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," said Dr. Robert Wheeler, chairman of 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, Wheeler said. That's longer than you think. Try counting slowly to 15 next time you wash up and you'll see how deficient the average 2-second rinse is.
Norovirus is usually spread 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.
An estimated 23-million Americans get norovirus each year without boarding a ship, according to the Centers for Disease Control and Prevention. They miss a day or two of work due to 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.
But cruise ships where outbreaks occur receive a great deal of media attention because they are required to report gastrointestinal illnesses to the CDC, which 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," said 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 onboard 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.
Inspectors look at spas, hot tubs, pools, water supply, food preparation and storage, and many other aspects of cleanliness and sanitation, from dishwasher temperature to the training of the crew on health and hygiene protocol. Inspection scores for every ship are available to the public online at www.cdc.gov/nceh/vsp; they are published once a month in the St. Petersburg Times Travel section, on Page 2T.
Forney said the industry has improved sanitation and disinfection procedures in the past few years, with more ships scoring higher on the 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 has gone up.
In 2002, the CDC reported 23 outbreaks aboard 19 ships; in 2003, it reported 28 outbreaks aboard 23 ships.
Norovirus is typically spread onboard 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 for 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, Forney said, passengers are ill when they board but don't want to lose their vacations. The disease spreads when they use public facilities rather than staying in their rooms.
Many cruise lines have become proactive. At Holland America, the staff is instructed to politely inquire about the health of passengers ordering Jell-O through room service. On some cruise lines, regular cabin stewards are forbidden to clean the rooms of infected guests or public facilities those guests have used. Instead, trained 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," said Dr. Grant Tarling, fleet medical officer for Princess Cruises.
And 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 that sick passengers were asked to isolate themselves or how many days of the voyage were lost to illness.
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FOR MORE INFORMATION: For the Centers for Disease Control and Prevention's inspection reports for cruise ships, visit www.cdc.gov/nceh/vsp or call toll-free 1-888-232-6789 for information.