Advice for Those Going on Cruises
On 12th March 2020 the Foreign & Commonwealth Office advised against all cruise ship travel, particularly for people aged 70 and over and those with underlying health conditions. This followed a number of cruise ships around the world being locked down due to COVID-19 outbreaks on board. Further information is available from the Foreign & Commonwealth Office website.
Cruise ship holidays remain popular, with passenger shipping industry estimates showing that in 2018, 27 million travellers will choose a cruise ship holiday. The average age of a passenger is gradually declining, now 45-50 years of age, however cruises, particularly those of a longer duration, attract older travellers, a group more likely to have chronic health conditions such as heart and lung disease. The most commonly reported on board health problems are respiratory tract infections, injuries, motion sickness and gastrointestinal illness. The relatively closed and crowded environment of a ship can facilitate the spread of disease among passengers and crew members, with Port visits having the potential to lead to exposure to infectious diseases, which may also be transmitted to the home communities of disembarking passengers and crew members.
The schedule of events and activities on board, and excursions in port can be tiring and arduous and travellers are advised to be as fit as possible prior to embarking on a cruise. Passengers with chronic health conditions should consult with their specialist physician or travel clinic to discuss their health and suitability for cruise ship travel.
The supply of medicines on board is limited and it is important that individuals bring their own regular medications with them, enough to cover at least the duration of the trip. It is also useful to bring a copy of any current repeat prescriptions. All cruise ships have a medical department; the number of medical staff is dependent on the number of passengers and crew. Primary and emergency care is provided, but there is no fully equipped hospital for in-patient care. The medical service on a ship is private so passengers will be charged for consulting a Doctor or nurse and for any subsequent treatment or medication issued. Seriously ill or injured passengers (and crew) are evacuated off the ship either by helicopter, or at the next available port. This is worth considering when choosing the type of cruise and destinations to be visited.
Having appropriate travel insurance is very important and this should cover repatriation – it is estimated that a helicopter evacuation from a ship costs approximately £6000.
Complicated vaccination schedules are usually unnecessary unless overnight stays on shore are anticipated. You should attend a pre travel consultation 6 – 8 weeks prior to departure where possible. All the destinations and potential activities during the trip will be explored, therefore it is important to take details of your cruise itinerary to the consultation.
Flu is a recognised problem on cruises where large numbers of people are living in close proximity. Vaccination should be considered especially for the elderly and others with underlying medical conditions. For these groups pneumococcal vaccine may also be considered if not received previously.
Determining the risk of yellow fever or necessity for a yellow fever vaccination certificate can be tricky for cruise travel. During the risk assessment the travel health specialist will need to consider all countries to be visited, and importantly, the order in which they are visited. The mosquito that spreads yellow fever bites during the day, so day excursions in risk areas may necessitate vaccination. In addition, even if not at risk of yellow fever during port calls, there may be a yellow fever vaccination certificate requirement. Taking a detailed itinerary with you to the pre-travel health consultation will greatly help your health practitioner advise you.
Cruise ship companies sometimes have requirements that differ from those of the country to be visited, so be sure to check the recommendations of the cruise line also. Unvaccinated passengers going to risk areas may not be allowed ashore. In high risk yellow fever areas disease may be a risk for those venturing into rural and jungle areas but is unlikely to be contracted by those staying on board.
Where there are multiple destinations, each port must be assessed in turn for malaria risk. The malaria risk is normally very small in ports of Central and South East Asia, and South and Central America (with the possible exception of Manaus in Brazil where urban outbreaks sometimes occur).
Overnight exposure is unusual (as the ship is normally back at sea) therefore many cruise travellers will not need antimalarial chemoprophylaxis although advice on awareness of risk, avoidance of mosquito bites, and prompt diagnosis of fever will still be required.
The risk of malaria may be significant when entering ports in infected countries in sub-Saharan Africa especially if berthed overnight. Your healthcare practitioner can advise you on whether antimalarial tablets are needed.
Mosquito bites should be avoided not just to reduce the risk of malaria but of other diseases such as dengue fever and zika virus. Accommodation on cruise ships is usually excellent with air-conditioning and well screened lounges and bars etc.
Passengers should always be aware when they may have been exposed, however small the risk, so that they can seek medical attention should any fever occur.
Gastroenteritis is a risk due to the very close proximity of passengers. The risks can be reduced by strict personal hygiene measures such as regular hand washing and the use of alcohol gels.
It is essential to report any episodes of diarrhoea or vomiting immediately to the medical team on board to help prevent onward transmission to other passengers and crew.
Norovirus is a major cause of acute gastroenteritis and diarrhoea.
- Norovirus circulates widely in the population and outbreaks can occur in semi closed communities such as on a cruise ship.
- Usually spread from person to person or from contaminated surroundings.
- Infection is spread easily.
- Once infected symptoms usually occur within 15 to 48 hours.
- Symptoms include vomiting, diarrhoea, nausea and stomach cramps.
- Vomit is highly infectious and can contaminate the environment creating an infection risk for others.
- Risk of transmitting norovirus is highest during early phase of illness and becomes less after 48hours.
- Illness is more serious in the elderly or those with pre-existing disease.
- There is no specific treatment other than relief of symptoms and rehydration.
- Prevention of onward spread is very important and ships have strict protocols on prevention and the treatment of those affected.
- Promotion of scrupulous personal hygiene and isolation in own cabin until clear of symptoms for 48 hours will be advised; some cruise companies will also isolate the cabin companion.
Historically ships have been one of the safest forms of transport due to strict international security regulations.
- Foreign and Commonwealth Office advice should be reviewed for each destination on the itinerary.
- Falls are a frequent cause of injury on ships, decks and stairways can be wet and slippery. Care should be taken partially during rough seas. Suitable footwear is advised.
- Piracy at sea has been around for many years it is important to be reassured that shipping companies have very extensive plans to prevent boarding by pirates when cruising near areas of high risk.
Travellers can be exposed to extremes of heat and cold depending on itineraries. Suitable clothing is advised. Sun exposure may be under estimated on a ship especially with the cooling effect of sea breezes. Protective measures such as covering up and the use of a high factor sunscreen are advised.
Increased alcohol can result in risk-taking behaviour, increasing the risk of sexually transmitted infections. Moderation of alcohol and safe sex practices are advised.