Medjet Update: It’s Cruise Season
By: John Gobbels
The cruise ship market is the fastest-growing sector of the travel industry. The crowded, semi-enclosed environment of the cruise ship facilitates transmission of communicable disease, either person-to-person or from contaminated food, water or environmental surfaces. The stress of travel can worsen chronic conditions in specific groups, such as pregnant women and the elderly, who may be more seriously affected by infectious illnesses. Additionally, crew members who are often from developing countries that may lack routine vaccination programs, can be sources of infection for vaccine-preventable diseases.
CRUISE SHIP MEDICAL CAPABILITIES
Medical facilities on cruise ships can vary widely, depending on a number of ship and traveler characteristics. Generally, shipboard medical clinics are comparable to ambulatory care centers. Although no official agency regulates medical practice aboard cruise ships, consensus-based guidelines have been published, which cruise lines are encouraged to adopt. The Cruise Lines International Association (CLIA) represents 25 major cruise lines, accounting for more than 97% of the North American cruise lines. CLIA’s Medical Facilities Working Group developed industry-wide guidelines and recommends cruise ship medical facilities have the capability to:
- Provide emergency medical care for passengers and crew
- Stabilize patients and initiate reasonable diagnostic and therapeutic intervention
- Facilitate the evacuation of seriously ill or injured patients
CRUISE SHIP ILLNESSES AND INJURY
Cruise ship medical clinics deal with a wide variety of illnesses and injuries. Most health-related events are treated or managed on-board. However, medical evacuation and shore-side consultation, particularly for dental problems, are not infrequent.
SPECIFIC HEALTH RISKS
In recent years, outbreaks of gastroenteritis on cruise ships have increased, despite good cruise ship environmental health standards. Most cruise ship gastrointestinal outbreaks are now due to norovirus, which is also the main cause of acute viral gastroenteritis in the United States. Characteristics of norovirus that facilitate outbreaks are low infective dose, easy person-to-person transmissibility and ability to survive routine cleaning procedures.
Since travelers originate from both the Northern and Southern Hemispheres, where the influenza seasons start in October or November and April or May, respectively, shipboard outbreaks of influenza A and B can occur year-round. Outbreaks usually result from the importation of influenza by embarking passengers and crew; infection subsequently spreads person-to-person.
Cruise ship port visits may include countries where vectorborne diseases, such as malaria, dengue, and yellow fever are endemic. Yellow fever vaccination certificates may be required by some countries for entry. Although cruise lines may schedule arrival and departure times to avoid peak mosquito biting periods, personal protection is still necessary. Preventive measures include the following:
- Remaining in well-screened or air-conditioned areas
- Wearing clothes that cover ankles, legs and arms
- Using an effective insect repellent
- Antimalarial chemoprophylaxis based on a destination and activity-specific risk assessment
Other Health Concerns
Stresses of cruise ship travel include varying temperature and weather conditions, as well as unaccustomed changes in diet and physical activity. Foreign travel increases the likelihood of risk-taking behaviors as well. Deaths on cruise ships are most often due to cardiovascular events. In spite of modern stabilizer systems, seasickness is a common complaint.
PREVENTIVE MEASURES FOR CRUISE SHIP TRAVELERS
Cruise ship travelers often have complex itineraries due to multiple short port visits and potential exposures. Although most of these port visits do not include overnight stays off the cruise ship, many exotic trips have options for travelers to venture off the ship for one or more nights. Here are a few simple tips to help prevent illness when traveling.
- Wash hands frequently, using soap and water or an alcohol-based cleaner.
- Follow safe food and water precautions when eating off the ship at ports of call.
- Use personal protective measures during port visits in malaria or dengue-endemic areas.
- Use sun protection and maintain good fluid intake.
- Avoid excessive alcohol consumption.
- Avoid contact with ill people.
As always be sure to pack your Medjet card along with your bathing suit and sunscreen. It could be the best decision you make!