Poor Hygiene Possible Cause of Gastro Issues Aboard Ships
hands may be the conventional greeting for landlubbers,
but on the high seas, the "forearm tap" has
become popular. This greeting of knocking elbows together
instead of shaking hands was encouraged by a number of
cruise lines to raise awareness of the importance of personal
hygiene on board ship, according to a representative for
Carnival Cruise Lines.
personal hygiene is the likely cause of gastrointestinal
illness (gastroenteritis) on cruise ships, according to
the Centers for Disease Control and Prevention (CDC).
The CDC investigated 22 reports of gastroenteritis outbreaks
aboard 18 cruise ships.
of norovirus infection include nausea, vomiting, diarrhea
and stomach cramping that can last from 12 to 60 hours.
The symptoms usually begin 24 to 48 hours after a virus
is ingested. Although people may feel very ill and vomit
frequently, norovirus infections are not considered serious
in most individuals. But they may become serious in the
very young, older people, and in those with weakened immune
are found in the stool or vomit of infected people, and
infection can spread in several ways:
food or drinking liquids that are contaminated with
contaminated surfaces or objects and then placing your
hands in or near your mouth
direct contact with another person who is infected and
showing symptoms (for example, sharing foods or eating
aren't the vacationer's only cause of gastrointestinal
illness. "Travelers can also get diarrhea from bacterial
infections," says Renata Albrecht, M.D., the director
of the Food and Drug Administration's Division of Special
Pathogen and Immunologic Drug Products. Bacterial infections
usually go away over time without treatment, but doctors
may prescribe antibiotics to treat some and shorten the
duration of the diarrhea, says Albrecht. No medications
are approved for preventing bacterial infection, nor are
there medications that prevent or treat noroviruses.
and thorough hand washing with warm, soapy water is the
best prevention against gastroenteritis, says LeeAnne
Jackson, Ph.D., a health science policy adviser in the
FDA's Center for Food Safety and Applied Nutrition. Travelers
who don't have ready access to soap and water may want
to carry along a hand gel sanitizer, found in most supermarkets
also advises travelers to choose foods and beverages carefully.
Foods should be thoroughly cooked and served hot. Poor
sanitation in some countries may lead to contaminated
food and drink, which are the major sources of stomach
or intestinal illness while traveling, according to the
CDC. Just about any food can become contaminated if handled
improperly, but items of particular concern include raw
meat, raw seafood, green salads, and raw sprouts. "In
some countries, it's wise to steer clear of street food
vendors, especially if they serve fresh-cut fruits," says Jackson, who advocates purchasing fruits whole, peeling
them and cutting them up yourself.
should avoid unpasteurized milk or products made with
unpasteurized milk, unpasteurized juices and ciders, says
Jackson. Beverages that may be safer than tap water in
some countries are hot beverages, such as coffee or tea
made with boiled water, canned or bottled carbonated beverages,
and beer and wine. Avoid ice made with tap water. Water
on the surface of a beverage can or bottle may be contaminated,
so wipe clean and dry the area of the container that will
touch your mouth.
Cruise Ship Connection
investigators believe that most of the recent norovirus
infections on cruise ships were spread person-to-person
through hand-to-mouth activity. "We suspect that
people are probably coming on board with the virus,"
says Dave Forney, chief of the CDC's Vessel Sanitation
Program. "On a cruise ship, people are out and about
in very public areas, and so we have this depositing of
the virus on various surfaces that then would be easily
picked up by others."
advises cruisers who are ill to avoid contact with other
individuals and to report to the ship's medical facility.
Unfortunately, many of them don't want to be told to stay
in their cabins, adds Forney, so passengers spreading
the virus around the ship are contributing to the ongoing
on cruise ships have gained media attention, but an estimated
60 percent to 80 percent of all outbreaks of severe gastroenteritis
occur on land, says the CDC. Norovirus infection is the
most common cause of non-bacterial gastrointestinal illness
in the United States; about 23 million cases of severe
gastroenteritis a year are due to noroviruses. Noroviruses
may be found in areas where people congregate together
for days at a time, such as in schools, hotels, camps,
nursing homes, and hospitals.
is not a reportable illness in the United States except
on cruise ships, so the public may be more aware of the
shipboard incidences, says Forney.
law, cruise ships that enter a U.S. port from a foreign
port are required to report to the CDC, 24 hours prior
to arrival, the number of passengers and crew on board
who go to the ship's medical facility with gastrointestinal
illness, even if the number is zero, says Forney. Having
3 percent or more of either passengers or crew reported
with a gastrointestinal illness is considered an outbreak
and cause for investigation.
shouldn't shun cruises, says Forney. "It is perfectly
safe to go on cruise ships. The standard by which they
are held for sanitation is the highest in the world."
Extensive cleaning and disinfecting were carried out on
ships immediately following reports of illness, Forney
adds. And cruise lines continue to scrub and sanitize
public areas of their ships, especially frequently touched
surfaces such as handrails, elevator buttons, and even
Importance of Hand Washing
care specialists generally cite hand washing as the single
most effective way to prevent the spread of disease, according
to the Centers for Disease Control and Prevention. If
you do not wash your hands frequently, you can pick up
germs and then infect yourself when you touch your eyes,
nose, or mouth. Wash your hands before eating, after using
the bathroom, and after changing diapers or playing with
best results, use warm water to moisten your hands and
then apply soap. Rub your hands together vigorously for
at least 20 seconds. It is the soap combined with the
scrubbing action that helps loosen and remove the germs
on your hands.
and Drug Administration and FDA Consumer)