Oh No No-rovirus

Before the cruise industry and the world were plagued with Coronavirus, there were other warning signs that should have led to more preventative precautions and safety protocols for those on board. Cruises have become a popular form of vacation and relaxation for many persons and families. However, they have the potential of harbouring serious illnesses. While this may be new information for some who have never had this occur, many others may recall experiencing discomfort where either you or someone you knew fell ill from any symptoms of stomach ache, diarrhea or vomiting while on a cruise vacation. Here is what you should know and how you can reduce the likelihood of falling ill.

In recent years there has been an upsurge in the number of norovirus cases on cruise ships. Norovirus is one of the most common causes of acute gastroenteritis in the world, it can be equated to approximately one out of every five cases of acute gastroenteritis. To put that number into perspective norovirus was the causative agent in over 685 million cases. According to the Center for Disease and Control (CDC), norovirus is one of the big 6 of food borne pathogens. The virus affects all age groups and is easily spread from a contaminated person to another. Symptoms include nausea, vomiting abdominal pain, cramps and diarrhea. The transferal of this virus to the human host is generally through the fecal to oral route i.e. person to person, contaminated food handlers, passengers etc. Essentially the main distributors of this virus are those who come in contact with an infected person.

A cruise ship, provides an ideal environment for the spread of the norovirus this includes: a large enclosed space, a large number of people (passengers and employees) from all over the world and cross-contamination through self service food stations. Furthermore, many cruise ships have inadequate facilities to support proper hygiene practices relative to onboard capacity. As a result, food service areas can easily become contaminated by an infected person and become the origin of an outbreak. Norovirus is a public health and an economic concern. The prevalence of norovirus has highlighted the need for revaluation of the standard procedures and practices regarding food safety in these environments.

Th cruise industry needs to foster positive influences of food safety culture onboard. Here are some possible solutions:

• Hand washing and sanitizer stations around serving areas as well as increasing the cleaning and sanitation of surfaces to improve hygiene practices among staff and passengers and reduce contamination.

• In addition to regular announcements and signage re-enforcing best practices.

Cruise Industry and the Caribbean – Do the Benefits outweigh the risks?

Many cruises are marketed towards Caribbean destinations and the Caribbean experience. The negative impact that food-borne diseases like norovirus could have on our socioeconomic development cannot be ignored. It is crucial that cruise ships and the cruise industry be closely monitored and regulated through-out the Caribbean. The strain an outbreak could place on our healthcare systems, as well as the harm to tourism and trade industries, would be too much for a small country to tolerate.

National enforcement of regulations by the World Health Organization (WHO) have proved to be essential and effective public health protection methods. More specifically cruise ships once entering a port must provide a Maritime Declaration of Health (MDH), this is a requirement of International Health Regulations (IHR).

Over the past three years there have been incidents recorded at ports of entry in Jamaica, Barbados and St. Lucia, fortunately, serious public health risks were avoided as passengers were quarantined and not allowed to disembark these vessels. Caribbean countries must be mindful and careful that passengers infected or affected by the virus do not infect the local populous resulting in a widespread disease outbreak. Small island states may not have the resources to contain and control and outbreak of that potential.

Some checks and balances are necessary to prevent the occurrence of an outbreak. Ports of entry have to be monitored there has to be some communication between vessels entering the country, carrying passengers who have been contaminated. Prechecks will have to be adopted whereby local and regional health agencies examine the ships and passengers for illnesses and make a resolute decision based on ensuring the health and safety of the population. Reducing or limiting the cruise ship aspect of tourism could lead to economic difficulty as these garner a large amount of foreign exchange.

Preventative measures present & are they effective

The IHR requires the use of the Maritime Declaration of Health (MDH) for reporting and information sharing. The MDH should be submitted each and every time a vessel arrives in a port of call, not only when there is an illness/death on board; however, it is up to each country as to whether to enforce this, since submission of an MDH is only required under the IHR when an illness/death has occurred on board the vessel.

CARPHA is the regional public health agency for the Caribbean and the lead authority for regional surveillance and response. It has three main roles with respect to surveillance of and response to public health issues occurring among visitors to the Caribbean arriving on passenger ships in the Caribbean: Surveillance Collect, analyse, and disseminate information on illnesses/outbreaks on ships coming to the Caribbean; Inform and evaluate various national and regional programs; Notify member countries and relevant agencies of illnesses/outbreaks on ships coming to the Caribbean; Train public health authorities and other competent authorities in the surveillance/detection, investigation, and reporting of travel-related illnesses and outbreaks. CARPHA has developed this protocol and guidelines to facilitate disease surveillance on cruise ships visiting the region.

The present methods have proven to be effective, however additional risk management principles would be necessary to circumvent the possibility of a norovirus outbreak. Robust monitoring and regular health status updates are important, protection of our ports of entry and will be the first line of defense against an outbreak. Governments must work with the cruise industry to ensure proper food safety techniques are utilized. Attention must be paid to the food handling workers and food service stations. Additionally, the surveillance methods introduced by CARPHA to benefit CARICOM member states should be employed. In this regard CARPHA has developed the Caribbean Vessel Surveillance System (CVSS) for rapid information flow and coordinated multi-sectoral response for public heath events occurring among visitors from passenger ships. This also involved in the establishment of protocols to facilitate the standardized submission of the Maritime Declaration of Health from ships to competent national authorities.

At the moment the world is in crisis, the cruise industry and many global economies are experiencing many challenges, my only hope is that we adapt and accept the changes necessary for the future.

References

Caribbean Public Health Agency. 2019. PASSENGER SHIP SURVEILLANCE. Accessed 04 19, 2019. http://carpha.org/What-We-Do/Tourism-and-Health-Programme/Surveillance-and-Response-System.

Center for Disease Control and Prevention . 2019. Outbreak Updates for International Cruise Ships. 04. Accessed 04 20, 2019. https://www.cdc.gov/nceh/vsp/surv/gilist.htm.

Center for Disease Control and Prvention. 2018. Common Setting for Norovirus Outbreak. Accessed 04 17, 2019. https://www.cdc.gov/norovirus/trends-outbreaks/outbreaks.html.

—. 2013. General Information about Norovirus. Accessed 04 19, 2019. https://www.cdc.gov/HAI/organisms/norovirus.html.

Cruise Lines International Association. 2019. Nororvirus on Cruise Ships. Accessed 04 18, 2019. https://cruising.org/about-the-industry/policy-priorities/public-health-and-medical/nororvirus-on-cruise-ships.

2019. Norovirus outbreak on Royal Caribbean cruise ship sickens 475 passengers. 01. Accessed 04 19, 2019. https://abcnews.go.com/US/270-cruise-ship-passengers-sickened-norovirus-royal-caribbean/story?id=60291868.

Orlando Sentinel. n.d. Oasis of the Seas’ norovirus outbreak among worst in a decade. But are cruises getting cleaner? Accessed 04 19, 2019. https://www.orlandosentinel.com/travel/florida-cruise-guide/os-bz-cruise-norovirus-outbreaks-20190116-story.html.