Norovirus

2nd to Only the Flu

Norovirus ~ Nutrition News

The public is still confused about this easily communicable virus.

Easy to catch, hard to get rid of.

It floats in the air and it sticks to dishes.

A quick rinse under the faucet doesn't remove it from your hands, and people can spread it before they feel sick themselves.

No wonder norovirus makes 21 million people sick every year in the United States.

It's commonly known as stomach flu or winter vomiting disease.

When it hits, it often causes huge outbreaks.

Each year, this virus makes 70,000 people sick enough to go to the hospital.

As many as 800 people die, mostly elderly patients who become dehydrated.

It's the most common cause of foodborne-disease outbreaks.

And it's hard to wash away.

Studies show a quick application of hand sanitizer won't get rid of it, and most people don't wash their hands properly, either.

It takes about 30 seconds of vigorous rubbing using hot water and soap to wash away the tiny bits of virus, and that means getting under the nails, too.

"Imagine you have a food handler who uses the bathroom and they haven't washed their hands thoroughly." 

"They can end up preparing a salad for the diners that evening and end up infecting a lot of people because the food isn't cooked."

Cruise industry executives tell us that they're still shaking their heads over general confusion about the easily communicable virus.

Following are the most common myths we've heard, one at a time.

Myth #1: It is not safe to cruise now because of the virus.

Reality: The epidemiologists at the Centers for Disease Control and Prevention say that's absolutely untrue.

Says David Forney, chief of the CDC's Vessel Sanitation Program, "it is perfectly safe to go on cruise ships.

The standard by which they (cruise lines) are held for sanitation is the highest in the world."

In fact, this might even be an incredibly healthy time to sail, as cruise lines and this is not limited to ships where outbreaks have occurred, are developing proactive procedures to ensure that passengers on voyages, particularly throughout the winter season, don't get sick.

How?

Royal Caribbean International is very candid about the company's new multi-pronged strategy.

This includes sweeping corporate directives (such as the creation of a task force to oversee increased health and sanitation efforts), the implementation of a three-stage illness-prevention program and enhanced passenger communication efforts.

Myth #2: Vessels that experience outbreaks are “sick” ships.

Reality: Not at all.

In most if not all cases, the ships involved have scored very high on the CDC's notoriously strenuous vessel sanitation inspection.

It wasn't the ships that were sick; it was the folks who came on-board and passed the illness around.

Norovirus is, according to the Centers for Disease Control and Prevention, one of the most contagious gastrointestinal illnesses in the world.

Myth #3: Norovirus is a cruise ship phenomenon.

Reality: That's simply not true.

It is second only to the common cold in reported illnesses, impacting millions of people around the world each year.

Previously known as Norwalk Virus, was actually named for a land-based outbreak in Norwalk, Ohio, that originally occurred some 30 years ago.

It can break out at any time of the year.

Myth #4: There is no way cruise ships can battle the spread of this ailment.

Reality: Again, not true.

There are intense and even more intense cleaning and service protocols that cruise lines follow when the possibility of a spreadable virus on board exists.

These protocols have only become more, not less, sophisticated, as a result of recent outbreaks.

All cruise lines are now in a ramped-up cleaning stage.

A Princess Cruises spokeswoman says, "Princess staff and crew are trained to be extremely vigilant regarding passenger health, and the line operates a thorough health monitoring system.

Employees receive special training and utilize a rigorous sanitary protocol that meets or exceeds CDC requirements."

Another improvement: Medical facilities on many ships are now equipped to test specimen samples onboard, which means that doctors can get results (and implement necessary measures) much more quickly than in the past.

Fairly new are service-related mandates; many buffet areas are no longer serve-yourself, passengers get a "welcome letter" offering stay-healthy tips about washing hands frequently, and those who do contract the disease are encouraged to stay in their cabin for a day or two so as not to spread when it's at its most communicable.

The second, more intense category involves taking the ship out of commission for a massive cleaning.

Recent examples include Freedom of the Seas and Carnival Liberty.

Back in the fall of 2002, Holland America couldn't break the cycle after four cruises on Amsterdam despite enhanced cleaning; it took the ship out of commission and embarked on an ambitious program.

This included sanitizing television remote controls and bibles, disinfecting poker chips and currency, discarding every pillow (more than 2,500) and steam cleaning carpets.

The end result?

Amsterdam's follow-up cruise was, thankfully, virus-free.

Myth #5: Caused by uncooked food.

Reality: That can be a cause, but it's typically spread through person-to-person contact.

What you need to know.

Cause of outbreaks not exclusive to cruise ships.

With cruise ship outbreaks appearing in the news more and more often, awareness of Norovirus, an extremely common and highly contagious virus that causes gastroenteritis, has been significantly raised.

In November 2006, Carnival Liberty battled the year's largest outbreak of gastrointestinal illness; a few weeks later, a significant number of folks fell ill on board the biggest ship afloat, Freedom of the Seas.

In both cases, the ships were taken out of service for extensive cleaning.

But before you reconsider that long-awaited cruise vacation because of gloom-and-doom reports on television and in your daily paper, know these facts:

Norovirus is not a "cruise ship" virus, nor does it limit itself to sea-going vessels.

Norovirus spreads swiftly wherever there are many people in a small area, including nursing homes, restaurants, hotels, dormitories and cruise ships.

The common cold is the only illness more common, and the Centers for Disease Control and Prevention in Atlanta estimates that there are 23 million cases of Norovirus annually.

Norovirus is associated with cruise travel simply because health officials are required to track illnesses on ships (and are not at hotels and resorts); therefore, outbreaks are found and reported more quickly at sea than on land.

What are the symptoms?

What are the cruise lines doing to combat germs?

In the following Q&A, we tell you everything you need to know about Norovirus and how to avoid getting sick on your next cruise vacation.

Question: What is Norovirus and how is it spread?

Answer: It's named after an outbreak that occurred in Norwalk, Ohio, some 30 years ago.

According to the Centers for Disease Control and Prevention's Vessel Sanitation Program, "Noroviruses are a group of viruses (previously known as Norwalk-like viruses) that can affect the stomach and intestines.

These viruses can cause people to have gastroenteritis, an inflammation of the stomach and the large intestines.

Gastroenteritis is sometimes called a calicivirus infection or food poisoning, even though it may not always be related to food."

Though Norovirus can be passed via contaminated food and water, when it comes to cruise ships, it is typically spread through physical contact with ill people or surfaces/objects they may have touched.

This includes shaking hands, caring for a sick friend or family member, sharing food or eating from the same utensils, and not washing hands after using the bathroom or changing diapers.

Bottom line?

For the most part, Norovirus outbreaks are the results of guests setting sail sick ... and passing it around.

Q: What are the symptoms?

A: Though generally moderate, symptoms are often flu-like (in fact, Norovirus is often called the "stomach flu," even though it is not related to influenza).

Symptoms include nausea, vomiting, diarrhea and abdominal cramps; children often vomit more than adults.

A low-grade fever and headache are also possible.

Q: What preventative measures should be taken to avoid coming down with Norovirus?

A: First and foremost, wash your hands often with hot water and soap; the CDC recommends hitting the sink before and after eating and smoking, after touching your face, after using the restroom, and whenever your hands are dirty.

Limit person-to-person contact as much as possible (we're not saying you absolutely must refuse the captain a handshake at his cocktail party ... just use your judgment throughout the cruise).

Cruise Critic members advise packing extra soap, a supply of Lysol, alcohol-based sanitizers like Purell and a bottle of Pepto-Bismol (just in case).

Beyond that, avoid uncooked food as much as possible.

Stick to bottled water, and don't share drinking glasses and eating utensils.

Q: What happens if I come down with Norovirus while on a cruise ship?

A: Beyond a visit to the ship's doctor, be sure to drink plenty of water as dehydration is a common side-effect.

Passengers are typically quarantined to their cabins to prevent spreading the illness to others, not an ideal situation, but necessary.

Q: How long will it take me to recover?

A: Once you have been exposed to Norovirus, it takes anywhere from one to three days for its symptoms to appear and symptoms typically last only 24 to 48 hours but keep up the good hygiene as people may be contagious for as long as two weeks after recovery.

Q: Why do I only hear about Norovirus outbreaks on cruise ships?

A: It has been a particular problem of late for cruise ships because passengers and crew typically occupy close and closed-in quarters, such as casinos, theaters and banquet-style dining rooms.

However, Norovirus has been known to close schools, attack college dormitories and even infect a Hollywood Academy Awards party.

"The reason you hear about Norovirus on cruise ships is because they are required to report every incidence of gastrointestinal illness." 

"Nowhere else in the public health system of the United States is this a reportable illness.

Norovirus is not a 'cruise ship' illness, but an illness commonly seen in many settings throughout the United States."

Q: What are cruise lines doing to halt the spread of?

A: Typically, when there's a significant outbreak of Norovirus or a similar illness (the CDC requires cruise lines to immediately file a report when more than 3 percent of passengers are ill), crew members clean even more thoroughly than usual with stronger solvents.

Beyond that, crew members distribute information to passengers on-board offering precautionary tips, as well as a heads-up memo at embarkation to travelers boarding a ship that had previously seen a high percentage of illness.

Buffet service often switches from "help yourself" to manned stations.

As we've seen recently, that isn't always enough: Both Carnival Liberty and Freedom of the Seas docked for two full days of extensive post-Noro cleaning sans passengers, overseen by the CDC.

There are also behind-the-scenes procedures that cruise lines must follow.

For instance, medical officers are required to maintain illness incident counts for each voyage that involves a stop at an American port.

They are also required to communicate to the CDC, within 24-hours of arrival at a U.S. port, "the number of passengers and crew members who reported diarrhea to the ship's medical staff" during that voyage.

Q: Is it more likely to break out on an unclean ship?

A: No.

The Vessel Sanitation Program also monitors vessel cleanliness and there is no correlation between scores and outbreaks of gastrointestinal illness.

In fact, Carnival Liberty scored a 94 on its more recent inspection; Freedom of the Seas netted a 97.

The twice-yearly exam is notoriously thorough and challenging; 86 or above is considered passing.

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