal hygiene is not maintained," according to a statement that it released to the Tampa Bay Times.

The CDC says that there have been 13 GI outbreaks this year, mostly involving norovirus with two e-coli outbreaks. 

The cruise ship says that it performed enhanced cleaning and left today for the Caribbean.

Photo credit: Sebastian Wessels wikipedia / commons, CC BY 2.5.

AdoniaThe Centers for Disease Control and Prevention (CDC) reports that there was an illness outbreak on Fathom’s Adonia this past week (October 16 – October 23, 2016).

The CDC states that 23 of 668 (3.44%) passengers reported being ill with diarrhea and vomiting during this voyage which returned to Miami from Cuba yesterday. Only 2 out of the 388 crew members were reportedly sick.   

A CDC environmental health officer boarded the ship when it returned to Miami.

The CDC has not determined the cause of what appears to be a gastrointestinal outbreak.  

Fathom increased its cleaning and disinfection procedures for the cruise ship.

Fathom’s historical first cruise on the Adonia cruise ship to Cuba was plagued by a norovirus outbreak. The captain of the ship announced a gastrointestinal outbreak with the passengers experiencing symptoms consistent with norovirus on the ship last May. Carnival later contradicted the captain and said that there was no confirmation that the passengers were sickened by norovirus.   

The Adonia also suffered a complete blackout last May and was ordered to return to the port of Miami when it regained power.  It had earlier failed U.S. Coast Guard inspections in April when it arrived in Miami from P&O Cruises when it was being readied for cruises to Cuba and the Dominican Republic.

The Adonia is currently sailing to Amber Cover in the Dominican Republic.

Photo credit: By Alessandro Ambrosetti from Rome, Italy – Fathom Adonia, CC BY 2.0.

Empress of the SeasAccording to the Centers for Disease Control and Prevention (CDC), Royal Caribbean’s Empress of the Seas flunked a surprise sanitation inspection conducted in early June. The Empress of the Seas scored a failing score of only 80.  You can read the report here. A score of 85 or lower is considered a failure.

The Empress of the Seas underwent an extended period of renovations in Spain and later in Freeport, Bahamas when the ship was transferred back from Pullmantur. Royal Caribbean canceled a total of thirteen cruises scheduled for earlier this year. The first sanitation violation related to the renovation and involved a bathroom for the medical staff which could be used only for storage and was "heavily soiled." Back in April of this year, Royal Caribbean told the Miami Herald that “as work has progressed, we learned that more significant infrastructure and physical improvements across the ship’s multiple galleys and provisioning areas were needed to meet our high standards.”

I was contacted previously by crew members, during the renovation period, who complained  of unsanitary conditions on the ship. There was talk that the CDC had inspected the ship and initially had not given the ship a passing score, although there was nothing officially posted on the CDC website. Several crew members said that the ship had fallen substantially in disrepair while operated by Pullmantur and had a major problem with pests.    

It is apparent, however, that once back in the Royal Caribbean fleet, the Empress failed to meet high standards. The report regarding the June inspection details forty four CDC violations, ranging from improper procedures to monitor acute gastrointestinal illness cases to incorrect potable water and swimming pool/whirlpool testing.   

The report included numerous references to live and dead flies and cockroaches around refrigerators, buffet lines and other areas used for food storage. The ships was also in violation of the CDC’s requirement to use rat guards, and was utilizing rat guards on only one out of six mooring lines while the ship was in port.

A crew member states that the Empress was reinspected earlier this month, on July 10th, and received a score of 97.  If such an inspection took place, the CDC has not posted that inspection yet.  

Royal Caribbean, including its Celebrity brand, has failed other inspections in the past.  In 2013, the Celebrity Century scored only a 78.  The same year, the Celebrity Summit scored only a 81. The Monarch of the Seas scored a 85 in 2011. 

Two years ago, Market Watch published the 5 Most Hygienic Cruise Lines and concluded that Costa and Disney and three other smaller lines had never failed a CDC inspection. Since then, the Disney Wonder experienced a gastrointestinal outbreak in April of this year.    

We last mentioned the Empress of the Seas three weeks ago when it experienced problems with one of its engines, causing Royal Caribbean to alter the cruise ship’s itinerary.

Photo Credit: By Jsausley – Own work, CC BY-SA 4.0.