Norovirus and Cruise Ships - Essay Example

Norovirus and Cruise ships The U.S. Centers for Disease Control reports that each year approximately 23people in the U.S. contract Noroviruses, a condition which causes symptoms similar to the stomach flu. It is the leading cause of gastroenteritis and the number of cases is rising, the most high profile example being the increase of outbreaks on cruise ships (“Norovirus Activity”, 2003). Last year, At least 700 people aboard the Liberty, a Carnival Cruise Lines ship, were afflicted while traveling across the Atlantic and almost 400 contracted Norovirus on a week-long cruise of the Caribbean aboard the Freedom of the Seas, a ship operated by Royal Caribbean (Associated Press, 2006). This discussion will give an overview of Norovirus, the myths regarding the condition and its relation to the cruise ship industry. The term Noroviruses which was previously called ‘Norwalk-like’ viruses refers to a set of viruses that negatively impacts the intestines and stomach. Gastroenteritis, a swelling of the large intestines and stomach is caused this group of viruses. Gastroenteritis has occasionally been identified as food poisoning or a calicivirus infection though it is not necessarily related to food. Norovirus is not associated with ‘the flu’ although it has been called the stomach flu. The flu, or influenza, is a respiratory sickness. Common symptoms of noroviruses include stomach cramps, diarrhea and vomiting which could result in dehydration if fluids are not adequately administered. Less frequent symptoms include chills, fever, nausea, headaches and fatigue. Symptoms usually arise suddenly, dramatically and last for a day or two. Children generally exhibit more violent symptoms than do adults. Noroviruses are located in the vomit or stool of infected persons and on surfaces that they have touched. Epidemics are more like to take place in small areas such as restaurants, nursing homes and cruise ships. Noroviruses are linked with the cruise ship industry because it is tracked by health officials more closely than are outbreaks on land. In addition, people are in closer contact with each other on ships because of the tight living quarter logistics and a constant cycling of passengers increases the risk of spreading viruses. Noroviruses are spread by ingesting liquids and food infected by noroviruses or coming in physical contact with infected surfaces via the eyes, nose, hands or mouth. Like all viruses, Noroviruses are extremely contagious but its affects are seldom serious. If infected with norovirus, fluids should be liberally consumed and hands should be washed often with a sanitizing solution especially when preparing food and after trips to the restroom so as not to spread the infection. Avoiding physical contact with others is also recommended (“Facts”, n.d.). Outbreaks of noroviruses on cruise-ships show the ease with which it can be passed between people who are in close contact in a closed setting resulting in an extensive outbreak. “The continuation of [norovirus] outbreaks on consecutive cruises with new passengers and the resurgence of outbreaks caused by the same virus strains during previous cruises on the same ship, or even on different ships of the same company, suggest that environmental contamination and infected crew members can serve as reservoirs of infection for passengers” (“Outbreaks”, 2002). As is common with highly publicized infectious diseases, public hysteria is inevitable along with myths and disinformation regarding the outbreaks. The cruise ship industry has been damaged by the confusion surrounding the facts regarding the contagious norovirus. People might believe that cruise ships are not a safe vacation option because of the recent outbreaks of Norovirus. According to officials at the Centers for Disease Control and Prevention, this is a false assumption. “It is perfectly safe to go on cruise ships. The standard by which they (cruise lines) are held for sanitation is the highest in the world,” said David Forney, chief of the CDC’s Vessel Sanitation Program (Cruise Critic, 2007). Because of the spotlight currently shining on cruise ships, it may be the best time to take vacation cruise. The entire industry has been very proactive since these outbreaks became so prevalent in ensuring that its passengers do not contract noroviruses during voyages. They have been especially concerned about the winter season traveler when viruses are spread more readily. The Royal Caribbean line has openly announced its new multi-faceted approach which includes comprehensive company directives such as implementing a three-phase disease-prevention curriculum, improved communication efforts with passengers and the establishment of a management team to administer improved sanitation and health procedures. Ships that have experienced outbreaks are often considered ‘infected ships.’ This is not the case, however. The ships which have experienced norovirus outbreaks scored high marks on CDC health inspections which are notoriously thorough. The ships themselves were not infected, it was the people who boarded the ships who infected others on the ships. As previously mentioned, according to the CDC, norovirus is a very contagious group of illnesses. Another myth is that noroviruses are largely illnesses that are confined to cruise ships. This assumption is not based in fact. Only the common cold is more prevalent than norovirus. It impacts many millions of people worldwide and many more are affected on land than at sea. Outbreaks of norovirus, much as the common cold, can occur during any season. It is wrongly believed that cruise ships cannot effectively fight the proliferation of Norovirus. Cleaning protocols, which are intense at all times, are heightened if there is a suspected case of a contagious disease such as norovirus. Besides the discomfort of fair-paying passengers being a concern, cruise lines will spend much time, effort and money to prevent outbreaks on ships so as to prevent negative publicity. Sanitation procedures have become more sophisticated and the highest priority on all cruise ships because of the recent illness outbreaks. According to a Princess Cruises spokesperson, “Princess staff and crew are trained to be extremely vigilant regarding passenger health, and the line operates a thorough health monitoring system. Employees receive special training and utilize a rigorous sanitary protocol that meets or exceeds CDC requirements” (Cruise Critic, 2007). Onboard medical services on most ships have been adequately outfitted so they can test viral samples immediately during the cruise instead of waiting for land-based lab results which come back following the cruise. Many lines now do not offer self-serve buffets and offer passengers pamphlets which give tips on how to avoid becoming sick during the cruise. Passengers who contract the virus, or any disease, are asked to remain in their room for a couple of days while the norovirus is more likely to be communicable. An example of the increased efforts by cruise lines to prevent widespread outbreaks of norovirus occurred in 2002 on the Holland America cruise line. Four consecutive outbreaks occurred on one of its ships despite exhaustive cleaning efforts so Holland America put the ship in dry-dock and sanitized every inch of the ship and its contents. This included items such as bibles, poker chips, remote controls and money. It threw away every one of its 2500 pillows and steam cleaned the carpeting throughout the ship. The extreme efforts resulted in the ship being free of norovirus. Another perception is that norovirus can be caused by food that in under-cooked. That could be an indirect cause but it is usually spread from physical contact by afflicted persons (Cruise Critic, 2007). Norovirus is highly contagious and because of the close environment inherent to cruise ships, controlling its widespread transmission is problematical in the course of standard sanitary procedures. Though those that contract norovirus are not considered to be at risk for fatality or even a long-term illness, the very young, elderly or cruise ship passengers with an acute, pre-existing medical condition may have an increased chance for developing further complications because the debilitating nature of the illness and the risk for dehydration and electrolyte depletion. Incidences of healthy adults having to be hospitalized after contracting norovirus are a very rare occurrence. Typically, those that require advanced medical attention upon contracting norovirus have other complicating factors as well. There are no particular treatments or vaccines for norovirus that have been developed or will be in the foreseeable future. The afflicted person simply has to allow it to ‘run its course’ over the period of a day of two. Quickly and effectively implementing control procedures when norovirus is first discovered is critical so that widespread outbreaks do not occur. Furthermore, “when routine disinfection measures are unsuccessful at interrupting the spread of virus during an outbreak, more extensive disinfection and a period of time without passengers aboard a ship might facilitate elimination of the virus” (“Outbreaks”, 2002). Media attention has been focused on outbreaks of norovirus on cruise ships but as the facts bear out, the vast majority of outbreaks are land-based. Norovirus has been unfairly labeled a ‘cruise ship virus’ but it, like the common cold, is hardly limited to cruise ships. References Associated Press. (December 8, 2006). “Nearly 400 Ill on World’s Largest Cruise Ship.” MSNBC. Available February 22, 2007 from Cruise Critic. (2007). “Demystifying the Myths of Norovirus.” MSNBC. Available February 22, 2007 from < http://www.msnbc.msn.com/id/16229084/> “Facts About Noroviruses on Cruise Ships.” (n.d.). Center for Disease Control and Prevention. Available February 22, 2007 from “Norovirus Activity – United States 2002.” (January 24, 2003). MMWR Weekly. Center for Disease Control and Prevention. Vol. 52, N. 3, pp. 41-45. Available February 22, 2007 from < http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5203a1.htm> “Outbreaks of Gastroenteritis Associated with Noroviruses on Cruise Ships – United States, 2002” (December 13, 2002). MMWR Weekly. Center for Disease Control and Prevention. Vol. 51, N. 49, pp. 1112-1115. Available February 22, 2007 from < http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5149a2.htm> Read More