Avoiding a Norovirus Nightmare on Your Cruise

Planning to take a cruise? Are you concerned that a tranquil voyage could turn nightmarish if norovirus spreads throughout the ship? Norovirus is a highly contagious virus that causes nausea, vomiting and diarrhea—truly an unwelcomed passenger on a cruise. Here are some helpful facts about cruise ships and norovirus.

Norovirus is Not Limited to Cruises and It is Not a Stomach Flu

As Cruise Critic points out, although it is sometimes known as the “cruise ship virus,” norovirus is not limited to cruise ships.  It is a seasonally recurring virus, especially in nursing homes, hospitals, schools and other confined venues because of the close quarters and the ability of the virus to spread so quickly. It is commonly associated with foodborne disease.  The elderly and the very young are most prone to norovirus infection although it also affects many healthy people.  Norovirus is frequently associated with cruise travel because health officials are required to track illnesses on ships and report the number of cases of diarrhea to the Centers for Disease Control and Prevention (CDC) within 24 hours of arrival at a US port.

Norovirus has another misnomer:  It is frequently called the “stomach flu.” But, norovirus is not flu:  Flu is characterized by fever, fatigue, muscular aches and pains and inflammation of the respiratory passages although the flu can sometimes cause nausea and vomiting.  Norovirus infects the gastrointestinal system.

The Sick Should Not Go Cruising

If you are sick, don’t risk spreading your illness by boarding a cruise ship. Although symptoms usually last only a few days, people remain contagious for at least three days after being sick with norovirus.  Norovirus can spread quickly in enclosed spaces like cruise ships, putting everyone at risk.  Both feces and vomit are infectious.  Vomiting can produce miniscule particles suspended in the air that can enter the mouths of others and be swallowed.

It is possible to have norovirus infections multiple times over a lifetime because the virus mutates into new forms.  In other words, norovirus can ruin more than one cruise for you.  If you are planning a cruise, purchasing travel insurance is a good idea, letting you cancel your trip without financial penalty.

Norovirus can Spread in Several Different Ways

Understanding the many ways norovirus spreads can help you avoid norovirus on land and sea:

• Consuming contaminated food, drinks or ice
• Touching surfaces or objects contaminated with norovirus and then putting hands or fingers into your mouth
• Having direct contact with another person who is infected, e.g., sharing food or eating from the same utensils as someone who is ill
• Taking in norovirus particles spread through the air by someone vomiting

Hand Washing is Key and Hand Sanitizer May Not be as Helpful

According to CDC, good hand hygiene is one of the most critical control strategies in managing infectious disease outbreaks. Wash hands with warm water and soap for about 30 seconds–including vigorous rubbing and getting under the fingernails too–followed by thorough drying with paper towels. Hand-washing is especially important after using the bathroom and before preparing food or eating. Hand sanitizers may not be as effective against norovirus because not enough of the virus is killed or removed.

All Aboard for Cruise Ship Infection Control

CDC’s Vessel Sanitation Program specifies isolating infected persons for at least 48 hours after the resolution of the last symptom.  Food handlers suffering from any communicable disease should be excluded from food preparation and service.  Additionally, according to NBCNEWS.com, self-service buffets are now disappearing and passengers are given a “welcome letter” offering tips on hand-washing and remaining in their cabins when ill.

When norovirus is about, infection control measures need stepping up to prevent germ transmission. The virus can live for days on surfaces and it is hard to kill.  Frequently touched hard surfaces must be properly cleaned and disinfected. Additionally, norovirus “incidents” of diarrhea or vomiting must be promptly cleaned and affected surfaces disinfected with solutions of chlorine bleach to help reduce the transmission of norovirus (downloadable poster resources).  Anything that has been in contact with vomit or diarrhea should be discarded or disinfected.  Affected fabrics should be machine washed with detergent, hot water and bleach–if recommended–choosing the longest wash cycle, then machine dried.  Carpets and upholstery should be steam-cleaned.

Keeping your cruise safe and enjoyable is a matter of common sense and hygiene. Bon voyage!

Barbara M. Soule, R.N. MPA, CIC, FSHEA, is an Infection Preventionist and a member of the Water Quality & Health Council.