Why Norovirus Is So Nasty and Terrifying to Travelers

Jan. 27, 2014— -- A nasty sickness has struck again aboard a cruise ship, sending more than 600 passengers and crew on Royal Caribbean's Explorer of the Seas to their sick beds with vomiting and diarrhea.

The Centers for Disease Control and Prevention has not yet identified the mystery illness as the ubiquitous norovirus -- the most common form of gastroenteritis in the U.S., according to the CDC -- but medical experts say they suspect the highly contagious virus was the culprit.

Norovirus outbreaks are notoriously difficult to control. The virus is easily passed from person to person, spreads through food and ice, and also can survive on inanimate objects for days.

Even with scrupulous cleaning, the virus can still remain intact, according to Dr. Richard Besser, ABC’s chief medical correspondent.

“The virus is not killed by alcohol sanitizers. It survives and can be infectious on surfaces,” he said. "People who are infected will shed the virus for days after their symptoms resolve. This is a real problem for food workers on cruise ships. Lastly, if you go into a bathroom that has been used by someone who has the norovirus, you can get sick.”

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About 21 million cases of the norovirus are reported each year, resulting in about 800 deaths a year.

In 2013, seven of the nine cruise ship disease outbreaks were from the norovirus, according to the CDC's Vessel Sanitation Program, which monitors these outbreaks.

The Royal Caribbean Explorer left for a 10-day cruise from Liberty, N.J., on Jan. 21 and was headed to St. Maarten. The cruise liner said on its website that reports of illness peaked at the weekend and are now decreasing daily, but it will still bring the ship back to port two days early, on Jan. 29.

“After consultation between our medical team and representatives of the U.S. Centers for Disease Control and Prevention, we think the right thing to do is to bring our guests home early, and use the extra time to sanitize the ship even more thoroughly," Royal Caribbean said in statement. "We are sorry for disappointing our guests, and we are taking several steps to compensate them for their inconvenience.”

Before better diagnostic techniques were available, the norovirus was more commonly known as “winter vomiting disease,” said Dr. William Schaffner, an infectious disease specialist at Vanderbilt University. “We’ve seen this virus forever.”

About 80 percent of all cases of the virus occur between November and April, according to the CDC.

“This is an infection that will involve both ends of the intestinal tract and cause great distress,” Schaffner said. “The real risk with this virus is dehydration for older folks and people who are frail, or diabetics whose sugar is out of whack.

“This is the time of year the norovirus is most active,” said Schaffner. “It is a common virus that causes small clusters of infection fairly frequently among landlubbers, but when it gets into an enclosed population -- nursing homes, occasionally prisons and boarding schools and the like -- it can cause big outbreaks. ...“The doses of the virus are so small that you can just touch your mouth and get infected," said Schaffner. “The illness can come on suddenly, and vomiting is usually the first sign of the illness. If you are in the vicinity, you can breathe in an aerosol of the virus.”

The norovirus is usually brought onboard by an already infected passenger. “They may be not feeling quite well and go on a cruise to relax a day or two before they get sick,” he said. “Once that starts in an enclosed population it spreads very readily.”

Government health officials boarded the Explorer of the Seas in the Virgin Islands on Jan. 26 to assist medical teams in containing the illness, according to CDC spokeswoman Bernadette Burden.

Passengers and crew who show symptoms are also asked to “self-quarantine” until they are well again, said Burden. Cruise ship medical staff provide care, making sure passengers have plenty of fluids and food when they can tolerate it.

Schaffner said medical crew will also encourage passengers and crew to observe “good hand-washing hygiene.”

He said cruise lines have good sanitation practices in place and are well-versed in these types of medical situations.

“We had a couple of people from our medical center go on cruises,” said Schaffner. "They both told me they are more obsessive about cleaning than we are in the hospital.”

At least one travel agent said her clients seemed unfazed by these occasional outbreaks.

“It’s really nasty,” Peggy Knipp of First In Service Travel in New York City said of the norovirus. “But we haven’t seen any decrease in cruise booking. Unfortunately, it’s as common as getting a cold.”

She said people are more apt to pay attention to hand washing and may bring sanitizers in their luggage, but they don’t want to stay home.

“Today it’s in the news and for a couple of days people won’t want to book a cruise. But once it’s out of the news, they will come back to cruising.”