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What's Behind the Latest Epidemic of Sick Cruise Ships?

Dec 8, 2002 | San Francisco Chronicle One by one, Caribbean cruises have become voyages of the damned as more than a thousand passengers in recent weeks have fallen victim to debilitating shipboard viruses. What's behind this rash of outbreaks, how serious are they and what can you do to protect yourself?

The Disney cruise ship Magic is scheduled to return to the seas this week after undergoing a thorough scrubbing at its Port Canaveral, Fla., base because of outbreaks that sickened more than 500 people on two voyages in the Caribbean.

The Magic is one of three cruise liners to be hit recently with outbreaks of the Norwalk virus, a common gastrointestinal bug that brings on short but intense bouts of abdominal cramping, vomiting and diarrhea. The highly contagious virus can lay victims low for two days.

In October and November, 524 people on four trips on Holland America's Amsterdam became ill. And on Monday, Carnival Cruises' Fascination returned from a three-day tour of the Bahamas with 200 sick passengers. (Norwalk is suspected, but lab results weren't available at press time.)

In the case of Disney and Holland America, the ships were thoroughly cleaned between sailings, but that apparently failed to stem the cycle of infection. The Fascination was cleaned Monday and returned to the seas.

The outbreaks, experts say, were not a complete surprise. Because cruises bring together people from all over and sequester them in a small, confined space, diseases can spread rapidly just as in college dormitories, military barracks and other close-quarters situations.

The Norwalk virus is the leading nonbacterial cause of gastrointestinal illness in the United States, according to Dave Forney, chief of the Vessel Sanitation Program, part of the Centers for Disease Control and Prevention in Atlanta. More than 180,000 cases were reported in the United States last year.

"There are routinely outbreaks linked to (Norwalk) in nursing homes, build-

ings, and the Boy Scout Jamboree last summer," said Forney. "This is not some mysterious bug."

Why are so many cases being reported on cruise ships lately? Forney said that the recent rash of cases is unusual but that investigators have not been able to find a clear explanation.

Still, keep it in perspective: Fewer than 1 percent of passengers get sick from something they picked up on board a cruise ship.

"If you look at the number of ships cruising today and the number of passengers, I think your risk of illness is not that high," Forney said.

That's at least in part because of the Vessel Sanitation Program, which started in 1975. Twice a year it conducts unannounced inspections of all ships carrying 13 or more passengers that dock in U.S. ports and have an itinerary that includes a foreign stop. The result is that the number of diarrheal- disease outbreaks per passenger per day has decreased steadily since the 1970s.

Results of the sanitation inspections are available on the Internet, at

A mid-1980s evaluation of the program showed that there was a correlation between lower scores on the routine inspections and more disease outbreaks. Forney said an update of that study to be published in March found that the association between scores and reports of illness still holds.

But the system is far from foolproof. Both the Magic and the Amsterdam came up with good scores on their most recent inspections 96 for the Amsterdam and 99 for the Magic. The Fascination scored a 93. A top score is 100 and a passing grade is 86.

Forney said investigations into the recent outbreaks have ruled out food and water as a source of the infection. Instead, it's clear that it has been largely transmitted person to person.

So what can you do?

The same precautions commonly recommended to avoid infectious diseases in high-risk areas also apply to cruise ships: Wash your hands thoroughly and often, keep your hands away from your face and mouth, and avoid contact with others who may be infected. And if you are sick, keep your distance from others and wash your hands frequently.

It's also wise to get a flu shot. Although it's not a reportable disease on cruise ships, there have been several influenza outbreaks on cruise ships over the years, and it makes sense to protect yourself. That's especially true if you are older than 65.

It's probably not necessary to take Cipro or another antibiotic with you. For one thing, the recent outbreaks were all linked to a virus, for which antibiotics are useless. And the ship's medical staff should have plenty on board if the need arises.

It may not be easy to get over-the-counter anti-diarrheal drugs such as Imodium and Kaopectate on board. Many cruise ships insist that you visit the infirmary to get them. Even those that sell them in the gift shop are required to keep tabs on sales, so that outbreaks don't go undetected.

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