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So far this year the CDC has already reported 11 outbreaks of vomiting and diarrhea on cruise ships visiting U.S. ports, more than the total for 2019. As cruise passengers return to the seas in force following a pandemic lull, an unwelcome side effect is also back: outbreaks of gastrointestinal illness. According to the Centers for Disease Control and Prevention, so far this year there have been 11 outbreaks of vomiting and diarrhea that reach the threshold for public notification on cruise ships visiting U.S. ports. The mid-May tally has already exceeded the total number of outbreaks reported in 2019 and tied the yearly number for both 2017 and 2018. Norovirus has been identified as the culprit in four of the 2023 cases; the others are all classified as unknown. The CDC did not immediately provide responses to questions about the increase in cases this year. In the latest outbreak, aboard Holland America Line’s Nieuw Amsterdam, 160 passengers and 26 crew have reported being ill. That represents a little more than 8 percent of guests and 3 percent of workers. The ship is on a 14-day Alaska cruise that returns to Vancouver on Sunday.
“Incidence of mild gastrointestinal illness among guests onboard Nieuw Amsterdam are suspected to be the common but highly contagious Norovirus, which is typically transmitted through close contact with unwell people and includes touching shared items,” Holland America Line said in an emailed statement. “The cases have been mostly mild and quickly resolving.” The CDC says crew on the ship, which can carry more than 2,100 passengers, are increasing cleaning and disinfection procedures and collecting stool specimens to send to a lab to confirm the cause. Once it arrives in Vancouver, the vessel will go through extra disinfection, leading to a slightly delayed departure time. According to a CDC norovirus tracking network that uses information from 14 states, there were 735 outbreaks reported from August through April 23. There were 907 during the same period of the 2021-2022 norovirus season. Norovirus causes 19 to 21 million illnesses on average every year in the U.S., the agency says. Outbreaks of gastrointestinal illness plummeted during the pandemic, which shut down the cruise industry for more than a year and forced a slow return with multiple health precautions in place. There were no reported cases in 2020, followed by one in 2021 and four last year.
William Schaffner, a professor of infectious diseases at the Vanderbilt University School of Medicine in Nashville, told The Washington Post last year that the lower number of cruises, reduced concentration of passengers and coronavirus precautions were all factors in the drop in cases. “The more rigorous we are with all of these hygienic measures, there’s spillover to other infectious agents,” he said. Health authorities say cruise passengers should wash their hands often and leave the area if they see someone get sick. If people are sick before a cruise, they should ask about alternative options and ask a doctor if it’s safe to sail. The Cruise Lines International Association says incidents of gastrointestinal illness are “quite rare” on ships, pointing to the millions who get sick every year on land. The group said in a statement that crew members clean and sanitize using practices developed with public health authorities, including the CDC. “All of the efforts made by cruise ship crews cannot replace the responsibility that rests with each and every individual,” the association said. “Passengers and crew alike must also be committed to keeping themselves, their family and their fellow travelers healthy.” Through its Vessel Sanitation Program, the CDC inspects cruise ships, monitors illness, trains crew and provides public health information. The agency releases information on outbreaks when 3 percent or more of passengers or crew report symptoms to medical staff on board. “Norovirus can be especially challenging to control on cruise ships because of the close living quarters, shared dining areas, and rapid turnover of passengers,” the CDC says. “When the ship docks, norovirus can be brought on board in contaminated food or water or by passengers who were infected while ashore.” Because norovirus can linger on surfaces and resists many common disinfectants, it can result in outbreaks on back-to-back cruises. Still, the agency says norovirus on cruise ships only account for 1 percent of all reported outbreaks of the illness and notes that “acute gastrointestinal illness is relatively infrequent” on ships. “Health officials track illness on cruise ships,” the CDC says. “So outbreaks are found and reported more quickly on a cruise ship than on land.”
