Like many others preparing for a cruise and hoping to stave off stomach ailments, I packed liquid hand sanitizer, Clorox wipes, antacid, and Imodium pills.
Before boarding, I wasn't surprised when I had to fill out a form asking about recent gastrointestinal ailments. I was surprised, though, to discover that passengers and crew from the previous week's voyage had contracted a norovirus, a common cause of stomach flu symptoms, and that extra measures were being taken to prevent its spread.
Our first day was an initiation into high-level sanitation. It was impossible to enter a dining area without using the hand sanitizer at the entrance. There were no self-serve buffets, and there were lines at coffee, tea, and water stations as gloved waiters served the drinks. Tables and chairs were wiped down as passengers left, and salt and pepper came in packets, not shakers. Playing cards were tossed out and fresh decks made available.
Our captain made several announcements, informing us of the symptoms we were to watch for - nausea, vomiting, and diarrhea. We were told what to do if they occurred, and that there would be no fees for medical care provided to those with stomach ailments. Although those who came down with the highly transmittable virus would be confined to their cabins, room service and other necessities would be provided.
Throughout the week the staff continued to wipe down surfaces. At night crew members with tanks of disinfectants on their backs sprayed doors and carpets. In port, hand-sanitizer dispensers were positioned outside the ship and at each pier.
Passengers worried that they would contract the virus. Some confronted anyone reaching for food at the buffet rather than waiting to be served. Others advised using our knuckles when pressing the elevator buttons so as not to get germs on fingertips that might then touch our faces.
But at times, concern bordered on paranoia. When a couple canceled a reservation at the specialty restaurant, they were asked about their health by the maitre d' and told they would be contacted by the medical staff to be certain they weren't sick. And on our day for a barbecue at a private island, a second ship scheduled to share the day with us sailed away as we drew near.
While no new cases were reported on our cruise, norovirus has interfered with many vacations. Gloria Cataldo of Waltham said she and her husband, John, contracted it on a February cruise through the Panama Canal.
"My husband was quarantined for 24 hours, but when I contracted it, I was quarantined for 48 hours. I don't know why there was a difference," Cataldo said. "We were offered whatever we wanted for room service, but I didn't feel like eating or anything, just lying in bed. After two days, I felt great again."
The Cataldos' cruise line, Holland America, reimbursed each of them $100 a day for the time they were confined to their cabin.
Ellie Glassman of Delray Beach, Fla., said she and her husband, Herb, were part of a group of 130 people on a Mediterranean cruise. About a third of their group contracted the virus, the Glassmans among them.
"Before we were sick, a number of people had nausea and symptoms of norovirus. They seemed to have self-treated, but if they had gone to the ship's hospital and been isolated, maybe others of us wouldn't have gotten sick," she said, adding that they gave her and her husband $100 a day credit for the days they were confined toward a future cruise.
Learning about norovirus is the best way to protect yourself. Commonly called a stomach bug, it usually runs its course in a couple of days, but it can become serious for some people, which is one reason it is monitored so closely.
The Centers for Disease Control estimates 23 million Americans - one in every 12 people - contract the virus each year. Yet only 3,600 people out of the 9 million cruise passengers sailing from US ports last year contracted it.
According to Lisa Beaumier, a public health analyst with the CDC, reports of outbreaks on cruise ships attract attention because "only cruise ships are required to report cases of gastrointestinal illness to the CDC."
Representatives for Carnival, Princess, Royal Caribbean, and Holland America say that the virus is brought aboard ship, most often by traveling passengers who pick it up on airplanes or in hotel rooms where sanitation regulation is not so strict.
While Carnival Cruise Lines does not compensate sick passengers, all guests are notified before boarding and may change to a later sailing at no penalty, a policy recommended by the CDC.
The CDC requires all ships carrying 13 or more passengers to report incidents of gastrointestinal illness as soon as they occur. If more than 3 percent of passengers and crew develop such an illness, the ship is listed at the Vessel Sanitation Program area on the CDC website (cdc.gov/nceh/vsp).
So far in 2007, 17 cruise ships representing 10 cruise lines have been listed. Last year, 34 ships from nine cruise lines were listed.
The bottom line for passengers: Wash your hands.
Susan Klibanoff is a freelance writer in Waltham.
