Our Mediterranean itinerary took us to the great cities of Venice, Rome, Florence and Barcelona, as well as two bustling Sicilian towns and a few sleepy Greek islands. In the old days, shore excursions were quick shopping trips and then back to the ship. But our favorite shore excursion was a full day guided tour called "Roman Holiday," following in the footsteps of the classic movie starring Audrey Hepburn and Gregory Peck.
From historical sites like the Coliseum to the gelato shop made famous in the film, we got to experience Rome up close and personal. The "Roman Holiday" excursion cost $230 and included a wonderful four-course lunch in an exquisite villa-turned-restaurant.
Customized excursions are also available, and most cruise lines now offer assistance in booking these day trips when you book your cruise. Crystal Cruises, a luxury cruise line, is leading a new trend, the overnight excursion, in which passengers can get off the ship in one port, spend a few days on land sightseeing and then meet up with the ship at the next port. Another twist on the excursion is Princess Cruises' "Ultimate Ship Tour," which offers a behind-the-scenes look at the inner workings of the ship, for $150 per person.
This spring, a number of cruise ships were forced to cancel stops in Mexican ports because of swine flu outbreaks on shore. In May, the Cruise Lines International Association, working with the Centers for Disease Control and Prevention and the World Health Organization, adopted new standardized screening protocols to detect swine flu. Before boarding any association ship, anywhere in the world, passengers who are already quizzed about Norovirus symptoms will now be required to complete and sign a questionnaire about swine flu as well.
People who report flulike symptoms are then screened by medical personnel who decide on a case-by-case basis whether to permit that person to board the ship. Passengers who become sick at sea with possible flu symptoms are isolated from other passengers and cared for by the ship's medical team. All association ships have medical staffs and protocols that comply with the CDC's Vessel Sanitation Program and were designed with the American College of Emergency Physicians for emergency care, medical treatments and evacuation of seriously ill or injured passengers.
Dr. Ronald Primas, medical director of TravelMD.com, has treated more than 100 travelers with the H1N1 virus in his New York City office this summer, but he's quick to point out they were all air travelers. Primas believes there's no health reason to cancel a cruise but encourages passengers to take common sense precautions.
"Cruise ships are enclosed environments, so the risk is somewhat higher of getting a respiratory illness. It's going to spread more easily," he warned.
He reminds travelers not to forget the basics: Move away from anyone who is sneezing or coughing. And, most important, wash your hands. "Since the cruise ships have implemented hand sanitation stations all around the ship, the number of respiratory illnesses have declined steadily."