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Viruses board with passengers

Cruise ships don't cause norovirus outbreaks.

Cruise passengers do, says the man who oversees the Vessel Sanitation Program for the Centers for Disease Control and Prevention.

"We have told cruise lines that every time they bring on a new group of passengers, they have to suspect some of those people will be ill," said Dave Forney, chief of the Vessel Sanitation Program. "The primary transmission is people who are ill."

In recent weeks, two cruise ships have returned to South Florida ports with hundreds of passengers and crew struggling with symptoms of norovirus, a highly contagious virus that causes gastroenteritis.

Forney said it's virtually impossible to prevent norovirus from getting on a ship. He said that because most people book cruises months in advance, they aren't likely to postpone voyages if they are ill on the day the ship departs.

"If I wake up vomiting and have diarrhea, what do you think I'm going to do?" Forney asked. "I'm going on my vacation because I've planned it for weeks. And you can't tell if someone has diarrhea when they walk on a ship."

As common as the common cold, norovirus affects 23-million Americans annually. The virus usually lasts 24 to 48 hours, and symptoms often include stomach ache, diarrhea and vomiting.

Royal Caribbean International's Freedom of the Seas returned Sunday to the Port of Miami after seven days at sea in which 338 passengers and 43 crew members experienced norovirus symptoms. Cruise line officials think the virus was brought on board Nov. 26 by a passenger. There were 3,823 passengers and 1,402 crew on board.

Last month, the Carnival Liberty had a suspected norovirus outbreak during a trans-Atlantic cruise that began in Rome on Nov. 3. During the cruise, 536 guests and 143 crew members reported being ill.

The number of norovirus outbreaks on cruise ships has increased dramatically over the last several years. So far in 2006, according to the CDC, there have been 22 norovirus outbreaks reported on ships with international itineraries. There are six other cases, including the most recent two, where virus symptoms were prevalent, but no official cause has yet been identified.

From 1994 to 2001, there were 24 reported norovirus outbreaks on ships, according to the CDC.

Cruise line officials said their industry is the only one that has to report every case to the CDC. They say the virus is common in many other places where large groups reside, including college dormitories and nursing homes.

Among those aboard the Carnival Liberty's voyage last month was a Tarpon Springs couple, David Lee Fitzgerald and Martha Fitzgerald. David Lee, 76, died aboard the ship on Nov. 10, after his wife said he visited the ship's infirmary three times with symptoms that included vomiting and diarrhea. Carnival officials have said his death was due to a prior heart problem. The Broward County medical examiner has not completed the autopsy and hasn't issued a cause of death.

Martha Fitzgerald said Tuesday that she was sickened by the virus first. She had just eaten breakfast and was waiting to go ashore to explore Barcelona.

"I threw up in the lobby and then the diarrhea started," Fitzgerald said. "Then the stomach cramps started. The cramps were like the kind a woman gets during her menstrual cycle but worse. And the diarrhea was like getting a colonoscopy, but worse."

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Cruise officials say companies have taken steps to combat the spread of the virus. Stricken passengers, for example, are encouraged to stay in their cabins while the virus runs its course.

"It's important to improve incentives for people to be willing to be isolated," said Michael Crye, executive vice president for Cruise Line International Association in Arlington, Va., which works with the travel distribution systems, regulators and legislators in representing the cruise line industry. Incentives could include room service and free movies in the stricken passengers' rooms, Crye said. Or if a lot of people are affected, he said, cruise credits could be offered.

The most effective way to prevent or curb the spread of the virus is thorough hand washing. Forney said using hand sanitizer is not an effective substitute for a good hand washing. He said people should wash their hands, then use sanitizer.

It's also suggested that if you're sick before a cruise, you should try to reschedule.

Cruise lines are inspected for cleanliness twice a year. To control the virus, crews clean "high-touch" areas. With Royal Caribbean International, those areas include countertops, restroom and vanity surfaces, door handles, railings, grab bars, exercise equipment, remote controls, light switches, elevator buttons and keyboards, said Michael Sheehan of Royal Caribbean.

Carnival offers a video in its cabins with information about norovirus, said Vance Gulliksen of Carnival. Martha Fitzgerald didn't notice many preventative measures on the ship when she caught the bug in November.

"There was no one there to give you wipes," Fitzgerald said. "At the food stations, yes, but in the cabin area and in the infirmary, they may have had them, but I didn't see them."

While those in the cruise industry take notice when there are outbreaks, Crye said the industry has not been affected.

"The ships are always almost full," Crye said.

In 2005, 11.5-million people worldwide went on cruises, an increase of 6 percent over the previous year, according to the International Council of Cruise Lines. And of the 8.6-million embarkations out of U.S. ports last year, more than half - 4.8-million - were out of Florida.

Demorris A. Lee can be reached at or (727) 445-4174.


What is norovirus?

Noroviruses are viruses that cause the stomach flu. The term norovirus was recently approved as the official name for this group of viruses. The symptoms of norovirus illness usually include nausea, vomiting, diarrhea and some stomach cramping. The illness often begins suddenly. In most people the illness is self-limiting with symptoms lasting a day or two.

Source: Centers for Disease Control and Prevention


How to prevent spread of virus

-Wash your hands before and after eating and smoking, after touching your face and going to the bathroom.

-Leave the area if you see someone get sick. Report it to cruise staff. You could become sick if you ingest contaminated airborne particles.

-Take care of yourself. Get plenty of rest, drink lots of water.

-If you're ill before a cruise, call the cruise line to determine your options.