The Times Australia
The Times World News

.

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

  • Written by Thea van de Mortel, Professor, Nursing, School of Nursing and Midwifery, Griffith University
From COVID to gastro, why are cruise ships such hotbeds of infection?

Dual outbreaks of gastro and COVID[1] on the Grand Princess cruise ship that docked in Adelaide on Monday have now been declared over[2] by the doctor on board[3].

A spokesperson for Princess Cruises, which operates the ship, said a number of passengers had presented with symptoms on a previous voyage[4]. 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[5] including SARS-CoV-2 (the virus that causes COVID) and influenza viruses. These can be spread by respiratory droplets and aerosols[6] released when people breathe, talk, laugh, cough and sneeze.

Historically, troop transport ships[7] 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[8], 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[9].

Read more: Cruise ships can be floating petri dishes of gastro bugs. 6 ways to stay healthy at sea this summer[10]

What is the risk?

In 2020, around 19% of Diamond Princess[11] passengers and crew docked in Japan tested positive to COVID. Ultimately, nearly one in four Ruby Princess[12] 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[13] before COVID of influenza-like illness (which includes fever), acute respiratory illness (which doesn’t require fever[14] 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[15] 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[16] of improved hygiene and sanitation standards.

The risk of getting sick with gastro was significantly higher on bigger ships and longer voyages[17]. 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.

A table with buffet food on a ship.
Buffets are one of the factors that can contribute to the risk of infection on a cruise. Solarisys/Shutterstock[18]

Why are cruise ships infection hotspots?

On cruise ships, people tend to crowd together[19] in confined spaces for extended periods. These include dining halls, and during social activities in casinos, bars and theatres.

The risk goes up when the environment is noisy, as more droplets and aerosols are shed when people are laughing, shouting or talking loudly[20].

Passengers may come from multiple countries[21], 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[22] if it has international passengers or is calling at international ports.

Human behaviour also contributes to the risk. Some passengers surveyed[23] 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 faecal contamination[24] is a major source of norovirus transmission, this is concerning.

Read more: Cruise ships are back and carrying COVID. No, it’s not 2020. But here’s what needs to happen next[25]

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[26] 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[27], such as covering their mouth if coughing or sneezing, disposing of used tissues, and washing or sanitising hands after touching their mouth or nose.

Read more: Fleas to flu to coronavirus: how 'death ships' spread disease through the ages[28]

South Australia’s chief health officer has commended[29] the Grand Princess crew for their infection protection and control practices, and for getting the outbreak under control.

References

  1. ^ gastro and COVID (www.abc.net.au)
  2. ^ have now been declared over (www.theguardian.com)
  3. ^ doctor on board (www.canberratimes.com.au)
  4. ^ on a previous voyage (www.9news.com.au)
  5. ^ a range of pathogens (wwwnc.cdc.gov)
  6. ^ respiratory droplets and aerosols (www.pnas.org)
  7. ^ troop transport ships (jmvh.org)
  8. ^ norovirus (wwwnc.cdc.gov)
  9. ^ bacteria in contaminated food or water (wwwnc.cdc.gov)
  10. ^ Cruise ships can be floating petri dishes of gastro bugs. 6 ways to stay healthy at sea this summer (theconversation.com)
  11. ^ Diamond Princess (www.bmj.com)
  12. ^ Ruby Princess (www.ncbi.nlm.nih.gov)
  13. ^ three-year study (www.sciencedirect.com)
  14. ^ doesn’t require fever (www.cdc.gov)
  15. ^ analysis (www.cdc.gov)
  16. ^ combination (www.ncbi.nlm.nih.gov)
  17. ^ bigger ships and longer voyages (www.cdc.gov)
  18. ^ Solarisys/Shutterstock (www.shutterstock.com)
  19. ^ crowd together (www.ncbi.nlm.nih.gov)
  20. ^ laughing, shouting or talking loudly (www.ncbi.nlm.nih.gov)
  21. ^ multiple countries (www.sciencedirect.com)
  22. ^ on a cruise ship (academic.oup.com)
  23. ^ surveyed (academic.oup.com)
  24. ^ faecal contamination (www.health.nsw.gov.au)
  25. ^ Cruise ships are back and carrying COVID. No, it’s not 2020. But here’s what needs to happen next (theconversation.com)
  26. ^ Department of Health and Aged Care (www.health.gov.au)
  27. ^ respiratory etiquette (www.cdc.gov)
  28. ^ Fleas to flu to coronavirus: how 'death ships' spread disease through the ages (theconversation.com)
  29. ^ commended (www.abc.net.au)

Read more https://theconversation.com/from-covid-to-gastro-why-are-cruise-ships-such-hotbeds-of-infection-217534

Times Magazine

Headless CMS in Digital Twins and 3D Product Experiences

Image by freepik As the metaverse becomes more advanced and accessible, it's clear that multiple sectors will use digital twins and 3D product experiences to visualize, connect, and streamline efforts better. A digital twin is a virtual replica of ...

The Decline of Hyper-Casual: How Mid-Core Mobile Games Took Over in 2025

In recent years, the mobile gaming landscape has undergone a significant transformation, with mid-core mobile games emerging as the dominant force in app stores by 2025. This shift is underpinned by changing user habits and evolving monetization tr...

Understanding ITIL 4 and PRINCE2 Project Management Synergy

Key Highlights ITIL 4 focuses on IT service management, emphasising continual improvement and value creation through modern digital transformation approaches. PRINCE2 project management supports systematic planning and execution of projects wit...

What AI Adoption Means for the Future of Workplace Risk Management

Image by freepik As industrial operations become more complex and fast-paced, the risks faced by workers and employers alike continue to grow. Traditional safety models—reliant on manual oversight, reactive investigations, and standardised checklist...

From Beach Bops to Alpine Anthems: Your Sonos Survival Guide for a Long Weekend Escape

Alright, fellow adventurers and relaxation enthusiasts! So, you've packed your bags, charged your devices, and mentally prepared for that glorious King's Birthday long weekend. But hold on, are you really ready? Because a true long weekend warrior kn...

Effective Commercial Pest Control Solutions for a Safer Workplace

Keeping a workplace clean, safe, and free from pests is essential for maintaining productivity, protecting employee health, and upholding a company's reputation. Pests pose health risks, can cause structural damage, and can lead to serious legal an...

The Times Features

Tricia Paoluccio designer to the stars

The Case for Nuturing Creativity in the Classroom, and in our Lives I am an actress and an artist who has had the privilege of sharing my work across many countries, touring my ...

Duke of Dural to Get Rooftop Bar as New Owners Invest in Venue Upgrade

The Duke of Dural, in Sydney’s north-west, is set for a major uplift under new ownership, following its acquisition by hospitality group Good Beer Company this week. Led by resp...

Prefab’s Second Life: Why Australia’s Backyard Boom Needs a Circular Makeover

The humble granny flat is being reimagined not just as a fix for housing shortages, but as a cornerstone of circular, factory-built architecture. But are our systems ready to s...

Melbourne’s Burglary Boom: Break-Ins Surge Nearly 25%

Victorian homeowners are being warned to act now, as rising break-ins and falling arrest rates paint a worrying picture for suburban safety. Melbourne residents are facing an ...

Exploring the Curriculum at a Modern Junior School in Melbourne

Key Highlights The curriculum at junior schools emphasises whole-person development, catering to children’s physical, emotional, and intellectual needs. It ensures early year...

Distressed by all the bad news? Here’s how to stay informed but still look after yourself

If you’re feeling like the news is particularly bad at the moment, you’re not alone. But many of us can’t look away – and don’t want to. Engaging with news can help us make ...