Should you avoid cruises this Spring Break?
A public health announcement, reported via CNN.com: outbreaks of norovirus occurred on two cruise ships out of Fort Lauderdale, Florida over the weekend, sickening almost 500 passengers and crew, out of just over 6000 people. Both ships were thoroughly sanitized on their return to port, and were set to return to sea. Cruises are notorious places to pick up infection, however the actual incidence overall is likely no worse on cruises as opposed to anywhere else. The apparent higher incidence is most likely attributable to the strict guidelines on reporting illnesses on board cruise ships.
Norovirus is a very easily directly and indirectly transmitted viral agent, and according to the CDC is the most commonly seen cause of gastroenteritis (mild-to-moderate infection of the gastrointestinal tract) in the United States. Signs and symptoms of norovirus include diarrhea, vomiting, and stomach pain, however almost all patients resolve without medical attention within 1 to 2 days. The most significant complication due to norovirus infection is dehydration due to the diarrhea. Up to 30% of infected individuals may be asymptomatic; they are infected however, and can also spread the infection in an outbreak without knowing it. Noroviruses can be spread within the constrained environment of a cruise ship either by direct contact between an infected and non-infected individual, or by handling food or surfaces contaminated by an infected individual.
Prevention of norovirus infection then becomes just a matter of promoting personal hygiene, and public health officials advise that good attention to handwashing and the use of antiseptic hand wipes is effective at curtailing an epidemic. Norovirus however is a non-enveloped virus, which means that unlike a number of other viruses, it is able to persist in the environment for an extended period of time. This means that sanitation, as opposed to waiting out the outbreak, is essential for bringing the number of new cases of infection under control.