The year is just halfway over and yet 13 norovirus outbreaks have been reported on cruises so far in 2023 – marking the largest number of norovirus incidents on these vessels in a single year since 2012, according to reports from the Vessel Sanitation Program of the Centers for Disease Control and Prevention (CDC).
The CDC reports outbreaks when two percent or more of passengers or crew report symptoms of gastrointestinal illness to the ship’s medical staff. Vessels are required to report the illness within 15 days of arriving at a U.S. port. The ships also must have more than 100 passengers and sailings between three and 21 days long for an outbreak to be reported.
The confined conditions of a cruise ship – coupled with widely shared food and drink – can spark outbreaks of communicable disease.
What is norovirus?
The norovirus, sometimes referred to as the "stomach bug" or "winter vomiting bug" is a nasty, highly contagious gastrointestinal virus that causes inflammation in the stomach lining and the intestines, according to a 2022 review in the journal Viruses.
The norovirus infection leads to unpleasant gastrointestinal symptoms, including non-bloody diarrhea, severe stomach pain and vomiting across all age groups. People infected with the virus may also have headaches overall body aches and fevers and are at risk of dehydration.
Norovirus is particularly contagious. It thrives in the closed environment of a cruise ship where the close person-to-person spread is so intense on a cruise ship that once this virus is introduced into that population, it has many, many opportunities to spread, says Dr. William Schaffner, a professor of infectious diseases at Vanderbilt University Medical Center.
Symptoms typically emerge within 12 to 48 hours of being exposed. Most people get better after a few days, but severe cases may require hospitalization. Studies have shown that norovirus can continue to spread for two weeks or more after an infected person stops having symptoms of the illness, according to the CDC.
In early 2020, the start of the Wuhan coronavirus (COVID-19) pandemic led to the grounding of cruise ships worldwide.
The CDC continued to warn against travel on cruise ships for the next several years, during which time there were little to no outbreaks of gastrointestinal illness reported. Finally, in March 2022, the agency lifted its formal travel health notice concerning cruise ships, though outbreaks remained much lower than usual that year.
Return to social norms drives recent outbreaks
Much like other recent spikes in common diseases, the return to social norms, like seafaring vacations, is the major factor behind these outbreaks. Prior to the pandemic, though, there did appear to be some progress made against cruise ship illness.
From 2006 to 2019, the rate of gastrointestinal illness on cruises steadily declined, according to the CDC. (Related: Norovirus cruise: Outbreak sickens passengers and crew on two ships.)
The most recent outbreak hit passengers and crew members on board a Viking Cruises Viking Neptune trip from Iceland that docked in the U.S. on June 20.
More than 100 passengers of 838 in total reported being ill while on board, accounting for 13.1 percent of all vacationers on the ship. Nine crew members reported being ill as well.
Viking Cruises told the Wall Street Journal that the recent outbreak on its ship "originated from a shoreside restaurant in Iceland where a group of guests dined during their free time."
Across the 13 outbreaks among cruises that docked in the U.S., nearly 1,700 passengers reported being ill during their voyages, along with more than 240 crew members.
Those cases in June came after multiple norovirus outbreaks in previous months that affected a range of cruise lines.
In May, two outbreaks were reported on voyages led by Celebrity Cruises and Holland America. In March, Celebrity Cruises reported two norovirus outbreaks, as did Royal Caribbean International and Princess Cruises.
Princess Cruises reported its first outbreak of the year in February, and Royal Caribbean International reported two the previous month. P&O Cruises also reported an outbreak on its Arcadia cruise ship this year.
The CDC's tally of norovirus outbreaks so far confirmed on cruise ships in 2023 is already higher than any annual outbreak tallies since 2012 when the health agency recorded 16 outbreaks.
While norovirus has become synonymous with cruise ships, it’s a prolific source of gastrointestinal misery everywhere. It’s seldom life-threatening, but it does cause upwards of 100,000 hospitalizations and nearly a half million visits to the emergency room in the U.S. alone.
Norovirus is incredibly contagious, even after it stops making people sick. However, these steps can be taken to prevent spreading it to others:
- Wash hands thoroughly with soap and water – using hand sanitizers alone isn’t very effective.
- Clean and disinfect surfaces with bleach.
- Avoid preparing or sharing food when sick.
- Cook food safely.
- Wash laundry well in hot water.
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Watch this news report about SARS-CoV-2's resurgence being compounded by norovirus outbreak.
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