Time for a hygiene review

More outbreaks of the Norwalk virus on cruise ships mean that travelers need to be reminded of some basic precautions.

By ROBERT N. JENKINS
Published February 6, 2005

FORT LAUDERDALE - As I waited last Sunday morning for U.S. Customs officials to allow the passengers on the Costa Atlantica to leave the vessel, a man who had chatted with me during the cruise sat down nearby, and we shook hands. He had had an enjoyable trip, he said in answer to my question - until two days earlier:

"I got so sick I had to go see the ship's doctor. My wife got sick on Saturday. She was up last night, vomiting."

I wish you hadn't shaken my hand, I thought; you may have just infected me.

He most likely had suffered the highly communicable, gastrointestinal illness called Norwalk virus. It brings on vomiting, diarrhea, stomach cramps and sometimes a low-grade fever and aching muscles. Although it typically passes within 24 to 48 hours, it doesn't make a good vacation memory.

Soon my group of passengers - not including this couple - was called to disembark. I grabbed my roll-aboard suitcase with one hand, and with the other I reached into my pocket for the alcohol towelette I was carrying. Before I got to the ship's lobby, I had rubbed the tiny piece of wet paper around both hands.

Still, when the assistant social director reached out to shake and say goodbye, I told her: "Sorry, Patricia, but one of the other passengers shook my hand a little while ago - before he told me he had been sick."

Her smile evaporated, and she wanted to know where he was. I told her he had been to the doctor but that his wife had not; they were sitting in the first row of the theater, I said as I headed for the gangway.

And four hours later, without thinking what I might be doing, I kissed my wife hello when she picked me up at the airport.

It's not the flu

On the way home, my wife told me about the early return to Tampa the day before of the Veendam because of an outbreak that affected about 270 of the 1,792 passengers and crew members.

What is at work is technically a norovirus, which causes symptoms most people associate with "stomach flu,' notes the National Center for Infectious Diseases. But, the center's Web site says, the illness has nothing to do with influenza, "which is a respiratory illness caused by influenza virus. Viral gastroenteritis - the most common name for illness caused by norovirus - refers to an inflammation of the stomach and intestines."

The bad news about this virus is that no medication can prevent it or cure it. "Norovirus infection cannot be treated with antibiotics," the center's Web site says, "because antibiotics work to fight bacteria and not viruses."

The many strains of norovirus make it difficult for the body to develop long-lasting immunity, so a person can suffer from the illness repeatedly.

The only good news is that this illness usually runs its course within 48 hours, though children, the elderly and those with weakened immune systems may suffer longer.

Recommended treatment is to drink plenty of fluids to replace those lost during the illness; juice, water and oral rehydration fluids are usually sufficient.

One estimate is that the illness strikes about 23-million Americans a year, the overwhelming number of cases involving people on land. The term "Norwalk virus" goes back to its diagnosis among nursing home patients in that Ohio city.

The illness spreads quickly through the consumption of food or liquids contaminated with norovirus, or by touching contaminated surfaces. This is the culprit aboard cruise ships, which had a string of outbreaks in 2002 and 2003, and had at least three in January.

Passengers often grasp railings in the corridors or stairways to help keep their balance. They push the buttons of elevators for easier travel through numerous decks of ever-larger ships. They simply use door handles and in-cabin telephones.

Also thought to be a major problem are the buffet lines in the ships' casual restaurants: Passengers share serving utensils, gathering the infection on their hands and transferring it to their mouths while eating.

Working to stop its spread

Cruise lines have taken a variety of precautions against spreading the illness. Many have placed bowls of disposable towelette packages at the beginning of buffet lines. Others have installed dispensers with an alcohol-based hand rinse in the cafeteria-style restaurants.

Some have increased the wiping down of common surfaces from back-to-back disinfection as one trip ends and before another begins to almost daily.

And after 116 passengers and crew members on Royal Caribbean's huge Enchantment of the Seas came down with the illness the first week of January, crew members, including officers, wore gloves and were told to not shake hands with passengers even at the traditional captain's welcome-aboard cocktail party. The buffet lines were eliminated, with all meals served at the dining room tables or in the cabins.

For passengers, the simplest precaution is the one they've heard since they were children: Wash your hands frequently. Also, it's easy enough to go to a drugstore for the disposable wipes (dozens to a box) to carry around the ship, but passengers must remember to use the wipes before and after all meals, and even after using handrails.

The outbreak aboard the Veendam in late January was the ship's second this year: About 70 passengers got sick during its previous sailing. After that, the crew made extra efforts at disinfecting the ship before other passengers boarded, Holland America Line's spokeswoman said. She said she believed an ill passenger brought the latest virus aboard.

FOR MORE INFORMATION: Federal law requires the captain of a ship carrying at least 13 passengers to report to the Centers for Disease Control and Prevention "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."

According to the Web site of the CDC's National Center for Infectious Diseases (www.cdc.gov/travel) symptoms of norovirus begin 12 to 48 hours after ingesting the virus. Infected people are contagious "from the moment they begin feeling ill to at least three days after recovery. Some people may be contagious for as long as two weeks after recovery."

Although it does not report on infectious outbreaks aboard cruise ships, the Vessel Sanitation Program does offer clues to a ship's food preparation.

Every ship that carries 13 passengers and that calls on a U.S. port must be inspected every six months. Inspectors arrive at dockside, unannounced, and check the ship's kitchen for more than three dozen health-code standards.

The major categories involve potable water, staff cleanliness in food-preparation areas, maintaining proper temperatures for hot and cold foods, and storage of cleaning items. Typical checks involve: How hot are the cooked foods kept before being served? Is the temperature in the ship's walk-in freezers low enough to prevent thawing? Are hot and cold foods kept a satisfactory distance apart? Are cleaning chemicals and utensils stored too close to food?

The highest score is 100. The lowest "acceptable" score is 86, but ships with lower scores are allowed to sail on schedule unless inspectors think there is an immediate health hazard. A ship scoring less than 86 must be reinspected within 60 days.

Results of inspections for more than 100 cruise ships are posted at www2.cdc.gov/nceh/vsp/vspmain.asp Results also are printed in the St. Petersburg Times Travel section once a month.

Robert N. Jenkins can be reached at 727 893-8496 or jenkins@sptimes.com.

[Last modified February 4, 2005, 11:03:08]