Norwalk Like Virus

INFORMATION AND FACTS REGARDING CRUISE SHIPS AND NLV

(NORWALK LIKE VIRUS)

Over the past month a common gastrointestinal ailment called Norwalk like virus (NLV) has affected a very small percentage of the overall number of guests aboard cruise ships. Over 99% of cruise passengers are enjoying their cruise vacations without being affected by NLV. This is a common ailment circulating in North America and Europe, prevalent at land-based facilities and occasionally occurs on ships.

“We continue to work very closely with the cruise lines,” said David Forney, chief of Vessel Sanitation Program of the U.S. Centers for Disease Control and Prevention (CDC). “These ships are maintaining the highest standard of sanitation in the world. They [cruise lines] are doing everything they can to minimize the risk of coming in contact with this gastrointestinal illness. There are no guarantees, but they’re doing everything they can to make sure that this is not an issue.”

“The illness [NLV] is seasonal, peaking in the colder months,” said Dr. Steven Wiersma, the Florida state epidemiologist. "We've already seen some [cases] in Florida - this is not just a cruise ship issue," he said.

“The safety and comfort of our guests and crew has been and will always be our highest priority,” said Michael Crye, president of the International Council of Cruise Lines. “We have a comprehensive and cooperative program with the CDC to minimize the chances that our passengers’ vacation experience will be compromised. We want to provide information about NLV and the cruise industry's preventative and response measures regarding vessel sanitation."

PRECAUTIONS

If an NLV outbreak should occur, cruise lines take extensive precautions to contain the spread through aggressive sanitation measures and open communication with their guests prior to boarding and whilst onboard the ship. Some of the measures employed when responding to an outbreak of NLV may include:

	Passengers with obvious symptoms may not be allowed to board.
	To avoid the risk of spreading NLV, passengers who experience typical gastrointestinal symptoms are sometimes asked to remain in their cabins until they are non-contagious but could be asked to disembark at the next available port. The CDC endorses this procedure.
	All crew with NLV symptoms are quarantined until they are non-contagious but may also disembark the ship at the next available port.
	An aggressive on-board communications effort encourages guests to frequently wash their hands. Washing one's hands regularly (each hour or two) is a very good way to reduce the spread of contact viruses such as NLV.
	Aboard ship, staterooms and public areas are cleaned and disinfected daily including, but not limited to, counters, bathroom surfaces, door handles, railings and grab bars, exercise equipment and TV remote controls.
	On turn-around days, extra crew are brought on-board to disinfect the ship with the CDC recommended chlorine-based solution from top to bottom before additional passengers board.
	On-board medical facilities and staff are always available to prescribe medication for symptomatic treatment gastrointestinal symptoms.

CRUISE SHIPS AND THE VESSEL SANITATION PROGRAM

	Cruise ships adhere to an extensive cleanliness and sanitation protocol, in coordination with the CDC, and the results of these programs and inspections are available to the public.
	Every vessel that has a foreign itinerary, carries 13 or more passengers, and calls on a U.S. port is subject to un-announced twice-yearly inspections and re-inspection by CDC staff. The ship is scored on a 100-point scale with a passing score of 86 or above. Ships most recently affected by NLV scored 96 or above out of 100 possible points in the CDC's Vessel Sanitation Program (VSP).
	The CDC established the Vessel Sanitation Program in the early 1970's as a cooperative activity with the cruise ship industry. Cruise lines and the CDC work closely together during the entire life of a ship. The CDC provides guidelines, reviews plans and conducts on-site inspections of all new ships and renovations. Cruise lines continue to work with the CDC to maintain the ship through regular inspections, crew training and passenger education.
	" The cruise industry continues to work closely with the CDC through the Vessel Sanitation Program to address and identify the incidence and control of illnesses on board ships. I am confident the cruise lines are taking all the appropriate steps within their power." David Forney, chief of Vessel Sanitation Program of the CDC.

WHAT IS THE NORWALK VIRUS (NLV)?

	NLV is a common gastrointestinal virus - only the common cold is reported more frequently. It has an incubation period of 12-48 hours and generally runs its course in about 24 - 48 hours. The patient can remain actively contagious for up to 72 hours after the symptoms have disappeared.
	Symptoms can include vomiting, diarrhea, abdominal cramps and a low-grade fever. NLV is not an upper respiratory virus such as the flu. This illness itself is not life-threatening.
	NLV is transmitted from person-to-person through direct contact, and indirectly from surfaces that are then touched by another person. NLV can also be transmitted through a food or water source. The CDC has concluded that this is not the case in the recent outbreaks but rather person-to-person transmission.
	Overall, there has been a decline in the relative number of gastroenteritis outbreaks on cruise ships. "We've seen a decline in the relative number of gastroenteritis outbreaks since 1990. It just looks like there are more outbreaks, because there are more ships and passengers at sea." Dr. Elaine Cramer, a CDC epidemiologist.
	In 2002, an estimated 7.4 million passengers will go on cruise vacations, of which less than .01% will be affected with NLV.

In summary, NLV is a very common ailment and incidents of NLV cases occur far more often in the home, office, and at school than on cruise ships. The cruise industry remains committed to providing the best vacation in terms of value, service and the comfort and care of our guests.

For more information, please visit the CDC’s Web site at www2.cdc.gov/nceh/vsp/vspmain.asp and ICCL’s Web site at http://www.iccl.org/policies/sanitation.htm.