Illness on European River Cruises

I would be interested if anyone knows what standards apply to the European river cruise companies in terms of dealing with a flu or gastroenteritis outbreak onboard? I know that for the ocean going cruise lines there is the Vessel Sanitation Program (VSP) at the Centers for Disease Control and Prevention (CDC) in the US. The VSP comes into effect if the ship visits US ports on a foreign itinerary, and you can get CDC online ratings for different cruise lines. I cannot locate online whether there is something similar for European river cruises. Looking at this forum and other online cruising forums such as Frommer’s, it seems that people have experienced flu or other illnesses on river cruise ships in the past, and there has been some previous discussion of this, but I haven’t been able to locate any statistics for how common an issue it is.

We have recently returned from an APT cruise on “Sound of Music” travelling from Amsterdam to Istanbul, and our experience was that a great number of people caught the flu virus while on the cruise. While some would argue that people may bring the flu on board with them (it seems to be rife in Australia at the moment), and this may indeed be the case, we were also told by our cruise director that on the cruise immediately before ours almost 50 people were ill, as well as crew. In fact both the captain and the hotel manager on our cruise were replaced due to illness just a few days after our cruise started. Some people on our cruise were very ill, and one couple returned home early from Rousse, missing the rest of the cruise and tour of Turkey. Others were ill for a great part of the cruise, and spent a lot of time sick and coughing in their cabins. As there was no doctor on board people were obliged to consult doctors in different countries en route, as they became ill. My husband and I were among the lucky ones, inasmuch as we did not catch anything till right at the end, and I had antibiotics with me which helped control the bug. However, we were sufficiently unwell during our privately arranged tour of Turkey after the APT tour finished to be affected in terms of what we felt capable of doing, and some planned things we just could not manage to do. Still a bit below par actually, now we are home again.

From observation, there isn’t much time between sailings for cabins to be adequately disinfected, as one group vacates their cabins round 8 or 9 am and the next group checks in at 3pm the same day. The room attendants work very hard, and our cabins seemed as clean and tidy as any motel when we checked in. However we found a couple of small items in the cupboard (lock, empty jewel box) and there were also traces of toothpaste residue in the bathroom glasses. Another passenger told us he found some Metamucil and other medication in his cupboard. This is probably an acceptable level of cleaning when there is no infection present in the cabin, but a bit cursory if the previous occupant had been ill with the flu.

Bedding was two pillows each, a bottom sheet, and a thin comforter encased in a cover (no top sheet), plus a bedspread – ours had an ink stain on it. I surmise that the pillows, comforters and bedspreads are not cleaned between passengers, but simply have the linen changed. As is the case in motels also. I also wonder how often the A/C filters are changed, since this is the most obvious source of spreading a respiratory infection. Our ship did have two hand sanitizers - at the entrance to the dining room and in the lobby for use after you returned on board from shore excursions. People used these religiously, but as SuJaDon (who was also on this cruise) observed in her posting on Turkish Visas elsewhere in the forum, there were a few who would cough before handling serving tongs, or before using the shared onboard computer.

It was my observation that the “Sound of Music” did not institute what might have been considered reasonable precautions (in line with recommendations from CDC) once people became ill, especially in view of the fact that there had also been illness on the previous cruise. For example, they continued with the self-serve buffet tables for breakfast and lunch (CDC considers this a “high-risk activity”); there was no isolation of ill people; there was no briefing of passengers on appropriate hand washing and health procedures; we were given no notification of the illness on the previous cruise prior to embarkation. I cannot say whether they stepped up the level of disinfection and daily cleaning of public areas, but suspect not. These, among others, are the recommendations that CDC makes in the event of outbreaks on board cruise ships.

My recommendations to anyone doing a European River cruise, therefore, would be: Take along your own inexpensive pillow ( which you can toss at the end of the cruise and use the liberated luggage space for souvenirs). Why? Think of all those people we heard coughing into their pillows all night…we did come to refer to our ship as “The Sound of Coughing”. Also have the flu shot before you go; take a supply of antibiotics, and also take any cold and flu remedies that work for you, like cough medicine, throat lozenges, painkillers. I would also take eye drops, we didn’t and the nasty bug also attacked us as conjunctivitis, often associated with a cough apparently. (Who knew?) Familiar medications are not always easy to find in a foreign country, and substitutes may not be as effective for you, or you may not be able to read the directions. I would also take my own hand sanitizer and antibacterial wipes, and those antiseptic bleach wipes for cleaning would be handy to do your own cabin sanitization.

:) This is not to in any way denigrate river cruising, by the way, or frighten anyone off. We loved the experience, and would definitely recommend it. It was one of the better travelling experiences that we have had (of a great many), and we will definitely do another river cruise someday. (I plan to write a review of this one once I am recovered). Many people cruise without any illness appearing on their ship at all, but a few precautions can’t hurt, just in case you are not so lucky.

I understand that people do get ill, but there is no excuse for finding debris from another passenger in your cabin. Also a trace of toothpaste residue is just disgusting.

I think that the European bedding that we had on the Amacello was cleaner than a hotel. I assume that they wash the duvet cover, so there isn't a gross blanket or bedspread like in a hotel.

Our room was immaculate.

Which ship were you on? We had about 75% of those on the Amadante, August 10-15, who had the flu, brought onboard by a 10 couples from Newcastle. They had been on the Amacello prior to moving over to the Amadante. The flu was brought onto the Amacello by a woman from Newcastle, and I understand the there were a large number of people on the Amacello who also were ill.

To answer your question, though, the US Centers for Disease Control has no authority over European, or any other river cruises. As I understand it, they only do ocean cruises that stop at any port in the US. I've been told that US river cruises are not inspected by the Centers for Disease Control, but don't know that for sure.

Judging from the lack of buffet "sneeze screens" and dishes to park utinsils the on the Amadante, I assume that the European Union does not have an inspection program for sanitation. You might be interested in my report on our cruise on this Board; it's titled "Our 14 Day Amadante Cruise".

Charlotte

We had an awful time last year on a ship infected with 'noro'. Do a search and you'll find all my comments.

Thanks for all your responses. It seems most likely as I thought, that passengers on European river cruises do not have the same protection as those on cruise ships operating through US ports, where the CDC gets involved with inspections.

hcross888. Yes agreed, debris from previous occupants of your cabin is unacceptable. The cabin was otherwise clean. Our cabin attendants were very sweet and worked very hard, it can’t be too pleasant for them having to clean all the cabins of people ill with flu or norovirus. I mentioned the debris because of course it indicated that the cabin cleaning between occupants clearly does not involve a thorough sanitizing procedure. I too like the European bedding, with duvet cover rather than a gross blanket. However, think about all that coughing into the duvet, which is then only covered with fresh linen, while the germs lurk below...(Just teasing)

Trash Queen We were on “Sound of Music”, Amsterdam to Istanbul, commencing 2 August, (organized by an Australian company, APT). In general I liked the ship, the crew were without exception very helpful and friendly, and the meals were generally good also. They did have the hand sanitizers, and also sneeze bars and trays for serving tongs. I think that they need stricter protocols for dealing with illness when it occurs, like those which CDC imposes. The cruise company should also give each passenger a welcome letter on what to do if they become ill, to avoid spreading it to others. On our ship some of those who were ill (and coughing) staked out the refreshments station in the lobby, and the one shared computer. (It was almost like the Middle Ages, when those with the plague sometimes tried to spread it to other healthy people!)

I also think that more effective preventative measures are needed, like thorough sanitizing of all surfaces in the cabin between occupants, sanitizing of bedding, cleaning of A/C filters and so on. Even if this means that they do not turn around the ships on the same day. Since I can’t find any information on what protocols exist for the European River Cruising industry I am assuming that it depends on the company.

I enjoyed your frank review of your cruise, and will comment on the appropriate thread. I plan to write something similar. Looks like we were travelling at pretty much the same time.

P598738. As you recommended, I looked back at your postings concerning your river cruise last year. Seems like the same thing happened then, only you had norovirus, whereas ours was flu. Also from recent postings it seems like it has happened this year on other cruises than mine. It is unfortunately a fact of life when groups of travellers are cooped up together, whether in planes, tour buses or on cruise ships. Someone will bring the infection on board and it will spread rapidly. I guess that all anyone contemplating a cruise can do is take all possible precautions and maybe press your travel agent for information on what process your intended cruise company has in place for preventing and dealing with outbreaks of illness. Since river cruising is an increasingly lucrative and burgeoning industry, if enough people ask for assurances about the health standards on board then attention will eventually be paid. In this forum people are constantly evaluating one cruise company against another. I suggest that, since our health is our most precious resource, a cruise company which goes out of its way to reassure customers that it takes extra precautions will get the business. I know I would rate it above cabin location or food on board – not that they aren’t important.:)

I'd add one more thing that it's important for ALL travelers to do: buy trip insurance, and if you are ill at departure time use the benefit to cancel the trip and have the insurance company refund your money.

To me, the woman who had been ill for three weeks before leaving home, then spread it around two ships that she boarded while on vacation (for a total of 7 weeks of being ill when we all disembarked) was very self-centered--she thought of herself and her own vacation much more than of all the people she caused to become ill.

Charlotte

I agree, trip insurance is a must.

Also agree that some travellers are self-centered unfortunately, sorry that in this case it was one of my compatriots. On our trip there were people with the flu bug who sat around coughing near the tea and coffee station, and the sole shared computer in the lobby. Not to mention coughing and then using serving utensils. Really, the ship should distribute a letter outlining appropriate measures to take if you become ill, and this should be also reinforced in briefings by the CD. Since apparently some people need such direction..

I think some of the river cruise companies are too laid back in their attitude to health on board. When we do a river cruise in future I'll be asking our TA to find out what health measures the company has in place, and using that information as an important factor in deciding which company to use. I imagine the company will be totally nonplussed! However, if we all did that then the companies would come to recognize that it is something they need to take seriously. Sneeze bars and hand sanitizers are all very well, but do not go far enough in ensuring onboard health of passengers.

Thank you all for sharing this information. We're leaving tomorrow for our Rhine cruise which starts this Sunday. I have packed a mini pharmacy and my doctor advised us to start taking Cold FX to boost our immune system. Apparently studies have shown it to have some effect. I'm praying that we won't come down with anything.

We cruised the Rhine last year and no one on the boat came down with anything. I think maybe this year is worse but many of the cruises did not have anyone ill - luck of the draw and your travel companions on the cruise.

Emma Chisit,

As for Germany I can confirm that there is nothing comparable to the CDC over here. Actually health is usually a county responsibility and therefore it´s up to the local authorities. There´s no European authority regarding such health issues.

I remember two incidents this spring when two river cruise ships on the Rhine river have been held by local health authorities because of a Noro virus outbreak. Passengers have been quartined to their cabins. Some had to be treated in a hospital. The ships were desinfected.

There´s definitely no time to deinfect all cabins on a turnover day. And usually only linens are changed on turnover. But that´s the same on ocean going vessels (and is the same on the US river cruise ships).

It´s definitely mainly up to the cruise company how to deal with a virus outbreak. Flu doesn´t need to be reported. Noro virus has to be reported.

steamboats

So, from what Steamboats says, there is scrutiny of river cruise ships in Europe when Norovirus is involved. I doubt that flu would have to be reported anywhere, yet a bad dose can devastate your trip, as happened with some on ours. If I had to choose my illness I would choose flu over Norovirus. Though you might get over it faster – we still have a cough from our trip. The same flu with lingering cough also seems to be prevalent in our local community back home. Not to be flippant, if I had been one of the people on our cruise who could not leave their cabin for days on end, or had to return home early, I would feel bitterly disappointed.

As Aussieflyer says, it sure is the luck of the draw whether there will be illness on your cruise ship; no reason to avoid cruising, you could stay home, miss out on a great trip and still get sick. Just take all the precautions you can pre-departure like tamadig2001 is doing. (Watch out packing Airborne in your checked baggage, have read somewhere it looks sinister to TSA because the packing tube is dense. Good stuff though, wish we had it in Oz).

We all want to know how big the cabins are, how tasty the food, how efficient the CD etc. I also think, if people made a habit of pressing their TA for information from cruise companies about health standards onboard, it might make the companies focus more on the health issue. Maybe eventually they might even do a better job of sanitizing cabins on turnover day – though economics weighs in here of course!

Due to economics every company is only doing what it´s forced to do.

Anyway, every cruise ship (river or ocean and it´s the same for kindergartens, schools, nursing homes, hospitals, public transportation...) has sort of a risk that passengers might fall ill because of the fact that a lot of people are gathered together in a small area.

Another fact is that most of the viruses are brought on by sick passengers (most of them might not be aware that they are already infected when they are boarding the ship).

So the best thing is to be aware of these facts and take precautions. Prepare your immune system by eating healthy, by doing sports and more...

Actually I´m not a fan of bringing my own sanitizer. Sorry to say, but that stuff you can buy usually doesn´t help anyway (especially in the case of a noro virus).

steamboats

Yes, I use antiseptic wipes, sanitizer etc - burt wonder if it is cosmetic. Just like the sanitizers on board ships, sneeze bars, prohibiting "sharps" in carry-on...

Yes, I use antiseptic wipes, sanitizer etc - burt wonder if it is cosmetic. Just like the sanitizers on board ships, sneeze bars, prohibiting "sharps" in carry-on...

There is an argument that over use of sanitizers and antibiotics contributes to the issue. The viruses mutate and become resistant to treatment.

You can't become to obessed. You'll never leave your house.

Eadien7, If You're Talking About Personal Use Of Antibiotics, I Agree That Overuse Can Cause Resistance.

However, If You're Talking About Sanitizers Used To Clean Hard Surfaces In A Room, I Believe You're Mistaken.

The Woman Who Brought The Disease From Newcastle, Australia, Onto The Amacello Had Been Ill For 5 Weeks Before She And The Other 9 Passengers Who Were Then Also Ill Moved Over To The Amadante In Budapest. By The Time She Left, She Was Still Ill And So Were Many Of Us Who Caught It. However, That Means That She Was Ill For 7 Weeks And Did Not Respond To At Least Two Full Courses Of Antibiotics.

I Have No Idea What's Happened To The Others Who Caught This Thing That We Dubbed The Newcastle Bug, But My Husband And I Are Still Ill And Still On Medications. I'm Beginning To Think That Perhaps It's A Fungal Infection And That An Antifungal Might Be More Appropriate Than The Antibiotics Our Doctor Has Prescribed. Will See As Time Goes On, I Guess. However, We Have Now Been Ill For 4 Weeks.

Believe Me, With About 75% Of The Passengers So Sick When We Disembarked In Amsterdam, There Is No Excuse Whatsoever If That Boat Was Not Sanitized From Bow To Stern. Don't Give Any Balogny About Having To Get The Next Group On; The Health Of That Next Group Would Be More Important Than Timing, And That's Exactly What They Do On Cruise Ships In The Us--if There's A Large Contingent Of Passengers Who Have A Disease, The Ship Is Sanitized Before The Next Group Is Allowed To Embark.

Charlotte

Charlotte,

Actually science is talking about bacteria becoming resistent because of the heavy use of sanitizers. Face it: sanitizing wet wipes, germ killing soap, germ killing dish liquid, germ killing detergent... This and the personal use of antibiotics is made responsible for mutation of bacteria.

Anyway, a real flu and noro is caused by a virus. An antibiotic doesn´t help anyway. But noro virus is pretty hard to fight against. And any sanitizer you can buy won´t help much with it. You need chlorine at least.

steamboats

Thanks for clarifying Steamboats, thats exactly what I meant. BTW -- you did your Mississippi Cruise just in time. We had 5 inches of rain in as many hours yesterday the the river is over its banks in the St. Louis area again! How was the cruise? Did you do your original itinerary or an alternate one?

eadien7,

Thanks, we had a wonderful cruise. Weather was hot and humid and didn´t change until we reached Dubuque (aftermaths of Gustav). Our itinerary was only altered slightly due to heavy fog. We got stuck until 9 am the last day and therefore weren´t able to arrive at Red Wing by noon as scheduled. But this gave us a great cruising day and it was the first time I´ve seen Lake Pepin by daylight :D !

I just read that Ike went up the Ohio river valley and Cincinnati is out of power. When we´ve been to St. Louis (BTW we had fun with all the pre-game activities of the Arch Rivalry) the river was down to nearly zero (gage)!!

steamboats

We are just returning from the Amadeus Amacello Danube Discovery--the ship was sanitized daily, everyone used the sanitizing dispensers and to my knowledge not one person became ill during the 14 day trip.

Good to hear all went well with your cruise, maybe the bug has run its course. Lets' hope so. It really is the luck of the draw. Lot of discussion on the thread "Virus on Rhine" about the bug in 2007, and in 2008. Some ships get flu bug, some don't . This year it seems that people on Danube Discovery cruise on Amadagio got it ('needshelp' posted on this). Also 'TravellingProf' and 'Trash Queen' on consecutive cruises on Amadante. And the one I was on, "Sound of Music", where the illness was on our cruise and the one preceding. People used the hand sanitizers religiously, but it still spread.

There is an argument that over use of sanitizers and antibiotics contributes to the issue. The viruses mutate and become resistant to treatment.

 

You can't become to obessed. You'll never leave your house.

We have been on one River cruise (Danube) a few years ago where

my wife was laid up for 2 days and I for one. I don't remember if there

was hand sanitizer on board but we have since taken 4 Carib. on big

liners. They all featured large number of hand sanitizers plus lots of

propaganda. The noro was practically non existent. Me, I will happily

use the stuff,

We recently disembarked the River Discovery in Bucharesnt Romania. The itinerary started in Amsterdam and some passengers got off in Budapest where we embarked. The Budapest to Bucharest leg of this trip had a Dr. onboard. My DH, sorry to say, had to use his services, and he came to our cabin. The price was $50 cash for the consultation and the medication. I did notice a lot of passengers chatting w/him in the lobby area, etc. and it appeared they were talking about illness, so I think he had a number of patients. The program mgrs. indicated they use a Dr. on that leg because the towns are few and far between in the area and they can't just pull up anywhere. However, I don't think it's at all common to have a Dr. onboard a river vessel.

If I'm not mistaken, the Peter Deilmann river cruises are the only company to have a physician aboard every river sailing.

My recommendations to anyone doing a European River cruise, therefore, would be: Take along your own inexpensive pillow ( which you can toss at the end of the cruise and use the liberated luggage space for souvenirs). Why? Think of all those people we heard coughing into their pillows all night…we did come to refer to our ship as “The Sound of Coughing”. Also have the flu shot before you go; take a supply of antibiotics, and also take any cold and flu remedies that work for you, like cough medicine, throat lozenges, painkillers. I would also take eye drops, we didn’t and the nasty bug also attacked us as conjunctivitis, often associated with a cough apparently. (Who knew?) Familiar medications are not always easy to find in a foreign country, and substitutes may not be as effective for you, or you may not be able to read the directions. I would also take my own hand sanitizer and antibacterial wipes, and those antiseptic bleach wipes for cleaning would be handy to do your own cabin sanitization.

A couple of things.

INFLUENZA (NOT Norovirus)

Here in the U.S. flu shots are typically administered beginning in the autumn. Any new strain of the flu (or any strain not selected as one of the 3 biggies for that annual season) will not be covered, i.e. will not be part of the annual vaccine, and I don't know how you would get a vaccine for it, because no one will have manufactured it. Sometimes they guess wrong, unfortunately, and the worst strain of flu is not even in the vaccine that you get. Nevertheless, get the vaccine each year when it is offered.

Antibiotics will not do one darned thing to rid you of this flu, since antibiotics do not work on viruses. However, it is not imprudent to carry antibiotics with you just in case you might need them for other reasons, such as a bacterial infection.

NOROVIRUS

Antibiotics will not do one darned thing to rid you of norovirus, since antibiotics do not work on viruses. However, it is not imprudent to carry antibiotics with you just in case you might need them for other reasons, such as a bacterial infection.

There have been studies to show that certain blood types tend not to get norovirus or to get it in a much lower percentage.

"Individuals who express type B antigen (B and AB phenotypes) were at decreased risk of infection. When these B and AB phenotypes were infected, they were more likely to be asymptomatic."

See http://microbiology.mtsinai.on.ca/bug/norwalk/nor-dis.shtml

As for carrying all the eyedrops, etc. with you: I guarantee that you can buy eyedrops and many other medications in Western Europe that are at least the equivalent of anything we have here in the U.S. (with some exceptions. Colace and its generic equivalent, docusate sodium, are banned in Germany, for example). You just need to know the name of the equivalent. Tylenol, the brand name for acetaminophen, is called Paracetamol in Europe.

I like the idea of the disposable pillow. That makes sense. If not a disposable pillow, then perhaps a tightly-woven, zippered pillowcase such as is used to protect against allergens, might be helpful and it would certainly be easier to pack.

With regard to the flu- we carry a drug called Tamiflu- as far as I am aware it is the only drug to combat viral infections but must be taken within 24 hrs of flu symptons for best results.

Also, for people with asthma, please note that while ventolin can be bought in Australia without script- in Europe you must have a script and an Australian script is not acceptable. On our last cruise my husband ran out in Amsterdam. We had to find a doctor- luckily the doctor we found was very nice and only charged us 10euro to write out the script. It is ironic that in Amsterdam, many things are legal ( that in other countries are considered illegal) however, you can't easily get a drug to save your life.