|Some luck, just when the price of a cruise vacation dropped to record levels, and you thought about taking your first cruise vacation, the news media started reporting that sick passengers were flooding ship infirmaries complaining of gastrointestinal illness with nausea, abdominal cramps, diarrhea and vomiting. Moreover, the flu-like symptoms were not effecting one cruise ship, or one particular cruise line, the reports were coming in from dozens of ships from just about every cruise line in the industry.
The culprit responsible for the passengers’ illness is not a terrorist attack, under cooked food, or the genesis of a new illness isolated to passenger cruise ships – it’s an old, well know perpetrator – a virus.
The particular virus that is currently plaguing the cruise lines is called Norwalk Virus. It bears the name of the place where is was first identified as the cause of a primary school outbreak of vomiting and diarrhea in Norwalk, Ohio.
Norwalk belongs to a family of distinct viruses that have been named after the places where the outbreaks occurred. In the United States we have the Norwalk, Montgomery County, Hawaii, and Snow Mountain viruses. Britain contends with the Taunton, Moorcroft, Barnett, and Amulree viruses. And in Japan, similar but distinct viruses are called Sapporo and the Otofuke viruses.
Before the discovery of diarrhea-causing viruses (in the early 1970′s), researchers were unable to identify an exact, causative, agent for gastroenteritis (a gastrointestinal illness) when it was not due to a bacterial source (like salmonella, shigella, staphylococcus, E. coli, etc). Prior to that time, physicians and researchers called any generalized gastrointestinal illness nonbacterial gastroenteritis, the stomach flu, winter vomiting disease, or it was just passed off as food poisoning, without a test to confirm whether bacteria was the culprit bug or not. With the identification of viruses and the development of sensitive and specific diagnostic tests, eventually researchers began to recognize viruses as causative agents of gastroenteritis.
This virus is passed from one person to another very quickly, which is why it often occurs in outbreaks. Have you ever had one child in your home get sick and the next thing you know you are spending what seems to be 3 nights in a row in the bathroom with sick kids? Most likely your house was infected with Norwalk Virus or Norovirus (formerly called “Norwalk-like Virus”). These are the group of viruses that cause vomiting and diarrhea. Next to the common cold, this is the most prevalent illness in the United States and Canada.
Norwalk Virus is passed through personal to person contact, consuming food or water contaminated with the virus, or by contact with contaminated surfaces (door handles, elevator buttons, hand rails, and food utensils are the big offenders). Cooked foods may also be contaminated though handling by an infected crew member. The foods most often causing Norwalk Virus outbreaks are shellfish and salad ingredients. The sources of water contamination associated with outbreaks are swimming pools, drinking water (not bottled water) and ice cubes.
One larger outbreak or Norwalk Virus occurred in Pennsylvania and Delaware in September, 1987. The source of both outbreaks was traced to ice that was made from water from a contaminated well. In Pennsylvania, the ice was consumed by spectators at a football game, and in Delaware, it was the guests at a cocktail party who downed the virus with the drinks.
The Norwalk Virus is common in situations where there are a lot of people in a group setting such as shopping malls, schools, nursing homes, banquet halls, dormitories, campgrounds, summer camps, churches, schools and cruise ships.
Of course you won ‘t be seeing Johnny’s camp aired on the news when half of the kids are sent home sick with a virus. Those headlines are reserved for large cruise lines. And that’s the reason why the news headlines about the cruise ship illness are misleading.
In our everyday lives, if we became ill with Norwalk Virus, it’s extremely difficult, if not impossible, to identify the location where we contracted it. Unless you’ve been isolated and had limited contact with others, to such an extent that identification of our exposure is an isolated instance, your guess about where you contacted Norwalk Virus would be just that – a guess. But, when you are isolated for seven to ten days on a cruise ship and you become ill midway through your voyage, it’s a bit of a “no-brainer” to assume you contracted the illness onboard ship.
The CDC (Center for Disease Control) estimates that each year 23 million people in the United States alone become ill from Norwalk virus – and that means that outbreaks are common place occurrence. From 1966 to 2000 the CDC recorded 348 outbreaks; most occurred in restaurants (39%) nursing homes and hospitals (29%), and daycare centers an schools (12%). Of the remaining incidents, cruise ships and vacation settings only accounted for 10% of the recorded outbreaks.
This doesn’t mean that the cruise industry is sitting on it’s laurels – quite to the contrary. The lines are doing everything possible to control illness onboard their ships. Surveillance teams have been assigned to ships, reporting standards above and beyond the CDC requirements (3% or more of the passengers and crew with vomiting and/or diarrhea) have been internally instituted and new behaviors for crew members and food preparation and storage are happening oceans wide – on every passenger vessel.
The main problems the cruise lines are facing are they can’t pretest passenger for Norwalk Virus before they board their (clean) ship, they can’t control the appetite of the news media for sensationalism, and they can’t control the perception of the public that cruise ships in someway are responsible for causing the illness. If you ask anyone in the travel industry, there’s no cleaner, safer place to be than on a passenger cruise ship.
As for the illness, there’s no real treatment for Norwalk Virus, only treatment for the symptoms. The objective of treatment is to replace fluids and electrolytes (salt and minerals) lost by diarrhea and/or vomiting. Antibiotic therapy is not effective in viral illness and antibiotic should not be taken. Unless for are actively ill on a day when you have to travel, DO NOT take an antidiarrheal medication like Petmo Bismol®, Lomotil®, or Imodium®, as they may prolong the illness, the symptoms and the infectious process.
A Norwalk Virus infection results in illness 24 to 48 hours after exposure, and symptoms last from 12-48 hours. Illness is characterized by the abrupt onset of vomiting and/or non-bloody diarrhea; abdominal cramps are common. 25-50% of patients report headache, nausea, malaise, myalgias and low-grade fever.
Self-care measures to avoid dehydration include drinking over the counter electrolyte solutions (Gatorade®) to replace fluids and electrolytes (minerals ) lost by diarrhea and/or vomiting.
Passengers who are unable to take fluids by mouth because of nausea may need intravenous fluids. This is particularly true in infants, small children, and the elderly who are greater risk for dehydration. Jell-O® water, soda and plain water and do nothing to replace lost electrolytes.
Do not give antidiarrheal medications to children (unless directed by a physician).The risk of dehydration is greatest in infants and young children, and parents should closely monitor the number of wet diapers changed per day, or the urine output when their child is sick.
For fluid replacement Pedialyte® or Lytren® have liquid and minerals and are recommend them for babies.
- Sport drinks like Gatorade, Power Ade, All Sport,
- Sodas like ginger ale, flat cola, 7-Up, or Sprite
(Mix them half-and-half with water.)
- Dilute tea with sugar
- Frozen popsicle
- Don’t use red Jell-O. It can look like blood in the stool.
- To give Jell-O Mix, 5 teaspoons of sugar and 1/2 teaspoon of salt with
4 cups of water. (Don’t use too much salt.)
Note: Water by itself is not good for children with diarrhea.
- Don’t give your child very hot or very cold liquids.
- Don’t give your child apple juice. Apple juice can make children’s diarrhea worse.
- Give your child as much to drink as they want. Call the doctor if you are not sure.
- Call the doctor if your child shows signs of dehydration:
- thirsty – muscle cramps – confused or dizzy
If you’re a passenger who’s prescribed diuretics (water pills) and you contract Norwalk Virus, you should go to the ship’s infirmary. The reason to be extremely caution is because dehydration develops very quickly in the presence of diuretics and vomiting and can be quite profound in a short period of time. But, don’t be guilty of practicing medicine without a license – don’t stop taking a prescribed medication or a diuretic until you consult consult with a physician!
The best way to prevent Norwalk Virus is to practice good hand washing techniques. This means to wash your hands frequently, and thoroughly with soap and hot running water for at least ten seconds:
- before each meal
- before ingesting any food item handed with your fingers (snacks, peanuts, etc.)
- between handling food raw and and ready-to-eat food
- after going to the bathroom
- after changing children’s diapers
- after smoking
- after using a tissue or handkerchief
An additional practice that needs to be learned over a period of time, is to never touch your head with your hands, anywhere above your neck, unless you have just washed your hands. Norwalk Virus, other viruses, and bacteria are easily transmitted when you touch your nose, eyes, or mouth. Resist scratching your itchy nose with anything but a clean tissue. Keep your hands away from your eyes, and never touch your lips, teeth or tongue. Sure, easier said than done, but it’s a travel practice long followed by savvy third world travelers.
Don’t worry; it isn’t deadly. It just causes some uncomfortable symptoms that will pass in 24 to 48 hours. No one likes to be sick, especially on vacation. You can be assured that every cruise line is doing everything they can to disinfect their ships and be sure that their food handlers are sanitary. The problem with the Norwalk Virus and cruise ships is that the cruise lines can’t prevent you from bringing the virus onboard and they can’t prevent the news media from getting out of hand – when all we’re talking about is a the most common stomach virus on the planet. Play it safe this year, take a cruise and call Accessible Jouneys – Choose to Cruise.