cruise ship covid reports

'I felt safer on the cruise than Walmart': COVID protocols on cruises prove effective, initial CDC data shows

• From June 26 through Aug. 26, there were 452 confirmed cases of COVID on cruise ships reported by cruise lines to the Centers for Disease Control and Prevention.
• CLIA "conservatively" estimates 262,000 passengers sailed in that time on ocean-going member lines.
• The protocol in place on ships to mitigate COVID-19 "absolutely has" worked to make cruise ships safer.

The coronavirus continues to be present on cruise ships sailing in U.S. waters, data from the Centers for Disease Control and Prevention obtained by USA TODAY shows.

But travelers are feeling more secure with the protocols in place. 

In the two-month period spanning from when the first cruise sailed with paying passengers on June 26 through Aug. 26, there were 452 confirmed cases of coronavirus on cruise ships reported by cruise lines to the health agency.

The cases reported were spread among crew and passengers who tested positive via viral testing on ships belonging to cruise lines including Carnival Cruise Line, Royal Caribbean International, Celebrity Cruises, Norwegian Cruise Line, MSC Cruises, Disney Cruise Line, Holland America Line and Princess Cruises, among others.

It doesn't come as a surprise that coronavirus found its way back onto cruise ships after more than a year without cruising in U.S. waters due to the pandemic. 

"We've never said that cruising will be a zero-risk activity," Capt. Aimee Treffiletti, who leads the CDC's maritime unit, told USA TODAY in late October.  "I think we've all always expected that cases would be identified."

►COVID on cruises: What happens if the coronavirus gets on board?

►Here's why I didn't panic: Six COVID-19 cases emerged on my Royal Caribbean cruise.

"Unlike other forms of travel, a cruise ship is more like congregate residential setting where thousands of travelers (passengers and crew) are living for multiple days (or months for crew) on the same ship: eating, sleeping, and participating in activities together in one location. COVID-19, like other illnesses, can spread quickly in group settings like cruise ships," ​​​​​Caitlin Shockey, spokesperson for the CDC, added in an email to USA TODAY.

But just because cases are emerging on cruise ships doesn't mean that cruising is as risky as it was at the beginning of the pandemic when outbreaks forced ships, including the Diamond Princess and Grand Princess, into quarantine with more than 700 infected on Diamond Princess and dozens infected on the Grand Princess.

COVID-19 protocols make ship environment safer

The protocol in place on ships to mitigate COVID-19 "absolutely has" worked to make cruise ships safer as the world faces a global pandemic, Treffiletti said.

While there still remains some risk of transmission of COVID-19 on board cruise ships, robust protocols including testing and masking, among other elements, have reduced the risk of the pandemic's onboard spread. 

Alex Heller, who cruises frequently with his husband, Michael Bonham, on Royal Caribbean International ships, told USA TODAY they have been on five cruises since the pandemic began and have four more scheduled for this year.

Royal Caribbean International has required that all passengers ages 12 and over show proof of vaccination and a negative test for every passenger age 2 and older, a protocol which was put into place Aug. 1. As a result, Heller said they have felt safe.

"On one of the trips, we stayed a few nights in Florida after we disembarked," Heller said. "It felt like Florida had hardly any restrictions and a few people even approached us with snide remarks about wearing our masks, so we actually felt safer on the ship than we did on land."

Kathy Simmons, who sailed on the Carnival Magic in September, echoed Heller's statement.

"I felt safer on the cruise than Walmart," Simmons told USA TODAY. "I live in rural (Georgia) and next to no one masks or distances anymore."

Alex Winter added that he felt safer sailing on MSC Meraviglia this October than he did on a December 2019 Norwegian cruise thanks to additional protocols and lowered capacity.

As of Thursday, 52 cruise ships were sailing with paying passengers in U.S. waters following CDC guidance, according to the CDC's cruise ship status tracker , spokesperson Dave Daigle told USA TODAY.

"We've never expected that there would be zero risk of transmission," Treffiletti said. "But one thing that's really important is that we haven't seen medical resources overwhelmed on ships – we haven't seen high rates of hospitalizations or deaths that we saw early on in the pandemic related to cruise ships. So, I think we can consider that a success."

►A year without cruising: There was no ‘crystal ball’ to tell when sailing could restart amid COVID-19

What the data tells us

Cruise lines are required to report confirmed coronavirus cases and COVID-19-like symptoms reported on ships in U.S. waters to the CDC, but most cases of coronavirus on cruise ships have not been required to publicly report those numbers.

Crewmembers are also required to be tested on a weekly basis or at other intervals as required by the health agency after an initial testing requirement and testing of newly arriving crew.

Of the 452 cases confirmed, 146 were among crew members and 306 were among passengers. Fifty-seven ships reported COVID-19 data to the CDC within the two-month period, 11 of which reported no confirmed cases at all. 

The CDC repeatedly told USA TODAY it does not have a count of how many people sailed on cruise ships in total during that period.

Story continues below.

Cruise Lines International Association, however, "conservatively" estimates 262,000 passengers sailed between June 26 and Aug. 26 on member cruise lines that sail on the ocean. The number does not include crew members, Bari Golin-Blaugrund, vice president of strategic communications, told USA TODAY.

The association's cruise lines make up more than 90% of ocean-going cruise capacity.

"The relatively low occurrence of COVID-19 during that period, particularly when compared to the rest of the country, further demonstrates the leadership of the cruise industry and the effectiveness of the science-backed protocols that have enabled a successful return to operations around the world," Golin-Blaugrund continued.

During the time that these 452 cases of coronavirus were identified on cruises, about 4.9 million cases were reported in the U.S. in the 62 days between June 26 and Aug. 26, CDC data show. With an American population of about 332.8 million, about 1 in 68 Americans tested positive during the same time when 452 cases of coronavirus were identified on cruises.

The ships that reported cases to the CDC were traveling under different circumstances: Some were sailing on test cruises (sailing with volunteer passengers to test onboard protocols to mitigate the spread of COVID-19); some were on restricted revenue sailings (with paying passengers); and some were sailing with crew only.

Cruise lines are required by the CDC to submit information on coronavirus cases in its "Enhanced Data Collection During COVID-19 Pandemic Form" as a part of its Conditional Sailing Order, originally introduced in October 2020  and extended last month.

The CDC did not specify when over the two month period cases were identified, on what sailing the cases happened or the conditions of the sailing whether it be a test sailing, a sailing with paying passengers, or a sailing with crew only. This information is not asked for in the daily form required by the CDC, USA TODAY reviewed the form required by ships.

And the vessels that reported coronavirus cases to the CDC were sailing for varying amounts of time during the two-month period. Some cruise ships resumed operations earlier, others started at a later date in the industry's phased-in resumption.

People who tested positive during quarantine or upon embarkation were not counted as the CDC classified those cases as not contributing to the onboard spread.

It is not clear over   how many sailings the cases were spread out, nor is it clear how many sailings each ship has completed and the duration of each sailing. Not all cruise ships in the U.S. are back in operation yet and it has been a rolling start with ships slowly resuming service. 

There are many other variables at play too: Ship size, capacity filled, protocols, port stops and other factors could have contributed to coronavirus on board ships.

Cruise lines sharing coronavirus protocol results

Cruise companies have begun to share how their protocols have mitigated coronavirus on board as well.

During its third-quarter earnings call on Oct. 30, Royal Caribbean Group's chief financial officer Jason Liberty shared that out of 500,000 passengers who have sailed with the brand globally, only 150 have tested positive for coronavirus across the cruise company's five brands including Royal Caribbean International, Celebrity Cruises and Silversea Cruises along with TUI Cruises and Hapag-Lloyd Cruises. Those 500,000 passengers have sailed around the globe since June not just in U.S. waters, spokesperson Jonathon Fishman told USA TODAY.

Jessica John, spokesperson for Norwegian Cruise Line Holdings Ltd., parent company to Norwegian Cruise Line, Regent Seven Seas Cruises and Oceania Cruises, told USA TODAY that the company has identified positive cases on certain sailings since resuming operations but did not specify the exact count.

"Our rigorous SailSAFE health and safety protocols, including mandatory vaccination and universal pre-embarkation testing, are working as designed to greatly mitigate the risk of introduction and transmission of COVID-19 on board our ships and the prevalence of cases we have seen since resuming has been well below the general population during that time," John said.

Roger Frizzell, spokesperson for Carnival Corp., parent to Carnival Cruise Line, Princess Cruises, Holland America Line, Seabourn, AIDA, Costa Cruises and P&O Cruises, told USA TODAY that onboard protocols are working to mitigate the spread of coronavirus.

"When those rare situations occur when there has been variant cases for fully vaccinated guests, they are typically extremely mild and our protocols in place have been effective."

Coronavirus cases identified on board don't mean cruising is unsafe

While coronavirus is on board cruise ships, that doesn't mean cruising is stopping again any time soon or that travelers should be discouraged from boarding.

"Given the ongoing COVID-19 pandemic and development of variants of concern, including the delta variant, CDC has continued to collaborate with cruise ship operators to provide safe and healthy cruising environments for crew and passengers," CDC's Shockey said.

The CDC issued a "Level 3: High Level of COVID-19" notice warning on Aug. 20 for cruise travel that remains in place.

The number of cases shows that the coronavirus protocol implemented on ships is working.

"I was very impressed by their vaccine and testing requirements," Simmons said of her Carnival cruise. "I know things can still slip through the cracks, but knowing that all adults were vaccinated and everyone was tested prior to boarding gave me great peace of mind."

Heller, who prefers to cruise with Royal Caribbean International, said he "certainly wouldn’t feel safe" without the protocols in place.

If public health measures were not in place, Shockey said the CDC "would expect COVID-19 cases to increase on ships and potentially overwhelm their medical and public health resources."

►Cleaning a floating petri dish: How is a cruise ship sanitized after a coronavirus outbreak?

Contributing: Mike Stucka

• Share full article

Advertisement

Supported by

On Cruise Ships, Omicron Puts Safety Protocols to the Test

Many lines are adjusting their masking, testing and vaccine rules, while criticism is mounting about the lack of transparency in reporting positive cases to passengers and crew members.

By Ceylan Yeginsu

By the time the Norwegian Breakaway cruise ship docked in New Orleans on Dec. 4, after a weeklong cruise that included stops in Belize, Honduras and Mexico, 17 coronavirus cases had been identified on the ship, including a case of the new Omicron variant. The local and federal health authorities were notified — but not all the disembarking passengers.

“I only found out after I got home and saw it on the news,” said Betsy Rodriguez, a retired veterinarian who took the Caribbean cruise with her daughter. “We felt pretty safe knowing everyone on the ship was vaccinated, but I guess it would have been good to know people tested positive so we could have been more careful.”

Since the cruise industry restarted operations in the United States this June, its efforts to keep the coronavirus at bay — or at least contained, unlike the major outbreaks experienced in 2020 — have been largely successful. Most cruise companies mandate full vaccinations for crew and most passengers, and have implemented strict health and safety protocols to swiftly identify coronavirus cases onboard and reduce their spread.

But in recent months, as new and highly contagious variants have emerged and case numbers steadily increase worldwide, these measures are being put to the test. Many lines are adjusting their masking, testing and vaccine rules, while criticism is mounting about the lack of transparency in reporting positive cases to passengers and crew members during sailings.

A crew member on the Breakaway, who spoke on the condition of anonymity because he was not permitted to speak to the news media, said he first heard about the outbreak from a friend and fellow employee. When he contacted management, they neither shared the number of positive cases nor identified who was infected.

“I would like to know who tested positive because this new variant spreads very quickly and I have a medical condition which means I need to be very careful and protect myself,” he said, voicing concern that if he became sick, he could be sent back to his home country. “I can’t afford that because I need to take care of my family at home.”

Most cruise companies do not publicly announce the number of coronavirus cases identified during sailings, but all cruise ships operating to and from U.S. ports must submit daily numbers to the Centers for Disease Control and Prevention, which uses a color-coded system to inform the public whether the number of cases is above or below the agency’s threshold for an investigation. Sharing this data is one of many requirements in the Framework for Conditional Sailing Order, a series of C.D.C. guidelines that cruise companies must follow to operate in U.S. waters.

The 17 cases on board the Norwegian Breakaway were first publicly reported by the Louisiana State Department of Health on Dec. 4. All passengers and crew members — more than 3,200 people — onboard were fully vaccinated, following the company’s policy.

Norwegian declined to comment on its policies for reporting cases on board its ships or whether any additional Breakaway crew members tested positive after passengers disembarked.

“All the identified cases onboard were asymptomatic,” a company spokesman said in a statement. “We implemented quarantine, isolation and contact tracing procedures for identified cases and tested all individuals on Norwegian Breakaway before disembarkation.” In addition, he said, passengers were given “post-exposure and quarantine public health guidance” as laid out by the C.D.C.

Reporting to the C.D.C.

The coronavirus wreaked havoc on the cruise industry in the early stages of the pandemic , infecting hundreds of cruise passengers and workers, and requiring the sector to shut down for 18 months. To begin sailing, cruise ships had to agree to the C.D.C.’s Conditional Sailing Order, which is valid until Jan. 15.

Among the safety measures the order requires — beyond submitting the daily number of coronavirus cases — is a prevention and control plan for each cruise ship. The plan, said Bari Golin-Blaugrund, a spokeswoman for the Cruise Line International Association trade group, includes “procedures for informing passengers and crew members that a threshold of Covid-19 has been met or exceeded.”

“The reporting requirements and practices of the cruise industry are practically unmatched compared to other sectors in the United States, especially within the travel and tourism sector,” she said.

In a C.D.C. report of coronavirus data published last month, cruise operators had reported 1,359 positive cases between June 26 and Oct. 21. During that time, 49 hospitalizations, 38 medical evacuations and one death occurred because of coronavirus infections detected onboard cruise ships.

The report highlighted several large outbreaks, including one in which a symptomatic passenger who tested positive on a ship in July was linked to 20 additional cases over two sailings. One ship reported 58 positive between July 24 and Aug. 28 and another reported 112 cases over four consecutive voyages, which ended on Sept. 7. Most of the cases were breakthrough infections in fully vaccinated passengers.

While the C.D.C. relies on data reported by the cruise companies, the agency also carries out inspections to make sure that cruise ships are in compliance.

With the rise of Delta and Omicron variants, and as the virus surges across the world, cruise lines have been adjusting their health and safety protocols, reinstating measures like mask mandates and requiring additional testing from passengers. Starting Jan. 13, Disney Cruise Line will require all children over the age of 5 to be fully vaccinated against the coronavirus.

Demand remains high

Despite the new restrictions and risks posed by new variants, demand for future cruises remains high. Carnival, the world’s largest cruise company, reported that its bookings for the second half of 2022 have surpassed bookings for 2019. Royal Caribbean said the Delta variant had hit bookings in 2021 and 2022, but not for 2023.

“I think what people have been saying is, I want to get out there, but I don’t want to do it too soon. I want to make sure that things have stabilized,” Richard D. Fain, chairman and chief executive of Royal Caribbean Cruises, said in the company’s last earnings call in October.

Miranda Gibson, 63, an avid cruiser from Tampa, Fla., took two cruises this summer, but then canceled three cruises she had planned for the rest of the year because of her concerns over the Delta variant.

“The first cruise I took in June in the Caribbean was heaven because everyone was vaccinated, Covid was under control and it was the first time in so long that we could have some carefree fun,” she said.

“Now with the variants everything is prickly again and you can’t really get a true relaxing cruise experience when you are worrying about Covid and masks and rules,” she explained. “I’m booked in June 2022 and I know I’ll be tempted to go before then but I’m going to wait until it’s safer.”

Others believe cruise ships are among the safest vacation environments, because of the vaccine requirements and testing protocols.

“When you’re on a plane, or in a hotel or at a theme park you don’t know who has Covid around you,” said Timothy Ryan, 67, a retired financial trader from Miami who has 16 cruises booked through 2022. “On a cruise, it’s detected right away and the positive cases are isolated, so you can continue your vacation in a Covid-free bubble. I really don’t know a safer way to travel.”

52 Places to Love in 2021

We asked readers to tell us about the spots that have delighted, inspired and comforted them in a dark year. Here, 52 of the more than 2,000 suggestions we received, to remind us that the world still awaits.

Follow New York Times Travel on Instagram , Twitter and Facebook . And sign up for our weekly Travel Dispatch newsletter to receive expert tips on traveling smarter and inspiration for your next vacation.

Ceylan Yeginsu is a London-based reporter. She joined The Times in 2013, and was previously a correspondent in Turkey covering politics, the migrant crisis, the Kurdish conflict, and the rise of Islamic State extremism in Syria and the region. More about Ceylan Yeginsu

Come Sail Away

Love them or hate them, cruises can provide a unique perspective on travel..

 Cruise Ship Surprises: Here are five unexpected features on ships , some of which you hopefully won’t discover on your own.

 Icon of the Seas: Our reporter joined thousands of passengers on the inaugural sailing of Royal Caribbean’s Icon of the Seas . The most surprising thing she found? Some actual peace and quiet .

Th ree-Year Cruise, Unraveled:  The Life at Sea cruise was supposed to be the ultimate bucket-list experience : 382 port calls over 1,095 days. Here’s why  those who signed up are seeking fraud charges  instead.

TikTok’s Favorite New ‘Reality Show’:  People on social media have turned the unwitting passengers of a nine-month world cruise  into  “cast members”  overnight.

Dipping Their Toes: Younger generations of travelers are venturing onto ships for the first time . Many are saving money.

Cult Cruisers: These devoted cruise fanatics, most of them retirees, have one main goal: to almost never touch dry land .

Confused about changing COVID-19 rules for cruise ships? Here's everything you need to know

Do you still need a COVID-19 vaccine to board a cruise ship? A negative COVID-19 test? A mask?

Not too many months ago, the answer was "all of the above" for most cruise vessels. But today it's not so straightforward. Some cruise lines have been loosening their COVID-19 rules. Others have been mostly holding fast to policies.

The divergence has come as more countries around the world, including the United States, peel back their COVID-19 rules for cruise ships, leaving it up to individual lines to decide just how strict — or not — they want to be.

The result is that preparing for a cruise has become more confusing than ever.

For more cruise guides, news and tips, sign up for TPG's cruise newsletter .

Don't panic. We're here to help. In the segments below, we look at the COVID-19 policy landscape as it stands right now across the world's biggest cruise lines and try to make sense of it all.

It's a landscape that is likely to continue to change markedly in the coming months. In just the last few weeks, several lines have done away with pre-cruise COVID-19 testing requirements, and the buzz in the cruise world is that more lines soon will follow suit.

Already, mask-wearing rules on ships have mostly disappeared, though not everywhere.

Do I still need a COVID-19 vaccine to cruise?

For the most part, yes. With just a few exceptions, cruise lines still require most, if not all, passengers to present proof of a COVID-19 vaccine to board a ship.

Some lines make exceptions for young children and people who can't be vaccinated due to medical conditions or religious beliefs. The world's largest cruise line, Royal Caribbean , for instance, exempts children under the age of 12 from its vaccine requirement on most sailings. So does Carnival Cruise Line , the world's second-largest cruise brand.

This has been the broad policy at nearly all cruise lines since cruises allowing Americans restarted in 2021. In recent weeks, a few cruise lines have relaxed their vaccine rules slightly but not to a great extent.

Adults-only line Virgin Voyages, for instance, on Thursday said it would allow up to 10% of passengers on any given sailing to be unvaccinated for COVID-19. Under its previous policy, all passengers had to be vaccinated. Would-be cruisers who are unvaccinated must contact the line before booking a cruise to ensure one of the limited slots for unvaccinated travelers is available.

Related: Do I need a COVID-19 vaccine to cruise? A line-by-line guide

Are children required to have a COVID-19 vaccine to cruise?

In many cases, yes. But as noted above, some lines make exceptions to vaccination rules for young children.

Many major cruise lines require anyone who is eligible to receive a COVID-19 vaccine to be fully inoculated before being allowed to sail.

For cruisers from the U.S., that means anyone 5 years or older must have proof that they've had their shots. Anyone 4 years old or younger is exempt from the vaccination rule. Some lines such as Royal Caribbean, Carnival and MSC Cruises set the cut-off for mandatory vaccines higher at the age of 12.

Passengers under these age cutoffs who aren't vaccinated typically have to present negative COVID-19 test results and submit to mandatory testing at the port on embarkation day to board. In general, the testing requirements for the unvaccinated on ships are more rigorous than the testing requirements for the vaccinated.

Note that some lines require that all passengers boarding ships be vaccinated for COVID-19, no matter their age. This means that young children who are not eligible for a COVID-19 vaccine by definition cannot sail.

Lines with such a rule include Oceania Cruises , Regent Seven Seas Cruises, Scenic Luxury Cruises and Tours, Silversea Cruises and Windstar Cruises .

Related: Do children need to be vaccinated to cruise? Here's the policies at the biggest lines

Do I need to test negative for COVID-19 before boarding a cruise ship?

It depends. For much of the past year, every major cruise line required passengers to test negative for COVID-19 before boarding a ship. However, a handful of lines in recent weeks, including Virgin Voyages and Norwegian Cruise Line, have dropped pre-cruise testing requirements for at least some sailings, and more lines are expected to follow suit in the coming months.

Virgin Voyages is among the lines that have loosened testing rules the most. On Thursday, it said it would no longer require pre-cruise tests on any sailing in the two markets where it operates: Europe and North America (the new policy takes effect July 24 for sailings in Europe and July 27 for sailings in North America).

Small-ship specialist Azamara, which currently has all its ships in Europe, also dropped testing requirements for all sailings in recent days.

Other lines are taking a more scattershot approach to dropping testing requirements, mostly due to lingering testing rules in some of the countries where they operate.

Norwegian, for instance, recently said it would drop pre-cruise test requirements for most sailings in Europe but not other regions on Aug. 1. An exception will be sailings from Greece, where testing is required by the local government and will continue. Holland America recently waived pre-cruise testing requirements for just one vessel, Rotterdam, on select itineraries out of Amsterdam.

Just remember, no matter what your cruise line's policy is on pre-cruise testing, some countries around the world such as Japan still require a negative COVID-19 test for entry. If you're planning a cruise out of one of these countries and are not already within the country, you'll still need to test negative in advance of the trip even if your cruise line doesn't require a negative test result.

Related: Do I need to take a COVID-19 test before cruising?

Could I still be quarantined on a cruise ship if I test positive for COVID-19 while on board?

Yes. Cruise lines are still quarantining passengers who test positive for COVID-19 while on a ship. Passengers who display COVID-19 symptoms even without testing positive are also being quarantined on some ships. Passengers who are deemed to be "close contacts" of such passengers may also find themselves isolated for a time while they undergo COVID-19 testing.

Some cruise lines still warn passengers in their travel documentation that they could be quarantined on land for a time if they test positive for COVID-19 just before embarkation after flying to a ship. Additionally, passengers may be forced to quarantine on land for a time after disembarking a ship if they test positive while on board.

Related: I got quarantined after testing positive for COVID-19 on a ship; here's what it was like

Is the CDC still setting the rules for cruise ship COVID-19 policies?

No. In the early days of the COVID-19 pandemic, the U.S. Centers for Disease Control and Prevention issued rules that cruise lines had to follow in order to resume cruising in U.S. waters that touched on everything from mask-wearing policies on ships to pre-cruise testing. However, the rules have morphed into non-binding guidelines in several steps over the past year.

The CDC's initial Conditional Sail Order imposing COVID-19-related rules on cruise lines expired in February and was replaced by a set of recommended policies that cruise lines could opt-in or opt-out of following. On July 18, this subsequent optional program was replaced by an even less formal set of recommendations that the agency said cruise lines "should carefully consider."

The bottom line is cruise lines have been free to choose whether they follow CDC recommendations for COVID-19 protocols on ships for many months.

Is the CDC still listing the COVID-19 outbreak status of ships?

No. As of July 18, the CDC stopped posting information on the extent of COVID-19 cases on cruise ships on its website.

Previously the line listed a color status for every cruise ship sailing in U.S. waters — red, yellow or green — on its Program for Cruise Ships website. This color status indicated how widespread COVID-19 was on board. As COVID-19 screening policies have begun to vary more widely from line to line in recent months, making apples-to-apples comparisons between ships has become more difficult, the CDC suggested.

"The previous color-coding system under CDC's COVID-19 Program for Cruise Ships depended upon each cruise line having the same COVID-19 screening testing standards, which may now vary among cruise lines," the CDC said Monday in announcing the end to the color-coded status postings. "Therefore, the cruise ship color status webpage has been retired."

Cruise lines are still required to report COVID-19 cases on ships to the CDC. The data just aren't being reported to the public.

Do I need to wear a mask on a cruise ship?

In most cases, no. Mask-wearing requirements were common on cruise ships through much of 2021 and into early 2022 as COVID-19 spread across the globe in several major waves. But most major cruise lines dropped mask mandates earlier this year as COVID-19 cases worldwide dropped significantly.

Where you'll still find mask-wearing rules on ships is a bit hit-or-miss. It often has to do with local laws that require mask-wearing or with cruise line concerns about short-term spikes in COVID-19 cases in specific areas.

In recent months, itineraries where mask-wearing rules on ships have been more common include voyages in the Mediterranean that include stops in Italy (where ports specifically require passengers to wear KN95/FFP2 type masks) and some sailings to Alaska . Mask-wearing inside ships is also required by local regulation on all sailings out of Singapore.

Note that some ports around the world still require mask-wearing in terminals. You might find that you don't need to wear a mask while aboard a cruise ship but must wear one while boarding and disembarking the ship in ports.

Do I need a negative COVID-19 test to get home from a cruise?

The answer to this question depends in part on where your home is. For U.S.-based cruisers returning to the U.S. by plane from a cruise overseas, there is no longer a COVID-19 testing requirement , as of June 12. You also don't need to test negative for COVID-19 to return home to a U.S. address after disembarking a cruise at a U.S. port.

Do I need to worry whether ports on my itinerary have extra COVID-19 requirements?

For the most part, no. Many cruise lines warn in their travel documentation that "guests are ...responsible for complying with all local health and safety requirements which may include additional pre-embarkation testing at the terminal," as Norwegian puts it in its documentation.

However, lines will typically tell you in advance if there are specific COVID-19 requirements in ports that could affect your trip.

Generally, if a port on your itinerary requires passengers to show proof of a COVID-19 vaccine or a negative COVID-19 test, the line will make that a condition of your sailing. In cases where a negative COVID-19 test is required to enter a certain port or port country, lines will likely test you on board before arriving at that port, often for free.

Note that lines do make clear that it's your responsibility to figure out what COVID-19 vaccine or testing documentation you need to pass through countries by air or land on the way to your cruise.

As Norwegian puts it, the line "recommends for all guests to follow, and where possible, sign up for notifications from their local government on international travel regulations that may prevent, restrict, or require additional documentation when traveling to another country for embarkation or during their cruise."

What onboard COVID safety measures are cruise ships still taking?

As noted above, most cruise lines still require all or most passengers to be vaccinated for COVID-19. Most cruise lines also require all crew on ships to be vaccinated for COVID-19, and on most ships crew also continue to wear masks at all times.

In addition, as noted above, most lines still require passengers to test negative for COVID-19 before boarding ships and crew are regularly tested for COVID-19, too. Passengers and crew who test positive for COVID-19 while on board a vessel are isolated.

In the past two years, cruise lines have made significant investments in sophisticated air filtration systems for cabins and other onboard areas of ships and have increased cleaning and sanitizing efforts on ships. Medical centers on ships have also been upgraded and often are staffed at a higher level than in pre-COVID-19 times.

What can I do to minimize my exposure to COVID-19 on ships?

Although many cruise lines no longer require mask-wearing on ships, they still recommend that you wear one, based on guidance from various health authorities and experts.

Keeping socially distant from other passengers is another strategy for staying healthy on ships as is regular hand-washing and hand sanitizing.

Major cruise lines typically place free hand sanitizer at the entrance to most public rooms on ships. Restaurants on newer cruise ships often have hand-washing stations at their entrances. On some ships, cruise ship staff are assigned to stand at the entrances to onboard restaurants and require passengers to wash or sanitize their hands.

Where can I find my specific cruise line's COVID-19 policy?

Every major cruise line lists its COVID-19 policies including vaccination and testing requirements on its website, often in great detail. Cruise lines regularly update these web pages, and they are the best place to find the very latest information.

Here are the key COVID-19 information pages on the websites of the eight major lines that account for the majority of cruising in North America:

• Carnival Cruise Line's Have Fun. Be Safe. policies page .
• Celebrity Cruises' Healthy at Sea page .
• Disney Cruise Line's Know Before You Go page .
• Holland America's Travel Well FAQ page .
• MSC Cruises' What to Know Before You Go page .
• Norwegian Cruise Line's Sail Safe page .
• Princess Cruises' Cruise Health requirements page
• Royal Caribbean's Healthy Sail Center .

How will I find out if policies change after I book?

As noted above, cruise lines list their COVID-19 policies on their websites. To be safe, check these websites often in the months leading up to your cruise. Cruise lines also notify customers by email when there are significant changes to their COVID-19 policies, as well as alert travel agents who book cruises.

Can I cancel for free if I get covid-19 in advance of a sailing?

In many cases, yes. Major lines will usually offer you a refund, sometimes in the form of a future cruise credit , if you have to cancel a cruise because of a positive COVID-19 test in your traveling party in the days leading up to a sailing.

Royal Caribbean, for instance, promises a 100% refund if anyone in your travel party tests positive for COVID-19 within 10 days of your cruise. Carnival has a policy with similar wording.

Cruise lines will also offer a refund, typically in the form of a future cruise credit, if you are denied embarkation or reboarding, or quarantined or disembarked during a voyage, due to a positive COVID-19 test or being suspected of having COVID-19. If you are quarantined for just part of a cruise due to a positive COVID-19 test, you'll likely receive a pro-rated refund for the days of the cruise you missed.

Planning a cruise? Start with these stories:

• The 5 most desirable cabin locations on any cruise ship
• The 8 worst cabin locations on any cruise ship
• A quick guide to the most popular cruise lines
• 21 tips and tricks that will make your cruise go smoothly
• 15 ways cruisers waste money
• 12 best cruises for people who never want to grow up
• What to pack for your first cruise

• Search the site GO Please fill out this field.
• Newsletters

CDC Stops Reporting COVID-19 Cases on Cruise Ships—Here's How You Can Still Stay Safe

As BA.5 cases continue to rise, cruises pose a significant risk of infection.

• The Centers for Disease Control and Prevention (CDC) has ended its program to report COVID-19 cases on cruise ships.
• Experts say this may make cruises less safe for people who want to avoid high levels of COVID-19 transmission
• Travelers are encouraged to check in with their preferred cruise line about COVID-19 infections and safety precautions.

The Centers for Disease Control and Prevention (CDC) will no longer report coronavirus cases for U.S. cruise ships, ending a program put in place during the pandemic to help the public monitor the spread of the virus.

The initiative, called the COVID-19 Program for Cruise Ships, ended on July 18, according to a notice from the CDC. Cruise lines will have to continue reporting case counts to the agency; however, the CDC will no longer share each ship's COVID status or a color-coded chart detailing the level of spread on their webpage.

"Cruise ships have access to guidance and tools to manage their own COVID-19 mitigation programs," the CDC said on its website . "While cruising poses some risk of COVID-19 transmission, CDC will continue to publish guidance to help cruise ships continue to provide a safer and healthier environment for crew, passengers, and communities going forward."

The agency also stated they ended the program because it depended upon each cruise line to have the same COVID-19 screening testing standards, which may now vary among cruise lines.

How Will This Affect COVID-19 Safety on Cruise Ships?

The CDC's decision to end the COVID-19 program will allow cruise lines to set their own COVID-19 policies, Sherrill Brown, MD , medical director of infection prevention at AltaMed Health Services, told Health .

Dr. Brown said depending on the cruise line, COVID safety precautions could be more or less strict, which could result in some cruise lines being safer to travel on compared to others.

For people looking to book a cruise, they won't have access to publicly available coronavirus data for cruise travel and "will no longer be able to tell if one cruise line or another has a better track record of reducing COVID cases on board," Dr. Brown added.

Terez Malka, MD , emergency medicine physician and pediatrician at K Health , told Health this change could also make it easier for people to go on a cruise because some companies will drop requirements like testing before embarking and while on board.

In addition, she said customers may not end up needing to quarantine while on a cruise in the event of testing positive, though some cruise lines may require quarantine if you are having symptoms and test positive.

"However, this also means that cruise travel will be less safe for those that are trying to avoid areas with high volumes of COVID infections, and means that travelers and staff will not know the COVID rates on board," Dr. Malka said.

Nevertheless, the CDC said customers will have the option "to contact their cruise line directly" to get information about outbreaks and other COVID-19 protocols on board their trip.

"Travelers will have to do their homework and trust that the cruise line they choose to travel with is following the recommended precautions and being honest regarding any outbreaks on board," Dr. Brown said.

What Are Cruise Lines Doing in Light of the CDC's Decision?

In a statement to Health , Carnival Cruise Line said it will work closely with public health officials to operate with a set of robust protocols to maintain public health and public confidence. Carnival said it welcomes the CDC's decision to end its current program, and it will "review the newest guidelines when they are posted in the coming days."

For now, Carnival Cruise said there are no immediate changes to the current COVID-19 protocols they have in place and guests should continue to use its " Have Fun. Be Safe " website when planning their upcoming trip.

Meanwhile, the Cruise Lines International Association (CLIA), will also continue to have health and safety protocols and policies in place, and will continue to prioritize the health and safety of passengers, crew, and communities, Anne Madison, a spokesperson for CLIA, told Health .

Is It Safe to Take a Cruise During The BA.5 Wave?

According to the CDC, as of July 16, the BA.5 Omicron subvariant makes up nearly 79% of all COVID-19 cases in the U.S.

Dr. Brown said because BA.5 is much more contagious than previous variants, a crowded cruise environment where individuals are not wearing masks will increase the chance of COVID-19 spreading both indoors and outdoors, especially on a crowded deck or pool.

She added while there have been fewer reported COVID-19 outbreaks on cruise lines in the news, outbreaks are still happening . Since cruise ships travel from one port to another with large volumes of people, getting on a cruise fosters an environment where "it would be very easy for outbreaks to occur."

Dr. Malka echoed this message and said since COVID cases and severity have risen significantly with the BA.5 wave, "there would be a significant risk of COVID infection when embarking on a cruise (or any vacation that involves crowds, is not requiring masks and distancing, and is not tracking cases)."

Travelers intending to go on cruises need to consider the safety of traveling in a closed environment where testing is not occurring and others could be spreading the virus unknowingly, Dr. Malka said. In addition, individuals that are at high risk of severe COVID complications or hoping to avoid COVID infection should opt not to embark on cruises that do not have COVID safety protocols and testing in place.

"The fact that there is less oversight could lead to a situation where cruise travel may be more risky if the cruise lines are not following very strict standards for COVID-19 safety," Dr. Brown said. "One must weigh the risks of travel and potentially being exposed and infected with the benefit of visiting beautiful places and experiencing cruise life."

How to Stay Safe on a Cruise

People who plan to go on a cruise should take safety precautions to keep themselves and others around them safe. One thing to do before going on a cruise is to research COVID-19 and other safety precautions being taken onboard by a specific cruise line.

For example, Dr. Malka said even though the CDC is no longer requiring COVID-19 testing, some cruise lines may still require a test prior to travel and while on board.

If you are unable to find a cruise line that is enforcing COVID precautions—or if you just want to be as COVID-safe as possible while on a cruise—Dr. Malka and Dr. Brown said there are other measures people can take to stay safe. Those include:

• Wearing masks indoors and outdoors in all public places or crowded environments.
• Engaging in activities that take place outdoors, have limited crowds, or are socially distanced.
• Drinking and dining outdoors when possible.
• Choosing to get vaccinated for COVID-19 and staying up to date with boosters at least two weeks in advance of the cruise.
• Washing your hands frequently with soap and water or using hand sanitizer regularly.

Dr. Malka added travelers can also avoid excessive alcohol, eat healthily and get proper sleep to help support their immune system which can decrease their risk of getting sick.

"I would also recommend that cruise travelers follow these same precautions when stopping at different ports throughout the cruise," Dr. Brown said.

Related Articles

• Ethics & Leadership
• Fact-Checking
• Media Literacy
• The Craig Newmark Center
• Reporting & Editing
• Ethics & Trust
• Tech & Tools
• Business & Work
• Educators & Students
• Training Catalog
• Custom Teaching
• For ACES Members
• All Categories
• Broadcast & Visual Journalism
• Fact-Checking & Media Literacy
• In-newsroom
• Memphis, Tenn.
• Minneapolis, Minn.
• St. Petersburg, Fla.
• Washington, D.C.
• Poynter ACES Introductory Certificate in Editing
• Poynter ACES Intermediate Certificate in Editing
• Ethics & Trust Articles
• Get Ethics Advice
• Fact-Checking Articles
• International Fact-Checking Day
• Teen Fact-Checking Network
• International
• Media Literacy Training
• MediaWise Resources
• Ambassadors
• MediaWise in the News

Support responsible news and fact-based information today!

• Newsletters

The CDC ends COVID reporting on cruise ships. Is this good for public health?

Plus, the who warns of rising covid hospitalizations, ba.2.75 is on the way, monkeypox may be declared a ‘global health emergency,’ and more..

Cruise ship companies are thrilled that the Centers for Disease Control and Prevention ended its COVID-19 monitoring program that tracked how many COVID-19 cases were reported ship-by-ship. On Monday, the constantly updated spreadsheet was gone without a trace, replaced with this notice:

It is hard to make sense of why the CDC would pull back from a detailed monitoring program just as COVID-19 cases are again rising worldwide . (The World Health Organization says cases in Europe have tripled in the last six weeks, and hospitalizations have doubled.)

When the site took down the monitoring page, 93 of the 95 ships reporting to the CDC system had enough COVID-19 cases among passengers and crew to be “under observation” by the CDC. You can see a cached version of the CDC cruise ship monitoring page from July 18 here . Here is a screenshot of that cached dashboard, which shows almost all of the ships reporting COVID-19 data were under observation:

The CDC’s cruise ship status dashboard on July 18, 2022. (CDC)

This is what those colors used to mean:

Cruise lines will report COVID-19 data to the CDC, but the CDC won’t pass that information along to you. Instead, the CDC says, passengers “have the option of contacting their cruise line directly regarding outbreaks occurring on board their ship.” In other words, the CDC will still have the data that could allow the public to see the COVID-19 levels on each ship, but it is up to you now to call the cruise line and ask for it.

The CDC website says the now-closed system “depended upon each cruise line having the same COVID-19 screening testing standards, which may now vary among cruise lines.”

CDC spokesperson Kristen Nordlund emailed an explanation to The Washington Post :

CDC has determined that the cruise industry has access to the necessary tools (e.g., cruise-specific recommendations and guidance, vaccinations, testing instruments, treatment modalities, and non-pharmaceutical interventions) to prevent and mitigate COVID-19 on board.

Cruise lines generally require adult passengers to be vaccinated and provide a recent negative COVID-19 test before boarding. Cruise lines have varied requirements for children.

Andy Bloch, who is a master at turning data into charts, posted this . I link to his Twitter post and his exhaustive charts with one caveat: Even the highest COVID-19 numbers on the ships are still not as high as you will find in some counties and countries.

Yesterday, the CDC ended its opt-in “COVID-19 Program for Cruise Ships” that tracked COVID-19 tests and cases. https://t.co/6Zmvug9xdr They updated the data one last time last night. I’ve been extracting the data and decided to publish it here: https://t.co/hWkL5EXOKy pic.twitter.com/SNDYX4v87G — Andy Bloch (@Andy_Bloch) July 19, 2022

With no pesky COVID-19 data to plant doubts in people’s minds, cruise ship stocks rose fast on Tuesday.

The cruise industry argued that the CDC kept ships under scrutiny that far exceeded any monitoring for concert halls, hotels or convention centers. Earlier this year, the CDC made the reporting program voluntary. But, of course, a key difference is that people don’t live in concert halls for days and go home if they notice sick or reckless people around them.

The CDC’s decision to take down the cruise ship monitoring page also comes just as a new book called “Cabin Fever” by Michael Smith and Jonathan Franklin goes public . It tells the nightmare story of 1,200 passengers and 600 crew stuck on the MS Zaandam when COVID-19 spread through the ship like wildfire during the first weeks of the pandemic’s rage.

WHO warns of COVID hospitalizations rising now, worse to come in a few months

The World Health Organization is warning that the newest variants of omicron are “super infectious” and that COVID-19 hospitalizations, which have doubled across Europe in the last few weeks, will grow worse soon.

Look at these increases from the WHO’s COVID-19 dashboard:

The Associated Press reports :

WHO’s Europe director, Dr. Hans Kluge, described COVID-19 as “a nasty and potentially deadly illness” that people should not underestimate. He said super-infectious relatives of the omicron variant were driving new waves of disease across the continent and that repeat infections could potentially lead to long COVID. “With rising cases, we’re also seeing a rise in hospitalizations, which are only set to increase further in the autumn and winter months,” Kluge said. “This forecast presents a huge challenge to the health workforce in country after country, already under enormous pressure dealing with unrelenting crises since 2020.” Earlier this week, editors of two British medical journals said the country’s National Health Service has never before had so many parts of the system so close to collapsing. Kamran Abbasi, of the BMJ and Alastair McLellan of the Health Service Journal wrote in a joint editorial that the U.K. government was failing to address persistent problems worsened by COVID, including ambulances lining up outside hospitals too overloaded to accept new patients.

We barely understand BA.5 and now BA.2.75 is on the way

A coronavirus variant called BA.5 is now the dominant vaccine-escaping COVID-19 variant to infect people in America. But already, the WHO is tracking what could be the next problem: BA.2.75.

The variant has shown up in 15 countries and is on the move . It has been detected in seven U.S. states, including Washington, California, Illinois, New York, North Carolina, Texas and Wisconsin.

The newest variant has gained the unofficial name “Centaurus,” after a Twitter user got the notion that the endless string variants that contain numbers and not a name are not being taken seriously enough.

Keep in mind that every person who gets infected with COVID-19 becomes a host, a potential incubator for the virus to morph again. So, the danger is not just that COVID-19 will make a person sick or cause long-COVID, but that every new case is a potential birthplace for a new threat.

WHO decides tomorrow if monkeypox is a ‘global health emergency’

At last count, 63 countries had reported 9,200 cases of monkeypox , and the number is growing fast. Now the WHO will hear the latest data and decide whether to declare the outbreak a “global health emergency.” That is the highest alarm that the WHO can sound about a health crisis.

The WHO says most infections have been reported in men of young age who have sex with men. Most of the cases are in or near big cities.

France24 reports :

The normal initial symptoms of monkeypox include a high fever, swollen lymph nodes and a blistery chickenpox-like rash. But the report said that in this outbreak, many cases were not presenting with the classically-described clinical picture. Among the cases who reported at least one symptom, 81 percent presented with a widespread rash on the body, 50 percent presented with fever and 41 percent presented with genital rash.

The WHO says :

Monkeypox is usually considered mild and most people recover within a few weeks without treatment. However, the disease is frequently uncomfortable or painful, and can sometimes lead to complications that require close medical follow-up.

The CDC’s latest state-by-state monkeypox case count shows 1,814 cases , which means cases are increasing by a few hundred daily.

The science behind ice cream headaches

Children sitting in a car in Prayagraj, in the northern Indian state of Uttar Pradesh, eat ice cream on Wednesday, April 13, 2022. (AP Photo/Rajesh Kumar Singh)

Ice cream and popsicles definitely are part of the treatment plan to cure summertime overheating. But when it is as hot as it is now, some of us ravage through our frozen treats to keep them from melting … and then the ice cream headache sets in.

There is a quick cure. But first you have to know what causes ice cream headaches.

Ice cream headaches have a couple of fancier names: cold-stimulus headaches or trigeminal headaches. They are “thought to be caused” by the cold treat touching the roof of your mouth and constricting the blood vessels in the palate. I say “thought to be caused” because there is still a bit of mystery behind them.

Here is the clinical explanation of how brain freezes happen from the University of Melbourne :

When a part of the body gets really cold, the blood vessels in that area will tend to constrict. This is called vasoconstriction , and it minimizes the amount of blood that can flow through that area and be cooled down. You might notice your fingers or toes going pale when you’re out in the cold, and this is exactly why! On the other hand, when your body gets too warm, blood vessels expand to allow more blood to pass through. When the blood vessels near the skin expand, this allows heat to be released and the body to cool down. This is why people can get flushed or red-faced after being in a warm room or exercising . So, when a really cold substance hits the roof of your mouth or the back of your throat, it causes a rapid change of temperature there. And it just so happens that at this location we find the juncture of two very important blood vessels: the internal carotid artery (which is responsible for supplying blood to the inside of the brain), and the anterior cerebral artery (which travels along the front of your brain and sits right on top of the brain tissue) When these arteries are hit with the sudden chill of your rapidly consumed ice cream, they constrict very quickly. The body then compensates for this rapid constriction by sending a bunch of blood there to try warm them back up. This causes them to widen. Scientists think it is this contracting and expanding that triggers pain sensors and creates the sensation of pain.

The Cleveland Clinic advises you to bring the temperature in your mouth back to normal to relieve a brain freeze. But a room temperature drink works best; not something too hot or cold that will just cause more blood vessel reaction. The other treatment, Cleveland Clinic says, is to “try pressing your thumb or tongue against the roof of your mouth.”

By the way, people who suffer migraines may be more likely to have ice cream headaches. There is also some evidence that cold stimulus headaches can touch off a migraine.

Johns Hopkins researchers say one of the unknowns about ice cream headaches is why the pain is not felt in the mouth so much as other parts of the head and face:

The pain, through a quirk of our anatomy, is not felt so much in the mouth as it is “referred” to other areas of the face — behind the eyes and nose, in the forehead or elsewhere.

So, you learned another phrase today, “referred pain.”

We’ll be back tomorrow with a new edition of Covering COVID-19. Are you subscribed? Sign up here  to get it delivered right to your inbox.

Opinion | Press Forward open call puts underrepresented communities first

Push focuses on bridging significant gaps in local news coverage

Shut Out: A guide to help the owner — the public — have access to open records

Part Two of a report from a Poynter ethics symposium explores increasing public records denials and how journalists can push back

Opinion | Right-wing network retracts story involving Donald Trump-Stormy Daniels affair

The OAN story said it was Michael Cohen, not the ex-president, who had an affair with the porn star. Cohen settled for an apology.

No, President Biden was not ignored by people at a Pittsburgh-area gas station

Fox News host Sean Hannity said in.a Facebook post that Biden got the cold shoulder from customers and workers at a Sheetz location

Shut Out: When sources won’t engage with journalists

Part One of a report from a Poynter ethics symposium explores dynamic of more sources refusing to engage with the press

Start your day informed and inspired.

Get the Poynter newsletter that's right for you.

You are using an outdated browser. Upgrade your browser today or install Google Chrome Frame to better experience this site.

• 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

Bibliography

Hill CD. Cruise ship travel. In: Keystone JS, Kozarsky PE, Connor BA, Nothdurft HD, Mendelson M, editors. Travel medicine, 4th edition. Philadelphia: Saunders Elsevier; 2019. pp. 377–82. 

Jenkins KA, Vaughan GHJ, Rodriguez LO, Freeland AL. Acute gastroenteritis on cruise ships—United States, 2006–2019. MMWR Morb Mortal Wkly Rep. 2021;70(6):1–19. 

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.

File Formats Help:

• Adobe PDF file
• Microsoft PowerPoint file
• Microsoft Word file
• Microsoft Excel file
• Audio/Video file
• Apple Quicktime file
• RealPlayer file
• Zip Archive file

Exit Notification / Disclaimer Policy

• The Centers for Disease Control and Prevention (CDC) cannot attest to the accuracy of a non-federal website.
• Linking to a non-federal website does not constitute an endorsement by CDC or any of its employees of the sponsors or the information and products presented on the website.
• You will be subject to the destination website's privacy policy when you follow the link.
• CDC is not responsible for Section 508 compliance (accessibility) on other federal or private website.

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

• View all journals
• Explore content
• About the journal
• Publish with us
• Sign up for alerts
• 26 March 2020

What the cruise-ship outbreaks reveal about COVID-19

• Smriti Mallapaty

You can also search for this author in PubMed   Google Scholar

When COVID-19 was detected among passengers on the cruise ship Diamond Princess , the vessel offered a rare opportunity to understand features of the new coronavirus that are hard to investigate in the wider population. Some of the first studies from the ship — where some 700 people were infected — have revealed how easily the virus spreads, provided estimates of the disease’s severity and allowed researchers to investigate the share of infections with no symptoms.

Access options

Access Nature and 54 other Nature Portfolio journals

Get Nature+, our best-value online-access subscription

24,99 € / 30 days

cancel any time

Subscribe to this journal

Receive 51 print issues and online access

185,98 € per year

only 3,65 € per issue

Rent or buy this article

Prices vary by article type

Prices may be subject to local taxes which are calculated during checkout

Nature 580 , 18 (2020)

doi: https://doi.org/10.1038/d41586-020-00885-w

Mizumoto, K., Kagaya, K., Zarebski, A. & Chowell, G. Euro Surveill . 25 , 2000180 (2020).

Article   Google Scholar  

Russell, T. W. et al. Preprint at medRxiv https://doi.org/10.1101/2020.03.05.20031773 (2020).

Mizumoto, K. & Chowell, G. Infect. Dis. Model. 5 , 264–270 (2020).

Article   PubMed   Google Scholar  

Download references

Reprints and permissions

Related Articles

Bird flu virus has been spreading in US cows for months, RNA reveals

News 27 APR 24

Bird flu in US cows: is the milk supply safe?

News Explainer 25 APR 24

WHO redefines airborne transmission: what does that mean for future pandemics?

News 24 APR 24

Video: Cancer-busting vaccines

Outline 27 MAR 24

Cancer-vaccine trials give reasons for optimism

How does a cancer vaccine work?

Bacteria deploy umbrella toxins against their competitors

News & Views 17 APR 24

Associate or Senior Editor, Communications Medicine

Job Title: Associate or Senior Editor, Communications Medicine Location: Philadelphia, New York, Jersey City, Washington DC (Hybrid Working) Closin...

Jersey City, New Jersey

Springer Nature Ltd

Associate or Senior Editor, BMC Psychology and BMC Psychiatry

Job Title: Associate Editor or Senior Editor, BMC Psychology and BMC Psychiatry Location(s): New York or Shanghai  Deadline: May 21st, 2024   You w...

New York (US)

W2 Professorship with tenure track to W3 in Animal Husbandry (f/m/d)

The Faculty of Agricultural Sciences at the University of Göttingen invites applications for a temporary professorship with civil servant status (g...

Göttingen (Stadt), Niedersachsen (DE)

Georg-August-Universität Göttingen

W1 professorship for „Tissue Aspects of Immunity and Inflammation“

Kiel University (CAU) and the University of Lübeck (UzL) are striving to increase the proportion of qualified female scientists in research and tea...

University of Luebeck

W1 professorship for "Bioinformatics and artificial intelligence that preserve privacy"

Kiel, Schleswig-Holstein (DE)

Universität Kiel - Medizinische Fakultät

Sign up for the Nature Briefing newsletter — what matters in science, free to your inbox daily.

Quick links

• Explore articles by subject
• Guide to authors
• Editorial policies

• Skip to main content
• Keyboard shortcuts for audio player

People are vacationing again on cruise ships following a COVID-19 decline

People are cruising again on big ships following a COVID-19 decline, but it's a tough comeback for the industry.

Copyright © 2023 NPR. All rights reserved. Visit our website terms of use and permissions pages at www.npr.org for further information.

NPR transcripts are created on a rush deadline by an NPR contractor. This text may not be in its final form and may be updated or revised in the future. Accuracy and availability may vary. The authoritative record of NPR’s programming is the audio record.

Norovirus: Nearly 200 sick in outbreaks on Princess, Royal Caribbean ships, CDC says

FILE - Tourists crowd upper decks and stateroom balconies as the Anthem of the Seas owned by Royal Caribbean International on Aug. 9, 2023, in Lisbon, Portugal. (Photo by Horacio Villalobos#Corbis/Corbis via Getty Images)

Nearly 200 passengers on U.S. cruise ships suffered from diarrhea and vomiting in norovirus outbreaks in April, according to the U.S. Centers for Disease Control and Prevention.

The CDC reported that 94 of the 2,532 (3.71%) passengers on Princess Cruises’ Sapphire Princess ship reported getting sick during its current voyage. The 32-day, roundtrip cruise began on April 5 and ends on May 7, according to the cruise tracking and information site CruiseMapper . 

Another 20 of the 1,066 crew members on board also reported getting sick, the CDC said.

Cruise ship rescued 14 stranded at sea for over a week

This was the scene from the lunch buffet during the first full day of cruising for the Icon of the Seas. The crew rescued all 14 from the distressed boat which was dwarfed by the largest cruise ship in the world.

On Royal Caribbean’s Radiance of the Seas ship, 67 of the 1,993 (3.36%) total passengers on board became ill during a voyage that began on April 8 and ended on April 22, according to the agency. Two crew members aboard also got sick. 

In both of the norovirus outbreaks, the main symptoms were diarrhea and vomiting, the CDC said.

Princess Cruises told FOX Television Stations that "at the first sign" of an increase in passengers reporting gastrointestinal illnesses, "we immediately initiated additional enhanced sanitization procedures to interrupt the person-to-person spread of this virus."

"Our sanitization program, includes disinfection measures, isolation of ill passengers and communication to passengers about steps they can take to stay well while onboard," the company told FOX Television Stations.

Royal Caribbean International did not immediately return a request for comment, but the CDC said in its notice that the company also took several steps in response to the outbreak – including isolating the sick passengers and crew members and "increased cleaning and disinfection procedures." 

RELATED: 'Vampire facials' at unlicensed spa likely resulted in HIV infections: CDC

Cruise ships expose passengers to high volumes of people and new environments, which can "create the risk for illness from contaminated food, or water or, more commonly, through person-to-person contact," the CDC says. 

The agency recommends that anyone feeling sick should report their illness. If it happens before the voyage, travelers can ask their cruise line about any possible alternative cruising options. 

Those on board should wash their hands often to prevent illness, as well as get plenty of rest and stay hydrated. 

This story was reported from Cincinnati.

• Updated Terms of Use
• New Privacy Policy
• Your Privacy Choices
• Closed Captioning Policy

Quotes displayed in real-time or delayed by at least 15 minutes. Market data provided by  Factset . Powered and implemented by  FactSet Digital Solutions .  Legal Statement .

This material may not be published, broadcast, rewritten, or redistributed. ©2024 FOX News Network, LLC. All rights reserved. FAQ - New Privacy Policy

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.

FOX Business Flash top headlines for April 29

Check out what's clicking on FoxBusiness.com

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.

Cruises Still Sailing Despite COVID Outbreaks

While the Omicron variant spreads, COVID-19 is not sparing cruise ships. 

The CDC lists nearly 90 ships that are under observation or investigation, including major cruise lines. 

But on a sunny Wednesday afternoon, passengers set for sail on a Royal Caribbean cruise out of Tampa. 

"When I’m seeing the number of people that kind of got on the ship I'm nervous but they said that everybody has to be double vaccinated and the boosters so we were comfortable about that," said Maissa King before boarding. 

"You gotta enjoy life, you can't hide away in a house all the time, you have to at least try," John Lunshof said. 

The CDC is also monitoring four other ships. The threshold for an investigation includes cases in at least 0.10% of passengers or in at least one crew member. 

Britany and Raymond Kelly said they looked forward to a vacation over Christmas with their daughter on a Royal Caribbean cruise out of Miami. 

"Kind of like a mixture between a comedy movie and a horror movie," Raymond Kelly said of their experience.

The Kelly’s said Britany first tested positive while on board the cruise. While Raymond and their daughter tested negative initially, they said the next day Raymond also tested positive. 

"It seemed like they didn't want to test me or my daughter again because they didn’t want another positive case on board," he said. 

They describe confusion with what tests to take before boarding, and later, frustration with the service and care they received after they said they tested positive on the ship and isolated in a hotel. 

"I'm just disappointed they were not prepared for the what if. I was honestly impressed with them like cleaning the boat and stuff but they didn't think it all the way through," said Britany Kelly. 

Royal Caribbean had not yet responded to Newsy's request for comment at the time of publication, but tells customers on its web site. "An inherent risk of exposure to COVID-19 exists in any public place where people gather." 

The cases come as the Omicron variant spreads. Some public health officials say some data shows it appears the variant may be less severe. 

But when it comes to next steps, Senator Richard Blumenthal called for a pause. He tweeted in part, "Cruises are repeating recent history as Petri dishes of COVID infection." 

"The numbers are a much higher average today than they were even a month ago," said James Walker.

Walker is an attorney who represents passengers and crew members against cruise lines and runs the blog Cruise Law News. 

"If you're gonna go on a cruise prepare for there to be a disruption. Prepare yourself for the possibility the port communities won’t let whatever cruise ship you're on stop in your jurisdiction," said Walker.

This week the Mexican government announced it would allow ships with cases to dock. 

Cruise lines have pointed to the protocols they've implemented to mitigate the spread of the virus.

"We are working closely with the CDC and local health authorities in all ports and destinations that we visit. The rapid spread of the Omicron Variant may shape how some destination authorities view even a small number of cases, even when they are being managed with our vigorous protocols. Some destinations have limited medical resources and are focused on managing their own local response to the variant. Should it be necessary to cancel a port, we will do our best to find an alternative destination," said AnneMarie Mathews, the senior director for communications for Carnival Cruise line, in part in a statement. 

"Whenever we experience a positive case on board, we immediately enact a series of proven protocols, including quarantine, contact tracing and PCR testing to identify, isolate and mitigate any further transmission. That said, largely in part to our vaccination policy and thorough embarkation procedures, we've been able to detect any possible positive cases prior to boarding and ensure those folks are well taken care of. As we continue to navigate the challenges we’re collectively facing in the fight against COVID-19, we are confident in our health and safety measures and will continue them moving forward," a Virgin Voyages spokesperson stated. 

The Cruise Lines International Association said cases in recent weeks make up a slim percentage of total population on board. 

"No setting is immune from the impacts of COVID-19. The difference with cruise ships is that our members have measures in place that were designed specifically for moments like this, and those measures continue to prove effective to mitigate COVID-19 amongst cruise passengers, crewmembers, and communities," said Bari Golin-Blaugrund, Vice President of Strategic Communications and Public Affairs.

When it comes to future cruises, people are still booking. 

"We're seeing the demand especially. It was very strong until beginning of December, then when Omicron came out things slowed down. But we are seeing after February, we're still seeing strong traction on bookings," said Bob Cook, the director of sales with Go Travel.

The CDC notes "cruising will always pose some risk of COVID-19 transmission."

Most Recent

Metro train collides with bus in downtown Los Angeles, injuring more than 50, 2 seriously

Judges reject map for new majority-Black House district in Louisiana

Bumble won't require women to make the first move on its app anymore

Vaping exposes users to toxic metals like lead and uranium, study says 

The EPA finalizes ban on paint-stripping chemical

CDC: 46 million Americans in rural areas more likely to die from leading causes of death

Watch Scripps News

Guidance for Cruise Ships on Management of Acute Respiratory Illness (ARI) due to Viral Infection

CDC Respiratory Virus Guidance has been updated. The content of this page will be updated soon.

Describing and Defining Passengers and Crew with Acute Viral Respiratory Illness (ARI)

Reducing the spread of viral respiratory infections, vaccination of crew and passengers, managing passengers or crew with ari upon disembarkation, medical evaluation and management, diagnostic tests for acute viral respiratory illness (ari), respiratory and hand hygiene, outbreak control, infection prevention and control.

• Additional Resources

Attribution Statement

Outbreaks of influenza, COVID-19, r espiratory syncytial virus (RSV) , and other viral respiratory infections can occur at any time of the year among cruise ship passengers and crew members. Many cruise ship travelers are older adults or have underlying medical conditions that put them at increased risk of complications from these respiratory virus infections. Early detection, prevention, and control of such acute viral respiratory infections are important, not only to protect the health of passengers and crew members on cruise ships, but also to avoid spread of these viruses into communities.

This document provides guidance for cruise ships originating from or stopping in the United States to help prevent, diagnose, and medically manage acute respiratory illness (ARI) caused by SARS-CoV-2 (the virus that causes COVID-19), influenza virus, or RSV. This guidance to cruise ship clinics will be updated as needed. CDC recognizes that cruise ships travel worldwide, necessitating awareness of, and responsiveness to, local jurisdictional requirements. Cruise ship management and medical staff need to be flexible in identifying and caring for people with ARI. The healthcare provider’s assessment of a patient’s clinical presentation and underlying risk factors is always an essential part of decisions about the need for further medical evaluation, testing, and treatment.

This document also provides guidance for preventing spread of ARI during and after a voyage, including personal protective measures for passengers and crew members and control of outbreaks.

Signs and symptoms of ARIs can include acute onset of some or all of the following:

• fever or feeling feverish
• nasal congestion
• sore throat
• shortness of breath
• difficulty breathing
• muscle or body aches
• fatigue (tiredness)
• loss of taste or smell

For cruise ship surveillance purposes, CDC defines ARI as an illness of presumed viral etiology with at least two of the following symptoms : fever/feverishness, cough, runny nose, nasal congestion, or sore throat and excluding:

• Confirmed acute respiratory infection diagnoses other than COVID-19 [1] , influenza [2] , or RSV [3] (e.g., Streptococcal pharyngitis, Epstein-Barr virus infection), *
• Diagnoses of bacterial pneumonia: either clinical or test-positive (e.g., by urine Legionella antigen, urine Streptococcus pneumoniae antigen), and
• Non-infectious conditions as determined by the ship’s physician (e.g., allergies)

Fever (a temperature of 100°F [37.8°C] or higher) will not always be present in people with influenza, COVID-19, or RSV. Cruise ship medical personnel should consider someone as having a fever if the sick person feels warm to the touch, gives a history of feeling feverish, or has an actual measured temperature of 100°F (37.8°C) or higher.

*Other respiratory viruses—for which point-of-care diagnostic tests are not available—may also cause ARI (e.g., rhinovirus, adenovirus, enterovirus, human parainfluenza viruses, human metapneumoviruses).

[1] Confirmed COVID-19 means laboratory confirmation for SARS-CoV-2, the virus that causes COVID-19, by viral test.

[2] Confirmed influenza means laboratory confirmation for influenza A or B by viral test.

[3] Confirmed RSV means laboratory confirmation for RSV by viral test.

Commercial maritime travel is characterized by the movement of large numbers of people in enclosed and semi-enclosed settings. Like other close-contact environments, these settings can facilitate the transmission of respiratory viruses from person to person through droplets and small particles or potentially through contact with contaminated surfaces.

CDC recommends that efforts to reduce the spread of respiratory viruses on cruise ships focus on encouraging crew members and passengers:

• 6 months and older to get vaccinated annually for influenza
• 6 months and older to stay up to date with their COVID-19 vaccines
• who are 60 years and above  to discuss and consider RSV vaccination  with their healthcare provider
• To follow recommendations for babies and young children  and if applicable, to receive monoclonal antibody products to prevent severe RSV
• To avoid contact with ill people prior to scheduled cruising
• To postpone travel if sick with an acute respiratory illness (passengers)
• To take steps to protect themselves and others while traveling
• To consider wearing a mask  in crowded or poorly ventilated indoor areas.

Cruise ship management should include:

• Encouraging good respiratory hygiene and cough etiquette
• Early identification and isolation of crew members and passengers with ARI
• Use of antiviral medications for treatment of people with suspected or confirmed influenza or COVID-19 with severe or complicated illness, or at increased risk of severe illness or complications
• Use of antiviral chemoprophylaxis for post-exposure prophylaxis (PEP) or during influenza outbreaks, if indicated, for people at increased risk of complications

All passengers and crew are also recommended to be up to date with all routine vaccines .

Influenza : CDC recommends that all people 6 months of age and older be vaccinated each year with the influenza vaccine. Crew members should be vaccinated yearly. Vaccination of passengers, especially those at high risk for influenza complications, is recommended at least 2 weeks before cruise ship travel, if influenza vaccine is available and the person has not already been vaccinated with the current year’s vaccine. For more information on influenza vaccine recommendations, see Seasonal Influenza Vaccination Resources for Health Professionals .

COVID-19: CDC recommends that all people 6 months of age and older be up to date with their COVID-19 vaccines. In addition to the protection COVID-19 vaccines provide to individual travelers in preventing severe illness or death from COVID-19, having a high proportion of travelers on board who are up to date with COVID-19 vaccines reduces the likelihood that cruise ships’ medical centers will be overwhelmed by cases of COVID-19. For more information on COVID-19 vaccine recommendations, see COVID-19 Vaccination Clinical and Professional Resources .

RSV : CDC recommends adult travelers ages 60 years and older discuss RSV vaccination with their healthcare provider prior to cruise travel. These new vaccines—which are the first ones licensed in the U.S. to protect against RSV—have been available since the fall of 2023. Babies and young children should follow recommendations and if applicable, receive monoclonal antibody products to prevent severe RSV. For more information, see For Healthcare Professionals: RSV (Respiratory Syncytial Virus) .

Pre-embarkation COVID-19 Testing

To reduce the likelihood of onboard transmission of SARS-CoV-2, pre-embarkation testing is recommended for all passengers, including those on back-to-back sailings [4] . Completion of testing closer to the time of embarkation (within 1 to 2 days) maximizes the benefit of preventing introduction of infectious persons onboard. Ships that choose to use COVID-19 antigen tests should follow FDA guidance .

[4] Back-to-back sailing refers to passengers who stay on board for two or more voyages.

Viral ARI Screening Procedures for Embarking Passengers

Cruise ship operators should consider screening embarking passengers for viral ARI symptoms, a history of a positive COVID-19 viral test within the 10 days before embarkation, and a history of exposure to a person with COVID-19 within the 10 days before embarkation.

Cruise ship operators should consider performing viral testing (e.g., COVID-19, influenza, RSV) for passengers with ARI before they embark. Ships that choose to use COVID-19 antigen tests should follow FDA guidance .

Cruise ship operators should consider denying boarding for passengers who test positive for infectious viral etiologies during pre-embarkation screening, as well as those who tested positive for COVID-19 within 10 days before embarkation. If boarding is permitted, see guidance for isolation and other measures provided below .

If the cruise ship operator chooses to test for other infectious etiologies and testing identifies an alternate etiology (e.g., Legionella , Epstein-Barr virus, Streptococcal pharyngitis) through laboratory testing, routine infection control precautions specific to the diagnosis should be followed.

For asymptomatic passengers who have a known COVID-19 close-contact exposure within the 10 days before embarkation, considerations for allowing boarding can include:

• being up to date with COVID-19 vaccines,
• having a negative result on a COVID-19 viral test conducted on the day of boarding, or
• having documentation of recent recovery [5]  from COVID-19

People who are up to date with COVID-19 vaccines are less likely to have severe outcomes if they develop COVID-19 after boarding. Testing is generally not recommended for asymptomatic people who recovered from COVID-19 in the past 30 days. If exposed passengers are allowed to board, see information below regarding recommendations for management onboard .

[5] Documentation of recent recovery from COVID-19 can include the following:

• Paper or electronic copies (including documentation of at-home antigen results) of their previous positive viral test result dated no less than 10 days and no more than 30 days before date of embarkation
• A positive test result dated less than 10 days before embarkation accompanied by a signed letter from a licensed healthcare provider indicating symptom onset more than 10 days before the voyage

Managing Cruise Travelers with ARI and Contacts while on Board

Travelers with ARI who board, as well as those who become sick with ARI onboard, should be identified and tested as soon as possible to minimize transmission of respiratory viruses. The table below provides disease-specific recommendations for persons on board with COVID-19, influenza, or RSV and those exposed (i.e., contacts).

§ The day of last exposure to a case is counted as day 0. Additional testing prior to day 6 can identify new cases earlier. Cruise ship operators may consider this strategy in situations where exposures may have occurred in crowded settings, if unsure of the date of exposure, or if there is difficulty identifying index cases, as often occurs in the cruise ship environment.

^ Individual should properly wear a respirator or well-fitting mask  at all times when outside of cabin indoors until 10 days after the last close contact with someone with COVID-19 (the date of last exposure to a case is considered day 0). During this time, these individuals should have in-cabin dining (with food trays placed and collected outside of cabins) and also wear a respirator or well-fitting mask inside their cabin if any other person (such as a crew cleaning staff) enters the cabin.

† Contacts with high risk of influenza complications should be identified in order to offer post-exposure prophylaxis (PEP)

Crew members with ARI, even if mild, should take the following additional steps—regardless of their COVID-19, influenza, or RSV vaccination status:

• Notify their supervisors.
• Report to the medical center for evaluation and testing, if indicated, according to shipboard protocols.
• Continue to practice respiratory hygiene, cough etiquette, and hand hygiene after returning to work, because respiratory viruses may be shed after the isolation period ends.

Disembarking cruise ship passengers or crew members who have ARI should continue to take recommended precautions after disembarkation. If a passenger or crew member with viral ARI is taken to a healthcare facility off the ship, the facility should be informed before arrival. Medical transport providers should also be notified in advance.

Medical centers on cruise ships can vary widely depending on ship size, itinerary, length of cruise, and passenger demographics.

• Cruise ship medical centers are recommended to follow the operational guidelines  published by the American College of Emergency Physicians (ACEP) as well as disease-specific clinical guidelines (see links provided at the bottom of this section).
• PPE should include surgical masks and NIOSH Approved® N95® filtering facepiece respirators or higher, eye protection such as goggles or disposable face shields that cover the front and sides of the face, and disposable medical gloves and gowns.
• Antiviral agents and other therapeutics for COVID-19 , influenza , and RSV (if commercially available), and other antimicrobial medications
• Antipyretics (e.g., acetaminophen and ibuprofen), oral and intravenous steroids, supplemental oxygen
• Onboard capacity to conduct viral tests for SARS-CoV-2 and influenza, and RSV, as well as other infections that may be in the differential diagnosis (e.g., group A Streptococcus , Streptococcus pneumoniae, Legionella )
• Medical center staff should adhere to standard and transmission-based precautions when healthcare personnel are caring for patients with suspected or confirmed COVID-19, influenza, RSV, or other communicable diseases.

For more information, read updated resources for clinicians and guidance on the medical evaluation and management of people with COVID-19 , influenza , or RSV  are available on CDC’s websites.

Respiratory specimens for ARI testing should be collected immediately upon illness onset, with the understanding that repeat testing may be indicated based on the viral etiology or state of the COVID-19 pandemic. In general, molecular tests are recommended over antigen tests because of their greater sensitivity; multiplex assays are available that can detect SARS-CoV-2, influenza A and B, and RSV.

Healthcare providers should understand the advantages and limitations of rapid diagnostic tests, and proper interpretation of negative results of any antigen diagnostic tests. Rapid antigen diagnostic tests have a lower sensitivity compared with RT-PCR, and false negative results can occur frequently. In symptomatic persons, negative rapid antigen diagnostic test results do not exclude a diagnosis of COVID-19, influenza, or RSV; clinical diagnosis of these illnesses should be considered; however, positive test results are useful to establish a viral etiology and to provide evidence of infection in passengers and crew members aboard ships.

People with ARI should be advised of the importance of covering coughs and sneezes and keeping hands clean because respiratory viruses may be shed after the isolation period ends.

Cruise operators should ensure passengers and crew have access to well-stocked hygiene stations with soap and water and/or hand sanitizer, tissues, paper towels, and trash receptacles.

Respirators or well-fitting masks should be readily available and symptomatic passengers and crew should be encouraged to use them if they have to be outside their cabins.

Passengers and crew members should be reminded to wash their hands often with soap and water, especially after coughing or sneezing. If soap and water are not available, they can use an alcohol-based hand sanitizer that contains at least 60% alcohol.

Used tissues should be disposed of immediately in a disposable container (e.g., plastic bag) or a washable trash can.

For more information on respiratory hygiene, see Coughing and Sneezing .

A combination of measures can be implemented to control ARI outbreaks, including isolation of infected people, increased infection prevention and control efforts, antiviral chemoprophylaxis of influenza-exposed people, crew member and passenger notifications, and active surveillance for new cases.

Recommendations when a voyage’s crew or passenger ARI attack rate reaches 2% ‡

• Provide all crew members with respirators or well-fitting masks and provide crew with information on how to properly wear, take off , and clean (if reusable)
• Minimize the number of crew members sharing a cabin or bathroom to the extent possible.
• Instruct crew members to remain in cabins as much as possible during non-working hours.
• Cancel nonessential face-to-face employee meetings as well as group events (such as employee trainings) and social gatherings.
• Close all crew bars, gyms, and other group settings.
• Close indoor crew smoking areas.
• Maximize the introduction of outdoor air and adjust HVAC systems to increase total airflow to occupied spaces. For additional information on ventilation, see Ventilation in Buildings
• Maximize air circulation in crew outdoor smoking areas.
• Expedite contact tracing (including the use of wearable technology, recall surveys, and the onboarding of additional public health staff).
• Consider serial viral (antigen or NAAT) screening testing of crew every 3–5 days. The onboarding of additional laboratorians may be needed to facilitate the testing process.
• If an influenza outbreak, antiviral chemoprophylaxis  can be considered for prevention of influenza in exposed people depending on their risk for complications, or could be given to all contacts on a cruise ship when the threshold is met or exceeded.

Recommendations when a voyage’s crew or passenger ARI attack rate reaches 3% ‡

• Provide all passengers with respirators or well-fitting masks and provide crew with information on how to properly wear, take off , and clean (if reusable)
• Position posters educating passengers on how to properly wear respirators or well-fitting masks  in high traffic areas throughout the ship.
• Eliminate self-serve dining options at all crew and officer messes.
• Reduce the dining cohort size for crew, and shorten dining times to avoid crowding.
• Send written notification to passengers on the current, previous, and subsequent voyages informing them of the ARI conditions and measures being taken to reduce transmission on board.
• Cancel crew shore leave.
• Implement a “working quarantine” policy for all crew (i.e., crew perform job duties then return to cabin).
• Require use of respirators or well-fitting masks and provide crew with information on how to properly wear, take off , and clean (if reusable)
• Test all passengers for COVID-19 prior to the end of the voyage, regardless of their vaccination status. Advise those who test positive or have known exposure to follow guidance following disembarkation .

‡ Sources of data should include medical center records and other established surveillance systems for passengers and crew (e.g., employee illness reports).

Considerations for Suspending Passenger Operations

In some circumstances, additional public health precautions, such as returning to port immediately or delaying the next voyage, may be considered to help ensure the health and safety of onboard travelers or newly arriving travelers.

A ship should consider suspending operations based on the following factors:

• 15% or more of the passengers have met ARI criteria; or
• 15% or more of the crew have met ARI criteria; or
• 15% or more of total travelers have met ARI criteria. [6]
• Shortages of supplemental oxygen or other medical supplies related to management of patients with ARI, or
• 3 or more deaths due to ARI in passengers and/or crew during a voyage.
• Evaluate symptomatic travelers and their close contacts,
• Conduct diagnostic and screening testing of travelers,
• Conduct routine medical checks of travelers in isolation, or
• Conduct contact tracing of close contacts, if applicable
• Testing equipment,
• Antipyretics (fever-reducing medications such as acetaminophen and ibuprofen),
• Antivirals and other therapeutics for COVID-19, influenza, and RSV (if commercially available),
• Oral and intravenous steroids, or
• Supplemental oxygen
• Inadequate onboard capacity to fulfill minimum safe manning or minimal operational services, including but not limited to housekeeping and food and beverage services
• A novel respiratory virus or SARS-CoV-2 variant of concern or a new or emerging SARS-CoV-2 variant with potential for increased severity or transmissibility identified among cases on board

[6] These thresholds are subject to change based on the characteristics of the dominant COVID-19 variant or a novel respiratory virus in the United States or elsewhere.

CDC requests that cruise ships submit a cumulative ARI report (even if no ARI cases have occurred) preferably within 24 hours before arrival in the U.S. [7] , and sooner if a voyage’s crew or passenger ARI attack rate reaches 3% [8] . These reports are requested by completing the Cruise Ship Cumulative Acute Respiratory Illness (ARI) Reporting Form. Access to the online reporting form has been provided to cruise lines by CDC. Cruise lines that do not have access may contact CDC (email [email protected] ).

In addition, CDC emphasizes that any deaths—including those caused by or suspected to be associated with influenza, COVID-19, RSV, or ARI—that occur aboard a cruise ship destined for a US port must be reported to CDC immediately. Report ARI deaths by submitting an individual  Maritime Conveyance Illness or Death Investigation Form [PDF – 4 pages] for each death.

Vessel captains may request assistance from CDC to evaluate or control ARI outbreaks as needed. If the ship will not be arriving imminently at a U.S. seaport, CDC maritime staff will provide guidance to cruise ship officials regarding management and isolation of infected people and recommendations for other passengers and crew members. CDC staff may also help with disease control and containment measures, passenger and crew notification, surveillance activities, communicating with local public health authorities, obtaining and testing laboratory specimens, and provide additional guidance as needed.

[7] For international voyages with >1 U.S. port (e.g., Canada to multiple Alaskan ports), please submit report to CDC within 24 hours before arrival in the final U.S. port.

[8] For international voyages with >15 days prior to arrival in the U.S., the time period for calculating this attack rate begins at day 15 prior to arrival at a U.S. port.

Infection prevention and control (IPC) are critical to reducing the spread of ARI. Each cruise ship should maintain a written  Infection Prevention and Control Plan (IPCP)  that details standard procedures and policies to specifically address infection control and cleaning/disinfection procedures to reduce the spread of ARI.

To reduce the spread of ARI, cruise ship operators should include the following as part of a written IPCP:

• Duties and responsibilities of each department and their staff for all passenger and crew public areas
• A graduated approach for escalating infection prevention and control measures in response to ARI cluster or outbreaks during a voyage with action steps and criteria for implementation
• Procedures for informing passengers and crew members that a threshold of ARI has been met or exceeded, and of any recommended or required measures to prevent spread of infection
• Crew members entering cabins or other areas where people with confirmed or suspected COVID-19 are should be limited, and crew should wear an NIOSH Approved® N95® filtering facepiece respirator or higher in accordance with the Occupational Safety and Health Administration’s (OSHA) Respiratory Protection standard   (29 CFR 1910.134 )
• Disinfectant products or systems used, including the surfaces or items the disinfectants will be applied to, concentrations, and required contact times
• Safety data sheets (SDSs)
• PPE recommendations for crew, which may include surgical masks or NIOSH Approved® N95® filtering facepiece respirators or higher, eye protection such as goggles or disposable face shields that cover the front and sides of the face, and disposable medical gloves and gowns in addition to those recommended by the disinfectant manufacturer in the SDS; for information on health hazards related to disinfectants used against viruses, see Hazard Communication for Disinfectants Used Against Viruses .
• Health and safety procedures to minimize respiratory and dermal exposures to both passengers and crew, when recommended
• Graduated procedures for returning the vessel to normal operating conditions after a threshold of ARI has been met, including de-escalation of cleaning and disinfection protocols

Frequent, routine cleaning and disinfection of commonly touched surfaces with an Environmental Protection Agency (EPA)-registered disinfectant is recommended. For COVID-19, EPA-registered disinfectant  effective against coronaviruses is strongly recommended.

• Isolation and Precautions for People with COVID-19
• COVID-19 Treatments and Medications
• Seasonal Influenza Prevention
• Seasonal Influenza Treatment: What You Need to Know
• Infectious Diseases Society of America guidelines for controlling institutional influenza outbreaks
• Symptoms and Care of RSV (Respiratory Syncytial Virus)
• RSV transmission
• Preventing RSV (Respiratory Syncytial Virus)

N95 and NIOSH Approved are certification marks of the U.S. Department of Health and Human Services (HHS) registered in the United States and several international jurisdictions.

• Importation
• Southern Border Health and Migration
• Travelers' Health
• Vessel Sanitation Program
• Funding and Guidance for State and Local Health Departments
• Emergency Preparedness and Response
• Division of Global Migration Health

Exit Notification / Disclaimer Policy

• The Centers for Disease Control and Prevention (CDC) cannot attest to the accuracy of a non-federal website.
• Linking to a non-federal website does not constitute an endorsement by CDC or any of its employees of the sponsors or the information and products presented on the website.
• You will be subject to the destination website's privacy policy when you follow the link.
• CDC is not responsible for Section 508 compliance (accessibility) on other federal or private website.

Royal Caribbean shares huge onboard health and safety news

W hen you go to a hotel or a theme park and get infected with a virus, you don't know exactly what happened. Maybe you caught the virus at the airport, in a rest stop, on an airplane, or even at your hotel or in a restaurant.

That's generally because by the time you get sick, you're no longer at the place where you got infected. Cruise ships, however, lack the same plausible deniability, and historically viruses spread quickly on ships.

Related: Royal Caribbean bets big on new ships, private destinations

On a seven-day cruise, you might actually have picked up an illness at the supermarket or at work, but when you get sick on the ship, people blame the cruise line. When someone falls ill, cruise lines don't actually care where they got infected. They simply want to slow down the spread of the disease.

That has always been the case, but the Covid pandemic and the Centers for Disease Control (CDC) shutting down the cruise industry from the U.S. for over a year put shipboard illness under a bigger microscope. For months, the federal agency reported on onboard Covid levels and did little to share all of the steps the major cruise lines had taken to mitigate outbreaks.

Now, with Covid becoming less of a concern, Royal Caribbean has shared some big news about its efforts to control another virus, norovirus, which spreads quickly on ships. 

Royal Caribbean has made ships safer

"Norovirus is a very contagious virus that causes vomiting and diarrhea. Anyone can get infected and sick with norovirus. 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," according to the CDC.

The virus can cause problems on cruise ships, but it's actually a pretty rare occurrence.

"Norovirus is the most frequent (over 90%) cause of outbreaks of diarrheal disease on cruise ships and these outbreaks often get media attention, which is why some people call norovirus the 'cruise ship virus.' However, norovirus outbreaks on cruise ships account for only a small percentage (1%) of all reported norovirus outbreaks," the federal agency reported.

You are much more likely to get norovirus in a land-based restaurant or healthcare facility than on a cruise ship, but cruise outbreaks make for good stories and get widespread media attention.

Royal Caribbean began its Norovirus Eradication Campaign in 2023. It's a six-step program that has worked to stop outbreaks on its ships, the Royal Caribbean Blog reported.

Royal Caribbean's plan has worked

Royal Caribbean has enacted a comprehensive plan designed to contain norovirus and prevent its spread.

• Enhanced acute GI training for onboard medical teams and traveling doctors
• Increased doctor oversight of its Outbreak Prevention Plan, which covers requirements like hand washing, buffet oversight, and disinfectant mandates for all public areas aboard its ships.

Switching to PDI SaniCloth Prime hospital-grade disinfectant wipes, wipes certified to kill norovirus by the EPA.

New contactless tap technology, eliminating the need for crew to handle guest cards

Enhanced crew training on what to do when experiencing acute GI symptoms and how to avoid cross-contamination in food and beverage service areas

An update to Royal Caribbean's Safety & Quality Management system to stop self-service in buffets if the onboard norovirus rate exceeds 1.5%

"After the eradication campaign was implemented in June 2023, there was not a single norovirus outbreak onboard any Royal Caribbean International or Celebrity Cruise ship for the remainder of 2023," the report shared.

Celebrity Constellation, however, did have an outbreak in January 2024 that was listed on a CDC website, according to Royal Caribbean Blog.

• Today's news
• Reviews and deals
• Climate change
• 2024 election
• Fall allergies
• Health news
• Mental health
• Sexual health
• Family health
• So mini ways
• Unapologetically
• Buying guides

Entertainment

• How to Watch
• My watchlist
• Stock market
• Biden economy
• Personal finance
• Stocks: most active
• Stocks: gainers
• Stocks: losers
• Trending tickers
• World indices
• US Treasury bonds
• Top mutual funds
• Highest open interest
• Highest implied volatility
• Currency converter
• Basic materials
• Communication services
• Consumer cyclical
• Consumer defensive
• Financial services
• Industrials
• Real estate
• Mutual funds
• Credit cards
• Balance transfer cards
• Cash back cards
• Rewards cards
• Travel cards
• Online checking
• High-yield savings
• Money market
• Home equity loan
• Personal loans
• Student loans
• Options pit
• Fantasy football
• Pro Pick 'Em
• College Pick 'Em
• Fantasy baseball
• Fantasy hockey
• Fantasy basketball
• Download the app
• Daily fantasy
• Scores and schedules
• GameChannel
• World Baseball Classic
• Premier League
• CONCACAF League
• Champions League
• Motorsports
• Horse racing
• Newsletters

New on Yahoo

• Privacy Dashboard

More than 150 passengers fell sick following norovirus outbreaks on US cruise ships in April

More than 150 passengers on board US cruises ships suffered diarrhoea and vomiting in two separate norovirus outbreaks in April, according to the Centers for Disease Control and Prevention (CDC).

The health agency said that 94 of 2,532 passengers on a Princess Cruises ship and 67 of 1,993 passengers onboard a Royal Caribbean ship reported sickness during voyages this month.

Diarrhoea and vomiting were the predominant symptoms reported during each of the outbreaks.

Alongside the 161 struck passengers, 20 crew members on Sapphire Princess and two on Radiance of the Seas also suffered from norovirus symptoms.

The Princess Cruise voyage departed Los Angeles for a month-long round trip to Hawaii and the South Pacific islands on 5 April, while the cruise operated by Royal Caribbean started its two-week trip from Tampa, Florida  to Los Angeles via South America on 8 April.

Both ships implemented “increased cleaning and disinfection procedures” and isolated ill passengers and crew, reported the CDC.

A spokesperson for Princess Cruises said in a statement: “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.

“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, includes disinfection measures, isolation of ill passengers and communication to passengers about steps they can take to stay well while onboard.”

The Independent  has contacted Royal Caribbean for comment.

Six outbreaks of gastrointestinal illness on cruise ships have been logged by the CDC  so far this year. The agency recommends washing your hands and hydrating for “healthy cruising”.

The outbreaks come after 28 passengers onboard Silver Nova, operated by  Silversea Cruises, were struck down by norovirus  earlier this month.

In the UK, 116 people on a cruise holiday with  Cunard suffered some form of gastrointestinal illness  on board a Queen Victoria ship from Southampton in January.

Recommended Stories

New details emerge in alleged gambling ring behind shohei ohtani-ippei mizuhara scandal.

It turns out the money was going from Ohtani's bank account to an illegal bookie to... casinos.

Sixers' Joel Embiid active for win-or-go-home Game 5 against Knicks

Joel Embiid will be on the floor to try to stop the Knicks from sending the Sixers home.

Midi is building a digital platform for an oft-overlooked area of women's health

When Joanna Strober was around 47, she stopped sleeping. While losing sleep is a common symptom of perimenopause, she first had to go to multiple providers, including driving 45 minutes out of San Francisco to pay $750 out of pocket, to get that diagnosis and proper treatment. "That feeling of wow, I've really been suffering unnecessarily for the past year really stuck with me," Strober said on a recent episode of TechCrunch's Found podcast.

Broncos reportedly declining 5th-year option on QB Zach Wilson

Wilson is now scheduled to become a free agent next offseason.

US will require all new cars to have advanced automatic braking systems by 2029

The National Highway Traffic Safety Administration just announced new safety standards for US cars. All new cars must have automatic braking systems installed by 2029.

Mike Trout to undergo knee surgery, which isn't expected to be season-ending

Trout is currently tied for the MLB lead in homers.

Binance founder Changpeng Zhao sentenced to four months in prison

A federal judge has sentenced Binance founder Changpeng Zhao to four months in prison. Prosecutors had recommended three years. Zhao pleaded guilty in November to violating the Bank Secrecy Act.

Walmart shuttering health units, including telehealth and 51 clinics

Walmart announced it is closing down its healthcare business Tuesday. The move will impact 51 locations in five states, as well as relationships with health systems, like the one penned with Florida's Orlando Health in November.

NBA playoffs: Celtics C Kristaps Porziņģis out for 'several games' with calf strain

If the Boston Celtics want to close out the Miami Heat on Wednesday, they'll have to do it without Kristaps Porziņģis.

AMD beats on Q1 revenue and EPS, stock edges lower on light guidance

Chip giant AMD reported its first quarter earnings on Tuesday beating analysts' expectations on the top and bottom lines, but lighter-than-anticipated guidance for the next quarter sent the stock lower.

Eli Lilly reports $2 billion from Mounjaro, Zepbound in Q1 2024

Eli Lilly missed on total sales in the first quarter, but its GLP-1 drugs helped boost sales by 26% over those in Q1 2023.

Screenshots suggest TikTok is circumventing Apple App Store commissions

TikTok may be routing around the App Store to save money on commissions. According to new findings, the ByteDance-owned social video app is presenting some of its users with a link to a website for purchasing the coins used for tipping digital creators. Typically, these coins are bought via in-app purchase, which requires a 30% commission paid to Apple.

King Charles returns to royal duties following his cancer treatment. Here's what to know about his health journey.

What to know about King Charles’s recent health issues, from an enlarged prostate to a cancer diagnosis.

These are the most expensive vehicles to gas up

Consumer Reports found that the Toyota Tundra is the most expensive vehicle in America to gas up, with costs nearing $120 per tank.

Want Reese Witherspoon's gorgeous glow? Her favorite vitamin C oil is nearly 40% off at Amazon

This Biossance serum has plenty of fans: 'Every woman over 50 should have this product on hand,' one says.

US consumer confidence hits lowest level since July 2022

Economic optimism from Americans fell sharply in April as inflation sticks around and the outlook on the job market sours.

10 worst and 10 best states for uninsured drivers

MarketWatch Guides found that up to a quarter of drivers in some states are on the road without insurance coverage.

'My bald spot faded' Nab this anti-thinning shampoo and conditioner set for just $18 each

This ultra-potent pair has racked up nearly 3,000 five-star reviews.

2025 Mercedes-Benz S-Class gets a few tiny modifications

The 2025 Mercedes-Benz S-Class gets some tiny modifications to its tech and luxury offerings before a larger facelift and refresh coming in 2026.

Bill to strengthen national tipline for missing and exploited children heads to Biden's desk

A bipartisan bill designed to protect children from online sexual exploitation is headed to President Biden's desk. Proposed by Senators Jon Ossoff (D-GA) and Marsha Blackburn (R-SC), the bill aims to strengthen the National Center for Missing and Exploited Children's (NCMEC) CyberTipline. When an online service provider detects child sexual abuse material (CSAM), the platform is legally required to report it to the CyberTipline.

Ukraine-Russia war latest: Child seriously hurt as number of dead rises after airstrike in Odesa seaside park

The Ukrainian authorities say the number of victims from a Russian airstrike in Odesa has risen, with many more injured. Listen to a Daily podcast on whether the UK should send troops to Ukraine as you scroll.

Tuesday 30 April 2024 11:19, UK

• Number of victims from Odesa attack rises to five, with child badly hurt
• Watch: Massive building in flames after attack
• Explained : Why is Chasiv Yar the next target for Russia?
• Your questions answered: Will Ukraine launch another spring offensive?
• Listen to the Sky News Daily above and  tap here  to follow wherever you get your podcasts

Live events elsewhere mean we are leaving our coverage of the Ukraine war there for the day. 

The main development this morning was the rise in the number of people killed in a Russian strike on Odesa yesterday to five.

Read more details in our posts below - and we'll be back with rolling updates and analysis of the war soon.

At least two people have been killed in another Russian strike, this time targeting the northeastern city of Kharkiv, local officials say.

Six more have been wounded in the attack, which Governor Oleh Synehubov says was carried out using guided bombs, according to preliminary information.

The attack damaged a residential building in one of the city districts, Kharkiv Mayor Ihor Terekhov said. 

Emergency services are on the scene, local officials say.

Yesterday, a woman was reportedly injured after a "series of explosions" hit the city, according to the mayor.

Russia denies targeting civilians in the war that is now in its third year.

As we reported yesterday, a Russian missile attack targeted an educational institution in a popular seafront park in the Black Sea port of Odesa.

The number of victims from that airstrike has risen, with five people now reported to have died. 

Local officials had initially said four were killed.

Regional governor Oleh Kiper said in addition to those killed in the attack, one man died after suffering a stroke attributed to the strike.

Another 32 are said to be injured, eight of whom seriously - including a four-year-old child.

A pregnant woman and another child are also among the injured.

"Monsters, beasts, savages, scum, I don't know what else to say," Odesa Mayor Hennadii Trukhanov said.

"People are going for a walk by the sea and they are shooting and killing."

Video footage, which could not be immediately verified, showed people receiving treatment on the street alongside pools of blood. 

One photo showed officials examining part of a missile.

Ukrainian navy spokesperson Dmytro Pletenchuk said the strike was conducted by an Iskander-M ballistic missile with a cluster warhead.

Odesa has been a frequent target of Russian missile and drone attacks, particular port infrastructure.

Hello and welcome back to our coverage of the war in Ukraine. 

Yesterday a Russian attack on the port city of Odesa killed at least four people, while dramatic footage showed a massive education facility ablaze in the aftermath. 

Here are the other key events to get you up to speed on from the past 24 hours:

• More than 30 Ukrainian conscripts have died while trying to cross the border illegally to avoid mobilisation, a Ukrainian official said;
• The Duchess of Edinburgh met with Volodymyr Zelenskyy in Ukraine, in what marks the first visit to the country by a member of the Royal Family since the war begin;
• Debris recovered from a missile that landed in the Ukrainian region of Kharkiv on 2 January was North Korean, according to the United Nations;
• NATO secretary-general Jens Stoltenberg visited Kyiv for a meeting with Volodymyr Zelenskyy;
• In a joint news conference, Mr Stoltenberg said NATO allies had "not delivered" on their military aid pledges to Ukraine in recent months, saying that "serious delays" had led to negative consequences on the battlefield;
• Mr Zelenskyy also called for the delivery of Western weapons to Kyiv's troops to be sped up;
• Russia's defence ministry claimed its forces have taken control of the village of Semenivka in the eastern Donetsk region;
• European Council president Charles Michel said the Russian invasion of Ukraine has given "new impetus" to calls for the EU to be enlarged beyond the 27 members;
• Germany's public prosecutor's office said it was assessing whether a political motive was behind the killing of two Ukrainian soldiers in Murnau.

As we reported a short time ago, the Duchess of Edinburgh has met with Volodymyr Zelenskyy in Ukraine, in what marks the first visit to the country by a member of the Royal Family since the war begin.

Sophie met the Ukrainian president and first lady Olena Zelenska and delivered a message to them on behalf of the King, Buckingham Palace said.

You can watch footage from her trip here...

Throughout the day, we've been reporting on a Russian attack on the city of Odesa in Ukraine, which has killed at least four people. 

These images show a burning educational institution building, which was struck. 

Airline Finnair has said it is pausing flights to Tartu in eastern Estonia for the next month, due to GPS disturbances in the area.

"Finnair will suspend its daily flights to Tartu, Estonia, from 29 April to 31 May, so that an alternative approach solution that does not require a GPS signal can be put in place at Tartu Airport," the Finnish airline said in a statement.

Finnair last week had to divert two flights back to Helsinki after GPS interference prevented the approach to Tartu airport, although a spokesperson said the company did not now where the interference came from.

However, Tallinn seems certain as where the issues are originating. 

"It is a fact that Russia affects GPS devices in our region’s airspace," Estonia's foreign minister said via a spokesperson.

Margus Tsahkna added that Estonia will raise the issue of GPS interference with its neighbours, and intends to discuss it with the EU and NATO. 

GPS jamming and spoofing have grown worse in eastern Europe, the Black Sea and the Middle East, all areas close to conflict zones, according to industry group OpsGroup. 

More than 30 Ukrainian conscripts have died while trying to cross the border illegally to avoid mobilisation, a Ukrainian official has said.

Andriy Demchenko, spokesman for the State Border Guard Service,  told Ukrinform that some men are prepared to pay "large sums" of money to groups promising to smuggle them across the border safely.

"Then they are faced with the fact that the route runs along a mountain river," he said.

Many conscripts have lost their lives after realising they didn't have the strength to swim the river, Mr Demchenko added.

"In total, since the beginning of the full-scale invasion, about 30 people have died trying to cross the border illegally," he said.

Such attempts occur "every day", he said.

For context: Ukraine has been under martial law since the Russian invasion in February 2022.

It lets draft officers call up men of a certain age to fight on the front line.

In April, Volodymyr Zelenskyy signed off a new law lowering the age of draft-eligible men from 27 to 25, in a bid to boost troop numbers in his depleted ranks.

The Duchess of Edinburgh has met with Volodymyr Zelenskyy in Ukraine, in what marks the first visit to the country by a member of the Royal Family since the war begin.

Her visit is aimed at demonstrating "solidarity with the women, men and children impacted by the war and in a continuation of her work to champion survivors of conflict-related sexual violence", the palace said.

Three women and a man have died after a Russian attack on Odesa.

A further 28 people have been injured, including two children aged five and 16. A pregnant woman has also been hurt.

This video shows the aftermath of the attack. 

Be the first to get Breaking News

Install the Sky News app for free