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Norovirus

What is Norovirus?

Norovirus is a highly contagious virus. It’s easily transmitted through the air, by touching contaminated surfaces, or eating contaminated food or water. The virus is highly resistant to temperatures as high as 140F, meaning washing dishes or contaminated laundry in boiling water doesn’t necessarily kill it. Disinfecting an area is tricky, too. Alcohol-based sanitizers are not effective at killing the viral cells. Plus the norovirus is very sticky and can live almost anywhere—like on lampshades or ceiling fans.

What are symptoms?

The two most common symptoms of a norovirus infection are vomiting and diarrhea. Sick passengers can feel stomach pain, nausea, and other flu-like symptoms such as a high fever, headache, and body aches. Infected patients can throw up or have diarrhea many times in a day, which is why it’s important to drink water to stay hydrated. Most people improve within 1-3 days, although they can remain contagious for up to two weeks. Very few people die from norovirus; in many instances death is the result of a compromised immune symptom or occurs in the extremely young or elderly.

What are the chances of an outbreak?

In 2013, there were seven norovirus outbreaks reported on cruise ships to the Centers for Disease Control and Prevention (CDC). Only four of those departed from the United States and involved 817 passengers. The Cruise Lines International Association reports that this number represents only about .006% of total global passengers, which is down from .008% in 2012. Compare that to the 21 million reported norovirus cases across the United States, and the chances of contracting norovirus while on vacation are slim. The GSII.4 Sydney strain, identified in 2012, is responsible for more recent reported cases of norovirus. Fewer particles are required to cause sickness, making it more contagious. Fewer people have immunity to this strain.

Why do cruise ships seem prone to norovirus?

Combine a virus that’s hard to kill, lives on multiple surfaces, and can be transmitted in different ways, and add thousands of people in an confined space like a cruise ship, and it’s easy to see why the norovirus can quickly spread. Cruise lines also follow stringent reporting laws and must answer to the CDC in the event of a suspected outbreak. That makes it easier for a norovirus incident to appear in the news than an outbreak in a college dormitory.

How do cruise lines respond to norovirus?

If an outbreak is suspected on a cruise ship, the cruise line first will remind passengers to take steps to prevent contracting the illness, like hand washing. Hand sanitizers may be given out. Expect to see frequently touched areas regularly sanitized. “Cleaning measures go as far as disinfecting the Scrabble game tiles, poker chips and anything that a passenger might touch,” said David Pelkin, spokesperson for Cruise Lines International Association, a group representing cruise lines and travel agents.

Proper hand washing is key in stopping the virus from spreading. Expect to hear frequently from crew via announcements, the daily bulletin, and around the ship about proper hygiene practices. Areas where people have been sick are immediately sanitized.

Food service procedures change in the event of an outbreak. Staff are assigned to the buffet area to serve passengers. Condiment containers disappear from tables and drinks will need to be finished in the area they were served--no grabbing wine from one bar and taking it to dinner in the dining room. Anyone handling food will wear plastic gloves.

Ill passengers or crew will be asked to remain in their cabins until symptoms ease to reduce chances to spreading the virus. This procedure is endorsed by the CDC.  Passengers still have access to room service.

In extreme cases, additional medical personnel will board the ship. The CDC typically sends an official to oversee sanitization and onboard measures to prevent the virus' spread. Cruise ships can delay the following cruise to send more time thoroughly disinfecting a vessel.

What can you do to minimize spread?

If an symptoms are reported onboard your cruise ship, make sure to wash your hands frequently with soap and water. The CDC recommends hand washing for 20 seconds or longer before and after eating, smoking, or using the restroom. Anytime your hands are dirty, they should be washed. Avoid touching your face and using shared utensils.

If someone is sick near you, leave the area immediately. Remember that norovirus can be transmitted through the air.

Should you begin experiencing gastrointestinal distress while onboard, inform medical personnel immediately and stay in your cabin. Be considerate of others: reducing the amount of contact you have with people can help contain the illness.

Most importantly, if you are sick before your cruise, call the cruise line. Don’t ruin your vacation and someone else’s. Cruise lines want their guests to enjoy their vacation experience and can work with you to find alternative arrangements.

Who else experiences norovirus outbreaks?

Cruise lines are not the only institutions to experience norovirus outbreaks; university dormitories, medical facilities, nursing homes, military barracks, and any place people gather in high numbers all are prone to experiencing norovirus. Since health officials like the CDC track illnesses on cruise ships so closely, outbreaks are found and more reported more quickly than on land.

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More Links:

CDC Norovirus Home

Preventing Norovirus Spread

Norovirus on Cruise Ships

Cruise Ship Outbreak Updates