cdc in cruise ship

Boost and cruise: CDC pushes for COVID boosters in new optional program for cruise lines

• The CDC released COVID guidelines for cruise lines with Feb. 18 deadline to opt in.
• Are COVID tests required on cruises with new CDC guidance? Yes, the new program still requires testing.
• Cruise Lines International Association called the CDC's latest cruise guidelines "out of step" and "unnecessary."

The Centers for Disease Control and Prevention announced new guidance for the cruise industry Wednesday and will give cruise lines until Feb. 18 to decide whether they want to opt in or not.

The new COVID-19 program comes nearly a month after the agency's Conditional Sailing Order – which outlined numerous health and safety protocols – expired on Jan. 15. Most guidelines outlined in the CSO remain in the updated program.

"The CDC is committed to continuing to work with a cruise industry," Capt. Aimee Treffiletti, who leads the CDC's maritime unit, told USA TODAY in January. "We do hope that cruise lines choose to follow this program, because it does represent the best public health measures to help prevent illness onboard, and COVID transmission, as well as severe outcomes."

The CDC still advises travelers against cruising , especially for those who are at an increased risk of severe illness, as daily COVID-19 case counts remain high due to the omicron variant. 

"The chance of getting COVID-19 on cruise ships is high because the virus spreads easily between people in close quarters on board ships," the agency says on its website.  "If you travel on a cruise ship, make sure you are vaccinated and up to date with your COVID-19 vaccines."

CDC pushes for COVID booster shots among passengers

The CDC's new COVID-19 program adds a new "vaccination status" tier that offers a tailored approach for ships that operate with passengers and crew that are almost entirely fully vaccinated and boosted.  

Cruise ships are split into three tiers under the new program: "Highly vaccinated" ships have at least 95% of passengers and crew fully vaccinated. "Not highly vaccinated" ships have less than 95% of passengers and crew fully vaccinated. Ships that fall under the third and newest tier, "vaccination standard of excellence," have at least 95% of passengers and crew "up to date" with their COVID-19 vaccines, which would mean full vaccination plus any eligible booster shots. 

COVID-19 quarantine and isolation rules will vary depending on vaccination status:

► On vaccination standard of excellence ships, close contacts to people identified with COVID-19 must quarantine until at least five full days after their last exposure. On ships that do not meet the vaccination standard of excellence, close contacts must quarantine at least 10 days.

► Isolation on vaccination standard of excellence ships can be discontinued after 5 days. On ships that do not meet the vaccination standard of excellence, isolation must last at least 10 days. 

Cruise lines with ships of any vaccination classification can opt into the COVID-19 program, but they must share the vaccination status of each ship with the CDC. The agency will post the information on its website along with the ship's color status , which indicates the number of COVID-19 cases reported on board.  

CRUISING DURING COVID: Cancellation, refund policies vary by cruise line

What are the new COVID-19 protocols?

Changes in the new COVID-19 program compared to the CSO program include: 

► Cruise ship operators will be able to report if no cases were identified or testing was conducted through an online Enhanced Data Collection form.

► Cruise lines will no longer need the pre-approval from the CDC for diagnostic and screening tests. Testing requirements will remain.

► The CDC will also scrap its requirement to have negative air pressure in quarantine cabins. The CDC does require quarantine cabins to remain in a separate HVAC zone, and isolation cabins will still need to have negative air pressure.

► U.S. ports will still be required to have port agreements with local health authorities, but signed contracts between medical and housing facilities will no longer be required. 

► The CDC is also changing its color-coded system for grading cruise ships from red-yellow-orange-green to red-orange-yellow-green, and the criteria for assigning a red, yellow and orange status has changed.

The CDC plans to reevaluate its guidance "based on public health conditions and available scientific evidence" by March 18 and update "as needed." 

Trade association 'dismayed' by new guidance

Cruise Lines International Association, a cruise industry trade association, released a statement Wednesday calling the CDC's latest cruise guidelines "out of step" and "unnecessary," pointing to the cruise industry's stringent testing requirements, on-site quarantine facilities and "extensive" response plans. 

"The result has been a dramatic drop in the number of COVID-positive cases, with hospitalizations being extraordinarily rare," the CLIA statement read. "The latest CDC guidance appears out of step with the actual public health conditions on cruise ships and unnecessary in light of societal trends away from more restrictive measures."

The trade group also noted that it is "dismayed" by the level 4 travel health notice label , noting that vaccination rates on cruises are much higher than on land.

"It seems unnecessarily discriminatory against cruise to maintain that the chances of getting COVID-19 on a cruise 'is very high' even if you are up to date with your COVID-19 vaccines," the statement said. 

Cruises will still be regulated by the CDC regardless of commitment

The CDC has said its new program is voluntary. Cruise lines can choose whether or not to participate. But "voluntary" doesn't mean that cruise ships will not be regulated by the CDC – regardless of whether they opt into the program.

Cruise ship operators "can choose the 'healthy sail' option, or they can choose to kind of do their own thing, but it's very important to keep in mind that ships will still be under CDC's regulatory authority," Treffiletti told USA TODAY in January.

If a cruise line chooses to opt out of the program, its ships would then fall under the CDC's mask order for public transportation and the agency's regulatory authority for inspections. And cruise ships, regardless of participation in the voluntary program, will still be required to report every COVID-19 case on board, just through a "different mechanism" than the way they now report cases.

And if the CDC is concerned about COVID-19 on a ship that isn't under the new program?

"I think (we) will be probably quicker to exercise our regulatory authority," Treffiletti said. "Because, you know, we won't know what's happening on the ship as far as the mitigation measures."

The CDC reserves the right to issue a "no sail" order for a particular ship if the agency has concerns about what is happening on board.

It's in the best interest of public health for lines to volunteer to follow the "healthy sail" program, Treffiletti said. She noted that the program will provide transparency about levels of COVID-19 on board and how the pandemic is being managed, while ships that don't opt in won't have to make public how they are managing the coronavirus on board.

"Passengers should feel good that the industry is really going above and beyond to create a very safe and healthy environment for them," Laziza Lambert, spokesperson for Cruise Lines International Association, told USA TODAY Wednesday. 

Contributing: Eve Chen, USA TODAY. 

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The cleanest—and dirtiest—cruise ships have been announced

These ships have the lowest and highest sanitation scores, according to the CDC

When planning a cruising vacation, it’s become increasingly important to look into the cleanliness of both the cruise line and the ship before booking. With Covid-19 cases taking an upturn at the moment, and a record number of norovirus outbreaks on cruise ships this year, it’s imperative to take your health into your own hands as much as you are able.

The Centers for Disease Control (CDC) released the results of its twice-yearly Vessel Sanitation Program inspections, which alert the public to what ships are the most (and least) sanitary. The inspections focus on eight distinct areas of each ship, including the dining rooms, pools and spas, child activity centers, and medical facilities. The ships are scored on a scale out of 100 and anything 85 or below is treated as a fail.

Luckily, only one ship failed the most recent inspection, but there were a few that just scraped by. MSC Seaside had a disturbingly low score of 67, while Carnival Liberty , Carnival Pride , and Margaritaville at Sea Paradise squeezed by with scores two scores of 86 and a score of 87, respectively.

The following ships, you can breathe easy (literally), all scored perfect marks on the latest inspection:

• Royal Caribbean Allure of the Seas
• Carnival Celebration
• Carnival Panorama
• Carnival Sunshine
• Celebrity Edge
• Celebrity Millenium
• Celebrity Summit
• Disney Fantasy
• Disney Wonder
• MSC Seascape
• Norwegian Joy
• Norwegian Pearl
• Oceania Riviera
• Holland America Line Rotterdam
• Silversea Silver Moon

Other ships that still passed muster include Noordam (score of 90), Star Pride (score of 90), Le Boreal (score of 90), and Norweigan Epic (score of 89).

While even the cleanest of ships can still harbor germs, passengers can now rest assured that these ships have been vetted and cleared for launch.

• Amanda Mactas

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Coronavirus Updates

Cdc drops its covid-19 risk advisory for cruise ship travel.

Jonathan Franklin

The Norwegian Gateway cruise ship is moored at PortMiami on Jan. 7 in Miami. The Centers for Disease Control and Prevention dropped its advisory warning Wednesday for cruise travel after more than two years of warning Americans. Joe Raedle/Getty Images hide caption

The Norwegian Gateway cruise ship is moored at PortMiami on Jan. 7 in Miami. The Centers for Disease Control and Prevention dropped its advisory warning Wednesday for cruise travel after more than two years of warning Americans.

The Center for Disease Control and Prevention has lifted its risk advisory for cruise ship travel Wednesday following two years of issuing warnings to travelers about the possibility of contracting COVID-19 onboard a cruise.

In an update posted online, the agency removed its "Cruise Ship Travel Health Notice," a notice that recommended individuals against traveling onboard cruise ships. Three months ago, the CDC increased its travel warnings for cruises to Level 4 — the highest level — following investigations of ships that had COVID outbreaks.

While the CDC has lifted its travel health notice, officials say it's up to the passengers to determine their own health risks before going onboard a cruise ship.

"While cruising will always pose some risk of COVID-19 transmission, travelers will make their own risk assessment when choosing to travel on a cruise ship, much like they do in all other travel settings," the agency said in a statement to NPR.

People should avoid cruise travel regardless of their vaccination status, the CDC says

The agency says it will continue to provide guidance to the cruise ship industry in order for cruise lines to operate in a way that will provide "safer and healthier" environments for crews, passengers and communities.

News of the CDC's decision to remove its travel health notice was praised by the Cruise Lines International Association, the industry's largest trade organization.

"Today's decision by the U.S. Centers for Disease Control and Prevention (CDC) to altogether remove the Travel Health Notice for cruising recognizes the effective public health measures in place on cruise ships and begins to level the playing field, between cruise and similarly situated venues on land, for the first time since March 2020. From the onset of the pandemic, CLIA's cruise line members have prioritized the health and safety of their guests, crew, and the communities they visit and are sailing today with health measures in place that are unmatched by virtually any other commercial setting."

A luxury cruise ship rerouted to the Bahamas over an arrest warrant for unpaid fuel

The CDC emphasizes that travelers should make sure they're up to date with their COVID-19 vaccines before taking a cruise, in addition to following their ship's requirements and recommendations against the virus.

Travelers are urged to check their cruise ship's COVID case levels and vaccination requirements online before traveling, the agency says.

• CDC COVID-19 guidance
• cruise ships

Influenza-Like Illness (ILI) Management

Outbreaks of influenza and other respiratory viral diseases can occur at any time of the year among cruise ship passengers and military personnel aboard ships. Early detection, prevention, and control of influenza are important, not only to protect the health of travelers on cruise ships, but also to avoid spread of disease into home communities by disembarking ill passengers and crew members.

This document provides interim guidance for cruise ships originating from or stopping in the United States, to help prevent, diagnose, and control outbreaks of influenza-like illness (ILI). This guidance will be updated as needed. The Centers for Disease Control and Prevention (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 persons with ILI. The health care 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.

Commercial maritime travel is characterized by the movement of large numbers of people in closed and semi-closed settings. As with other close-contact environments, these settings can facilitate the transmission of influenza viruses and other respiratory viruses from person to person through droplet spread or potentially through contact with contaminated surfaces.

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

• Get vaccinated annually for influenza
• Postpone travel when sick
• Take everyday steps to protect themselves and others while traveling

Specific management should include early identification and isolation of crew members and passengers with ILI, implementation of good respiratory hygiene and cough etiquette, use of influenza antiviral medications for treatment of persons with suspected or confirmed influenza, and use of antiviral chemoprophylaxis during influenza outbreaks if indicated for high-risk persons exposed to persons ill with influenza. This document provides guidance for the management of ILI during and after a voyage, including personal protective measures for the crew.

Influenza Vaccination of Crew and Passengers

CDC recommends that all persons 6 months of age and older be vaccinated each year with 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 in advance of 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, review the recommendations for use of the influenza vaccine .

Managing Passengers and Crew with Influenza-Like Illness

Signs and symptoms of influenza can include some or all of these symptoms: fever or feeling feverish, chills, cough, sore throat, runny or stuffy nose, muscle or body aches, headache, fatigue (tiredness), and sometimes diarrhea or vomiting. Fever (a temperature of 100° F [37.8° C] or higher) will not always be present in persons with influenza, especially not in elderly persons. Cruise ship medical personnel should consider someone to have a fever if the ill 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. Because the signs and symptoms of influenza are not specific and most persons who have a respiratory illness are not tested for influenza, ILI has been defined for surveillance purposes as an illness with fever or feverishness plus either cough or sore throat.

Persons who are experiencing severe illness (e.g., high fever, shortness of breath, difficulty breathing, rapid breathing, chest pain, altered mental status, dehydration, or worsening of chronic underlying medical conditions) or who have ILI and are at high risk for severe influenza due to their age or chronic conditions should seek medical evaluation immediately.

Respiratory Hygiene and Cough Etiquette

Persons with ILI should be advised of the importance of covering coughs and sneezes with their shoulder, elbow, or a tissue. Used tissues should be disposed of immediately in a disposable container (e.g., plastic bag) or a washable trash can. 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.

Screening and Isolation

Any passenger who has ILI at the time of embarkation should be advised not to travel until at least 24 hours after resolution of fever (100° F [37.8° C]) without the use of fever-reducing medications (e.g., acetaminophen, ibuprofen, paracetamol). Aspirin should not be used to treat influenza symptoms in children or adolescents younger than 19 years because of the risk of Reye’s syndrome.

Passengers with ILI who nonetheless decide to board, as well as passengers who become ill with ILI en route, should be medically evaluated (see next section) and remain isolated in their cabins or quarters until at least 24 hours after resolution of fever (100° F [37.8° C]) without the use of fever-reducing medications.

Crew members with ILI should take the following actions:

• Notify their supervisors.
• Report to the infirmary for medical evaluation, according to shipboard protocols.
• Remain isolated in their cabins or quarters until at least 24 hours after resolution of fever (100° F [37.8° C]) without the use of fever-reducing medications.
• Continue to practice respiratory hygiene, cough etiquette, and hand hygiene after returning to work, because respiratory viruses can continue to be shed for several days after fever resolves.

While temporarily in common areas, passengers and crew members with ILI should be encouraged to remain as far away from others as possible (at least 6 feet), and either wear face masks or cover their mouths and noses with their elbow, shoulder, or tissues when they cough or sneeze.

Management of Passengers or Crew with ILI upon Disembarkation

A disembarking cruise ship passenger or crew member who has ILI or who has had fever within the 24 hours prior to disembarking should be advised to take the same precautions: to stay in home or hotel isolation in the city of disembarkation and to refrain from further travel until at least 24 hours after he or she is free of fever (100° F [37.8° C]) without the use of fever-reducing medications.

If a passenger or crew member with ILI is taken to a health-care facility off the ship, the facility should be informed before arrival.

Managing Passengers and Crew Following Exposure to an Ill Person

Passengers and crew who may have been exposed to an ill person suspected of having influenza should monitor their health for 5–7 days after the exposure. Passengers and crew who develop ILI while still onboard should notify the shipboard infirmary immediately and remain isolated in their cabins or quarters until at least 24 hours after resolution of fever (100° F [37.8° C]) without the use of fever-reducing medications. Ill persons should be advised to seek health care if they are at high risk of developing severe illness from influenza or if they are concerned about their illness.

Medical Evaluation and Management

For more information, read updated resources for clinicians and guidance on the medical evaluation and management of persons with influenza, available on CDC’s influenza website .

Influenza Diagnostic Tests

CDC’s  influenza website also includes interim recommendations for the clinical use of influenza diagnostic tests .

Rapid influenza diagnostic tests have low to moderate sensitivity, and many false-negative results occur. As a result, many influenza virus infections will be missed. Therefore, negative rapid influenza diagnostic test results do not exclude a diagnosis of influenza; clinical diagnosis of influenza should be considered. However, positive test results are useful to establish a diagnosis of influenza and to provide evidence of influenza in passengers and crew aboard ships.

Use of Antiviral Treatment and Chemoprophylaxis for High-Risk Persons

Early antiviral treatment with neuraminidase inhibitors (oral oseltamivir or inhaled zanamivir) is recommended for persons with suspected or confirmed influenza who have severe illness or who are at high risk for influenza complications pdf icon , including persons with asthma, diabetes, and heart disease. Early antiviral treatment of influenza is most effective.

For patients aged 7 years and older (who do not have chronic pulmonary disease, including asthma) when oseltamivir resistance is demonstrated or highly suspected (e.g., for immunosuppressed patients with prolonged viral replication during oseltamivir treatment and persons who developed illness while receiving oral oseltamivir chemoprophylaxis), inhaled zanamivir is the treatment of choice.

In addition to treatment of  suspected or confirmed influenza with antiviral medications, antiviral chemoprophylaxis can be considered for prevention of infection in exposed persons who are at high risk for complications or for controlling influenza outbreaks on cruise ships when large numbers of persons at higher risk for influenza complications are on board.

The Advisory Committee on Immunization Practices (ACIP) makes recommendations on the use of antiviral agents for the treatment and chemoprophylaxis of influenza and CDC’s  influenza website also provides information about the use of antiviral agents and antiviral resistance .

Outbreak Control

A combination of measures, including isolation and early antiviral treatment of ill persons, following recommended infection control, antiviral chemoprophylaxis of exposed persons, and active surveillance for new cases, can be implemented to control influenza outbreaks.

Preventing Influenza in Crew

In addition to annual influenza vaccination, the following recommendations should be followed, when possible, by crew members whose work activities involve contact with passengers and by other crew members who have ILI.

• Maintain a distance of about 6 feet from the ill person while interviewing, escorting, or providing other assistance.
• Keep interactions with ill persons as brief as possible.
• Limit the number of persons who interact with ill persons. To the extent possible, the ill person should receive care and meals from a single person.
• Avoid touching your eyes, nose, and mouth.
• Wash your hands often with soap and water . If soap and water are not available, use an alcohol-based hand sanitizer.
• Ask the ill person to consider wearing a face mask, and provide one, if wearing it can be tolerated.
• Cover his or her mouth and nose with a tissue (or face mask) when coughing or sneezing. If the ill person does not have a tissue and is not wearing a face mask, he or she should cough or sneeze into his or her upper sleeve or elbow, not into his or her hands.
• Dispose of used tissues immediately in a disposable container (plastic bag) or a washable trash can.
• If soap and water are not available, the ill person can use an alcohol-based hand sanitizer.

CDC does not require that ships traveling to or within U.S. waterways report individual cases of suspected or confirmed influenza, but requests reporting of total ILI/influenza cases (including zero) for each voyage by using the Maritime Illness and Death Reporting System (MIDRS) cumulative report form.

The following situations should be immediately reported to the CDC Quarantine Station in the jurisdiction of the U.S. seaport where the ship is expected to arrive:

• Changes in the clinical profile and severity of illnesses reported or severe complications among at least two epidemiologically linked influenza cases.
• Outbreaks of influenza among passengers or crew members.
• A death caused by or suspected to be associated with influenza or ILI onboard the vessel

Vessel captains may request assistance from CDC to evaluate or control influenza outbreaks, as needed. If the ship will not be arriving imminently at a U.S. seaport, CDC quarantine officials will provide guidance to cruise ship officials regarding the management and isolation of the suspected case and recommendations for other passengers and crew members.

Before the ship arrives, local port health authorities should be informed if any support is needed, including hospitalization of ill persons and laboratory testing of clinical specimens.

For influenza cases requiring hospitalization, CDC quarantine officials will work with the cruise line and local and state health departments to facilitate medical transportation of the patient upon arrival. In outbreak situations, CDC staff may also assist with disease control and containment measures, passenger and crew notification, surveillance activities, communicating with local public health authorities, obtaining and testing laboratory specimens, and providing additional guidance as needed.

For ships on international voyages, if an illness has occurred onboard, the Maritime Declaration of Health should be completed and sent to the competent authority, according to the 2005 International Health Regulations (IHR) and the national legislation of the country of disembarkation. Before entering a seaport, cruise ships may also be required to report the ship’s previous itinerary.

Additional Recommendations

Personal protective equipment.

Crew members and other staff who may have contact with persons with ILI should be instructed in the proper use, storage, and disposal of personal protective equipment (PPE). Improper handling of PPE can increase transmission risk.

Crew members should wear impermeable, disposable gloves if they need to have direct contact with ill persons or potentially contaminated surfaces, rooms, or lavatories used by ill passengers and crew members. Crew members should wash their hands with soap and water or use an alcohol-based hand sanitizer after removing gloves. Gloves should be discarded in the trash and should not be rewashed or saved for reuse. Crew members should avoid touching their faces with gloved or unwashed hands.

Use of N95 respirators or face masks is not generally recommended for cruise ship crew members for general work activities. Use of face masks can be considered for cruise ship workers who cannot avoid close contact with persons with ILI. Crew members who use N95 respirators should receive annual fit testing. Crew members who provide health care to passengers or to other crew members (e.g., onboard nurses and physicians) should follow CDC’s prevention strategies for seasonal influenza in health care settings .

Ships should ensure availability of conveniently located dispensers of alcohol-based hand sanitizer; where sinks are available, they should ensure that supplies for hand washing (i.e., soap, disposable towels) are consistently available.

Ships should carry a sufficient quantity of PPE such as face masks, N95 respirators, and disposable gloves as may be needed for influenza and other diseases.

Ships should carry a sufficient quantity of medical supplies to meet day-to-day needs. Contingency plans are recommended for rapid resupply in outbreak situations. Stocking oral oseltamivir and inhaled zanamivir for antiviral treatment or chemoprophylaxis of influenza virus infection is recommended.

Ships are encouraged to carry sterile viral transport media and sterile swabs to collect nasopharyngeal and nasal specimens. These optimal recommendations can be modified to reflect individual ship capabilities and characteristics.

Cleaning and Disinfection

In addition to routine cleaning and disinfection strategies, during influenza outbreaks cruise ships may consider more frequent cleaning of commonly touched surfaces, such as handrails, countertops, and doorknobs. Surfaces contaminated by the respiratory secretions of an ill person (e.g., in the ill person’s living quarters or work area, and in isolation rooms) can also be cleaned. The primary mode of influenza virus transmission is believed to be through respiratory droplets that are spread from an infected person through coughing or sneezing to a susceptible close contact within about 1-2 meters. Therefore, widespread disinfection to control influenza outbreaks is unlikely to be effective.

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

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

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

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

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

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

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

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

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

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

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

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

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

The 15 cruise ships with perfect scores of 100

The 15 cruise ships with scores below a 95.

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

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The CDC inspects and scores cruise ships — here’s what those scores mean

Editor's Note

On a cruise ship, you share common areas with a couple of hundred, or thousand, of your closest friends. It's important to know these spaces are clean and safe for every passenger.

Luckily, the Centers for Disease Control and Prevention (CDC) established the Vessel Sanitation Program to ensure cleanliness and sanitation on cruise ships . This program educates, tracks and responds to outbreaks on ships across the industry, with the main focus on gastrointestinal illnesses.

Below is an overview of what the VSP does to protect you and your loved ones from a crippling sickness that could keep you locked in your stateroom during what should be a beautiful and relaxing getaway .

Want to learn more about cruise lines, itineraries and deals? Sign up for the biweekly TPG Cruise newsletter .

What is the Vessel Sanitation Program?

The main goal of the Vessel Sanitation Program is to help the cruise industry prevent and control the introduction, transmission and spread of gastrointestinal illnesses, such as norovirus. The program operates within the CDC and is under the authority of the Public Health Service Act.

The cruise ships under VSP jurisdiction are those that have a foreign itinerary with U.S. ports and carry 13 or more passengers. The ships are given a score, with a maximum of 100. Eighty-five and below is considered a failing score.

VSP's purpose is to train cruise ship employees on public health practices. It also provides health education and reliable and current public health information to a larger audience, including the cruise ship industry, the traveling public, public health professionals, state and local health authorities and the media, according to the CDC's website .

Related reading: 15 ways that cruising newbies waste money on their first cruise

The inspection categories

Source: CDC

How often are cruise ships evaluated?

The inspections are periodical and unannounced, with the goal of inspecting operational sanitation. Under the program, cruise ships are inspected two times a year.

The CDC notes that "If a ship sails outside of the United States for an extended period, it may not be inspected twice a year, but it will be inspected again when it returns to the United States."

So rest assured, the ships will be checked if they are under the VSP's jurisdiction.

Related reading: Trip wrecked: 7 ways to prepare for any kind of travel disaster

Who got the best scores?

In the past two years, here are the cruise ships that received the maximum score of 100 and their date of inspection:

• Aurora , P&O Cruises, 09/24/2018
• Carnival Valor , Carnival Cruise Line, 02/24/2020
• Celebrity Reflection , Celebrity Cruises, 12/09/2019
• Disney Dream , Disney Cruise Line, 11/29/2019
• Disney Wonder , Disney Cruise Line, 10/20/2019
• Nieuw Amsterdam , Holland America Line, 06/17/2019
• Norwegian Sky , Norwegian Cruise Line, 12/02/2019
• Rhapsody of the Seas , Royal Caribbean International, 02/09/2019
• Ruby Princess , Princess Cruises, 08/31/2019
• Sea Princess , Princess Cruises, 08/19/2018
• Seabourn Quest , Seabourn, 11/04/2018
• Viking Sea , Viking, 10/23/2019
• Viking Sky , Viking, 02/21/2020
• Viking Star , Viking, 10/15/2018

Related reading: Which cruise brand is best for you? A guide to the most popular lines

Worst cruise ship scores

Here are the bottom nine cruise ship scores from the past two years. Remember that 85 and below is a failing grade. Click on the accompanying link to see a breakdown of each score:

• World Odyssey , CMI Ship Mgmt, 01/03/2019, score: 89
• MS Grand Classica , Bahamas Paradise Cruise Line, 10/26/2019, score: 88
• Oceania Sirena , Oceania Cruises, 01/20/2019, score: 88
• Seven Seas Mariner , Regent Seven Seas Cruises, 02/01/2020, score: 88
• Victory I , Victory I Partners, Ltd., c/o Cruise Mgmt Intl Inc, 07/31/2019, score: 88
• Kydon , Ferries Del Caribe, 06/10/2019, score: 87
• Queen Victoria , Cunard Line, 01/21/2019, score: 87
• National Geographic Sea Lion , Lindblad Expeditions, 07/06/2019, score: 86
• Norwegian Epic , Norwegian Cruise Line, 02/06/2020, score: 86

Bottom line

Nobody wants to spend the majority of their vacation doubled over in their room, while everyone else experiences once-in-a-lifetime excursions. Not only is it a waste of time and money, but it could be dangerous for your health.

Check out recent VSP scores for a cruise ship you plan to board. These scores allow you to cruise in peace, so you can take the trip of your dreams without the fear of being wracked with an illness.

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The Cleanest Cruise Lines, According to CDC Inspections

While keeping passengers healthy has always been a priority for cruise lines, never has the issue been important than today. 

Following the health crisis and the suspension of sailing, you should know that cruise lines are serious about cleanliness. Any sort of incident — whether a virus or not — would lead to a flurry of headlines and negative press, potentially turning some passengers away and hurting business.

Meanwhile, the government also has an interest in keeping cruise passengers healthy. That’s why they have oversight in inspecting ship cleanliness.

Vessel Sanitation Program: Health Inspections for Cruise Ships

Many people don’t realize it, but the Centers for Disease Control (CDC) operates the Vessel Sanitation Program (VSP).

This program is essentially a health inspection for cruise ships. Just like a restaurant in your town would be checked by a health inspector, ships sailing from the United States are also checked out on a regular basis. These inspections are done without prior knowledge by the cruise line.

In particular, the CDC inspections focus on eight areas:

• Medical facilities
• Water systems
• Swimming pools and whirlpools
• Galleys and dining rooms
• Child activity centers
• Hotel accommodations
• Ventilation systems
• Common areas

Cruise ships overall do well on these inspections. Scores are on a 100-point scale and tallies in the high-90s and above are common. In fact, since the start of 2022, more than 20 ships have scored perfect a perfect 100 grade.

On the other end, anything less than 86 is considered unsatisfactory . If a ship scores below this mark, they have the chance to correct the issues and be re-inspected. 

Scoring below an 86 only happens on occasion across dozens and dozens ships. Since the start of 2022 until today, we found only one ship with a failing grade.

The good news for cruise passengers is not only do ships score well when inspected, but the results are also published publicly. You can visit the CDC website and see the scores and reports for hundreds of vessels. Each report is also complete with a write-up of any issues found. No doubt any cruise ship you are sailing on will have their latest report listed.

Now, while ships tend to score well, there are some lines that seem to do better than others on a consistent basis.

Given the current environment, we know that cleanliness is important to passengers. With this in mind, we recently combed through the latest inspection scores from the CDC to determine which cruise line is the cleanest on average by the standards of the Vessel Sanitation Program.

The Average Score of Every Cruise Line

As mentioned above, the CDC lists the inspections scores for an enormous number of vessels sailing from the United States. These scores go back years. For our research, we focused only on scores from the start of 2022 through today to provide more recent information.

In addition, we looked only at those lines with at least two ships receiving scores during that time. This removes small specialty lines that might only occasionally sail from the U.S.

Using the VSP data, we looked at the most recent scores for each ship listed. From there, we averaged the scores across the entire fleet of each line — giving us a single score for each cruise line.

In total, no cruise line scored a perfect average, but every line had a score of at least 91 . The scores ranged from a low of 91.6 to a near-perfect 99.8.

You can see the results in the chart below:

As you can see, in general cruise lines score well on their inspections. That said, some do score higher marks than others.

The 3 “Cleanest” Cruise Lines According to the CDC

According to the CDC data, here are the three cruise lines that scored the highest average scores on their latest inspection reports:

Disney Cruise Line – When it comes to high scores on CDC inspections, Disney takes the top honor. With five ships, every Disney cruise ship scored well on their latest inspections. Four of the ships — Disney Fantasy, Magic, Wish, and Wonder — scored a perfect 100. Disney Dream scored the only non-perfect score… a “lowly” 99. Taken together, the five scores come out to a near-perfect 99.8 average inspection score, making Disney the cleanest cruise line based on inspection scores.

Silversea- While Disney took top honors, Silversea wasn’t far behind. The average score on this luxury cruise line was a 98.5. One thing to note is that the CDC only inspects ships sailing from the United States. If a ship doesn’t come to the U.S. often, it could be longer before another inspection. As a result, despite a 13-ship fleet, only two ships were recently inspected by the CDC.  Still, they had solid inspection scores, including a perfect 100 for the Silver Moon and a 97 for Silver Dawn. 

Celebrity – Celebrity makes a strong showing as a luxury brand that sails larger vessels than Silversea and has a much larger fleet than Disney. The cruise line came in with an average score of 98.1 across its inspections, which includes eight different ships with recent inspection scores. Celebrity Edge, Millennium and Summit all scored a 100 in their last inspections, while two others — Celebrity Beyond and Equinox — scored a near-perfect 98. The lowest score in the fleet was a still-strong 95 aboard Celebrity Reflection.

These Ships Scored Lowest at Last Inspection

Overall, the average scores of cruise lines were strong, with no line averaging below an 91. That said, there were a few lower scores on the inspection reports for individual ships in our search:

MSC Seaside: 67 (Not Satisfactory) — This ship had the lowest score listed during our search and was the only one to score below 86 (indicating “not satisfactory” according to the CDC) since 2022. That’s surprising because all other MSC ships checked by the CDC scored at least 95, with MSC Seascape scoring a perfect 100.

According to the inspection report , violations included various issues ranging from incorrect data logs on crew counts, issues with dishwashing operations, and one crew member with hamburger blood on their hands opening a cooler door, leaving the “refrigerator door handle covered in hamburger blood.”

Carnival Liberty: 86   (Satisfactory) — An 86 is a satisfactory mark according to the CDC, but it is still lower than most among the scores we analyzed. The CDC took issue with dishwashers being out of service, leaky faucets, as well as employees not reporting gastro illness soon enough after onset of symptoms.

Carnival Pride : 86 (Satisfactory) — During an inspection of Carnival Pride , the CDC inspectors found some food areas on the ship “infested with flies that were too many to count.” This went along with “old food soil” in multiple areas. 

Despite the lower scores on Liberty and Pride, Carnival overall posted high marks. The average score was 96.1, with four ships — Celebration, Magic, Panorama, and Sunshine — earning perfect scores.

How to See What Your Cruise Ship Scored

Headed on a cruise soon and want to know what your specific ship scored on its latest inspection? You can search the VSP database by ship using this page . Simply find your ship in the list and then click search. It will also allow you to see reports, which you can read to see the specific violations found on the ship.

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So 3 of the most expensive scored the lowest. hmmmmm!!

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Live updates, nearly 30 silverseas cruise passengers fall ill with diarrhea at sea.

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This vacation stinks.

Nearly 30 people aboard a luxury cruise liner known for its phenomenal cuisine have fallen ill thanks to a gastrointestinal outbreak that swept through the ship.

At least 28 of the Silver Nova ship’s 633 guests and one of its crew members reported feeling sick during their 16-day voyage from Peru, the Centers for Disease Control and Prevention  said Monday.

The group all reported one main symptom: diarrhea.

The cause of the outbreak — which has impacted roughly 5% of the ship’s passenger population — is still unknown, but the CDC notes that norovirus outbreaks are primarily caused by eating contaminated food or drinking contaminated water.

The Silver Nova is Silversea Cruises’ newest liner and among its most luxurious.

Introduced in 2023, the Silver Nova boasts butler service for every suite, one crew member for every 1.3 guests and “outstanding gastronomy” — it even welcomed “Top Chef’s” Nina Compton to its ranks at the end of last year.

The ship includes multiple kitchens, grills and even an interactive space where guests can cook with Compton.

To quell the spread of the stomach bug, Silversea Cruises reportedly quarantined its impacted passengers and crew member and “increased cleaning and disinfection procedures,” the CDC said.

“The health and safety of our guests, crew, and the communities we visit are our top priority,” a spokesperson for Silversea Cruises told The Post in a statement.

“To maintain an environment that supports the highest levels of health and safety onboard our ships, we implement rigorous cleaning procedures, many of which far exceed public health guidelines.”

The outbreak was reported one day before the “Easter” themed cruise was scheduled to end.

The 11-deck cruise ship started its journey in Callao-Lima, Peru, on March 31 and is set to end on April 16.

Prices for the 16-day excursion started at $11,700 for a double occupancy room, according to CruiseMapper.

The Silversea Cruises outbreak marks the fourth this year — including one that saw 104 become infected aboard a Holland America Line ship and more than 130 people on Cunard Cruise Line’s Queen Victoria struck down by a bout of diarrhea and vomiting in February .

Norovirus was the cause of the three preceding outbreaks.

In 2023, the CDC logged a jaw-dropping 14 cruise ship outbreaks.

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Royal Caribbean shares huge onboard health and safety news

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

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

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

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

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

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

Royal Caribbean has made ships safer

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

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

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

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

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

Royal Caribbean's plan has worked

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

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

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

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

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

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

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

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

CDC Reveals Outbreak on Cruise Ship From ‘Unknown’ Illness

Friends Read Free

The U.S. Centers for Disease Control and Prevention (CDC) reported that more than two dozen people on board a cruise ship fell ill due to a gastrointestinal outbreak.

The predominant symptom was diarrhea, the agency reported. Other details were not provided about what may have caused it.

The CDC has previously noted that norovirus can spread quickly on cruise lines, and multiple norovirus outbreaks on cruise ships have been reported over the years to the agency.

Silversea Cruises, which is described as a luxury line, quarantined the impacted passengers and one crew member, according to the CDC. It also “increased cleaning and disinfection procedures,” the agency said.

It also “made announcements to notify onboard passengers and crew of the outbreak, encourage case reporting, and encourage good hand hygiene,” the CDC said. The CDC is now “remotely monitoring the situation, including reviewing the ship’s outbreak response and sanitation procedures.”

“To maintain an environment that supports the highest levels of health and safety onboard our ships, we implement rigorous cleaning procedures, many of which far exceed public health guidelines,” the spokesperson added. No other details were provided by the firm.

The Silversea incident marks the fourth such outbreak in 2024, according to CDC data.

In a normal year, according to the CDC, norovirus causes between 19 million and 21 million cases of vomiting and diarrhea, 109,000 hospitalizations, and 900 deaths across the United States. The virus also is associated with about 495,000 emergency department visits, mostly in younger children, the CDC says.

If there is a new strain of the virus, the CDC says, there can be upward of 50 percent more norovirus illnesses in a given year.

The CDC’s webpage for norovirus says the virus is very contagious and generally causes vomiting and diarrhea. “Anyone can get infected and sick with norovirus. Norovirus is sometimes called the ’stomach flu‘ or ’stomach bug,’” the agency says. “However, norovirus illness is not related to the flu.”

“These outbreaks often get media attention, which is why some people call norovirus the ‘cruise ship virus,’” the CDC says. “However, norovirus outbreaks on cruise ships account for only a small percentage ... of all reported norovirus outbreaks. Norovirus can be especially challenging to control on cruise ships because of the close living quarters, shared dining areas, and rapid turnover of passengers.”

“Currently, norovirus outbreak activity in the United States is within the range we would expect for this time of year and is within the range reported during the same time periods in previous years,” a spokesperson for CDC told NBC’s “Today” show on Thursday.

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Volume 30, Number 5—May 2024

Interventional Study of Nonpharmaceutical Measures to Prevent COVID-19 Aboard Cruise Ships

Cite This Article

Cruise ships carrying COVID-19–vaccinated populations applied near-identical nonpharmaceutical measures during July–November 2021; passenger masking was not applied on 2 ships. Infection risk for masked passengers was 14.58 times lower than for unmasked passengers and 19.61 times lower than in the community. Unmasked passengers’ risk was slightly lower than community risk.

In the summer of 2021, several European Union Member States (EUMS) and European Economic Area (EEA) countries gradually lifted COVID-19 public health measures and reopened borders. The easing of restrictions enabled cruise lines to resume operations, applying guidelines published by the EU Healthy Gateways Joint Action, the European Centre for Disease Prevention and Control, and European Maritime Safety Agency. We assessed the effectiveness of nonpharmaceutical measures (NPMs) by comparing COVID-19 incidence rates among EUMS and EEA communities and populations of cruise ships and applying different sets of measures.

We conducted an ecologic study in which cruise ships in group 1 (passenger and crew populations on 2 cruise ships, ships A and B) and group 2 (passenger and crew populations of 9 cruise ships) carrying vaccinated populations applied identical NPMs apart from face masking in passengers and physical distancing, which group 1 did not apply ( 1 ) ( Table ). The cruise ship company provided epidemiologic data and screening and diagnostic results for group 1 ( Appendix ). Ship captains or doctors reported epidemiologic data and screening and diagnostic results to competent health authorities and EU Healthy Gateways Joint Action ( Appendix ). Passenger populations changed in every cruise, but ≈6 passengers remained onboard the ship for >1 voyage. COVID-19 imposed severe crew change restrictions, and most crew remained the same during the study; the percentage of crew disembarking likely represented <0.5% of the crew population. We calculated COVID-19 incidence rates for the period of July–November 2021 for groups 1, 2, and 3 (EUMS communities). We obtained epidemiologic data for EUMS communities from the European Centre for Disease Prevention and Control website ( 4 ).

We calculated incidence rate ratios, standardized incidence ratios (SIRs), and 95% CI using the epiR package in R ( 5 ). We used Fisher’s exact test to determine statistical significance. We considered p<0.05 statistically significant. We calculated SIRs for groups 1 and 2 by using epidemiologic COVID-19 data in EUMS and EEA countries during the study period as a reference population to calculate expected number of cases onboard ( 4 ) ( Appendix ).

The group 1 health measures protocol was reviewed and agreed upon by the Hellenic Ministry of Health’s national COVID-19 taskforce. The study received approval from the University of Thessaly’s Research Ethics Committee (protocol no. 103/16.11317 1.2021; decision no. 103/01.12.2021). Written consent for serologic testing was obtained from all crew members.

The risk for COVID-19 infection in group 2 (masked passengers of 9 ships) was 14.58 (95% CI 7.799–28.361) times lower than risk for group 1 (unmasked passengers) and 19.61 (95% CI 18.86–34.48) times lower than in group 3 (EUMS community members). Infection risk for unmasked passengers in group 1 was lower than in the community (SIR 0.744, 95% CI 0.512–1.045; p = 0.094) ( Appendix ).

Conclusions

Our ecologic study demonstrated that COVID-19 infection risk among masked cruise ship passengers was 19.61 times lower than in the community (95% CI 18.86–34.48); the risk for infection among unmasked passengers was lower than in the community but not statistically significant (SIR 0.744, 95% CI 0.512–1.045; p = 0.094). Those findings suggest that NPMs implemented onboard the cruise ships were effective in reducing risk ( 1 ). Recent vaccination for the circulating variant appeared to contribute to reduced infection risk onboard ships, where vaccination coverage was almost 100%, compared with 66% cumulative vaccine uptake among the EUMS population ( 3 ). No outbreak occurred during the study period (group 1: median no. cases per voyage 1.00, range 0–15; group 2: median 0 cases per voyage, range 0–4). Of 44 close contacts of SARS-CoV-2–positive persons, 10 tested positive during quarantine, which could be attributed to protective effects of up-to-date vaccination for the circulating SARS-CoV-2 Delta variant. No deaths or severe cases were reported among the 11 cruise ships, despite the highly pathogenic nature of the Delta variant and older average age of cruise passengers.

Experimental studies in confined spaces demonstrated that masking is one of the most effective NPMs to prevent aerosol infection transmission ( 6 ). However, a systematic review of clinical trials in community settings and healthcare facilities demonstrated that wearing masks in the community likely makes little difference to outcomes compared with not wearing a mask ( 7 ). Masking in different settings (ships, hospitals, communities) might have different effects, however, the effectiveness of masking measures is likely influenced by how strictly those measures are enforced. During the pandemic, an absence of mask-wearing measures resulted in large outbreaks onboard ships ( 8 , 9 ). Our study demonstrated reduced COVID-19 incidence rates because of the protective effect of masking onboard ships. We suggest integrating use of high-filtration masks into routine case management, outbreak response measures, and preparedness and contingency planning for future public health emergencies of international concern. Crew members presented a lower infection risk than passengers and community populations, possibly because of mandatory mask use, recent vaccination, the strict enforcement of masking and vaccination policies, and reinforced education on symptoms and reporting requirements.

The first limitation of our study is that direct, individual observation of passenger and crew compliance was impossible in the uncontrolled environments of live cruises. The estimated case underreporting rates applied (1:4) were based on US data (February 2020–September 2021), but our study was implemented in Europe (July–November 2021), so differences could apply ( 10 ). The practice of 14-day quarantine and monitoring for disembarking passengers was applied only for close contacts of SARS-CoV-2–positive persons, so secondary cases could have been unidentified. We did not collect data on vaccination type, cabin occupancy, shore-based excursions, and onboard activities for the entire study population, so incidence rate differences for those factors could not be tested. Previous research of a COVID-19 cruise outbreak demonstrated that involvement in certain group activities (e.g., shows) and shore-based bus excursions were associated with infection, as well as a consistent dose-response relationship between number of cabinmates and attack rates in which attack rates decreased as passenger occupancy per cabin decreased ( 11 , 12 ). Alternative exposures, such as preembarkation queuing, social activities, contaminated surface contact, and common area use, deserve attention. Incubating passengers might not have been identified, but daily fever screening and diagnostic testing before boarding, during voyage, and before disembarking enhanced surveillance, reducing the possibility of undetected incubating COVID-19 cases ( 1 ). Strategies guaranteeing study protocol adherence were unfeasible on active voyages; however, enforcing company protocols and competent authority inspections maintained the intervention’s fidelity. Use of buffet lines in group 1 might be a confounder, but both groups applied identical food service occupancy limits; fomite transmission was unlikely given strict hand hygiene measures, replacement of serving utensils, sneeze-guards, and food service by crew. The ship company uniformly applied and enforced clear policies in groups 1 and 2. That uniform application was impossible in group 3 (communities) because implementation policies varied: full or partial; national, regional, or local; mandatory or voluntary; and groups targeted (i.e., at-risk persons, healthcare workers, travelers). Topics for further research include cost-effectiveness of NPMs on cruise ships in the context of pandemics, public health emergencies of international concern or during respiratory illness outbreaks.

In conclusion, our ecologic study demonstrated the safe restart of cruise ship sector operations and indicated that mask use added an extra layer of protection; further studies should be conducted to verify the results. Masking should be considered in future public health emergencies when making decisions regarding NPMs and other measures that could interfere with international traffic and trade.

Dr. Mouchtouri, an associate professor of hygiene and epidemiology at the University of Thessaly, is scientific manager of the European Union project Healthy Sailing and led the maritime transport work package of the European Union Joint Action Healthy Gateways. Her primary research interests include the prevention and control of cross-border health threats and public health aspects in maritime transport.

Acknowledgments

We wish to acknowledge the contribution of the Hellenic Ministry of Health’s COVID-19 taskforce, the National Public Health Organization of Greece and the Biomedical Research Foundation, Academy of Athens, for the next-generation sequencing (NGS) analysis of positive samples. Moreover, we thank the ships’ medical doctors and all ship officers and crew members for their contributions. We express our sincere thanks to the National Public Health Organization of Greece and to the President of the Biomedical Research Foundation, Academy of Athens, Dimitrios Thanos for the NGS analysis of positive samples.

Part of this research was conducted in the framework of the Healthy Sailing project which received funding from the European Union’s Horizon Framework Programme under grant agreement no. 101069764. Moreover, part of this research was conducted in the framework of the EU Healthy Gateways Joint Action, which received funding from the European Union’s Health Programme (2014–2020) under grant agreement no. 801493. The cost of laboratory testing (serological tests and rapid antigen detection tests conducted onboard ships) was covered by the cruise lines.

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• Table . COVID-19 health measures, laboratory screening, and diagnostic testing for SARS-CoV-2 per comparison population group in interventional study of nonpharmaceutical measures to prevent COVID-19 aboard cruise ships

DOI: 10.3201/eid3005.231364

Original Publication Date: April 17, 2024

Table of Contents – Volume 30, Number 5—May 2024

Please use the form below to submit correspondence to the authors or contact them at the following address:

Varvara A. Mouchtouri, Laboratory of Hygiene and Epidemiology, Faculty of Medicine, University of Thessaly, 22 Papakyriazi str, 41222, Larissa, Greece

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Princess Cruises Cancels 9 Sailings on Its Newest Ship After Inaugural Voyage Gets Delayed

What to know if you've booked a trip that's now been canceled.

Courtesy of Princess Cruises

Princess Cruises has pushed back the inauguration of its newest ship and canceled several sailings for next year in the process.

The cruise line delayed the delivery of its next ship, the Star Princess , by about two months, pushing the start date from July 29, 2025, to Sept. 26, 2025, according to the company . The setback means Princess has been forced to cancel nine different cruises.

“Despite our collective dedication and relentless pursuit to deliver the ship in late July, it has become evident that additional time is required to ensure the Star Princess is delivered to the highest standards expected by our guests,” John Padgett, the president of Princess Cruises, said in a statement.

Travelers who were set to sail with the company on the brand-new ship can either receive a full refund of the cruise fare or choose to rebook on a future cruise and receive an onboard credit, which will depend on the cruise they choose. 

Passengers can rebook on any Princess cruise, including a future cruise on the Star Princess or on the Sun Princess , which launched this year.

Going forward, Princess will schedule its new inaugural voyage for the Star Princess on Oct. 4, 2025, sailing an 11-day route along the Mediterranean roundtrip from Barcelona. That will be followed by a 7-day trip on the Mediterranean on Oct. 15 and a 14-day transatlantic crossing to Fort Lauderdale on Oct. 22. The ship will then spend time in the Caribbean.

These cruises open for sale on April 30.

When finished, the Star Princess will feature room for 4,300 guests across 21 decks, and come complete with more than 29 different bars and restaurants, a multi-level glass-enclosed covered deck called The Dome, a two-story spa, an infinity pool, and more. The ship will be the second in Princess’ Sphere Class of ships, joining the Sun Princess .