Norovirus on Cruise Ships: What Every Travel Advisor Should Know

The good news is that most past cruisers don’t worry about norovirus and won’t bring it up as a concern with their travel advisor.

The bad news is that the media loves to pick on cruise ships when it comes to norovirus, leading many non-cruisers to associate cruise ships with terms like “dirty” and “cesspool.” A recent piece in CNN declaring a surge of norovirus outbreaks doesn’t help.

But what is the truth about norovirus and how can travel advisors help alleviate non-cruisers’ concerns?

We’ve rounded up some of the most common questions about norovirus on cruise ships to help you deal with any norovirus-related objections.

What is norovirus?
Norovirus is a highly contagious virus that causes gastrointestinal distress in people including stomach pain, nausea, diarrhea, and vomiting. It is not the only cause of so-called stomach bugs but is the most common.

According to the Centers for Disease Control and Prevention (CDC), norovirus causes between 19 and 21 million cases of acute gastroenteritis in the U.S. every year. In a typical year, the virus also leads to about 900 deaths (mostly among adults aged 65 and older) and 109,000 hospitalizations.

Why is norovirus called the “cruise ship sickness”?
Norovirus is highly infectious. In places where people are packed tightly together, like cruise ships (and in schools, hospitals, and nursing homes, among other more commonly affected places), norovirus can spread quickly.

Unfortunately for the cruise industry, norovirus outbreaks on cruise ships make for excellent news headlines. (Cruise ships are also required to report gastrointestinal outbreaks more stringently than other entities, making it easier for media to catch wind of outbreaks.)

Even small outbreaks on a cruise ship often make it into local and even national news, giving many viewers the impression that norovirus is a disease frequently associated with cruise ships.

How common is norovirus on a cruise?
On its “Facts About Norovirus on Cruise Ships” page, the CDC states that “acute gastrointestinal illness is relatively infrequent on cruise ships.”

While it is true that norovirus causes more than 90% of the outbreaks of diarrheal disease on cruise ships, the CDC says “norovirus outbreaks on cruises ships account for only a small percentage (1%) of all reported norovirus outbreaks.”

Let’s do some quick math. In 2019, eight norovirus outbreaks were recorded by the CDC, accounting for 1,038 passengers. (Remember in a typical year, between 19 and 21 million people get sick with norovirus.) On just the eight ships affected, these 1,038 passengers accounted for 5% of the total passengers sailing. When you add in the hundreds of thousands of passengers sailing on all cruise ships reporting into the CDC’s Vessel Sanitation Program (VSP) in the entire year of 2019, those 1,038 people account for an infinitesimal number. 

You are more likely to contract norovirus at a land-based restaurant, in a school, or in a healthcare facility than on a cruise ship.

How can I avoid norovirus on a cruise ship?
The number one preventative measure for avoiding norovirus in all situations is to wash your hands regularly, and particularly before handling food and eating.

Cruise ships put a lot of emphasis on hand sanitizers, but, as the CDC points out, hand sanitizer does not actually work well against norovirus. While it doesn’t hurt to use the hand sanitizers you’ll find around the ship, hand washing is your best protection.

If you can, wash your hands in your stateroom immediately before heading to a meal. Or, if there’s a handwashing station – usually found outside buffets on newer cruise ships – take the time to wash your hands there.

Additionally, use a paper towel to turn off faucets or open bathroom doors after washing your hands.

You may also want to bring bleach-based wipes with you to wipe down high-touch surfaces in your stateroom. While cruise lines have strict cleaning protocols, an ounce of extra prevention never hurts.

What happens to me if I catch norovirus on a cruise ship?
While it is unlikely, if you do catch norovirus on a cruise ship, you will most likely be quarantined in your stateroom. The cruise ship’s medical team will supply you with medicine including anti-diarrheal, anti-vomiting, and antibiotics as needed. You will be encouraged to drink lots of fluids and someone from the medical team will call to check up on you.

Depending on the severity of your illness you may be quarantined for as little as 24 hours or as long as it takes for your symptoms to abate.  

How long are you contagious with norovirus?
According to the Idaho Department of Health and Welfare, people infected with norovirus are most contagious from the moment they start to feel sick until at least three days after they recover. The virus can also remain in your feces for two weeks or more after you feel better. If you’re the one who gets norovirus, you’ll want to wash your hands more than usual for up to two weeks after recovery in order to protect others from potentially getting sick.

Additionally, the CDC says that the norovirus can remain on surfaces for days and weeks and is resistant to many common disinfectants. If you want to do any extra cleaning in your stateroom bathroom, you’ll want to use a bleach-based cleaning wipe.

What kind of extra cleaning does a cruise ship undergo after an outbreak of norovirus?
Should even a small outbreak occur on a cruise ship, the cleaning staff will amp up their cleaning and sanitizing efforts. You’re likely to see high-touch areas like elevators and staircases getting cleaned more frequently.

On ships where a larger or more severe outbreak occurs, the crew will conduct a deeper cleaning of the ship after cruisers have disembarked and before new cruisers are permitted onboard. In some cases, this can delay the embarkation of the next cruise.

How can I find out which cruise ships have had norovirus outbreaks?
As defined by the CDC, A norovirus “outbreak” is defined as “an occurrence of two or more similar illnesses resulting from a common exposure that is either suspected or laboratory-confirmed to be caused by norovirus.”

Despite an outbreak occurring after just two cases, the CDC’s Vessel Sanitation Program (VSP) only posts records of cruise-related norovirus outbreaks that meet all of the following criteria: are on ships under VSP jurisdiction, are on ships carrying 100 or more passengers, are on voyages from 3-21 days long, and are on voyages where 3% or more of passengers or crew report symptoms of gastrointestinal illness to the ship’s medical staff.

So far in 2013, the VSP has 13 outbreaks listed (the most in a single year since 2012). The worst of these was a June sailing on Viking Neptune that saw 13.1% of passengers (110 people) fall ill over the course of the two week cruise. Additionally, 1.98% of the crew (nine people) got sick.

What was the worst norovirus outbreak on a cruise ship?
The worst outbreak of norovirus – by percentage of those sickened – on a cruise ship that TMR could find a record of dates all the way back to 2008 on the Grande Caribe, a small cruise ship that sailed for American Canadian Cruise Line (now called Blount Small Ship Adventures). Of the 68 passengers onboard, 29 – or 43% – fell ill with norovirus. An additional eight crew members got sick. Another large-scale norovirus outbreak occurred in 2016 when 277 of 915 passengers (or 30.2%) on Fred. Olsen Cruises’ Balmoral got sick with norovirus.