As the cruise industry is preparing for its biggest year yet, health experts say norovirus outbreaks about the ships are on the rise.
A record 19 million Americans are expected to take a cruise this year, according to AAA. It'll be the third year in a row with an increase. Meanwhile, norovirus outbreaks have also steadily increased, according to the Centers for Disease Control and Prevention's Vessel Sanitation Program (VSP).
So, is it safe to cruise?
Experts say it is, as long as you're taking precautions.
"I still believe that the cruise ship industry is one of the safest and most fun family adventures to go on," said Jessica Wickey Byrd, a professor of hospitality at the University of Central Florida. "The ships have created and designated hand-washing stations. So when you go into any restaurant or any food area, you cannot get to the line to get your food until you wash your hands."
Hand-washing is recommended as the primary way to prevent norovirus infection and outbreaks, according to the CDC. But the agency's ability to monitor outbreaks will be hindered heading into the summer.
Outbreak counts may be off this summer
The VSP will be sailing into the peak of cruise season with limited resources after the federal government released all of the program's full-time employees. The CDC will still be able to maintain its outbreak monitoring system, but it may not be as reliable as previous years, said Jerne Shapiro, an assistant professor of epidemiology at the University of Florida.
"Not only will it impact the safety and ability for us to control outbreaks on cruises, but it impacts the ability to know that someone who goes on a cruise is drinking safe water," Shapiro said.
VSP employees inspected a lot of different cruise ship elements, Shapiro said. "Are the pools maintained for safety? Do they have a high enough chlorination level for there not to be organisms that are transmissible in a pool setting as well? Are they using the right disinfectants to be able to kill the pathogens?"
Central Florida Public Media reached out to the CDC and asked how much part-time staff would be part of the VSP, but the agency did not respond.
Passenger and virus volume increase
Since 2016, the cruise industry has seen big gains in passenger volume. That year, AAA numbers show 11 million Americans went on a cruise. The numbers grew steadily through 2019, with 14 million taking a cruise. The numbers dipped in 2020 and 2021 due to COVID-19, but attendance returned to the pre-COVID trend in 2023, with 16 million.
In 2023, the CDC reported 13 norovirus outbreaks – when at least 3% of the cruise population is infected. In 2024, there were 15. So far this year, there have been 10.
The outbreaks have persisted in part because of a new norovirus strain, GII.17. Most of the population has no exposure to the bug, meaning transmission from person to person is very easy.
Also concerning, norovirus is hard to kill, Shapiro said.
"It does take specific cleaning agents to be able to kill this virus, so crew staff do have to use particular products, she said. So it's "really important to ensure that they're using the appropriate products."
Norovirus is hearty and can cling to surfaces for days, and only certain cleaning agents can kill it. Hand sanitizer does not kill it, Shapiro said. Washing hands with soap won't kill norovirus, either, but it will push it down the drain.
How norovirus spreads
The virus is very contagious and can spread through contact with fecal matter and vomit. But it can also spread in a fairly unique way, as it is one of the rare viruses that can transmit through the air after someone has vomited.
"The scientific community has done investigations, and you can actually measure distinct concentric rings around the person who has vomited," Shapiro said.
Norovirus can cause nausea, diarrhea, abdominal pain, fever and body aches, according to the Mayo Clinic.
The virus also has a short incubation time, Shapiro said. "The time from exposure to the time of onset of symptoms is about 24 to 48 hours."
Shapiro also recommended that you contact a health care provider and get rest at home if you're feeling sick two days before a cruise. Even if you're feeling better, you can still be contagious.
"It takes two days after your symptoms resolve before you are no longer infectious," she said. "Nobody wants to be patient zero who brings it into the cruise and accidentally infects a whole bunch of other people."
What if you're sick before the trip?
Many folks purchased tickets months or even over a year before the cruise, making it hard to sit out the vacation if they're feeling sick, said Wickey Byrd. She recommends still participating in the cruise if they feel just slightly sick, but to wear a mask and wash hands.
But if someone has norovirus symptoms just a couple of days before the cruise, Wickey Byrd agrees it's best to stay home. The trip can be salvaged with trip insurance.
"I highly recommend it," she said. "If you book through a travel planner that's reputable, they can help you to get travel insurance, too. Then, if something happens, they can help you change it. You don't pay any additional money when you go through a travel agent."
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