By
Guest |
Assisting the cruise industry to prevent and control the spread of gastrointestinal (GI) illnesses on passenger ships is one of the key tasks of the Vessel Sanitation Program (VSP) at the US Centers for Disease Control and Prevention (CDC), which comes under the auspices of the US Public Health Service (USPHS).
Captain Jaret Ames, USPHS and chief of VSP, says: “We do this by carrying out both unannounced cruise ship sanitation and scheduled construction inspections, by monitoring GI illnesses and investigating or responding to outbreaks, and by training cruise ship employees on public health practices.”
The CDC inspections – which are carried out while a ship is at a US port – do not track specific violation categories but regularly determine how well ships are operating and maintaining sanitation standards. “For example, we look closely at a ship’s medical facilities for GI illness surveillance documentation and medical logs; at swimming pools for filtration, disinfection, and safety standards; and at dining rooms and kitchens to ensure that food is being properly stored, handled and prepared,” explains Ames. “Inspectors provide public health guidance to cruise ship staff when standards are out of compliance and, at the end of the inspection, write a report describing inspection findings and recommendations.”
The main area of concern for the organisation is a group of viruses called noroviruses (NoVs), which can affect the stomach and intestines and may be spread easily by coming into contact with infected surfaces that have been touched by ill people. “This illness occurs more often where there are more people in a small area, such as nursing homes, restaurants, catered events and, of course, cruise ships,” says Ames. “Common symptoms of NoV include vomiting, diarrhea and some stomach cramping and, in some cases, low-grade fever, chills, headache, muscle aches, nausea and tiredness. This illness often begins suddenly, and the infected person may feel very sick for about one to two days.”
With regard to the frequency of onboard NoV outbreaks and how these have changed over the past five to 10 years, Ames says: “While there are variations in the total number of annual outbreaks, it’s not easy to say for sure why these differences occur. Higher outbreak years are sometimes associated with new norovirus strains circulating, but in other years we have increases not associated with new strains. Although outbreaks occur throughout the year, there tends to be a seasonal pattern of increased activity during the winter months and ships typically follow the pattern of land-based outbreaks.”
One strain of NoV associated with most of the land-based outbreaks and sporadic cases of GI outbreaks worldwide, is GII.4 – its ability to mutate and generate new strains means new variants occur as often as every two years. Late 2012 saw an increase in the incidence of NoV-related illness or outbreaks related to a novel GII.4 variant, Sydney – which was first identified in Australia – across a number of countries. “Within the US it is now the leading cause of NoV outbreaks and we don’t yet know if the new strain will cause more norovirus illness than in other years, but CDC will continue to watch this closely.”
Do new strains such as GII.4 Sydney require a different approach to onboard management? “There aren’t major differences in terms of managing these for NoV or other GI illnesses. There is no specific medicine to treat people who fall ill with NoV and the infection itself cannot be treated with antibiotics because it is a viral, as opposed to a bacterial, infection. The best advice for all – passengers and crew – is always to drink plenty of fluids to replace those lost from vomiting and diarrhoea, and to help prevent dehydration.”
Referring to the successes associated with the work the CDC undertakes across the multitude of passenger shipping vessels visited by its sanitation officers, Ames says: “The vast majority of the hundreds of cruise ships we inspect each year pass with a ‘satisfactory’ score of 86 or higher out of 100, so this is certainly a measurement of success. Of those who fail inspections, we typically work with the crew to address the areas of most concern within a reasonable amount of time to ensure the ship meets sanitation standards.
“CDC has a long-standing, positive relationship with the cruise industry that we look forward to continuing far into the future,” Ames concludes. “Both CDC and the cruise industry care about the health and safety of cruise ship passengers. We’ll continue to work with the passenger shipping industry to prevent and control the introduction, transmission, and spread of GI illnesses on cruise ships.”
This article appeared in the Autumn/Winter 2013 edition of International Cruise & Ferry Review. To read other articles, you can subscribe to the magazine in printed or digital formats.