cruise ship illness outbreaks

Nearly 200 people sick in norovirus outbreaks on Royal Caribbean, Princess Cruises ships

Nearly 200 people got sick in norovirus outbreaks on Princess Cruises and Royal Caribbean International ships.

The Centers for Disease Control and Prevention said 94 of the 2,532 guests on Sapphire Princess reported being ill during its April 5 cruise, along with 20 crew members. The round-trip cruise, which left from Los Angeles with stops in Hawaii and the South Pacific, will end on May 7, according to CruiseMapper .

On Royal Caribbean’s Radiance of the Seas, 67 of its 1,993 guests reported being ill in addition to two crew members during a cruise that ended April 22, according to the CDC . The two-week voyage sailed from Tampa, Florida to Los Angeles with stops in countries like Colombia and Panama, according to CruiseMapper .

In both outbreaks, the guests and crew members’ main symptoms were diarrhea and vomiting.

Princess, Royal Caribbean and the ships’ crews implemented heightened cleaning and disinfection measures and isolated those who were sick, among other steps, the health agency said.

"Onboard the most current sailing of Sapphire Princess, there have been a small number of cases of mild gastrointestinal illness among passengers, the cause likely is the common but contagious virus called Norovirus," a Princess spokesperson told USA TODAY in an emailed statement. "At the first sign of an increase in the numbers of passengers reporting to the medical center with gastrointestinal illness, we immediately initiated additional enhanced sanitization procedures to interrupt the person-to-person spread of this virus. Our sanitization program, developed in coordination with the CDC, includes disinfection measures, isolation of ill passengers and communication to passengers about steps they can take to stay well while onboard."

Royal Caribbean did not immediately respond to a request for comment.

The CDC has logged six outbreaks of gastrointestinal illness on cruise ships that met its threshold for public notification since the beginning of the year. Norovirus was listed as the causative agent in five, while one was unknown.

The illness is often associated with cruise ships but outbreaks occur in communities on land as well, according to Dr. Sarah E. Hochman, a hospital epidemiologist and the section chief of infectious diseases at NYU Langone Health’s Tisch Hospital.

“There's not something special or unique about cruise ships,” she said. “It's really any type of congregate setting, but it's also happening out in the community on a much smaller scale among households and household contacts. It just doesn't come to the attention of public health as much as it does for larger congregate settings.”

Hochman said the virus is “incredibly infectious” and congregate settings tend to have many shared surfaces, such as handrails in cruise ship stairwells or elevators. “And so, if you just have one person who's shedding the virus and touches the surface and then someone else touches it and then touches their mouth, that's how it can spread in those types of settings.”

Cruise ship medical facilities: What happens if you get sick or injured (or bitten by a monkey)

Alcohol-based hand sanitizer isn't as effective against norovirus, and Hochman emphasized that washing hands with soap and water “will do a lot to prevent the spread.”

The news comes after more than two dozen Silversea Cruises guests got sick in a gastrointestinal illness outbreak on the luxury line’s Silver Nova ship during a sailing that began in late March.

Nathan Diller is a consumer travel reporter for USA TODAY based in Nashville. You can reach him at [email protected].

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C.D.C. Investigating Gastrointestinal Illness on Luxury Cruise Ship

The Queen Victoria was on its way to Honolulu from San Francisco on a 107-night world cruise when more than 150 people on board reported symptoms, officials said.

By Johnny Diaz

The Centers for Disease Control and Prevention is investigating an outbreak on a luxury cruise ship after more than 150 people reported symptoms of gastrointestinal illness, including diarrhea and vomiting.

The ship, the Queen Victoria, operated by Cunard Line, departed Southampton, England, on Jan. 11 on a 107-night cruise that included recent stops in Florida and San Francisco, according to the company’s website . The ship is scheduled to arrive in Honolulu on Monday.

The C.D.C. said that, as of Thursday, 129 passengers and 25 crew members had reported being ill on the ship. The agency said 1,824 passengers and 967 crew members were aboard at the time of the outbreak.

The cause of the illnesses was unknown, the agency said.

In a statement, Cunard Line, which is based in Southampton, said that “a number of guests had reported symptoms of gastrointestinal illness” on the ship, which arrived in San Francisco on Tuesday after stops in Mexico, Guatemala, Panama and Aruba.

The cruise line “immediately activated their enhanced health and safety protocols to ensure the well being of all guests and crew on board and these measures have been effective,” the company said.

In response to the outbreak, the crew of the Queen Victoria have “increased cleaning and disinfection procedures” and have “isolated ill passengers and crew,” the C.D.C. said.

The agency said that it was remotely monitoring the situation, including “reviewing the ship’s outbreak response and sanitation procedures.”

The ship left San Francisco for Honolulu on Wednesday and was traveling off the west coast of the United States on Thursday, according to the ship-tracking website Cruise Mapper .

After it arrives in Hawaii on Monday, the ship’s scheduled stops include Fiji, New Zealand and Australia.

Though intestinal illness can spread quickly on cruise ships, outbreaks are infrequent, according to the C.D.C.

One high-profile outbreak took place in 2014, when 595 passengers and 50 crew members aboard Royal Caribbean’s Explorer of the Seas fell ill with bouts of vomiting and diarrhea, forcing the ship to return early to New Jersey.

Acute gastrointestinal illnesses, including the highly contagious norovirus, are associated with cruise ships because close quarters among passengers and crew members increase the amount of group contact, the agency said.

People who are infected when they board the ship may spread viruses to other passengers and crew.

Public health officials track illnesses on cruise ships so “outbreaks are found and reported more quickly on a cruise ship than on land,” the C.D.C. said.

Johnny Diaz is a general assignment reporter covering breaking news. He previously worked for the South Florida Sun Sentinel and The Boston Globe. More about Johnny Diaz

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More cruise ships are under CDC investigation following COVID-19 outbreaks on board

The Associated Press

Carnival Cruise Line's Carnival Horizon cruise ship is shown docked at PortMiami in April. The Centers for Disease Control and Prevention is investigating more cruise ships due to new COVID-19 cases aboard. Wilfredo Lee/AP hide caption

Carnival Cruise Line's Carnival Horizon cruise ship is shown docked at PortMiami in April. The Centers for Disease Control and Prevention is investigating more cruise ships due to new COVID-19 cases aboard.

MIAMI — The U.S. Centers for Disease Control and Prevention is investigating more cruise ships due to new cases of COVID-19 as the omicron variant drives extremely high infection levels in the industry hub of Florida.

The CDC said 88 vessels are now either under investigation or observation, but it did not specify how many COVID-19 cases have been reported. Four other vessels are also being monitored by the CDC as well.

Florida hit a new record for daily cases on Tuesday with 46,900 new cases in a day. Since Christmas, the state's 7-day average of daily cases has surpassed previous records set during last summer's surge, rising to 29,400 infections.

Coronavirus hospitalizations in the state have also risen from about 1,200 patients two weeks ago to about 3,400 on Wednesday. But that is still less than one-fifth the number of hospitalizations reported in late August due to the delta wave.

Democratic Sen. Richard Blumenthal is calling for the CDC and cruise lines to again halt cruise travel, six months after the industry mounted its comeback.

"Our warnings have proved sadly prescient and continuously compelling. Time for CDC and cruise lines to protect consumers, again pause — docking their ships," the Connecticut senator posted on Twitter.

Cruise lines have not announced any plans to halt cruising. And the CDC did not say it would adopt any changes, adding it still had plans to allow for the expiration of a set of rules that cruises must follow to sail during the pandemic. The regulation, called a conditional sailing order, is scheduled to expire on Jan. 15 to become a voluntary program.

Coronavirus Updates

Covid-19 outbreaks hit 3 cruise ships as florida breaks record for new cases.

"CDC acknowledges that it is not possible for cruising to be a zero-risk activity," CDC spokesperson Jasmine Reed said in an emailed statement.

Most lines require adult passengers to show proof of vaccination against COVID-19. Cruise ships are allowed to relax measures such as mask use if at least 95% of passengers and 95% of crew are fully vaccinated.

The federal agency recommends that people avoid cruise travel if they are at increased risk of severe illness, regardless of vaccination status.

None of the ships so far appear to have so many cases that they would overwhelm medical resources on board and require a return to port. But some have been denied entry at some foreign ports.

Several Florida-based ships have reported outbreaks. The Carnival Freedom was denied entry to Aruba and Bonaire after an undisclosed number of passengers and crew aboard caught the virus.

Some cruise ships have not been allowed to disembark in Mexican ports due to cases reported, bringing to memory the early days of the pandemic when cruise lines negotiated docking plans as ships were being turned away by officials worried about the virus's spread.

The Mexican government said Tuesday it would allow cruise ships with reported coronavirus cases to dock. The country's Health Department said passengers or crew who show no symptoms will be allowed to come ashore normally, while those with symptoms or a positive virus test will be quarantined or given medical care.

CDC is investigating gastrointestinal sickness on luxury cruise ship Queen Victoria

SAN FRANCISCO — The Centers for Disease Control and Prevention is investigating an outbreak on a luxury cruise ship where more than 150 people have reported gastrointestinal illness, including diarrhea and vomiting.

The Queen Victoria, operated by Cunard Cruise Line, departed San Francisco Wednesday on its way from Florida to Hawaii. The ship is carrying 1,800 passengers and 970 crew members.

The cause is unknown. Cunard told the CDC that the ship increased cleaning and disinfection, and isolated ill passengers and crew.

The reported cases are totals for the entire voyage and do not represent how many people are actively sick at any one time, the CDC said.

The company did not immediately respond to an email from The Associated Press seeking more details.

The ship originated in Germany Jan. 9 and departed Florida Jan. 22, according to ship tracker Cruise Mapper. Its next stop is Honolulu, Hawaii, on Feb. 12 and ends in Australia next month.

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Norovirus outbreaks on cruise ships surge to decade-high levels: How to avoid the stomach bug

In 2023, a decade-high number of cruise ships have reported an unwelcome passenger on board: norovirus.

Outbreaks of the stomach bug have surged on cruise ships this year, reaching the highest levels seen in 10 years. Since January 2023, there have been 13 confirmed norovirus outbreaks on cruise ships under U.S. jurisdiction — that's more outbreaks in six months than there have been during any full year since 2012, according to data from the U.S. Centers for Disease Control and Prevention .

After a lull during the COVID-19 pandemic, cases of the highly contagious virus that causes diarrhea and vomiting, aka stomach flu, spiked this winter and spring on land. As post-pandemic travel surges and millions of Americans return to cruise ships, an increasing number of cruise lines are reporting outbreaks at sea.

Norovirus outbreaks on cruise ships

Most recently, a norovirus outbreak in June on the Viking Neptune sickened 110 passengers (over 13% of the ship's guests) and nine crew members with vomiting, diarrhea and abdominal cramps, according to the CDC . The CDC has tracked outbreaks of gastrointestinal illness on cruise ships through its Vessel Sanitation Program (VSP) since 1994.

Several weeks prior, a Celebrity Summit cruise ship reported an outbreak of norovirus that sickened more than 150 passengers and 25 crew members, per the CDC . It was the third norovirus outbreak on a Celebrity Cruises vessel this year. Another popular cruise line, Royal Caribbean International, has reported four outbreaks since January.

Cruise ships are required to report cases of gastrointestinal illness to the CDC before arriving at any U.S. port, and the CDC will notify the public about outbreaks if they meet certain criteria, including: the ship is carrying 100 or more passengers, the voyage is three to 21 days long, and 3% or more of passengers or crew report symptoms, per the CDC .

The number of outbreaks in the first six months of 2023 is higher than the yearly total during every year since 2012, when there were 16 outbreaks on cruise ships reported to the CDC.

Norovirus can spread year-round, but it tends to have a wintertime seasonality and peak during the colder months. Outbreaks are most common between November and April, TODAY.com previously reported.

"It's a virus we typically see all throughout spring, so it’s not unusual to be see cases in April and May, (and) we are continuing to see many cases now," Dr. Luis Ostrosky, an infectious disease specialist at UTHealth Houston and Memorial Hermann in Houston, tells TODAY.com.

However, as travel surges this summer, travel-related illnesses are expected to surge, as well. “I think our travel frenzy after COVID is partially fueling this continued spread (of norovirus),” says Ostrosky.

What should people know about norovirus and how to avoid getting sick on cruise ships this summer?

Norovirus symptoms and treatment

The most common symptoms of norovirus are vomiting, nausea, diarrhea and abdominal pain, Dr. Albert Ko, infectious disease physician and professor of public health, epidemiology and medicine at Yale School of Public Health, tells TODAY.com.

Less commonly, norovirus may cause a headache, muscle aches, or a low-grade fever — symptoms usually develop within one to two days after exposure to the virus,  per the CDC .

In the vast majority of people, norovirus symptoms will last several days and resolve on their own.

There’s no specific treatment or antiviral for norovirus, according to Ostrosky, but most cases can be managed at home with supportive care like hydration and rest. Sick people should also isolate until their symptoms resolve, the experts emphasize.

Some people are at higher risk of developing severe norovirus symptoms — these include infants, the elderly, and people with compromised immune systems, Ostrosky noted.

How does norovirus spread?

Norovirus is highly contagious and can spread directly through sick people and contaminated surfaces, food, or drinks.

Transmission often occurs when tiny virus particles in feces or vomit from an infected person end up in another person's mouth through direct contact or by touching contaminated surfaces and putting unwashed hands in the mouth or nose, TODAY .com previously reported .

Norovirus can also get into food before, during or after preparation, and it's the top germ causing foodborne illness in the U.S., per the CDC . Virus particles can contaminate drinking water that isn't treated properly or pools when people poop in the water.

It only takes a small number of virus particles for norovirus to spread, which is why norovirus causes so many explosive outbreaks, Ko previously told TODAY.com.

Exposure to less than 100 norovirus particles can make someone sick, and infected people typically shed billions of particles, according to the CDC.

Most people are infectious from symptom onset until about two or three days after recovering, but some people can remain contagious for weeks, Ko notes. People can get infected with norovirus multiple times in their lifetime.

Is norovirus common on cruise ships?

Certain environments are more conducive to the virus spreading. According to the CDC , the most common settings for norovirus outbreaks are health care facilities, restaurants or catered events, schools, day cares and, of course, cruise ships.

Cruise ships are often associated with norovirus because of the enclosed spaces, close living quarters, communal dining and high turnover of passengers, experts note. That said, outbreaks of acute gastrointestinal illnesses are relatively infrequent on cruise ships compared to settings on land, the CDC notes .

How to avoid norovirus on a cruise

Hand hygiene is key to prevent the spread of the highly contagious virus — but the way you clean your hands matters, experts note. It has to be with soap and water, because alcohol-based hand sanitizers are not effective against norovirus.

“Norovirus is one of the few viruses that doesn’t get deactivated by alcohol. You actually need to use soap and water to physically destroy it and remove it from your hands,” Ostrosky previously told TODAY.com.

It's important to wash your hands with soap and clean water frequently, but especially after using the bathroom or changing diapers, before eating and before touching your face.

Surfaces or objects that are contaminated with norovirus can be cleaned with a high-level disinfectant like bleach, per Ostrosky.

On cruise ships, avoid sick people if you can. Passengers who experience norovirus symptoms like vomiting and diarrhea should notify staff and follow recommended precautions, per the CDC .

Caroline Kee is a health reporter at TODAY based in New York City.

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These are the cruise ships with the best — and worst — sanitation scores so far this year

• The CDC randomly inspects cruise ships to help prevent the spread of stomach viruses. 
• The agency has reported 13 norovirus outbreaks on cruise ships this year.
• These are the cruise ships with the best and worst sanitation report cards in 2023 so far.

There's nothing like a stomach virus to ruin your vacation, as hundreds of cruise ship passengers have unfortunately learned this year.

The Centers for Disease Control and Prevention has reported 13 norovirus outbreaks on cruise ships so far in 2023. The last time the industry's yearly gastrointestinal illness outbreak total was that high was back in 2016 — and it's only July.

For the agency to report a cruise-ship outbreak, 3% or more of passengers or crew members must report symptoms of gastrointestinal illness, such as vomiting and diarrhea, to the ship's medical staff. During the most recent outbreak, a 14-day cruise aboard the Viking Neptune in June, slightly over 13% of passengers (110 of 838) reported being ill with predominant symptoms of abdominal cramps, vomiting, and diarrhea, according to the CDC.

The nasty stomach bug isn't just a cruise-ship problem, though. Norovirus cases have spiked across the United States this year, which some experts say is the result of ending COVID-19 restrictions .

"People often associate cruise ships with acute gastrointestinal illnesses such as norovirus, but acute gastrointestinal illness is relatively infrequent on cruise ships," the CDC says on its website. "Health officials track illness on cruise ships. So outbreaks are found and reported more quickly on a cruise ship than on land."

To try to help prevent the spread of stomach viruses at sea, the CDC randomly inspects cruise ships and scores them on a scale of 0 to 100 through the Vessel Sanitation Program . Inspection scores of 85 and lower are considered "not satisfactory" by the agency.

Related stories

Most vessels have received scores in the high 90s — only one cruise ship, the MSC Seaside, has failed the CDC's sanitation inspection so far this year. The vessel received an unusually low score of 67 , nearly 20 points below the agency's passing grade.

An MSC Cruises representative told Insider at the time that the cruise line had launched an internal investigation based on the inspector's concerns and taken immediate corrective actions.

"MSC Cruises rigorously adheres to health protocols, and the results of this inspection do not reflect the brand's high standards," the person added.

In the past 10 years, only three other cruise ships have received sanitation scores below 70, CDC records show. Violations can include something as small as not posting a raw-eggs advisory on the omelet station or a single fly hovering in a food area. But before going on your next cruise adventure, it doesn't hurt to check out the ship's most recent sanitation rating.

These are the cruise ships with the highest and lowest sanitation scores so far this year:

The 15 cruise ships with perfect scores of 100

The 15 cruise ships with scores below a 95.

Correction: July 17, 2023 — An earlier version of this story included a photo caption that misstated how many passengers and crew members aboard the Nieuw Amsterdam reported being ill during a May voyage. It was 284 people, not 539.

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Illness outbreak spreads aboard Queen Victoria cruise ship, leaving 154 sick

The cause of the outbreak aboard the Queen Victoria Cruise is currently unknown.

An illness outbreak aboard a Cunard Cruise Line ship has spread , now leaving at least 154 people experiencing symptoms such as vomiting and diarrhea, according to the U.S. Centers for Disease Control and Prevention.

A total of 129 passengers and 25 crew members on the Queen Victoria have reported being ill during the voyage, an increase of 15 people from when the illness was reported on Feb. 1.

The cause of the gastrointestinal disease outbreak aboard the Queen Victoria cruise, which departed Fort Lauderdale, Florida, on Jan. 22, is currently unknown.

The ship is scheduled to dock in Honolulu on Feb. 12.

The Queen Victoria has 1,824 passengers and 967 crew members on board.

The cruise line reported it would increase cleaning and disinfection procedures according to its outbreak prevention and response plan, isolate ill passengers and crew and inform current and embarking passengers and crew of the situation on board.

MORE: 139 passengers, crew sickened during gastrointestinal illness outbreak on Queen Victoria cruise: CDC

The CDC's Vessel Sanitation Program is monitoring the situation and reviewing the ship's outbreak response and sanitation procedures.

Cunard Cruise Line confirmed that guests aboard the Queen Victoria had fallen ill in a statement to ABC News.

"Cunard confirms that a number of guests had reported symptoms of gastrointestinal illness on board Queen Victoria on voyage V405 which departed Florida on [Jan. 22] and arrived in San Francisco on [Feb. 7]. They immediately activated their enhanced health and safety protocols to ensure the wellbeing of all guests and crew on board and these measures have been effective," the company said in a statement.

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Norovirus outbreaks linked to 2 cruise ships with over 150 infected

A total of 161 passengers have reported falling ill during voyages on princess cruises' sapphire princess and royal caribbean international's radiance of the seas.

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The Centers for Disease Control and Prevention are investigating two seemingly separate outbreaks of Norovirus linked to U.S. cruise ships.

Cases have been linked to Princess Cruises' Sapphire Princess and Royal Caribbean International's Radiance of the Seas.

The CDC's Vessel Sanitation Program (VSP) is tracking the "very contagious" outbreaks following reports of passengers in distress .

CARNIVAL FREEDOM PASSENGER ONBOARD DURING FIRE RECOUNTS 'DANGEROUS, TERRIFYING' EXPERIENCE

The Radiance of the Seas, a Royal Caribbean cruise ship, is pictured docked at a port in Seward, Alaska. (iStock)

Approximately 67 out of 1,993 passengers on the Radiance of the Seas reported falling ill during its voyage from Tampa to Los Angeles between Apr. 8 and 22. An additional two crew members also reported illness . 

The predominant symptoms reported from those affected by the Norovirus were diarrhea and vomiting.

WORRIED THE CRUISE SHIP WILL LEAVE WITHOUT YOU? KEEP THESE THINGS IN MIND

A view of the sign at the Center for Disease Control headquarters is seen in Atlanta, Georgia. (Nathan Posner/Anadolu Agency via Getty Images / Getty Images)

Approximately 94 of 2,532 passengers on the Sapphire Princess reported similar symptoms during its voyage from Los Angeles into the South Pacific that began Apr. 5 and is scheduled to conclude on May 7.

An additional 20 members of the 1,066 crew reported symptoms as well.

Fox Business reached out to both Princess Cruises and Royal Caribbean International for comment on the situation but did not receive a response.

CLICK HERE TO READ MORE ON FOX BUSINESS

This photo shows the Sapphire Princess cruise ship, operated by Princess Cruises, docked at the Marina Cruise center in Singapore. (ROSLAN RAHMAN/AFP via Getty Images / Getty Images)

"Norovirus is a very contagious virus that causes vomiting and diarrhea. Anyone can get infected and sick with Norovirus," the CDC states on its website. "Norovirus is sometimes called the 'stomach flu' or 'stomach bug.' However, norovirus illness is not related to the flu, which is caused by influenza virus."

One of the biggest health risks posed by Norovirus infection is dehydration — the CDC recommends those infected drink plenty of liquids to aid recovering.

The CDC's Vessel Sanitation Program requires cruise lines to report and document cases of illness on their ships in order to facilitate coordinated responses in case of emergency.

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• Vessel Sanitation Program
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Cruise Ship Illness Frequently Asked Questions

• Find answers to common questions about gastrointestinal illness outbreaks, our inspections, and more.
• Note that ships under our jurisdiction are those that have a foreign itinerary, a U.S. port, and more than 13 passengers. Other organizations handle cruise ships outside our jurisdiction.

Norovirus and acute gastroenteritis (AGE)

Why do people associate age (including norovirus) with cruise ships.

Norovirus is a very contagious virus. Close living quarters may increase the amount of group contact. People joining the ship may bring the virus to other passengers and crew. Additionally, health officials track illness on cruise ships. So outbreaks are found and reported more quickly on a cruise ship than on land.

Does CDC address other illnesses on cruise ships?

Yes. Learn more about other common health concerns during cruise travel and what you can do to prevent illness.

The ship I sailed on had a lot of sick passengers or crew. Where can I find more information?

We consider it an outbreak when 3% or more of a ship's passengers or crew report being sick with AGE symptoms. We investigate outbreaks on ships within our jurisdiction. Explore our outbreak information on specific ships .

I think the ship I was on had an outbreak, but I don't see an outbreak posting. Why not?

There could be several reasons why an outbreak isn't posted on our site:

• The number of cases might not have met our threshold for what we can consider an outbreak (3% or more of a ship's passengers or crew report being sick with AGE symptoms).
• The ship might be outside our jurisdiction. Other organizations handle outbreaks outside our jurisdiction.
• People who were sick might not have reported it, so an outbreak could have gone undetected. This is why reporting illness is important.

Public health inspections

How often are ships inspected.

Cruise ships under our jurisdiction are subject to two unannounced inspections each year. We inspect cruise ships to determine how well they are operating and maintaining public health standards (learn more about the eight areas we inspect ). If a ship sails outside of the United States for an extended period, it may not be inspected twice a year, but it will be inspected again when it returns to the United States.

Why isn't the ship I'm looking for in the inspection database?

The ship might not be in the inspection database because it does not meet our criteria for inspection.

The ship could be sailing outside the United States for an extended period (in which case it will be inspected and added in the database when it returns).

How are cruise ships inspections scored?

Cruise ships are scored on a 100-point scale as outlined in our current Vessel Sanitation Program (VSP) Operations Manual .

• Points are deducted when there is a pattern of similar violations or when there is a single, significant violation.
• An 85 or below is a failing score.

We post all inspection scores .

Are ships required to correct violations found during inspections?

Yes. Ships are responsible for correcting all violations. They must correct certain critical violations immediately.

In addition, some violations can be corrected during the inspection, while others may take longer to correct. Each ship submits a corrective action statement describing how violations were corrected.

What happens if a ship fails an inspection?

A failing score indicates violations that the ship is responsible for correcting. Ships that fail inspections are reinspected within a reasonable period.

No-sail recommendation

When would vsp recommend a ship not sail.

People sometimes assume that we will recommend a ship not sail if it fails an inspection. However, we have rarely issued such recommendations.

We may recommend a ship not sail if there are imminent public health risks . Examples of such risks are

• Inability to properly chlorinate potable (drinking) water.
• Inability to keep food within safe temperatures.
• Inadequate facilities for cleaning and sanitizing food equipment.
• Inability to properly dispose of solid or liquid waste.

We may also recommend a ship not sail during an infectious disease outbreak where continuing normal operations could subject newly arriving passengers to disease.

If a cruise line refuses to follow a VSP no-sail recommendation, it can become a no-sail order.

Children and pools

Why can't children who are not toilet trained use pools on cruise ships.

Children who wear any type of diaper, including swim diapers, are not allowed in pools. Swim diapers and swim pants might hold in some solid feces, but they are not leak proof.

The Vessel Sanitation Program helps the cruise ship industry prevent and control the introduction and spread of gastrointestinal illnesses on cruise ships.

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5 Illnesses You Can Get on a Cruise Ship (Besides COVID)

Plus, tips on how to avoid getting sick while at sea and ports of call.

Rachel Nania and Nicole Gill Council,

Concerns over the spread of COVID-19 have loomed over the travel industry for the last three years, but with the public health emergency coming to an end and a robust menu of preventive tools and treatments available, many of those fears are fading.

A new  AARP survey  shows 81 percent of adults 50-plus who plan to travel in 2023 believe it’s safe to do so now, up from 77 percent in 2021. And while interest in cruising is down slightly among the 50-plus population this year compared to last, a recent AAA survey finds that, overall, the share of travelers considering a cruise vacation in 2023 is up.

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However, the return to the skies and seas does not mean COVID-19 is no longer a threat.

“Indoor densely populated places where we’re exchanging exhaled breath with one another is still going to be a concern for me,” says Wilbur Chen, M.D., adult infectious disease physician and director of the University of Maryland, Baltimore Travel Medicine Practice.

That concern isn’t limited to COVID, either. Flu spreads in a similar way, Chen points out.

It’s important to note, though, that since the start of the pandemic, many cruise lines have invested in better air circulation systems with medical-grade HEPA filters , says travel expert Pamela Kwiatkowski, cofounder and chief insurance officer at Goose Insurance Services in Vancouver, British Columbia. “I think that’s the first step they’ve taken in terms of improving the air filtration system, which removes almost all of the airborne pathogens,” she says.

Still, plenty of bugs can lurk on busy boats. Read on to discover some common illnesses you can pick up on a cruise — and what you can do to help keep yourself healthy on your next getaway. 

1. Flu and other respiratory illnesses

Flu season spiked early this year in the U.S., along with another  respiratory illness  that can be particularly dangerous for older adults, respiratory syncytial virus, which is known as RSV . Cases of flu and RSV have declined from fall’s peak, data from the Centers for Disease Control and Prevention (CDC) shows, but the viruses that cause these two illnesses are still circulating in the U.S. and other parts of the globe.

“Influenza is complicated during cruise travel because, of course, people on a cruise ship — both the passengers and the crew — may come from different parts of the world, which means that the rates of influenza for your particular country may not necessarily be the same as in other places,” says Jose Lucar, M.D., an infectious disease physician and associate professor of medicine at the George Washington University School of Medicine and Health Sciences in Washington, D.C.

According to the CDC, flu season in the southern hemisphere, which includes Australia and parts of South America and Africa, typically runs April through September. In the tropics, flu flares up throughout the year.

Staying healthy:  If you haven’t rolled up your sleeve for the flu shot yet, make sure you get it at least two weeks before going on a cruise, Lucar says. The same applies to the latest  COVID booster . When it comes to RSV, there isn’t a vaccine yet, but the FDA could approve one soon.

A few other tips: If you’re at high risk for  flu complications , talk to your doctor about antiviral treatment and prevention before your trip, the CDC recommends. Don’t forget about high-quality face masks, which can help to tamp down the spread of respiratory illnesses. And be sure to make — and pack — a list of all the medications you take, in case you wind up needing medical care on board. “That just makes it easier for everyone, so that if there is an emergency, if you’re not able to talk really well, you can at least hand the sheet over and it’s done,” Chen says.

2. Norovirus

This is one of the most well-known bugs that can foil fun on a ship. Norovirus — marked by diarrhea , vomiting, nausea and stomach pain — is to blame for more than 90 percent of diarrheal disease outbreaks on cruises, according to the CDC. That said, norovirus outbreaks on ships account for only 1 percent of all such reported cases.

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“This infection is very contagious,” Lucar says. The virus is also a “hearty” one, Chen points out. It can survive for long periods of time on surfaces and is resistant to common disinfectants.

Close living quarters, shared bathrooms, populated pools, busy buffet lines and rapid turnover of passengers make it difficult to control the spread of the virus once it hits a ship. “It’s just really the perfect scenario for transmission of highly contagious GI [gastrointestinal] pathogens,” Lucar says.

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According to the Cruise Lines International Association, the risk each year of getting laboratory-confirmed norovirus during a ship outbreak is about 1 in 5,500. The association, which says it is the largest cruise industry trade association in the world, noted on its website that crew members use strict sanitation and cleaning practices created with the CDC’s Vessel Sanitation Program. Cabins are cleaned once a day, and other common areas, such as elevators and pools, are cleaned multiple times a day.

In late February, more than 300 people aboard a Princess Cruises ship fell ill with diarrhea and vomiting, according to the CDC, though the agency didn’t cite the cause of the illness that sickened the 284 passengers and 34 crew. The  Ruby Princess  increased disinfection and cleaning procedures in the wake of the outbreak.

Other bugs that have popped up on boats include salmonella and E. coli. One to keep an eye on is shigella, which the CDC notes has been behind GI outbreaks on cruise ships. This bacterium causes an infection known as shigellosis, which can cause fever, stomach pain and diarrhea that can be bloody or prolonged.

Typically, the infection is treated with antibiotics, Chen says, but the CDC recently  issued a warning  that antibiotic-resistant strains are circulating in the U.S. Chen isn’t aware of any outbreaks of the resistant varieties on cruise ships, but it’s something to monitor.

Staying healthy:  To avoid getting a GI bug, be sure to wash your hands with soap and water before eating and after going to the bathroom and coming into contact with high-touch surfaces, like doorknobs and stair railings. Hand sanitizers don’t work well against norovirus, Lucar notes.

Travel expert Kwiatkowski also recommends  drinking plenty of water  to keep your body running at its best. However, she advises passengers stay away from the water at ports, particularly if a passenger is vulnerable to gastrointestinal illnesses.

“Handwashing, cleaning your stateroom, watching what you eat and how much you eat, and making sure that you stay hydrated will go a long way in preventing these illnesses, from you catching them even if they are there,” she says.

Talk to a doctor or pharmacist about any medications you should pack, such as loperamide (Imodium) to help treat diarrhea or dimenhydrinate (Dramamine, Gravol) for nausea. If your immune system is compromised, your doctor may want to prescribe something ahead of your trip.

Although less common than respiratory and GI illnesses, measles, along with chicken pox and other  vaccine-preventable diseases , can circulate on cruise ships.

Measles, a highly contagious virus that can linger in the air even hours after an infected person leaves the room, was declared eliminated from the U.S. in 2000, thanks to a successful vaccine program. But cases still pop up in the States, and the virus is common in many countries around the world.

If an unvaccinated or under-vaccinated passenger or crew member contracts the virus and brings it on board, other vulnerable people can get sick, Chen explains. (A ship was quarantined off the coast of St. Lucia in 2019 when measles was reported on board.) The same goes for chicken pox (varicella), which is similarly caused by a highly contagious virus that can circulate among unvaccinated people.

Staying healthy:  To avoid these and other vaccine-preventable diseases, make sure you’re up to date on your routine vaccines before traveling. Two doses of the chicken pox vaccine are more than 90 percent effective at preventing the disease, and two doses of MMR (measles, mumps, rubella) are about 97 percent effective at preventing measles.

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4. Seasickness

Is the motion of the ocean getting to you? Seasickness, while not contagious or related to an infection, can make you feel downright miserable. The good news: Most people recover quickly from seasickness, formally known as motion sickness, and there are medications that can help.

Motion sickness — which can cause dizziness, nausea and vomiting whether you’re on a boat, in a car or on a roller coaster — occurs when the movement you see is different from what your inner ear senses. Interestingly, adults 50 and older are less susceptible than younger adults and children, the CDC notes.

Staying healthy:  If you’re prone to going a little green when you travel, talk to your doctor ahead of your trip about medications that can help with symptoms. Prescription and over-the-counter antihistamines — like dimenhydrinate (Dramamine), for example — are most frequently used to treat motion sickness. 

However, antihistamines can interact with other medications and often cause drowsiness and decreased mental alertness, and the nonsedating ones appear to be less effective, the CDC says. Your doctor may also prescribe or recommend a patch that can help prevent nausea and vomiting caused by motion sickness.

Another tip: Have your physician review your current list of medications, since common pills — including some antidepressants and painkillers — can make seasickness worse, according to the CDC. 

A few other things that can help with seasickness:

• Try lying down on your stomach, shutting your eyes or looking off into the horizon.
• Avoid the upper levels of the boat.
• Stay hydrated and limit alcohol and caffeine consumption.
• Avoid smoking . Even short-term cessation reduces your susceptibility to motion sickness, the CDC says.
• Distract yourself with music, controlled breathing or aromatherapy (try mint or lavender). Sucking on a flavored lozenge (some experts recommend a hard ginger candy) may also help, the CDC says.
• While the CDC says the scientific data on acupressure for seasickness is lacking, it works for some. You can find wrist bands for motion sickness in many drugstores.

5. Burns and bites

A word of advice from Lucar and Chen: Don’t forget the SPF when packing for your cruise. A burn on vacation can ruin your fun in the sun  and  put you at higher risk for  skin cancer .

“Also, if you’re going to places that have a lot of insects and mosquitoes, make sure you wear your insect repellent so that you don’t get a bunch of bites, because we also are worried about malaria, dengue, chikungunya, Zika — those sorts of things — at ports of call,” Chen says.

Staying healthy:  Opt for a sunscreen with an SPF of at least 15, the CDC recommends, and be sure your bottle says “blocks UVA and UVB” or “broad spectrum” on the label.

When it comes to insect repellent, look for a spray that’s registered with the Environmental Protection Agency. Layering it with sunscreen? Put the repellent on second, over the sunscreen, the CDC advises.

To ease any health-related concerns you might have before booking a cruise, Kwiatkowski suggests using a travel agent who is a cruise line expert or contacting the cruise line to ask about their cleaning protocols and track record. “I know it sounds like a lot of work,” she says, “but travel is a big investment, and you really want to travel worry-free.”

Rachel Nania writes about health care and health policy for AARP. Previously she was a reporter and editor for WTOP Radio in Washington, D.C. A recipient of a Gracie Award and a regional Edward R. Murrow Award, she also participated in a dementia fellowship with the National Press Foundation.

Nicole Gill Council is a writer and editor of travel and diversity, equity and inclusion content for aarp.org. Previously, she was a digital planning manager and a news editor at  USA Today  and Gannett News Service, and a copy editor at the  Los Angeles Times  and  Newsday.​

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• Section 8 - Road & Traffic Safety
• Section 8 - Motion Sickness

Cruise Ship Travel

Cdc yellow book 2024.

Author(s): Kara Tardivel, Stefanie White, Aimee Treffiletti, Amy Freeland

Cruise Ship Medical Capabilities

Illness & injury, infectious disease health risks, noninfectious health risks, travel preparation.

Cruise ship travel presents a unique combination of health concerns. Travelers from diverse regions brought together in the often crowded, semi-enclosed shipboard environment can facilitate the spread of person-to-person, foodborne, and waterborne diseases. Outbreaks on ships can be sustained over multiple voyages by crewmembers who remain onboard, or by persistent environmental contamination. Port visits can expose travelers to local diseases and, conversely, be a conduit for disease introduction into shoreside communities.

Some people (e.g., those with chronic health conditions or who are immunocompromised, older people, pregnant people) merit additional considerations when preparing for a cruise. Because travelers at sea might need to rely on a ship’s medical capabilities for an extended period, potential cruise passengers with preexisting medical needs should prepare accordingly by calling the cruise line’s customer service center to learn what type and level of health care services are (and are not) available on specific ships.

Medical facilities on cruise ships can vary widely depending on ship size, itinerary, cruise duration, and passenger demographics. Generally, shipboard medical centers can provide medical care comparable to that of ambulatory care centers; some are capable of providing hospitalization services or renal dialysis. Although no agency officially regulates medical practice aboard cruise ships, the American College of Emergency Physicians (ACEP) published consensus-based guidelines for cruise ship medical facilities in 1995, and updated the guidelines in 2013. ACEP guidelines , which most major cruise lines follow, state that cruise ship medical facilities should be able to provide quality medical care for passengers and crew; initiate appropriate stabilization, diagnostic, and therapeutic maneuvers for critically ill or medically unstable patients; and assist in the medical evacuation of patients in a timely fashion, when appropriate.

Cruise ship medical centers deal with a wide variety of illnesses and injuries; ≈10% of conditions reported to cruise ship medical centers are an emergency or require urgent care. Approximately 95% of illnesses are treated or managed onboard, with the remainder requiring evacuation and shoreside consultation for dental, medical, or surgical issues. Roughly half of all passengers seeking medical care are >65 years old.

Medical center visits are primarily the result of acute illness or injury. The most frequently reported diagnoses include respiratory illnesses (30%–40%); injuries from slips, trips, or falls (12%–18%); seasickness (10%); and gastrointestinal (GI) illness (10%); 80% of onboard deaths are due to cardiovascular events.

Infectious Disease Outbreaks

The most frequently reported cruise ship outbreaks involve GI infections (e.g., norovirus), respiratory infections (e.g., coronavirus disease 2019 [COVID-19], influenza), and other vaccine-preventable diseases (VPDs), such as varicella. Although cruise ships do not have public health authority, to reduce the risk of introducing communicable diseases, some ships conduct medical screening during embarkation to identify ill passengers, prevent them from boarding, or require isolation if permission to board is given.

Before travel, to help limit the introduction and spread of communicable diseases on cruise ships, prospective cruise ship travelers and their clinicians should consult the Centers for Disease Control and Prevention (CDC) Travelers’ Health website for updates on outbreaks and destination-specific travel health notices. People who become ill with a communicable disease before a voyage should consult their health care provider and delay their travel until they are no longer contagious. When booking a cruise, travelers should check the trip cancellation policies and consider purchasing trip cancellation insurance (see Sec. 6, Ch. 1, Travel Insurance, Travel Health Insurance & Medical Evacuation Insurance ).

Travelers who become ill during a voyage should seek care in the ship’s medical center; the onboard staff will provide clinical management, facilitate infection-control measures, and take responsibility for reporting potential public health events. For information on how to report travelers who become ill with suspected communicable diseases after they return home from a cruise, see Sec. 8, Ch. 8, Airplanes & Cruise Ships: Illness & Death Reporting & Public Health Interventions .

Gastrointestinal Illnesses

During 2006–2019, rates of GI illness among passengers on voyages lasting 3–21 days fell from 32.5 to 16.9 cases per 100,000 travel days. Despite the decrease, outbreaks continue to occur. CDC assists the cruise ship industry to prevent and control the introduction, transmission, and spread of GI illnesses on cruise ships. See information on cruise ship GI illnesses and updates on GI illness outbreaks involving ships with US ports of call, specifically.

On cruise ships, >90% of GI illness outbreaks with a confirmed cause are due to norovirus. Characteristics of norovirus that facilitate outbreaks include a low infective dose, easy person-to-person transmissibility, prolonged viral shedding, absence of long-term immunity, and the ability of the virus to survive routine cleaning procedures (see Sec. 5, Part 2, Ch. 16, Norovirus ). For international cruise ships porting in the United States during 2006–2019, an average of 12 norovirus outbreaks occurred each year.

Other Sources of Gastrointestinal Illness

GI outbreaks on cruise ships also have been caused by contaminated food or water; most outbreaks were associated with  Campylobacter ,  Clostridium perfringens , or enterotoxigenic  Escherichia coli .

Protective Measures

Travelers can reduce the risk of acquiring a GI illness on cruise ships by frequently washing hands with soap and water, especially before eating and after using the restroom. Travelers should call the ship’s medical center promptly, even for mild symptoms of a GI illness, and strictly follow cruise ship guidance regarding isolation and other infection-control measures.

Respiratory Illnesses

Respiratory illnesses are the most common medical complaint on cruise ships. During the pretravel visit, evaluate whether vaccines or boosters (e.g., COVID-19, influenza) are needed and emphasize the importance of practicing good respiratory hygiene and cough etiquette while onboard. As with GI illnesses, cruise ship passengers should report respiratory illness to the medical center promptly and follow isolation recommendations as instructed.

Coronavirus Disease 2019

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus that causes COVID-19, spreads more easily between people in close quarters, and multiple studies have concluded that transmission rates of SARS-CoV-2 among travelers on ships are much greater than in other settings. Cruise ship COVID-19 outbreaks can tax onboard medical and public health resources. Ship-to-shore medical evacuations to facilities capable of providing higher levels of medical care can present logistical challenges and pose additional risks to ill patients.

Cruise passengers and crewmembers who are not up to date with their COVID-19 vaccines are at increased risk for severe illness, hospitalization, medical evacuation, and death. Since cruising will always pose some risk of SARS-CoV-2 transmission, ensure that people planning cruise ship travel are up to date with their vaccinations, and assess their likelihood for developing severe COVID-19. For people at increased risk of severe COVID-19 regardless of their vaccination status (e.g., pregnant people, people who are immunocompromised), discuss the potential health hazards associated with cruise ship travel. CDC has developed recommendations and guidance designed to help cruise ship operators provide a safer and healthier environment for crewmembers, passengers, port personnel, and communities.

Historically, influenza has been among the most often reported VPDs occurring on cruise ships. Because passengers and crew originate from all regions of the globe, shipboard outbreaks of influenza A and B can occur year-round, with exposure to strains circulating in different parts of the world (see Sec. 5, Part 2, Ch. 12, Influenza ). Thus, anyone planning a cruise should receive the current seasonal influenza vaccine ≥2 weeks before travel if vaccine is available and no contraindications exist. For people at high risk for influenza complications, health care providers should discuss chemoprophylaxis and how and when to initiate antiviral treatment.

See additional guidance on the prevention and control of influenza on cruise ships .

Legionnaires’ Disease

Less common on cruise ships, Legionnaires’ disease is nevertheless a treatable infection that can result in severe pneumonia leading to death (see Sec. 5, Part 1, Ch. 9, Legionnaires’ Disease & Pontiac Fever ). Approximately 10%–15% of all Legionnaires’ disease cases reported to CDC occur in people who have traveled during the 10 days before symptom onset. Clusters of Legionnaires’ disease associated with hotel or cruise ship travel can be difficult to detect, because travelers often disperse from the source of infection before symptoms begin. Data reported to CDC during 2014–2015 included 25 confirmed cases of Legionnaires’ disease associated with cruise ship exposures.

In general, Legionnaires’ disease is contracted by inhaling warm, aerosolized water containing the bacteria,  Legionella . Transmission also can sometimes occur through aspiration of  Legionella -containing water. Typically, people do not spread  Legionella  to others; a single episode of possible person-to-person transmission of Legionnaires’ disease has been reported. Contaminated hot tubs are commonly implicated as a source of shipboard  Legionella  outbreaks, although potable water supply systems also have been culpable. Improvements in ship design and standardization of water disinfection have reduced the risk for  Legionella  growth and colonization.

Diagnosis & Reporting

People with suspected Legionnaires’ disease require prompt antibiotic treatment. When evaluating cruise travelers for Legionnaires’ disease, obtain a thorough travel history of all destinations during the 10 days before symptom onset to assist in identifying potential sources of exposure, and collect urine for  Legionella  antigen testing. Most cruise ships have the capacity to perform this test, which detects  L. pneumophila  serogroup 1, the most common serogroup.

Perform culture of lower respiratory secretions on selective media to detect non– L. pneumophila  serogroup 1 species and serogroups. Culture also is used for comparing clinical isolates to environmental isolates during an outbreak investigation. Notify CDC of any travel-associated Legionnaires’ disease cases by sending an email to [email protected]. Quickly report all cases of Legionnaires’ disease to public health officials, who can determine whether a case links to previously reported cases and work to stop potential clusters and new outbreaks.

Other Vaccine-Preventable Diseases

Although most cruise ship passengers come from countries with routine vaccination programs (e.g., Canada, the United States), many of the crew are from low- or middle-income countries where immunization rates can be low. Outbreaks of hepatitis A, measles, meningococcal disease, mumps, pertussis, rubella, and varicella have all been reported on cruise ships. The majority (82%) of these outbreaks occur among crewmembers; prior to the COVID-19 pandemic, varicella was the most frequently reported VPD. Other VPDs (e.g., pertussis) occur more often among passengers.

Each cruise line sets its own policies regarding vaccinations for its crew; some have limited or no requirements. Thus, all passengers should be up to date with routine vaccinations before travel, as well as any required or recommended vaccinations specific for their destinations. People of childbearing age should have documented immunity to measles, rubella, and varicella (either by vaccination or titer) before cruise ship travel.

Vectorborne Diseases

Some cruise ship ports of call include destinations where vectorborne diseases (e.g., dengue, Japanese encephalitis, malaria, yellow fever, Zika) are known to be endemic. In addition, new diseases can surface in unexpected locations; chikungunya was reported for the first time in the Caribbean in late 2013, with subsequent spread throughout the region and numerous other North, Central, and South American countries and territories. Zika was first reported in Brazil in 2015, and subsequently spread across the Caribbean and Latin America, sparking concern because of its association with microcephaly and other congenital abnormalities in the fetus. For disease-specific information, see the relevant chapters of Section 5.

For guidance on how to avoid bites from mosquitoes and other disease-transmitting arthropod vectors, both onboard and while on shore at ports of call, see Sec. 4, Ch. 6, Mosquitoes, Ticks & Other Arthropods . For specific details on yellow fever vaccination and malaria prevention, see Sec. 2, Ch. 5, Yellow Fever Vaccine & Malaria Prevention Information, by Country .

Stresses of cruise ship travel include varying weather and environmental conditions, and unaccustomed changes to diet and levels of physical activity. Despite modern stabilizer systems, seasickness is a common complaint, affecting up to 25% of travelers (see Sec. 8, Ch. 7, Motion Sickness ). Note that travel is an independent risk factor for behaviors such as alcohol and illicit drug use and misuse (see Sec. 3, Ch. 5, Substance Use & Substance Use Disorders ), and unsafe sex (see Sec. 9, Ch. 12, Sex & Travel ).

Cruise ship travelers have complex itineraries due to multiple short port visits. Although most port visits do not include overnight stays off ship, some trips offer travelers the opportunity to venture off the ship for ≥1 night. These excursions can complicate decisions about exposures and the need for specific antimicrobial prophylaxis, immunizations, and other prevention measures.  Boxes 8-04  and  8-05  summarize recommended cruise travel preparations and healthy behaviors during travel for health care providers and cruise ship travelers.

Box 8-04 Healthy cruise travel preparation: a checklist for health care providers

Risk assessment & risk communication.

☐ Discuss itinerary, including season, duration of travel, and activities at ports of call. ☐ Review the traveler’s medical and immunization history, allergies, and any additional health needs. ☐ Discuss relevant travel-specific health hazards and risk reduction. ☐ Provide travelers with documentation of their medical history, immunizations, and medications.

VACCINATION & RISK MANAGEMENT

☐ Provide routinely recommended (age-specific), required (yellow fever), and recommended vaccines. ☐ Discuss safe food and water precautions. ☐ Discuss insect bite prevention. ☐ Provide older travelers with a baseline electrocardiogram, especially those with coronary artery disease.

MEDICATIONS BASED ON RISK & NEED

☐ Consider prescribing malaria chemoprophylaxis if itinerary includes stops in malaria-endemic areas. ☐ Consider prescribing motion sickness medications for self-treatment.

Box 8-05 Healthy cruise travel preparation: a checklist for travelers

☐ Carry prescription drugs in original containers with a copy of the prescription and a physician’s letter. ☐ Check the Centers for Disease Control and Prevention (CDC) Outbreak Updates for International Cruise Ships website for gastrointestinal outbreaks. ☐ Consider purchasing additional insurance coverage for overseas health care and medical evacuation. ☐ Consult medical and dental providers before cruise travel. ☐ Consult CDC Travelers’ Health website for travel health notices . ☐ Defer travel while acutely ill. ☐ Evaluate the type and length of the planned cruise in the context of personal health requirements. ☐ Notify the cruise line of additional health needs (e.g., dialysis, supplemental oxygen, wheelchair). ☐ Pack Environmental Protection Agency (EPA)–registered insect repellent; consider treating clothes and gear with permethrin. ☐ Pack sunscreen.

DURING TRAVEL

☐ Avoid contact with people who are ill. ☐ Follow safe food and water precautions when eating off ship at ports of call. ☐ Maintain good fluid intake and avoid excessive alcohol consumption. ☐ Practice safe sex. ☐ Report all illnesses to ship’s medical center and follow their recommendations. ☐ Use insect bite precautions during port visits, especially in vectorborne disease–endemic areas or areas experiencing outbreaks of vectorborne diseases (e.g., Zika, yellow fever) ☐ Use sun protection. ☐ Wash hands frequently with soap and water; if soap and water are not available, use ≥60% alcohol–based hand sanitizer.

POST TRAVEL

☐ See CDC’s latest post-cruise health guidance regarding coronavirus disease 2019.

Travelers with Additional Considerations

Travelers with chronic illnesses and travelers with disabilities who have additional needs (e.g., dialysis, supplemental oxygen, wheelchairs) should inform their cruise line before traveling. Highly allergic travelers and travelers with underlying medical conditions should carry a file that contains essential, pertinent health information (e.g., allergies, blood type, chest radiograph [if abnormal], chronic conditions, electrocardiogram, medication list, primary and/or specialty care provider contact information). Travelers also should bring any medications recommended by their health care provider (e.g., an epinephrine auto-injector) to help facilitate care during a medical emergency. For detailed information on preparing travelers who have additional considerations for international travel, including severe allergies, chronic illness, disabilities, or immune compromise, see Section 3.

Pregnant Travelers

Most cruise lines have policies that do not permit people to board after their 24th week of pregnancy. Contact cruise lines directly for specific guidance before booking. For additional information on preparing pregnant people for international travel, see Sec. 7, Ch. 1, Pregnant Travelers .

Insurance Coverage

All prospective cruise travelers should verify coverage with their health insurance carriers and, if not included, consider purchasing additional insurance to cover medical evacuation and health services received onboard cruise ships and in foreign countries (see Sec. 6, Ch. 1, Travel Insurance, Travel Health Insurance & Medical Evacuation Insurance ).

The following authors contributed to the previous version of this chapter: Kara Tardivel, Stefanie B. White, Krista Kornylo Duong

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Kordsmeyer A-C, Mojtahedzadeh N, Heidrich J, Militzer K, von Münster T, Belz L, et al. Systematic review on outbreaks of SARS-CoV-2 on cruise, navy and cargo ships. Int J Environ Res Public Health. 2021;18(10):5195. 

Millman AJ, Kornylo Duong K, Lafond K, Green NM, Lippold SA, Jhung MA. Influenza outbreaks among passengers and crew on two cruise ships: a recent account of preparedness and response to an ever-present challenge. J Travel Med. 2015;22(5):306–11. 

Mouchtouri VA, Lewis HC, Hadjichristodoulou C. A systematic review for vaccine-preventable diseases on ships: evidence for cross-border transmission and for pre-employment immunization need. Int J Environ Res Public Health. 2019;16(15):2713. 

Payne DC, Smith-Jeffcoat SE, Nowak G, Chuwkwuma U, Geibe JR, Hawkins RJ, et al. SARS-CoV-2 infections and serologic responses from a Sample of U.S. Navy service members—USS Theodore Roosevelt, April 2020. MMWR Morb Mortal Wkly Rep 2020;69(23):714–21. 

Peake DE, Gray CL, Ludwig MR, Hill CD. Descriptive epidemiology of injury and illness among cruise ship passengers. Ann Emerg Med. 1999;33(1):67–72. 

Rice ME, Bannerman M, Marin M, Lopez AS, Lewis MM, Stamatakis CE, et al. Maritime varicella illness and death reporting, U.S., 2010–2015. Travel Med Infect Dis. 2018;23:27–33. 

Rocklöv J, Sjödin H, Wilder-Smith A. COVID-19 outbreak on the Diamond Princess cruise ship: estimating the epidemic potential and effectiveness of public health countermeasures. J Travel Med. 2020;27(3):taaa030. 

Stamatakis CE, Rice ME, Washburn FM, Krohn KJ, Bannerman M, et al. Maritime illness and death reporting and public health response, United States, 2010–2014. J Travel Med Inf Dis. 2017;19:16–21.

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Stomach viruses are back up on cruise ships, with hundreds falling ill

The CDC has already reported 12 outbreaks of gastrointestinal illness on cruises this year

This story has been updated.

As cruise passengers return to the seas in force following a pandemic lull, an unwelcome side effect is also back: outbreaks of gastrointestinal illness.

According to the Centers for Disease Control and Prevention, so far this year there have been 12 outbreaks of vomiting and diarrhea that have reached the threshold for public notification on cruise ships visiting U.S. ports. The tally has already exceeded each yearly total number of outbreaks reported from 2017 to 2019.

Norovirus has been identified as the culprit in five of the 2023 cases; the others are all classified as unknown. The CDC did not immediately provide responses to questions about the increase in cases this year.

In a May outbreak, aboard Holland America Line’s Nieuw Amsterdam, 213 passengers and 35 crew reported being ill. That represents almost 11 percent of guests and about 4 percent of workers.

300 passengers and crew fall ill on Ruby Princess cruise from Texas

“Incidence of mild gastrointestinal illness among guests onboard Nieuw Amsterdam are suspected to be the common but highly contagious Norovirus, which is typically transmitted through close contact with unwell people and includes touching shared items,” Holland America Line said in an emailed statement. “The cases have been mostly mild and quickly resolving.”

The CDC says crew on the ship, which can carry more than 2,100 passengers, increased cleaning and disinfection procedures and collected stool specimens to send to a lab to confirm the cause.

According to a CDC norovirus tracking network that uses information from 14 states, there were 735 outbreaks reported from August through April 23. There were 907 during the same period of the 2021-2022 norovirus season. Norovirus causes 19 million to 21 million illnesses on average every year in the United States, the agency says .

Outbreaks of gastrointestinal illness plummeted during the pandemic, which shut down the cruise industry for more than a year and forced a slow return with multiple health precautions in place. There were no reported cases in 2020, followed by one in 2021 and four last year.

William Schaffner, a professor of infectious diseases at the Vanderbilt University School of Medicine in Nashville, told The Washington Post last year that the lower number of cruises, reduced concentration of passengers and coronavirus precautions were all factors in the drop in cases.

“The more rigorous we are with all of these hygienic measures, there’s spillover to other infectious agents,” he said.

Love that cheap cruise price? Don't forget the boatload of fees.

Health authorities say cruise passengers should wash their hands often and leave the area if they see someone get sick. If people are sick before a cruise, they should ask about alternative options and ask a doctor whether it’s safe to sail.

The Cruise Lines International Association says incidents of gastrointestinal illness are “quite rare” on ships, pointing to the millions who get sick every year on land. The group said in a statement that crew members clean and sanitize using practices developed with public health authorities, including the CDC.

“All of the efforts made by cruise ship crews cannot replace the responsibility that rests with each and every individual,” the association said. “Passengers and crew alike must also be committed to keeping themselves, their family and their fellow travelers healthy.”

Through its Vessel Sanitation Program , the CDC inspects cruise ships, monitors illness, trains crew and provides public health information. The agency releases information on outbreaks when 3 percent or more of passengers or crew report symptoms to medical staff on board.

“Norovirus can be especially challenging to control on cruise ships because of the close living quarters, shared dining areas, and rapid turnover of passengers,” the CDC says. “When the ship docks, norovirus can be brought on board in contaminated food or water or by passengers who were infected while ashore.”

Because norovirus can linger on surfaces and resists many common disinfectants, it can result in outbreaks on back-to-back cruises. Still, the agency says that norovirus on cruise ships only account for 1 percent of reported outbreaks of the illness and notes that “acute gastrointestinal illness is relatively infrequent” on ships.

“Health officials track illness on cruise ships,” the CDC says . “So outbreaks are found and reported more quickly on a cruise ship than on land.”

More cruise news

Living at sea: Travelers on a 9-month world cruise are going viral on social media. For some travelers, not even nine months was enough time on a ship; they sold cars, moved out of their homes and prepared to set sail for three years . That plan fell apart, but a 3.5-year version is waiting in the wings.

Passengers beware: It’s not all buffets and dance contests. Crime data reported by cruise lines show that the number of sex crimes has increased compared to previous years. And though man-overboard cases are rare, they are usually deadly .

The more you know: If you’re cruise-curious, here are six tips from a newcomer. Remember that in most cases, extra fees and add-ons will increase the seemingly cheap price of a sailing. And if you happen to get sick , know what to expect on board.

• CruiseMapper
• Cruise news

Norovirus outbreak prompts later boarding for P&O's Ventura ship

Passengers scheduled to board the cruise ship Ventura , which recently experienced a norovirus outbreak , have been advised to arrive later than usual to allow for enhanced cleaning procedures.

The Ventura is scheduled to depart on Saturday, June 28, at 19:00 BST for a 10-night voyage to Spain and Portugal.

Port health officials boarded the ship on May 25 after several passengers fell ill during a 2-week cruise around the Canary Islands.

P&O Cruises has announced that embarkation, typically beginning at midday, will be delayed by 2 hours to facilitate thorough sanitation efforts.

P&O spokesperson said that was "an additional measure given the elevated levels of gastrointestinal symptoms in the UK as a whole at the moment."

"We work closely with relevant global and regional health authorities and we have approved, recognised and proven protocols that are in place throughout every cruise to uphold the health and wellbeing of all guests and crew onboard."

The latest Ventura cruise is listed as sold out.

15 Reasons Retiring on a Cruise Ship is a Terrible Idea

R etirees looking for affordable new places to live are getting creative with their choices. Instead of moving to a retirement community like The Villages in Florida or a small town with a low cost of living, some are opting to retire on a cruise ship.

Traveling around the world to different ports of call sounds like a fantastic way to spend retirement years, but all is not what it seems. There can be numerous drawbacks to retiring at sea. Before setting sail, here are some reasons why retiring on a cruise ship is a bad idea. 

1. It’s Expensive

Several factors affect the cost of retiring on a cruise ship, such as how long you plan to travel, the destination, and the type of cabin you plan to book. 

Expect to pay around $130 to $260 daily for a cruise trip. Discounts are available if you’re a frequent cruise traveler or plan to travel long-term.

2. Health Insurance Coverage 

Retirees in poor health might want to pass on cruise ship retirement because they don’t have the facilities to care for chronically ill people or provide long-term medical care. 

Medicare only covers medically necessary healthcare when a cruise ship is at or within six hours of a U.S. port, and the doctor is permitted to perform medical services on the cruise ship. Private health insurance may be required. 

3. Lack of Control 

When traveling on a cruise ship, guests have no control over the ship’s travel itinerary. There could be ports of call of no interest to a passenger, or the time spent at a desired destination is too short. 

Cruise ship travelers are at the mercy of the schedule and must make the best of it. If you don’t like being stuck at a particular port for a given time, retiring on a cruise ship may not be for you. 

4. Absence From Family and Friends 

Traveling worldwide as part of an extended retirement trip is a lifetime opportunity, but that means leaving behind loved ones for several months or years. When you retire and live in a brick-and-mortar home, people can visit you and vice versa. 

Living on a cruise ship removes the ability to visit someone or receive visitors. It also means missing out on seeing major life events in person. That’s a huge sacrifice and should be carefully considered. 

5. Chronic Illness 

Generally speaking, cruise ships have medical facilities capable of providing routine and emergency medical care. They’re not equipped to be assisted living or long-term care facilities. 

Taking months or years-long cruises sounds like a dream when you’re healthy, but what happens if there’s a serious enough decline in health that the cruise ship medical staff isn’t equipped to handle? 

6. Jobs and Gig Work

It’s not unusual for retirees to take on another part-time, full-time, or gig job. Being away from land makes that more than a bit challenging. 

Remote jobs are available, but there’s a lot of competition for them. So it could be hard to land one. Plus, you’d have to always ensure a strong Wi-Fi signal to perform work duties. 

7. Fitness Challenges 

Cruise ships are notorious for having decadent food and beverages available 24/7. There’s no escaping it. The temptation to eat until your heart desires is understandable.

If changes in eating habits aren’t balanced by increased fitness activities, your health and weight will likely be negatively affected. Practice healthy eating as much as possible and splurge only on occasion. 

8. Boredom 

For all of the activities cruise liners have to offer their guests, there are only so many times you can do the same activities before boredom sets in. That’s even with the stops to different ports. 

Retiring on dry land allows you to explore different places and enjoy new experiences at your schedule and pace. That’s not necessarily the case on a cruise ship. 

9. Seeing the Same People

Whether the cruise liner is a small or large ship, there’s a high probability of running into the same retirees day after day. Some of these interactions are pleasant, and others aren’t. 

There aren’t many places to escape or hide on a cruise ship except your cabin; you might meet a variety of shorter-term cruise guests and citizens of the ports visited. Otherwise, you’re in the same circle of travelers.

10. Social Isolation

Despite being around many people on a cruise line, there’s always the risk of social isolation. At home, retirees have their families and established groups of friends. 

On a cruise ship, getting to know people well enough to develop deep friendships with them could be a challenge. Not having extended family around can also lead to feeling isolated. 

11. Disease Outbreaks

Living close to others means communicable illnesses travel quickly among ship passengers. Imagine what it was like to be on a cruise ship during the early stages of COVID-19. 

Norovirus, also called the stomach flu, is a common illness that quickly spreads through cruise ship communities. The illness can be fatal to the very young, the elderly, and the immune-compromised, so extra caution must be taken to avoid getting sick. 

12. Bedbugs

You may be confident you don’t have a bedbug infestation at home that you inadvertently transmit throughout a cruise ship. Can you say the same for your fellow passengers?

It’s kind of a gross thing to think about, but it’s a legitimate concern. It’s also a risk that’s taken when embarking on a cruise and when new passengers come on board. 

13. Small Living Quarters

One of the biggest adjustments to living on a cruise ship is getting used to living in much smaller accommodations than a house or an apartment. 

Living in smaller cruise ship quarters, about the size of one or two rooms in your house, means paring down your belongings to what you need. 

14. Add-Ons

Just because cruise ship passengers pay a daily charge to sail the seas doesn’t mean it’s all-inclusive. There could be extras that the cruise liner charges in addition to the basics. 

Even the cheapest cruises have extra fees for drinks and premium meals, additional costs when exploring at port destinations, some onboard activities, taxes, and even Wi-Fi. 

15. Homesickness 

Going on a one—or two-week vacation away from home is enough to cause homesickness. That feeling is magnifiedwhen traveling for months or even years. 

Laptops, smartphones, and tablets make it easy to contact friends and loved ones at home, but it’s not the same as seeing them in person. 

18 Affordable Places to Call Home for Less Than $1,000 Monthly

Money makes the world go round. Many of the decisions you make are influenced by your financial situation, including the place you call home or the places you travel to. Living in a mansion is a dream come true, but that’s only possible if you have the money to support that lifestyle. If you’re on the frugal side or have a lower income, you may want to live in a place with low costs and a reasonable quality of life.

13 Incredible Beaches Around the World That You Must Visit

There are so many amazing beaches all over the world. Of course, what one person thinks is the best beach might not appeal to others. We have included a variety on this list to appeal to people of all interests. If you love water sports, there are ones here for you. If you love nothing more than remote beaches and the sound of the waves as the backdrop to your day, then we have some of those in here as well. 

Retire Like Royalty: Top 15 Spots to Live Comfortably on Social Security

One of the most challenging decisions retirees have to make is where to live. Most retirees must live on a budget and be mindful of their money. Living in a place with a low cost of living is critical.

Ukraine war latest: Belarus deploys extra air defence forces to border; 10 Ukrainian prisoners freed with Vatican's help

Ten Ukrainian civilians who had been imprisoned in Russia for years have been released after mediation from the Vatican. Overnight, five people were killed in a Ukrainian drone strike on a Russian village. Listen to a Sky News podcast on Putin and North Korea while you scroll.

Saturday 29 June 2024 18:05, UK

• Five killed, including two children, in Ukrainian strike on Russian village
• Ten Ukrainians imprisoned in Russia freed after Vatican mediation
• Belarus deploys additional air defence forces to Ukraine border
• Your questions answered : Has the West been honest about Ukraine's failures?
• Listen to the Daily above and tap here to follow wherever you get your podcasts

Ask a question or make a comment

We're pausing our live coverage for now. 

You can scroll below to catch up on the latest developments, and we'll be back with our regular coverage tomorrow. 

Six people have been killed in a Russian attack on a small town in the southern Zaporizhzhia region, a Ukrainian official has said. 

A further eight people have been injured, regional governor Ivan Fedorov said. 

Infrastructure, a shop and residential buildings in Vilniansk have also been damaged, he added. 

The strike comes after five people were killed in the Kursk region of Russian due to a Ukrainian drone attack. 

Two young children were also injured in the strike on the village of Gorodishche, around 73 miles (118km) from the Ukrainian border, Kursk governor Alexey Smirnov said. 

Two other people were injured and were in a "serious condition" in hospital, he added. 

Volodymyr Zelenskyy has met one of the men released from Russian captivity earlier today. 

The Ukrainian president met Nariman Dzhelyal who was successfully returned home after three years in captivity. 

"We will bring security to all our people and peace to Ukraine. I thank everyone who is helping. I thank Nariman for this meeting and for his strength," Mr Zelenskyy said. 

Mr Dzhelyal was detained in Crimea in 2021 while serving as the first deputy chairman of the Mejlis of the Crimean Tatar People. 

During his imprisonment, he sent several letters, Mr Zelenskyy said. 

He added that in one of them he wrote: "We are fighting not only for the integrity of our territories but also for the unity of our society, our beautiful, strong nation." 

US officials told Reuters news agency late last night that the Biden administration would provide Ukraine with $150m (£118.6m) worth of weapons and ammunition, including HAWK air defence interceptors and 155 millimetre artillery munitions.

The weapons aid package is expected be unveiled on Monday, the officials said.

Ukraine has urgently requested air defence support as Russia has pounded its energy facilities in recent weeks via aerial attacks. 

The US began shipping HAWK interceptor missiles to Ukraine in 2022 as an upgrade to the shoulder-launched Stinger air defence missile systems - a smaller, shorter-range system. 

The support package will include other munitions and equipment to support Ukraine's defence needs, the officials added. 

The US has provided Ukraine with more than $50bn (£39.5bn) in military aid since 2022. 

We reported earlier on the 10 Ukrainian civilians who were released from Russian captivity earlier today after years of imprisonment (see 8.49am post). 

Watch them reunite with their loved ones in Kyiv's international airport in newly released footage.

A report by the Ukrainian military's centre for strategic communications has found that the country's forces have damaged or destroyed more than 30 Russian military aircraft in the first six months of 2024. 

Most of the strikes against the aircraft have taken place in occupied Ukraine except for a handful of strikes over the Sea of Azov and within Russia, the centre said, as reported by the Institute for the Study of War (ISW). 

The centre did not specify what portion of these Ukrainian strikes were air defence interceptions of Russian aircraft in flight and what percentage were strikes against Russian aircraft at airfields. 

The ISW said they were unable to verify the report.

But it said the downing of Russian aircraft, especially critical aircraft like the A-50 and Il-22, has temporarily constrained Russian aviation activities over occupied Ukraine, but added Ukrainian forces "have yet to be able to significantly attempt to contest the air domain".

President Volodymyr Zelenskyy has revealed that Russian strikes have resulted in Ukraine losing around 80% of its thermal power and one third of its hydroelectric power.

Discussing the attack in Dnipro, Mr Zelenskyy said it was a reminder to Ukraine's allies that the country needed more air defence systems. 

He said: "This is why we constantly remind all of our partners: only a sufficient amount of high quality of air defence systems, only a sufficient amount of determination from the world at large can stop Russian terror."

Kyiv has also struck back at Russia with its own attacks, which also often target energy infrastructure.

Belarus has deployed additional air defence forces to its border with Ukraine to protect "critical infrastructure facilities" due to increased Ukrainian drone activity, a Belarusian military commander has said.

Belarus, an ally of Russia, said earlier this week it had shot down a quadcopter that had illegally crossed the border from Ukraine "to collect information about the Belarusian border infrastructure". 

The situation in the airspace over the border remains tense, Andrei Severinchik, commander of the Belarusian Air Defence Forces, said. 

"We are ready to decisively use all available forces and means to protect our territory and the population of the Republic of Belarus from possible provocations in the airspace," he said. 

Belarus' defence ministry said earlier today it had information showing Ukraine had been moving more troops, weapons and military equipment to the northern Zhytomyr region, which borders Belarus. 

There was no immediate response from Ukraine. 

Russian elites and oligarchs have reportedly moved from criticising the country's war effort in Ukraine to supporting it, the Institute for the Study of War (ISW) has reported.

Mikhail Zygar, the founder of the Russian opposition television channel TV Rain, reported that many elites who were opposed to the war in 2022 started to support the war in 2023 because they "believe Russia is prevailing".

Mr Zygar said these people made this assessment due to Russia's slow but steady battlefield gains, a persisting Ukrainian munitions disadvantage, and perceived "waning" Western security assistance to Ukraine.

One anonymous Russian oligarch who previously criticised the war reportedly told Mr Zygar that Russia must win the war otherwise "they won't allow us to live... and Russia would collapse".

The ISW said it cannot independently verify Mr Zygar's reporting but it is consistent with the institute's assessment that this section of Russian society came to heel behind Vladimir Putin in support of the war after his government intensified crackdowns against elites in the wake of the 2022 invasion. 

As Russia announces it has captured a second village in 24 hours (see 12.26pm post), let's take a look at where Russia has advanced along the frontline with Ukraine. 

As well as pockets of advances on the border north of Kharkiv, Russia appears to have captured areas along the length of the front, from the Donetsk region right up to the western edge of Luhansk.

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