- The Washington Times - Thursday, February 26, 2004

NEW YORK — If you’re taking a cruise and have concerns about norovirus, you can do one simple thing to protect your health.

Wash your hands.

“Proper personal hygiene is the most important thing that each individual can do to try to prevent the spread of norovirus,” says Dr. Robert Wheeler, chairman of the American College of Emergency Physicians’ cruise ship and maritime medicine sector. “People just don’t wash their hands properly, and that’s why that particular bug spreads so much.”

To cleanse your hands of germs, you must use soap and rub and rinse for 15 seconds, Dr. Wheeler says. That’s longer than you think; try counting slowly to 15 next time you wash up, and you’ll see how deficient the average two-second rinse really is.

Norovirus is usually spread either person to person or via contaminated surfaces — meaning you can catch the bug by holding a germy handrail and then putting your hand to your face just as easily as if you stood next to an infected person in a buffet line.

About 23 million Americans get norovirus each year without ever stepping on a ship, according to the federal Centers for Disease Control and Prevention. They miss a day or two of work because of what usually is referred to as “stomach flu” and don’t think much about whether they picked it up at a party, a restaurant or the office.

However, cruise ships where outbreaks occur receive a great deal of media attention because they are required to report gastrointestinal illnesses to the CDC, which then makes those reports public.

“This is the most common cause of gastrointestinal illness in the United States, but it is not reportable anywhere except from cruise ships,” says Dave Forney, chief of the CDC’s Vessel Sanitation Program.

Ships must notify the CDC when 2 percent or more of those on a cruise experience gastrointestinal illness. The CDC’s statistical definition of an outbreak is when 3 percent or more of those on board report symptoms.

In an effort to prevent occurrences, the CDC conducts surprise inspections twice a year of every ship with an international itinerary that calls on U.S. ports and carries more than 13 people. That includes cruises to the Caribbean, Mexico and Canada, Mr. Forney says.

Inspectors look at spas, hot tubs, pools, water supply, food preparation and storage, and many other aspects of cleanliness and sanitation, including dishwasher temperature and the training of the crew on health and hygiene protocol.

Mr. Forney says that overall, the industry has improved sanitation and disinfection procedures in the past few years, and more ships are scoring higher on the CDC inspections. At the same time, the number of people taking cruises is on the rise, the number of cruise ships has increased, and the incidence of gastrointestinal illness on ships also has gone up. In 2002, the CDC reported 23 outbreaks aboard 19 ships; in 2003, the CDC reported 28 outbreaks aboard 23 ships.

Norovirus typically is spread on board when someone vomits in a public place or uses a public bathroom. Others can be infected by virus particles that survive on surfaces.

It takes a day or two to develop symptoms once you are exposed. Nausea, vomiting, diarrhea, low fever, headaches, muscle aches and stomach cramps can last a few hours or a couple of days. There is no cure other than to let the illness run its course. Antibiotics won’t help, and patients can become dehydrated if they don’t consume enough liquids.

In some cases, Mr. Forney says, passengers are ill when they board but don’t want to lose their precious vacations. The disease spreads when they use public facilities rather than staying in their rooms.

Many cruise lines have become proactive. At Holland America Cruise Line, the staff is instructed to inquire politely about the health of passengers ordering Jell-O through room service. At some cruise lines, regular cabin stewards are forbidden to clean the rooms of infected guests or public facilities they have used; instead, trained hit squads wearing disposable gowns and wielding heavy-duty chlorine-bleach-based disinfectants are sent in.

“You can’t grab Lysol and make it go away,” says Dr. Grant Tarling, fleet medical officer for Princess Cruises. Also, because crew members in the past sometimes tried to conceal their illnesses so as not to lose pay for days not worked, policies are changing so that workers can call in sick without being penalized.

Refund policies vary, but companies sometimes offer compensation based on how many days sick passengers were asked to isolate themselves or how many days of the voyage were lost to illness. Stories about sick passengers woozily disembarking ships after they return to port continue to receive media attention.

In September, an outbreak aboard Princess Cruises’ Regal Princess forced the ship to dock in New York City a day earlier than scheduled after a trans-Atlantic trip that had originated in Copenhagen. In October, Carnival Cruise Lines had two outbreaks on different cruises aboard the same ship, Holiday, and dozens of passengers came down with a stomach illness on the Carnival ship Legend in November.

One recent and highly publicized voyage involved a 17-day trip aboard the Princess ship Aurora on which 500 of the 1,800 passengers fell ill. Port calls were canceled in an effort to contain the outbreak, and some passengers were furious.

Tricia Campbell of Hatfield, England, says the virus confined her to her cabin for a week, and she wanted compensation. “It was a ruined holiday,” she says.

Others were more philosophical. David Roderick from Lytham St. Annes, England, who also became ill, says, “The crew did everything they could, and I am taking the view that it’s one of those things.”

• • •

Cruise-ship inspections: For the CDC’s inspection reports for cruise ships, visit www.cdc.gov/nceh/vsp or call 888/232-6789.

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