Avoiding Cabin Fever

How to Stay Healthy Aboard a Cruise

Lady Macbeth had her share of problems, but at least she'd have had a decent shot at staying healthy on a cruise. According to industry experts and public health officials, the surest-fire way to keep from becoming sick -- on land or at sea -- is to wash your hands pretty much constantly.

"I've been on 109 cruises now," says Stewart Chiron, a cruise-taking expert who calls himself the Cruise Guy. "Thankfully, I've never been sick." The Cruise Guy's secret? "Wash your hands."

For the record, you're no more likely to catch an infectious illness on a cruise ship than you would be if you were stuck with the same 3,000 people for a week in another setting: a hotel, for instance, or a desert island. You hear about cruises beset by widespread vomiting and diarrhea because cruise ships are required to report incidents of gastrointestinal (GI) illness to the U.S. Centers for Disease Control and Prevention (CDC). Hotels and desert islands are bound by no such regulations.

The prime culprit among the various illness-causing agents that make their presence known on cruise ships is the norovirus (formerly known as the Norwalk-like virus), a highly transmissible pathogen that swiftly causes victims to expel nasty stuff out of both ends. Mercifully, the illness norovirus causes lasts only a day or two, though victims remain contagious for up to two weeks after symptoms have passed. Of the 17 outbreaks of GI illness on cruise ships reported in 2005, all but five were attributed to norovirus; only one stemmed from salmonella contamination.

Knowing all this can help you arm yourself against the enemy. Here are some stay-healthy tips, compiled after conversations with David Forney, chief of the CDC's Vessel Sanitation Program; Michael Crye, president of the International Council of Cruise Lines; and Oivind Mathisen, editor of Cruise Industry News.

· Wash, wash, wash . . . The CDC, on the Web site of its Vessel Sanitation Program ( http://www.cdc.gov/nceh/vsp ), names hand-washing as the first and best defense against onboard illness. So strong is the agency's espousal of the practice, it even offers instructions on doing it right (see box, at right). Hand-washing can protect against a wide range of disease-causing viruses and bacteria.

· . . . .and then sanitize. Carry a little bottle of alcohol-based hand sanitizer in your pocket, and use it frequently. Most cruise ships have dispensers of hand sanitizer mounted all over the place. Use them whenever you pass one, even if you've just washed your hands.

· Hands off! Okay, it's gross to think about this, but everywhere you're tempted to put your hands -- staircase handrails, elevator buttons, poker chips, doorknobs -- is likely to have been touched by someone who just sneezed into his hands -- or worse. Don't touch that handrail. Use your knuckle to press the elevator buttons (and then be careful not to use the same knuckle to scratch your nose). Keep your hands away from your face, especially when handling poker chips, gambling tokens or money; wash up when you're finished playing. Use a paper towel when you turn a doorknob, then throw the towel in the nearest wastebasket. David Forney of the CDC recommends that cruisers planning to travel as a group agree beforehand to police one another, issuing reminders when one of them sees another putting fingers near their face.

· When you hear that telltale splat, scram! One of norovirus's most charming attributes is that the upchucking and diarrhea it causes tend to strike with urgency. All too often, folks are feeling just fine until, suddenly, they're sick, sometimes quite publicly. If you see this happening, overcome your compassionate urges and get the heck out of Dodge. (Same goes for finding a mess in a bathroom. Get out now!) Those disgusting puddles are teeming with norovirus; if you're nearby, you're likely to ingest the virus (of which it takes only a tiny bit to do harm). Twelve to 48 hours later, you're the one retching on deck.

· Beware of swim diapers. The CDC forbids kids who aren't potty-trained to use onboard pools; even those sturdy swim diapers won't protect clean water against an infected bowel movement. But it's hard for some parents to accept that their wee one's not allowed in the water, so it's wise to keep your eyes peeled for scofflaws. If you see a kid in a swim diaper (or, much worse, a regular one), bail out, fast.

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If, despite your vigilance, you end up sick, do your fellow passengers a favor: Report your illness to your cabin steward or visit the onboard medical center. Fair warning: There's not much they can do to remedy norovirus illness. They might give you an electrolyte beverage to ward off dehydration, but there's no treatment for norovirus except to let it run its course. (If it were caused by bacteria, antibiotics might help. But it's not, so don't even ask for them.)

You'll be asked to keep to your cabin for a day or two, which is all you'll probably feel like doing anyway. But by checking in, you give notice that the virus is onboard; when a certain percentage of passengers and crew turn up sick, cruise staff put in place extra precautions to help contain the outbreak.

Check with your health insurance carrier before you embark to be sure your policy will cover medical services rendered onboard (or in port). And consider taking out extra travelers' insurance to cover a really big health emergency that would require your being transported by helicopter from ship to shore; folks with preexisting or chronic illnesses are more likely than others to need such coverage, but bad things can happen to anyone.

Just for fun, you might want to check the CDC's Vessel Sanitation Program Web site before you sail to read the latest inspection report for the ship you'll be on; you can also check the ship's history of GI outbreaks and their causes.

But even if your ship scores a perfect 100 (the site lists those stellar performers, too), don't let your guard down. It just takes one sick passenger with less-than-perfect hygiene habits to bring even the most sanitary ship to its knees.

Have we mentioned that you should wash your hands a lot?