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Outbreaks of Viral Illness Continue On Cruise Ships

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Apr. 28--The viral illness that has dogged cruise passengers since 2002 shows no sign of declining this year, disease control experts said at a Fort Lauderdale conference on Tuesday.

Through mid-April, 11 ships have reported gastrointestinal outbreaks and seven were confirmed as caused by viruses.

The most recent outbreak was on the Holland America Line ship Amsterdam, which arrived in San Diego on April 17 with 75 passengers and 11 of the crew reporting symptoms, primarily diarrhea.

Viruses, particularly strains of the Norovirus, caused a sharp upswing in illness on passenger ships starting in 2002 when there were 13 outbreaks and continuing last year when 18 were reported to the Centers for Disease Control.

"The way it's unfolding we're looking at the same high numbers" this year, CDC specialist Dr. Elaine Cramer said Tuesday.

Cramer and other top managers of the CDC's Vessel Sanitation Program met Tuesday at Port Everglades for the program's annual meeting, attended by about 60 cruise industry and public health experts.

No one knows for sure why there are more cases of norovirus cropping up both at sea and on land. "There's more of it in the environment," said Dave Forney, chief of the program.

Norovirus causes vomiting, diarrhea, cramps and weakness but is nonfatal and usually passes within 48 hours. In addition, it is highly contagious and spreads in the confined population of a cruise ship more readily than at land-based resorts.

Still, Forney said a persistent outbreak at the California Hotel & Casino in Las Vegas has sickened more than 1,200 people since Dec. 6.

"The hotels out in Las Vegas are right now where you were two years ago" in learning how to limit spread of the disease, Forney told the group.

Cruise lines have developed systems for cleaning ships, disinfecting cabins and quarantining sick passengers. Some bundle linens from isolated cabins in special self-dissolving bags so they don't have to be opened by laundry workers before washing.

The most severely soiled bedsheets are incinerated, cruise officials said.

Cruise lines have begun to focus on preventing passengers who are already sick from boarding their ships. But it isn't easy, Forney said. "Some passengers are coached by travel agents not to report illnesses," he said. Sick passengers and their companions are typically isolated while they're sick and up to 48 hours after symptoms disappear.

Viruses have supplanted bacteria as the leading cause of stomach illness on ships. They tend to spread by person-to-person contact, rather than in food and water, as bacterial illnesses traditionally do. The CDC last year inspected ships about 250 times for problems that lead to food- and water-spread disease. About 6 percent failed, compared to about 15 percent five years ago.

"As environmental health prevention has improved, we're seeing fewer bacterial outbreaks," Cramer said.

The most often seen bacteria is enterotoxigenic E. coli, which is associated with Third World water bunkering or land excursions, Cramer said. That remains a concern, especially for the old, the very young, or those with immune system problems.

"With E. coli, kids will die," Forney said.


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