Norovirus: Stomach Flu Joins the Cruise on Royal Caribbean’s Independence of the Seas

Royal Caribbean Independence of the Seas was struck by highly contagious Norovirus December 2017

Royal Caribbean Independence of the Seas, docked in Labadee, Haiti. Photograph from Shutterstock.

When the Independence of the Seas returned to Port Everglades in Ft. Lauderdale on Saturday, Royal Caribbean confirmed a large outbreak of norovirus on the ship.

The Royal Caribbean cruise began its five-day cruise on Monday, December 11, 2017. Independence of the Seas is one of the largest cruise ships in the world, with the capacity to carry 4,370 passengers, along with a crew of 1,360. Instead of having fun in the sun, only two days into the trip many passengers began falling ill, struck by severe gastrointestinal pain, vomiting, and diarrhea. On Thursday, Royal Caribbean officially announced the outbreak and began its virus-mitigating protocol.

While the Royal Caribbean company stated that only 220 passengers came down with the virus, passengers interviewed by Local 10 News in Miami reported far more passengers were affected, but that the small medical crew onboard Independence of the Seas were so overwhelmed that many people simply stayed in their cabins as they tried to recover. Passenger Victoria Nolan, who became ill with the virus, told Local 10 News that passengers were throwing up in the elevators as they headed toward the ship’s medical facility. Many waited for hours to see anyone.

This is the second outbreak of norovirus on Royal Caribbean ships in December 2017. The Associated Press reported that more than 200 people became ill on Royal Caribbean’s Ovation of the Seas on a two week cruise from Singapore to Sydney. Five were hospitalized upon disembarkation in Australia.

What is Norovirus?

It is a highly contagious virus that is spread by contaminated food, infected people, or surfaces that have been contaminated by feces, vomit, or contaminated food. According to the CDC, norovirus is responsible for more than 20 million illnesses a year in the United States alone, and more than two-thirds of all cases of gastroenteritis. Norovirus causes as many as 800 deaths a year in this country. It is highly infectious, and it is difficult to kill.

“Norovirus is named for Norwalk, Ohio, where the first confirmed outbreak was recorded, in 1968. People sometimes refer to a norovirus infection as “stomach flu,” even though the virus is not related to influenza.” — Live Science

An up-close view of norovirus - also called cruise ship virus or stomach flu.

An up-close view of norovirus, also known as cruise ship virus or stomach flu. Photograph, iStock Photos.

Symptoms include abdominal cramping, diarrhea, vomiting, loose watery stools, low grade fever, and general malaise.

How contagious is norovirus?  According to infectious disease expert Robert Frenck, MD, people can shed up to 1 billion viral particles in each gram of stool. How much does it take to infect someone? As little as 1,000 viral particles. This is why it spreads so quickly in closed environments like cruise ships.

Tips for Avoiding Norovirus

Rather obviously, the best way not to become ill is to avoid contact with norovirus. Past that, regular, religious practice of these habits will help avoid becoming ill:

  1. Wash your hands with soap and water for MORE THAN 20 SECONDS. Regularly! And if you are on a cruise ship — do it more often than you do normally.
  2. DO NOT count on hand sanitizer! It doesn’t kill norovirus (see below).
  3. Avoid people displaying symptoms of norovirus.
  4. If a ship is having a norovirus outbreak, avoid eating at the buffet restaurant. This is where you touch more things that MANY people have touched.
  5. Use bleach to sanitize. Consider bringing rubber gloves and Clorox wipes with bleach on your cruise — obviously be careful with bleach arounds clothes. That way if a family member becomes ill, you can try to prevent the spread on bathroom surfaces, door, cabinet, and drawer handles.
Hand sanitizer doesn't kill norovirus

Hand sanitizer is great for killing many kinds of germs and viruses, but it won’t kill norovirus! Photograph, iStock Photos.

Alcohol hand sanitizers will help kill many types of viruses and germs, such as the common cold or influenza, which is great — BUT IT DOESN’T KILL NOROVIRUS! A 2011 study by the CDC showed that long-term care facilities that relied on alcohol hand sanitizer as the primary way to clean hands, showed a six-time higher outbreaks of norovirus than facilities that used hand washing with soap and water.

Common mistakes when washing hands: not washing long enough, not thoroughly cleaning under fingernails, not drying thoroughly, and only washing after using the bathroom. Germs and viruses hide in nooks and crevices of your hands — pay attention and be thorough. Dry your hands completely — paper towels are better than electric dryers which blow water around and people often don’t use until their hands are REALLY dry. Wash your hands FREQUENTLY during the day, not just after using the bathroom.

Should you avoid going on cruises because of norovirus? No. Remember that this is a common virus all over the United States and throughout the world. You can catch it anywhere. Cruise ships are tremendously more pro-active about sanitization and prevention than most hotels and public buildings. Jeff Fornay, chief of the CDC’s Vessel Sanitation Program, which oversees health and sanitation aboard ships that visit U.S. ports, stated in an interview with Cruise Critic, “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.”

According to the CDC: “From 2008 to 2014, 74 million passengers sailed on cruise ships in the Vessel Sanitation Program’s jurisdiction. Only 129,678 passengers met the program’s case definition for acute gastrointestinal illness and only a small proportion of those cases (1 in 10) were part of a norovirus outbreak.” This would mean that less than .002% of cruise ship passengers in this time frame were diagnosed with any type of gastrointestinal illness.

So, go enjoy your cruise, but be your own best friend when keeping yourself and your family healthy!


Updated December 27, 2017: Royal Caribbean now states that 332 of the 5,447 passengers and crew on the December 11, 2017, Independence of the Seas cruise became ill with norovirus.


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