U.S. Centers For Disease Control
And Prevention
Letter On Cruise Ship Norovirus
Dear Mrs. Hamilton,
Sorry for my error on the point of the ill crew who are food employees. Actually the standard in our VSP Operations Manual is in fact isolation of food employees for a 48 hour period after their final gastrointestinal illness symptom. As I stated before there is not the depth of scientific evidence at this point to truly establish if that is or is not sufficient for norovirus caused gastrointestinal illness, but it has been effective so far within the VSP experience. Some companies have decided to go beyond that minimum standard and impose a 72 or even 96 hour symptom free period before allowing food employees to return to work and we of course support that as well. The number of ill cases I quoted you was incorrect, based on the final arrival of the ship in Honolulu. The ship made the report I quoted on the arrival in the first U.S. port following a foreign port call (Fanning Island) as required by law, so that was on 27 November (the day before arriving in Kona). There was a second report made because more cases occurred more than 4 hours prior to arrival in Kona, so we also received a report on 28 November with an increase in the passenger cases from 21 to 24 cases total. Again this was in accordance with our foreign quarantine laws. Lastly, there is no requirement for another report to our program unless a 2% GI illness ratio occurs within the passenger or crew population. This is because the ship was sailing now from Kona to Honolulu (both U.S. ports)
I called the medical office this morning to find out the log record on the final count when the ship disembarked the passengers in Honolulu. The final gastrointestinal illness count from the medical logs was 30 passenger GI cases from a total of 1,746 onboard and 2 crew from a total of 689. I can't speak to what was provided on the ship in those last days, but it is good for the Captain to warn passenger thru announcements when GI illness levels reach a point beyond what is normally expected. It is hghly unusual for a Captain to actually give a number or a percentage in such announcements, so I find the 60 number curious given the report was half that number. I have asked for the gastrointestinal illness log for that cruise and will look at it for comparison of the numbers reported.
Our program website details not only how and why we function, but also provides all the written inspection reports and the responses from the cruise lines regarding their corrections. There are gastrointestinal illness outbreaks listed and descriptions of actions taken. We are required to conduct 2 unannounced operational inspections per fiscal year. For that reason we don't attempt to make the inspections follow an exact 6 month cycle. We vary ports and dates quite often. It is true the ship was last inspected in May of this year. You can visit our site at www.cdc.gov/nceh/vsp for more information.
I also read your description of the experience you and your husband had on the cruise. I have copied the NCL Director of Public Health on this message and feel confident he will investigate the matter and respond to you directly. The isolation policy for GI cases is normally clearly communicated both verbally in writing as soon as that is determined by the medical staff. It is difficult to answer the separation part when people come to the waiting room, as it is the place where the ill congregate for care. Typically a ship will try to make cabin calls when a person informs them they feel too sick or are having symptoms they cannot control. When a lot of people become ill it's very hard for the medical team to make those calls quickly, but I don't know why that didn't happen in your case. I know the Wind will be coming up on our inspection in the near future and we can follow-up on this complaint when the medical inspection is made. I hope NCL will get back to you promptly and that your health improves.
Sincerely,
CAPT Jaret Ames
Deputy Chief,
CDC Vessel Sanitation Program
NOTE: Cases reported in this category only reflect those reported to the infirmary. Many passengers do not seek medical care aboard a ship, due to the high expense.
