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.

Silver Shadow The Center for Disease Control and Prevention (CDC) is reporting that there is a gastrointestinal outbreak on the Silver Shadow operated by the Silversea Cruises company.

The CDC reports that 28 of 327 (8.56%) of the passengers suffered from vomiting and diarrhea and other GI symptoms and reported being ill during the cruise, which took place between May 10th and today (May 24, 2018). 8 of 290 crew members reported ill with such GI symptoms during the cruise.

The CDC has not been able to determine the causative agent (norovirus, E. coli, etc.for the outbreak.

This is the fifth GI outbreak this year on a cruise ship meeting the threshold requirements of the CDC. The CDC’s Vessel Sanitation Program (VSP) is required to post a report when 3% or more of passengers or crew report symptoms of gastrointestinal illness to the ship’s medical staff. The medical staff of a cruise ship must send the reports to the CDC within 15 days of arriving at a U.S. port.  

The Silver Shadow failed a CDC inspection back in 2013 in a heavily publicized case when crew members were ordered to hide food and galley equipment in the cruise ship’s crew quarters. The Silver Shadow failed another CDC inspection in 2015.  The Silver Shadow passed four CDC inspections since 2015 (with scores ranging from 95 to as high as 100) and there is no indication of a correlation between the past failed CDC inspections and the current GI outbreak on this cruise ship. (The Silver Wind, on the other hand, recently failed a CDC inspection, in May of this year, with a score of only 79).

The Silver Shadow is currently at the end of a two week cruise which started in Tokyo, Japan on May 10th. The ship has called on a number of other ports in Japan (Aomori, Hakodate, and Kushiro) and Petropavlovsk, Russia before arriving at various ports in Alaska, including Seward where it stopped this morning. 

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Photo credit: Bahnfrend – CC BY-SA 4.0, commons / wikimedia.

May 25, 2018 Update: Here is a statement from Silversea Cruises:

Monaco; May 25, 2018

GI cases on Silver Shadow

“Following a number of passengers and crew reporting gastrointestinal symptoms to the medical staff on board the Silver Shadow the vessel registered these cases with the Centre for Disease Control and Prevention (CDC) in line with standard procedures.

Over the period May10-24, 28 out of 327 passengers and 8 out of 290 crew members reported GI symptoms to the ship’s Doctor during the cruise from Japan to Alaska with a call at the Russian Port of Petropavlosk.

The ship’s Doctor kept in regular contact with the CDC Officer during the passage to Seward Cruise Port, Alaska, where the Silversea Head of Fleet Operations, together with a CDC Officer joined the vessel to review all sanitation procedures and confirmed that the ship’s Management were following all the correct procedures. No further cases of GI of symptoms have been reported and the vessel has been cleared to continue cruising. All passengers are currently recovering.”

May 28, 2018 Update: Here is another statement from Silversea:

Monaco; 28th May 2018

“In its latest US Public Health/ CDC Inspection in Juneau on May 26, cruise ship “Silver Shadow” scored 93 out of a possible 100 points. This outcome, reflecting the company’s high standards, is the result of the work done by the ship’s management and staff in dealing with an occurrence of gastrointestinal symptoms reported to the USPH/CDC in line with standard procedures prior to the ship’s arrival in Seward, Alaska following a cruise from Japan.

Over the period May 10-24, 28 out of 327 passengers and 8 out of 290 crew members reported GI symptoms to the ship’s medical staff.

The ship’s Doctor kept in regular contact with the CDC Officer during the passage to Seward Cruise Port, Alaska, where the Silversea Head of Fleet Operations, together with a CDC Officer joined the vessel to review all sanitation procedures and confirmed that the ship’s Management were following all the correct procedures. No further cases of GI of symptoms have been reported and all passengers have recovered”

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.

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. 

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.

A gastrointestinal sickness outbreak on the Silver Shadow in March was found by the Centers for Disease Control and Prevention (CDC) to be caused by Enterotoxigenic E. coli (ETEC).

The outbreak occurred during a cruise from March 3 – 21, 2016. The outbreak sickened 37 people according to the CDC report on the incident. The CDC concluded that 24 of 388 (6.19%) passengers and 13 of 366 (3.55%) crew members fell ill due to the disease.

Outbreak News Today said that “according to the Centers for Disease Control and Prevention (CDC), Silver SpiritETEC is a major bacterial cause of diarrhea among travelers and children in the developing world. ETEC is increasingly recognized as an important cause of foodborne illness in developed nations, such as the United States. Infection occurs when a person eats food, or drinks water or ice contaminated with ETEC bacteria. Human or animal wastes (e.g., feces) are the ultimate source of ETEC contamination.”

Silversea Cruises was last in the news several years ago when the USPH caught crew members hiding perishable food and galley equipment in crew quarters on the Silver Shadow and flunked the cruise line. CNN covered the scandal. You can see the video here.

The Silver Shadow failed another USPH inspection last year as well.

The Silver Spirit, on the other hand, has always scored highly by the USPH (93-100) in the last 6 years, and it scored a 98 during the last inspection in January. However, in a lawsuit filed by a Silversea crew member (aboard the Silver Spirit and Silver Wind) in 2011, the crew member alleged that his employment as a bartender was terminated after he complained that he was required to fill expensive, premium top-shelf brand liquor bottles with cheaper brands and to fill empty expensive French champagne bottles with cheaper Italian sparkling wines. The case is Marin Asenov v. Silversea Cruises, Ltd., Case No. 0:11 CV 62360 WJZ. You can read the allegations in the lawsuit here.

Photo credit: This image photographed by Brian Burnell with permission was uploaded to Commons by George Hutchinson. CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=15252523