Norovirus Outbreak
Celebrity Cruise - Mercury
March 6, 2006
In what seemed like three isolated incidents, the Celebrity Mercury was racking up Norovirus victims, for months, and passengers had no idea they were boarding a sick ship, voyage after voyage. The CDC only 'suggests' the cruise line notify boarding passengers when there has been a reportable incident, the cruise before.
If the cruise ship keeps the numbers below the reportable level, passengers board, unaware that hundreds of people have been sickened on past back-to-back voyages aboard the plagued ship.
The CDC report on the incidents gives us hints of what really happened, beginning with the first outbreak On March 6. But, even that report hints that the incident began prior to that date. The word 'increased' is found in each of the reports, signifying that that the report is on a consecutive event not required to be documented.
Celebrity Cruises reported an increased number of cases of gastrointestinal (GI) illness on the cruise ship, Mercury, for the 12 day voyage completed on March 17, 2006, (sailing dates: 3/6/2006-3/17/2006) in San Diego, CA.
On March 14, 2006, Celebrity Cruises contacted CDC’s Vessel Sanitation Program (VSP) staff to report that an elevated number of Mercury passengers and crew were experiencing symptoms that were consistent with gastrointestinal illness. The predominant symptoms were diarrhea and vomiting.
On March 17, the ship’s medical staff reported that 14 of 840 (1.67%) crew were and 191 of 1902 (10.04%) passengers were ill. Stool specimens were collected and tested positive for norovirus.
The ship's staff provided daily updates to CDC throughout the following voyage (sailing dates: 3/17/2006-3/27/2006). The medical staff reported a higher number of ill passenger and crew than expected. On March 24, VSP staff boarded the ship in Puerto Vallarta, Mexico and sailed for the remainder of the voyage to conduct an environmental and an epidemiological investigation. VSP staff consulted with onboard medical staff, observed cleaning, and disinfection procedures, distributed a survey to determine the cause of illness, and made recommendations.
Then continues with the second reportable outbreak.
Celebrity Cruises reported an increased number of cases of gastrointestinal (GI) illness on the cruise ship, Mercury, for the 11 day voyage completed on March 27, 2006, (sailing dates: 3/17/2006-3/27/2006) in San Diego, CA.
On March 21, 2006, Celebrity Cruises contacted CDC’s Vessel Sanitation Program (VSP) staff to report that an elevated number of Mercury passengers and crew were experiencing symptoms that were consistent with acute gastroenteritis and that the higher number of ill passengers and crew was consistent from the previous voyage. The predominant symptoms were diarrhea and vomiting.
On March 24, VSP staff boarded the ship in Puerto Vallarta, Mexico to sail for the remainder of the voyage to conduct an environmental and an epidemiological investigation. VSP staff consulted with onboard medical staff, observed cleaning and disinfection procedures, distributed a survey to determine the cause of illness, and made recommendations.
The ship’s medical staff reported that at the end of the voyage, 24 of 844 (2.84%) crew were and 107 of 1986 (5.39%) passengers were ill. Stool specimens were collected and tested positive for norovirus.
The ship's staff continued increased cleaning and disinfection procedures and provided daily updates to CDC throughout the voyage with sailing dates: 3/27/2006-4/7/2006. On April 6, medical staff reported that number of ill passengers and crew had returned back to expected levels.
This tells us passengers and crew were still getting sick in mid April, with the CDC specifically saying there were sick passengers on the ship for that April 7 to April 17th cruise and no doubt beyond, as the victim-attacking-virus declined over the coming weeks. Then, another large outbreak takes place. It is more likely this outbreak is the same as the one beginning March 6th.
While at first the crew had a handle on the outbreak, keeping the numbers below the CDC radar, and the numbers declined, sloppiness reversed the course and the numbers began to grow to a reportable level again. The June 2nd cruise, the numbers are again at reportable levels.
On the third cruise we have reportable levels that include 125 people. There can be no doubt those numbers didn't just being on that cruise. They grow over a period of back-to-back cruises, to a level that require reporting. We see that time and time again, as the reports are read in detail.
Celebrity Cruise Line reported an increased number of cases of gastrointestinal (GI) illness on the cruise ship, Mercury, for the 7 day voyage completed on June 9, 2006, (sailing dates: 6/2/2006-6/9/2006) in Seattle, WA.
On June 7, Celebrity Cruise Line contacted with CDC’s Vessel Sanitation Program (VSP) staff to report an elevated number of Mercury passengers and crew were experiencing symptoms that were consistent with acute gastroenteritis.
On June 9, the ship’s medical staff reported that 4 of 848 (0.47%) crew were and 121 of 2025 (5.98%) passengers were ill. The predominant symptoms were diarrhea, vomiting. On June 9, VSP staff boarded the ship to conduct an onboard environmental investigation.
The ship's staff implemented additional cleaning and disinfecting procedures. Medical staff provided daily updates to CDC; the number of ill people returned to expected levels on the following voyage (voyage ending on 6/16/06).
The hint here that the third outbreak had been ongoing, is the CDC wording in the report.
Celebrity Cruise Line reported an increased number of cases of gastrointestinal (GI) illness on the cruise ship, Mercury, for the 7 day voyage completed on June 9, 2006, (sailing dates: 6/2/2006-6/9/2006) in Seattle, WA.
It is clear from the wording "increased number" this is not a new outbreak. Because infected ships don't just become clean after the passengers leave and the ship is sanitized. Outbreaks begin slowly to a peak, then generally decline.
However, the common thread in any outbreak on a ship, that continues for more than one voyage is the crew. They stay aboard and continue to spread the infection.
This outbreak likely continued on for weeks, or perhaps months and the cruise line took no responsibility for the many cruises that were affected, causing loss of expected pleasure to the passengers who boarded, unaware of the history of the outbreak.
Total for only the three cruises the CDC documented was 461. This number could have been less than half this amount, had the cruise line done the responsible thing, and held the ship in port until it was really clean, and disease-free. Since profits are important than the well-being of the passengers and crew,the wrong choice is made by this line, and most others, each and every time.
When one hotel was hit with the Norovirus bug, they took appropriate action and ended the plague on their business. About 100 guests and 20 workers at a Hilton hotel near Dulles International Airport in January 2007 were sickened by highly contagious norovirus, causing the hotel to shut down for several days and put guests in other area hotels.
More importantly, the hotel with a restaurant on site, threw out all the food they had in the restaurant. This single act likely made the difference between the hotel cutting off the virus, and suffering the fate of the cruise industry.
Since cruise ships board passengers for the next voyage within hours of ending the past voyage, and have crew aboard between one cruise and the next, the food on the ship stays. This food, touched by crew, some of who were likely sick, before the realized they had symptoms, is most likely infected and the cause of outbreaks that go on for numerous cruises.
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.
