These are the cruise ships with the best — and worst — sanitation scores so far this year

  • The CDC randomly inspects cruise ships to help prevent the spread of stomach viruses. 
  • The agency has reported 13 norovirus outbreaks on cruise ships this year.
  • These are the cruise ships with the best and worst sanitation report cards in 2023 so far.

Insider Today

There's nothing like a stomach virus to ruin your vacation, as hundreds of cruise ship passengers have unfortunately learned this year.

The Centers for Disease Control and Prevention has reported 13 norovirus outbreaks on cruise ships so far in 2023. The last time the industry's yearly gastrointestinal illness outbreak total was that high was back in 2016 — and it's only July.

For the agency to report a cruise-ship outbreak, 3% or more of passengers or crew members must report symptoms of gastrointestinal illness, such as vomiting and diarrhea, to the ship's medical staff. During the most recent outbreak, a 14-day cruise aboard the Viking Neptune in June, slightly over 13% of passengers (110 of 838) reported being ill with predominant symptoms of abdominal cramps, vomiting, and diarrhea, according to the CDC.

The nasty stomach bug isn't just a cruise-ship problem, though. Norovirus cases have spiked across the United States this year, which some experts say is the result of ending COVID-19 restrictions .

"People often associate cruise ships with acute gastrointestinal illnesses such as norovirus, but acute gastrointestinal illness is relatively infrequent on cruise ships," the CDC says on its website. "Health officials track illness on cruise ships. So outbreaks are found and reported more quickly on a cruise ship than on land."

To try to help prevent the spread of stomach viruses at sea, the CDC randomly inspects cruise ships and scores them on a scale of 0 to 100 through the Vessel Sanitation Program . Inspection scores of 85 and lower are considered "not satisfactory" by the agency.

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Most vessels have received scores in the high 90s — only one cruise ship, the MSC Seaside, has failed the CDC's sanitation inspection so far this year. The vessel received an unusually low score of 67 , nearly 20 points below the agency's passing grade.

An MSC Cruises representative told Insider at the time that the cruise line had launched an internal investigation based on the inspector's concerns and taken immediate corrective actions.

"MSC Cruises rigorously adheres to health protocols, and the results of this inspection do not reflect the brand's high standards," the person added.

In the past 10 years, only three other cruise ships have received sanitation scores below 70, CDC records show. Violations can include something as small as not posting a raw-eggs advisory on the omelet station or a single fly hovering in a food area. But before going on your next cruise adventure, it doesn't hurt to check out the ship's most recent sanitation rating.

These are the cruise ships with the highest and lowest sanitation scores so far this year:

The 15 cruise ships with perfect scores of 100

The 15 cruise ships with scores below a 95.

Correction: July 17, 2023 — An earlier version of this story included a photo caption that misstated how many passengers and crew members aboard the Nieuw Amsterdam reported being ill during a May voyage. It was 284 people, not 539.

norovirus on princess cruise ships 2023

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Cruise Ship Norovirus Outbreaks

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Here are listed latest cruise ship Norovirus outbreaks on passenger ships, with information what is and how to avoid Norovirus on cruise ships, CDC reports, and news updates.

From the following links, you can skip the intro and jump directly to illness outbreaks in 2024 , 2023 , 2022 , 2020 , 2019 , 2018 , 2017 , 2016 , 2015 , 2014 , 2013 , 2012 , also read about Zika virus , Seasickness , Hospital (shipboard infirmary) and Mercy Ships (hospital ship Africa Mercy) .

Note: The following CruiseMapper link provides information on Coronavirus/COVID outbreaks on cruise ships .

Norovirus outbreaks on cruise ships in 2024

Cruise norovirus outbreaks updates.

Norovirus on ships is spread through contaminated water, foods and surfaces (public restrooms, railings, doorknobs, handles, board games-cards-puzzles-toys, etc). Norovirus withstands chlorine, prolonged exposure outside the body, as well as temperature extremes. Like a virus, Norwalk can't be effectively treated with antibiotics, making it extremely difficult to eliminate in closed environments - like cruise vessels.

Norovirus may incubate up to 48 hours before the symptoms appear. This makes it difficult to restrict an outbreak. Noro symptoms include nausea, vomiting (kids more than adults, abdominal cramps, diarrhea, general weakness, low fever, headache, muscle aches. The illness could last up to 5 days (depending on the person's age, general health, and severity of the exposure to the virus. Recovered patients can still spread the virus for up to 2 weeks.

Quarantining the ill passengers and crew to their cabins is mandatory (at least for 48 hours) to slow the outbreak's spread. Failing to comply with the crew's orders results in fines or even discharge from the ship.

CruiseMapper's Norovirus survey is based on official data from (USA's "Centers for Disease Control and Prevention"). CDC's "Vessel Sanitation Program" assists the cruise tourism industry in preventing and controlling the transmission and spread of gastrointestinal illnesses (Norovirus, ETEC) on passenger ships calling on US seaports.

Cruise Ship Norovirus - CruiseMapper CruiseMinus

This program operates under the authority of the Public Health Service Act (, "Quarantine and Inspection Regulations to Control Communicable Diseases"). CDC sanitation inspections on passenger ships are conducted twice a year. Scores of 86 are considered passing. Among the issues that CDC health inspectors usually find on board and report are:

  • food debris
  • dead insects
  • insect droppings
  • records indicating crewmembers (including cooks and galley staff) working while sick (suffering from gastrointestinal disorders or with acute gastroenteritis/AGE symptoms)
  • cracked/corroded equipment
  • soiled cutting boards
  • food served undercooked
  • lack of safety instruction signs.

CDC cruise ship Norovirus reports

Cruise ship outbreaks are reported (posted on the CDC website) when the illness incident meets the following criteria:

  • The ship falls within the purview of the Vessel Sanitation Program (VSP). This means if it carries 13+ passengers and has a foreign cruise itinerary with US ports of call in it. Keep in mind, that most departures are from US-based home ports.
  • The ship cruise itinerary length is between 3 and 21 days,
  • The ship carries 100+ passengers.
  • The percentage of infected passengers or crew (cases reported to the ship's med staff) during the cruise is 3% or more. This means small outbreaks on cruise ships will not be reported to the CDC.

CDC cruise ship inspection fees are payable by the shipowner. Fees are based on the vessel's size. VSP doesn't charge fees for consultations related to shipping facilities renovations or new ships. Inspection fees are as follows.

  • Small ships (under 3000 GT/gross tons) pay USD 1500 per inspection.
  • Small ships (between 3000-15000 GT) pay USD 3000 per inspection.
  • Medium ships (between 15000-30000 GT) pay USD 6000 per inspection.
  • Large ships (between 30000-60000 GT) pay USD 9000 per inspection.
  • Extra-large ships (between 60000-120000 GT) pay USD 12000 per inspection.
  • Mega-liners (above 120000 GT) pay USD 18000 per inspection.

Note: When the itinerary doesn't include US cruise ports, the ship is not required to report to CDC, thus no official illness outbreak report would be issued.

CDC ship illness outbreak investigations

VSP (abbrev "Vessel Sanitation Program") monitors CDC's observations on illness patterns for GI (gastrointestinal) outbreaks on passenger shipping vessels ( ferries and cruise ships ).

  • VSP conducts outbreak investigations only in cases with 3% or more passengers or crew reported sick with GI symptoms. VSP may also conduct outbreak investigations in cases of unusual GI illness patterns (even if the rate is less than 3%).
  • VSP conducts outbreak investigations only on vessels visiting ports in the USA or which are within 15 days of arriving at a US port.
  • When an outbreak occurs, VSP asks for ship logs and infirmary records of reported GI cases (symptoms and timing) and illness distribution (among passengers/crew, during each day of the cruise).
  • VSP staff usually boards the vessel for epidemiological assessment, interviews, distribution and analysis of illness questionnaires, monitoring cleaning procedures.
  • Lab investigations - the onboard med staff often collects stool, vomit, blood specimens, which are then sent to land-based labs to confirm the illness cause.

During the onboard illness outbreak, VSP requires the cruise company to activate the "Outbreak Prevention and Response Plan" (vessel's response to illness cases).

During an outbreak:

  • Cleaning and disinfection frequencies are Increased.
  • Self-service buffets are stopped.
  • All infected (pax/crew) are quarantined to their staterooms/cabins
  • Clinical specimens are collected for analysis.
  • Daily updates are provided to VSP (cases counts and measures reports)
  • All passengers and crew are alerted of the illness.
  • Upon boarding on the next scheduled cruise, passengers are notified about the previous voyage's outbreak.
  • Occasionally, VSP requires the company to notify port authorities and also to perform cleaning and disinfection in cruise port terminal buildings.

Illness outbreaks on cruise ships (annual statistics)

The following statistics show the number of cruise ship illness outbreaks in recent years. You can compare the number of reports (CDC and news media sources) and the total number of infected (passengers and crew).

In 2014, Time Magazine published the article "The 13 Worst Norovirus Outbreaks on Cruise Ships". In it, the overall winner was Princess Cruises with 5 epidemic illness outbreaks:

  • Coral Princess (February 2009, infected 271)
  • Crown Princess (January 2010, infected 396)
  • Crown Princess (February 2012, infected 363)
  • Sun Princess (July 2012, infected 216)
  • Ruby Princess (March 2013, infected 276)

Norovirus outbreaks 2023 reports

Norovirus outbreaks 2022 reports, norovirus outbreaks 2020 reports, outbreaks 2019 reports.

In the following table, you can see all 2019-reported Norovirus outbreaks on cruise ships. The listed statistical data is based on CDC or news media reports. It shows the number of sick passengers and crew (with the respective percentage to all), along with the corresponding CDC report pages (if available) as outgoing links.

Note: When the itinerary doesn't include US cruise ports, the ship is not required to report to CDC, thus no official illness report would be issued.

Outbreaks 2018 reports

In 2018, the number of reported illness outbreaks on cruise ships was 15. The total number of infected was 1177 (of those 1099 passengers and 78 crew).

Outbreaks 2017 reports

In 2017, the number of reported illness outbreaks on cruise ships was 21. The total number of infected was 2535 (of those 2450 passengers and 85 crew).

Outbreaks 2016 reports

In 2016, the number of reported illness outbreaks on cruise ships was 23. The total number of infected was 2504 (of those 2378 passengers and 126 crew).

Outbreaks 2015 reports

In 2015, the number of reported illness outbreaks on cruise ships was 23. The total number of infected was 2570 (of those 2458 passengers and 112 crew).

Outbreaks 2014 reports

In 2014, the number of reported illness outbreaks on cruise ships was 17. The total number of infected was 3559 (of those 3354 passengers and 205 crew).

Outbreaks 2013 reports

In 2013, the number of reported illness outbreaks on cruise ships was 22. The total number of infected was 2385 (of those 2249 passengers and 136 crew).

  • According to CDC, in 2013 from Norovirus and similar GI (gastrointestinal) illnesses suffered a total of 1409 passengers (which is 7,5% of all passengers on the inspected cruise vessels) and 96 crew/staff members (which is 1,2% of all). With nearly 12 million cruisers departing from USA and Canada ports in 2013, the Norovirus infection rate is ~0,01% of all passengers.
  • It should be noted, that in the past years on many CDC inspections was concluded the Noro virus illness source was off the ship.

Outbreaks 2012 reports

In 2012, the number of reported illness outbreaks on cruise ships was 34. The total number of infected was 5542 (of those 5079 passengers and 463 crew).

Norovirus on cruise ships

All important things you should know about the "cruise virus".

Why do Norovirus incidents happen on cruise ships? There are more than 21 million US cases reported annually, of which 1 mill related to kids. Outbreaks happen mostly during winter months and mainly in more crowded places with close quarters. Among those are schools, hospitals, nursing homes, dormitories, prisons, big resorts, bigger passenger ships (including cruise ferries ). Norovirus is often branded as "cruise ship virus" simply because on ships health officials are required to report every gastrointestinal illness incident. This means Norovirus outbreaks are reported more quickly on ships than on land. Just for comparison, the virus can afflict as many as 3000 people per day in only one big city, which is about the passenger capacity of a typical modern cruiser.

What is Norovirus infection? It's a very common, highly contagious, ruthlessly efficient and uncomfortably bad virus affecting the stomach and large intestines. Often called "stomach flu" (the med term is "Gastroenteritis") the infection results in massive vomiting and diarrhea. Sickness outbreaks are considered as such if the percentage of infected people is over 3%. The virus is not seasonal and usually not serious (in medical terms). It hits 1 in 5 people annually and is the cause of ~50% of all foodborne illness outbreaks in the USA and for ~90% of all non-bacterial gastroenteritis worldwide.

The virus is named after an outbreak in Norwalk (OH, USA). Numerous studies confirm that a quick application of hand sanitizer doesn't kill the Norovirus. It takes about 30 sec of hard rubbing with hot water and soap (including under the nails) to wash it. This virus also mutates (changing its strains). As to its efficiency - a mere 20 particles are enough to get you.

What causes Norovirus on cruise vessels is mainly contaminated food/water. When it comes to ships, it spreads mostly through physical contact with sick people or handling contaminated objects. This includes sharing food/utensils and poor hygiene (not washing hands after bathroom use). The virus also spreads fecally, so you can catch it into the onboard laundry, or while changing diapers, etc. However, many passengers likely can blame a sick crewmember for the virus. According to a survey based on 170 inspection records on ships that docked in Florida ports in 2012, on 59 cruises violations of the required illness reporting laws were reported. A total of 130 crew had gotten sick on those voyages and didn't report their illness in the required time period.

The symptoms are nausea, vomiting, diarrhea, indigestion, abdominal cramps. Also possible are mild fever and headache. It takes 1-2 days for the symptoms to appear. The illness lasts 1 to 4 days, but some people (especially elderly) may be contagious for up to 2 weeks after recovery.

What is the treatment? What to do if you got it? Obviously, the first thing is to go to the ship's infirmary (medical center) and contact the doctor. You should drink plenty of water as dehydration is a side-effect of the illness. There is no real treatment for Norovirus - you just wait it out. A few years ago an experimental Norovirus vaccine (applied as nasal spray) was developed by the "Center for Infectious Diseases and Vaccinology" (Arizona State University). The new vaccine generates a good immune response.

How to avoid Norovirus on cruise ships?

  • Wash your hands often (hot water and soap), especially before/after eating and after using the bathroom
  • Limit physical contacts as much as possible, pack some extra soap, a personal disinfectant (Lysol, Pepto-Bismol), oral rehydration sachets and treatments for diarrhea
  • Avoid eating uncooked food (including salads and sandwiches) and food that cannot be washed (unless it can be peeled or shelled), drink only bottled liquids (preferably without ice), don't share drinks/utensils.
  • Drink lots of water.
  • Compensation for cruise illness. By contract, cruise lines are not required to compensate passengers who fall ill on cruises. However, they will compensate you if the itinerary was altered/canceled due to an illness outbreak. The deal may include up to 50% refund, up to 50% FCC (future cruise booking discount) or an option to cancel for a full refund plus reimbursement of airline change fees. If you have travel insurance, it covers cancellation due to illness. If you've been infected on the ship, it could also cover medical expenses and to compensate you for all days you're not on the ship before the cruise end.

The following "health advisory" list of recommended actions is often issued during gastrointestinal illness outbreak or on embarkation day (of the next scheduled voyage). It has important suggestions on how to avoid spreading the cruise ship virus infection.

  • It is critical that excellent standards of personal hygiene are maintained by all on board, as well as avoiding touching surfaces, such as handrails, door handles, elevator buttons, walls.
  • Report any observed evidence of vomiting or diarrhea that you may encounter on the ship.
  • Ensure that you minimize direct contact with others during this time, such as handshakes, etc.
  • Avoid touching your mouth.
  • Wash your hands frequently and thoroughly with soap for at least 20 sec and rinse them well under running water. Ensure that you follow this procedure every time you use the WC, after coughing or sneezing, and before eating, drinking or smoking.
  • Attempt to always use your own cabin toilet facilities.
  • In addition to hand washing, also use the alcohol hand gels provided where available, and in particular before eating in the self-serve buffet restaurant and outdoor food outlets.
  • Should you experience any symptoms of vomiting or diarrhea, return to your cabin and immediately report to the Medical Center or Front Office (Reception, if the infirmary is busy) by dialling 999.

Cruise ship virus procedures

What do they do about it? What actions do lines/operators/CDC actually take in response to a Norovirus cruise outbreak?

An "illness outbreak" is considered when 3% or more of all passengers report symptoms to the ship's med staff. In such cases, the CDC requires cruise lines to file a medical report.

The hotel staff is required to implement special cleaning and disinfection procedures for sanitizing the whole ship. To do that, they use stronger solvents, like Microbac, chlorine bleach, hydrogen peroxide. The Lido Deck's bistro/buffet service switches to manned stations. Often, salt-pepper shakers are taken off the tables. The crew starts offering precautionary tips. Sick passengers and crew are quarantined in their rooms, typically for at least 2 days. When Norovirus outbreaks can't be contained, cruise lines might also pull the ship out of service for a few days for sanitizing.

The CDC's "Vessel Sanitation Program" is for monitoring illness outbreaks on passenger ships carrying 100 or more guests on sailings from 3 to 21 days in length. The ship's medical staff is required by the CDC to maintain illness counts for each itinerary involving a stop at a US cruise port and to give CDC the number of all passengers/crew, plus the number of reported diarrhea cases during that voyage. This is done 24 hrs prior to arrival at any US port of call from a foreign port. And they file such reports even if the "illness number" is zero. This protocol only confirms that the CDC knows everything about it.

Other possible actions and results are red level ("Code Red") cleaning. The boarding/embarkation of new passengers is often delayed to permit more extensive disinfection of public areas and the cabins. Usually, a pre-embarkation health advisory is distributed to all boarding passengers. Additional med staff is sent to the ship in port to assist the disembarkation of infected passengers. Another possibility is the cruise ship to cancel all the itinerary's foreign ports of call and to return to its US home-port before the end of the voyage.

Some cruise lines offer hand-sanitizer dispensers near the ship's restaurants, Lido/pool deck areas and other more crowded public spaces in their effort to keep a lid on sickness outbreaks.

In February 2020, the shipowner cruise company Lindblad Expeditions announced the "Premium Purity" program with a shipwide cleaning system based on ACT CleanCoat technology. The program was rolled out fleetwide after a year trial. The innovative ship cleaning process is based on photocatalytic antibacterial spray that when activated by light kills viruses, bacteria, airborne microbes, mould. The disinfecting product and technology were developed by the Danish company ACT Global AS ( Copenhagen ). The spray is chemical-free, odourless, transparent and can be applied to all surfaces.

Zika virus on cruise ships

Zika virus (aka ZIKV) is a Flavivirus - from the genus of the viruses named West Nile, dengue, tick-borne encephalitis, yellow fever. These plus several other viruses may cause encephalitis (acute brain inflammation). In humans, Zika virus causes the Zika fever which is known to occur only within some equatorial regions. In 2014, Zika spread across the Pacific Ocean to French Polynesia, and soon to Easter Island. In 2015, Zika virus reached Central America, the Caribbean, and South America. In South America were recorded several pandemic outbreaks.

The most severe outbreaks were reported in Brazil, with an alarming surge in newborns with microcephaly. If the mother is infected, the virus may cause microcephaly in newborns. This is a neurodevelopmental disorder - babies are born with an underdeveloped head.

Generally, Zika is a mosquito-borne virus spread by Aedes aegypti (aka "yellow fever mosquito") and Aedes albopictus (aka "Asian tiger mosquito"). However, it became "cruise virus" since the decease can also result from intrauterine (contraceptive device), sexual intercourse, blood transfusion, lab exposure, organ/tissue transplantation, breast milk transmission.

In January 2016, the CDC issued travel guidance on affected countries and suggested using enhanced precautions and even postponing travel. Guidelines (specifically for pregnant women) were issued as well. Similar travel warnings were issued by other health agencies and governments. The CDC list of potentially dangerous for travel countries included (alphabetically) Barbados, Bolivia, Brazil, Cape Verde, Colombia, Ecuador, French Guiana, Guadeloupe, Guatemala, Guyana, Haiti, Honduras, Martinique, Mexico, Panama, Puerto Rico, Paraguay, Salvador, Samoa, St Maarten, Suriname, Venezuela.

Cruise lines should warn their pregnant passengers of the virus. Cruise ships publish daily health and safety instructions to their passengers on how to avoid mosquito bites. Zika symptoms are fever, skin rash, pain in joints, conjunctivitis (pink eye). It typically lasts from a few days to a week. For now, the illness cannot be prevented by drugs or vaccines.

"Cruise ship virus" politics

Virus outbreaks on cruise ships are actually not that uncommon. Such viral/bacterial outbreak incidents affect the vacation experience of thousands of people, being packed up in a floating resort for many days on end. In confined spaces with frequent passenger turnover (like big capacity cruise ships), it is easy for diseases to spread - whether food- or air-borne, or otherwise. However, there's a tendency to cover up the severity of this issue.

Some of the world's most famous passenger ships are listed in the virus outbreak statistics, yet one hears so little of it in mass media news. And there is no surprise in that since the "cruise illness" news are nothing but bad publicity for the companies - which is bad for a prosperous multi-billion dollar sea travel vacation business. All major cruise line companies will do their best to keep quiet about virus outbreaks on their ships. There are passenger testimonials about quarantined ships and how badly guests have been treated by the line. Virus outbreak news speaks of a lack of proper hygiene control, badly trained staff, bad ship management. The whole responsibility goes to the shipowner (cruise line company) and its management.

Major (in some cases epidemic) illness outbreaks are among the "biggies" that can bring down the brand's reputation on the market. Cruise illness issues often result in lower booking rates and cheaper prices - which is bad for the business.

So it comes as no surprise that when CDC reports an illness outbreak on some vessel, big media sources do not immediately (or ever) respond to the news. You may hear about it on your local radio station, or on your local cable operator, but not necessarily on ABC, CNN, and often not even on Yahoo and MSN news online. It's not about the passengers' health (never been) - it's about the big money that rules our world.

So keep your hands clean, keep your mind clear, always hope for the best. Bad, if meant to happen, will happen anyway, and nothing can change it.

Seasickness on cruise ships

Seasickness is physical disorientation as a result of conflicting signals received by the brain from different body senses. Our inner ear senses the ship's irregular motion, which our eyes can't see because the floor and walls are stable. Depending on individual balance, our ability to adjust to motions varies, so not everyone experiences seasickness.

Seasickness is one of the most common "cruise illnesses". Passengers sensitive to nausea or motion sickness should consult their doctors for medical recommendations prior to departure. Drugs (like Dramamine) are effective against seasickness. At the cruise ship's Infirmary, and also at Reception Desk is provided (free of charge) Meclizine. Know that the bigger the vessel the more stable it is. Also, motion in midship-located areas (including staterooms) is highly reduced in comparison to forward and aft areas.

Seasickness manifests in different ways and is always a result of the body's attempt to correct for the conflicting inputs received from its senses. Common symptoms are cold sweat, dizziness, drowsiness, headache, nausea. When such symptoms are noticed, passengers should take precautions to prevent intensifying the disorientation. The harder the symptoms, the longer the recovery.

If seasickness symptoms are accompanied by diarrhea or fever, passengers should immediately seek medical treatment for Norovirus and avoid spreading the illness to others.

How to prevent seasickness on cruise ships (tips)

Passengers prone to motion sickness are more likely to suffer seasickness. The following prevention tips can minimize discomfort, so before the cruise:

  • choose more sheltered routes (clam waters). Open sea and ocean waters are rough and have larger swells, thus river cruises are among your best choices.
  • Choose a large liner as larger vessels are more stable and motions are minimized.
  • Book centralized/midship stateroom and/or middle deck cabin, where motions are less noticeable.
  • Get a good sleep before the voyage - an energetic, well-rested body adjusts easier to new conditions.

During the cruise tips to divert seasickness symptoms include:

  • Get involved in onboard activities - this will occupy your mind while the inner ear adjusts to equilibrium changes.
  • Avoid napping or lying down - when the body is horizontal, the ship's motion is more pronounced.
  • Avoid eating unknown foods - you don't know how your stomach may react to new food/ingredients. Avoid alcohol and acidic-fatty-spicy foods. Stay well-hydrated by drinking plenty of water.
  • Walk around to adjust the body's equilibrium to the ship's motion. When on open decks, focus on the horizon to give your eyes and body similar inputs about any tilting or other motion. Depending on the symptoms' severity, it may take several hours.
  • Often get fresh air, take deep breaths, keep your lungs clear.
  • Some herbal remedies (in tablets or teas) also can ease the symptoms, including ginger and peppermint. Their efficacy varies by person, and are best used together with other prevention methods.

Search for medical assistance - consult the ship's physician if no actions provide relief.

Cruise ship hospital (medical care)

Cruise vessels are not "hospital ships".

Navy hospital ship

Hospital ships are designated as floating medical facilities (hospitals).

Most hospital ships are navy vessels (operated by military forces) which are specifically built for use in war zones.

Attacking a hospital ship is considered a war crime, but enemy forces have the right to board them for inspections.

As of 2018, hospital ships have Brazil (6), China (5), Russia (6), USA (2), Spain (2), and India-Indonesia-Peru-Vietnam (x1).

The navies of USA, UK, Australia, China, France, Italy, Spain, Argentina, and Japan have some classes of military ships fitted with onboard hospitals.

For passengers with health concerns, medical care on cruise ships is a vital part of their travel planning. Most cruise vessels are equipped with either basic infirmary (a small clinic) or larger hospital where sick or injured passengers are treated and cared for by contractor physicians and nurses on 24-hour duty.

Shipboard hospitals as facilities and equipment vary by cruise line and vessel. Clinic's size usually depends on the ship's capacity (passengers plus crew). Generally, bigger and newer ships offer larger and better-equipped medical facilities and are served by bigger infirmary staff.

The ship's medical personnel are independent contractors. This is for limiting the cruise company's liability. There are no internationally specified regulations governing ship infirmaries and medical staffing. Each company has its own standards provided for its passengers' healthcare.

For finding the Infirmary you can use the ship deck plans . On most vessels, the medical facilities are located midship on a lower deck (for easier access and better stability) and usually among other crew facilities. Every passenger stateroom has the Infirmary's number - posted or by the cabin's phone.

Basic medical care on cruise ships

A cruise ship's medical facility can treat only passengers experiencing minor health issues - seasickness, scrapes, sunburns, etc. More severe medical emergencies can't be handled on the ship and usually require medevacs. Coast guard helicopter teams fly to the ship, hoist the passenger (accompanied by a spouse/relative and a crew nurse) and fly them to the nearest land hospital.

Infirmary's equipment and med supplies provide only emergency response and basic treatments in order to stabilize the passenger until transferred ashore.

In cases of severe emergencies, passengers with life-threatening illnesses or injuries are evacuated off the ship - either by boat (if in or near seaport) or by rescue helicopter dispatched from nearest coast guard or other station. In some cases, nearby ships with better medical facilities may assist.

Both emergency and basic care are available on the ship 24 hours a day. All treatments are paid. Outside regular opening hours fees are higher.

Like inland hospitals, medical treatments at sea are pricey. However, unlike on land, most basic travel insurance policies don't cover medical treatments on cruise ships as they are not from the patient's primary caregiver. Purchasing cruise travel insurance with health coverage (medical clauses) is highly recommended.

Shipboard medical service fees vary and are usually set by medical practitioners. General consultations incur costs similar to home visits. Prescription medications or other treatments cost extra. In most cruise ship hospitals, some supplies and medications are provided to passengers and crew for free - like aspirin, seasickness pills, small bandages.

Mercy Ships

"Mercy Ships" is a charity accredited by Better Business Bureau. It operates hospital ships since 1978 and also has currently the world's largest hospital ship (excluding navy vessels) - MV Africa Mercy.

The organization provides free humanitarian aid worldwide, including health care, community development, and health education projects, mental health, agriculture, and water development programs in mainly developing countries in Africa, Caribbean, South America, Oceania.

The organization's headquarters are in Garden Valley (Texas USA), with another 16 offices worldwide - in UK, Spain, Canada, Germany, France, Denmark, Switzerland, Belgium, Holland, Sweden, Norway, South Africa, Australia, New Zealand, South Korea.

Financial support and supplies are mainly through donations from medical companies (medications, supplies, equipment), corporations (fuel, food, building supplies), governments (port fees, drydock costs), general public and also by the crew (all volunteers on a rotational basis). The crew serves with short-term (2 weeks to 2 years) and long-term (min 2 years) contracts. Volunteer crew members occupy both medical (surgeons, dentists, nurses) and general jobs (deckhands, seamen, engineers, machinists, electricians, teachers, cooks, welders, plumbers, agriculturalists.

The crew on Mercy Ships pay all costs associated with their service - fees, travel expenses, passports, insurance, personal expenses.

As 95 of the world's top 100 largest megapolises are port cities, "hospital ships" could provide healthcare very quickly and more efficiently to large numbers of people.

MV Africa Mercy

MV Africa Mercy is a converted former rail ferry (1980-built as "Dronning Ingrid") drydock-refitted in 2007 at Cammell Laird shipyard (Hebburn, England).

The ship project started in March 1999 with the vessel's acquisition through a donation from Balcraig Foundation (UK), which purchased the boat for US$6,5 million.

Ferry's train deck was reconstructed and converted into a hospital. Project's total cost was over USD 62 million.

Africa Mercy ship (hospital ship)

Vessel details include:

  • Volume/GT tonnage 16572 tons
  • LOA length 152 m (499 ft )
  • Width 23,7 m (78 ft)
  • Draft 6 m (20 ft)
  • Powerplant 4x BW main engines plus diesel generators
  • Propulsion two shafts with controllable pitch propellers
  • Speed 19 Kn/35 kph/22 mph
  • Passenger capacity 484
  • Crew capacity 450
  • Fleet of 28 vehicles (used in land-based operations)
  • Annual drydock maintenance and refurbishment are done in Durban (South Africa).

As for facilities and amenities, the hospital ship has 5 operating rooms, Intensive Care Unit, an ophthalmic unit, CT scanner, X-Ray, labs, recovery ward (82 beds), a daycare center, a school (for all ages), library, launderette, convenience store, restaurant, gymnasium, shops, Starbucks Cafe (donated), satellite communications.

Africa Mercy has a total of 126 staterooms for the staff/crew. They are located on upper decks and include cabins for families, couples and single cabins.

Land-based operations ("Field Service") include mobile clinics providing screening for potential surgery patients, healthcare, dental care, also mental health programs, infrastructure projects.

clock This article was published more than  1 year ago

300 passengers and crew fall ill on Ruby Princess cruise from Texas

Princess cruises said the cause is probably norovirus.

norovirus on princess cruise ships 2023

More than 300 passengers and crew on the Ruby Princess contracted a gastrointestinal illness causing vomiting and diarrhea, the Centers for Disease Control and Prevention said this week.

The Princess Cruises voyage carrying about 4,000 people ran from Feb. 26 to Sunday in the western Caribbean and docked in Galveston, Tex.

Although the CDC has not listed a specific virus, Princess Cruises said in a statement that the cause was probably norovirus.

About 10 percent of the passengers and 3 percent of the crew onboard were sick, according to the CDC.

“At the first sign of an increase in the numbers of passengers reporting to the medical center with gastrointestinal illness, we immediately initiated additional enhanced sanitization procedures to interrupt the person-to-person spread of this virus,” Princess Cruises said in a statement.

The company said the ship underwent an additional disinfection ahead of its next voyage.

The Ruby Princess incident is one of six outbreaks of a gastrointestinal illness on a cruise this year. The first was norovirus on a months-long voyage from P&O Cruises (owned by Carnival) that is sailing until April. The CDC said 86 passengers and 20 crew fell ill aboard the Arcadia . Two Royal Caribbean and Celebrity cruises also had outbreaks this year.

One side effect of cruise covid rules: Norovirus has plummeted

Outbreaks of gastrointestinal illness had been lower than in pre-pandemic years, thanks to the enhanced cleaning and safety protocols cruises were taking to prevent the spread of the coronavirus . In 2022, there were four reported outbreaks. There was one in 2021, although cruises did not begin a full return to sailing until June.

Passengers traveling in close quarters on cruises are vulnerable to the spread of viruses. Several ships were hit by coronavirus outbreaks that marked the early days of the pandemic and led to an industry-wide pause. In 2020, a Ruby Princess voyage from Sydney had the deadliest known coronavirus outbreak on any cruise ship, with 28 deaths and about 700 infections, according to the Australian Broadcasting Corp.

‘People just didn’t care’: How the Ruby Princess cruise ship became a deathtrap

In 2019, the last full year of cruising before the pandemic, the CDC reported 10 cases of gastro illnesses; eight were norovirus, and two were unknown. Cruise lines reported a total of 32 outbreaks between 2017 and 2019, though cases dropped overall since 2006.

“Norovirus can be especially challenging to control on cruise ships because of the close living quarters, shared dining areas, and rapid turnover of passengers,” the CDC says on its website . “When the ship docks, norovirus can be brought on board in contaminated food or water or by passengers who were infected while ashore.”

The CDC’s Vessel Sanitation Program has worked with the industry to monitor gastrointestinal illness since 1975, after “an excessive number” of outbreaks.

Hannah Sampson contributed to this report.

More cruise news

Living at sea: Travelers on a 9-month world cruise are going viral on social media. For some travelers, not even nine months was enough time on a ship; they sold cars, moved out of their homes and prepared to set sail for three years . That plan fell apart, but a 3.5-year version is waiting in the wings.

Passengers beware: It’s not all buffets and dance contests. Crime data reported by cruise lines show that the number of sex crimes has increased compared to previous years. And though man-overboard cases are rare, they are usually deadly .

The more you know: If you’re cruise-curious, here are six tips from a newcomer. Remember that in most cases, extra fees and add-ons will increase the seemingly cheap price of a sailing. And if you happen to get sick , know what to expect on board.

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Cdc investigating outbreak on galveston-based cruise ship after 300-plus become ill.

Nearly 10 percent of the passengers aboard Princess Cruises’ Ruby Princess between Feb. 26 and March 5 reported symptoms including vomiting and diarrhea. Princess Cruises said the “likely” cause of the gastrointestinal illnesses was norovirus.

Ruby Princess Cruise Ship

More than 300 people reported becoming ill on a Galveston-based cruise ship last week, prompting an ongoing investigation into the outbreak by the Centers for Disease Control and Prevention (CDC).

Vomiting and diarrhea were the most prominent symptoms among those who fell ill while on board Princess Cruises' Ruby Princess, which left Galveston on Feb. 26 and returned Sunday, March 5, according to the CDC. As of Wednesday, the illness had not been identified by the CDC, which said 284 of the ship's 2,881 passengers and 34 of its 1,159 crew members reported being ill during the voyage.

Briana Latter, a spokesperson for Princess Cruises, wrote in an emailed statement that there were cases of "mild gastrointestinal illness" among those on board the ship. She did not answer a question seeking to determine whether any passengers or crew members were hospitalized after disembarking – a detail that also was not addressed in an online report released by the CDC .

"The cause likely is the common but contagious virus called norovirus," Latter added.

According to the CDC website, norovirus causes vomiting, diarrhea, nausea and stomach pain and can be spread quickly and easily through person-to-person contact, consuming contaminated food or water and by touching contaminated surfaces and then putting unwashed hands in your mouth. Norovirus outbreaks occur most often between November and April, according to the CDC, which recommends that infected people stay home while they are sick and for two days after their symptoms resolve.

The Ruby Princess was disinfected before another set of passengers and crew members embarked on another cruise shortly after the infected group arrived in Galveston, with the current seven-day trip to the western Caribbean and back set to conclude this Sunday, according to Latter.

The CDC noted that the number of gastrointestinal illnesses reported on the Feb. 26-March 5 cruise reflect the total for the entire trip and did not represent the number of active, symptomatic cases when the ship returned to Galveston. Epidemiologists and environmental health officers from the CDC's Vessel Sanitation Program, which tracks viral outbreaks on cruise ships, conducted a field response in Galveston upon the ship's return.

While the Ruby Princess remained at sea, the CDC said Princess Cruises increased cleaning and disinfection procedures, notified all guests about the outbreak and collected stool samples from those who were infected so the samples could be sent to a CDC lab for testing.

Latter said Princess Cruises' sanitization program, developed in coordination with the CDC, includes disinfecting high-touch surfaces like railings, door handles and elevator buttons; encouraging passengers to use their in-cabin restrooms along with washing their hands and using hand sanitizer; and isolating ill passengers in their cabins until they no longer are contagious.

"At the first sign of an increase in the numbers of passengers reporting to the medical center with gastrointestinal illness, we immediately initiated additional enhanced sanitization procedures to interrupt the person-to-person spread of this virus," Latter said.

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From COVID to gastro, why are cruise ships such hotbeds of infection?

by Thea van de Mortel, The Conversation

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Dual outbreaks of gastro and COVID on the Grand Princess cruise ship that docked in Adelaide on Monday have now been declared over by the doctor on board .

A spokesperson for Princess Cruises, which operates the ship, said a number of passengers had presented with symptoms on a previous voyage . But the ship has since been disinfected and the number of people who were ill when the ship arrived into Adelaide was said to be in single digits.

While this is positive news, reports of infectious outbreaks on cruise ships evoke a sense of deja vu. We probably all remember the high-profile COVID outbreaks that occurred on cruise ships in 2020.

So what is it about cruise ships that can make them such hotspots for infection?

First, what causes these outbreaks?

Respiratory infectious outbreaks on cruise ships may be caused by a range of pathogens including SARS-CoV-2 (the virus that causes COVID) and influenza viruses . These can be spread by respiratory droplets and aerosols released when people breathe, talk, laugh, cough and sneeze.

Historically, troop transport ships also helped to spread the lethal 1918 flu virus between continents.

Gastro outbreaks on cruise ships are similarly well documented. More than 90% of cruise ship gastro outbreaks are caused by norovirus , which is spread from person to person, and through contaminated objects or contaminated food or water.

Gastro can also be caused by other pathogens such as bacteria in contaminated food or water .

What is the risk?

In 2020, around 19% of Diamond Princess passengers and crew docked in Japan tested positive to COVID. Ultimately, nearly one in four Ruby Princess passengers and crew docked in Sydney tested positive.

However, COVID generally presents a lesser risk nowadays, with most people having some level of immunity from vaccination or previous infection. The outbreak on the Grand Princess appears to have been much smaller in scale.

A three-year study before COVID of influenza-like illness (which includes fever), acute respiratory illness (which doesn't require fever to be present) and gastro on cruise ships found these were diagnosed in 32.7%, 15.9% and 17% of ill passengers, and 10.9%, 80% and 0.2% of ill crew, respectively.

An analysis of data from 252 cruise ships entering American ports showed the overall incidence of acute gastro halved between 2006 and 2019. Passenger cases decreased from 32.5 per 100,000 travel days to 16.9, and crew cases from 13.5 per 100,000 travel days to 5.2. This decline may be due to a combination of improved hygiene and sanitation standards.

The risk of getting sick with gastro was significantly higher on bigger ships and longer voyages . This is because the longer you are in close contact with others, the greater the chance of exposure to an infectious dose of viruses or bacteria.

Why are cruise ships infection hotspots?

On cruise ships, people tend to crowd together in confined spaces for extended periods. These include dining halls, and during social activities in casinos, bars and theaters.

The risk goes up when the environment is noisy, as more droplets and aerosols are shed when people are laughing, shouting or talking loudly .

Passengers may come from multiple countries , potentially bringing variants from different parts of the world. Influenza, which is usually seasonal (late autumn to early spring ) onshore, can occur at any time on a cruise ship if it has international passengers or is calling at international ports.

Human behavior also contributes to the risk. Some passengers surveyed following cruise ship gastro outbreaks indicated they were ill when they boarded the ship, or they became ill but didn't disclose this because they didn't want to pay for a doctor or be made to isolate, or they thought it wasn't serious.

Those who became ill were more likely than those who did not to think that hand hygiene and isolation were not effective in preventing infection transmission, and were less likely to wash their hands after using the toilet. Given fecal contamination is a major source of norovirus transmission, this is concerning.

While there are usually a la carte dining options on board, many people will choose a buffet option. From personal experience , food tongs are handled by multiple people, some of whom may not have cleaned their hands.

What can help?

The Department of Health and Aged Care recommends cruise companies encourage crew and passengers to be up-to-date with flu and COVID vaccinations, and encourage anyone who becomes ill to stay in their cabin, or at least avoid crowded spaces and wear a mask in public.

They also recommend cruise ships have a plan to identify and contain any outbreaks, including testing and treatment capacity, and communicate to passengers and crew how they can reduce their transmission risk.

All passengers and crew should report any signs of infectious illness, and practice good hand hygiene and respiratory etiquette , such as covering their mouth if coughing or sneezing, disposing of used tissues, and washing or sanitizing hands after touching their mouth or nose.

South Australia's chief health officer has commended the Grand Princess crew for their infection protection and control practices, and for getting the outbreak under control.

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These Cruise Ships Have the Highest and Lowest Sanitation Scores in 2023

The CDC inspects ships twice a year to see how well they're maintaining standards

Which cruise ship is the cleanest? And which is more likely to leave you with gastrointestinal distress on your vacation itinerary?

The Centers for Disease Control (CDC) has released the results of its Vessel Sanitation Program inspections, showing which ships are the most sanitary, and which have room for improvement.

With a record high of 13 norovirus outbreaks on cruise ships this year (the highest number since 2012), prospective cruisers may want to take a look at the results before booking.

The CDC's inspections cover eight areas on the ship, including medical facilities, dining rooms, pools and spas, and child activity centers. The twice-a-year inspections result in a score out of 100; 85 or below is considered failing.

 Celebrity Cruises

According to the CDC’s website, the following ships were all given a score of 100 in 2023.

Allure of the Seas, Royal Caribbean International

Carnival Celebration, Carnival Cruise Lines, Inc.

Carnival Panorama, Carnival Cruise Lines, Inc.

Carnival Sunshine, Carnival Cruise Lines, Inc.

Celebrity Edge, Celebrity Cruises

Celebrity Millennium, Celebrity Cruises

Celebrity Summit, Celebrity Cruises

Disney Fantasy, Disney Cruise Lines

Disney Wonder, Disney Cruise Lines

MSC Seascape, MSC Cruise Management (UK) Ltd

Norwegian Joy, Norwegian Cruise Lines

Norwegian Pearl, Norwegian Cruise Lines

Oceania Riviera, Oceania Cruises

Rotterdam, Holland America Line

Silver Moon, Silversea Cruises Ltd

While only one ship had a failing score, the MSC Seaside with a shocking 67 rating, the following ships were all given a score of 90 or below this year.

Noordam, Holland America Line: 90

Star Pride, Wind Star Cruises: 90

Le Boreal, Compagnie Du Ponant SA: 90

Norwegian Epic, Norwegian Cruise Lines: 89

Margaritaville at Sea Paradise, Margaritaville at Sea: 87

Carnival Liberty, Carnival Cruise Lines, Inc.: 86

Carnival Pride, Carnival Cruise Lines, Inc.: 86

MSC Seaside, MSC Cruise Management (UK): 67

Even a sanitation score of 100 doesn’t mean ships are immune to illnesses. A recent norovirus outbreak occurred in May on Celebrity Cruises’ Celebrity Summit, which earned a perfect score.

And even sanitation on board isn't a guarantee of an illness-free voyage. The most recent outbreak occurred in June on the Viking Neptune , during which 13% of the 838 passengers fell ill. However a Viking representative told CNN the passengers are not believed to have contracted the virus aboard the ship, but rather at “a shoreside restaurant in Iceland where a group of guests dined during their free time.”

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CDC Reports 14th Cruise Ship Norovirus Outbreak of 2023

Andrea Santillan

Andrea Santillan

  • October 16, 2023

A cruise ship norovirus outbreak was reported on Virgin Voyages’ Scarlet Lady during its October 8 sailing, according to the Centers for Disease Control and Prevention (CDC).

The cruise ship reported over 70 cases of norovirus during an October 8 to 13 sailing. The ship’s next batch of passengers were alerted while sanitary measures have been adopted to prevent another outbreak.

virgin voyages terminal v portmiami

While sailing on a Riviera Maya cruise that included stops at Cozumel, Mexico, and Bimini, the Bahamas, 66 out of 2,198 passengers and seven crew members onboard the Scarlet Lady reported symptoms of the norovirus. These included vomiting, diarrhea, and stomach cramps. 

Though the virus’s origin remains unknown, news of the outbreak has been shared with the Centers for Disease Control and Prevention (CDC).

This move complied with established CDC health protocols to report gastrointestinal outbreaks affecting at least 2% of a cruise ship’s passengers and crew members of 3% of the passengers.

RELATED: Truth and Lies About Norovirus

COO for Virgin Voyages , Michelle Bentubo, assured the public of the company’s timely response, saying, “Our medical team isolated these travelers, and we immediately enacted enhanced sanitization procedures, including additional cleaning of cabins and high-contact areas around the ship. We are working closely with the CDC and their medical professionals.”

According to the cruise line , its next sailing to Grand Turk and Bimini on October 13 proceeded as scheduled. The Vessel Sanitation Program under the CDC will continue monitoring the situation, including the ship’s response to the outbreak and sanitation measures.

Ships make up a “tiny minority” of norovirus cases

cruise ship norovirus outbreak

Scarlet Lady’s October 8 voyage was the 14th sailing in 2023 to experience an outbreak of norovirus. While that may seem like a lot, an epidemiology professor told USA Today that cruise ships are only accountable for a “tiny minority of norovirus outbreaks.”

To reduce your risk of catching it, the CDC recommends washing your hands often, getting plenty of rest, drinking sufficient water, and leaving areas where people are showing symptoms. In case you get sick, report your illness to the crew. 

Over the summer, a Viking cruise ship had a noro incident with 119 guests and crew, bringing the total to over 13%.

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Norovirus outbreaks on cruise ships surge to decade-high levels: How to avoid the stomach bug

In 2023, a decade-high number of cruise ships have reported an unwelcome passenger on board: norovirus.

Outbreaks of the stomach bug have surged on cruise ships this year, reaching the highest levels seen in 10 years. Since January 2023, there have been 13 confirmed norovirus outbreaks on cruise ships under U.S. jurisdiction — that's more outbreaks in six months than there have been during any full year since 2012, according to data from the U.S. Centers for Disease Control and Prevention .

After a lull during the COVID-19 pandemic, cases of the highly contagious virus that causes diarrhea and vomiting, aka stomach flu, spiked this winter and spring on land. As post-pandemic travel surges and millions of Americans return to cruise ships, an increasing number of cruise lines are reporting outbreaks at sea.

Norovirus outbreaks on cruise ships

Most recently, a norovirus outbreak in June on the Viking Neptune sickened 110 passengers (over 13% of the ship's guests) and nine crew members with vomiting, diarrhea and abdominal cramps, according to the CDC . The CDC has tracked outbreaks of gastrointestinal illness on cruise ships through its Vessel Sanitation Program (VSP) since 1994.

Several weeks prior, a Celebrity Summit cruise ship reported an outbreak of norovirus that sickened more than 150 passengers and 25 crew members, per the CDC . It was the third norovirus outbreak on a Celebrity Cruises vessel this year. Another popular cruise line, Royal Caribbean International, has reported four outbreaks since January.

Cruise ships are required to report cases of gastrointestinal illness to the CDC before arriving at any U.S. port, and the CDC will notify the public about outbreaks if they meet certain criteria, including: the ship is carrying 100 or more passengers, the voyage is three to 21 days long, and 3% or more of passengers or crew report symptoms, per the CDC .

The number of outbreaks in the first six months of 2023 is higher than the yearly total during every year since 2012, when there were 16 outbreaks on cruise ships reported to the CDC.

Norovirus can spread year-round, but it tends to have a wintertime seasonality and peak during the colder months. Outbreaks are most common between November and April, previously reported.

"It's a virus we typically see all throughout spring, so it’s not unusual to be see cases in April and May, (and) we are continuing to see many cases now," Dr. Luis Ostrosky, an infectious disease specialist at UTHealth Houston and Memorial Hermann in Houston, tells

However, as travel surges this summer, travel-related illnesses are expected to surge, as well. “I think our travel frenzy after COVID is partially fueling this continued spread (of norovirus),” says Ostrosky.

What should people know about norovirus and how to avoid getting sick on cruise ships this summer?

Norovirus symptoms and treatment

The most common symptoms of norovirus are vomiting, nausea, diarrhea and abdominal pain, Dr. Albert Ko, infectious disease physician and professor of public health, epidemiology and medicine at Yale School of Public Health, tells

Less commonly, norovirus may cause a headache, muscle aches, or a low-grade fever — symptoms usually develop within one to two days after exposure to the virus,  per the CDC .

In the vast majority of people, norovirus symptoms will last several days and resolve on their own.

There’s no specific treatment or antiviral for norovirus, according to Ostrosky, but most cases can be managed at home with supportive care like hydration and rest. Sick people should also isolate until their symptoms resolve, the experts emphasize.

Some people are at higher risk of developing severe norovirus symptoms — these include infants, the elderly, and people with compromised immune systems, Ostrosky noted.

How does norovirus spread?

Norovirus is highly contagious and can spread directly through sick people and contaminated surfaces, food, or drinks.

Transmission often occurs when tiny virus particles in feces or vomit from an infected person end up in another person's mouth through direct contact or by touching contaminated surfaces and putting unwashed hands in the mouth or nose, TODAY .com previously reported .

Norovirus can also get into food before, during or after preparation, and it's the top germ causing foodborne illness in the U.S., per the CDC . Virus particles can contaminate drinking water that isn't treated properly or pools when people poop in the water.

It only takes a small number of virus particles for norovirus to spread, which is why norovirus causes so many explosive outbreaks, Ko previously told

Exposure to less than 100 norovirus particles can make someone sick, and infected people typically shed billions of particles, according to the CDC.

Most people are infectious from symptom onset until about two or three days after recovering, but some people can remain contagious for weeks, Ko notes. People can get infected with norovirus multiple times in their lifetime.

Is norovirus common on cruise ships?

Certain environments are more conducive to the virus spreading. According to the CDC , the most common settings for norovirus outbreaks are health care facilities, restaurants or catered events, schools, day cares and, of course, cruise ships.

Cruise ships are often associated with norovirus because of the enclosed spaces, close living quarters, communal dining and high turnover of passengers, experts note. That said, outbreaks of acute gastrointestinal illnesses are relatively infrequent on cruise ships compared to settings on land, the CDC notes .

How to avoid norovirus on a cruise

Hand hygiene is key to prevent the spread of the highly contagious virus — but the way you clean your hands matters, experts note. It has to be with soap and water, because alcohol-based hand sanitizers are not effective against norovirus.

“Norovirus is one of the few viruses that doesn’t get deactivated by alcohol. You actually need to use soap and water to physically destroy it and remove it from your hands,” Ostrosky previously told

It's important to wash your hands with soap and clean water frequently, but especially after using the bathroom or changing diapers, before eating and before touching your face.

Surfaces or objects that are contaminated with norovirus can be cleaned with a high-level disinfectant like bleach, per Ostrosky.

On cruise ships, avoid sick people if you can. Passengers who experience norovirus symptoms like vomiting and diarrhea should notify staff and follow recommended precautions, per the CDC .

Caroline Kee is a health reporter at TODAY based in New York City.

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2023 is the year of getting sick on a cruise

The reported occurrence of gastrointestinal diseases on cruises is worse than pre-covid.

A cruise ship seen from above

Holland America’s Nieuw Amsterdam, a cruise ship that, according to the company’s site , “celebrates historic New York City with an inspired design and art collection,” is currently traveling along the western coast of Canada for a 14-day tour to Alaska and back.

For tickets starting at $2,699 per-person , double occupancy rate, 1,970 passengers get to enjoy a spa treatments, fine meals, and pickleball at sea. For 160 of them, and 26 members of its 813-person staff, the journey also featured a gastrointestinal illness.

They aren’t alone. The Nieuw Amsterdam outbreak is the 11th to occur this year. It’s a sign—if not the most desirable one—that things are back to pre-covid levels: This is the highest number of outbreaks recorded on ships since 2018, and even then it took the whole year to get to 11.

Norovirus and more

As part of its Vessel Sanitation Program (VSP), the Centers for Disease Control and Prevention (CDC) tracks occurrences of gastrointestinal disease on board, which cruises are required to report. The cases are reported before arriving to the US from a foreign port, or whenever 3% or more of cruise passengers or crew are ill.

So far this year, 1,503 people—1,321 passengers, and 182 crew members—have come down with gastrointestinal illnesses on cruises that had the US as part of their itinerary. Most of the infections are still of unknown origin, while in three cases the outbreaks were identified as norovirus, which is a relatively common cause of gastrointestinal disease on cruises. Norovirus survives on surfaces, and it can spread easily on ships where rooms are close, buffets proliferate, and people share confined spaces.

Though it was one of the largest of the year, the outbreak on the Nieuw Amsterdam was mild, and all sick individuals were quarantined. Only on the Princess Cruises’s Ruby Princess , which had a norovirus outbreak during its mid-February trip, were there were more cases, with 234 passengers and 34 members of the crew becoming ill. Data on outbreaks on cruises is available starting from 1994, and the rate of incidence has diminished significantly since it reached a peak in the early 2000s, when outbreaks regularly surpassed 20 per year.

The number of outbreaks might also be a sign that ridership on cruise ships is returning to pre-pandemic levels. In 2019, nearly 15 million people took cruises in the US , while that number was down to only 2 million in 2021, and about 5 million in 2022.

Illness on cruises isn’t as common as it is on land

Gastrointestinal disease of this type isn’t usually serious serious—though it’s hardly fun, especially at sea. But it’s hardly exclusive to cruises: The vast majority of outbreaks happen on land, and every year there are around 2,500 outbreaks of norovirus recorded in the US, causing up to 21 million cases .

As the CDC notes , millions of people travel on cruises every year, making less than a dozen outbreaks a relatively minor concern. “Health officials track illness on cruise ships. So outbreaks are found and reported more quickly on a cruise ship than on land,” says the CDC.

Still, it’s helpful to follow basic health precautions to limit the chance of getting sick, including reporting any illness that occurs prior to joining a voyage, or while on board, frequent and washing hands , and leaving the area if someone is sick.

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Cruise lines battle norovirus outbreaks, affecting crews, hundreds of passengers. Here's what to know

In all, about 1,700 people reported being sick with norovirus aboard a cruise ship between January and June of this year. 

By Monica Galarza and Marissa Bagg • Published July 13, 2023 • Updated on July 13, 2023 at 6:49 pm

The Centers for Disease Control and Prevention is reporting the highest number of norovirus outbreaks in over a decade and it is impacting hundreds of passengers and crew members onboard some of the most prominent cruise lines.

In the first six months ending in June, cruise lines have reported 13 separate outbreaks to the CDC. It’s the most number of reported norovirus outbreaks on cruise ships since 2012.

And this year’s outbreaks represent the highest number since cruises began sailing again in the summer of 2021 after being suspended due to COVID-19.

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One local expert says it’s in part because more people are cruising. 

“The hundreds of thousands, if not millions of people that have already gone on cruises without incident. It’s a very small number and it’s there’s nothing to be concerned about,” said Steward Chiron, a cruise expert. “I would not think twice about going on a cruise. I would not think twice about going on a cruise or traveling anywhere.”

Celebrity, Royal Caribbean International, Holland America, Princess and P&O were among the Royal Caribbean and Carnival lines affected.

norovirus on princess cruise ships 2023

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norovirus on princess cruise ships 2023

Could there be an earthquake in Florida like the one in New York?

So if you're planning to set sail this summer, here's everything you need to know about the norovirus.

What is norovirus?

According to the CDC, norovirus is the leading cause of vomiting, diarrhea, and foodborne illness in the United States.

It's also not a one-and-done virus. You can get norovirus illness many times in your life because there are many different types of noroviruses and one type may not protect you against the others.

It is possible, however, to develop protection against specific types, but it's not known exactly how long protection lasts.

This may explain why so many people of all ages get infected during norovirus outbreaks.

According to the CDC, your likelihood of getting a norovirus infection is also determined in part by your genes.

How does norovirus spread?

Because people of all ages can get sick with norovirus, it can spread easily and quickly.

The CDC says norovirus can be spread by:

  • Having direct contact with someone with norovirus, such as by caring for them, sharing food or eating utensils with them, or eating food handled by them.
  • Eating food or drinking liquids that are contaminated with norovirus.
  • Touching surfaces or objects contaminated with norovirus and then putting your unwashed fingers in your mouth.

You are at your most contagious when you have  symptoms  of norovirus illness, especially vomiting or during the first few days after you feel better.

But studies have shown that you can still spread norovirus for two weeks or more after you feel better.

According to Mayo Clinic , norovirus most often spreads in closed and crowded environments, such as hospitals, nursing homes, child care centers, schools and cruise ships.

But it can also spread through contaminated food, water or through sick people and contaminated surfaces.

What are the symptoms of norovirus?

According to the CDC, the most common symptoms of norovirus are diarrhea, vomiting, nausea and stomach pain.

You may, however, experience fevers, headaches, and body aches.

Symptoms usually last one to three days and most people recover, according to the Mayo Clinic.

How do you treat norovirus?

There is no specific medicine to treat people with norovirus illness.

If you have norovirus illness, the CDC recommends you drink plenty of liquids to replace fluid lost from vomiting and diarrhea and help prevent dehydration.

Sports drinks and other drinks without caffeine or alcohol can help with mild dehydration, but these drinks may not replace important nutrients and minerals.

It is important to note that antibiotic drugs will not help treat norovirus infections because they fight bacteria, not viruses.

When was the most recent norovirus outbreak on a cruise ship?

The CDC's latest report of a norovirus outbreak happened on Viking Neptune, a cruise ship owned by Switzerland-based Viking Cruises, during a voyage from June 6 to June 20.

According to the CDC, 110 of 838 passengers and nine of the 455 crew members reported feeling ill during the trip.

The following ships saw outbreaks so far in 2023: Celebrity Summit, Nieuw Amsterdam, Grand Princess, Emerald Princess, Enchantment of the Seas, Celebrity Equinox, Celebrity Constellation, Ruby Princess, Viking Neptune, Jewel of the Seas, Brilliance of the Seas, Arcadia.

What can I do to prevent contracting norovirus?

The key to preventing norovirus , and most other illnesses is simply washing your hands well.

Norovirus is very contagious, but you can take steps to stop it from spreading.

Wash your hands often with soap and water for at least 20 seconds, especially:

  • After using the toilet or changing diapers.
  • Before eating, preparing, or handling food.
  • Before giving yourself or someone else medicine.

It is important to continue washing your hands often even after you feel better.

Chiron says cruise lines try to keep ships clean and limit some interactions. 

“What they do is they reduce the person-to-person interactions. So when you go to the buffet for example for breakfast or lunch. Instead of serving yourself a gloved crew member will do it for you,” said Chiron.

When on board, if you see someone with norovirus symptoms, you’re urged to leave the area and alert a crew member. 

Norovirus can be found in your vomit or feces (poop) even before you start feeling sick. The virus can also stay in your poop for two weeks or more after you feel better and you can still spread norovirus during that time.

Hand sanitizer does not work well against norovirus. You can use hand sanitizers in addition to hand washing, but hand sanitizer is not a substitute for handwashing.

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Norovirus Outbreaks on Cruise Ships: How to Avoid Getting Sick on Vacation

norovirus on princess cruise ships 2023

  • There have been 13 norovirus outbreaks on cruise ships in 2023.
  • Experts note that the highly congested environment, as well as the fact that people have not been exposed to as many illnesses due to the COVID-19 pandemic, are likely the reason for the increased norovirus numbers.
  • Experts recommend maintaining proper hygiene habits and contacting the ship’s medical facility as soon as you don’t feel well in order to avoid spreading illnesses while at sea.

Multiple cruise lines are experiencing norovirus outbreaks.

There have currently been 13 norovirus outbreaks on cruise ships in 2023. The most recent outbreak occurred on a Viking Cruises ship, which traveled from Iceland and docked in New York City. About 13% of its passengers and several crew members became ill with the virus while on board.

With more than 31 million passengers worldwide expected to set sail this year, experts told Health that these highly-congested environments—along with the fact that people have not been exposed to a normal amount of illnesses due to the pandemic—could be the reasons for the increased numbers.

“Loosening of restrictions after the COVID-19 pandemic makes us more susceptible to picking up viruses after several years in seclusion,” Sanjiv Shah, MD, MPH , an infectious disease specialist and chief medical officer for MetroPlusHealth, New York City’s public health insurance program, told Health.

“Children who have been able to avoid the virus during the pandemic are now being exposed to viruses that tend to peak during the school year,” he said. “While norovirus is higher this year, the numbers are not a big outlier compared to pre-pandemic levels.”

Getty Images / Michael Dunning

What Is Norovirus?

Norovirus is the most common cause of gastroenteritis and foodborne illness . Though people often call it the “ stomach flu ,” it has nothing to do with flu, Brian Labus, PhD, MPH, REHS , an expert in infectious diseases, told Health .

“You have to swallow the virus to get sick,” Labus, an assistant professor in the Department of Epidemiology and Biostatistics at the UNLV School of Public Health, said. “That can be through consuming contaminated food or touching a contaminated surface and then touching your mouth or not washing your hands before you eat.”

Norovirus, which causes inflammation of the stomach or intestines, typically causes diarrhea , vomiting, nausea, and stomach pain Bernadette Boden-Albala, DrPH, MPH , director and founding dean of the Program in Public Health at the University of California Irvine told Health . Other symptoms can include fever, headache, and body aches.

Typically, norovirus lasts for one to three days, though you can spread the illness for a few days after.

“Infected people spread the virus widely and make it difficult for public health officials to contain the virus,” Boden-Albala said.

Why the Number of Norovirus Outbreaks Increased

The exact cause for the increase in the number of norovirus cases is not clear, but the increasing demand for cruises could be one explanation for the rise in reported cases, said Labus.

During COVID, the options for cruises were limited, but now that restrictions have been lifted , more people are deciding to take that cruise they had been putting off.

People also are more likely to get sick now since pandemic restrictions have been lifted. For the past few years, people have not been exposed to as many common viruses and illnesses and now that exposure is rising, illnesses are bound to rise as well.

It also is possible the numbers for norovirus on cruise ships appear more alarming than they truly are.

On cruise ships, health officials are legally required to track any illnesses that occur, while this same reporting is not required on land. For this reason, the Centers for Disease Control and Prevention note that outbreaks are reported more frequently on sea than on land.

“The risk of getting norovirus each year is about 1 in 15 [but] a cruise passenger has about a 1 in 5,500 risk of getting norovirus,” Sally Andrews, vice president of strategic communications and public affairs for the Cruise Lines International Association told Health .

Environments Where Norovirus Spreads Quickly

According to Shah, norovirus spreads rapidly anywhere there are large groups of people, like school classrooms, family gatherings, and weddings.

Cruise ships in particular have many of the conditions that make people susceptible to norovirus—close quarters, enclosed spaces, communal dining, and high turnover of passengers.

“The virus is often associated with cruise travel simply because health officials are required to track illnesses on ships,” Shah said. “The CDC estimates only about 1% of annual U.S. norovirus cases happen on cruise ships. Rates are much higher in schools, nursing homes, hospitals, and restaurants, which collectively account for about 91% of cases.”

Minji Kang, MD, an assistant professor and infectious disease specialist in the Department of Internal Medicine at UT Southwestern Medical Center added that norovirus can also be brought onboard by contaminated food or water, or passengers who were infected while ashore.

Yes, Cruise Ships Have Strategies to Prevent Outbreaks

Because norovirus outbreaks can flare up in the close quarters of a ship, the cruise industry has had norovirus prevention programs in place for nearly 20 years, Labus said. “They have the right chemicals needed to control it and the plans and training for how to use them appropriately.”

Cruise ships also have plans for how to deal with ill guests to ensure that they are not infecting other passengers, he said. “It’s important to let the ship’s medical staff know if you are sick so that they can protect the rest of the passengers.”

According to the American College of Emergency Physicians (ACEP), every cruise ship must have a place to isolate any passengers who have a contagious disease. This step helps them minimize the risk of spreading the disease to others.

What’s more, the CDC has established a rigorous Vessel Sanitation Program (VSP) to help prevent the overall spread of illnesses on cruise ships. Not only do they inspect a cruise ship’s medical center, but they also monitor their portable water systems, dining rooms, housekeeping procedures, heating, ventilation, air conditioning (HVAC) systems, and more.

If a cruise ship does not do well on its inspection—or gets an 85% or lower—it cannot set sail until it corrects the issues.

Staying Healthy While on a Cruise

While there have been 13 outbreaks of norovirus on cruise ships this year, Labus explained that not every cruise passenger is going to be exposed to the virus. Still, taking certain steps to prevent the likelihood of getting sick is never a bad idea.

“The most important measure to prevent the spread of norovirus is to wash your hands with soap and water for at least 20 seconds,” said Kang. “This should be done before eating and drinking, brushing one’s teeth, and after going to the bathroom, touching high-hand contact surfaces, and taking care of a sick person.”

She noted that hand sanitizers do not work well against norovirus and that they are not a substitute for handwashing.

For extra peace of mind, you can also research your cruise line prior to booking.

To see how your specific cruise line performed on its VSP inspections, you can visit the CDC website and search their portal. This site also lists any corrective actions taken to remedy any issues. You can even look for cruise lines that have scored a perfect 100.

If you do happen to get sick while on a cruise, Boden-Albala recommends that you follow CDC guidelines and report your illness to the ship’s medical facility as soon as possible. “[You also should] rest and drink plenty of water to rebuild your immunity system and prevent dehydration.”

Even though you may be tempted to conceal your illness, you would be doing a great disservice to the other passengers and the crew on the cruise by keeping it a secret.

“While staying in your cabin [for a day or two] may not make for the best vacation,” Shah said, “it’s important to take precautions to avoid infecting others.”

Centers for Disease Control and Prevention. Outbreak updates for international cruise ships .

Cruise Lines International Association. State of the cruise industry 2023 .

Centers for Disease Control and Prevention. Symptoms of norovirus .

Centers for Disease Control and Prevention. Facts about noroviruses on cruise ships .

Cruise Lines International Association. Norovirus on cruise ships .

American College of Emergency Physicians. Healthcare guidelines for cruise ship medical facilities .

Centers for Disease Control and Prevention. Vessel sanitation program: inspection infographic .

Centers for Disease Control and Prevention. Advanced cruise ship inspection search .

Centers for Disease Control and Prevention. Cruise ship inspection scored 100 .

Related Articles

Investigation Update on the Emerald Princess

Cruise Line : Princess Cruises

Cruise Ship : Emerald Princess

Voyage Dates : March 17–April 1, 2023

Voyage Number : EP307

Number of passengers who reported being ill during the voyage out of total number of passengers onboard : 99 of 2,123 (4.66%)

Number of crew who reported being ill during the voyage out of total number of crew onboard : 21 of 1,192 (1.76%)

Predominant symptoms : vomiting and diarrhea

Causative agents : norovirus

Actions : In response to the outbreak, Princess Cruises and the crew aboard the ship reported the following actions:

  • Increased cleaning and disinfection procedures according to the ship’s outbreak prevention and response plan.
  • Collecting stool specimens from gastrointestinal illness cases to send to the CDC lab for pathogenic identification.

VSP is monitoring the situation and the ship’s outbreak response and sanitation procedures.

Note : The gastrointestinal illness cases reported are totals for the entire voyage and do not represent the number of active (symptomatic) gastrointestinal cases at any given port of call or at disembarkation.

Learn how passengers can protect themselves with these tips for healthy cruising .

  • Inspection Reports
  • About Inspections
  • Cruise Ship Outbreak Updates
  • About Noroviruses on Cruise Ships
  • VSP Operations Manual   [PDF – 5 MB]
  • VSP Construction Guidelines   [PDF – 4 MB]
  • Illness Prevention Information
  • Publications

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Princess Cruises says norovirus is 'likely' source of ship outbreak

The cruise ship is on its next voyage in the western caribbean.

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Hundreds of Ruby Princess cruise ship passengers who fell ill on a recent voyage were likely infected with norovirus, according to the cruise ship operator. 

The Centers for Disease Control and Prevention (CDC), which has been investigating the outbreak on the Ruby Princess, has not confirmed a cause. 

However, Carnival-owned Princess Cruises, which operates the ship, told FOX Business in a statement "there was a number of cases of mild gastrointestinal illness among passengers" and that "the cause likely is the common but contagious virus called norovirus."


Ruby Princess cruise ship

The Ruby Princess cruise ship begins her departure from Port Kembla April 23, 2020, in Wollongong, Australia. (James D. Morgan/Getty Images / Getty Images)

Over 280 passengers and 34 crew members fell ill on the ship. In total, there were 2,881 passengers and 1,159 crew members. 

The ship left Texas Feb. 26 for a voyage to the western Caribbean, according to the CDC. The agency also reported that vomiting and diarrhea were the predominant symptoms. 


"At the first sign of an increase in the numbers of passengers reporting to the medical center with gastrointestinal illness, we immediately initiated additional enhanced sanitization procedures to interrupt the person-to-person spread of this virus ," Princess Cruises said in a statement. 

Royal Caribbean Group Chief Financial Officer Naftali Holtz discusses the strong consumer demand for cruises and the impact the pandemic had on the industry on ‘Mornings with Maria.’

Cruises and vacation experiences continue to see ‘very strong demand’: Naftali Holtz

Royal Caribbean Group Chief Financial Officer Naftali Holtz discusses the strong consumer demand for cruises and the impact the pandemic had on the industry on ‘Mornings with Maria.’

The cruise line said its sanitation program includes measures such as thorough disinfection of high-touch surfaces, encouraging passengers to use correct hand-washing procedures and isolating ill passengers in cabins until they are non-contagious. 


When the ship returned to Texas March 5, it "underwent an additional disinfection" before its next voyage as an added precaution, the company said. 

It is on a seven-day western Caribbean cruise and is slated to return to Texas March 12.

norovirus on princess cruise ships 2023

Watch CBS News

Norovirus outbreak sickens Princess Cruises ship passengers

Updated on: November 16, 2014 / 5:57 PM EST / CBS News

LOS ANGELES - Officials investigated an outbreak of Norovirus on Sunday found in cruise ship passengers who traveled across the Pacific Ocean.

According to the Princess Cruises Media Relations Department, the 28-day cruise originated in Los Angeles, and traveled to Hawaii and Tahiti, reports CBS Los Angeles .

Officials explained about 170 people on board the Crown Princess reported having symptoms of the virus.

Over the last few days, crew members said an increased number of gastrointestinal illnesses caused by Norovirus were reported.

Princess Cruises has "enacted our stringent disinfecting protocols" developed in consultation with the CDC and will do a deep cleaning of the ship and terminal in Los Angeles before departing Sunday night for a weeklong cruise through the Mexican Riviera, said spokeswoman Susan Lomax.

In April, 129 people on the same ship contracted norovirus during a seven-day cruise off the California coast. Lomax said that the ship went through the same stringent disinfecting process after it docked.

"As it is the cold and flu season, when the stomach flu circulates on land, we encourage all of our guests to be diligent in following the widely accepted practices of frequent hand washing with soap and water and the use of hand sanitizers," Lomax said.

According to the CDC, Norovirus is very contagious and can be transmitted from an infected person, contaminated food or water, or by touching contaminated surfaces.

The virus causes the stomach to become inflamed, which leads to stomach pains, diarrhea, nausea and vomiting, officials explained.

The ship arrived at 7:00 a.m. in Los Angeles.

More from CBS News

norovirus on princess cruise ships 2023

Ready for Norovirus 2024? The stomach bug is on the rise again

N orovirus, the extremely contagious stomach bug that causes vomiting and diarrhea, is spreading and sickening millions in the United States. Cases of the nasty gastrointestinal illness, also known as the "stomach flu," continue to climb as the country enters spring.

Respiratory virus season may be coming to an end, but the 2023–2024 norovirus season is still well underway. Nationally, norovirus is circulating at the highest levels since last April, according to data from the U.S. Centers for Disease Control and Prevention .

Outbreaks are spiking in many parts of the country, including the Northeast and Midwest, and even hitting cruise ships.

Norovirus spreads easily among people in enclosed settings and tends to peak in the cooler winter months. As thousands of Americans travel this month for spring break and Easter, U.S. health officials are urging people to take steps to stop the spread.

Although norovirus is commonly called the “stomach flu,” it is not related to the flu, which is caused by influenza viruses.

Norovirus is a leading cause of acute gastroenteritis, or an inflammation of the lining of the stomach and intestines, per the CDC . This can result in intense bouts of vomiting, diarrhea, nausea and stomach cramps.

Symptoms usually begin 12 to 48 hours after exposure — these are often sudden and very unpleasant, but most people will recover on their own.

“This is the dreaded virus that leaves us in the bathroom for about a day or two, we’ve all been there,” NBC News medical contributor Dr. Tara Narula said on TODAY in a segment on Feb. 27 .

Norovirus is highly contagious, and anyone can become infected. Every year in the U.S., it causes about 20 million cases of vomiting and diarrhea, 465,000 emergency room visits, 109,000 hospitalizations and 900 deaths,  per the CDC .

Although norovirus can spread year-round, outbreaks are most common during the late fall, winter and early spring. As of late March, norovirus cases are still climbing in the U.S.

According to the latest data from laboratories across the country reporting to the CDC , the rate of norovirus tests coming back positive, averaged over three weeks, was just over 13.3% as of Mar. 30 — up from about 9% in mid-January.

Outbreaks have also been rising steadily in recent months. During Aug. 1, 2023 to Mar. 12, 2024, there were 1,020 norovirus outbreaks reported by the 15 states participating in the CDC’s NoroSTAT surveillance program . During the same period the last seasonal year, there were 789 norovirus outbreaks reported by these states.

However, total number of outbreaks reported during the 2023–2024 norovirus seasonal year is comparable to the number reported during the 2012–2020 seasonal years, according to the CDC.

“Currently,  norovirus outbreak activity  in the United States is within the range we would expect for this time of year and is within the range reported during the same time periods in previous years,” a spokesperson for CDC tells

“We generally see an increase during winter and are continuing to monitor this," the CDC spokesperson added.  

Where is norovirus spreading?

Outbreaks of norovirus are impacting communities nationwide, but certain regions of the country are getting hit harder than others.

In February and March, the Northeast had the highest norovirus positivity rate of any region. The percent of tests coming back positive in Northeastern states, averaged over three weeks, was nearly 10% as of Mar. 30 , down from about 16% in late February, per CDC data.

Cities such as Philadelphia have reported spikes in norovirus outbreaks, prompting public health officials to urge residents to take precautions, NBC Philadelphia reported .

"Data from the  northeastern region  of the United States look similar to what we would expect for this time of year,” a CDC spokesperson tells

Currently, the hardest-hit region is the Midwest, which saw a three-week positivity rate of over 15% as of Mar. 30 , followed by the Western U.S., which had a positivity rate of 12% as of Mar. 30 , according to the CDC.

“We’re also seeing a big spike in California,” Dr. Joanna Turner Bisgrove, a family medicine physician and assistant professor at RUSH University Medical Center, tells

Norovirus cases surged in the Southern U.S. last month as well. An elementary school in Fairhope, Alabama, was closed for two full days in late February due to a suspected outbreak of norovirus that sickened an “alarming” number of students and staff members, NBC News affiliate NBC15 in Mobile , Alabama, reported.

The infamous stomach bug is also spreading at sea. Since January, there have been three confirmed norovirus outbreaks on cruise ships under U.S. jurisdiction, which have sickened hundreds of passengers, per the CDC .

Why is norovirus surging?

Norovirus cases and outbreaks are most common between November and April. “Norovirus is actually a seasonal virus ... and usually the peak within that window is between January and early March," Dr. Ericka Hayes, senior medical director of infection prevention at Children’s Hospital of Philadelphia, tells

During the colder winter months, people tend to spend more time gathered indoors, which makes it easier for infectious diseases like norovirus to spread quickly between people, says Bisgrove.

The current surge in norovirus is not surprising, the experts note, but rather an expected increase that occurs every winter in the U.S. “It’s following pretty classic trends,” says Bisgrove.

Last winter was a tough norovirus season for the U.S., as virus activity rebounded to pre-pandemic levels following the dropping of COVID-19 restrictions. Cases peaked in early March 2023, but norovirus activity still remained high well into the spring.

In 2023,  norovirus outbreaks also surged on cruise ships , reaching the highest levels seen in over a decade.

“Compared to the past years, we are in the same neighborhood, if not a little bit more (in terms of) the number of outbreaks in the region and nationally, but we are well within the normal range,” says Hayes.

How does norovirus spread?

"Norovirus is an extraordinarily contagious virus. It's one of the most contagious kind of pathogens, viral or bacterial," says Hayes.

Infected people shed billions of norovirus particles in their stool and vomit, and it only takes a few virus particles to make another person sick, Hayes adds.

People typically get norovirus when these tiny particles end up in their mouths, previously reported. This can occur through direct person-to-person contact, consuming contaminated food or liquids, or touching contaminated surfaces then putting your unwashed fingers in your mouth.

It can spread rapidly through schools, day cares, nursing homes and other enclosed settings where people are gathered close together, says Bisgrove. Norovirus is also the leading cause of foodborne illness outbreaks in the U.S., per the CDC.

A person who has been infected can continue to shed the virus for about two weeks after their symptoms are gone and they feel better, says Bisgrove.

Norovirus symptoms

These are the most common symptoms of norovirus in children and adults, according to the experts:

  • Stomach cramps

Other possible symptoms include a headache, body aches and a low-grade fever,  per the CDC .

The first signs of norovirus may include a sudden loss of appetite, stomach pain or generally feeling out of it, says Bisgrove.

These are typically followed by intense vomiting and watery diarrhea, though these may occur at the same time. "It's usually a very abrupt onset and unfortunately, there's quite a lot of it. ... Patients may have dozens of stools per day," says Hayes.

Norovirus symptoms usually last for 24 to 72 hours. "Due to all the vomiting and diarrhea you may also feel weakness, fatigue or lightheadedness," says Bisgrove.

People with norovirus may become dehydrated due to the loss of fluids through vomit and diarrhea. Symptoms of dehydration include decreased urination, dry mouth or dizziness, per the CDC. Signs in children include crying without tears, becoming fussy or suddenly lethargic and sleepy, says Hayes.

Blood in the vomit or stool is not a normal symptom of norovirus, says Bisgrove, and could be a sign of something more serious. "If you see blood, go to the emergency room," says Bisgrove.

Norovirus treatment

There is no specific treatment or medicine for norovirus, and the vast majority of people will recover on their own at home, the experts note.

It's important to rest and consume plenty of fluids and electrolytes to replenish those lost through vomiting and diarrhea, says Bisgrove. These include water, sports drinks and oral rehydration fluids — but avoid drinks with caffeine or alcohol until you recover.

"We also recommend bland, simple foods (rice, bananas, broths) that (the) body can handle and are more likely to stay down," says Bisgrove.

If symptoms become severe, persist for longer than a few days, or you are unable to keep fluids down or urinate, seek care, says Bisgrove. Some people may need additional support or IV fluids to prevent dehydration or its complications.

Certain groups are at a higher risk of developing complications, including children, the elderly and people with chronic illnesses or weakened immune systems, says Bisgrove.

Children under 5 years old and adults 85 and older are more likely to visit the emergency room, per the CDC.

Preventing norovirus

Norovirus is an incredibly hardy virus. "It's hard to disinfect, and it's resistant to a lot of standard cleaners," says Narula.

Alcohol-based hand sanitizers do not work well against norovirus, the experts note, so good hand-washing is key — this means washing your hands with soap and water for at least 20 seconds, per the CDC. Wash your hands after using the bathroom, after changing diapers and before eating.

If you are sick with norovirus, the experts recommend taking the following steps to prevent spreading the virus to others:

  • Stay home until you feel better
  • Avoid contact with others if possible while sick
  • Wash hands before touching any communal surfaces
  • Clean and disinfect surfaces with bleach
  • Wash laundry in hot water
  • Do not prepare and handle food until at least 48 hours after symptoms stop

This article was originally published on

Ready for Norovirus 2024? The stomach bug is on the rise again

Brightline train wrapped with Princess Cruise Line promo

April 5, 2024

Princess and brightline unveil new ‘rail & sail’ program offering affordable, convenient transportation and luggage express service for guests sailing from florida ports.

ORLANDO (April 5, 2024) – Princess Cruises, the world’s most iconic cruise brand, and Brightline, the intercity passenger rail seamlessly connecting travelers to top destinations and major events in Central and South Florida, have joined forces to introduce the innovative Rail & Sail program, offering guests swift and hassle-free access to Princess cruise ships departing from two popular Florida homeports – Fort Lauderdale and Orlando (Port Canaveral).

With Rail & Sail, guests enjoy a seamless journey in luxurious comfort, arriving at their preferred homeport in significantly less time than traditional travel methods.

The announcement also included the debut of a train with four custom-designed cars adorned with Princess’ iconic Love Boat branding, complete with its signature seawitch logo and depictions of popular ports of call. Princess’ branding will also be featured within Brightline’s five terminals throughout Florida.

Also announced was a value-added luggage express service offering guests the ultimate convenience as their bags are checked at their Brightline station and are waiting for them securely in their stateroom upon arrival to the ship.

Princess guests can also enjoy special discounts of up to 15% when booking Smart and Premium Rail & Sail packages through Brightline’s web site. And for a limited time only, guests who book a Princess cruise through May 5 will receive a Brightline credit of up to $150 per person for its signature Smart and Premium class service based on stateroom type.

“A Princess cruise is already the best value in travel and this new partnership with Brightline makes it even easier and more enjoyable to sail with us from the top-rated ports in South and Central Florida,” said John Padgett, president of Princess Cruises. “Our guests can just sit back, relax, and let us do the rest, including delivering their luggage directly to their stateroom.”

“Brightline has been connecting travelers to South Florida ports since we began operations in 2018 and cruisers from the beginning have found our train to be the easiest way to start their vacation,” said Patrick Goddard, president of Brightline. “Today’s partnership with Princess Cruises and this train wrap with the iconic Love Boat branding is yet another example of the connection between cruisers and Brightline.”

One-of-a-Kind ‘Rail & Sail’ Service

Princess guests will have access to Brightline’s full schedule of convenient trains departing daily with 16 round-trip transits between Orlando and Fort Lauderdale. Options include:

  • Southbound from Orlando to Fort Lauderdale (with stops at West Palm Beach and Boca Raton)
  • Northbound from Fort Lauderdale to Orlando (with stops at Boca Raton and West Palm Beach)
  • South Florida residents can also take Brightline from its downtown Miami and Aventura terminals with stops in Fort Lauderdale or Orlando.

Princess will also provide guests with complimentary motorcoach service between Brightline’s Orlando and Fort Lauderdale stations and their embarkation terminal.

Special Discount Offer, Convenient Luggage Express Service

With the convenient new luggage express service guests can check their bags upon arrival at their Brightline station and their luggage will be automatically delivered to their stateroom, making their cruise experience seamless and hassle-free and saving valuable time and effort. The cost is $35 per bag. Luggage express will be initially available on Orlando-to-Fort Lauderdale trains with plans to add the service to Fort Lauderdale-to-Orlando trains ahead of Caribbean Princess’ arrival and homeport at Port Canaveral in November.

For a limited time only, Princess guests who book a cruise through May 5 will receive a credit that can be used toward Brightline’s signature Premium and Smart class:

  • Interior/Oceanview stateroom – $50 per person Brightline credit
  • Balcony/Deluxe stateroom – $100 per person Brightline credit
  • Mini-Suite/Suite – $150 per person Brightline credit

Brightline’s Smart service includes hand-stitched leather seats, complimentary WiFi and multiple power and USB connections at each seat while Premium service adds complimentary snacks and beverages and access to a Premium Lounge.

Love Boat Sailings from Fort Lauderdale, Space Coast

  • Fort Lauderdale :  Princess is one of Port Everglades’ largest cruise operators with seven ships – nearly half its fleet – sailing from Fort Lauderdale. Voyages include week-long getaways to the Caribbean to longer length 10- to 20-day cruises offering guests a chance to explore a host of tropical island destinations, including through the Panama Canal.
  • Port Canaveral : Caribbean Princess will inaugurate Love Boat cruises from Port Canaveral November 27, 2024, with a series of four- to 14-day sailings visiting some of the western Caribbean’s most picturesque locales, including Grand Turk, San Juan, St. Thomas, San Juan, Belize, Amber Cove (Dominican Republic) and Mahogany Bay (Isla Roatan). The program runs through April 2025.

Additional information on the new Rail & Sail service is available at or .

About Princess Cruises

Princess Cruises is The Love Boat, the world’s most iconic cruise brand that delivers dream vacations to millions of guests every year in the most sought-after destinations on the largest ships that offer elite service personalization and simplicity customary of small, yacht-class ships. Well-appointed staterooms, world class dining, grand performances, award-winning casinos and entertainment, luxurious spas, imaginative experiences and boundless activities blend with exclusive Princess MedallionClass service to create meaningful connections and unforgettable moments in the most incredible settings in the world - the Caribbean, Alaska, Panama Canal, Mexican Riviera, Europe, South America, Australia/New Zealand, the South Pacific, Hawaii, Asia, Canada/New England, Antarctica, and World Cruises. The company is part of Carnival Corporation & plc (NYSE/LSE:CCL; NYSE:CUK).

About Brightline

Brightline seamlessly connects travelers to top destinations and major events between Central and South Florida.  The company serves Miami, Aventura, Fort Lauderdale, Boca Raton, West Palm Beach, and Orlando with future stops in Stuart and Cocoa. Brightline is recognized by Inc. 5000 Regionals as one of the fastest-growing private companies in the Southeast for 2023 and is one of the World’s 50 Most Innovative by Fast Company in 2024. Brightline offers a guest-first experience designed to reinvent train travel and take cars off the road. The company plans to bring its award-winning service to additional city pairs and congested corridors across the country that are too close to fly and too long to drive, with immediate plans to connect Las Vegas to Southern California. For more information, visit and follow us on  Facebook ,  Instagram , and X .


For Brightline

Vanessa Alfonso, [email protected]

Michael Hicks, [email protected]

For Princess Cruises

Caitlin Dineen, [email protected]

Vance Gulliksen, [email protected]


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