Guarding against sickness on ships

In today's Travel section of the St. Petersburg Times (page 2E) is the cruise ship sanitation chart. We have published it monthly in the Travel section for more than 10 years. It reports the results of unannounced inspections of cruise ship galleys, or kitchens, by inspectors for the federal Centers for Disease Control and Prevention.

Reading the chart will not stop you from getting aboard a cruise ship and coming down with Norwalk-like virus, the gastrointestinal illness that has been in the news for the past month. But washing your hands a lot once on board any ship could prevent you from suffering the bouts of diarrhea and vomiting attributed to that virus.

First, let's consider the chart, then the illness.

Federal law requires the CDC to inspect any vessel carrying at least 13 passengers that calls at U.S. ports. The inspections are to occur at least once every six months.

The inspections fall under the National Center for Environmental Health's Vessel Sanitation Program. General categories of inspection are: potable water, food preparation and holding, potential contamination of food, and general cleanliness and storage.

Within those categories, dozens of specific checks are made:

How hot are the cooked foods kept before being served? Is the temperature in the ship's walkin freezers low enough to prevent thawing? Are hot and cold foods kept a satisfactory distance apart before being served? Are cleaning chemicals and utensils stored too close to food? Is the water in the dishwashers hot enough?

The highest score is 100. Various infractions carry differing point deductions. Generally, the lower the score, the lower the level of kitchen sanitation.

However, the CDC says that scoring below 85 "does not necessarily imply an imminent risk of an outbreak of gastrointestinal disease." But the agency can "recommend that a ship not sail when circumstances so dictate."

That rarely happens. It has not been the case during the current outbreaks of Norwalk-like virus.

Which brings us to the illness in the news; if you are squeamish, skip the next paragraph.

Federal law requires passenger ships to maintain reports of medical problems for passengers and crew. According to the CDC: "A reportable case of gastrointestinal illness is defined as three or more episodes of loose stools in 24 hours, reported by a passenger or crew member to the (captain) or to the ship's medical staff."

In turn, the captain must report "to CDC 24 hours before arrival to a U.S. port the number of passengers or crew members who reported diarrhea to the ship's medical staff during the current cruise.

"If at least 3 percent of the ship's passengers or crew members have gastrointestinal illness, the (Vessel Sanitation Program) may conduct an investigation."

An investigation may also be ordered if there are "relatively high incidences of illnesses in successive cruises, unusual severity of illnesses . . . or a high number of persons reporting illnesses over a brief period."

The repetition of illness on successive cruises has brought the Vessel Sanitation Program's attention since mid October to Holland America's Amsterdam and more recently the Disney Magic.

The CDC's experts say that the culprits are passengers with lax hygiene habits. Says Dave Forney, chief of the Vessel Sanitation Program:

"We suspect that people are probably coming on board . . . and (already) have the virus on their hands. And on a cruise ship, people don't go there to sit in their cabins. They're out and about in very public areas, and so we have this depositing the virus on various surfaces that then would be easily picked up by others, and then they put their hands in their mouths" during meals.

"We have looked very closely at all of the food-handling practices on board these vessels, from how the food is stored when it's brought on board all the way through to how it's prepared, served and how the dishes are washed, and have found no deficiencies in either one of these vessels that would point to a food-borne outbreak.

"The best preventive measure . . . is frequent and thorough hand washing with warm water and soap, wiping your hands off and keeping your hands out of your mouth."

At the same news conference about two weeks ago, Marc A. Widdowson, a CDC epidemiologist, said that health workers "often see outbreaks of Norwalk-like virus when people are congregated for . . . more than two or three days together. We classically see it in schools, hotels, often camps, and nursing homes, hospitals . . . . Cruise ships are not special.

"With this virus, wherever we look for it, we find it."

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