Stay Healthy on a Cruise

Keeping your hands clean on a cruise

• To stay healthy and clean, wash your hands with warm water and soap.

• When to Wash your Hands:

• Before:
• Touching your hand to your mouth including:
• Eating and drinking,
• Smoking,
• Brushing your teeth,
• Helping a sick person.
• After:
• Going to the bathroom
• Changing diapers
• Touching high-hand contact surfaces, such as:
• Door knobs
• Railings
• Returning to your cabin
• Helping a sick person
• Blowing your nose

• How to wash your hands:

• 1. Wet your hands with warm water.
• 2. Apply a generous amount of soap.
• 3. Rub your hands together for 20 seconds.
• 4. Rinse your hands.
• 5. Dry your hands with a paper towel.
• 6. Use the paper towel to turn off the faucet and open the door.

• What about alcohol-based hand sanitizers?

• CDC recommends that cruise ship passengers use warm water and soap to wash their hands. Washing is always best.
• If water and soap are NOT available (perhaps on excursions), use an alcohol-based hand sanitizer with 62% ethanol based hand-sanitizer, preferably in a gel form.
• Each year millions of U.S. citizens enjoy cruise vacations. In 2005, approximately 9.8 million passengers embarked from North American ports for their cruise vacation. Traveling on cruise ships exposes people to new environments and high volumes of people, including other travelers. Although an infrequent occurrence, this exposure creates the risk for illness, either from contaminated food, water or more commonly through person to person contact. Follow these tips to help prevent the spread of illness:
• 1. Wash your hands!
• Before and after
• eating,
• smoking,
• After
• touching your face,
• going to the bathroom
• When your hands are dirty.
• Learn more about handwashing techniques.
• 2. Leave the area if you see someone get sick (vomiting or diarrhea).
• Report to cruise staff, if not already notified.
• You could become sick if you ingest contaminated particles that travel through the air.
• 3. Take care of yourself.
• Get plenty of rest, drink lots of water. Resting helps rebuild your immune system. Drinking water helps prevents dehydration.
• 4. Be considerate of other people’s health.
• If you’re ill before taking a cruise, call the cruise line to determine if there are alternative cruising options.
• Learn more about viral outbreaks aboard ships.
• CDC’s Vessel Sanitation Program helps the cruise industry to control and prevent the spread of gastrointestinal illnesses aboard cruise ships and assists them in monitoring ships if they have an outbreak. 

• Noroviruses

• 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.
• Norovirus is sometimes called the “stomach flu,” although it is not related to the flu (a common respiratory illness cause by the influenza virus).
• Symptoms caused by noroviruses
• Common symptoms: vomiting, diarrhea, and some stomach cramping
• Less common symptoms: low-grade fever, chills, headache, muscle aches, nausea, and tiredness
• This illness often begins suddenly, and the infected person may feel very sick. Normally the illness lasts about 1 to 2 days. Children often vomit more than adults.
• Where noroviruses are found
• Noroviruses are found in the stool or vomit of infected people and on infected surfaces that have been touched by ill people. Outbreaks occur more often where there are more people in a small area, such as nursing homes, restaurants, catered events, and cruise ships.
• Reasons why noroviruses are associated with cruise ships
• Health officials track illness on cruise ships. Therefore, outbreaks are found and reported more quickly on a cruise ship than on land.
• Close living quarters may increase the amount of group contact.
• New passenger arrivals may bring the virus to other passengers and crew.
• How noroviruses are spread
• People can become infected with the virus by:
• Eating food or drinking liquids infected with noroviruses
• Touching surfaces or objects infected with noroviruses and then touching own mouth, nose, or eyes
• Having person-to-person contact (with a norovirus-infected person) by
• being present while someone is vomiting
• sharing food or eating from the same utensils
• caring for a sick person
• shaking hands
• Not washing hands after using the bathroom or changing diapers and before eating or preparing food.
• Norovirus infections are not usually serious
• Noroviruses are highly contagious, but infections are not usually serious. People may feel very sick and vomit often or get diarrhea, becoming dehydrated if lost liquids are not replaced. Most people recover within 1 or 2 days and have no long-term adverse health effects.
• What to do if you get norovirus
• Advise the medical staff of your illness. Drink plenty of fluids. Wash hands often.
• How to prevent getting and spreading noroviruses
• Wash hands often. Wash hands after using the bathroom or changing diapers and before eating or preparing food. Wash hands more often when someone in your home is sick. For hand washing tips, click on the following link: www.cdc.gov/nceh/vsp/pub/Handwashing/HandwashingTips.htm
• Avoid shaking hands during outbreaks.
• Use alcohol-based hand sanitizer along with handwashing.
• For more information, visit www.cdc.gov/nceh/vsp, E-mail

Diseases Common on Cruises

• What is infectious gastroenteritis?

• Gastrointestinal illness (gastroenteritis) is the inflammation of the stomach and small and large intestines. The main symptoms include vomiting and watery diarrhea. Other symptoms include fever, abdominal cramps, nausea, and headache. Infections causing gastroenteritis can be viral, bacterial, or parasitic in origin. Norovirus is a common cause of viral gastroenteritis found on cruise ships. Types of bacterial gastroenteritis infections include Escherichia coli and salmonella.

• How does infectious gastroenteritis spread?

• Infections causing gastroenteritis can be spread by contaminated food or water or through an infected food handler. Individuals who are symptomatic with gastroenteritis can spread illness to others by touching handrails, elevator buttons, and shared utensils, as well as through direct intimate contact with others while they are ill.

• Can infectious gastroenteritis be prevented?

• Yes. You can reduce your chance of becoming ill by washing your hands more frequently, keeping your hands away from your mouth, and avoiding any food or water that is thought to have been contaminated. When a higher than expected number of passengers or crew become sick, ships implement additional cleaning procedures and use disinfectants that are targeted to stop the illness. More information on handwashing tips and techniques.
• To learn more about gastroenteritis, visit

• What should I do if I become ill with diarrhea or vomiting during a cruise?

• If you become ill during a cruise, visit the ship’s medical center and follow the instructions of the medical staff aboard the ship. Be considerate of others, and wash your hands more frequently.

• What can I do to stay healthy during a cruise?

• For tips to stay healthy on your cruise vacation, see our Healthy Cruising Tips.

• What additional measures are ships asked to take when an increased number of passengers or crew become ill?

• Ships may be advised by CDC to do the following to reduce the spread of gastroenteritis on a ship:
• implement additional disinfection measures and cleaning procedures,
• ask for stool or vomit specimens from passengers and crew,
• advise passengers and crew who are ill to stay in their cabins until they are well for 24 hours after recovery from illness,
• report numbers of cases of illness to CDC on a daily basis,
• discontinue certain high-risk activities or activities during a cruise.

• Why have more outbreaks occurred since 2001?

• More outbreaks have been reported since 2001 because:
• more passengers are sailing on more ships at sea, increasing the risk for spread of illness between passengers and increasing the total outbreak count, and
• outbreaks associated with noroviruses, a type of gastroenteritis spread from person to person have increased.



• The ship that I sailed on had a high number of sick passengers or crew. Where can I find more information about the voyage?

• The VSP Web site lists voyages during which the percentage of sick passengers or crew was over 3%, as well as additional outbreak prevention and control strategies conducted by the cruise line. You can find more information about the voyage at www.cdc.gov/nceh/vsp/surv/GIlist.htm.

• Why are children who are not toilet trained forbidden from swimming in pools on cruise ships?

• Children who wear any type of swimming diaper or who are diaper-aged are not allowed to swim because fecal matter may contaminate the water. This can expose other swimmers to fecal matter that is potentially infectious.

• Why isn’t the ship that I’m looking for listed in the inspection database?

• The ship may not be in the inspection database because it does not meet the criteria for inspection, no foreign itinerary, no U.S. port or less than 13 passengers. VSP conducts twice yearly unannounced inspections. For more information about inspections, see ../scores/score100.htm.

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