Although cruises are marketed as floating holidays, they can also be helpful in learning about public health. For days at a time, a large number of people reside, eat, unwind, and travel around the same common areas on cruise ships, which are well designed environments.
They demonstrate the ease with which disease can proliferate in a crowded, linked setting.
Consider a cruise ship as a transient maritime metropolis. Restaurants, theatres, cabins, kitchens, water systems, lifts, and indoor meeting areas are all present.
This is really convenient, but it also means that if an illness enters the ship, it can spread in ways that are difficult to halt.
Probably the most well-known case is the Diamond Princess COVID-19 epidemic. 619 members of the ship’s staff and passengers tested positive for the illness in February 2020. Researchers discovered that the new coronavirus propagated more readily due to the ship’s environment.
Although their modelling indicated that public health interventions like isolation and quarantine prevented many more cases, it also demonstrated that an earlier reaction would have further contained the outbreak.
The ailment most strongly associated with cruise ships is norovirus, also known as the stomach bug. Researchers discovered 127 reports of norovirus outbreaks on cruise ships in a review of previously published papers, many of which were connected to contaminated food, contaminated surfaces, and person-to-person transmission.
Norovirus, which affects 20 million Americans annually, can spread quickly from person to person on a cruise ship, according to a more recent report from the CDC’s Vessel Sanitation Program.
An image of the cruise ship MV Hondius anchored off the coast of Cape Verde’s city, Praia. The cruise ship’s operator, Oceanwide Expeditions, reported that a potential virus epidemic has resulted in three fatalities and eight illnesses.
A patient is being evacuated by medical personnel from the opulent cruise ship MV Hondius, which is the epicentre of a hantavirus outbreak.
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A distinct type of risk is demonstrated by legionnaires’ disease, a dangerous lung illness brought on by the Legionella bacteria.
It typically doesn’t spread directly from person to person and affects 6,000 to 10,000 Americans annually. Rather, inhaling microscopic particles from tainted water systems, hot tubs, or showers might cause infection.
A whirlpool spa was connected to an outbreak of legionnaires’ disease among 50 cruise guests in 1994, and more subsequent CDC studies have detailed other legionnaires’ disease outbreaks connected to ship water systems, such as outdoor hot tubs.
Ships like Celebrity Mercury, Explorer of the Seas, and Carnival Triumph have become well-known names in outbreak reports, which can be explained by these outbreaks.
These weren’t particularly exceptional; they were just environments where frequent movement through common areas, intimate contact, and shared dining allowed infection to spread quickly.
Now that three guests on the Dutch-flagged MV Hondius cruise ship have perished from the hantavirus and at least eight more have been ill, many medical professionals worry that a major outbreak is imminent.
Outbreaks of the hantavirus, which is mostly transmitted by rodents, are uncommon on ships. However, as the MV Hondius outbreak develops, it becomes much simpler for germs to propagate in close quarters.
A significant portion of the risk on cruise ships is related to food service. The transmission of stomach bugs can be facilitated by shared utensils, buffet-style dining, and numerous persons touching the same surfaces.
It is possible for an infected person to contaminate food or surfaces before they become unwell.
At a port in Praia, Cape Verde, medical personnel wearing protective gear transfer patients from the MV Hondius cruise ship onto an ambulance.
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The design of the ship exacerbates the issue. Dining rooms, pubs, lifts, hallways, theatres and spa areas are places where people congregate.
Illness can spread from passenger to passenger or between passengers and personnel because crew members live and work in the same environment, frequently in shared housing.
Another important factor is ventilation. Although cruise ships are not confined environments, they do rely significantly on internal areas where people congregate for extended periods of time.
Research on the quality of the air on cruise ships has revealed that if the ventilation system is inadequate, disease can spread more readily in busy, enclosed areas like cabins, restaurants, and entertainment venues.
Passenger safety is influenced by things like sufficient fresh air circulation, specialised filters, and air-purifying technologies.
Age is important as well. Older folks are particularly drawn to cruise vacations, and many of the passengers have chronic illnesses that make infections more dangerous. On a cruise, a lung infection might result in pneumonia or hospitalisation, while a stomach bug can cause dehydration.
Although there are medical services on cruise ships, they are not as extensive as those on shore. They are not designed to handle a rapidly spreading outbreak on a broad scale, but rather to provide first aid, rudimentary treatment, and short-term care. Because of this, early reporting, prompt isolation, and strict cleaning procedures are crucial to ship health.
In anticipation of the arrival of the cruise ship MV Hondius, a command post is established at the port of Granadilla de Abona on Tenerife Island.
How to reduce your risk
The best protection for travellers begins before to boarding.
It makes sense to see if the cruise line has explicit standards for isolation, cleaning, and reporting illnesses. Verify that your regular immunisations are current.
Before flying, speak with your primary care physician if you are an elderly person, a pregnant woman, or have any health issues. Make sure illness-related disruptions are covered by your travel insurance as well.
The best way to avoid stomach infections like norovirus once you’re on board is to wash your hands with soap and water. Although it can be helpful, hand sanitiser cannot take the place of soap and water.
The best course of action if you begin to feel ill is to stay away from buffets and crowded public areas and to report symptoms as soon as possible rather than attempting to continue as usual.
Although many cruises go off without incident and cruise companies have improved their hygiene and outbreak response procedures over time, the fundamental nature of cruise travel still presents the same problem: a large number of people sharing meals, air, water, and common areas.
Because of this, outbreaks continue to occur, and cruise ships continue to serve as a helpful reminder that design influences public health just as much as pathogens.
The Conversation, a nonprofit news outlet devoted to disseminating expert knowledge, is the source of this article. Vikram Niranjan, an assistant professor in public health at the University of Limerick, wrote it, and Emily Joshu Sterne, the assistant health editor at Daily Mail, edited it.
