News Roundup [abridged Versions Appear In The Paper Journal]

Viral gastroenteritis sickens hundreds on cruise ships

BMJ 2002; 325 doi: (Published 23 November 2002) Cite this as: BMJ 2002;325:1192
  1. Fred Charatan
  1. Florida

    Cruise ship companies are advising passengers to wash their hands after several outbreaks of gastroenteritis among travellers. But they deny that the problem is caused by anything on the ships.

    Since last May, passengers on at least 10 US cruise ships sailing from ports as far apart as Seattle, Vancouver, Fort Lauderdale, Miami, Barcelona, and the United Kingdom have been infected with the virus, which is similar to the Norwalk virus (also known as winter vomiting virus). It has infected at least 1400 passengers and crew on the 10 ships.

    US cruise lines are required to report outbreaks to the US Public Health Service, which may investigate and order appropriate measures if more than 3% of passengers or crew develop gastroenteritis.

    On the Holland America's Amsterdam, which was cruising the Caribbean last month out of Port Everglades, Florida, 163 of the ship's mainly elderly passengers and 18 crew members were affected—out of 1905 people aboard. They had one to two days of diarrhoea, vomiting, abdominal cramps, and dehydration. That is the third sailing in which the ship has had a sizeable viral outbreak.

    Rose Abello, public relations vice president for Holland America, said that the boat was cleaned thoroughly after all three cruises. “The ship is not sick. There are sick people getting on the ship,” she said. On the latest trip, said Ms Abello, 21 people became sick when the ship docked at St Thomas. With their companions, they were flown home at the company's expense. Others who became sick received refunds, plus discounts on their next cruise. On board there were signs everywhere asking passengers to wash their hands and avoid personal contact.

    In Alaska over the summer, another of Holland America's ships, the Ryndam, had outbreaks on two cruises, affecting 218 and 176 people, and on the Princess cruise ship the Ocean Princess 52 and 127 people were infected with a Norwalk-type virus confirmed by laboratory tests. The numbers may not reflect the true prevalence, as cases may go unreported.

    Inspectors from the US vessel sanitation programme have scrutinised the ships' food, water, and sanitation systems and found no evidence that they were the source of the outbreaks.

    “The Norwalk virus is extremely infectious and fairly easily transmitted. We feel strongly that it is spreading person to person,” said David Forney, chief of the vessel sanitation programme of the US Centers for Disease Control and Prevention (CDC). “We've had no indications on any of the ships that it was due to anything on the ships.”

    The sanitation programme requires the ship to scrub every surface with bleach solution during the outbreak and layover in port. Ships with repeat outbreaks may choose to cancel a trip and stay in port for a week of intense cleaning. The CDC can “dock” a ship but has not done so recently, Mr Forney said.

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