Noro Virus

[lenquixote66]

Why are there so many outbreaks recently ? A few weeks ago the Oasis and now on the Norwegian Escape.

I would think cruise lines would find a way to make conditions more sanitary.

[CPT Trips]

The cruise line can't fix stupid. As in the pax that don't wash hands, and engage in other unsanitary practices in dining rooms and buffets.

[Flatbush Flyer]

49 minutes ago, CPT Trips said:

The cruise line can't fix stupid. As in the pax that don't wash hands, and engage in other unsanitary practices in dining rooms and buffets.

AMEN!

So many people with the filthiest of sanitary practices (e.g., lack of hand washing, sneezing into one's hand instead of sleeve, etc). AND those cruise lines that have self-service in their casual dining venues-  GROSS.

[MCC retired]

It is this time of year , every year , nothing different .

Happens in school systems all over the country but when it happens on a cruise ship it make the news.

Poor hygiene habits 

[chengkp75]

The only time people hear about noro virus and outbreaks is on cruise ships.  The CDC says that annually, noro virus causes between 19-21 million cases of GI illness in the US alone.  Did all of those happen on cruise ships?  Their Calicinet outbreak tracking site lists 655 outbreaks in the US between September 2017, and August 2018.  Between September 2018 and November 2018 there were 58 outbreaks.  Did anyone hear about these?  Does anyone know how many people were affected by these hundreds of outbreaks?  Nope.  Over the same 14 month period, there were only 14 outbreaks on cruise ships that reached the 3% reporting level.  Now, there may have been other outbreaks on ships that reached the 2% "outbreak" reporting level, but this number is not posted on the CDC site, so there is no data directly on that, but these outbreaks are included in the Calicinet numbers, so the number of outbreaks on cruise ships is a very small percentage of the total outbreaks in the US.  The CDC, which regulates the sanitation of cruise ships through the USPH and their VSP (Vessel Sanitation Program), considers that cruise ships are not a very significant portion of the noro virus problem.  Their statistics show that over a seven year period (2008-2014), only 129,678 passengers, out of 74 million cruise ship passengers (0.16%) reported GI illness, and about 1 in 10 of those were confirmed as noro virus.  So, looking at the larger picture, taking that 129k sick passenger number, and averaging it over the 7 years to (18,500/year), the percentage of cruise ship passengers to total cases of noro virus in the US is 0.09%.

 

From the CDC VSP website:

 

"People often associate cruise ships with acute gastrointestinal illnesses such as norovirus, but acute gastrointestinal illness is relatively infrequent on cruise ships."

[Hlitner]

A CDC physician we met, who was onboard a, then. RCCL ship to conduct training for the crew told us that the assumption (based on studies) was that most Norovirus outbreaks were brought aboard by passengers, who likely contracted the virus during their journey to the ship.  It is believed that one of the most common places to contract the virus is commercial aviation...be it on a plane or in an airport.  As another poster mentioned, the best prevention is if folks simply wash their hands (and do not touch their face)….but many folks refuse to follow this simple practice.  

 

Hank

[donaldsc]

There is another thing - cruise companies encourage people who are sick to travel.  Not purposely but that is what they effectively do.  They don't still have you fill out one of those "I am Not Sick" cards but if you did not feel well or had thrown up the night before and were honest, what do you think could happen to you.  They don't let you cruise.  They don't refund your cruise payments.  They don't cover your plane flight home.  So you are out both the money and the cruise.

 

What would you do if you didn't feel well pre cruise - answer the form honestly or lie on the form and board hoping that you felt better tomorrow.

 

DON

[leaveitallbehind]

1 hour ago, Hlitner said:

A CDC physician we met, who was onboard a, then. RCCL ship to conduct training for the crew told us that the assumption (based on studies) was that most Norovirus outbreaks were brought aboard by passengers, who likely contracted the virus during their journey to the ship.  It is believed that one of the most common places to contract the virus is commercial aviation...be it on a plane or in an airport.  As another poster mentioned, the best prevention is if folks simply wash their hands (and do not touch their face)….but many folks refuse to follow this simple practice.  

 

Hank

Appreciate the insight as far too many people blame the ships for creating the situation when in fact it is the passengers who bring the virus on board and, due to the close proximity with other passengers and opportunities with food contact, pass it on to other passengers and the crew.  IMO the cruise lines do a very good job at prevention through sanitary measures and, when affected, containment.

 

Again, it is not the ships or cruise line practices that are responsible for noro outbreaks, it is the people coming on board affected with the virus.

Edited January 19, 2019 by leaveitallbehind

[sfaaa]

3 hours ago, Hlitner said:

, the best prevention is if folks simply wash their hands (and do not touch their face)….but many folks refuse to follow this simple practice.  

 

 

It's hard not to touch your face  when it gets itchy or feels disturbed. It's a natural reaction and something you don't think about until after it is done.

[txflood33]

2 hours ago, leaveitallbehind said:

Appreciate the insight as far too many people blame the ships for creating the situation when in fact it is the passengers who bring the virus on board and, due to the close proximity with other passengers and opportunities with food contact, pass it on to other passengers and the crew.  IMO the cruise lines do a very good job at prevention through sanitary measures and, when affected, containment.

 

Again, it is not the ships or cruise line practices that are responsible for noro outbreaks, it is the people coming on board affected with the virus.

 

Do you have any data that shows all noro breakouts on ships come from passengers? Maybe something that says even though the crew live and work closely in tight, cramped quarters they are immune from the virus? Something that shows they are unable to catch the virus when they take a day off and leave the ship and go into port....maybe they know someone there and visit a home. 

 

This is a genuine question, because I truly don't know the answer....does the crew get sick days? Is it like restaurants in the US where they expect you to come in if you have the sniffles? If they are expected to work their shifts like most American based service industries, there are sick employees working. Maybe not with food, but folding sheets and towels? sweeping/vacuuming areas of the ship? Washing dishes? It happens every day....and I would be willing to bet, it happens on all ships/hotels/resorts/Disneyworld/Amusement Parks/public transportation/etc 

 

Noro can come from anyone....fun fact, you could even be a contagious carrier without showing symptoms yourself. The hand sanitizer they push on everyone is worthless..at least for noro. 

[jagsfan]

I hope they keep pushing hand sanitizers on everybody since there are a lot more germs out there. 

[GUT2407]

4 minutes ago, jagsfan said:

I hope they keep pushing hand sanitizers on everybody since there are a lot more germs out there. 

But most are useless against Noro.

 

if you want to avoid Noro, stop worrying what everyone else is doing and wash your hands  and done put your hands to your mouth, you have now reduced YOUR risk by about 90+%.

[txflood33]

5 minutes ago, jagsfan said:

I hope they keep pushing hand sanitizers on everybody since there are a lot more germs out there. 

 

Excessive hand sanitizer can actually start to kill the good bacteria in your body making it more difficult to fight off the bad viruses. Also, many people will substitute using hand sanitizer for actual hand washing because they believe it's a safe alternative.

[GUT2407]

I think that is a big factor the cruise lines act like sanitiser is the be all and end all, where as it’s really not and lulls people into relaxing the real protections.

[leaveitallbehind]

24 minutes ago, txflood33 said:

 

Do you have any data that shows all noro breakouts on ships come from passengers? Maybe something that says even though the crew live and work closely in tight, cramped quarters they are immune from the virus? Something that shows they are unable to catch the virus when they take a day off and leave the ship and go into port....maybe they know someone there and visit a home. 

 

This is a genuine question, because I truly don't know the answer....does the crew get sick days? Is it like restaurants in the US where they expect you to come in if you have the sniffles? If they are expected to work their shifts like most American based service industries, there are sick employees working. Maybe not with food, but folding sheets and towels? sweeping/vacuuming areas of the ship? Washing dishes? It happens every day....and I would be willing to bet, it happens on all ships/hotels/resorts/Disneyworld/Amusement Parks/public transportation/etc 

 

Noro can come from anyone....fun fact, you could even be a contagious carrier without showing symptoms yourself. The hand sanitizer they push on everyone is worthless..at least for noro. 

 

Point well taken.  And clearly the crew is included as a possible source of any outbreak. What I meant is that it is not the ship per se or lack of proper cleaning and prevention practices by a cruise line that is the cause but rather a human source coming on the ship with the virus.  And as mentioned elsewhere in the thread, land based instances at the examples you indicate are far more common - albeit not reported - than cruise ships.

Edited January 19, 2019 by leaveitallbehind

[Hlitner]

30 minutes ago, sfaaa said:

It's hard not to touch your face  when it gets itchy or feels disturbed. It's a natural reaction and something you don't think about until after it is done.

So true.  On the other hand, if you get a nasty case of Noro that might give you a great future incentive.  Bottom line is folks have all kinds of excuses not to take simple precautions (wash hands, don't touch face, wash hands, wash hands) and they are probably the first to whine that "its the ship's fault" when they get sick.   To modify your own quote, It's the body's natural reaction to get quick ill when Noro enters your mouth, eyes or nose.  

 

Hank

[txflood33]

4 minutes ago, leaveitallbehind said:

 

Point well taken.  And clearly the crew is included as a possible source of any outbreak. What I meant is that it is not the ship per se or lack of proper cleaning and prevention practices by a cruise line that is the cause but rather a human source coming on the ship with the virus.  And as mentioned elsewhere in the thread, land based instances at the examples you indicate are far more common - albeit not reported - than cruise ships.

 

I will agree with this..to a point.

 

I have no doubt the policies are set in place to go beyond what precautions are needed to prevent outbreaks like this. It's the execution that always comes into question. 

 

Please make no mistake, I am in no way trying to shift the blame or responsibility of these outbreaks on the ship and crew. I am well aware humans are disgusting, gross creatures, many with little regard of the consequences of their actions. However, 30 years in the restaurant industry, corners get taken to reach goals....these goals could be for a bonus, or to not miss a day of pay, or reaching plateaus for other rewards. Money and/or a bad boss is a big motivator. 

[leaveitallbehind]

14 minutes ago, txflood33 said:

 

I will agree with this..to a point.

 

I have no doubt the policies are set in place to go beyond what precautions are needed to prevent outbreaks like this. It's the execution that always comes into question. 

 

Please make no mistake, I am in no way trying to shift the blame or responsibility of these outbreaks on the ship and crew. I am well aware humans are disgusting, gross creatures, many with little regard of the consequences of their actions. However, 30 years in the restaurant industry, corners get taken to reach goals....these goals could be for a bonus, or to not miss a day of pay, or reaching plateaus for other rewards. Money and/or a bad boss is a big motivator. 

 

Well maybe chengkp75 will come back to weigh in on ship-board procedures and enforcement.  Can't argue your point as I have no idea what can or does take place on board relative to cutting corners.  But cleaning and sanitizing is very evident IMO on board..

Edited January 19, 2019 by leaveitallbehind

[jocap]

We have a local TV station which reports which hospitals have closed their wards to visitors because of noro outbreaks, and in winter we hear this quite frequently- much more than I hear about cruise ships.

It was a frequent occurrence when I was teaching, too, although it was just called winter vomiting;  probably once each winter. It's always been around, but just not as newsworthy as on a ship at sea.

[chengkp75]

2 hours ago, txflood33 said:

 

I will agree with this..to a point.

 

I have no doubt the policies are set in place to go beyond what precautions are needed to prevent outbreaks like this. It's the execution that always comes into question. 

 

Please make no mistake, I am in no way trying to shift the blame or responsibility of these outbreaks on the ship and crew. I am well aware humans are disgusting, gross creatures, many with little regard of the consequences of their actions. However, 30 years in the restaurant industry, corners get taken to reach goals....these goals could be for a bonus, or to not miss a day of pay, or reaching plateaus for other rewards. Money and/or a bad boss is a big motivator. 

The crew are well trained in USPH requirements for proper sanitation, and anyone can see what is involved if you search for "CDC VSP manual", and you will find both the construction manual (how the ships are required to build the food service, laundry, pool, kid center, medical center, etc to meet USPH requirements) and the operations manual.  The USPH inspectors who ensure compliance with these requirements are well practiced in determining when crew are reciting rote answers to questions about proper procedures, and when those procedures are being followed on a daily basis.  This is why they require that a meal service be observed during their inspections, so that they can observe procedures and question staff during the stress of a full meal service, as this quickly detects whether the procedures are ingrained or "prepped" for the inspection.

 

The best way to get crew to follow these procedures is to ensure they are done every day, day in and day out, and the motivator is that supervisors tend to lose their jobs, not the front line crew, when a ship fails an inspection.  I assume that other lines do similar exercises, but at NCL, we had monthly "USPH" inspections involving every supervisor on the ship.  We would set up teams where one supervisor from the area to be inspected would be part of the team and one supervisor from a totally different area would make up the "fresh eyes" of the team, and every spot on the ship was inspected to USPH standards.  Supervisors and their department's performance were then discussed, rated, and corrective actions instituted.

 

What many folks don't realize is that these USPH requirements cover so much more than what is covered by a health inspection on land.  It will include not only food safety, but the operational status and construction of food handling equipment (they require special screws to be used that can be easily cleaned), the availability of hand washing stations for food handlers, ventilation, lighting, potable water handling, pool sanitation, kids club operation, laundry operation, garbage operations, hazardous chemical handling, pest control, etc.

[cb at sea]

Noro is NOT a "ship" thing....it comes from the PASSENGERS.  The schools are full of it...as are nursing homes, hotels, and anyplace large numbers of people frequent this time of year.

 

The ship is only as "sanitary" as the passengers!

 

You can have it and be contagious BEFORE you have symptoms, and that's why it's so contagious!

 

[MicCanberra]

I know someone who suspects it is Russian infiltrators ?

Personally, I think it is down to two types of people, one type is the unhygienic passengers that spread disease by not washing their hands, also touching things like their nose, mouth, (other body places) and then spreading those germs to other surfaces like the tongs, food etc. The other type are the selfish ones that are slightly ill and do not quarantine themselves until they have spread their germs amongst others.

The best course of action is protect yourself by washing often and not touching your face or eating with your hands at any time.

[GUT2407]

Last cruise Mrs Gut saw some passengers taking food at the buffet, to their table, then deciding to change tables and going via the bathroom, or maybe needing to go to the bathroom, and then changing tables or not trusting table police not to move their food, but taking the food with them. 

 

We reported that real real quick and washy washy girl was relocated to be near the bathroom door.

[chengkp75]

4 hours ago, txflood33 said:

 

Do you have any data that shows all noro breakouts on ships come from passengers? Maybe something that says even though the crew live and work closely in tight, cramped quarters they are immune from the virus? Something that shows they are unable to catch the virus when they take a day off and leave the ship and go into port....maybe they know someone there and visit a home. 

 

This is a genuine question, because I truly don't know the answer....does the crew get sick days? Is it like restaurants in the US where they expect you to come in if you have the sniffles? If they are expected to work their shifts like most American based service industries, there are sick employees working. Maybe not with food, but folding sheets and towels? sweeping/vacuuming areas of the ship? Washing dishes? It happens every day....and I would be willing to bet, it happens on all ships/hotels/resorts/Disneyworld/Amusement Parks/public transportation/etc 

 

Noro can come from anyone....fun fact, you could even be a contagious carrier without showing symptoms yourself. The hand sanitizer they push on everyone is worthless..at least for noro. 

The thing is, even if you catch noro, if your hand hygiene is good, you won't spread it.  So, no, the crew is not immune, nor are they "unable" to catch it from shore.  But their inculcation into the required hand hygiene required by USPH standards means that they are far less likely to spread the disease than the general public (passengers).  What the epidemiologists study more than the raw number of cases of noro on a ship, is the trend of newly reported cases.  If the trend increases from the start of the cruise, and then start to decrease when additional mediation measures kick in, and then don't show again next cruise, or increase again after turn around day, the most likely vector is a sick passenger on each cruise.  If it were a crew member, the trend would rise during the cruise, then remain steady, and remain steady over the turn around period, as this crew member would not change their hand hygiene from one week to the next, and would be a potential source for the major part of their employment, and the ship would experience outbreak after outbreak.  Crew do not get sick days, with one exception.  If any crew member, regardless of department, even engineering, shows symptoms of GI illness, they are required to report to medical, and will be removed from duty.  This is on pain of termination for failure to report the illness.

[leaveitallbehind]

chengkp75, thanks as always for taking the time to respond with your insightful and informative answers.  txflood33, hopefully these responses will address your concerns.