Some new facts on the most recent high profile nororivus outbreak on a cruise line raise an interesting question – whose job is it to keep people who are already ill from starting the cruise in the first place?  And how could that task be accomplished?

CNN reported new details today on the outbreak aboard the Celebrity Cruises’ Mercury vessel.  The ship returned to port in Charleston, South Carolina, early, "from a sailing during which more than 20 percent of passengers — about 400 — fell ill."

An investigation by the CDC has identified norovirus, as the culprit.  According to CNN, illnesses appeared on the ship almost immediately:

"There were cases on the first day that were passenger cases, and there certainly is a connection with respect to increased norovirus in South Carolina. So it could have been from a passenger," said Capt. Jaret Ames, branch chief of the Vessel Sanitation Program, which works with the cruise industry to prevent and control gastrointestinal illnesses.

Given the incubation period for norovirus, this could suggest that passengers may have entered the ship already ill.  This raised a question- does the cruise industry make any efforts to limit this phenomenon?   What education, if any, do they give the passengers regarding not embarking on the cruise if they are ill?  Do they provide information about what symptoms to be on the lookout for?   

Also, if a potential cruise passenger comes forth admitting symptoms or illness before they leave, can they get a refund?  If they can’t, common sense suggests they will be a lot more likely to believe they can tough it out for a day or two, not realizing they are putting fellow passengers at risk.

The report also indicate that the rate of incidence of norovirus on land correlated to the incidence on cruises:

High rates of norovirus illness on shore typically translate to cruise ships, Ames said. Outbreaks also frequently occur in other confined areas, including schools and nursing homes.  South Carolina’s Department of Health and Environmental Control has reported more than twice the usual number of norovirus outbreaks or unknown outbreaks that appear to be norovirus since early January.

Might it make sense for the cruise industry to monitor norovirus incidence in its port cities, to know when to be on increased watch for ill passengers starting their journey?

Once the cruise is underway with ill persons on board, the likelihood of additional exposures is high.   It makes sense to explore all available ways from limiting the pathogen’s access to passengers in the first place.