Collaboration in Civic Spheres

Gastroenteritis outbreak on Seattle-based cruise line’s ship

by Matt Rosenberg November 22nd, 2011

One hundred and forty-eight passengers and eleven crew members took ill with with vomiting or diarrhea, or infectious gastroenteritis, on a two-week voyage from Barcelona which ended November 20 in Tampa, on the ms Ryndam, a cruise ship of Seattle-based Holland America Line. In a statement, Holland America said as the cruise continued, affected passengers were asked to stay in their staterooms until symptoms subsided, and that it has been working closely with the U.S. Centers for Disease Control and Prevention (CDC) in response to the outbreak. According to an an investigation update posted online by the CDC’s Vessel Sanitation Program, Holland increased cleaning and disinfection, made numerous announcements to passengers and encouraged reporting of illnesses, reported daily to CDC, collected stool specimens from ill passengers for CDC lab testing, and developed disembarkation plans for ill passengers arriving in Tampa. No cause for the outbreak of gastrointestinal illness has been pinpointed yet, such as norovirus, a frequent culprit in such cases. (UPDATE, 11/30/11: The cause has now been identified as norovirus).

According to CDC’s investigation update, an agency health officer and two epidemiologists boarded the ship in the Bahamas Friday to do a comprehensive evaluation and the ship’s crew “completed a full….super-sanitation turn around between disembarking and embarking passengers on November 20, 2011. Stool specimens were sent to the CDC lab for testing. The ship remains in contact with CDC Vessel Sanitation Program for follow-up and monitoring.” Jay Dempsey, VSP health communications specialist, said today no determination of cause is expected until after Thanksgiving. The ms Ryndam sailed from Tampa November 20 on a seven-day round-trip Caribbean cruise to include stops at Key West, Ocho Rios, Grand Cayman and Cozumel. Demspey said the CDC had received no notification of new GI illness cases on the new cruise, as of this afternoon.

The CDC’s Vessel Sanitation Program investigates and issues reports on outbreaks of gastrointestinal disease on board cruise ships when the illness count exceeds two percent of the total number of passengers and crew on board.

According to CDC annual compendiums detailing GI illness outbreaks on cruise ships since 1994, this was the eighth time the ms Ryndam was afflicted. Seven earlier cases were all caused by norovirus: in February 2004; May 2006; May 2006 again; on three successive cruises starting in January, February and March of 2007; and February 2008.

Headquartered in Seattle, Holland America Line was founded in Rotterdam in 1873 to convey cargo and passengers to the Americas. It shed its cargo division in 1973 and was purchased in 1989 by Carnival Corp. Its 15 mid-size cruise ships make 500 sailings a year, to all seven continents.

The recent Ryndam GI illness outbreak was the first for Holland in 2011. CDC records show that only three outbreaks were reported for the company in 2010, compared to nine in 2009, six in 2008, five in 2007, seven in 2006, two in 2005, four in 2004, none in 2003 and five in 2002. From 1994 through 2001, Holland America had only three outbreaks altogether. The company’s record of onboard illness outbreaks roughly parallels that of the U.S. cruise ship industry as a whole, where incidents were relatively infrequent through 2001 but then grew in frequency starting in 2002 before scaling down over the last two years.

Norovirus, which has been the cause of the vast majority of GI illness outbreaks reported by the CDC, is found in the stool or vomit of infected people and according to a CDC backgrounder for cruise ship passengers, can be spread through ingesting infected food or drink; sharing food utensils; touching infected surfaces and then one’s eyes, nose or mouth; shaking hands; caring for a sick person; or not washing one’s hands after using the bathroom. In a 2009 article originally published in the journal Clinical Infectious Diseases, medical researchers stressed that norovirus on cruise ships may often flourish due to lack of thorough disinfection of common surfaces in public restrooms, including toilet seat, flush handle or button, toilet stall inner handhold and door handle, restroom inner door handle, and baby changing table. As a result, just-washed hands can become contaminated again.

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