The purpose of the Vessel Sanitation Program (VSP) at the Centers for Disease Control and Prevention (CDC) is to assist the cruise ship industry to "prevent and control the introduction, transmission, and spread of gastrointestinal (GI) illnesses on cruise ships." VSP operates under the authority of the U.S. Public Health Service Act.

USPH sanitation inspectors conduct inspections twice a year on cruise ships when they are in a U.S. port. The inspections are supposedly a surprise, although many crew members have stated that federal inspectors sometimes give advance notice of the inspections to the cruise ships. A score of 85 or below constitutes a failed sanitation score, and often leads to the firing of the shipboard Food & Beverage department heads and/or managers and always result in increased work by the shipboard employees.

Market Watch just published a comprehensive article, by reporter Jacob Passy, titled Record Number Carnival Libertyof Cruise Ships Failed Health and Safety Inspections in 2017, concluding that there were 14 instances where a cruise ship failed a sanitation inspection last year.  The article found that  Carnival Cruise Line cruise ships received five failing grades, in addition to one one failure this year.

Carnival claims that its food handling and preparation are of the "highest quality, which seems questionable regarding the details of the scores like on the Carnival Breeze (77), Carnival Triumph (78), Carnival Vista (79), Carnival Legend (83), and Carnival Paradise (83). The Carnival Liberty failed this year with a score of only 83.  

The Carnival Vista was re-inspected yesterday and receive a score of only 88, a passing but not a good score coming off of such a spectacular failure last year.  The CDC has not published the re-inspection score yet.

Carnival also claims that it "immediately" corrected the unsanitary conditions found by the inspectors. (Carnival ships failed inspections 4 times in the last 2 months). But the truth is that Carnival has still not even filed a "corrective actions" report for the Carnival Vista which failed the USPH inspection last year. The report found that not only did Carnival try to intentionally hide food and dirty galley equipment in crew quarters, but the the USPH noted that a Carnival supervisor disciplined a food handler who was experiencing acute gastrointestinal virus symptoms when he did not report to work.

The VSP requires cruise lines to correct the non-conforming conditions and file a "corrective report" promptly after the violation. The Vista failed its inspection over six weeks ago, but Carnival has still not filed a corrective report as of today’s date, January 27, 2018. 

Market Watch state that the CDC can advise a ship not to sail if "particularly egregious violations are uncovered," which may be true in theory but never occurs in reality. It’s difficult to imagine more egregious violations than what the USPH found on the Vista last month, but there is no evidence that the cruise line has even bothered to file a report admitting to its violations and outlining its corrective actions. 

Part of this problem is that there is often a cozy relationship between federal inspectors and cruise line officials where unsanitary conditions are sometimes not noted or enforced. Indeed, it took over a month for the CDC to even publish the failed inspections on the Carnival Breeze and Carnival Heath Inspection - ClosedTriumph last month on its official website. 

A shore-side restaurant with a failed health inspection will quickly find a "closed due to health inspection" placard (photo right) taped on its front door. For health violations on cruise ships, however, the public has to search the online database, which is often not current, for information. 

A cruise ship which is caught intentionally hiding food and galley equipment in its crew quarters, or which does not timely submit a corrective report, should be barred from sailing.  A local shore-side restaurant would be shut down in a minute for such unsanitary conditions. But the USPH often bends to the cruise line’s the-show-must-go-on mentality. 

Market Watch interviewed cruise expert cruise expert Dr. Ross Klein who noted that a failed CDC inspection is all the more questionable when looking at the details of the reports for cruise ships that have actually passed inspections. According to Dr. Klein, “you can get 100% but there can still be a number of citations for things that were not up to standards."

Market Watch wrote that one ship which received a 100% score was cited for storing boxes of fruit juice near raw egg shells and for one crew member was working while showing symptoms of gastroenteritis.

Dr. Klein also noted that the Vessel Sanitation Program applies only to cruise ships calling on U.S. ports. Few countries outside of the U.S. inspect cruise ships for sanitation problems.

Which cruise ships which flunked the USPH sanitation inspections last year? See the list below:

  • Carnival Breeze (77);
  • Carnival Legend (83);
  • Carnival Paradise (83);
  • Carnival Triumph (78);
  • Carnival Vista (79);
  • Ferries Del Caribe Kydon (55, 61);
  • Japan Cruise Line’s Pacific Venus (76); 
  • Japan Grace Line’s Ocean Dream (82);
  • Oceania Regatta (84); 
  • Paradise Cruise Line’s Grand Celebration (84);
  • Ponant’s Le Boreal (84);
  • Princess Cruises Crown Princess (84); and
  • Victory I Partners, Ltd.’s Victory 1 (78);

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Photo credit: Carnival Liberty – Workman – Own work, CC BY-SA 4.0, commons / wikimedia.

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.

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.

Oceania RivieraYesterday we received information about the current cruise of the Oceania Rivieria which is sailing through the Caribbean (Miami March 20-April 3). "The captain came on the intercom yesterday informing the passengers that a large number of passengers had come down with flu like/gastrointestinal issues and the CDC had been informed. The ship ported at their first stop Santa Marta, Colombia as scheduled today."

The Centers for Disease Control and Prevention (CDC) has now officially reported the third norovirus outbreak on the cruise ship.  

The first recent outbreak was during the November 18 – December 2, 2015 sailing and involved 74 ill passengers. The second outbreak occurred during the  February 12-22, 2016 sailing which had to be ended early and involved at least 124 sick passengers. We wrote about how the crew members had to work overtime, often off the clock and without extra pay, to try and super-clean the cruise ship. 

This latest outbreak involves at least 52 passengers who are ill with norovirus. Zero crew members were reported ill during the current cruise.

Unfortunately, the under-staffed CDC never tries to conduct a meaningful epidemiology assessment to determine whether the outbreak can be traced to a particular type of food contamination, an ill food handler, poor cleaning of the ship or an ill passenger who brought the noro aboard the ship. 

Expect the number of affected passengers to increase during the cruise notwithstanding the extra hours spraying and wiping by the crew. 

So far this year, there have been 8 gastrointestinal outbreaks reported to the CDC by cruise ships calling on U.S ports. 

Photo Credit: Kefalonitis94 CC BY-SA 4.0, creative commons / wikimedia.

Golden Princess9News in Australia reports that the Golden Princess cruise ship docked in Melbourne this morning “after hundreds of passengers were struck down with gastro.”

The newspaper reports that “more than 300 passengers” on-board the cruise ship are believed to have been affected with a gastrointestinal illness.

Princess Cruises spokesman praised the ship’s crew and medical personnel who handled what the newspapers said is believed to be norovirus.

In the last two month, Princess Cruises has experienced a number of gastrointestinal outbreaks, on the Ocean Princess, Diamond Princess, and the Crown Princess.

Princess Cruises has experienced the most gastrointestinal outbreaks in the last decade – over 20.

Norovirus is primarily a food-borne virus which often spreads through contaminated food or water.  It can be spread by food handlers, people who touch contaminated surfaces and from person to person transmission.

Photo credit: Jean-Philippe Boulet, CC BY 3.0.

Norwegian GemEarlier this week, we reported that health officials banned the Norwegian Gem from calling on St. Maarten because a number of passengers were ill with a gastrointestinal illness. The NCL cruise ship then sailed on to Tortola where it called on the port there.

The Centers for Disease Control and Prevention (CDC) is now officially reporting that 128 of 2,882 cruise passengers (4.44%) and 7 of 1,100 of crew members (0.64%) on the Gem have been ill during the cruise with norovirus. 

Although it was suggested on the cruise ship that the cause of the outbreak may be contaminated water, there has been no information released to the public confirming or excluding this possible cause. Norovirus is primarily a food-borne disease. Outbreak News Today correctly states that "norovirus is typically spread through contaminated food and water, 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."

Unfortunately, the CDC has limited resources and does not attempt to conduct an epidemiology assessment regarding the source of the norovirus outbreak.    

Photo credit: Corgi5623 at English Wikipedia, CC BY-SA 3.0.       

Several passengers on the Norwegian Gem have contacted me, saying that health officials in St. Maartan have reportedly prohibited the NCL cruise ship from porting there.

The passengers are saying that there is a gastrointestinal outbreak reported on the Gem, thought to be norovirus.

I have not previously heard there was any type of outbreak on the ship. Anyone have information?

Photo credit: Corgi5623 at English Wikipedia, CC BY-SA 3.0 

March 18, 2016 Update: We are receiving some interesting comments on our Facebook page, including one suggesting that the source of the outbreak may be contaminated port water – rather than the cruise lines’ usual excuse of cruise passengers blamed for not washing their hands.

March 21, 2016 Update: The Gem next called on Tortola. Many local citizens are not happy. VI allows cruise ship to dock despite alleged Norovirus infection outbreak