illness hits cruise ship

More than 175 people fall ill in Celebrity Cruises norovirus outbreak

More than 175 people got sick with norovirus during a recent Celebrity Cruises’ sailing, the Centers for Disease Control and Prevention said.

The agency said 152 of the Celebrity Summit ship’s 2,144 passengers, as well as 25 crew members, reported being ill during its May 15 voyage, according to its website . Their main symptoms were diarrhea, vomiting, abdominal cramps and headache.

"The health and safety of our guests, crew and communities we visit are our top priority," a Celebrity spokesperson said in an emailed statement. "To maintain the highest levels of health onboard our ships, we implement rigorous safety and cleaning procedures, many far exceeding public health guidelines. Combined, these efforts allow us to maintain some of the lowest levels of community spread."

The cruise line and ship’s crew implemented heightened “cleaning and disinfection procedures according to the ship’s outbreak prevention and response plan,” notified guests and encouraged practicing good hand hygiene and reporting illness, according to the agency. They also provided reports of gastrointestinal illness cases to the CDC’s Vessel Sanitation Program twice a day during the outbreak investigation, among other steps.

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The incident marks the third norovirus outbreak on Celebrity ships the CDC has posted this year. The line previously saw outbreaks on its Celebrity Equinox and Celebrity Constellation vessels in March. On Celebrity Equinox, 136 passengers and crew reported being ill, while 96 did so on Celebrity Constellation.

Gastrointestinal illness at sea plummeted during the COVID-19 pandemic, but cases have ticked up again as the industry has rebounded.

While norovirus is frequently associated with cruise ships, Ben Lopman, a professor of epidemiology at Emory University’s Rollins School of Public Health, told USA TODAY in February that those represent a "tiny minority of norovirus outbreaks.” The vast majority take place in health care settings like nursing homes, he said.

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

Weekend Rundown: Here's the biggest news you missed this weekend

Nearly 140 people onboard a cruise ship sick in gastrointestinal illness outbreak

Around 140 people have fallen sick with a gastrointestinal illness onboard the Cunard Queen Victoria cruise ship that docked in Fort Lauderdale, Florida, on Jan. 22 when the CDC began monitoring the outbreak.

According to the U.S. Centers for Disease Control and Prevention , 123 passengers and 16 crew members have reported being ill during a three-week leg of the voyage as of Thursday. Around 1,800 passengers and 960 crew members are onboard the ship in total.

The predominant symptoms of the gastrointestinal illness include diarrhea and vomiting. The cause of the outbreak remains unknown, according to the CDC.

The Queen Victoria is on a 107-night world voyage. The cruise ship is scheduled to stop in San Francisco on Feb. 6 and Honolulu on Feb. 12 before sailing to countries in Oceania, according to the Cunard website . 

In response to the outbreak, the Queen Victoria crew has reportedly "increased cleaning and disinfection procedures" and "isolated ill passengers and crew." 

"Cunard confirms that a small number of guests had reported symptoms of gastrointestinal illness on board Queen Victoria, Cunard Cruise Line told NBC News in a statement.

"They immediately activated their enhanced health and safety protocols to ensure the well-being of all guests and crew on board. Measures have been effective,” Cunard added.

The CDC's Vessel Sanitation Program continues to remotely monitor the situation, including "reviewing the ship's outbreak response and sanitation procedures."

Medical staff on cruise ships under U.S. jurisdiction are required to report gastrointestinal illness cases to the Vessel Sanitation Program when at least two percent of people onboard are infected.

Katherine Itoh is a news associate for NBC News.

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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.

Watch CBS News

More than 300 sickened on Ruby Princess cruise ship, CDC says

By Aliza Chasan

March 8, 2023 / 12:32 PM EST / CBS News

Hundreds of passengers and crew members fell ill while on board a Princess Cruises ship, the Centers for Disease Control and Prevention said. 

In total, 284 of 2,881 passengers on the Ruby Princess reported being sick during the voyage between Feb. 26 and March 5, CDC investigators said , and 34 of the 1,159 crew members also reported illness. The symptoms reported were vomiting and diarrhea.

The CDC's Vessel Sanitation Program epidemiologists and environmental health officers responded to the ship when it docked in Galveston, Texas on March 5, the agency said. They have not yet determined what caused the illnesses. 

Crew on the ship cleaned more frequently and used disinfection procedures once the outbreak began, the CDC said. They also collected stool samples for CDC analysis. 

Workers also directed sick passengers to isolate themselves in their rooms, a Princess Cruises spokesperson said. The company said the sickness was likely caused by norovirus, a very contagious virus that causes vomiting and diarrhea. Norovirus, which is sometimes called the "cruise ship virus," causes more than 90% of diarrheal disease outbreaks on cruise ships , according to the CDC.

The Ruby Princess has since embarked on a new voyage, the company said. The latest group of passengers, currently on a seven-day Caribbean cruise, were told about the increased illnesses on the previous trip.

The Ruby Princess has made headlines in the past as the site of several COVID-19 outbreaks , including a 2020 cruise early in the coronavirus pandemic that docked in Australia with hundreds of positive cases on board.

In recent years, the CDC monitored COVID-19 outbreaks on cruise ships. The program tracking cases ended in July of 2022. 

Aliza Chasan is a digital producer at 60 Minutes and CBSNews.com. She has previously written for outlets including PIX11 News, The New York Daily News, Inside Edition and DNAinfo. Aliza covers trending news, often focusing on crime and politics.

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Celebrity Cruises norovirus outbreak leaves more than 175 sick, CDC says

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More than 175 people reported feeling sick with norovirus during a recent  Celebrity Summit cruise to Bermuda, the Centers for Disease Control and Prevention (CDC) says. 

The outbreak, which happened on the voyage from May 15 to 25, affected 152 of the 2,144 passengers onboard and 25 crew members, according to the CDC. 

Those who became ill suffered symptoms such as diarrhea, abdominal cramps, vomiting and headaches. 

The CDC said that in response to the outbreak, the Summit’s crew "Increased cleaning and disinfection procedures according to the ship’s outbreak prevention and response plan" and "Notified current guests of the situation onboard and encouraged illness reporting and good hand hygiene." 

CARNIVAL CRUISE SHIP ROCKED BY ROUGH SEAS, SEVERE WEATHER, SHAKING SOME PASSENGERS  

It also "Collected and sent stool specimens from gastrointestinal illness cases to the CDC laboratory." 

A Celebrity Cruises spokesperson told FOX Business in a statement Tuesday that "The health and safety of our guests, crew and communities we visit are our top priority.  

The French-made cruise ship "Celebrity Edge" of the US company of tourism cruise, Celebrity Cruise, leaves the shipyards of Saint-Nazaire to go to Miami, United States, on November 4, 2018 in Saint-Nazaire, western France. (Photo by SEBASTIEN SALOM G

"To maintain the highest levels of health onboard our ships, we implement rigorous safety and cleaning procedures, many far exceeding public health guidelines," the spokesperson added. "Combined, these efforts allow us to maintain some of the lowest levels of community spread." 

The Summit’s round-trip voyage, according to the website CruiseMapper, left Bayonne, New Jersey, before making stops in Bermuda, Charleston, South Carolina, Newport, Rhode Island, and Martha’s Vineyard, Massachusetts. 

It was the third norovirus outbreak aboard a Celebrity Cruises ship this year, CDC data shows. 

MAN’S BODY STORED IN DRINK COOLER AFTER HE DIES ON CELEBRITY CRUISE: LAWSUIT  

During two weeks in March, norovirus outbreaks were reported on Celebrity’s Equinox and Constellation ships. 

In the Equinox outbreak, 122 of its 2,579 passengers and 14 crew members reported experiencing "vomiting and diarrhea" during a voyage from March 9 to 18, according to the CDC. 

RELATED: Sick workers linked to 40% of restaurant food poisoning outbreaks, CDC says

That ship departed from Fort Lauderdale, Florida, and made stops in the Cayman Islands, Aruba, Curacao and Bonaire. 

In the Constellation outbreak, 87 of its 2,062 passengers and nine crew members suffered the same norovirus symptoms during a voyage from March 6 to 17. 

That ship left Tampa, Florida, and made stops in Key West, Cartagena, Colombia, Panama, Costa Rica and Mexico.

The CDC says on its website that norovirus outbreaks can happen anytime, but occur "most often from November to April." 

"Norovirus is the leading cause of vomiting and diarrhea, and foodborne illness in the United States," it adds. "People of all ages can get infected and sick with norovirus, which spreads very easily and quickly." 

Find out more about this story at FOXBusiness.com .

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

The Associated Press

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

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

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

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

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

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

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

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

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

Coronavirus Updates

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

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

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

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

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

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

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

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

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More than 100 passengers ill on Cunard cruise ship after sickness outbreak

Enhanced health and safety protocols were activated on the vessel, the operator said, article bookmarked.

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More than 100 passengers on a cruise holiday gave fallen ill after an outbreak of sickness on a Cunard ship.

Of the 1,824 on board Queen Victoria, 116 have suffered some form of gastrointestinal illness, according to the US Centers for Disease Control and Prevention (CDC) – around 6 per cent all passengers .

Fifteen crew members have also been sick, with the main symptoms reported as diarrhoea and vomiting.

Queen Victoria, which has been in service since 2007, is currently sailing a 107-night world voyage, and departed from Southampton on 11 January. It is due to return to the UK port at the end of April.

The current leg of the voyage is a 16-night cruise between Florida ’s Port Everglades and San Francisco, California . The sailing departed on 22 January, and some passengers disembarking on 7 February.

The CDC reported that issues began on 22 January, and that currently no cause is known. The Vessel Sanitation Program is “remotely monitoring the situation”.

In response to the outbreak, the crew increased cleaning and disinfection procedures – according to the ship’s outbreak prevention and response plan – and isolated the ill passengers and crew.

A spokesperson for the cruise line told The Independent : “Cunard confirmed that a small number of guests had reported symptoms of gastrointestinal illness on board Queen Victoria.

“They immediately activated their enhanced health and safety protocols to ensure the wellbeing of all guests and crew on board.”

The incident comes just weeks after almost 100 passengers on a Celebrity Cruises ship, Celebrity Constellation, contracted norovirus after it departed from Florida on 3 January.

The health agency recorded 14 incidents of gastrointestinal illness in 2023 that breached its threshold for public notification, and it states that although people “often associate cruise ships with acute gastrointestinal illnesses”, such as norovirus, outbreaks are “relatively infrequent” on the vessels.

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• CruiseMapper
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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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140 Passengers Sick with Gastrointestinal Illness on 55-Day Cruise Aboard Queen Victoria, CDC Says

According to the Centers for Disease Control, the outbreak affected 128 of the 1,824 passengers on the ship and a number of crew members

A gastrointestinal illness has left nearly 140 passengers traveling on the Cunard Queen Victoria cruise ship sick.

According to the Centers for Disease Control , the outbreak affected 128 of the 1,824 passengers on the ship. Amongst the crew, 25 of the 967 staff reported catching the illness. Their symptoms include diarrhea and vomiting.

The CDC reported that the cause of the illness and how it spread remains unknown.

In response the the outbreak, the CDC also confirmed in their statement that the Cunard Cruise Line and the crew aboard the ship have increased cleaning and disinfection procedures. They've also recommended that sick passengers remain isolated.

Cunard Cruise Line did not immediately respond to PEOPLE's request for comment.

Never miss a story — sign up for  PEOPLE's free daily newsletter  to stay up to date on the best of what PEOPLE has to offer, from juicy celebrity news to compelling human interest stories.

"Cunard confirms that a small number of guests had reported symptoms of gastrointestinal illness on board Queen Victoria," the company told NBC News in a statement.

"They immediately activated their enhanced health and safety protocols to ensure the well-being of all guests and crew on board. Measures have been effective,” Cunard added.

The ship's 55-day voyage began in Southampton, U.K. on January 9, according to ship tracking site Cruise Mapper . It reached Ft. Lauderdale, Florida on Jan. 22, shortly after which the spread seems to have begun, per ABC .

It is currently in San Francisco and bound for Hawaii, after which it will continue on to Australia by march 4. The Vessel Sanitation Program is also currently monitoring the situation.

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

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

Rachel Nania and Nicole Gill Council,

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

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

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

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

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

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

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

1. Flu and other respiratory illnesses

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

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

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

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

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

2. Norovirus

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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4. Seasickness

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

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

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

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

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

A few other things that can help with seasickness:

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

5. Burns and bites

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

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

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

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

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

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

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

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• Cruise News

Gastro Outbreak Hits Luxury Cruise Ship

• April 18, 2024

The Centers for Disease Control and Prevention (CDC) reported a gastrointestinal viral outbreak that sickened several cruise ship guests earlier this week.

Twenty-eight guests on Silversea Cruises’ Silver Nova, along with one crew member, fell ill. This represented over 4% of the passengers aboard (required for CDC reporting). 

Fourth cruise ship outbreak of the year

The CDC monitored the outbreak as the ship completed a 16-day sailing and docked at Port Everglades earlier this week.

The ship departed Peru and made several port calls in South America, the Caribbean, and Mexico. The CDC hasn’t confirmed this, although symptoms disclosed, like diarrhea, make Norovirus a possible cause. 

So far this year, three cruise ship outbreaks have been attributed to Norovirus: on Celebrity Constellation, Cunard’s Queen Victoria, and aboard Holland America Line’s ms Koningsdam .

The CDC said sick guests were isolated in their staterooms, and Silversea has implemented more stringent deep cleaning and disinfection measures.

The agency said the cruise line “made announcements of the outbreak, encourage case reporting, and encourage good hand hygiene.”

Silver Nova departed on Monday for a 20-night Panama Canal transit to San Francisco.

Silver Nova was christened in January 2024, and the CDC has yet to receive its bi-annual sanitation inspection from the Vessel Sanitation Program .

Last year, there were 14 cruise ship outbreaks, all but one of which were attributed to Norovirus. Princess Cruises and Celebrity Cruises each had three separate outbreaks.

The CDC said the Virgin Voyages ‘ Scarlet Lady illness was caused by salmonella and E. coli.

The CDC says the Norovirus bug can be extremely contagious and is the leading cause of foodborne illness.

It generally spreads through contaminated food and water or by touching surfaces or other objects already contaminated by the virus.

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Royal Caribbean's CEO says passengers would stop getting norovirus if they would just wash their hands

• Norovirus is a highly contagious virus that has symptoms resembling those of food poisoning or the flu. 
• That makes a dense, enclosed space like a cruise ship the perfect environment for the illness to spread.
• Even if a cruise ship enforces perfect hygiene, the illness can still spread from an infected person's respiratory system.

Norovirus might be a cruise line's worst nightmare.

The illness, whose symptoms resemble those of food poisoning or the flu, is highly contagious, which makes a dense, enclosed space like a cruise ship the perfect environment for the illness to spread. Norovirus is the most common cause of mass illness on cruise ships , and when it hits, it can hit hard, sometimes affecting hundreds of passengers on a single cruise .

Cruise lines can't do much to prevent norovirus

In an interview with Business Insider , Royal Caribbean CEO Michael Bayley said there isn't much a cruise line can do to prevent a norovirus outbreak. Even if employees maintain a high level of hygiene on the ship, one infected passenger can negate hours of careful cleaning. The illness is commonly spread through contact with infected vomit or fecal matter, which means that if an infected person doesn't wash his hands, he can put everyone around him at risk.

Related stories

According to Bayley, the simplest and most effective way to prevent a norovirus outbreak is for passengers to regularly wash their hands. That's  Royal Caribbean reminds passengers to wash their hands through animated videos that play on screens throughout their ships.

"The simple fact is that if people washed their hands, there would be no norovirus," Bayley said.

But personal hygiene isn't always enough, according to Michael Osterholm, director of the University of Minnesota's Center for Infectious Disease Research and Policy. In addition to physical contact, the illness can also spread from an infected person's respiratory system, which means that simply breathing the same air as an infected person can leave you vulnerable.

Some people are immune to it, some aren't

And a person can become contagious twelve hours before he shows any symptoms, so it can be difficult to tell if a given passenger may be a risk in some cases. Often, a cruise ship is at the mercy of its passengers.

"They can do everything perfect in terms of food and safety and overall ship hygiene, but the problem is, if someone comes on board with norovirus at the beginning of the trip, it's very possible in that closed environment that there'll be transmission to other passengers as well as staff," Osterholm told Business Insider.

The good news, for some people, is that you can be biologically immune to norovirus, so you won't get sick even if you come in contact with someone who's infected. But if you aren't immune, there's nothing to prevent you from contracting norovirus "over and over again," according to Osterholm.

"It just makes cruise ships or airplanes and things like that challenging environments."

Watch: This is what it takes to be a cruise ship performer

• Main content

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)

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Ukraine-Russia war latest: Fighting 'intensifies in eastern Ukraine as troops fall back'; UK estimates 450,000 Russian losses since war began

Gen Oleksandr Syrskyi says his troops have taken up new positions west of Berdychi, Semenivka and Novomykhailivka in order to conserve their forces while armed forces minister Leo Docherty tells the UK Defence Journal tens of thousands have deserted Russian's military since February 2022.

Sunday 28 April 2024 22:34, UK

• Fighting intensifies in eastern Ukraine as troops fall back
• UK minister estimates 450,000 Russian losses since war began
• Tajikistan citizens warned not to travel to Russia
• 'Well-provisioned' Ukrainian troops could prevent Russian advances
• Russia destroys 17 drones launched by Ukraine
• 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

That's all from our live coverage for tonight. For a reminder of today's updates, you can scroll back through this live blog. 

Volodymyr Zelenskyy has said Ukraine is still waiting for promised supplies from its allies, urging the international community to hurry up. 

In his nightly video address today, he said: "We are expecting those volumes and scope that can change the situation on the battlefield in Ukraine's interests." 

He also said he had spoken with US House minority leader Hakeem Jeffries, and had thanked Congress for passing the long-awaited aid package for Ukraine. 

"In my conversation with Mr Jeffries, I underscored that Patriot systems are needed, and as soon as possible," he said. 

Ukrainian forces are facing a worsening position in the east and are still awaiting the delivery of US weapons. 

Mr Zelenskyy has repeatedly called for more air defence systems to protect its citizens and infrastructure, particularly the Patriot systems. 

Russia will start restricting those called up for military service from leaving the country, according to news site Meduza. 

Electronic summonses will reportedly be sent out from 1 November.

Those who are called up will not be allowed to leave Russia, and they will face further restrictions if they do not go to a military registration and enlistment office within 20 days.

In that case, they will not be allowed to register to run a business, drive a car, take out loans, or conduct real estate transactions, Meduza said.

New satellite imagery appears to show damage at Russia's Kushchyovskaya military airbase in the Krasnodar region. 

Planet Labs shared images comparing how the base looked on 19 March compared with today. 

A source in Ukraine's security and defence forces earlier told Ukrainian media that Kyiv had launched drone strikes against the airbase and two oil refineries overnight. 

They told the Kyiv Independent the SBU and Ukraine's Defence Forces hit the airbase where "dozens of military aircraft, radars, and electronic warfare devices were stationed".

Earlier we brought you news of a Russian drone strike on the Black Sea city of Mykolaiv. 

The attack set a hotel ablaze and damaged energy infrastructure, Ukrainian officials said. 

Vitaliy Kim, the governor of the southern Mykolaiv region, said in an update the attack had "seriously damaged" the hotel.

The strike also damaged heat-generating infrastructure in the city.

There were no casualties, he said. 

A priest sprinkles holy water on believers holding willow branches during an Orthodox Palm Sunday service. 

The service is being held in Donetsk, in an area occupied by Russian forces. 

Russia gained full control of the city of Donetsk in October 2022, but the area has been a major site of fighting since 2014. 

The majority of people in Ukraine are Orthodox Christian, although they follow different branches. 

As we've been reporting, Russia has been pushing forward in Ukraine's eastern Donetsk region. 

Ukrainian military officials say their troops are falling back to new positions in at least three places along the frontlines. 

But they are facing public criticism about the transparency of their military updates. 

Ukrainian military blogger Myroshnykov and Ukraine's DeepState monitoring group, which updates daily changes in frontline positions, both say the updates have been unrealistic. 

DeepState shared a video on social media of a Russian soldier being killed in a drone strike in the village of Soloviove, arguing such footage was being used to mask a bigger picture. 

"You can watch with pleasure forever the video of a Russian [soldier] being torn to pieces, but nearby there is another location that requires attention: Muscovites calmly moving around the village, keeping it under control. 

"The [Ukrainian] Defence Forces inflict fire damage on them, and one can repeat at least a billion times that two-thirds of the village is under the control of the Ukrainian military, but the picture of reality is completely different." 

It appeared to be referring to a statement from Nazar Voloshyn, a spokesperson for Ukraine's military in the east, who also said the nearby village of Ocheretyne was still two-thirds controlled by Ukraine. 

However, DeepState says it believes Russian troops have been in control of the centre of Ocheretyne for at least three days. 

The site accused some military spokespersons of incompetence last week. 

Police have arrested a 57-year-old Russian on suspicion of murder following the killings yesterday evening, German news agency dpa reported. 

The two Ukrainians were 23 and 36 years old, and lived in the southern German county of Garmisch-Partenkirchen.

They were killed at a shopping centre in the village of Murnau in Upper Bavaria.

The names of the victims and suspect have not been released due to German privacy rules. 

It is not clear if the men knew each other. 

More than one million Ukrainian refugees fled to Germany following Russia's invasion of Ukraine in 2022. 

Donald Trump's stance on Ukraine is "not as black and white as some people think", the Polish foreign minister has said. 

The former US president, who is running for election again this year, has said he will not commit to providing Ukraine with defence assistance. 

Republicans aligned with Mr Trump were also the reason behind a six-month delay to aid for Ukraine. 

But foreign minister Radoslaw Sikorski said in an interview with the Axel Springer media company that Mr Trump had sent Ukraine anti-tank missiles before Russia's invasion "when others were not doing it". 

He was referring to Javelin anti-tank missiles supplied by the US in 2018. 

Mr Sikorski also said Mr Trump was "right in urging us all in Europe to spend more on defence".

He said he "did not hear any protests from Trump" once the $61bn aid package for Ukraine was approved. 

"So, I hope that candidate Trump has seen that this opposition to helping Ukraine is not actually popular in the United States, that it is harming his chances [to be re-elected]," he added.

Earlier we reported that a top Ukrainian general said troops had fallen back from three villages in the east of the country. 

We can now bring you more from Oleksandr Syrskyi, the chief of Ukraine's armed forces, about the situation on the ground.

Mr Syrskyi said the Donetsk region (in the east) remains one of the hottest sectors of the frontline as Russia continues its offensive.

He described the situation in the eastern cities of Pokrovsk and Kurakhove as "the most difficult one" now.

Russia is reportedly using up to four brigades (anywhere from an estimated 8,000 to 32,000 personnel) to conduct assault operations in the direction of both the cities, which lie west of Avdiivka, which was captured earlier this year. 

Mr Syrskyi said the situation is changing "dynamically" on the frontline as a result. 

Meanwhile, Mr Syrskyi said the situation in the south also remains "intense" as Russia tries to advance near the village of Krynky in Kherson.

It also wants to advance towards the villages of Robotyne and Verbove villages in Zaporizhzhia.

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