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Mosquito-Borne Diseases

When cruise ships travel to tropical and subtropical countries, there is potential risk of malaria, dengue fever, and yellow fever especially in the ports and in any land-based side trips. (See endnote 16.)

Best Practices in Avoiding Outbreaks of Disease on Cruise Ships

  • • Passengers who are acutely ill with contagious diseases should not be permitted to board the ship.
  • • If a passenger becomes ill with a communicable disease, the individual should be treated by the medical staff and then isolated.
  • • All passengers should be given specific information concerning the spread of disease, symptoms, instructions on what to do in the event the individual becomes ill, how to properly wash your hands, and when to utilize alcohol-based sanitizers in a variety of situations where the person comes in contact with surfaces, food, drinking water, etc.
  • • All crew members should be given the same instructions as in the item above.
  • • Passengers and crew should have appropriate vaccinations or protective medications when going into areas such as tropical and subtropical communities for specific types of diseases such as malaria, yellow fever, etc.
  • • Proper hand washing techniques using soap and water are the most effective means of preventing and controlling outbreaks of disease on cruise ships. Hands should be washed thoroughly after using the bathroom, changing diapers, before eating, preparing or handling food, and at any time before putting hands to the mouth. The use of alcohol-based hand sanitizers on the hands is effective after the soil or potential soil has been removed from the hands and is secondary to thorough hand washing in these situations.
  • • Wash fruits and vegetables and cook seafood thoroughly before consuming them.
  • • Discard all foods that may have become contaminated or suspected of being contaminated with noroviruses.
  • • Keep infants and children who are sick away from areas where food is being handled, served, or prepared.
  • • When sick, do not prepare food or care for other people who are sick.
  • • After vomiting or having diarrhea, cleaning staff should clean and disinfect all contaminated surfaces. First use a good detergent and water and then rinse the area. Finally, use a chlorine bleach solution of 5-25 tablespoons of household bleach per gallon of water on the area and then allow it to air dry.
  • • Handle all soiled laundry gently and put it through a complete washing cycle. Dry thoroughly on maximum cycle. Wear disposable gloves and then wash hands and forearms very carefully with soap and water. (See endnotes 18, 19.)
  • • If the same ship has more than one outbreak of noroviruses, then it must be taken out of service and thoroughly decontaminated before it can be used again. The crew members should be checked carefully to determine if they have gastrointestinal symptoms or if they have had them in the past several weeks.
  • • When leaving the ship for short trips, consume only food and water which can be certified as safe. Wash hands frequently during the trip and before returning to the ship.
  • • Make sure that all passengers are well hydrated at all times.
  • • Since food is the most common means of transmitting noroviruses, be extra vigilant concerning preparation, storage, refrigeration, and heating, and protection of salads, peeled fruits, deli-type sandwiches, finger foods, hors d’oeuvres, and dips.
  • • Cleaning staff should clean and decontaminate all surfaces which typically come in contact with passengers and crew including carpets, toilet seats, toilet handles, faucets, sinks, phones, door handles, horizontal surfaces such as railings, toys etc. (See Chapter 8, “Healthcare Environment and Infection Control” for details on cleaning.)
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