Sailing Into Sickness?

Cruising should be as good as it gets. Exotic destinations. A party atmosphere. Food feasts galore.

But there's been trouble in paradise in recent months. Highly publicized outbreaks of gastrointestinal illnesses have left many cruisers sprinting for bathrooms that weren't supposed to be part of their itinerary. Newspaper headlines have blared the names of highly contagious bugs - most notably, the Norwalk virus - that most people had never heard of. And for anxious travelers who once thought of cruise ships as a welcome oasis from the fears and hassles of airline travel, they're now thinking twice, or at least taking a few more precautions before they stroll up the gangplank.

Of course, a little perspective is in order. More than seven million people took cruises out of North American ports in 2002, and most of them returned home with splendid memories and enough photographs to bore their friends and neighbors for months. But for the relatively small percentage whose voyage was sabotaged by a queasy stomach and diarrhea , they probably wish they had stayed on solid ground and close to home.

"Given the millions of people who go on cruise ships every year, outbreaks are not a real frequent occurrence, but they do seem to be increasing," says David Freedman, MD, director of the Travelers Health Clinic at the University of Alabama at Birmingham. "The data appear to suggest that there have been at least three times as many recent outbreaks of diarrheal disease on cruise ships, as compared to a year ago."

Nevertheless, you may be able to sail past any perils lurking at sea with a little knowledge of what you may encounter and the ways to avoid it.

The Norwalk Nemesis

Outbreaks of the Norwalk virus and other infections really shouldn't be a surprise. After all, says Aaron Glatt, MD, cruise ships can become something of a breeding ground for these microorganisms, quickly spreading from one person to another in the confined space and close living quarters of an oceangoing vessel populated by hundreds and even thousands of people. When these bugs strike, the result can be 24 to 48 hours of misery: nausea, vomiting, diarrhea, low-grade fever, and abdominal pain. It's not exactly what the travel brochures promised.

"If you have a Norwalk infection, and you're walking around on dry land, you probably won't infect a lot of people, whereas in a closed space like a cruise ship, it's easy to spread a very hardy virus like this one," says Winnie Ooi, MD, director of the Travel and Tropical Medicine Clinic at the Lahey Clinic in Burlington, Mass. "Because there are a lot of common areas on the ship that people move through, outbreaks can certainly occur."

The Norwalk infection and various respiratory illnesses (like the common cold and flu) are the most common afflictions that can rise to the surface on cruise ships, but bacterial ailments may become problematic as well. Organisms such as salmonella, shigella and E. coli have caused recent outbreaks of diarrhea on ships, and fall into the grab-bag category of "traveler's diarrhea."

In a recent cluster of gastrointestinal illnesses on a cruise ship sailing from Tenerife to the U.S., salmonella was identified as the likely culprit. Most often, these bacterial infections are food-borne, and are a consequence of a breakdown in sanitation measures in the ship's kitchen, says Freedman.