My cruise ship had a norovirus outbreak. Should I be worried? - The Washington Post

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"What do you do if you're a passenger on a cruise directly following a norovirus outbreak? Should you rebook?" — Washington Post travel reporter Andrea Sachs

Even though it feels as if we hear a lot about gastrointestinal illness on cruise ships, the Centers for Disease Control and Prevention says outbreaks are "relatively infrequent." Because health officials track illness on cruises, outbreaks are found and reported quicker on ships than on land, the CDC says.

But it happens. So far this year, the CDC has reported 13 outbreaks of norovirus — more than the annual total of gastrointestinal illnesses reported on cruise ships visiting U.S. ports in each year dating back to 2017; the CDC imposed a no-sail order for much of 2020 because of the coronavirus pandemic, and U.S. cruises were required to follow pandemic-era restrictions until January 2022, which may have also helped contain norovirus. Although outbreaks may affect more than 100 passengers, the two most recent cases represented about 13 percent and 7 percent of guests, respectively.

So how far do you need to go to evade the stomach bug on your vacation?

Let's start with what I heard from Bernadette Boden-Albala, the director and founding dean of the Program in Public Health at the University of California at Irvine, who has extensively researched and studied norovirus and is still a fan of cruise travel. In fact, she emailed me from a cruise ship.

Her take: You don't need to rebook if you hear there has been an outbreak on the sailing before yours. You and the cruise line are on the same page: Nobody wants you getting sick on board.

"Norovirus is a worst fear for all cruise lines," Boden-Albala says.

She mentioned information you'll also find on the norovirus page of the Cruise Lines International Association website: When a gastrointestinal illness plagues a cruise, the captain and crew follow deep-cleaning and sanitation practices developed with public health authorities. Additionally, Kendra Holmes, the CEO of Miray Cruises, says a ship's crew is monitored for symptoms, and if anyone does display symptoms, they're quarantined and treated.

Shoshana Ungerleider, a board-certified internal medicine physician and host of the "TED Health" podcast, also says that, thanks to the norovirus cleaning protocols on ships, the risk of getting an infection on the following cruise should be quite low.

Flying during summer storm season? Better have a backup plan.

"That being said, norovirus is highly contagious and can be spread from person to person," she wrote in an email. "If any of the crew members were infected and are still in the incubation period or showing symptoms, there might be some risk of transmission."

According to the CDC, the incubation period for norovirus — the time it takes between infection and the onset of symptoms — is between 12 and 48 hours.

So the decision to travel or not should depend on several factors, Ungerleider says, including your personal health status and risk tolerance.

For most young and healthy people, norovirus isn't much of a health risk, says Eyal Leshem, an infectious-disease expert at Sheba Medical Center who previously worked at the CDC. With some hydration and rest, you should recover within days.

But for elderly people or those who suffer from chronic illnesses, Leshem says norovirus can cause severe disease, which may occasionally result in hospitalization and even death. He would advise such travelers to follow up to make sure the ship has followed the CDC's guidance and recommendations for outbreaks.

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Ungerleider says those high-risk travelers may want to consider rebooking their trip for the peace of mind alone.

But not all cruise ships are the same, Boden-Albala says; you can allay some of your fears by choosing ships that come with less risk. Because norovirus risks increase when you have lots of people inside close quarters, look for smaller ships that carry fewer passengers and give you lots of opportunities to spend time outdoors. (So, not a ship like this.)

On board, Boden-Albala avoids crowded situations. "I rarely use a buffet," she says.

Most importantly, wash your hands a lot. Boden-Albala says this is the best measure you can take to protect yourself and your loved ones from the potential spread of disease. Do it the way you relearned during the pandemic: with soap and warm water for at least 20 seconds, scrubbing around and under your fingernails and between your fingers. Do it not just before eating or drinking, but also before brushing your teeth, blowing your nose, changing a diaper, et cetera.

"You must be diligent beyond your common understanding of when to wash your hands, because there are millions of norovirus particles spreading in various areas," Boden-Albala says.

You can use hand sanitizer in addition to — but not as a substitute for — hand-washing, as Boden-Albala notes that it doesn't do well against norovirus on its own.

Lastly, "if you see someone sick like vomiting or having diarrhea, remove yourself from the area and notify cruise staff if they are not already aware," Boden-Albala says.

Hannah Sampson contributed to this report.

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