

Travel Health Journal

IAMAT - The International Association for Medical Assistance to Travellers

Cruise Travel Health Basics

As a record number of travellers are booking cruise holidays – the latest numbers show that there were approximately 15 million cruise passengers worldwide in 2010 – the risk of getting ill on a cruise ship increases.

Illnesses on large ships have a ripple effect; living in close quarters with hundreds or thousands of other travellers for an extended period of time not only exposes you to infectious diseases, but can also have a negative health impact on host port communities where passengers disembark for sightseeing tours and on-land activities.

What are common illnesses found on cruise ships?

Gastro-intestinal illnesses (gastroenteritis) caused by norovirus, e. coli, and salmonella can be present on cruise ships. These highly contagious viral and bacterial infections are transmitted by:

Symptoms usually develop within 12 to 48 hours after exposure and can appear suddenly. They include vomiting, watery diarrhea, abdominal cramps, fever, headache, and nausea. The illness typically lasts 1 to 2 days, but you can be contagious anywhere from 3 days to 2 weeks after
getting sick.

Respiratory illnesses such as influenza are also common on ships. The virus is transmitted among passengers through infected air droplets by sneezing or coughing. A person can be contagious 1
day before and up to 7 days after symptoms appear. Symptoms include high fever, sore throat, nasal congestion, high fever, muscle aches, headache, fatigue, and general weakness. Patients usually recover after 1 or 2 weeks, but the illness can cause complications in young children or persons with pre-existing health problems.

The hepatitis A virus is transmitted through contaminated water and food or by the fecal-oral route, and may cause severe liver damage. Hepatitis A symptoms can mimic the flu – fatigue, nausea, abdominal pain, fever, loss of appetite, and jaundice (skin and eyes). Symptoms appear anywhere from 2 to 6 weeks after being exposed. The illness can last up to 6 months. However, some people are long-term hepatitis A carriers and will not exhibit any symptoms during their lifetime.

Legionnaire’s Disease is a lung infection caused by the Legionella bacteria. Passengers acquire the infection when breathing contaminated air droplets from water found in hot tubs, hot water tanks, building air conditioner and plumbing systems that are not properly cleaned and disinfected. Symptoms mimic pneumonia (cough, chills, high fever, muscle aches and headache) and usually appear 2 to 14 days after being exposed. If caught and treated early with antibiotics, patients can make a full recovery, however it is responsible for fatalities in up to 5% – 30% of cases. The bacteria does not spread from person to person.

Due to the different immunity status of passengers and being in a confined area, persons who are not vaccinated are also at higher risk of contracting vaccine preventable diseases.

What should I do before my trip?

  1. Consult with your doctor to make sure your routine immunizations are up-to-date. We also recommend getting the hepatitis A and B vaccine.
  2. If you have any chronic illnesses such as diabetes, heart disease, or a compromised immune system, ask your health practitioner if taking a cruise holiday is right for you. You may want to consider specialty cruises for passengers with chronic illnesses and disabilities.
  3. If you are sick before your trip, advise the cruise company to see if there are alternatives or if you can postpone the trip. You don’t want to be responsible for making other passengers sick.
  4. Research your cruise line’s reputation. Tour companies are required to report any illnesses and evaluations are publicly available through government websites. If the ship reported illnesses in the past, find out how they dealt with it and what measures they have taken since to prevent the spread of infectious diseases.
  5. Check if your cruise trip is covered by your travel health insurance.

How do I protect myself and others?

  1. Wash your hands often and thoroughly. We cannot emphasize this enough! Good hand hygiene is proven to reduce illness and the spread of infectious diseases. Wash your hands with soap and water for at least two minutes before eating, after using the toilet, touching publicly used surfaces such as door handles, hand rails, elevator buttons, and currency, or if they’re dirty. Also remembers to keep your hands away from your mouth and face. If you don’t have access to soap and water, an alcohol-based hand sanitizer is an alternative.
  2. Stay healthy and hydrated. Drink lots of water, eat healthy foods, and get regular sleep. Check out your cruise ship’s exercise room and wellness schedule. Book an aerobics, pilates or yoga class. Maintaining a healthy immune system and good mental health will decrease the risk of getting ill during travel.
  3. Boil it, cook it, peel it, or forget it should be your mantra when travelling. Many cruise lines have a good reputation when it comes to food preparation and handling. However, when you get off the ship make sure to eat well cooked foods or fruits that you can peel. Avoid shellfish, meat, and dairy products that have been out for a long time.
  4. Practice safe sex.

What to do if I or others around me get sick?

  1. If you get sick, immediately report your illness to the cruise’s medical staff. They will tell you what precautions you should take to improve your health and prevent further infection.
  2. If someone gets sick in your vicinity (such as vomiting or diarrhea), leave the area and notify medical staff.
  3. Avoid shaking hands or being in close contact with other passengers. Make sure to wash your hands frequently.
  4. Stay well hydrated.

For more information on ship health go to:
Health Canada Cruise Ship Inspection Program
CDC Vessel Sanitation Program