Health Risks Food and Waterborne Diseases
Infectious diarrhea, most frequently caused by the norovirus (Norwalk virus) is found more frequently on cruise ships than in the normal population of travelers. The virus can survive on practically all surfaces including door handles, sinks, railings, glassware, etc. and therefore may easily be spread in the closed environment of the ship. Enterotoxigenic Escherichia coli, Shigella, Salmonella, and other organisms have also caused outbreaks of disease, however the most frequent cause in the recent past has been norovirus. (See endnote 17.)
Hepatitis A is spread by the oral-fecal route and may also be transmitted through contaminated food or water. Exposure may occur on board the cruise ship or by eating food or drinking water which is contaminated at the various ports of call.
Respiratory Infections, Rubella, and Tuberculosis
These diseases may be spread because of the places from which the passengers and crew have come, the susceptible elderly passengers, the common ventilation system, the large population in close quarters, and through aerosols generated in spas, pools, and from buffet misting devices. Influenza and pneumonia have both occurred aboard ship. Legionnaires’ disease has been linked to ships where several people died and others have become ill. Rubella outbreaks have been limited to crew members. There appears to be limited transmission of tuberculosis in public transportation and then only when there is close contact. There is always a potential for SARS if infected individuals are part of the cruise ship passengers or crew.