Illness at sea, on land

Just because you haven't been on a cruise lately doesn't mean you are safe from the norovirus

December 15, 2006|By Martha Brannigan | Martha Brannigan,McClatchy-Tribune

Cruise ships are getting a tidal wave of bad publicity from norovirus -- including back-to-back outbreaks on voyages of Royal Caribbean's Freedom of the Seas, the world's largest cruise ship.

Drowned out amid the recent spate of outbreaks is that the stomach bug is hitting hard on land these days, too. It's probably on a doorknob or handrail near you.

The Centers for Disease Control and Prevention in Atlanta say the norovirus family of viruses seems to be on the rise lately, though it has data only for cruise ships and food-borne outbreaks. Cruise ships are required to log gastrointestinal incidents, and the CDC gets involved when outbreaks strike at least 2 percent of the passengers or crew.

"Informal reports suggest there has been an increase in norovirus outbreaks around the country," said Dr. Marc-Alain Widdowson, a CDC medical epidemiologist. "It's not a cruise-ship virus. Cruise ships are just sentinels of what's happening on land."

Most cases of noncruise norovirus stay under the radar because the illness doesn't have to be reported to health officials on an individual basis. Victims typically get miserably sick -- symptoms include nausea, vomiting, diarrhea, cramping and chills -- for a day or two, then recover, although the virus can kill the elderly and frail.

Generally, the bug gets the spotlight only when it shows up in a group setting -- such as a cruise, a nursing home, a school or a restaurant.

Case in point: The Dinosaur Bar-B-Que in Syracuse, N.Y. At the popular biker bar and restaurant, about 960 patrons were hit during the busy Thanksgiving weekend. The hangout was shuttered for four days while workers gave it a thorough washing.

Around Roanoke, Va., seven nursing homes and assisted-living centers, a doctor's office and a high school sports team have been hit in recent weeks.

South Dakota's state Health Department took the unusual step of issuing a norovirus warning Dec. 4. "Since Thanksgiving, we've been seeing an increase in nursing homes in the state and outbreaks associated with parties, such as wedding parties," said Dr. Lon Kightlinger, the state's epidemiologist.

Public health officials in Oregon and California and the Food and Drug Administration are recalling certain frozen oysters shipped from Central Fisheries Co. in Korea after a batch tested positive for norovirus.

Named after Norwalk, Ohio, where the first known outbreak was documented at an elementary school in 1968, the virus is unusually hardy. It can also be spread on surfaces such as doorknobs, countertops, paper or glass, and it takes only a few viral particles to wreak havoc. It can be ingested through aerosolized vomit, too, experts say.

Norovirus used to be called winter vomiting disease, because it seems to favor cold weather, when people crowd indoors.

"It's very common, and when you get it in a closed society like a cruise ship or a nursing home or a prison, it's very easy to spread back and forth," said Dr. Roberta Hammond, Florida's food and waterborne diseases coordinator.

Hand-washing with soap and water is the best defense against contracting it from surfaces. Health officials say alcohol gels won't purge it.

This is a particularly active year for norovirus aboard cruise ships. The CDC has logged outbreaks of norovirus-like illness on 33 cruises, compared with 18 cruises during 2005.

The most recent case was reported Monday. Holland America's Zaandam, which arrived in San Diego, logged 64 passengers and four crew members with symptoms.

"Noroviruses love cruise ships. There's lots of available food handled by lots of people. There are tongs and ice," said the CDC's Widdowson.

After 338 passengers and 43 crew members took ill on the Nov. 26-Dec. 3 voyage of Freedom of the Seas, Royal Caribbean scrubbed the ship. CDC experts boarded Dec. 3 to conduct an epidemiological and environmental health investigation of the outbreak.

Yet on her next voyage, 97 of the 3,907 passengers and 11 of the 1,400 crew showed gastrointestinal symptoms matching norovirus. Another ship, Princess Cruises' Sun Princess, which arrived in Port Everglades, Fla., on Sunday, logged 119 cases of norovirus.

Now the Freedom of the Seas is taking extra precautions. At the urging of the CDC, the ship's voyage was delayed two days so an extra team of cleaners could disinfect the ship.

Health officials say the key is keeping sick people isolated from others, and most importantly, away from food and beverages that others will eat.

Michael Sheehan, a spokesman for Royal Caribbean, said passengers who get norovirus during a cruise get credits for days spent isolated in cabins. Medical consultation is free in cases of norovirus.

Passengers who call ahead to cancel claiming the sickness are handled on a "case-by-case basis," Sheehan said.

Jennifer de la Cruz, a spokeswoman for Carnival Cruise Lines, which saw a big outbreak of the bug in November on a trans- atlantic crossing of the Liberty, said if a passenger cancels because of norovirus-like symptoms, the line will credit toward a future cruise with medical documentation.

If a passenger shows up at port ready to embark on a cruise and admits being ill, she said, "We'll give them full credit for a future cruise, so there's no downside."

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