March 24, 2019
Couple on Deck Chairs of Cruise Ship, Caribbean

How to Stay Healthy on a Cruise

by Jeanine Barone

As if motion sickness on the high seas were not enough, many passengers on cruise lines have been struck down by gastrointestinal illnesses over the last few years, resulting in ruined vacations. “Pukefest on the Crown Princess,” a January 2016 headline read, describing a norovirus outbreak on a Princess Cruises cruise ship that sickened 180 of 2,060 passengers with vomiting and diarrhea. Another outbreak, aboard a British cruise ship in April 2016, sickened 277 out of 915 passengers.

Such outbreaks of acute gastroenteritis are caused by viruses like norovirus (the most common culprit), as well as other microbes, including some strains of E. coli. (Though commonly called stomach flu, this is medically inaccurate.) The microbes can spread in many ways: by ingesting contaminated food and water, touching contaminated objects, shaking hands with an infected person, and, with norovirus, inhaling the organism if someone vomits near you.

Just how risky is it to take a cruise? And how can you prevent getting sick yourself? Here’s to putting your mind (and body) at ease.

Putting the numbers into perspective

The CDC provides sanitation standards and tracks cruise ships that are members of its Vessel Sanitation Program (VSP). This involves unannounced inspections, monitoring of gastrointestinal illness, and crew training in public health practices for ships that carry at least 13 passengers and have a foreign itinerary with U.S. ports.

According to a 2016 CDC report using VSP data, the rate of acute gastroenteritis among passengers declined from 27.2 cases per 100,000 travel days in 2008 to 22.3 cases in 2014. So despite what you may hear on the news, cases of gastrointestinal illness on board are actually relatively infrequent. In fact, culling data from this CDC report, the average person has more than a 99 percent chance of not getting sick on a cruise ship. (Note that this applies only to ships under VSP surveillance, not ships in other countries that have no U.S. ports of call.)

How to protect yourself

  • If you’re curious, before booking a cruise you can visit the CDC’s Vessel Sanitation Program website, where you can find out which cruise lines are members of the program and see inspection scores (100 is best; scores under 85 are “not satisfactory”) and outbreak information for specific vessels.
  • A key to preventing illness from norovirus and other disease-related pathogens is to wash your hands frequently with soap and water—and always after you visit the restroom and before you eat. (Many people inadvertently touch their eyes, nose, and mouth with unclean hands.) You should also wash your hands when you return to your cabin. Keep in mind that any surface—including stairwell banisters, elevator buttons, and equipment in the ship’s gym—can be contaminated. If you don't have easy access to soap and water, use a hand sanitizer containing at least 60 percent alcohol. Another reason to keep your hands clean: If you are infected, this will help prevent other people from getting sick.
  • People who are immunocompromised or otherwise in frail health, as well as young children and pregnant women, might want to take extra precautions by avoiding buffet foods (get hot foods made to order instead). Buffets are risky because the foods may not be kept at proper safe temperature and may sit around for long periods. In addition, there is a greater risk of cross-contamination at self-serve buffets between different foods and between utensils, compared to when foods are served by trained food staff.
  • When going on shore excursions in developing countries, choose your food wisely: Don’t eat food from street vendors, eat only foods that are served piping hot in restaurants, and drink only bottled water from sealed containers. Avoid ice and foods containing ice or made with tap water (including juice concentrates and ice pops), unless you know that the restaurant uses purified water for food preparation and to make ice (some restaurants, especially those that cater to tourists, take this precaution). Do not eat raw fruit or vegetables unless it’s something that you peel yourself, such as a banana or an orange. And beware of hidden sources of raw produce, such as chutneys and salsas.

Cruise lines are taking extra steps these days to prevent pathogen-related illnesses. Among the policies in place in some are a no-handshaking rule when meeting the officers and a ban on passengers serving themselves at buffets. Hand sanitizers are now typically found throughout ships and at all food stations. But if you do become ill, you should report it to the medical staff. It’s important to do this not only to be assessed and treated, but also so that illnesses on board can be monitored.

Also see How to Avoid Motion Sickness.