Norovirus - What You Need to Know - Cruise Critic Norovirus - What You Need to Know Norovirus - What You Need to Know Subscribe By Cruise Critic staff With cruise ship "outbreaks" regularly appearing in the news, awareness of Norovirus -- an extremely common and highly contagious virus that causes gastroenteritis -- has been significantly raised. But before you reconsider that long-awaited cruise vacation because of gloom-and-doom reports on television and in your daily paper, know these facts: Norovirus is not a "cruise ship" virus, nor does it limit itself to sea-going vessels. Norovirus spreads swiftly wherever there are many people in a small area, including nursing homes, restaurants, hotels, dormitories ... and cruise ships. The common cold is the only illness more common, and the Centers for Disease Control and Prevention in Atlanta estimates that there are more than 20 million cases of Norovirus annually. Norovirus is associated with cruise travel simply because health officials are required to track illnesses on ships (and are not at hotels and resorts); therefore, outbreaks are found and reported more quickly at sea than on land. What are the symptoms? What are the cruise lines doing to combat germs?

In the following Q&A, we tell you everything you need to know about Norovirus -- and how to avoid getting sick on your next cruise vacation. Question: What is Norovirus and how is it spread? Answer: Norovirus is named after an outbreak that occurred in Norwalk, Ohio, some 35 years ago. According to the Centers for Disease Control and Prevention's Vessel Sanitation Program, "Noroviruses are a group of viruses (previously known as Norwalk-like viruses) that can affect the stomach and intestines. These viruses can cause people to have gastroenteritis, an inflammation of the stomach and the large intestines. Gastroenteritis is sometimes called a calicivirus infection or food poisoning, even though it may not always be related to food." Though Norovirus can be passed via contaminated food and water, when it comes to cruise ships it is typically spread through physical contact with ill people or surfaces/objects they may have touched. This includes shaking hands, caring for a sick friend or family member, sharing food or eating from the same utensils, and not washing hands after using the bathroom or changing diapers (the highly transmittable fecal-oral spread). Bottom line?

For the most part, Norovirus outbreaks are the results of guests setting sail sick ... and passing it around. Q: What are the symptoms? A: Though generally moderate, symptoms are often flu-like (in fact, Norovirus is often called the "stomach flu," even though it is not related to influenza). Symptoms include nausea, vomiting, diarrhea and abdominal cramps; children often vomit more than adults. A low-grade fever and headache are also possible. Q: What preventative measures should I take to avoid coming down with Norovirus? A: First and foremost, wash your hands often with hot water and soap; the CDC recommends hitting the sink before and after eating and smoking, after touching your face, after using the restroom, and whenever your hands are dirty. Limit person-to-person contact as much as possible (we're not saying you absolutely must refuse the captain a handshake at his cocktail party ... just use your judgment throughout the cruise). Cruise Critic members advise packing extra soap, a supply of Lysol and a bottle of Pepto-Bismol (just in case). Beyond that, avoid uncooked food as much as possible. Stick to bottled water, and don't share drinking glasses and eating utensils.

Q: What happens if I come down with Norovirus while on a cruise ship? A: Beyond a visit to the ship's doctor, be sure to drink plenty of water as dehydration is a common side-effect. If they report symptoms, passengers are typically quarantined to their cabins to prevent spreading the illness to others -- not an ideal situation, but necessary. Q: How long will it take me to recover? A: Once you have been exposed to Norovirus, it takes anywhere from one to three days for its symptoms to appear; symptoms typically last only 24 to 48 hours but keep up the good hygiene -- people may be contagious for as long as two weeks after recovery. Q: Why do I only hear about Norovirus outbreaks on cruise ships? A: It has been a particular problem of late for cruise ships because passengers and crew typically occupy close -- and closed-in -- quarters, such as casinos, theaters and banquet-style dining rooms. However, Norovirus has been known to close schools, attack college dormitories and even infect a Hollywood Academy Awards party. According to a spokesman at the CDC, "the reason you hear about Norovirus on cruise ships is because they are required to report ... gastrointestinal illness.

Nowhere else in the public health system of the United States is Norovirus a reportable illness. Norovirus is not a 'cruise ship' illness, but an illness commonly seen in many settings throughout the United States." Q: What do cruise lines do to halt the spread of Norovirus? A: Typically, when there's a significant outbreak of Norovirus or a similar illness (the CDC requires cruise lines to immediately file a report when more than 2 percent of passengers report symptoms), crewmembers clean even more thoroughly than usual -- with stronger solvents. Buffet service often switches from "help yourself" to manned stations. You may see salt and pepper shakers disappear from tables. Beyond that, crewmembers distribute information to passengers onboard offering precautionary tips, as well as a heads-up memo at embarkation to travelers boarding a ship that had previously seen a high percentage of illness. And, as mentioned above, passengers who report symptoms may be quarantined to the their cabins. There are also behind-the-scenes procedures that cruise lines must follow. For instance, medical officers are required to maintain illness incident counts for each voyage that involves a stop at an American port.

They are also required to communicate to the CDC, within 24-hours of arrival at a U.S. port, "the number of passengers and crew members who reported diarrhea to the ship's medical staff" during that voyage. In serious cases where outbreaks cannot be contained, cruise lines might actually pull a ship out of service for a few days so it can undergo a more thorough sanitization. These enhanced cleanings are generally coordinated with the CDC. Q: Is Norovirus more likely to break out on an unclean ship? A: No. The Vessel Sanitation Program also monitors vessel cleanliness and there is no correlation between scores and outbreaks of gastrointestinal illness. In fact, Crown Princess, which was forced to end a cruise early in February 2012 to contain an outbreak, scored a 100 on its November 2011 inspection. The twice-yearly exam is notoriously thorough and challenging; 86 or above is considered passing. Q: What exactly is the CDC, and how is it involved? A: The CDC operates under the authority of the U.S. Public Health Service Act; its mission is to prevent the introduction and spread of communicable diseases in the U.S.

More specifically, its Vessel Sanitation Program monitors illness outbreaks on ships carrying more than 13 passengers. Twenty-four hours prior to arrival at a U.S. port from a foreign port, vessels must report to the CDC the number of passengers and crew onboard, and the number of passengers and crew who have reported to the ship's medical staff with a gastrointestinal illness -- even if that number is zero. Therefore, the CDC has reports from every cruise vessel, on just about every cruise, even if there was no illness. If at any time during the cruise the number of ill passengers or crew exceeds 2 percent, the vessel must file a special report notifying CDC of the illness. Almost all of these reports are generated electronically. Q: Am I entitled to compensation from the cruise line if I get Norovirus while on a voyage? A: Tricky question. Cruise lines are not required to compensate guests who fall ill on a voyage. However, cruise lines will generally compensate passengers whose voyage is altered or canceled due to an outbreak.

Guests booked on the voyage of Carnival Liberty that was shortened for the two-day cleaning were offered the chance to sail with a 50 percent refund and 50 percent future cruise credit, or cancel for a full refund and reimbursement of airline change fees. Royal Caribbean offered guests on the shortened Freedom of the Seas sailing the chance to cancel for a full refund and a future cruise discount, or sail and receive a future cruise discount and additional compensation. Be sure to read your contract -- on the back of your cruise documents or ticket -- very carefully. Each line has specific rules regarding compensation. Q: Will travel insurance cover me in case I want to cancel because of fear of illness? A: There is no fear-of-illness coverage in the industry. However, travel insurance will cover you if you cancel because you got sick before you went or are stricken onboard. Specifically, it could also pick up medical expenses and/or compensate you for days you missed if you left the ship before the end of the cruise. Since policies vary between travel insurers, read the fine print before you go. Norwalk Virus or Norovirus Prevention on Cruise Ships By Linda Garrison Updated May 08, 2016.

The Norwalk virus or norovirus occasionally comes up in the news whenever more than 2 percent of the total passengers become ill with a "stomach flu", causing them to be very ill for one or two days. This virus can be very unpleasant, and the symptoms include stomach cramping, nausea, vomiting, and diarrhea. Some people even run a fever or have chills, and many report head or muscle aches. This ailment can certainly ruin a vacation! Let's take a look at the Norwalk virus ( norovirus ) and how you can takes steps to avoid this nasty disease. What are Norwalk Viruses (Noroviruses)? Noroviruses are a group of viruses that cause the "stomach flu", "stomach bug", or gastroenteritis in people. Although people often refer to noroviruses (or the Norwalk virus) as the "flu", the virus is not the influenza virus, and getting a flu shot will not prevent it. Sometimes a norovirus is referred to as food poisoning, but it is not always transmitted in food, and there are other types of food poisoning not in the norovirus family.

continue reading below our video America's Best Foodie Cities The symptoms come on very suddenly, but the illness is very brief, usually only one to three days. Although the norovirus is very nasty while you have it, most people do not have adverse long-term health effects. The Norwalk virus was named for Norwalk, Ohio, where there was an outbreak in the 1970's. Today, similar viruses are called noroviruses or Norwalk-like viruses. Whatever they are named, this stomach virus ranks second (behind the common cold) in the occurrence of viral illnesses in the United States. The Centers for Disease Control (CDC) reported over 267 million cases of diarrhea in 2000, and estimates about 5 to 17 percent of these may have been caused by a Norwalk virus. Cruise ships are not the only place where you can pick up this nasty bug! Of the 348 outbreaks reported to the CDC between 1996 and 2000, only 10 percent were in vacation settings such as cruise ships. Restaurants, nursing homes, hospitals, and daycare centers are the most likely places you will get a norovirus.

How Do People Become Infected with the Norwalk Virus (Norovirus)? Noroviruses are found in the feces or vomit of infected people. People can become infected with the virus in several ways, including: eating food or drinking liquids that are contaminated with norovirus; touching surfaces (such as doorknobs) or objects (such as eating utensils) contaminated with norovirus, and then placing their hand in their mouth; having direct contact with a person who is infected and showing symptoms The norovirus is very contagious and can spread rapidly throughout cruise ships. Like the common cold, the norovirus has many different strains, which makes it difficult for a person's body to develop long-lasting immunity. Therefore, norovirus illness can recur throughout a person's lifetime. In addition, some people are more likely to become infected and develop more severe illness than others due to genetic factors. When Do Norwalk Virus Symptoms Appear? Symptoms of Norwalk virus or norovirus illness usually begin about 24 to 48 hours after exposure to the virus, but they can appear as early as 12 hours after ingestion.

People infected with norovirus are contagious from the moment they begin feeling ill until at least 3 days after recovery. Some people may be contagious for as long as 2 weeks. Therefore, it is particularly important for people to use good handwashing practices after they have recently recovered from a Norwalk virus. What Treatment Is Available for People with a Norwalk Virus Infection? Since the Norwalk virus is not bacterial, antibiotics are ineffective in treating the illness. Unfortunately, like the common cold, there is no antiviral medication that works against the Norwalk virus and there is no vaccine to prevent infection. If you are vomiting or have diarrhea, you should try to drink plenty of fluids to prevent dehydration, which is the the most serious health effect that can result from Norwalk virus or norovirus infection. Can a Norwalk Virus Infection Be Prevented? You can decrease your chance of coming in contact with the Norwalk Virus or norovirus on a cruise ship by following these preventive steps: Frequently wash your hands, especially after using the toilet, changing diapers, and before eating or preparing food. Use a bleach-based cleanser to thoroughly clean and disinfect contaminated surfaces immediately after an illness episode.

Immediately remove and wash clothing or linens (with hot water and soap) that may be contaminated with virus after an illness episode Flush or discard any vomitus and/or stool in the toilet and make sure that the surrounding area is kept clean. Getting a Norwalk-type virus or norovirus can ruin your vacation, but the fear of getting this virus should not keep you at home. Use proper sanitation procedures and remember that you are just as likely to get sick in your hometown! Why Norovirus Is So Nasty and Terrifying to Travelers - ABC News ABC News Why Norovirus Is So Nasty and Terrifying to Travelers By Susan Donaldson James WATCH 600 Cruise Passengers Sick in Vacation Nightmare 0 Shares Email A nasty sickness has struck again aboard a cruise ship, sending more than 600 passengers and crew on Royal Caribbean's Explorer of the Seas to their sick beds with vomiting and diarrhea. The Centers for Disease Control and Prevention has not yet identified the mystery illness as the ubiquitous norovirus -- the most common form of gastroenteritis in the U.S., according to the CDC -- but medical experts say they suspect the highly contagious virus was the culprit. Norovirus outbreaks are notoriously difficult to control.

The virus is easily passed from person to person, spreads through food and ice, and also can survive on inanimate objects for days. Even with scrupulous cleaning, the virus can still remain intact, according to Dr. Richard Besser, ABC’s chief medical correspondent. “The virus is not killed by alcohol sanitizers. It survives and can be infectious on surfaces,” he said. "People who are infected will shed the virus for days after their symptoms resolve. This is a real problem for food workers on cruise ships. Lastly, if you go into a bathroom that has been used by someone who has the norovirus, you can get sick.” Doctors warn of new stomach ‘superbug’ hitting U.S. About 21 million cases of the norovirus are reported each year, resulting in about 800 deaths a year. In 2013, seven of the nine cruise ship disease outbreaks were from the norovirus, according to the CDC's Vessel Sanitation Program , which monitors these outbreaks. The Royal Caribbean Explorer left for a 10-day cruise from Liberty, N.J., on Jan. 21 and was headed to St. Maarten.

The cruise liner said on its website that reports of illness peaked at the weekend and are now decreasing daily, but it will still bring the ship back to port two days early, on Jan. 29. “After consultation between our medical team and representatives of the U.S. Centers for Disease Control and Prevention, we think the right thing to do is to bring our guests home early, and use the extra time to sanitize the ship even more thoroughly," Royal Caribbean said in statement. "We are sorry for disappointing our guests, and we are taking several steps to compensate them for their inconvenience.” Before better diagnostic techniques were available, the norovirus was more commonly known as “winter vomiting disease,” said Dr. William Schaffner, an infectious disease specialist at Vanderbilt University. “We’ve seen this virus forever.” About 80 percent of all cases of the virus occur between November and April, according to the CDC. “This is an infection that will involve both ends of the intestinal tract and cause great distress,” Schaffner said. “The real risk with this virus is dehydration for older folks and people who are frail, or diabetics whose sugar is out of whack. “This is the time of year the norovirus is most active,” said Schaffner.

“It is a common virus that causes small clusters of infection fairly frequently among landlubbers, but when it gets into an enclosed population -- nursing homes, occasionally prisons and boarding schools and the like -- it can cause big outbreaks. ...“The doses of the virus are so small that you can just touch your mouth and get infected," said Schaffner. “The illness can come on suddenly, and vomiting is usually the first sign of the illness. If you are in the vicinity, you can breathe in an aerosol of the virus.” The norovirus is usually brought onboard by an already infected passenger. “They may be not feeling quite well and go on a cruise to relax a day or two before they get sick,” he said. “Once that starts in an enclosed population it spreads very readily.” Government health officials boarded the Explorer of the Seas in the Virgin Islands on Jan. 26 to assist medical teams in containing the illness, according to CDC spokeswoman Bernadette Burden. Passengers and crew who show symptoms are also asked to “self-quarantine” until they are well again, said Burden. Cruise ship medical staff provide care, making sure passengers have plenty of fluids and food when they can tolerate it.

Schaffner said medical crew will also encourage passengers and crew to observe “good hand-washing hygiene.” He said cruise lines have good sanitation practices in place and are well-versed in these types of medical situations. “We had a couple of people from our medical center go on cruises,” said Schaffner. "They both told me they are more obsessive about cleaning than we are in the hospital.” At least one travel agent said her clients seemed unfazed by these occasional outbreaks. “It’s really nasty,” Peggy Knipp of First In Service Travel in New York City said of the norovirus. “But we haven’t seen any decrease in cruise booking. Unfortunately, it’s as common as getting a cold.” She said people are more apt to pay attention to hand washing and may bring sanitizers in their luggage, but they don’t want to stay home. “Today it’s in the news and for a couple of days people won’t want to book a cruise. But once it’s out of the news, they will come back to cruising.” 0 Shares Norovirus - The Cruise Ship Virus Body Aches When Are You Contagious?

Norovirus can be contagious before you start showing symptoms, and for as long as two weeks after you start to feel better. But it's most contagious while you're sick, and during the first three days after your symptoms subside. Who It Affects Norovirus sickens 21 million people a year and leads to approximately 800 deaths. Those at highest risk are young children and older adults. Both of these groups have immune systems that aren't as strong as those of older children or adults who are otherwise healthy, making it more difficult to recover from the symptoms, and leading to complications. Possible Complications The most common complication from a stomach virus is dehydration. If not treated, dehydration can be very serious. If you are unable to keep even small amounts of fluid down, or have had very severe diarrhea (or both), you may be dehydrated. Severe dehydration may require medical treatment such as IV fluids or medications to help stop the vomiting. If you think you might be dehydrated due to vomiting or diarrhea, contact your health care provider. Treatment Options Most people who get norovirus will not need any medical treatment. Typically, it's something that can be treated at home and will go away on its own.

If you are concerned about vomiting or you aren't sure what to do to treat it at home, this guide will take you through every step you need to take when you are vomiting. Vomiting Treatments Occasionally, a norovirus infection will be bad enough to require medical treatment. Although there is no medication that can kill or cure the infection, there are medications that can help stop or reduce vomiting so that you don't get dehydrated—or you can rehydrate if your body is already dehydrated. These medications are available only by prescription, so it's important to seek medical attention if you think it's something you need. Prevention Because norovirus is so contagious, it can be hard to avoid. There is no vaccine to prevent it, and there is no medication to treat it. The best way protection we have against norovirus is good hand washing . Always wash your hands after using the bathroom or changing diapers, before and after handling food, and before eating. Norovirus can be found in the stool before you start showing any symptoms, and for as long as 2 weeks after you are feeling better. Washing your hands well and frequently—especially if you think you could have been exposed to norovirus—is extremely important.

If you get sick, do not prepare food for others. This is important for people working in the food services industry, because they come into contact with the food of so many other people. If you have a stomach bug—even if you aren't sure it's norovirus—recommendations are that you not return to preparing food for others for at least 2 to 3 days after you are feeling better. Good hand washing and hygiene practices are even more important in these environments where outbreaks can occur so easily. Sources: "Overview" Norovirus 12 Apr 12. Centers for Disease Control and Prevention. US Department of Health and Human Services. 17 Oct 12. "Symptoms" Norovirus 12 Apr 12. Centers for Disease Control and Prevention. US Department of Health and Human Services. 17 Oct 12. "Preventing Norovirus Infection" Norovirus 12 Apr 12. Centers for Disease Control and Prevention. US Department of Health and Human Services. 17 Oct 12.

Continue Reading CDC - Vessel Sanitation Program - Norovirus Summary Document single-stranded(+)-RNA Human Genogroups: GI, GII, GIV. GI and GII cause the majority of illness in humans. GIII is not known to cause illness in humans. There is no evidence of zoonotic transmission Epidemiology Incidence/Prevalence: Specific data are not available for the United States. Estimated to cause 23 million cases of acute gastroenteritis in the United States each year. It is also estimated that at least 50% of foodborne illness outbreaks are caused by noroviruses. Attack rates generally do not differ significantly between are or gender groups. Norovirus gastroenteritis outbreaks are usually characterized by high attack rates Geographic distribution: Worldwide Temporal distribution: Outbreaks occur throughout the year in the United States, with the lowest frequency during the winter months.

Reservoir: Unknown Outbreak definition: Provisional diagnosis of infection with noroviruses can be made if the following criteria are met (Kaplan's criteria): Bacterial or parasitic pathogens are not detected Vomiting occurs in more than 50% of the cases Mean or median duration of illness ranges from 12 to 60 hours Incubation period is 24 to 48 hours Clinical characteristics Symptoms: Generally produces a mild, self-limiting gastrenteritis characterized by nausea,, vomiting, diarrhea, abdominal cramps, headaches, chills, myalgia and sore throat. Bloody diarrhea is not usually associated with gastroenteritis caused by noroviruses. Low-grade fever sometimes occurs. Vomiting usually occurs more frequently than diarrhea in children; diarrhea usually occurs more frequently than vomiting in adults. Duration of illness: 12 to 60 hours Treatment: Usually gastroenteritis associated with noroviruses is self-limited. Oral or intravenous rehydration may become necessary if severe vomiting or diarrhe persist. Deaths from norovirus-associated gastroenteritis have been documented, but are considered rare. Usually deaths are associated with underlying disease in elderly populations.

Susceptibility and resistance: High degree of susceptibility in all populations. Immunity to infection is poorly understood. Strain-specific immunity may last a few months. It is not believed that long-term immunity is conferred with infection. Repeat infections can occur. Control and Prevention Effective hand washing with soap and running water for at least 20 seconds Prompt disposal or disinfection of contaminated materials Isolation of infected persons for at least 48 hours after the resolution of the last symptom Food protection: Hygienic processing of food items Exclusion of infected food handlers from food preparation and service Potable water supplies: Prevention of cross-contamination with non-potable water supplies Strict adherence to prescribed upkeep and maintenance of drinking and recreational water systems, including acceptable halogen levels, filtration subsystems and distribution systems. Illness on Passenger Ships Cruise Ship Illness Hello Traveler Some luck, just when the price of a cruise vacation dropped to record levels, and you thought about taking your first cruise vacation, the news media started reporting that sick passengers were flooding ship infirmaries complaining of gastrointestinal illness with nausea, abdominal cramps, diarrhea and vomiting.

Moreover, the flu-like symptoms were not effecting one cruise ship, or one particular cruise line, the reports were coming in from dozens of ships from just about every cruise line in the industry. The culprit responsible for the passengers' illness is not a terrorist attack, under cooked food, or the genesis of a new illness isolated to passenger cruise ships - it's an old, well know perpetrator - a virus. About Norwalk Virus The particular virus that is currently plaguing the cruise lines is called Norwalk Virus. It bears the name of the place where is was first identified as the cause of a primary school outbreak of vomiting and diarrhea in Norwalk, Ohio. Norwalk belongs to a family of distinct viruses that have been named after the places where the outbreaks occurred. In the United States we have the Norwalk, Montgomery County, Hawaii, and Snow Mountain viruses. Britain contends with the Taunton, Moorcroft, Barnett, and Amulree viruses. And in Japan, similar but distinct viruses are called Sapporo and the Otofuke viruses.

Before the discovery of diarrhea-causing viruses (in the early 1970's), researchers were unable to identify an exact, causative, agent for gastroenteritis (a gastrointestinal illness) when it was not due to a bacterial source (like salmonella, shigella, staphylococcus, E. coli, etc). Prior to that time, physicians and researchers called any generalized gastrointestinal illness nonbacterial gastroenteritis, the stomach flu, winter vomiting disease, or it was just passed off as food poisoning, without a test to confirm whether bacteria was the culprit bug or not. With the identification of viruses and the development of sensitive and specific diagnostic tests, eventually researchers began to recognize viruses as causative agents of gastroenteritis. Contracting Norwalk Virus This virus is passed from one person to another very quickly, which is why it often occurs in outbreaks. Have you ever had one child in your home get sick and the next thing you know you are spending what seems to be 3 nights in a row in the bathroom with sick kids? Most likely your house was infected with Norwalk Virus or Norovirus (formerly called "Norwalk-like Virus"). These are the group of viruses that cause vomiting and diarrhea.

Next to the common cold, this is the most prevalent illness in the United States and Canada. Norwalk Virus is passed through personal to person contact, consuming food or water contaminated with the virus, or by contact with contaminated surfaces (door handles, elevator buttons, hand rails, and food utensils are the big offenders). Cooked foods may also be contaminated though handling by an infected crew member. The foods most often causing Norwalk Virus outbreaks are shellfish and salad ingredients. The sources of water contamination associated with outbreaks are swimming pools, drinking water (not bottled water) and ice cubes. One larger outbreak or Norwalk Virus occurred in Pennsylvania and Delaware in September, 1987. The source of both outbreaks was traced to ice that was made from water from a contaminated well. In Pennsylvania, the ice was consumed by spectators at a football game, and in Delaware, it was the guests at a cocktail party who downed the virus with the drinks. The Norwalk Virus is common in situations where there are a lot of people in a group setting such as shopping malls, schools, nursing homes, banquet halls, dormitories, campgrounds, summer camps, churches, schools and cruise ships.

The Cruise Ship Problem Of course you won 't be seeing Johnny's camp aired on the news when half of the kids are sent home sick with a virus. Those headlines are reserved for large cruise lines. And that's the reason why the news headlines about the cruise ship illness are misleading. In our everyday lives, if we became ill with Norwalk Virus, it's extremely difficult, if not impossible, to identify the location where we contracted it. Unless you've been isolated and had limited contact with others, to such an extent that identification of our exposure is an isolated instance, your guess about where you contacted Norwalk Virus would be just that - a guess. But, when you are isolated for seven to ten days on a cruise ship and you become ill midway through your voyage, it's a bit of a "no-brainer" to assume you contracted the illness onboard ship. The CDC (Center for Disease Control) estimates that each year 23 million people in the United States alone become ill from Norwalk virus - and that means that outbreaks are common place occurrence.

From 1966 to 2000 the CDC recorded 348 outbreaks; most occurred in restaurants (39%) nursing homes and hospitals (29%), and daycare centers an schools (12%). Of the remaining incidents, cruise ships and vacation settings only accounted for 10% of the recorded outbreaks. This doesn't mean that the cruise industry is sitting on it's laurels - quite to the contrary. The lines are doing everything possible to control illness onboard their ships. Surveillance teams have been assigned to ships, reporting standards above and beyond the CDC requirements (3% or more of the passengers and crew with vomiting and/or diarrhea) have been internally instituted and new behaviors for crew members and food preparation and storage are happening oceans wide - on every passenger vessel. The main problems the cruise lines are facing are they can't pretest passenger for Norwalk Virus before they board their (clean) ship, they can't control the appetite of the news media for sensationalism, and they can't control the perception of the public that cruise ships in someway are responsible for causing the illness. If you ask anyone in the travel industry, there's no cleaner, safer place to be than on a passenger cruise ship.

Treatment for Norwalk Virus As for the illness, there's no real treatment for Norwalk Virus, only treatment for the symptoms. The objective of treatment is to replace fluids and electrolytes (salt and minerals) lost by diarrhea and/or vomiting. Antibiotic therapy is not effective in viral illness and antibiotic should not be taken. Unless for are actively ill on a day when you have to travel, DO NOT take an antidiarrheal medication like Petmo Bismol®, Lomotil®, or Imodium®, as they may prolong the illness, the symptoms and the infectious process. A Norwalk Virus infection results in illness 24 to 48 hours after exposure, and symptoms last from 12-48 hours. Illness is characterized by the abrupt onset of vomiting and/or non-bloody diarrhea; abdominal cramps are common. 25-50% of patients report headache, nausea, malaise, myalgias and low-grade fever. Self-care measures to avoid dehydration include drinking over the counter electrolyte solutions (Gatorade®) to replace fluids and electrolytes (minerals ) lost by diarrhea and/or vomiting. Passengers who are unable to take fluids by mouth because of nausea may need intravenous fluids.

This is particularly true in infants, small children, and the elderly who are greater risk for dehydration. Jell-O® water, soda and plain water and do nothing to replace lost electrolytes. Do not give antidiarrheal medications to children (unless directed by a physician).The risk of dehydration is greatest in infants and young children, and parents should closely monitor the number of wet diapers changed per day, or the urine output when their child is sick. For fluid replacement Pedialyte® or Lytren® have liquid and minerals and are recommend them for babies. - Sport drinks like Gatorade, Power Ade, All Sport, - Sodas like ginger ale, flat cola, 7-Up, or Sprite (Mix them half-and-half with water.) - Dilute tea with sugar - Dont use red Jell-O. It can look like blood in the stool. - To give Jell-O Mix, 5 teaspoons of sugar and 1/2 teaspoon of salt with 4 cups of water. (Dont use too much salt.) Note: Water by itself is not good for children with diarrhea. - Dont give your child very hot or very cold liquids. - Dont give your child apple juice.

Apple juice can make childrens diarrhea worse. - Give your child as much to drink as they want. Call the doctor if you are not sure. - Call the doctor if your child shows signs of dehydration: - thirsty - muscle cramps - confused or dizzy If you're a passenger who's prescribed diuretics (water pills) and you contract Norwalk Virus, you should go to the ship's infirmary. The reason to be extremely caution is because dehydration develops very quickly in the presence of diuretics and vomiting and can be quite profound in a short period of time. But, don't be guilty of practicing medicine without a license - don't stop taking a prescribed medication or a diuretic until you consult consult with a physician! Preventing Norwalk Virus The best way to prevent Norwalk Virus is to practice good hand washing techniques.

This means to wash your hands frequently, and thoroughly with soap and hot running water for at least ten seconds: - before each meal - before ingesting any food item handed with your fingers (snacks, peanuts, etc.) - between handling food raw and and ready-to-eat food - after going to the bathroom - after changing children's diapers Sea Sick -- Infection Outbreaks Challenge the Cruise Ship Experience Sea Sick -- Infection Outbreaks Challenge the Cruise Ship Experience For decades, cruise ships have been a popular vacation destination for those seeking a reprieve from the wintertime blues. Over ten million people traveled on cruise ships in 2000 and that number is expected to double by 2010. But some recent vacationers have found themselves wishing they never said, "Bon Voyage." In 2002, a wave of gastroenteritis outbreaks occurred aboard several international cruise ships, turning the sojourns of many sea-bound, sun-revelers into shortened trips they would most likely want to forget. As recently as February 2004, more than 300 Carnival Cruise Line ship passengers were stricken with the stomach malady while aboard the Celebration luxury liner while on a Valentine's cruise in Mexico.

Unfortunately, such outbreaks are not a surprise to the industry. According to a 2003 World Health Organization (WHO) study, "Emerging Issues in Water and Infectious Disease," since 1970 over 100 disease outbreaks associated with cruise ships have been documented. The WHO considers this figure low, because many such illnesses go unreported. Virus on the High Seas Among the several illnesses and maladies that can affect a cruise ship passenger, food and water borne viral gastrointestinal illness is the most common culprit. Symptoms include nausea, vomiting, diarrhea and in some instances, severe stomach cramping. Transmitted person-to-person (meaning it can be transferred both through human contact and through contact with food, water or surfaces that are contaminated with illness-causing germs), an infectious virus has the ability to take on outbreak proportions quickly in the closed environment of a cruise ship. With the complicating factor that these viruses can remain active on objects and surfaces for periods of up to 14 days, the likelihood of human exposure to the virus is greatly increased, facilitating its spread and increasing the probability of infection outbreaks.

The most common type of virus linked to gastrointestinal illness is the Norwalk-like Virus (NLV) or norovirus, which gained notoriety from a 1968 outbreak in Norwalk, Ohio. The term norovirus was recently approved as the official name for this group of viruses. Several other names have been used for noroviruses, including, caliciviruses (from its origin in the virus family Caliciviridae) and "small round structured viruses". Noroviruses are the leading cause of gastrointestinal illness with an estimated 23 million cases a year, according to the U.S. Centers for Disease Control & Prevention (CDC). Typically, shipboard norovirus spawns from poor sanitation conditions, including contaminated bunkered water, inadequate disinfection of potable water, potable water contaminated by sewage on ship, deficiencies in food handling, and poor food preparation and cooking methods. Significantly, there is no vaccine to prevent contracting norovirus. Antibiotics will only work to fight bacterial infection, not to treat viral outbreaks.

From July 1997 to June 2000 there were 232 outbreaks of norovirus illness reported to the CDC of which, 57% were foodborne, 16% were due to person-to-person spread, and 3% were waterborne. In 23% of outbreaks, the cause of transmission was not determined. According to the CDC common settings for outbreaks include restaurants and catered meals (36%), nursing homes (23%), schools (13%), and vacation settings or cruise ships (10%). The CDC estimates that as many as half of all food-related outbreaks of illness may be caused by norovirus. In many of these cases, food handlers experiencing a viral illness were identified as the likely carriers and transmitters of the disease. Complicating matters, it has been discovered that norovirus is a nimble and difficult virus to control. Recent research conducted by the UK Health Protection Agency suggested that a new variant of the virus was to blame for the spate of 2002 cruise ship outbreaks. Through data collection, the Agency discovered a specific and identifiable mutation in one of its genes.

Nothing New Under the Sun While recent events have focused media attention as never before on the public health conditions in the cruise ship industry, the story of shipboard illness is not a new tale. In an effort to prevent contamination aboard luxury cruise ships in the early 1970's, the CDC established the Vessel Sanitation Program (VSP). Under the VSP, over 140 cruise ships are subjected to unannounced, twice-yearly inspections where the ship must score 86 or above on a 100-point scale. The inspections are conducted in U.S. ports only, and are overseen by VSP environmental health officers. Inspectors focus on the ship's water supply, spas and pools, food, employee hygiene, ship cleanliness and a review of the ship environmental training programs. The VSP also monitors reports of diarrheal illness on each ship. If an outbreak of gastrointestinal illness occurs, the VSP works with other infectious disease programs at the CDC to initiate an investigation. An outbreak is defined as having 3% or more of either passengers or crew reported with illness. Cruise vessels sailing to U.S.

ports are required to notify the CDC of every case of gastrointestinal illness reported to the ships' medical staff for each cruise. This summary report must be filed 24 hours prior to arrival at a U.S. port. If the number of ill passengers or crew reaches 2% during the cruise, the vessel is required to file a special alert report informing health authorities of the abnormality. The CDC closely monitors these illness reports on a daily basis. Back-to-Basics Is the Key to Prevention Whether shipboard or at home, preventive steps are considered to be the best means of avoiding contracting norovirus infection or similar viral illness. By practicing sound and sensible personal hygiene, individuals can help reduce the chances of contracting the virus and spreading it. The CDC's recommended preventive measures include: Frequently wash your hands (especially after toilet visits) Carefully rinse fruits and vegetables Thoroughly clean and disinfect contaminated surfaces with a chlorine bleach-based cleaner immediately after an episode of illness Immediately remove and wash clothing or linens that may be contaminated with the virus after an episode of illness Prevention of food-borne norovirus disease is based on safe storage and handling habits for both food and water.

While noroviruses are relatively resistant to environmental conditions (they are able to survive freezing, temperatures as high as 60�C, and have even been associated with illness after being steamed in shellfish), relatively simple, common sense measures can limit much of their impact. Correct handling of cold foods, frequent hand washing, and not handling food when ill are suggested as habits that may substantially reduce food-borne transmission of norovirus. Additionally, many local and state health departments are requiring that food handlers and food preparers who have suffered recent bouts of gastroenteritis not work until 2 or 3 days after they recover from their illness. Significantly, since the virus continues to be present in human waste for as long as two to three weeks after the person feels better, strict hand washing after using the bathroom and before handling food items is considered critical to the prevention of a viral spread. Recommendations include the proviso that food handlers who have experiences illness can be given alternate duties to direct contact with consumables, such as running the cash register or hostessing. A Recent Wave The year 2002 was a wake up call for a world largely unfamiliar with noroviruses.

There were 25 reported outbreaks of the Norwalk-like virus on cruise ships, leaving a total of 2,648 passengers ill on their vacation get-aways. Major cruise lines such as Norwegian, Royal Caribbean, Carnival, Holland America and Disney were hit 19 times by outbreaks of gastrointestinal illness, all of which were attributed to norovirus. In October and November 2002, Holland America's Amsterdam cruise ship experienced four successive cruises in which norovirus struck members of both the crew and passengers. A total of 524 people (passengers and crew) had become ill -- roughly 25% of the ship population for the total of the four cruises. The first cruise, which ran from Oct. 1st - 22nd, had 196 passengers and a dozen crew contract the Norwalk like virus. The ship was disinfected, scrubbed and cleared to embark on its next voyage. The following cruise (Oct. 22nd - Nov. 1st) had an outbreak as well, with 41 passengers and 8 crewmembers becoming ill from Norwalk-like viral infection.

The result was that Holland America was drowning in a sea of bad publicity, as the cruise line was routinely portrayed as an unhealthy breeding ground for the virus. Prior to boarding on its Nov. 1st -11th cruise, the staff of Holland America distributed a printed notice to passengers, informing them that the previous cruise had been disinfected. Yet despite adhering to CDC's disinfection and sanitation measures, the outbreaks continued with 163 passengers and 18 crewmembers confirmed ill. It was reported that the common greeting among passengers was to rub elbows to avoid direct hand-to-hand contact. Despite three successive cruises with an outbreak, Holland America's Amsterdam set out Nov. 11th on another cruise. Yet again an outbreak developed, with 36 people offloaded for symptoms associated with Norwalk. Finally on November 21st, the vessel was temporarily taken out of service for aggressive cleaning, isolation of affected crew and other control methods. The Amsterdam was back on the seas December 1st, reporting on a daily basis to the CDC. An Ongoing Battle While the cruise ship industry in total reports that it is follows strict regulations designed to prevent viral contamination and public health challenges, norovirus outbreaks have continued to occur.

In December 2002, Carnival Cruise Lines suffered back-to-back outbreaks on its 7-day Caribbean cruises bound for New Orleans. That same month Royal Caribbean also reported that two of its cruise ships had Norwalk-like virus outbreaks. The CDC reported in its 2002 year-end review that the cruise ship outbreaks of that year demonstrated just how easily norovirus is transmitted from person to person in a closed environment. According the CDC, both the event of outbreaks on consecutive cruises populated by new passenger and the resurgence of outbreaks caused by the same virus strains during previous cruises on the same ship (or on different ships of the same company), suggests that environmental contamination and infected crew members can serve as reservoirs of infection for passengers. It also offered possible explanations for the increase in infection rates, positing that the 2002 outbreaks might have reflected either an actual increase in norovirus outbreaks, or could have been attributable to improved surveillance with an electronic reporting format implemented January 1, 2001. New bio-surveillance systems and the increased application of sensitive molecular assays capture data on cases of illness reported to the ship's infirmary or to designated staff on board the ship.

Emphasizing basic food and water sanitation measures, the CDC recommended control efforts that should include thorough and prompt disinfection of ships during cruises, and isolation of ill crew members and passengers (if possible) for 72 hours after clinical recovery. Rapid implementation of control measures at the first sign of a suspected gastrointestinal outbreak is considered to be critical in preventing additional cases of illness aboard ship. Chlorine-based cleaning solutions are recommended for disinfection. When routine disinfection measures are unsuccessful in interrupting the viral spread, the CDC recommends more extensive disinfection procedures, as well implementation of a waiting period - a sustained time without passengers aboard a ship to facilitate final eradication of the virus. With no single, easy-to-implement solution on-tap, conventional public health regimens are still considered to be the best method of halting infection outbreaks in the cruise ship industry. A back-to-basics approach that includes common sense personal hygiene routines and safe, effective disinfection practices are viewed as the best defense against a public health foe that continues to ride the waves. Norovirus on Cruise Ships - Cruise International Norovirus on Cruise Ships Tweet on Twitter The one thing that’s worse than getting seasick is catching a virus at sea.

Here’s what you need to know about cruise ships and the Norovirus Every so often you read a story about a norovirus outbreak on a cruise ship striking down passengers and crew alike. But what is it about cruise ships that seems to make Norovirus thrive? This virus (the second most frequently occurring in the world after the common cold) is spread in environments where people live day to day in close proximity, sharing facilities. It is mainly spread through person-to-person contact, and the reason why it thrives on board cruise ships is because it can also be spread from touching things like handrails, doorknobs, and lift buttons. According to the US Centers for Disease Control, the main reason norovirus is associated with cruise ships is because of the higher sanitation and mandatory reporting requirements on board cruise ships, so that all gastrointestinal illnesses must be reported. To find out how to Avoid the Norovirus while on a cruise , read our expert advice from Dr Martin Carroll here How long does Norovirus last? On average, the incubation of the virus is 36 hours, and symptoms, which include fever, headache, stomach cramps, vomiting and diarrhoea, usually last one to two days.

Like the common cold, there is no way to treat the virus besides staying hydrated and letting it run its course, although the ship’s doctor can prescribe medications to treat specific symptoms. How are the cruise ships responding to norovirus? Anyone who has cruised recently will have noticed that you cannot move for hand-sanitiser dispensers from the moment you board. Specifically, you will find them at the entrance to every single public space. The problem with this approach is that it involves enforcement by the crew, as many passengers either forget to use the dispensers or choose not to. Responding to a recent blog on CruiseCritic.co.uk by Cruise International’s contributing editor Sue Bryant, Dick Smith, a passenger on board Fred.Olsen’s Boudicca cruising up the Amazon, said: “The most serious thing to us was the sheer number of passengers who went to enormous lengths to avoid having to use the hand cleansers. One woman was most indignant when staff challenged her as we went into the Four Seasons Restaurant. The same woman was seen to avoid the cleanser at the gangway by squeezing past the crew member on his blind side.

I’d like to see her reaction if she ever catches the bug.” Cruise lines also keep their kitchens and dining areas scrupulously clean, as well as all of the decks. This is why you see crew constantly polishing railings and lifts – it’s not just about keeping the ship sparkling. The crew are also responsible for ensuring that the hot tubs and swimming pools are kept at the right temperatures, and that all the plumbing is in good order. Royal Caribbean, to give just one example, operates a highly conscientious illness prevention programme with specific sanitation procedures for crewmembers from the captain to the housekeepers, and cleaning procedures and protocols in line with the most rigorous recommendations from the Centers for Disease Control. The cruise line uses special cleaning products and disinfectants to clean throughout the ships, with especially frequent and intensive cleaning of all “high-touch” areas, including counter tops, rest-room and vanity surfaces, door handles, railings and grab bars, exercise equipment, TV remote controls, light switches, elevator buttons, and computer keyboards. When Norovirus Strikes Each line operates a different policy when an outbreak hits, but all will as a matter of top priority quarantine ill passengers to their cabins.

Often they will disable your room key so you can’t get off the ship, and you have to rely on your travelling companions to bring you things to read or watch. In the case of Fred. Olsen the breakfast and lunch buffets are cordoned off, and food is instead delivered directly to the tables by the staff. Princess Cruises closed the shops onboard a cruise Vivian Kruger was on two years ago. She said, responding to Sue Bryant’s blog: “The ship’s crew were excellent. “The waiters were the only ones allowed to put salt and pepper on our meals, and rolls were given to us instead of us handling them ourselves. “All of the crew cleaned everything – for one minute I thought they might wipe me down too. We all laughed at that.” Ultimately it is down to you – keep washing your hands and keep using those hand sanitisers, and the likelihood of an outbreak will be minimised. Norovirus under the microscope For more information about avoiding the Norovirus on Cruise Ships: The US-based Centers for Disease Control and Prevention run a Vessel Sanitation Program cdc.gov/nceh/vsp/desc/aboutvsp.htm that monitors cruise ships through surprise inspections.

They also have a database cdc.gov/InspectionQueryTool/Inspection Search.aspx for specific ships and entire cruise lines to see how they have scored (anything less than an 85 out of100 points is unsatisfactory). They have a list of all ships that have had illness outbreaks since 1994 here: cdc.gov/nceh/vsp/surv/GIlist.htm SHARE Norovirus | U.S. Trends and Outbreaks | CDC U.S. Trends and Outbreaks Each year on average in the United States, norovirus— causes 19–21 million cases of acute gastroenteritis (inflammation of the stomach or intestines or both) leads to 1.7–1.9 million outpatient visits and 400,000 emergency department visits, primarily in young children contributes to about 56,000–71,000 hospitalizations and 570-800 deaths, mostly among young children and the elderly You can get norovirus illness at any time during the year. But, it is most common in the winter.

Also, there can be 50% more norovirus illness in years when there is a new strain of the virus going around. Top of Page Outbreaks Most outbreaks of norovirus illness happen when infected people spread the virus to others. But, norovirus can also spread by consuming contaminated food or water and touching things that have the virus on them. Norovirus is the leading cause of illness and outbreaks from contaminated food in the United States. About 50% of all outbreaks of food-related illness are caused by norovirus. Food can get contaminated with norovirus at any point when it is being grown, shipped, handled, or prepared. Foods that are commonly involved in outbreaks of norovirus illness are— leafy greens (such as lettuce), fresh fruits, and shellfish (such as oysters). But, any food that is served raw or handled after being cooked can get contaminated. To search for foodborne outbreaks caused by norovirus, go to the Foodborne Outbreak Online Database (FOOD) .

Common Norovirus Outbreak Settings Norovirus in Healthcare Facilities Health care facilities, including nursing homes and hospitals, are the most commonly reported settings for norovirus outbreaks in the United States and other industrialized countries (see Norovirus in Healthcare Settings ). Over half of all norovirus outbreaks reported in the United States occur in long-term care facilities. The virus can be introduced into healthcare facilities by infected patients—who may or may not be showing symptoms—or by staff, visitors, or contaminated foods. Outbreaks in these settings can be quite long, sometimes lasting months. Illness can be more severe, occasionally even fatal, in hospitalized or nursing home patients compared with otherwise healthy people. Norovirus in Restaurants and Catered Events Most norovirus outbreaks from contaminated food occur in food service settings like restaurants. Infected food workers are frequently the source of these outbreaks, often by touching ready-to-eat foods, such as raw fruits and vegetables, with their bare hands before serving them. (See For Food Workers: Norovirus and Working with Food .) Foodborne outbreaks of norovirus illness have also occurred in banquet halls, and even at family dinners, where people eat food handled or prepared by others.

Norovirus outbreaks can also occur from fecal (stool) contamination of certain foods at their source. For example, oysters harvested from contaminated water and raspberries irrigated with contaminated water have caused norovirus outbreaks. Norovirus on Cruise Ships Over 90% of diarrheal disease outbreaks on cruise ships are caused by norovirus (see Facts about Noroviruses on Cruise Ships ). Norovirus can be especially challenging to control on cruises ships because of the close living quarters, shared dining areas, and rapid turnover of passengers. When the ship docks, norovirus can be brought on board in contaminated food or water or by passengers who were infected while ashore. Repeated outbreaks on consecutive cruises may also result from infected crew or environmental contamination. This is because norovirus can persist on surfaces and is resistant to many common disinfectants. Norovirus in Schools and Other Institutional Settings Norovirus outbreaks occur in a range of other institutional settings, for example, schools, child care centers, colleges, prisons, and military encampments. Norovirus outbreaks on university campuses have led to campus closures. Norovirus was the most common cause of gastroenteritis in U.S.

Marines during Operation Iraqi Freedom and a common cause of outbreaks among British troops deployed to Iraq during 2002 to 2007. Norovirus outbreaks have also been caused by contaminated water from sewage in wells and in recreational water settings, such as pools and lakes. Learn More about Norovirus BBB - The Norwalk virus family BBB - The Norwalk virus family Foodborne Pathogenic Microorganisms and Natural Toxins Handbook The Norwalk virus family A new version of the Bad Bug Book was released in 2012, below is a previous version. 1. Name of the Organism: The Norwalk virus family Norwalk virus is the prototype of a family of unclassified small round structured viruses (SRSVs) which may be related to the caliciviruses . They contain a positive strand RNA genome of 7.5 kb and a single structural protein of about 60 kDa. The 27-32 nm viral particles have a buoyant density of 1.39-1.40 g/ml in CsCl. The family consists of several serologically distinct groups of viruses that have been named after the places where the outbreaks occurred.

In the U.S., the Norwalk and Montgomery County agents are serologically related but distinct from the Hawaii and Snow Mountain agents. The Taunton, Moorcroft, Barnett, and Amulree agents were identified in the U.K., and the Sapporo and Otofuke agents in Japan. Their serological relationships remain to be determined. 4. Diagnosis of Human Illness: Specific diagnosis of the disease can only be made by a few laboratories possessing reagents from human volunteer studies. Identification of the virus can be made on early stool specimens using immune electron microscopy and various immunoassays. Confirmation often requires demonstration of seroconversion, the presence of specific IgM antibody, or a four-fold rise in antibody titer to Norwalk virus on paired acute-convalescent sera. 5. Associated Foods: Norwalk gastroenteritis is transmitted by the fecal-oral route via contaminated water and foods. Secondary person-to-person transmission has been documented. Water is the most common source of outbreaks and may include water from municipal supplies, well, recreational lakes, swiming pools, and water stored aboard cruise ships. Shellfish and salad ingredients are the foods most often implicated in Norwalk outbreaks.

Ingestion of raw or insufficiently steamed clams and oysters poses a high risk for infection with Norwalk virus. Foods other than shellfish are contaminated by ill food handlers. 6. Relative Frequency of Disease: Only the common cold is reported more frequently than viral gastroenteritis as a cause of illness in the U.S. Although viral gastroenteritis is caused by a number of viruses, it is estimated that Norwalk viruses are responsible for about 1/3 of the cases not involving the 6-to-24-month age group. In developing countries the percentage of individuals who have developed immunity is very high at an early age. In the U.S. the percentage increases gradually with age, reaching 50% in the population over 18 years of age. Immunity, however, is not permanent and reinfection can occur.

Question: What is the name of the virus that frequently occurs on cruise ships?
Answer: Norovirus