The latest update by CDC on cruise ship ‘Balmoral’ has claimed that 27.4% of the passengers with symptoms of vomiting and diarrhea have a confirmed culprit — norovirus — behind it.

To help improve the situation at the cruise, two health officers and an epidemiologist of CDC boarded the ship at Baltimore, Maryland. Norovirus rapid tests were conducted on the stool specimen from infected passengers and crew members. These tests results were positive for the presence of norovirus. These specimens will be sent to CDC laboratories for further tests.

919 passengers were travelling from UK to US in a Fred Olsen Cruise line, Balmoral, that began its journey from Southampton, England, on 16th April. The illnesses started to report when the ship was in Norfolk, Virgania. However, it was at Baltimore when the cause of illness was found to be norovirus.

Norovirus is a food-borne virus that can cause acute stomach and intestine inflammation even if present in minute viral titers. According to a finding of Journal of Medical Virology, as few as 18 viral particles can infect a person. Amongst the passengers, the majority is reported to be British national, while only two US nationals are said to be aboard.

The cleanliness of the space is being re-evaluated and improved to get rid of any traces of the virus to control this outbreak from affecting more passengers. Steps have been taken to initiate disinfection procedure in the area under the CDC guidance. Public health and sanitation manager from cruise line office has been called aboard to implement the sanitation and disease outbreak responses. Daily health reports are being maintained to record the number of affected people. According to the cruise line management, they are taking every possible step to improve the sanitation and cleanliness of the ship due to which the number of affected people has significantly reduced and the ship will continue its journey as planned. It was set for a 34-night journey that is now on its way to St John, New Brunswick, Canada. The ship is scheduled to return to Southampton on 20th May.

Norovirus Outbreak

The cruise management personnel added that the ill passengers were asked to stay in their rooms to restrict the virus from spreading, these passengers were also offered complementary services and in room entertainment facilities so they are comfortable during the stay.

Previously, on 29th April, the cruise management released a statement which said that the passengers were falling ill by a probable “gastroenteritis” causing illness. The number had continued to increase. Eight out of 502 crew members have also fallen prey to the infection.

Portland Mayor Ethan Strimling boarded the cruise for a tour, he was not aware of the outbreak as he walked in. But once he found out, he was said to be satisfied by the hygiene and disinfecting measures taken by the staff of the cruise.

The cruise had made stops at different points during its voyage, crossing through Portugal and Bermuda to make its way into the US. Officials said, “The passengers who boarded the cruise from Portland, Maine, might have been infected by the virus.”

Cruise liner Balmoral has been hit by norovirus outbreak six times since 2009. The authorities will have to look deep into what are the causes that have been repeatedly causing inconvenience and an alarming health concern for the passengers.

Balmoral that set out this year in April has a capacity for 1,350 passengers. It is the largest and newest from Fred Oslen cruise. Ranked amongst the top five cruises in the world, Fred Oslen cruise attracts tourists and travelers from many countries and makes huge revenues, but it is high time for them to combat norovirus and find permanent solution to the problem. A long term health strategic planning will have to be adapted to avoid exposure to norovirus in the future.

According to CDC, norovirus is a highly contagious virus that is a leading cause of illness in the United State caused by contaminated food. The symptoms one may show after contracting the virus include nausea, diarrhea, stomach pain, headache, body ache and fever. Norovirus is spread quickly in closed areas increasing healthcare facilities, restaurants, banquet halls and ships. Another CDC research says that over 90% of diarrheal illnesses on cruises are attributed to norovirus. The virus can be spread from eating contaminated food that may usually include leafy vegetables, raw fruits and shellfish. However, cooked food that has been touched with norovirus contaminated hands can also make people fall ill. It is the most common way of actively contracting the virus. However, one can also get infected by touching surfaces that are contaminated by the virus and taking your contaminated finger into your mouth. Accidently taking in the infected stool or vomit, or sharing food and utensils with an infected person can also cause a person to contract the virus.

A person who has contracted the virus will start showing symptoms 12-48 hours after the virus has entered the system. The virus tracks can be found in the stool for two weeks after the symptoms end. It takes 1-3 days for the symptoms to get better. But due to intense dehydration, a person can feel dizzy and weak, with experiencing dry throat and reduced urination.

The strains of norovirus are resistant to temperature as high as 140 0F so cooking shellfish e.g., oysters which might be carrying the virus is not safe to be eaten. Such oysters should be discarded and not consumed.

At present, no treatment is present to treat norovirus. However, some prevention steps are recommended by health agencies that assist in reducing the spread of the virus. If a person is affected by the virus, they should shift themselves to a confined place or quarantined; they should not cook for others in family and should not share utensils with others. After using washroom, they should thoroughly wash their hands. Surfaces that come in contact with the infected stool or vomit should be washed with disinfectants like chlorine bleach. Raw vegetables and fruits should be washed thoroughly and shellfish should be cooked properly for a longer time so that no traces of virus are left behind.

Vulnerable groups, like children, pregnant women and elderly should be given extra care if infected. In cases of severe dehydration, hospitalization is suggested where intravenous fluids are given to repletion the lost body fluids.

CDC says that each year in the United States norovirus causes 18-21 million illnesses out of which 56,000-71,000 get hospitalized and 570-800 die. Therefore, all the internationally acclaimed cruise services should take preventive steps against winter vomiting bug so that such outbreaks can be minimized in future.