The Travel Doctor

Recent news reports have raised new fears regarding cruise travel. Now everyone is talking about Norwalk virus.

Actually, the Norwalk (or Norwalk-like) virus is a group of related organisms all of which cause nausea, vomiting and diarrhea. And they are by no means limited to cruise ships. The CDC estimates that 23 million Americans a year suffer symptoms from these viruses. Most of these are “sporadic” cases, contracted though normal, every day contact with other people. It’s just when those people are crowded together into a closed environment (like a nursing home, day care center, or cruise ship) that we get an “epidemic.” Also, because cruise ships are so carefully monitored, these problems come to light a lot sooner than they would in other settings.

Although a few cases of the virus have been due to contaminated seafood, most of the problem has been person-to-person spread from people who were already ill when they got on the ship. When ill people vomit in public places, have diarrhea in the public lavatories and handle all the railings and elevator buttons with unwashed hands, the virus spreads very quickly.

The truth is that in recent years the more serious problem aboard cruise ships has been the plain old flu virus. Once again, close quarters contribute to the problem. But since many senior citizens travel on cruises, the consequences of an influenza outbreak on a ship can be quite severe.

The cruise lines are doing all they can to prevent these outbreaks. This includes vigorous cleaning regimes, careful attention to food preparation and presentation, quick attention to sick passengers and crew and even temporarily removing the ship from service when necessary.

But you need to do your part too. Those things that are in your control include the following:

Before you go on a cruise, get a flu shot. If you are prone to respiratory infections, ask your doctor about a pneumonia shot as well.
Buy trip cancellation insurance. If you are ill when it comes time to cruise, cancel your trip and go at a later date.
When meeting and greeting new people, as much as possible let it consist of waving, nodding and “rubbing elbows.” Keep handshaking, kissing and hugging to a minimum.
For meal service, sit in the dining room, relax and be waited on. If you must use the buffet, follow the rules regarding fresh dishes and utensils and keeping things covered.
When eating on shore, avoid seafood and shellfish unless it is in a first class restaurant.
Use the toilet in your stateroom; not the public restrooms.
Try not to touch elevator buttons. Use the stairs. You need the exercise anyway!
Wash your hands frequently with soap and water. The alcohol gels just do not do the trick in this sort of situation.
If you become ill, retire to your cabin and call the ship’s health center. Don’t sit in the sick bay waiting area spreading germs.

(Many thanks to Dr. Alastair Smith, International & Maritime Health Consultant for much of the information contained in this article.)