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Healthy Cruising: Beyond Norovirus

Douglas Esposito, MD, MPH

Jul 10, 2013

A cruise can be a fun and relaxing way to see the world, but not if you get sick. Norovirus outbreaks receive a lot of media attention, but what else might travelers encounter on a cruise ship? I'm Dr. Douglas Esposito with the Travelers' Health Branch at the Centers for Disease Control and Prevention (CDC), here to discuss the health risks of cruise ship travel and how you can counsel patients to avoid these risks. The crowded, enclosed environment of a cruise ship facilitates the spread of infectious diseases, primarily gastrointestinal (such as norovirus) and respiratory (such as influenza and legionellosis). Because crew members often originate from developing countries with low rates of immunization, outbreaks of vaccine-preventable diseases, such as rubella and varicella, have also been reported. If you have patients who are planning a cruise vacation, they need to be up-to-date on all routine immunizations, particularly an annual flu shot. Also, consider destination-specific risks at ports of call. Although most port visits are short and the risk for vectorborne illness is low, many trips have the option to spend 1 or more nights off the ship. Ask your traveling patients about their itineraries; depending on where they are going and what they are doing, antimalarial medication or additional vaccinations may be indicated. Some countries require proof of yellow fever vaccination if the cruise has been at port in a country where yellow fever is endemic. Travelers should also adhere to insect precautions and food and water precautions while at port. Check the CDC Travelers' Health Website for destination-specific risks. Perhaps the simplest and most effective thing that cruise ship travelers can do to keep themselves healthy is to be diligent about hand hygiene and respiratory etiquette. Counsel your patients to wash their hands often and to use the hand sanitizer dispensers found throughout the ship. Remind patients to cover coughs and sneezes with their shoulder, elbow, or a tissue. Encourage your patients to postpone their trip if they are sick. If they get sick on the ship, they can seek onboard medical attention. To prevent spreading the infection to others, ill passengers need to remain isolated in their cabins until their symptoms subside. Cruise ship medical clinics can deal with a wide variety of illnesses and injuries. In general, shipboard clinics are comparable to ambulatory care centers. However, passengers should confirm that their insurance will cover care received in international waters, and if not, they should consider purchasing supplemental travel health insurance. Cruises can disrupt a patient's normal routine and diet, which can exacerbate chronic illnesses. These travelers should confirm that the clinic on their ship is equipped to manage their related health issues. Guests with serious medical issues should travel with a recent medical summary and ECG. Some cruises cater to chronically ill travelers with special needs, such as dialysis patients.
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A common complaint of cruise ship passengers is motion sickness. Contrary to popular belief, it is not likely to be related to the location of the cabin. Consider prescribing an antiemetic drug such as ondansetron or the scopolamine patch, or recommend patients to pack an over-the-counter drug such as dimenhydrinate or meclizine. Overall, the risk for illness or injury on a cruise ship is low; most passengers return safely with happy memories and maybe a few extra pounds. Still, please encourage your patients who are planning a cruise vacation to follow these guidelines to protect their health. Best wishes for safe and healthy travels! Web Resources CDC Yellow Book: Cruise Ship Travel CDC Yellow Book: Motion Sickness CDC Vessel Sanitation Program Douglas Esposito, MD, MPH, is a medical epidemiologist with CDC's Travelers' Health Branch. He primarily works with GeoSentinel, the global provider-based system of disease surveillance for travel-related illnesses, administered through a cooperative agreement between CDC and the International Society of Travel Medicine. Dr. Esposito received his bachelor's degree from the University of Rochester in Rochester, New York. He received his MD and MPH degrees from the University of North Carolina at Chapel Hill and completed a residency in pediatrics at the Children's Hospital and Medical Center in Seattle, Washington. Dr. Esposito began his career at CDC in 2008 as an Epidemic Intelligence Service (EIS) Officer where he was assigned to the Division of Viral Diseases, Viral Gastroenteritis Team. He joined Travelers' Health in 2010 after completing his EIS training. Prior to coming to CDC, Dr. Esposito worked for 13 years in a variety of roles with the Indian Health Service in remote northern Arizona and in Alaska. His current research activities focus on defining the epidemiology of disease among international travelers and in characterizing the clinical and epidemiologic characteristics of acute muscular sarcocystosis, a parasitic infection of increasing importance to international travelers. Dr. Esposito is the author of a number of reports and peer-reviewed articles, and is a member of the International Society of Travel Medicine and the American Academy of Pediatrics.

Public Information from the CDC and Medscape

Cite this article: Healthy Cruising: Beyond Norovirus. Medscape. Jul 10, 2013.

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