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.

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

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.

The Sun Sentinel is reporting that the Fathom Travel’s historical first cruise on the Adonia cruise ship to Cuba may have experienced a norovirus outbreak aboard the ship sickening passengers, according to reports from the captain. 

At around 2:45 P.M. this afternoon, there were at least 14 people on the ship complaining of diarrhea, vomiting and stomach cramps mentioned by the captain according to the Sun Sentinel. With only around 600 people aboard the cruise ship, that’s over 2% of the cruise passengers which is near the threshold where the Centers for Disease Control and Prevention (CDC) become involved.

The photos and video from the cruise ship show crew members already rubbing and scrubbing the surfaces of the ship. Norovirus is primarily a foodborne virus although the virus can last for weeks on contaminated surfaces. It can also be spread by person to person contact. Hand shaking on the ship is apparently discouraged. Self-serve buffets have also reportedly been replaced with service by crew members wearing gloves. 

The cruise ship, of couse, quickly blamed the passengers with the ship doctor writing a letter saying "we suspect that the virus may have been inadvertently introduced on board by embarking travelers, even though the ship had not even performed tests to make such a determination.  One of those sick, a former public health social worker, said "I think it was something I ate." Read Fears of Norovirus mar last day of cruise to Cuba.

You can see a video related to the gastrointestinal virus on the Adonia here

Norovirus on the first cruise to Cuba?  There must be a Jimmy Fallon joke here somewhere. 

May 8 2016 Update:  Spin Masters? Carnival PR team tells the Sun Sentinel that there is no verification that the Adonia guests were sick due to norovirus.

 

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Fathom Travel Adonia Ship Doctor Norovirus

 

https://youtube.com/watch?v=YBeEE9vh8kA%3Frel%3D0

The Fred Olsen Balmoral cruise ship has docked in Norfolk amidst what the Centers for Disease Control and Prevention (CDC) is saying is a norovirus outbreak which has inflicted diarrhea and vomiting symptoms on 153 of 917 (16.68%) passengers and 6 of 518 (1.16%) of crew members, over the course of the two week cruise according to a CDC report

It is the ninth gastrointestinal outbreak this year involving a cruise ship calling on a U.S. port according to the CDC

The Balmoral is an old (1987) cruise ship flagged in Nassau which has struggled with gastrointestinal illness outbreaks over the years. 300 passengers were stricken with symptoms when the ship experienced aFred Olsen Balmoral massive outbreak in May of 2015. The cruise line curtailed the cruise from 8 to 7 days to return to Southampton for "barrier cleaning." In early 2010, a newspaper reported that the Balmoral could have been detained after 250 passengers fell ill with norovirus. In an article entitled "Cursed Cruise Ship Balmoral to be Investigated," the newspaper reported that the sick cruise ship was heading from the Canary Islands to Dover, England. From 2009 to 2010, the number of those affected in three sickness outbreaks on the ship was "541 in under 12 months."

Norovirus is a disease which, although common on shore as well, is a public relations nightmare for the cruise lines. Unfortunately, gastrointestinal outbreaks on the high seas are handled differently than ashore. The cruise lines cast blame on the customers 100% of the time.  

Norovirus, according to the FDA and CDC, is primarily a food-borne disease caused by contaminated food or water.  It can also be caused by ill food handlers as well as by cruise passengers who come aboard the ship already ill.  Chipotle, for example, has taken great responsibility for norovirus outbreaks whenever they occur in one of their stores, by not opening the stores whenever a food handler becomes ill, improving food-handling policies and procedures and carefully scrutinizing food sources to determine whether the outbreak can be tracked down before it infects customers in the stores.

On cruise ships, on the other hand, neither the cruise lines nor the minimally funded and staffed CDC conduct any epidemiology analysis. The cruise lines resort simply to massive spraying, rubbing and scrubbing every surface in sight. But such measures don’t help if the lettuce comes on the ship contaminated or if handled by a sick chef who infects 75 passengers who eat a salad. Crew members are placed under incredible stress and work long hours whenever there is a code red issued. Crew lines automatically blame the personal hygiene of the passengers time after time, ship after ship, no matter the real source of the outbreak and even though no scientific process has taken place to pinpoint the true cause of the outbreak.  

I anticipate readers who will respond to this article by posting anecdotal stories of seeing passengers not bothering to wash their hands after they use public bathrooms or not using hand sanitizers, which are largely ineffective against norovirus in the first place.  

Chipotle has funded studies to investigate how it can ensure its food quality by improving food handling techniques. It clearly has a commitment to get to the root of the cause of the illness. I know of no commitment by the cruise lines to allocate any of their massive profits to study the problem. Indeed, no cruise line has even acknowledged the studies which indicate that the virus can become airborne when vomited, which seems like a massive problem given the confined space on a cruise ship. (Read: Airborne Norovirus – What Now Cruise Lines?

So there will be more and more outbreaks, the crew members will continue to be pressed to work longer hours spraying and wiping, the cruise lines will continue to blame the dirty hands of their customers, and no one will figure out the real cause of the outbreak.   

Statement by Fred Olsen: The cruise line is already blaming its guests.  It cites its alleged compliance with, among other things, the "strict" requirements of the "flag state" (Nassau).

May 8. 2016 Update:  The Centers for Disease Control and Prevention says 27 percent of the passengers aboard the Balmoral have gotten sick since the cruise began April 16th. WMTW-TV says that according to the CDC,  252 of the 919 passengers on the Balmoral have fallen ill, as well as eight crew members.   

May 11 2016 Update:  The CDC says the total number of passengers sickened since the beginning of the cruise has increased to 272 passengers. According to the Evening Standard, Cruise ship Balmoral was infected with vomit bug BEFORE setting sail.  

 

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Photo credit: LesMeloures CC BY-SA 3.0, commons / wikimedia (photo taken 2008 before paint change)

    

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P&O OceanaA month ago, a crew member aboard the P&O Oceana notified me that the cruise ship failed a sanitation inspection by the enters for Disease Control and Prevention (CDC) while the ship was in port in Charleston, South Carolina.  Oceana received a score of 82; 85 or lower is considered a failure.

I have been checking the CDC’s online inspection scores since then. I have been asking the CDC when it will release its report on the Oceana.

The report was finally released today. You can read the report here. The report indicated that several back-flow prevention devices, to prevent the contamination of potable water, did not have test results and appeared not to be tested. The ship’s Riviera swimming pool and Crystal whirlpool did not have adequate levels of chlorinated and bromine, failed to have hair and lint strainers / filters and were not disinfected. The inspector closed the recreational water facilities on the ship.

The report also revealed that a food handler had an onset of Acute Gastroenteritis (AGE) and exhibited symptoms at 9:00 A.M. in the morning but did did not report to the medical center until 11:20 A.M. A review of the crew member’s work history indicated that this crew member worked, notwithstanding his illness, from 7:30 A.M. until 10:30 A.M.

The ship’s galley appeared dirty. There were comments like “the tile grout in this area was soiled and in disrepair.”  “The deck below under counter refrigerator . . . had a significant buildup of more than a week’s accumulation of food debris, dirt, equipment parts, and what appeared to be insect remains.” Food service equipment was broken or out of service and many operational ovens and ice-makers were overflowing their drip pans and/or leaking onto the floor.

Oceana has not prepared a “corrective action report” in response to the failed score, as required by the CDC.

In an era when cruise lines are quick to blame every single norovirus outbreak on the passengers, this CDC report provides an insight into how deficient water sanitation and disgusting food handling practices by a cruise line can jeopardize the health of the traveling public.

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April 4, 2016 Update: The CDC vessel sanitation inspectors inspected the P&O Oriana in February.  Although the cruise ship passed with a score of 90, there were several significant sanitation problems including dirty and out of service galley equipment.  Also food handlers working while ill with gastrointeritis: “A Chef de Partie experienced onset of GI symptoms on 20 January 2016 at 6:45 am. This crew member worked from 7 am to 11 am, took lunch at the crew mess, then returned to work from 1 pm to 5 pm. The chef reported his symptoms to the medical center at 6 pm.”   You can read the report here.

April 5, 2016 Update:  Cruise Law News was quoted today in the Southampton’s Daily  Echo and the U.K.’s Daily Mail.

Fortune magazine also covered the story, writing that it “raises questions about the industry’s squeaky-clean image, and indeed, that there may be more unreported cases that were either ignored or dismissed by the sickened passengers or the cruise lines themselves.”

April 6, 2016 Update:  FoxNews covers the story today – Health inspectors find cockroaches, ‘potentially hazardous’ food aboard two luxury cruise ships.  The Cruise Line International Association (CLIA) interjects the blame-the-passenger-wash-your-hands excuse but ignores the fact that crew members were handling food while contagious and the ship’s galley was found to be unsanitary and potentially hazardous to the guests’ health.

Photo credit: Piergiuliano Chesi, CC BY 3.0, commons / wikimedia.

Adam GoldsteinRoyal Caribbean’s Adam Goldstein was on FOX Business’s @MorningsMaria yesterday. The FOX analysts questioned Mr. Goldstein after the terrorists’ attack on the airport and subway in Belgium yesterday.  

Mr. Goldstein, the President and Chief Operating Officer of the cruise line, explained that his company makes a lot of effort into its security. Royal Caribbean’s cruise ships call on approximately 500 ports annually. Like other companies, it makes judgments based on the security information it has received prior to calling on a port. Occasionally, it will decide that it is not in the best interests of the cruise line and its guests to go to a particular port, like the recent case of Bali which its Celebrity Solstice and Royal Caribbean Radiance of the Seas  avoided.

Most places Royal Caribbean sails to are "absolutely safe," Mr. Goldstein claims.

He said that after the terrorist attacks last year in Paris, there was a "brief" decline in business of a week or two from Northern Europe countries. He said the effect on his cruise line business was "de Royal Caribbean Jim Cramerminimis."  He does not expect anything different after this latest attack in Brussels.

The FOX News panel also questioned Mr. Goldstein on the effect of the Zika virus on bookings. He also downplayed the effect of this serious medical problem, which is believed to cause abnormally underdeveloped heads (microcephaly) in newborn children.

Mr. Goldstein said: "We are not aware that we ever saw any sort of impact on the business and it doesn’t seem to be a conversation today."

This is an interesting perspective. Yesterday, another financial show on CNBC, Jim Cramer’s MAD MONEY, suggested that although cruise lines deny that the Zika virus has affected their operations to date, it will severely impact cruising in the coming months

You can hear Mr. Goldstein below.

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Watch the latest video at video.foxbusiness.com

Carnival SunshineThe Centers for Disease Control and Prevention (CDC) reports that the Carnival Sunshine is suffering through a gastrointestinal outbreak. This is the fifth GI outbreak of a U.S. based cruise line this year according to the CDC,

The CDC says that 118 of 3,005 (3.93%) of passengers sickened with noro during the cruise in addition to 5 crew members out of 1,142 (0.43%).

As I have mentioned in other recent articles, Carnival cruise lines has reported only three norovirus outbreaks to the CDC for U.S. based cruise since since 2006.  This is to be sharply contrasted with the norovirus outbreaks reported by Carnival owned Princess and HAL which have reported 32 GI outbreaks between them in the last decade.

Photo Credit: Piergiuliano Chesi 3.0 creative commons / wikimedia

March 5, 2016 Update: The CDC reported that the number of passengers sickened during the cruise is 173 with 5 crew members also stricken with noro virus.

 

Ocean PrincessThe Centers for Disease Control and Prevention (CDC) reported that there is a gastrointestinal outbreak on the Ocean Princess cruise ship, with 43 of 603 (7.13%) of passengers ill during the cruise and 5 of 387 (1.29%) crew members sick.

The Princess cruise ship is currently sailing on a February 13 – March 7, 2016 itinerary. The cruise ship is scheduled to go into dry dock on March 7th.

Princess has 50% of the four cruise ship norovirus that meet the CDC’s criteria so far this year. This should be no surprise to anyone who follows gastrointestinal outbreaks on cruise ships.

As I pointed out in my last article about a gastrointestinal outbreak on a Princess cruise ship (the Crown Princess), during the six year period from 2010 to the current date, Princess Cruises experienced the most norovirus outbreaks on its cruise ships calling on a U.S. port, according to the CDC. Including this most recent outbreak, Princess has reported twenty (20) cases to the CDC during this time period.

In contrast, Carnival cruise lines reported just two (2) cases during the same time period.

Celebrity Cruises reported 15 cases (and Royal Caribbean reported 9). HAL also reported a high number (12) during the 2010 to 2016 time period. Cunard reported 4; NCL -3; Oceania – 3; and Crystal – 2.

Anyone have an explanation why there have been 10 times as many CDC-reported GI outbreaks on Princess cruise ships compared to Carnival cruise line ships?

Photo Credit: Pjotr Mahhonin – CC0, Wikipedia