norovirus cruise ship 2022

• CruiseMapper
• Ships and Lines

Cruise Ship Norovirus Outbreaks

Here are listed latest cruise ship Norovirus outbreaks on passenger ships, with information what is and how to avoid Norovirus on cruise ships, CDC reports, and news updates.

From the following links, you can skip the intro and jump directly to illness outbreaks in 2024 , 2023 , 2022 , 2020 , 2019 , 2018 , 2017 , 2016 , 2015 , 2014 , 2013 , 2012 , also read about Zika virus , Seasickness , Hospital (shipboard infirmary) and Mercy Ships (hospital ship Africa Mercy) .

Note: The following CruiseMapper link provides information on Coronavirus/COVID outbreaks on cruise ships .

Norovirus outbreaks on cruise ships in 2024

Cruise norovirus outbreaks updates.

Norovirus on ships is spread through contaminated water, foods and surfaces (public restrooms, railings, doorknobs, handles, board games-cards-puzzles-toys, etc). Norovirus withstands chlorine, prolonged exposure outside the body, as well as temperature extremes. Like a virus, Norwalk can't be effectively treated with antibiotics, making it extremely difficult to eliminate in closed environments - like cruise vessels.

Norovirus may incubate up to 48 hours before the symptoms appear. This makes it difficult to restrict an outbreak. Noro symptoms include nausea, vomiting (kids more than adults, abdominal cramps, diarrhea, general weakness, low fever, headache, muscle aches. The illness could last up to 5 days (depending on the person's age, general health, and severity of the exposure to the virus. Recovered patients can still spread the virus for up to 2 weeks.

Quarantining the ill passengers and crew to their cabins is mandatory (at least for 48 hours) to slow the outbreak's spread. Failing to comply with the crew's orders results in fines or even discharge from the ship.

CruiseMapper's Norovirus survey is based on official data from CDC.gov (USA's "Centers for Disease Control and Prevention"). CDC's "Vessel Sanitation Program" assists the cruise tourism industry in preventing and controlling the transmission and spread of gastrointestinal illnesses (Norovirus, ETEC) on passenger ships calling on US seaports.

This program operates under the authority of the Public Health Service Act (fda.gov, "Quarantine and Inspection Regulations to Control Communicable Diseases"). CDC sanitation inspections on passenger ships are conducted twice a year. Scores of 86 are considered passing. Among the issues that CDC health inspectors usually find on board and report are:

• food debris
• dead insects
• insect droppings
• records indicating crewmembers (including cooks and galley staff) working while sick (suffering from gastrointestinal disorders or with acute gastroenteritis/AGE symptoms)
• cracked/corroded equipment
• soiled cutting boards
• food served undercooked
• lack of safety instruction signs.

CDC cruise ship Norovirus reports

Cruise ship outbreaks are reported (posted on the CDC website) when the illness incident meets the following criteria:

• The ship falls within the purview of the Vessel Sanitation Program (VSP). This means if it carries 13+ passengers and has a foreign cruise itinerary with US ports of call in it. Keep in mind, that most departures are from US-based home ports.
• The ship cruise itinerary length is between 3 and 21 days,
• The ship carries 100+ passengers.
• The percentage of infected passengers or crew (cases reported to the ship's med staff) during the cruise is 3% or more. This means small outbreaks on cruise ships will not be reported to the CDC.

CDC cruise ship inspection fees are payable by the shipowner. Fees are based on the vessel's size. VSP doesn't charge fees for consultations related to shipping facilities renovations or new ships. Inspection fees are as follows.

• Small ships (under 3000 GT/gross tons) pay USD 1500 per inspection.
• Small ships (between 3000-15000 GT) pay USD 3000 per inspection.
• Medium ships (between 15000-30000 GT) pay USD 6000 per inspection.
• Large ships (between 30000-60000 GT) pay USD 9000 per inspection.
• Extra-large ships (between 60000-120000 GT) pay USD 12000 per inspection.
• Mega-liners (above 120000 GT) pay USD 18000 per inspection.

Note: When the itinerary doesn't include US cruise ports, the ship is not required to report to CDC, thus no official illness outbreak report would be issued.

CDC ship illness outbreak investigations

VSP (abbrev "Vessel Sanitation Program") monitors CDC's observations on illness patterns for GI (gastrointestinal) outbreaks on passenger shipping vessels ( ferries and cruise ships ).

• VSP conducts outbreak investigations only in cases with 3% or more passengers or crew reported sick with GI symptoms. VSP may also conduct outbreak investigations in cases of unusual GI illness patterns (even if the rate is less than 3%).
• VSP conducts outbreak investigations only on vessels visiting ports in the USA or which are within 15 days of arriving at a US port.
• When an outbreak occurs, VSP asks for ship logs and infirmary records of reported GI cases (symptoms and timing) and illness distribution (among passengers/crew, during each day of the cruise).
• VSP staff usually boards the vessel for epidemiological assessment, interviews, distribution and analysis of illness questionnaires, monitoring cleaning procedures.
• Lab investigations - the onboard med staff often collects stool, vomit, blood specimens, which are then sent to land-based labs to confirm the illness cause.

During the onboard illness outbreak, VSP requires the cruise company to activate the "Outbreak Prevention and Response Plan" (vessel's response to illness cases).

During an outbreak:

• Cleaning and disinfection frequencies are Increased.
• Self-service buffets are stopped.
• All infected (pax/crew) are quarantined to their staterooms/cabins
• Clinical specimens are collected for analysis.
• Daily updates are provided to VSP (cases counts and measures reports)
• All passengers and crew are alerted of the illness.
• Upon boarding on the next scheduled cruise, passengers are notified about the previous voyage's outbreak.
• Occasionally, VSP requires the company to notify port authorities and also to perform cleaning and disinfection in cruise port terminal buildings.

Illness outbreaks on cruise ships (annual statistics)

The following statistics show the number of cruise ship illness outbreaks in recent years. You can compare the number of reports (CDC and news media sources) and the total number of infected (passengers and crew).

In 2014, Time Magazine published the article "The 13 Worst Norovirus Outbreaks on Cruise Ships". In it, the overall winner was Princess Cruises with 5 epidemic illness outbreaks:

• Coral Princess (February 2009, infected 271)
• Crown Princess (January 2010, infected 396)
• Crown Princess (February 2012, infected 363)
• Sun Princess (July 2012, infected 216)
• Ruby Princess (March 2013, infected 276)

Norovirus outbreaks 2023 reports

Norovirus outbreaks 2022 reports, norovirus outbreaks 2020 reports, outbreaks 2019 reports.

In the following table, you can see all 2019-reported Norovirus outbreaks on cruise ships. The listed statistical data is based on CDC or news media reports. It shows the number of sick passengers and crew (with the respective percentage to all), along with the corresponding CDC report pages (if available) as outgoing links.

Note: When the itinerary doesn't include US cruise ports, the ship is not required to report to CDC, thus no official illness report would be issued.

Outbreaks 2018 reports

In 2018, the number of reported illness outbreaks on cruise ships was 15. The total number of infected was 1177 (of those 1099 passengers and 78 crew).

Outbreaks 2017 reports

In 2017, the number of reported illness outbreaks on cruise ships was 21. The total number of infected was 2535 (of those 2450 passengers and 85 crew).

Outbreaks 2016 reports

In 2016, the number of reported illness outbreaks on cruise ships was 23. The total number of infected was 2504 (of those 2378 passengers and 126 crew).

Outbreaks 2015 reports

In 2015, the number of reported illness outbreaks on cruise ships was 23. The total number of infected was 2570 (of those 2458 passengers and 112 crew).

Outbreaks 2014 reports

In 2014, the number of reported illness outbreaks on cruise ships was 17. The total number of infected was 3559 (of those 3354 passengers and 205 crew).

Outbreaks 2013 reports

In 2013, the number of reported illness outbreaks on cruise ships was 22. The total number of infected was 2385 (of those 2249 passengers and 136 crew).

• According to CDC, in 2013 from Norovirus and similar GI (gastrointestinal) illnesses suffered a total of 1409 passengers (which is 7,5% of all passengers on the inspected cruise vessels) and 96 crew/staff members (which is 1,2% of all). With nearly 12 million cruisers departing from USA and Canada ports in 2013, the Norovirus infection rate is ~0,01% of all passengers.
• It should be noted, that in the past years on many CDC inspections was concluded the Noro virus illness source was off the ship.

Outbreaks 2012 reports

In 2012, the number of reported illness outbreaks on cruise ships was 34. The total number of infected was 5542 (of those 5079 passengers and 463 crew).

Norovirus on cruise ships

All important things you should know about the "cruise virus".

Why do Norovirus incidents happen on cruise ships? There are more than 21 million US cases reported annually, of which 1 mill related to kids. Outbreaks happen mostly during winter months and mainly in more crowded places with close quarters. Among those are schools, hospitals, nursing homes, dormitories, prisons, big resorts, bigger passenger ships (including cruise ferries ). Norovirus is often branded as "cruise ship virus" simply because on ships health officials are required to report every gastrointestinal illness incident. This means Norovirus outbreaks are reported more quickly on ships than on land. Just for comparison, the virus can afflict as many as 3000 people per day in only one big city, which is about the passenger capacity of a typical modern cruiser.

What is Norovirus infection? It's a very common, highly contagious, ruthlessly efficient and uncomfortably bad virus affecting the stomach and large intestines. Often called "stomach flu" (the med term is "Gastroenteritis") the infection results in massive vomiting and diarrhea. Sickness outbreaks are considered as such if the percentage of infected people is over 3%. The virus is not seasonal and usually not serious (in medical terms). It hits 1 in 5 people annually and is the cause of ~50% of all foodborne illness outbreaks in the USA and for ~90% of all non-bacterial gastroenteritis worldwide.

The virus is named after an outbreak in Norwalk (OH, USA). Numerous studies confirm that a quick application of hand sanitizer doesn't kill the Norovirus. It takes about 30 sec of hard rubbing with hot water and soap (including under the nails) to wash it. This virus also mutates (changing its strains). As to its efficiency - a mere 20 particles are enough to get you.

What causes Norovirus on cruise vessels is mainly contaminated food/water. When it comes to ships, it spreads mostly through physical contact with sick people or handling contaminated objects. This includes sharing food/utensils and poor hygiene (not washing hands after bathroom use). The virus also spreads fecally, so you can catch it into the onboard laundry, or while changing diapers, etc. However, many passengers likely can blame a sick crewmember for the virus. According to a survey based on 170 inspection records on ships that docked in Florida ports in 2012, on 59 cruises violations of the required illness reporting laws were reported. A total of 130 crew had gotten sick on those voyages and didn't report their illness in the required time period.

The symptoms are nausea, vomiting, diarrhea, indigestion, abdominal cramps. Also possible are mild fever and headache. It takes 1-2 days for the symptoms to appear. The illness lasts 1 to 4 days, but some people (especially elderly) may be contagious for up to 2 weeks after recovery.

What is the treatment? What to do if you got it? Obviously, the first thing is to go to the ship's infirmary (medical center) and contact the doctor. You should drink plenty of water as dehydration is a side-effect of the illness. There is no real treatment for Norovirus - you just wait it out. A few years ago an experimental Norovirus vaccine (applied as nasal spray) was developed by the "Center for Infectious Diseases and Vaccinology" (Arizona State University). The new vaccine generates a good immune response.

How to avoid Norovirus on cruise ships?

• Wash your hands often (hot water and soap), especially before/after eating and after using the bathroom
• Limit physical contacts as much as possible, pack some extra soap, a personal disinfectant (Lysol, Pepto-Bismol), oral rehydration sachets and treatments for diarrhea
• Avoid eating uncooked food (including salads and sandwiches) and food that cannot be washed (unless it can be peeled or shelled), drink only bottled liquids (preferably without ice), don't share drinks/utensils.
• Drink lots of water.
• Compensation for cruise illness. By contract, cruise lines are not required to compensate passengers who fall ill on cruises. However, they will compensate you if the itinerary was altered/canceled due to an illness outbreak. The deal may include up to 50% refund, up to 50% FCC (future cruise booking discount) or an option to cancel for a full refund plus reimbursement of airline change fees. If you have travel insurance, it covers cancellation due to illness. If you've been infected on the ship, it could also cover medical expenses and to compensate you for all days you're not on the ship before the cruise end.

The following "health advisory" list of recommended actions is often issued during gastrointestinal illness outbreak or on embarkation day (of the next scheduled voyage). It has important suggestions on how to avoid spreading the cruise ship virus infection.

• It is critical that excellent standards of personal hygiene are maintained by all on board, as well as avoiding touching surfaces, such as handrails, door handles, elevator buttons, walls.
• Report any observed evidence of vomiting or diarrhea that you may encounter on the ship.
• Ensure that you minimize direct contact with others during this time, such as handshakes, etc.
• Avoid touching your mouth.
• Wash your hands frequently and thoroughly with soap for at least 20 sec and rinse them well under running water. Ensure that you follow this procedure every time you use the WC, after coughing or sneezing, and before eating, drinking or smoking.
• Attempt to always use your own cabin toilet facilities.
• In addition to hand washing, also use the alcohol hand gels provided where available, and in particular before eating in the self-serve buffet restaurant and outdoor food outlets.
• Should you experience any symptoms of vomiting or diarrhea, return to your cabin and immediately report to the Medical Center or Front Office (Reception, if the infirmary is busy) by dialling 999.

Cruise ship virus procedures

What do they do about it? What actions do lines/operators/CDC actually take in response to a Norovirus cruise outbreak?

An "illness outbreak" is considered when 3% or more of all passengers report symptoms to the ship's med staff. In such cases, the CDC requires cruise lines to file a medical report.

The hotel staff is required to implement special cleaning and disinfection procedures for sanitizing the whole ship. To do that, they use stronger solvents, like Microbac, chlorine bleach, hydrogen peroxide. The Lido Deck's bistro/buffet service switches to manned stations. Often, salt-pepper shakers are taken off the tables. The crew starts offering precautionary tips. Sick passengers and crew are quarantined in their rooms, typically for at least 2 days. When Norovirus outbreaks can't be contained, cruise lines might also pull the ship out of service for a few days for sanitizing.

The CDC's "Vessel Sanitation Program" is for monitoring illness outbreaks on passenger ships carrying 100 or more guests on sailings from 3 to 21 days in length. The ship's medical staff is required by the CDC to maintain illness counts for each itinerary involving a stop at a US cruise port and to give CDC the number of all passengers/crew, plus the number of reported diarrhea cases during that voyage. This is done 24 hrs prior to arrival at any US port of call from a foreign port. And they file such reports even if the "illness number" is zero. This protocol only confirms that the CDC knows everything about it.

Other possible actions and results are red level ("Code Red") cleaning. The boarding/embarkation of new passengers is often delayed to permit more extensive disinfection of public areas and the cabins. Usually, a pre-embarkation health advisory is distributed to all boarding passengers. Additional med staff is sent to the ship in port to assist the disembarkation of infected passengers. Another possibility is the cruise ship to cancel all the itinerary's foreign ports of call and to return to its US home-port before the end of the voyage.

Some cruise lines offer hand-sanitizer dispensers near the ship's restaurants, Lido/pool deck areas and other more crowded public spaces in their effort to keep a lid on sickness outbreaks.

In February 2020, the shipowner cruise company Lindblad Expeditions announced the "Premium Purity" program with a shipwide cleaning system based on ACT CleanCoat technology. The program was rolled out fleetwide after a year trial. The innovative ship cleaning process is based on photocatalytic antibacterial spray that when activated by light kills viruses, bacteria, airborne microbes, mould. The disinfecting product and technology were developed by the Danish company ACT Global AS ( Copenhagen ). The spray is chemical-free, odourless, transparent and can be applied to all surfaces.

Zika virus on cruise ships

Zika virus (aka ZIKV) is a Flavivirus - from the genus of the viruses named West Nile, dengue, tick-borne encephalitis, yellow fever. These plus several other viruses may cause encephalitis (acute brain inflammation). In humans, Zika virus causes the Zika fever which is known to occur only within some equatorial regions. In 2014, Zika spread across the Pacific Ocean to French Polynesia, and soon to Easter Island. In 2015, Zika virus reached Central America, the Caribbean, and South America. In South America were recorded several pandemic outbreaks.

The most severe outbreaks were reported in Brazil, with an alarming surge in newborns with microcephaly. If the mother is infected, the virus may cause microcephaly in newborns. This is a neurodevelopmental disorder - babies are born with an underdeveloped head.

Generally, Zika is a mosquito-borne virus spread by Aedes aegypti (aka "yellow fever mosquito") and Aedes albopictus (aka "Asian tiger mosquito"). However, it became "cruise virus" since the decease can also result from intrauterine (contraceptive device), sexual intercourse, blood transfusion, lab exposure, organ/tissue transplantation, breast milk transmission.

In January 2016, the CDC issued travel guidance on affected countries and suggested using enhanced precautions and even postponing travel. Guidelines (specifically for pregnant women) were issued as well. Similar travel warnings were issued by other health agencies and governments. The CDC list of potentially dangerous for travel countries included (alphabetically) Barbados, Bolivia, Brazil, Cape Verde, Colombia, Ecuador, French Guiana, Guadeloupe, Guatemala, Guyana, Haiti, Honduras, Martinique, Mexico, Panama, Puerto Rico, Paraguay, Salvador, Samoa, St Maarten, Suriname, Venezuela.

Cruise lines should warn their pregnant passengers of the virus. Cruise ships publish daily health and safety instructions to their passengers on how to avoid mosquito bites. Zika symptoms are fever, skin rash, pain in joints, conjunctivitis (pink eye). It typically lasts from a few days to a week. For now, the illness cannot be prevented by drugs or vaccines.

"Cruise ship virus" politics

Virus outbreaks on cruise ships are actually not that uncommon. Such viral/bacterial outbreak incidents affect the vacation experience of thousands of people, being packed up in a floating resort for many days on end. In confined spaces with frequent passenger turnover (like big capacity cruise ships), it is easy for diseases to spread - whether food- or air-borne, or otherwise. However, there's a tendency to cover up the severity of this issue.

Some of the world's most famous passenger ships are listed in the virus outbreak statistics, yet one hears so little of it in mass media news. And there is no surprise in that since the "cruise illness" news are nothing but bad publicity for the companies - which is bad for a prosperous multi-billion dollar sea travel vacation business. All major cruise line companies will do their best to keep quiet about virus outbreaks on their ships. There are passenger testimonials about quarantined ships and how badly guests have been treated by the line. Virus outbreak news speaks of a lack of proper hygiene control, badly trained staff, bad ship management. The whole responsibility goes to the shipowner (cruise line company) and its management.

Major (in some cases epidemic) illness outbreaks are among the "biggies" that can bring down the brand's reputation on the market. Cruise illness issues often result in lower booking rates and cheaper prices - which is bad for the business.

So it comes as no surprise that when CDC reports an illness outbreak on some vessel, big media sources do not immediately (or ever) respond to the news. You may hear about it on your local radio station, or on your local cable operator, but not necessarily on ABC, CNN, and often not even on Yahoo and MSN news online. It's not about the passengers' health (never been) - it's about the big money that rules our world.

So keep your hands clean, keep your mind clear, always hope for the best. Bad, if meant to happen, will happen anyway, and nothing can change it.

Seasickness on cruise ships

Seasickness is physical disorientation as a result of conflicting signals received by the brain from different body senses. Our inner ear senses the ship's irregular motion, which our eyes can't see because the floor and walls are stable. Depending on individual balance, our ability to adjust to motions varies, so not everyone experiences seasickness.

Seasickness is one of the most common "cruise illnesses". Passengers sensitive to nausea or motion sickness should consult their doctors for medical recommendations prior to departure. Drugs (like Dramamine) are effective against seasickness. At the cruise ship's Infirmary, and also at Reception Desk is provided (free of charge) Meclizine. Know that the bigger the vessel the more stable it is. Also, motion in midship-located areas (including staterooms) is highly reduced in comparison to forward and aft areas.

Seasickness manifests in different ways and is always a result of the body's attempt to correct for the conflicting inputs received from its senses. Common symptoms are cold sweat, dizziness, drowsiness, headache, nausea. When such symptoms are noticed, passengers should take precautions to prevent intensifying the disorientation. The harder the symptoms, the longer the recovery.

If seasickness symptoms are accompanied by diarrhea or fever, passengers should immediately seek medical treatment for Norovirus and avoid spreading the illness to others.

How to prevent seasickness on cruise ships (tips)

Passengers prone to motion sickness are more likely to suffer seasickness. The following prevention tips can minimize discomfort, so before the cruise:

• choose more sheltered routes (clam waters). Open sea and ocean waters are rough and have larger swells, thus river cruises are among your best choices.
• Choose a large liner as larger vessels are more stable and motions are minimized.
• Book centralized/midship stateroom and/or middle deck cabin, where motions are less noticeable.
• Get a good sleep before the voyage - an energetic, well-rested body adjusts easier to new conditions.

During the cruise tips to divert seasickness symptoms include:

• Get involved in onboard activities - this will occupy your mind while the inner ear adjusts to equilibrium changes.
• Avoid napping or lying down - when the body is horizontal, the ship's motion is more pronounced.
• Avoid eating unknown foods - you don't know how your stomach may react to new food/ingredients. Avoid alcohol and acidic-fatty-spicy foods. Stay well-hydrated by drinking plenty of water.
• Walk around to adjust the body's equilibrium to the ship's motion. When on open decks, focus on the horizon to give your eyes and body similar inputs about any tilting or other motion. Depending on the symptoms' severity, it may take several hours.
• Often get fresh air, take deep breaths, keep your lungs clear.
• Some herbal remedies (in tablets or teas) also can ease the symptoms, including ginger and peppermint. Their efficacy varies by person, and are best used together with other prevention methods.

Search for medical assistance - consult the ship's physician if no actions provide relief.

Cruise ship hospital (medical care)

Cruise vessels are not "hospital ships".

Hospital ships are designated as floating medical facilities (hospitals).

Most hospital ships are navy vessels (operated by military forces) which are specifically built for use in war zones.

Attacking a hospital ship is considered a war crime, but enemy forces have the right to board them for inspections.

As of 2018, hospital ships have Brazil (6), China (5), Russia (6), USA (2), Spain (2), and India-Indonesia-Peru-Vietnam (x1).

The navies of USA, UK, Australia, China, France, Italy, Spain, Argentina, and Japan have some classes of military ships fitted with onboard hospitals.

For passengers with health concerns, medical care on cruise ships is a vital part of their travel planning. Most cruise vessels are equipped with either basic infirmary (a small clinic) or larger hospital where sick or injured passengers are treated and cared for by contractor physicians and nurses on 24-hour duty.

Shipboard hospitals as facilities and equipment vary by cruise line and vessel. Clinic's size usually depends on the ship's capacity (passengers plus crew). Generally, bigger and newer ships offer larger and better-equipped medical facilities and are served by bigger infirmary staff.

The ship's medical personnel are independent contractors. This is for limiting the cruise company's liability. There are no internationally specified regulations governing ship infirmaries and medical staffing. Each company has its own standards provided for its passengers' healthcare.

For finding the Infirmary you can use the ship deck plans . On most vessels, the medical facilities are located midship on a lower deck (for easier access and better stability) and usually among other crew facilities. Every passenger stateroom has the Infirmary's number - posted or by the cabin's phone.

Basic medical care on cruise ships

A cruise ship's medical facility can treat only passengers experiencing minor health issues - seasickness, scrapes, sunburns, etc. More severe medical emergencies can't be handled on the ship and usually require medevacs. Coast guard helicopter teams fly to the ship, hoist the passenger (accompanied by a spouse/relative and a crew nurse) and fly them to the nearest land hospital.

Infirmary's equipment and med supplies provide only emergency response and basic treatments in order to stabilize the passenger until transferred ashore.

In cases of severe emergencies, passengers with life-threatening illnesses or injuries are evacuated off the ship - either by boat (if in or near seaport) or by rescue helicopter dispatched from nearest coast guard or other station. In some cases, nearby ships with better medical facilities may assist.

Both emergency and basic care are available on the ship 24 hours a day. All treatments are paid. Outside regular opening hours fees are higher.

Like inland hospitals, medical treatments at sea are pricey. However, unlike on land, most basic travel insurance policies don't cover medical treatments on cruise ships as they are not from the patient's primary caregiver. Purchasing cruise travel insurance with health coverage (medical clauses) is highly recommended.

Shipboard medical service fees vary and are usually set by medical practitioners. General consultations incur costs similar to home visits. Prescription medications or other treatments cost extra. In most cruise ship hospitals, some supplies and medications are provided to passengers and crew for free - like aspirin, seasickness pills, small bandages.

Mercy Ships

"Mercy Ships" is a charity accredited by Better Business Bureau. It operates hospital ships since 1978 and also has currently the world's largest hospital ship (excluding navy vessels) - MV Africa Mercy.

The organization provides free humanitarian aid worldwide, including health care, community development, and health education projects, mental health, agriculture, and water development programs in mainly developing countries in Africa, Caribbean, South America, Oceania.

The organization's headquarters are in Garden Valley (Texas USA), with another 16 offices worldwide - in UK, Spain, Canada, Germany, France, Denmark, Switzerland, Belgium, Holland, Sweden, Norway, South Africa, Australia, New Zealand, South Korea.

Financial support and supplies are mainly through donations from medical companies (medications, supplies, equipment), corporations (fuel, food, building supplies), governments (port fees, drydock costs), general public and also by the crew (all volunteers on a rotational basis). The crew serves with short-term (2 weeks to 2 years) and long-term (min 2 years) contracts. Volunteer crew members occupy both medical (surgeons, dentists, nurses) and general jobs (deckhands, seamen, engineers, machinists, electricians, teachers, cooks, welders, plumbers, agriculturalists.

The crew on Mercy Ships pay all costs associated with their service - fees, travel expenses, passports, insurance, personal expenses.

As 95 of the world's top 100 largest megapolises are port cities, "hospital ships" could provide healthcare very quickly and more efficiently to large numbers of people.

MV Africa Mercy

MV Africa Mercy is a converted former rail ferry (1980-built as "Dronning Ingrid") drydock-refitted in 2007 at Cammell Laird shipyard (Hebburn, England).

The ship project started in March 1999 with the vessel's acquisition through a donation from Balcraig Foundation (UK), which purchased the boat for US$6,5 million.

Ferry's train deck was reconstructed and converted into a hospital. Project's total cost was over USD 62 million.

Vessel details include:

• Volume/GT tonnage 16572 tons
• LOA length 152 m (499 ft )
• Width 23,7 m (78 ft)
• Draft 6 m (20 ft)
• Powerplant 4x BW main engines plus diesel generators
• Propulsion two shafts with controllable pitch propellers
• Speed 19 Kn/35 kph/22 mph
• Passenger capacity 484
• Crew capacity 450
• Fleet of 28 vehicles (used in land-based operations)
• Annual drydock maintenance and refurbishment are done in Durban (South Africa).

As for facilities and amenities, the hospital ship has 5 operating rooms, Intensive Care Unit, an ophthalmic unit, CT scanner, X-Ray, labs, recovery ward (82 beds), a daycare center, a school (for all ages), library, launderette, convenience store, restaurant, gymnasium, shops, Starbucks Cafe (donated), satellite communications.

Africa Mercy has a total of 126 staterooms for the staff/crew. They are located on upper decks and include cabins for families, couples and single cabins.

Land-based operations ("Field Service") include mobile clinics providing screening for potential surgery patients, healthcare, dental care, also mental health programs, infrastructure projects.

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

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

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

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

Norovirus outbreaks on cruise ships

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

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

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

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

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

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

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

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

Norovirus symptoms and treatment

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

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

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

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

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

How does norovirus spread?

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

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

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

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

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

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

Is norovirus common on cruise ships?

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

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

How to avoid norovirus on a cruise

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

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

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

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

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

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

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Surge at Sea: Alarming Increase of Norovirus Outbreaks on Cruise Ships

By SciTechDaily July 14, 2023

The allure of the open sea, captivating itineraries, and the luxurious promise of a carefree escape have long made cruising a popular choice for vacationers. However, this industry’s lustrous appeal has recently been overshadowed by a surge in outbreaks of a particularly stubborn and contagious pathogen — Norovirus.

Since the start of this year, an unsettling trend has emerged. According to data compiled by the Centers for Disease Control and Prevention (CDC), there have been 13 outbreaks across six different cruise lines. This alarming number marks the highest incidence of such outbreaks since 2012 when there were 16 across eight lines over the entire year.

In light of these recent developments, it’s imperative to explore and understand the nature of Norovirus — what it is, why it’s a recurring issue aboard cruise ships, and its impact on the cruise industry. This article aims to shed light on these matters, unpacking the complexities of the problem, and highlighting the steps that are being taken to address it.

The recent surge in Norovirus outbreaks underscores the necessity of vigilance and proper understanding of this issue, both for those planning a dream vacation at sea and for those in the cruise industry itself. Together, we can work towards ensuring that cruise ships remain a place of relaxation and enjoyment, rather than a breeding ground for this troublesome virus .

What is Norovirus?

Norovirus, sometimes referred to as the “winter vomiting bug,” is a highly contagious virus that causes gastroenteritis, an inflammation of the stomach and intestines. Named after Norwalk, Ohio, where the first outbreak was identified in 1968, norovirus can lead to severe vomiting, diarrhea, stomach cramps, and, in certain cases, even more serious consequences such as severe dehydration.

The virus is commonly spread through direct contact with an infected person, consuming contaminated food or water, or touching surfaces or objects contaminated with the virus. One of the main challenges in containing norovirus is its ability to survive on various surfaces for a significant amount of time, making it easy to pick up unknowingly.

Why is Norovirus a problem on Cruise Ships?

Highly contagious in close quarters.

The design and operation of cruise ships often involve large groups of people living in close proximity, sharing dining areas, entertainment spaces, and public restrooms. This makes it easy for norovirus to spread rapidly from person to person.

Quick and Vast Outbreaks

When a single case of norovirus appears on a cruise ship, it can quickly become an outbreak affecting hundreds or even thousands of people. This can happen incredibly quickly due to the confined nature of a cruise ship and the frequency of close interactions among passengers and crew.

Contaminated Food and Water

Cruise ships are known for their vast buffets and dining options. This presents an opportunity for the virus to spread if food or water becomes contaminated, either by an infected person or through improper handling and storage.

Difficulty in Proper Sanitation

While cruise ships have strict sanitation practices, the resilience of norovirus complicates matters. The virus can survive for days on surfaces and is resistant to many common disinfectants, making it challenging to eliminate once an outbreak has occurred.

Interruption of Planned Activities

A norovirus outbreak can cause significant disruption to the planned activities and itineraries of a cruise. Infected individuals must be isolated, common areas may need to be closed for cleaning, and in severe cases, the ship may even have to return to port.

The Impact of Norovirus on Cruise Industry

Cruise lines have had to invest heavily in cleaning and sanitation protocols, disease detection methods, and passenger education to combat the threat of norovirus. In many instances, outbreaks have led to public relations challenges, decreased passenger satisfaction, and financial losses due to trip cancellations and medical costs.

Moreover, the cruise industry often finds itself under scrutiny following an outbreak, which can affect the public’s perception and willingness to book cruises, ultimately impacting the industry’s bottom line.

The threat of norovirus on cruise ships is a serious issue that has both health and economic impacts. The confined environment of a cruise ship, combined with the virus’s highly contagious nature, creates a significant challenge. It’s crucial for cruise lines, passengers, and health officials to remain vigilant, proactive, and informed to prevent and contain potential norovirus outbreaks.

While the industry has made strides in improving sanitation protocols and disease prevention measures, the threat of norovirus remains a considerable concern that must be continuously addressed to ensure the safety and well-being of all passengers at sea.

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2 comments on "surge at sea: alarming increase of norovirus outbreaks on cruise ships".

Pay tons of money to be crammed onto a petri dish and no way off, no thanks. Then once you are on board its more $$$ for anything.

I might enjoy a cruise in a small ship with a few people, but having done a trip on a large ship many years ago I found all the hobnobbing with hundreds of other people to be psychologically scream-making ! Far too many humans in one place – no amount of luxury things would compensate for the horror of that, let alone worrying about a virus. So no thanks !

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Watch CBS News

Norovirus outbreaks surge on cruise ships

Updated on: July 12, 2023 / 3:41 PM EDT / CNN

MIAMI - Whether from Miami, New York, Seattle or more, millions of Americans pack aboard cruise ships on vacation. But when it comes to the health of those travelers, it's not always smooth sailing.

There have been 13 outbreaks of norovirus on cruises this year, according to the US Centers for Disease Control and Prevention. That's the highest number of norovirus outbreaks on cruises recorded since 2012, with almost half of the calendar year left to go.

The most recent norovirus outbreak occurred on a Viking Cruises voyage from Iceland that docked in New York City on June 20. About 13% of passengers and several crew members fell ill on board.

"We believe the gastrointestinal illness originated from a shoreside restaurant in Iceland where a group of guests dined during their free time," a Viking representative told CNN.

'An extraordinarily contagious virus' Norovirus is a highly infectious virus that causes inflammation in the stomach and intestines, a condition called acute gastroenteritis. Often labeled a "stomach bug," norovirus is the most common cause of nausea, vomiting, diarrhea and stomach pain, according to the CDC.

A person can get norovirus by accidentally ingesting microscopic particles of feces or vomit - which could happen when coming into contact with someone who's infected, consuming contaminated food or water or touching contaminated surfaces. Although symptoms usually last only a few days, a person can be infectious over two weeks later.

"This is an extraordinarily contagious virus," said Dr. William Schaffner, a professor of infectious diseases at Vanderbilt University. "It takes but a few normal viral particles to initiate an infection in someone who's exposed. In other words, this doesn't take a large dose; it takes only a little bit."

While there is no medicine to treat the illness, most people fully recover without treatment. Hydration therapy to replace lost fluids from vomiting or diarrhea is standard practice to address symptoms.

Still, to prevent the spread of norovirus, Schaffner recommends that cruise passengers take extra precautions and wash their hands thoroughly with soap and warm water. Antiseptic gels and hand sanitizers are not effective against the virus.

"As far as hand washing goes, we've all been doing it since we've been children," said Jeffrey Fisher, an associate professor of nutrition and dietetics at Central Michigan University. "But there've been a lot of studies done that say we're not doing it well enough, or as often as we should. So we want to revisit best hand washing practices."

Surging cases The exact cause of this year's uptick in cruise cases remains unclear, but experts believe that soaring demand for cruises and record numbers of passengers might be behind it.

According to data from the CDC's Vessel Sanitation Program, the number of norovirus outbreaks on cruise ships docking at U.S. ports had years of steady decline after 2015. Overall rates of acute gastroenteritis on cruise ships in the U.S. also decreased from 2006 to 2019.

In response to the Covid-19 pandemic, the CDC instituted a travel health notice that recommended against cruise ship travel over safety concerns. Cruising was limited, CDC spokesperson Kathleen Conley said, and outbreaks were few as the number of passengers on board decreased.

In fact, the program recorded no norovirus outbreaks in 2020 and 2021, likely due to limited cruising and updated sanitation protocols through the Covid-19 pandemic.

In March 2022 though, the agency lifted that risk advisory for cruise travel, and passengers are returning at record rates.

31.5 million passengers worldwide are expected to set sail this year, surpassing pre-pandemic levels and creating high-density environments that are ripe for transmission.

The CDC releases information about outbreaks on cruises that have over 100 passengers traveling between three and 21 days, and when over 3% of passengers and crew report symptoms.

Those conditions have been met 13 times this year, up from twice in 2022.

Four norovirus outbreaks, involving a total of 449 passengers and crew members, have happened aboard Royal Caribbean ships this year, the most of any individual cruise company, according to CDC data.

"The health and safety of our guests, crew and communities we visit are our top priority," a spokesperson from Royal Caribbean International told CNN in an email. "To maintain the highest levels of health onboard our ships, we implement rigorous safety and cleaning procedures, many far exceeding public health guidelines."

A perfect storm Compared with the general population, norovirus outbreaks are fairly uncommon on cruise ships. It infects 19 million to 21 million people in the US each year, according to the CDC, compared with a few thousand cases aboard cruises.

Transmission often occurs in crowded environments where tiny particles can float through the air, and Schaffner says cruises can create the perfect environment for norovirus outbreaks. A large group living and eating in proximity, he said, can serve as a breeding ground for the disease.

"They're an enclosed population: a very large, compactly packaged population that's together for long periods of time, often in really tight quarters," he said. "So there are just very many opportunities for people to encounter each other ... making it relatively easy for this virus to be transmitted."

Norovirus symptoms can also come on suddenly, he said. A passenger could be walking to their cabin or attending an event and abruptly begin throwing up. That vomit is aerosolized, and those floating microscopic particles can infect people nearby.

"You have this highly transmissible virus that's introduced into an environment, the cruise ship, which is ideally designed for the rapid spread of a communicable disease," Schaffner said.

Although symptoms like diarrhea and vomiting often fade away in a few days, they can also cause dehydration. For older passengers who may make up a disproportionate number of cruise clientele, Schaffner warned, rapid fluid loss can create the risk of more serious illness. For people with diabetes, dehydration can throw off treatment strategies.

Fisher thinks that much of the problem stems from a "knowledge gap" about the virus among the public. "People are relaxing" as the Covid-19 pandemic appears to wind down, rather than remaining vigilant about spreading disease.

"I think a lot of the public don't even understand norovirus, let alone how to begin to protect themselves," he said. "They're not taking those precautions, those good protection behaviors they learned over the pandemic."

Schaffner also suspects that people feeling ill before boarding are now more inclined to set sail. Eager for a vacation after a 2½-year pandemic delay, many could be bringing norovirus with them, he suggested.

"The first thing that passengers can do is postpone their trip if they're not feeling well," he recommended. "Try to limit the exposure of others on the front end, and take another cruise a month later."

Besides monitoring disease outbreaks on board, the CDC's Vessel Sanitation Program also requires periodic illness reports from cruise ships, conducts regular unannounced inspections, and conducts training for cruise ship employees about public health.

As precautions, the CDC advises passengers to thoroughly wash their hands, avoid contaminated food and keep their hands away from their mouths. If a passenger does become ill, Schaffner and the CDC both recommend staying in their cabins and notifying the ship's medical team immediately.

"Let them take over and care for you," Schaffner said. "Don't go out and about and spread the virus."

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We asked: Should I cancel a cruise if my ship had norovirus?

Does it matter what happens on the cruise before your cruise we asked infectious-disease experts for answers..

Traveling has always come with complications. Our By The Way Concierge column will take your travel dilemmas to the experts to help you navigate the new normal. Want to see your question answered? Submit it here .

“What do you do if you’re a passenger on a cruise directly following a norovirus outbreak? Should you rebook?” — Washington Post travel reporter Andrea Sachs

Even though it feels as if we hear a lot about gastrointestinal illness on cruise ships, the Centers for Disease Control and Prevention says outbreaks are “relatively infrequent.” Because health officials track illness on cruises, outbreaks are found and reported quicker on ships than on land, the CDC says.

But it happens . So far this year, the CDC has reported 13 outbreaks of norovirus — more than the annual total of gastrointestinal illnesses reported on cruise ships visiting U.S. ports in each year dating back to 2017; the CDC imposed a no-sail order for much of 2020 because of the coronavirus pandemic, and U.S. cruises were required to follow pandemic-era restrictions until January 2022 , which may have also helped contain norovirus . Although outbreaks may affect more than 100 passengers, the two most recent cases represented about 13 percent and 7 percent of guests, respectively.

So how far do you need to go to evade the stomach bug on your vacation?

Let’s start with what I heard from Bernadette Boden-Albala, the director and founding dean of the Program in Public Health at the University of California at Irvine, who has extensively researched and studied norovirus and is still a fan of cruise travel. In fact, she emailed me from a cruise ship.

Her take: You don’t need to rebook if you hear there has been an outbreak on the sailing before yours. You and the cruise line are on the same page: Nobody wants you getting sick on board.

“Norovirus is a worst fear for all cruise lines,” Boden-Albala says.

She mentioned information you’ll also find on the norovirus page of the Cruise Lines International Association website: When a gastrointestinal illness plagues a cruise, the captain and crew follow deep-cleaning and sanitation practices developed with public health authorities. Additionally, Kendra Holmes, the CEO of Miray Cruises, says a ship’s crew is monitored for symptoms, and if anyone does display symptoms, they’re quarantined and treated.

Shoshana Ungerleider, a board-certified internal medicine physician and host of the “TED Health” podcast, also says that, thanks to the norovirus cleaning protocols on ships, the risk of getting an infection on the following cruise should be quite low.

Flying during summer storm season? Better have a backup plan.

“That being said, norovirus is highly contagious and can be spread from person to person,” she wrote in an email. “If any of the crew members were infected and are still in the incubation period or showing symptoms, there might be some risk of transmission.”

According to the CDC, the incubation period for norovirus — the time it takes between infection and the onset of symptoms — is between 12 and 48 hours.

So the decision to travel or not should depend on several factors, Ungerleider says, including your personal health status and risk tolerance.

For most young and healthy people, norovirus isn’t much of a health risk, says Eyal Leshem, an infectious-disease expert at Sheba Medical Center who previously worked at the CDC. With some hydration and rest, you should recover within days.

But for elderly people or those who suffer from chronic illnesses, Leshem says norovirus can cause severe disease, which may occasionally result in hospitalization and even death. He would advise such travelers to follow up to make sure the ship has followed the CDC’s guidance and recommendations for outbreaks.

Have a travel dilemma for By The Way Concierge? Send it to us here.

Ungerleider says those high-risk travelers may want to consider rebooking their trip for the peace of mind alone.

But not all cruise ships are the same, Boden-Albala says; you can allay some of your fears by choosing ships that come with less risk. Because norovirus risks increase when you have lots of people inside close quarters, look for smaller ships that carry fewer passengers and give you lots of opportunities to spend time outdoors. (So, not a ship like this .)

On board, Boden-Albala avoids crowded situations. “I rarely use a buffet,” she says.

Most importantly, wash your hands a lot. Boden-Albala says this is the best measure you can take to protect yourself and your loved ones from the potential spread of disease. Do it the way you relearned during the pandemic: with soap and warm water for at least 20 seconds, scrubbing around and under your fingernails and between your fingers. Do it not just before eating or drinking, but also before brushing your teeth, blowing your nose, changing a diaper, et cetera.

“You must be diligent beyond your common understanding of when to wash your hands, because there are millions of norovirus particles spreading in various areas,” Boden-Albala says.

You can use hand sanitizer in addition to — but not as a substitute for — hand-washing, as Boden-Albala notes that it doesn’t do well against norovirus on its own.

Lastly, “if you see someone sick like vomiting or having diarrhea, remove yourself from the area and notify cruise staff if they are not already aware,” Boden-Albala says.

Hannah Sampson contributed to this report.

More travel tips

Vacation planning: Start with a strategy to maximize days off by taking PTO around holidays. Experts recommend taking multiple short trips for peak happiness . Want to take an ambitious trip? Here are 12 destinations to try this year — without crowds.

Cheap flights: Follow our best advice for scoring low airfare , including setting flight price alerts and subscribing to deal newsletters. If you’re set on an expensive getaway, here’s a plan to save up without straining your credit limit.

Airport chaos: We’ve got advice for every scenario , from canceled flights to lost luggage . Stuck at the rental car counter? These tips can speed up the process. And following these 52 rules of flying should make the experience better for everyone.

Expert advice: Our By The Way Concierge solves readers’ dilemmas , including whether it’s okay to ditch a partner at security, or what happens if you get caught flying with weed . Submit your question here . Or you could look to the gurus: Lonely Planet and Rick Steves .

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Norovirus Outbreaks on Cruise Ships: How to Avoid Getting Sick on Vacation

• There have been 13 norovirus outbreaks on cruise ships in 2023.
• Experts note that the highly congested environment, as well as the fact that people have not been exposed to as many illnesses due to the COVID-19 pandemic, are likely the reason for the increased norovirus numbers.
• Experts recommend maintaining proper hygiene habits and contacting the ship’s medical facility as soon as you don’t feel well in order to avoid spreading illnesses while at sea.

Multiple cruise lines are experiencing norovirus outbreaks.

There have currently been 13 norovirus outbreaks on cruise ships in 2023. The most recent outbreak occurred on a Viking Cruises ship, which traveled from Iceland and docked in New York City. About 13% of its passengers and several crew members became ill with the virus while on board.

With more than 31 million passengers worldwide expected to set sail this year, experts told Health that these highly-congested environments—along with the fact that people have not been exposed to a normal amount of illnesses due to the pandemic—could be the reasons for the increased numbers.

“Loosening of restrictions after the COVID-19 pandemic makes us more susceptible to picking up viruses after several years in seclusion,” Sanjiv Shah, MD, MPH , an infectious disease specialist and chief medical officer for MetroPlusHealth, New York City’s public health insurance program, told Health.

“Children who have been able to avoid the virus during the pandemic are now being exposed to viruses that tend to peak during the school year,” he said. “While norovirus is higher this year, the numbers are not a big outlier compared to pre-pandemic levels.”

Getty Images / Michael Dunning

What Is Norovirus?

Norovirus is the most common cause of gastroenteritis and foodborne illness . Though people often call it the “ stomach flu ,” it has nothing to do with flu, Brian Labus, PhD, MPH, REHS , an expert in infectious diseases, told Health .

“You have to swallow the virus to get sick,” Labus, an assistant professor in the Department of Epidemiology and Biostatistics at the UNLV School of Public Health, said. “That can be through consuming contaminated food or touching a contaminated surface and then touching your mouth or not washing your hands before you eat.”

Norovirus, which causes inflammation of the stomach or intestines, typically causes diarrhea , vomiting, nausea, and stomach pain Bernadette Boden-Albala, DrPH, MPH , director and founding dean of the Program in Public Health at the University of California Irvine told Health . Other symptoms can include fever, headache, and body aches.

Typically, norovirus lasts for one to three days, though you can spread the illness for a few days after.

“Infected people spread the virus widely and make it difficult for public health officials to contain the virus,” Boden-Albala said.

Why the Number of Norovirus Outbreaks Increased

The exact cause for the increase in the number of norovirus cases is not clear, but the increasing demand for cruises could be one explanation for the rise in reported cases, said Labus.

During COVID, the options for cruises were limited, but now that restrictions have been lifted , more people are deciding to take that cruise they had been putting off.

People also are more likely to get sick now since pandemic restrictions have been lifted. For the past few years, people have not been exposed to as many common viruses and illnesses and now that exposure is rising, illnesses are bound to rise as well.

It also is possible the numbers for norovirus on cruise ships appear more alarming than they truly are.

On cruise ships, health officials are legally required to track any illnesses that occur, while this same reporting is not required on land. For this reason, the Centers for Disease Control and Prevention note that outbreaks are reported more frequently on sea than on land.

“The risk of getting norovirus each year is about 1 in 15 [but] a cruise passenger has about a 1 in 5,500 risk of getting norovirus,” Sally Andrews, vice president of strategic communications and public affairs for the Cruise Lines International Association told Health .

Environments Where Norovirus Spreads Quickly

According to Shah, norovirus spreads rapidly anywhere there are large groups of people, like school classrooms, family gatherings, and weddings.

Cruise ships in particular have many of the conditions that make people susceptible to norovirus—close quarters, enclosed spaces, communal dining, and high turnover of passengers.

“The virus is often associated with cruise travel simply because health officials are required to track illnesses on ships,” Shah said. “The CDC estimates only about 1% of annual U.S. norovirus cases happen on cruise ships. Rates are much higher in schools, nursing homes, hospitals, and restaurants, which collectively account for about 91% of cases.”

Minji Kang, MD, an assistant professor and infectious disease specialist in the Department of Internal Medicine at UT Southwestern Medical Center added that norovirus can also be brought onboard by contaminated food or water, or passengers who were infected while ashore.

Yes, Cruise Ships Have Strategies to Prevent Outbreaks

Because norovirus outbreaks can flare up in the close quarters of a ship, the cruise industry has had norovirus prevention programs in place for nearly 20 years, Labus said. “They have the right chemicals needed to control it and the plans and training for how to use them appropriately.”

Cruise ships also have plans for how to deal with ill guests to ensure that they are not infecting other passengers, he said. “It’s important to let the ship’s medical staff know if you are sick so that they can protect the rest of the passengers.”

According to the American College of Emergency Physicians (ACEP), every cruise ship must have a place to isolate any passengers who have a contagious disease. This step helps them minimize the risk of spreading the disease to others.

What’s more, the CDC has established a rigorous Vessel Sanitation Program (VSP) to help prevent the overall spread of illnesses on cruise ships. Not only do they inspect a cruise ship’s medical center, but they also monitor their portable water systems, dining rooms, housekeeping procedures, heating, ventilation, air conditioning (HVAC) systems, and more.

If a cruise ship does not do well on its inspection—or gets an 85% or lower—it cannot set sail until it corrects the issues.

Staying Healthy While on a Cruise

While there have been 13 outbreaks of norovirus on cruise ships this year, Labus explained that not every cruise passenger is going to be exposed to the virus. Still, taking certain steps to prevent the likelihood of getting sick is never a bad idea.

“The most important measure to prevent the spread of norovirus is to wash your hands with soap and water for at least 20 seconds,” said Kang. “This should be done before eating and drinking, brushing one’s teeth, and after going to the bathroom, touching high-hand contact surfaces, and taking care of a sick person.”

She noted that hand sanitizers do not work well against norovirus and that they are not a substitute for handwashing.

For extra peace of mind, you can also research your cruise line prior to booking.

To see how your specific cruise line performed on its VSP inspections, you can visit the CDC website and search their portal. This site also lists any corrective actions taken to remedy any issues. You can even look for cruise lines that have scored a perfect 100.

If you do happen to get sick while on a cruise, Boden-Albala recommends that you follow CDC guidelines and report your illness to the ship’s medical facility as soon as possible. “[You also should] rest and drink plenty of water to rebuild your immunity system and prevent dehydration.”

Even though you may be tempted to conceal your illness, you would be doing a great disservice to the other passengers and the crew on the cruise by keeping it a secret.

“While staying in your cabin [for a day or two] may not make for the best vacation,” Shah said, “it’s important to take precautions to avoid infecting others.”

Centers for Disease Control and Prevention. Outbreak updates for international cruise ships .

Cruise Lines International Association. State of the cruise industry 2023 .

Centers for Disease Control and Prevention. Symptoms of norovirus .

Centers for Disease Control and Prevention. Facts about noroviruses on cruise ships .

Cruise Lines International Association. Norovirus on cruise ships .

American College of Emergency Physicians. Healthcare guidelines for cruise ship medical facilities .

Centers for Disease Control and Prevention. Vessel sanitation program: inspection infographic .

Centers for Disease Control and Prevention. Advanced cruise ship inspection search .

Centers for Disease Control and Prevention. Cruise ship inspection scored 100 .

Related Articles

After months of norovirus outbreaks on cruise ships, a smoothie is finally implicated

It was a whodunit on the high seas: For several months in the summer of 2019, a handful of passengers on 10 European cruises came down with acute stomach bugs .

The passengers were on different ships that departed from July to September. All of the patients, however, were on ships from the same cruise line and had the same symptoms: a rapid onset of vomiting and diarrhea that lasted about 24 hours.

The Centers for Disease Control and Prevention published a report on the cruise ship outbreaks Thursday. The report did not name the cruise ship line.

Throughout the summer, the cruise line investigated the source of the outbreak, extensively testing possible foods, but no culprit was identified, the report said.

That changed on Sept. 18, 2019, when the CDC was informed that one of the cruise ships was sailing into U.S. jurisdiction. The agency’s Vessel Sanitation Program was informed of an outbreak that had sickened 117 passengers and eight crew members on a ship sailing from Germany to New York City. Stool samples revealed that the passengers and crew members were sickened with norovirus , a common stomach virus. However, the source of the virus remained unknown.

Health 5 Things You Didn't Know About Nasty Norovirus

One month later, a second outbreak occurred on the same cruise ship, which, by that point was carrying different passengers and sailing from Montreal to New York City. At the same time, another ship, also from the same cruise line, also experienced a norovirus outbreak. This ship was sailing along the U.S.’s Eastern Seaboard, leaving from and returning to New York City.

Sick passengers were asked to fill out food questionnaires, and on the second ship, 80 percent said they had consumed a smoothie made from frozen fruits and berries. Further testing of the frozen fruit found that the raspberries, along with the tropical fruit cocktail and the berry mix, tested positive for norovirus.

The same berries were found on both ships, the CDC report concluded. In fact, further investigation revealed that the cruise line had purchased nearly 22,000 pounds of frozen raspberries from a single supplier in China beginning in June 2019. The findings led the World Health Organization to issue a recall for the frozen raspberries in November 2019.

After the frozen raspberries were removed from the ships, no further outbreaks were reported.

Follow NBC HEALTH on Twitter & Facebook .

Sara G. Miller is the health editor for NBC News, Health & Medical Unit. 

Guidance for the Management of Norovirus Infection in Cruise Ships

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Norovirus on Cruise Ships

• Cruise Industry Regulation
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• Incidents of norovirus or other gastrointestinal (GI) disease are quite rare on cruise ships. The Centers for Disease Control and Prevention (CDC) reports that 20 million people on land in the U.S. come down with norovirus every year.
• In the U.S., the risk of getting norovirus each year is about 1 in 15; a cruise passenger has about a 1 in 5,500 risk of getting laboratory-confirmed norovirus during a shipboard outbreak.

What is Norovirus?

Worldwide Industry Facts

• Worldwide, norovirus is the leading cause of acute gastroenteritis. About 1 in 5 cases of acute gastroenteritis, which leads to diarrhea and vomiting, is caused by norovirus.

Incorrectly Called the Cruise Ship Disease

• While global information on norovirus outbreaks is not available, the CDC runs the Vessel Sanitation Program (VSP) , which collects the total number of GI illness cases on cruise ships before the ship arrives at a U.S. port, when sailing from a foreign port.
• “Cases of acute gastroenteritis illness on cruise ships are relatively infrequent.”
• “Collaborative efforts with the cruise industry have allowed VSP to provide more rapid support to cruise lines and ships experiencing higher than expected levels of acute gastroenteritis.”
• “Fewer and less severe outbreaks are likely the result of earlier detection of acute gastroenteritis, along with cruise industry efforts to identify and control outbreaks.”

Preventing Norovirus Onboard

• Cruise lines do their part to ensure a healthy cruise experience and that passengers and crew maintain good hygiene onboard.  
• Cruise ship crew members employ strict cleaning and sanitation practices developed with the CDC and other public health authorities.
• The best way to prevent norovirus is thorough, frequent hand washing, taking care of yourself by getting plenty of rest and drinking lots of water, and being aware and considerate of other people’s health.
• All of the efforts made by cruise ship crews cannot replace the responsibility that rests with each and every individual. Passengers and crew alike must also be committed to keeping themselves, their family and their fellow travelers healthy.

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Cruise Etiquette: How to Avoid Getting Sick on a Cruise

I f you’ve been on a cruise recently, you may have noticed the great lengths to which crew members go to remind passengers to wash their hands. On Royal Caribbean’s Icon of the Seas , staff dressed as hot dogs and pizza slices stand by the food hall imploring guests to disinfect before eating. On some ships, crew stationed in the bathroom repeat “washy washy" on loop while others sing catchy jingles and dole out hand sanitizer like candy.

While this may seem overkill, healthy hand washing habits can make the difference between the vacation of a lifetime and a travel horror story. From norovirus outbreaks to pandemic quarantines, it’s no secret that cruise ships are not immune (pun intended) to the occasional health scare—to the point that they’ve developed a bit of a reputation among germaphobes.

Unfortunately, the close quarters of cruise ships can make the vessels good environments for spreading a variety of ailments. But the good news is that cruise ships follow stringent health regulations and reporting requirements, and are subject to random sanitation inspections in the US.

But what can travelers do to avoid getting sick on a cruise? Sally Andrews, vice president of strategic communications and public affairs for the Cruise Lines International Association (CLIA), the world’s largest cruise industry trade association, advises that passengers exercise the same sensible health practices that they do on land. “This includes thorough and frequent hand washing, protecting the health of others if they start to not feel well, and contacting the ship’s medical staff as they would at home based on their individual health needs,” she tells Condé Nast Traveler.

For those looking for more in-depth guidance, the US Centers for Disease Control and Prevention (CDC) maintains a set of health guidelines specifically for cruise passengers. Some of the CDC’s suggestions are simply good travel advice that isn’t particularly cruise-related, like keeping up-to-date on regular vaccinations, checking with a doctor or travel health specialist if any additional vaccines or boosters might be necessary based on the itinerary's ports of call, and staying home if you feel sick in the days immediately leading up to the cruise. (Most cruise line and third-party travel insurance providers will cover cancellations if a medical provider advises you not to travel.)

Specific to cruising, the CDC recommends frequent hand washing and hand sanitizing (more often than on shore) and wearing a mask in crowded or poorly ventilated areas. Hand washing and sanitizing is particularly effective, the CDC notes, in preventing norovirus, which causes a gastrointestinal illness characterized by vomiting, stomach cramps, and diarrhea.

CLIA says that norovirus is rare on cruise ships when compared to the general risk in the US, but outbreaks do seem to be reported with some frequency. In 2023, there were 14 reports of gastrointestinal outbreaks onboard cruise ships arriving in the US (out of thousands of sailings), and all but one was attributed to norovirus.

Captain Luis Rodriguez, the acting chief of the CDC Vessel Sanitation Program, notes that the CDC reported more cruise ship outbreaks in 2023 than 2022, but there was also an increase in shoreside cases during this time. Rodriguez, who holds a graduate degree in public health, explains that the CDC directly “tracks illnesses on cruise ships, so cases are found and reported more quickly on a cruise ship than on land” (which relies on state and local health departments to collect data and report to the agency separately).

“Norovirus outbreaks commonly occur in crowded living accommodations or communities where persons are physically close,” Rodriguez says. “Pathogens that cause norovirus outbreaks can spread quickly in closed and semi enclosed environments, such as a cruise ship.” In short, any crowded space comes with higher transmission risks, and since the reporting requirements of illnesses on cruise ships are so stringent, outbreaks can appear more common than they actually are.

In order to help prevent and control the spread of gastrointestinal illnesses on cruises, all ships are subject to inspection by the CDC when operating in US ports and territorial waters. The inspection results (including every nitty gritty detail) are publicly available on the CDC website —curious passengers can check out how their ship performed during past inspections by using the site's search function.

Because cruise line medical staff track the number of illnesses and likely causes, it’s important that travelers alert the onboard medical team when they feel unwell. This not only allows for accurate reporting to authorities, it also gives onboard teams a chance to prevent disease from spreading by beefing up sanitation protocols during the sailing.

But even passengers who take precautions to avoid transmittable illnesses can be subject to the oldest of seagoing maladies—the old mal de mer, or seasickness , chief among them. Thankfully, most modern cruise ships have sophisticated stabilizer systems which significantly curtail pitch and roll, even in rough seas—leaving many would-be sufferers almost unaware of any movement from the ship at all.

Seasickness is caused by an imbalance between the perception and realities of motion, and conventional wisdom is to keep the horizon in the line of sight. Travelers particularly prone to motion sickness or worried about being affected might prefer balcony staterooms for this reason. There are also a number of over-the-counter medications, available in pill or patch form, that travelers can take with them to treat seasickness. If a bout of nausea catches a passenger by surprise, ship medical staff generally carry a generous supply on board.

If you do get sick on a cruise, rest assured that international maritime law requires virtually all passenger ships to employ a medical doctor onboard. The 50-plus major cruise lines that belong to CLIA go a step further and are required to train clinical staff members in advanced life support, and additionally have defibrillators, cardiac monitors, X-ray machines, and lab equipment onboard.

At the end of the day, cruise ship crew members and passengers each do their part to keep everyone on board happy and healthy during their sailing. Just remember, washy washy!

Condé Nast Traveler does not provide medical advice, diagnosis, or treatment. Any information published on this website or by this brand is not intended as a substitute for medical advice, and you should not take any action before consulting with a healthcare professional.

Notes from the Field: Multiple Cruise Ship Outbreaks of Norovirus Associated with Frozen Fruits and Berries — United States, 2019

Weekly / April 24, 2020 / 69(16);501–502

Jared R. Rispens, MD 1 ,2 ; Amy Freeland, PhD 2 ; Beth Wittry, MPH 2 ; Adam Kramer, ScD 2 ; Leslie Barclay, MPH 3 ; Jan Vinjé, PhD 3 ; Aimee Treffiletti, MPH 2 ; Keisha Houston, DrPH 2 ( View author affiliations )

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From July to September 2019, cruise line X experienced sudden, unexplained outbreaks (>3% of the passenger population) of acute gastroenteritis (AGE) among passengers on 10 cruise ships sailing in Europe. The rapid onset of vomiting and diarrhea followed by recovery within 24 hours were consistent with norovirus infection. Investigations by the cruise line throughout the summer yielded no clear source of the outbreaks even after extensive food testing. On September 18, 2019, CDC’s Vessel Sanitation Program (VSP) was notified of an outbreak of AGE on cruise ship A of cruise line X, sailing into U.S. jurisdiction (defined as passenger vessels carrying ≥13 passengers sailing to the United States from a foreign port) from Germany to New York City ( 1 ). By the end of the 19-day voyage on September 23, a total of 117 of 2,046 (5.7%) passengers and eight of 610 (1.3%) crew members met the case definition for AGE (three or more loose stools within a 24-hour period or more than normal for the patient, or vomiting plus one other sign or symptom including fever, diarrhea, bloody stool, myalgia, abdominal cramps, or headache). Four stool specimens were collected and tested for norovirus at CDC’s National Calicivirus Laboratory; three tested positive for norovirus by quantitative reverse transcription–polymerase chain reaction (RT-PCR). No outbreak source was determined after a field investigation by a VSP team on September 22.

The following month, on October 7, CDC’s VSP was notified of two more outbreaks in U.S. jurisdiction. The first outbreak occurred on another ship (ship B) of cruise line X sailing to and from New York City along the eastern seaboard and affected 85 (3.9%) of 2,166 passengers and 10 (1.6%) of 612 crew members; the second outbreak occurred on ship A sailing from Montreal to New York City and affected 83 (3.7%) of 2,251 passengers and 10 (1.6%) of 610 crew members. VSP again conducted outbreak investigations on October 12 (ship B) and October 13 (ship A). Five stool specimens from ship B and two from ship A were collected for laboratory testing. During the field investigations, cruise line X’s public health officials reported to VSP that after reviewing food questionnaires completed by ill passengers on ship B, nearly 80% of completed questionnaires implicated a smoothie made from frozen fruits and berries. Because of the epidemiologic link and because berries have been implicated in past outbreaks ( 2 , 3 ), CDC requested assistance from the Food and Drug Administration (FDA) to collect frozen fruit and berry items from ship B for norovirus testing. Food item lot numbers from ship B matched those from the same frozen fruit and berry items on ship A.

Overall, nine of 11 stool samples from the three outbreak voyages on ships A and B tested positive for norovirus by quantitative RT-PCR at CDC; these included three of four from ship A’s first voyage, four of five from ship B, and two of two from ship A’s second voyage. The samples were typed as GII.2[P16]. FDA tested 16 frozen fruit and berry items, and three items tested positive for norovirus: raspberries (norovirus genogroup II), tropical fruit cocktail (norovirus genogroup I), and berry mix (norovirus genogroup I). Norovirus sequences from the stool samples and from raspberries were 97.5% similar. After removal of the fruit items, no further outbreaks were reported on cruise line X.

Upon further review of food provisioning, cruise line X determined that its food vendor had purchased several containers (nearly 22,000 pounds) of frozen raspberries of the same lot from a supplier in China beginning the end of June 2019. These raspberries had been supplied to the entire fleet of cruise line X. Both the epidemiologic and laboratory data implicated the raspberries as the cause of the outbreaks. As a result of these findings, on November 11, the World Health Organization issued a recall notice* for frozen raspberries traced back to China. This investigation highlights the importance of AGE surveillance at sea to prevent transmission of AGE illness through U.S. ports and to identify contaminated foods at sea that had not yet been implicated on land.

Acknowledgments

Aron Hall, Division of Viral Diseases, National Center for Immunizations and Respiratory Diseases, CDC; Meghan Holst, ORISE fellow, Division of Environmental Health Science and Practice, National Center for Environmental Health, CDC; Nicole Vaught, Food and Drug Administration (FDA); Yuyan Liang, Tracy Portelli, FDA; FDA food laboratories.

Corresponding author: Jared R. Rispens, [email protected] , 404-498-5990.

1 Epidemic Intelligence Service, CDC; 2 Division of Environmental Health Science and Practice, National Center for Environmental Health, CDC; 3 Division of Viral Diseases, National Center for Immunizations and Respiratory Diseases, CDC.

All authors have completed and submitted the International Committee of Medical Journal Editors form for disclosure of potential conflicts of interest. No potential conflicts of interest were disclosed.

* https://webgate.ec.europa.eu/rasff-window/portal/?event=notificationDetail&NOTIF_REFERENCE=2019.3843 .

• CDC. Vessel sanitation program 2018 operations manual. Atlanta, GA: US Department of Health and Human Services, CDC; 2018. https://www.cdc.gov/nceh/vsp/docs/vsp_operations_manual_2018-508.pdf
• Food and Drug Administration. FDA sampling frozen berries for harmful viruses. Silver Spring, MD: US Department of Health and Human Services, Food and Drug Administration; 2020. https://www.fda.gov/food/cfsan-constituent-updates/fda-sampling-frozen-berries-harmful-viruses
• Food and Drug Administration. Microbiological surveillance sampling: FY 19–20 frozen berries (strawberries, raspberries and blackberries). Silver Spring, MD: US Department of Health and Human Services, Food and Drug Administration; 2020. https://www.fda.gov/food/sampling-protect-food-supply/microbiological-surveillance-sampling-fy-19-20-frozen-berries-strawberries-raspberries-and

Suggested citation for this article: Rispens JR, Freeland A, Wittry B, et al. Notes from the Field: Multiple Cruise Ship Outbreaks of Norovirus Associated with Frozen Fruits and Berries — United States, 2019. MMWR Morb Mortal Wkly Rep 2020;69:501–502. DOI: http://dx.doi.org/10.15585/mmwr.mm6916a3 .

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