cruise ship returns with covid cases

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A cruise ship returns to Miami with 48 coronavirus cases.

The Royal Caribbean International ship, carrying more than 6,000 people, made stops that included St. Maarten and St. Thomas before returning to Miami on Saturday.

By Johnny Diaz

• Dec. 20, 2021

Dozens of passengers and crew members aboard a Royal Caribbean cruise ship tested positive for the coronavirus last week, according to the cruise line.

Royal Caribbean International said in a statement that the ship, the Symphony of the Seas, was carrying more than 6,000 guests and crew members when 48 people onboard tested positive.

The ship departed on Dec. 11 for a seven-night Caribbean cruise and returned to port in Miami on Saturday, the company said.

The cases were identified because of contact tracing after a guest tested positive, the cruise line said.

“Each person quickly went into quarantine,” the statement said. “Everyone who tested positive was asymptomatic or mildly symptomatic, and we continuously monitored their health.”

The cruise line said that the ship sailed with 95 percent of its guests aboard fully vaccinated and that 98 percent of the people who tested positive were fully vaccinated. It was not immediately clear whether any of the people who tested positive had received a booster shot of a Covid-19 vaccine.

Royal Caribbean requires travelers 12 and older to be fully vaccinated against Covid-19 and test negative before boarding the ship. Children who are not yet vaccinated must provide a negative P.C.R. test result before sailing and test negative at the terminal before boarding.

The company said that all its crew members were full vaccinated against Covid-19 and were tested weekly.

During the early days of the pandemic in 2020, outbreaks on cruise ships sickened hundreds of people and upended the tourism industry, as officials and companies struggled to keep crews and passengers safe.

For months , cruise ships were barred from sailing to many ports. Even after vaccinations became more widely available in the United States in April, allowing much of the travel industry to ramp up again, cruise ships remained docked in ports, costing the industry billions of dollars each month.

The cruise industry rebounded in the summer, with many companies reporting an increase in bookings and a better handle on Covid-19 protocols.

But a recent spike in coronavirus cases in parts of the United States and Europe and growing concerns over the Omicron variant may hinder that momentum .

This month, at least 17 coronavirus cases were identified on a Norwegian Breakaway cruise ship that docked in New Orleans, including a case of the new Omicron variant.

Johnny Diaz is a general assignment reporter covering breaking news. He previously worked for the South Florida Sun Sentinel and The Boston Globe. More about Johnny Diaz

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There's COVID-19 on nearly every cruise ship right now: Here's what cruisers need to know

Things are getting iffy again for cruisers -- at least for those with near-term bookings.

The ongoing surge in COVID-19 cases around the world is causing a growing number of disruptions to itineraries and even some last-minute cancellations of entire voyages.

The number of passengers being quarantined on ships (after testing positive for COVID-19) also is on the rise. And passengers who aren't COVID-19 positive are getting caught up in short-term quarantines for being "close contacts" of shipmates who are.

For more cruise guides, tips and news, sign up for TPG's cruise newsletter .

Meanwhile, just getting to ships is becoming increasingly stressful, as getting the pre-cruise COVID-19 test that's often required before cruising is getting more difficult . Plus, a "perfect storm" of soaring COVID-19 cases and rough winter weather has wreaked havoc with airline operations for weeks.

Still, the situation isn't anywhere near as dramatic or disruptive as what we saw at the start of the COVID-19 pandemic two years ago, when whole ships were being quarantined due to outbreaks of the illness and, eventually, the entire industry shut down.

As I saw myself during a cruise to Antarctica in recent weeks, many sailings are operating relatively normally, even when there are COVID-19 cases on board.

Here's a look at everything you need to know if you've got a cruise booked in the coming weeks -- or further out.

COVID-19 cases on ships are up a lot

While cruise ships have recorded relatively few cases of COVID-19 over the past year, in part due to unusually strict health protocols , the number of passengers and crew testing positive on ships has been rising sharply in recent weeks along with the greater surge on land.

At the end of December, the U.S. Centers for Disease Control and Prevention reported that 5,013 COVID-19 cases had been reported on cruise vessels operating in U.S. waters during the last two weeks of the month, up from just 162 cases during the first two weeks of the month.

That's a 3,094% increase.

Anecdotal reports are that the number of cases on ships is up even more in the first 10 days of the new year.

Notably, all 92 cruise vessels currently operating in U.S. waters have recorded at least a handful of COVID-19 cases in recent weeks, according to CDC data.

Still, it's important to note that most of these "cases" of COVID-19 are asymptomatic or mild, only discovered during routine testing. While some ships only are testing passengers who report feeling ill for COVID-19 (and close contacts of those who subsequently test positive), other ships are testing every single passenger at least once per voyage, sometimes more. One line, Viking , is testing every single passenger for COVID-19 every day.

Cruise lines also are testing all crew members regularly.

The result is the detection of many asymptomatic cases that otherwise would have gone undetected. This is a level of surveillance that is much greater than what is the norm for other travel venues such as land-based resorts or theme parks, and it can give the false impression that the positivity rate for COVID-19 on ships is unusually high as compared to other places.

If anything, the positivity rate is far lower on ships than on land, thanks to much stricter health protocols (more on that in a moment).

It's also important to note that the detection of COVID-19-positive passengers or crew on board your ship won't necessarily impact your sailing (unless you are among those testing positive).

Health authorities no longer are quarantining whole ships when a few -- or even a lot -- of passengers and crew test positive for COVID-19. The current protocol on most ships is to isolate COVID-19-positive passengers and crew but otherwise continue on with voyages as planned.

Your itinerary could change

While health authorities no longer are quarantining whole ships when a few passengers or crew test positive for COVID-19, the presence of the illness on board a vessel still could result in notable disruptions to your itinerary.

Cruise lines in recent weeks have faced a growing number of ports that are balking at allowing ships with COVID-19-positive passengers or crew to dock.

Several ships recently had to skip port calls in Mexico , for instance, after passengers and crew on board the vessels tested positive for COVID-19. The ports have since reopened after Mexico's Health Department overruled the decisions of local port officials.

Cruise ships also have had to cancel stops recently at the islands of Aruba, Bonaire and Curaçao, and at San Juan, Puerto Rico, due to local worries about COVID-19-positive passengers and crew on board and/or tighter COVID-19-related entry requirements.

Lines also are dealing with a small but growing number of destinations -- India and Hong Kong, for example -- that are at least temporarily closing to cruising completely, even for ships where no one has tested positive for COVID-19.

Viking on Sunday was forced to announce a major revision of its soon-to-begin, 120-day world cruise after India notified the line it was closing to cruise ships. Viking's 930-passenger Viking Star will begin its world cruise this week by heading south from Los Angeles to Central America and South America instead of sailing westward toward Asia, where it was scheduled to spend a significant amount of time in India.

Your cruise could be canceled on short notice

A growing number of cruise lines are canceling sailings on short notice, citing the disruptions caused by COVID-19. The world's largest cruise operator Royal Caribbean on Friday canceled soon-to-depart sailings on four of its 25 ships, including the next three departures of the world's largest ship, Symphony of the Seas .

Norwegian Cruise Line on Wednesday canceled soon-to-depart voyages on eight of its 17 ships.

Other lines canceling one or more sailings in recent days include Holland America , Silversea , Atlas Ocean Voyages, Regent Seven Seas Cruises, MSC Cruises , Costa Cruises and Oceania Cruises .

The cancellations come as lines struggle to maintain adequate staffing levels on some ships due to crew members testing positive. When crew test positive, they and their close contacts must stop working and isolate, even if asymptomatic, leaving shipboard venues short-staffed.

You probably won't be quarantined, stranded or stuck

As noted above, health authorities no longer are quarantining whole ships when a few -- or even a lot -- of passengers and crew test positive for COVID-19.

The current protocol on most ships is to quickly isolate COVID-19-positive passengers and their close contacts. But only the COVID-19-positive passengers are being isolated long term.

As my colleague Ashley Kosciolek experienced first-hand on a cruise in 2021, close contacts only are being isolated for a short period while they are tested for COVID-19. If they test negative, they typically are allowed out of their rooms to rejoin the rest of their fellow cruisers on board.

This means that many sailings are going ahead as planned, with little disruption, even when some passengers and crew on the trips test positive for COVID-19. I experienced this myself in late December when on a Silversea vessel where four passengers tested positive for COVID-19. Some passengers who were deemed close contacts of the passengers who tested positive were isolated for a short period while being tested for COVID-19. But the positive cases had little impact on most of the passengers on board the vessel, and the voyage went ahead as planned.

Such a protocol comes at the recommendation of the CDC, which has set guidelines for how cruise lines should respond to COVID-19-positive cases on board ships, and it has worked well for the past year .

Of course, if you do test positive for COVID-19 on a ship, you will, unfortunately, face what could be several days of isolation in a cabin on a ship or on land. If you are an American cruising overseas, you also won't be able to return to the U.S. until you have tested negative for COVID-19 (or until you recover from the illness and are cleared in writing to travel by a licensed healthcare provider or a public health official).

This is one of the biggest risks of taking a cruise right now, and one reason you may consider canceling a sailing scheduled in the short term (see the section on more-flexible cancellation policies below).

Most COVID-19 cases on ships aren't serious

Cruise lines are reporting that the vast majority of passengers testing positive for COVID-19 in recent weeks are asymptomatic or have mild symptoms.

All major cruise lines currently are requiring all or nearly all passengers to be fully vaccinated for COVID-19, with some also starting to require booster shots , to boot. This creates an onboard population that is far less likely to experience serious symptoms of COVID-19 than a cross-section of people on land, according to CDC data.

For all adults ages 18 years and older, the cumulative COVID-19-associated hospitalization rate is about eight times higher in unvaccinated persons than in vaccinated persons, according to the latest CDC data.

You'll face lots of new health protocols

If you haven't cruised since before the pandemic, you might be surprised by how many new health- and safety-related policies cruise lines have implemented to keep COVID-19 off ships.

For starters, there are the vaccine mandates noted above. No other segment of the travel industry has been as uniform in requiring almost every customer to be fully vaccinated against COVID-19.

Related: Will I need a COVID-19 vaccine to cruise? A line-by-line guide

As noted above, cruise lines also are requiring passengers to undergo COVID-19 tests before boarding ships -- a screening process that is keeping many COVID-19 positive people from ever stepping on board a vessel.

When COVID-19 is detected on a ship, cruise lines sometimes then test passengers multiple times to ensure it isn't spreading. On my recent trip to Antarctica, I underwent six COVID-19 tests in just eight days -- three in advance of stepping on board the vessel (including a PCR test required by Chile, where my trip began) and three while on board.

In addition, most cruise lines now are requiring passengers to wear masks at all times while in interior spaces of vessels, and they have stepped up cleaning regimens, improved air filtration systems on ships and made other onboard changes.

The CDC says to avoid cruising for now

On Dec. 30, the CDC added cruise ships to its list of "Level 4" destinations you should avoid visiting for now due to high levels of COVID-19.

For what it's worth, more than 80 countries around the world -- including a good chunk of all the places you might want to travel -- are on this list. So, the CDC is basically telling you that now isn't a good time to travel. Fair enough. But the warning shouldn't be seen as a call-out on any elevated risk to cruising as opposed to visiting other places, per se.

Places on the Level 4 list currently include Canada, much of Europe and nearly every country in the Caribbean.

The cruise industry has been highly critical of the designation, arguing that cruise ships are far safer places to be right now than almost anywhere else, given their strict health protocols.

"The decision by the CDC to raise the travel level for cruise is particularly perplexing considering that cases identified on cruise ships consistently make up a very slim minority of the total population onboard — far fewer than on land — and the majority of those cases are asymptomatic or mild in nature, posing little to no burden on medical resources onboard or onshore," the main trade group for the industry, the Cruise Lines International Association, said in a statement to TPG.

You can cancel if you're worried (in many cases)

If you're booked on a cruise in the coming weeks, and you're having second thoughts, there's a good chance you can get out of your trip. Many lines continue to be far more flexible than normal about cancellations.

Take cruise giant Carnival Cruise Line . Its current flexible cancellation policy allows passengers to cancel as long as a public health emergency remains in effect and receive 100% of the cruise fare paid in the form of a future cruise credit. Passengers are also able to cancel if they test positive for COVID-19. (Proof of a positive test result is required.)

Another large line, Norwegian, just last week extended its pandemic-era Peace of Mind policy to allow passengers to cancel any sailing taking place between now and May 31. For now, the cancellation needs to be done by Jan. 31, and the refund would come in the form of a future cruise credit to be used on any sailing that embarks through Dec. 31.

That means you could call the line right now to back out of a cruise that is just days away. In normal times, you'd lose all your money if you backed out of a seven-night Norwegian cruise with fewer than 31 days' notice.

Planning a cruise? Start with these stories:

• A beginners guide to picking a cruise line
• The 5 most desirable cabin locations on any cruise ship
• The 8 worst cabin locations on any cruise ship
• A quick guide to the most popular cruise lines
• 21 tips and tricks that will make your cruise go smoothly
• 15 ways cruisers waste money
• What to pack for your first cruise

COVID-19 Spreads to 89 Cruise Ships, Prompting a U.S. CDC Investigation

T he U.S. Centers for Disease Control and Protection identified 89 cruise ships with COVID-19 cases on Tuesday, nearly all of which have met the threshold for a formal investigation.

Democratic Senator Richard Blumenthal urged cruise companies and health agencies to stop ships from sailing, saying they are “repeating recent history as petri dishes of Covid-19 infection.” Operators such as Carnival Corp. have implemented safeguards including mandatory masking and proof of vaccination, but the fast-spreading omicron variant has triggered an increasing number of infections and reports of ships being turned away at ports.

“Time for CDC & cruise lines to protect consumers & again pause—docking their ships,” Blumenthal said in a tweet.

Roger Frizzell, a spokesperson for Carnival, said in an email that “our health and safety protocols put in place have proven to be effective time and time again over the past year with our sailings being restarted across each of our brands.”

Of the 86 cruise ships under investigation by the CDC, Carnival operates 32, Royal Caribbean Cruises Ltd. operates 25 and Norwegian Cruise Line Holdings Ltd. operates 15. Four ships operated by Walt Disney Co.’s Disney Cruise Line are now also under watch, according to the CDC website. The list is rapidly changing and the next stage for ships with outbreaks could involve taking additional public health measures.

Royal Caribbean, Norwegian, Disney Cruise Line and Viking Cruises didn’t immediately respond to requests for comment.

More from TIME

“Health and safety is the cruise industry’s highest priority,” said Bari Golin-Blaugrund, a spokesperson for the Cruise Lines International Association trade group, in an email. “In fact, the latest data show that cases have occurred less frequently on cruise ships than on land, with a greater proportion of asymptomatic or mild cases.”

Shares of cruise operators rebounded Tuesday along with the travel sector. As of 12:35 p.m. New York time, Carnival was up 1.2%, Royal Caribbean gained 0.4% and Norwegian was little changed. Of the three, only Royal Caribbean shares have had positive returns this year and they have significantly trailed the broader market, up less than 6% year to date compared to a 27% gain in the S&P 500 Index.

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Norwegian Cruise Line Ship Reports at Least 17 COVID Cases — Including 'Probable' Omicron Variant

The Louisiana Department of Health initially reported 10 cases on board Saturday, but that number has since grown

A Norwegian Cruise Line ship with at least 17 passengers infected with COVID-19 docked in New Orleans, Louisiana, over the weekend.

On Sunday, the Norwegian Breakaway ship — which had departed from New Orleans on Nov. 28 with more than 3,200 individuals on board — returned to the city after making stops in Belize, Honduras and Mexico on its voyage, the Louisiana Department of Health said in a statement .

Initially identifying 10 cases of COVID-19 on Saturday, the Department of Health updated their findings to more the following day.

"This brings the total number of COVID-19 cases identified among the passengers and crew members to 17," the organization wrote in a Sunday statement .

The Department of Health also noted that a crew member was among those infected, and the organization believes that individual has a "probable case" of the new Omicron variant . "The crew member is not a Louisiana resident and did not leave the ship," the organization wrote.

In a statement, a spokesperson for Norwegian Cruise Lines confirmed to PEOPLE that there were "a handful of COVID-19 asymptomatic cases among guests and crew." The cruise company similarly reiterated the Department of Health's statement that the crew member is "suspected to have the COVID-19 Omicron variant."

Norwegian Cruise Lines also explained that "guests who opt to sail must wear masks while indoors except while actively eating or drinking and will be tested twice during the cruise."

Never miss a story — sign up for PEOPLE's free daily newsletter to stay up-to-date on the best of what PEOPLE has to offer, from juicy celebrity news to compelling human interest stories.

"As always, the health and safety of our guests, crew and the communities we visit is our highest priority," the company continued. "Since the relaunch of our fleet, we have required 100% of guests and crew to be fully vaccinated per our comprehensive and stringent health and safety protocols."

"We will never compromise on health and safety and we will of course, continue to take all appropriate action to ensure everyone's well-being and to protect public health," they added.

RELATED VIDEO: Unvaccinated TikToker Who Died of COVID Spent Last Days Urging Followers to Get the Vaccine

Select passengers disembarking from the ship told local outlet WVUE-TV that they were notified about the positive cases on the ship. Others, however, explained that they were not aware of the outbreak.

"We didn't hear of this until we kind of heard you talking a second ago," Don Canole, a passenger from North Carolina, told the outlet. "It would have been nice to have known. We would have taken maybe a few more precautions."

Passengers also told WVUE-TV that they were tested for COVID-19 on Saturday before disembarking the following day. The cruise line also gave passengers take-home rapid tests as they left, the outlet reported.

The ship where the infected individuals were located was scheduled to depart once more later that same day, WVUE-TV reported.

"At this time, there have been no changes to scheduled future sailings on Norwegian Breakaway," a Norwegian Cruise Line spokesperson told the outlet. "We will provide additional updates to impacted guests as appropriate."

As the omicron variant starts to spread around the world, health experts are working to understand just how contagious it is and if it can evade COVID-19 vaccines. Researchers were concerned to see that it has the most mutations of any strain yet, which indicates that it would be highly contagious. But reassuringly, the cases so far have been mild or asymptomatic . Either way, getting a COVID-19 vaccine will provide protection against omicron and the Centers for Disease Control is urging everyone to get vaccinated or a booster dose.

Related Articles

Watch CBS News

First cruise ship set to sail from a U.S. port since the pandemic

June 25, 2021 / 3:42 PM EDT / CBS/AP

The first cruise ship to board passengers at a U.S. port in 15 months is set to sail Saturday from the industry's South Florida hub, a symbolic stride toward normalcy that will be watched closely by health experts as vaccines curb the coronavirus' spread .

Industry officials hope the voyage by Royal Caribbean's Celebrity Edge vessel serves as a bookend for people for whom the gravity of the pandemic first hit home in the alarming reports last year of deadly outbreaks on crowded ships, with guests quarantined for weeks , vessels begging to dock and sickened passengers carried away on stretchers at ports.

"We are excited to be part of that," said Russ Schwartz, a Florida school principal who is honeymooning on the ship and is confident it will be smooth sailing. "Things have changed drastically. Back then we really didn't know much about the virus. Cruises at that point weren't prepared."

Celebrity Cruises says at least 95% of those boarding the Celebrity Edge have been vaccinated against the coronavirus in line with health requirements from the Centers for Disease Control and Prevention, and the ship will run at a reduced capacity.

It will be a luxurious voyage aboard a boat that was unveiled in December 2018 featuring a giant spa and multi-floor suites. The $1 billion vessel will be led by Capt. Kate McCue, who in 2015 became the first American woman to captain a cruise ship and has drawn a following of more than 1 million on TikTok and 250,000 on Instagram.

The stakes are high for cruise lines as they emerge from a CDC-imposed shutdown that lasted 15 months. During that period the three industry giants — Carnival, Norwegian and Royal Caribbean — have had to raise more than $40 billion in financing just to stay afloat without any revenue.

Collectively they lost $20 billion last year and another $4.5 billion in the first quarter of 2021, according to Securities and Exchange Commission filings. 

"The cruise lines are getting up off their knees after getting crippled by COVID-19," said Michael Winkleman, a maritime attorney. "There's just too much money at stake for the cruise lines not to get it right."

Royal Caribbean on June 4 said  six of its ships would start sailing from ports in Florida and Texas beginning next month. The Miami-based cruise line credited the successful rollout of vaccines in readying for its comeback after getting shut down by COVID-19 in March 2020, when the U.S. Centers for Disease Control and Prevention issued a "no-sail" edict barring passenger cruise ships from leaving domestic ports. 

The CDC has since set conditions for cruise lines to resume sailing, including  a provision that an overwhelming majority on board  be immunized against the coronavirus. Florida Governor Ron DeSantis in May signed a law to prohibit companies from requiring customers be vaccinated against COVID-19, with his state previously  filing suit to block the CDC requirements. 

Carnival Cruise Line is also  eyeing  a July restart in the U.S., with tentative plans for three of its ships to set sail from Galveston and Miami.  

Norwegian Cruise Line in late May said it expected to resume cruise operations from the U.S. starting August 7 with departures from Seattle to Alaska.

Asking but not requesting

To comply with both the CDC's 95% vaccination requirement and the new Florida law banning businesses from requiring customers to show proof of vaccination , Celebrity Cruises is simply asking guests if they would like to share their status, spokeswoman Susan Lomax said.

Those who don't voluntarily show proof of vaccination will be treated as unvaccinated and be subjected to additional protocols such as wearing face masks and being restricted to designated seating areas in common areas like dining rooms, casinos and theaters.

Last year the CDC castigated the cruise industry for keeping bars, gyms and self-service buffets open and continuing to allow crew members to gather even as the pandemic raged.

Beginning in March 2020, data showed 3,689 confirmed or suspected cases of COVID-19 on cruise ships in U.S. waters, and at least 41 deaths. The CDC says it spent 38,000 person-hours handling just the cruise response to COVID-19, including contact tracing for 11,000 passengers.

Medical evacuation and logistical efforts for passengers disembarking ships such as the Zaandam in Fort Lauderdale and the Grand Princess in Oakland, California, also diverted resources from local agencies that were trying to curb the spread of COVID-19.

Passenger lawsuits

Dozens of passengers have since filed lawsuits saying companies failed to protect them and warn them about the virus, especially after an outbreak on Carnival's Diamond Princess off the coast of Japan with more than 700 confirmed cases and nine deaths.

The prolonged shutdown has also been challenged in court. In April, Florida sued the federal government to demand cruise ships be allowed to start sailing, arguing the ban disproportionately harms the state where the industry generates billions each year for the economy.

Last week a judge granted a preliminary injunction that prevents the CDC from enforcing sailing conditions, which the state says effectively block most cruises.

Celebrity Edge will sail before the injunction takes effect, so it is complying with the conditions.

"Getting back to living"

The Cruise Lines International Association, which represents about 90% of the global cruise capacity, said it appreciated Florida Gov. Ron DeSantis' efforts to back the industry and cruise lines are prioritizing health and safety. About 600,000 passengers have sailed in member ships outside the U.S. since last summer and incidence of the coronavirus has been low.

"The industry's protocols are working as intended," the association said in a statement. "The highly successful rollout of vaccines in the United States is a game changer and facilitates safe travel."

About 44% of people nationwide are fully vaccinated, according to the CDC, and new COVID-19 cases in the U.S. are down sharply from their peak earlier this year.

Katherine Quirk-Schwartz, a Celebrity Edge passenger and registered nurse who's excited for the upcoming cruise and hopes to meet Capt. McCue, recalled how her hospital took in some of the first COVID-19 patients from cruise ships when they were finally allowed onshore in Florida after days of negotiation.

"It's almost like full circle. It's amazing to reflect on that," she said. "As more things change, more things open up, we will see more of the effects of the vaccine. People are getting back to living, people are getting back to sailing."

Kate Gibson contributed to this report.

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Do I need a COVID vaccine to cruise? A line-by-line guide

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Editor’s note: This post has been updated with new information.

When the first cruises allowing Americans restarted in spring 2021, all major lines were sailing with at least 90% of passengers vaccinated against COVID-19. That meant they required just about everyone on board to have their shots, with only a few exceptions allowed for young children and people who can’t be vaccinated due to medical conditions or religious beliefs.

Since then, the Centers for Disease Control and Prevention has withdrawn its opt-in guidance for cruise lines, and most are now allowing unvaccinated passengers to sail. In fact, most aren’t even checking to see if cruisers are vaccinated or not.

However, with cases picking up seasonally and new booster vaccines rolling out, will you need a vaccine to cruise? Click on your favorite cruise line above, under “Jump to Section,” to find out.

For more cruise news, reviews and tips, sign up for TPG’s new cruise newsletter .

Note: In order to be considered “fully vaccinated,” passengers must have received their final shot (not including boosters) at least 15 days prior to embarkation. Most lines only accept vaccines (or a combination of vaccines) recognized and approved by the World Health Organization and the CDC. Generally, proof of inoculation must include your name, the type of vaccine you received and the dates on which you received all required doses.

Booster shots are not required unless specifically noted. However, keep in mind that the rules may vary by country, with some lines requiring boosters for international departures due to local regulations or for extra-long sailings like ocean crossings when port calls are few or nonexistent. Passengers who have their boosters are considered “up to date” rather than merely “fully vaccinated.”

For general information on testing, please refer to our article on cruise testing requirements .

AmaWaterways

Vaccine required no.

AmaWaterways no longer requires proof of vaccination for passengers. However, cruisers are responsible for meeting the requirements of the countries in which they’ll be traveling. If they do not, standard cancellation fees will apply. Pre-cruise testing is not required. Should passengers become ill during their cruise, AmaWaterways will assist in procuring testing and other medical services, which will be the financial responsibility of those guests.

American Cruise Lines

American Cruise Lines does not have a vaccine requirement for all passengers on any of its sailings. Pre-cruise testing is no longer required.

American Queen Voyages

Vaccines are not required to sail with American Queen Voyages , and pre-cruise testing is no longer required.

Related: What happens if someone tests positive for COVID-19 on your cruise

Atlas Ocean Voyages

Vaccination is not mandatory for Atlas cruises, but passengers must comply with regulations in countries on their scheduled itinerary, which could require that they be up to date on their shots. Additionally, pre-cruise testing is no longer a requirement.

Avalon Waterways

Avalon Waterways no longer requires proof of vaccination or a negative test prior to passenger boarding. However, mandatory testing and proof of vaccination could still be required in some countries the line visits.

Azamara recommends that passengers follow local regulations and the latest guidance from government health organizations when determining which vaccines to obtain prior to travel. The line also does not require negative test results in order to board unless mandated by local governments in the ports where the line’s ships sail.

Carnival Cruise Line

Neither vaccines nor pre-cruise testing is required for Carnival sailings. However, the line recommends that anyone 5 years or older be up to date on their shots and carry proof. It also suggests that cruisers test themselves no further than three days from their sailing date to make sure they’re in good health.

Celebrity Cruises

Celebrity does not mandate vaccination or testing for any passenger on any sailing unless required by regulations in the ports its ships are visiting.

Related: Cruise ship contact tracing: How the world’s major lines are tracking COVID-19 exposure

Celestyal Cruises

Celestyal continues to require all crew members to be fully vaccinated, but passengers don’t have to be. The line recommends anyone 12 and older be up to date on their inoculations. Testing is also no longer necessary in order to board Celestyal ships.

Cunard Line

Although Cunard suggests that travelers be fully vaccinated and current with their boosters, proof of immunization is not required, nor is pre-cruise testing for any of the line’s sailing unless required by law.

Disney Cruise Line

Disney Cruise Line encourages — but does not require — all passengers to be fully vaccinated before sailing. It also recommends pre-cruise testing, no more than two days prior to embarkation, for anyone who doesn’t have their shots.

Emerald Cruises

Emerald Cruises suggests that all passengers be vaccinated, but it no longer checks for proof. Pre-cruise testing is also no longer required, but the line advises travelers to check local regulations in the places they’ll be visiting.

Grand Circle Cruise Line

Vaccine required yes.

Grand Circle has mandated that all passengers must be fully vaccinated at least 14 days prior to embarkation as a condition of carriage, and proof must be provided before boarding. Passengers who are not fully vaccinated will have to return home at their own expense. Boosters are not mandatory. Pre-cruise testing might be required, depending on your port of embarkation. (The line will send you that information prior to your sailing.)

Hapag-Lloyd Cruises

Hapag-Lloyd does not require vaccinations or pre-cruise testing as a condition of sailing. However, the line recommends both to passengers as precautions. It also advises that cruisers are responsible for knowing and adhering to all local guidelines and regulations.

Holland America

Holland America now allows unvaccinated passengers to sail and does not make pre-cruise testing compulsory unless either of these is required by local regulations in the areas its vessels sail. Booked cruisers can search for requirements specific to their individual sailings by using this tool .

Hurtigruten

Vaccine required sometimes.

On expedition cruises with Hurtigruten , passengers are not required to show proof of vaccination, except on 2023 and 2024 voyages to Antarctica and the Northwest Passage or West Africa sailings departing from and returning to Dakar. Immunization is also not necessary for the line’s non-expedition itineraries, but it is recommended for both coastal voyages and expedition cruises. Neither type of cruise requires negative test results as a condition of embarkation. Passengers with reservations can check specific protocols for their specific bookings using this tool .

Lindblad Expeditions

Lindblad passengers no longer need to provide proof of vaccination in order to cruise, and pre-cruise testing is no longer required, including at embarkation. Exceptions might apply for departures from certain destinations. The line urges passengers to follow government recommendations for masking, testing and vaccination.

Related: Why I feel safer now on a cruise ship than in my hometown

MSC Cruises

Vaccination and testing are no longer terms of carriage when sailing with MSC Cruises . The line still recommends that passengers receive their shots and notes that it’s each passenger’s responsibility to comply with local regulations in the places their sailing visits.

Norwegian Cruise Line

In early August 2022, Norwegian Cruise Line became the first major cruise line to roll back its vaccination requirements. Proof of immunization is no longer required, nor is testing in order to board for any voyage.

Oceania Cruises

Upscale cruise line Oceania does not check vaccination records for passengers, nor does it require pre-cruise testing for its sailings.

P&O Cruises

There are no vaccination or testing mandates in place for any of P&O Cruises ‘ voyages.

Ponant ‘s website simply reads, “when you visit certain destinations, vaccines can be recommended,” but they are not required by the line. Ponant also says it will alert passengers to their specific requirements after they have booked a voyage. Testing is also not needed in order to board.

Princess Cruises

Following an industry-wide rollback of protocols, Princess passengers no longer have to show proof of a COVID-19 vaccine, nor proof of a negative test result, unless either is required by local regulations. Passengers are responsible for knowing the requirements for the places their ships will visit.

Regent Seven Seas Cruises

Regent doesn’t check the vaccination status of any of its passengers unless required by local protocols. Testing requirements vary by location and might depend on whether or not you are up to date on your shots. If vaccination or testing is required, the line will alert cruisers approximately 30 days prior to their sailing date.

Royal Caribbean

To board Royal Caribbean ships, you don’t have to be vaccinated or provide test results. However, the line advises staying up to date on inoculations and following guidelines issued by federal health authorities.

Saga has rolled back its vaccination and testing requirements, which is significant, given that the line only allows passengers 50 and older to sail on its vessels. They will only be required if local authorities dictate them.

Scenic Luxury Cruises & Tours

Passengers embarking on river and ocean voyages with Scenic will not need to be fully immunized prior to sailing. Testing is not required by the line but might be needed to enter the country in which you’re embarking on your sailing. Passengers are responsible for meeting entry requirements.

For cruises with luxury line Seabourn , there are no line-enforced regulations for vaccination or testing unless required by local authorities in the countries on which its vessels call. To see if your booked sailing requires either of these, check out the line’s search tool .

Luxury brand Silversea does not require shots for its passengers or pre-cruise tests unless they’re needed to meet local regulations.

Star Clippers

Star Clippers has eliminated all vaccine checks and testing protocols for all passengers on all voyages.

For all voyages through 2023, Tauck requires passengers 12 and older to be fully vaccinated and have at least one booster dose and/or show proof of recovery from COVID-19. Passengers 11 years old and younger are not required to be fully vaccinated. If they aren’t fully vaccinated or don’t have a booster, they must provide proof of a negative PCR or antigen test result from a test taken no more than three days prior to embarkation. For sailings in 2024, vaccination and testing requirements will be waived for all passengers.

UnCruise Adventures

All UnCruise passengers are exempt from vaccine and testing requirements. The line will continue to monitor the effects of new variants, as well as CDC recommendations and will adjust its policies accordingly.

Uniworld Boutique River Cruise Collection

Testing requirements are determined by the countries the ships visit, but the line itself has no vaccine or testing mandates of its own. You can check the protocols for the places on your itinerary for the most up-to-date information by visiting the protocols page on Uniworld’s website .

All Viking passengers, whether on a river sailing or an ocean voyage, must be fully vaccinated for sailings departing on or before Oct. 31, 2023. It will not be required for cruisers embarking on or after Nov. 1, 2023. Testing is no longer required unless passengers are exhibiting symptoms and seek medical assistance.

Virgin Voyages

Virgin Voyages will not check proof of immunization or a negative COVID-19 test prior to boarding.

Windstar Cruises

Windstar no longer mandates shots for passengers of any age. Testing is not required by the line but might be necessary based on local regulations, which with passengers must comply.

Planning a cruise? Start with these stories:

• The 5 most desirable cabin locations on any cruise ship
• The 8 worst cabin locations on any cruise ship
• A quick guide to the most popular cruise lines
• 21 tips and tricks that will make your cruise go smoothly
• 15 ways cruisers waste money
• 15 best cruises for people who never want to grow up
• What to pack for your first cruise

SPONSORED:  With states reopening, enjoying a meal from a restaurant no longer just means curbside pickup.

And when you do spend on dining, you should use a credit card that will maximize your rewards and potentially even score special discounts. Thanks to temporary card bonuses and changes due to coronavirus, you may even be able to score a meal at your favorite restaurant for free. 

These are the best credit cards for dining out, taking out, and ordering in to maximize every meal purchase.

Editorial Disclaimer: Opinions expressed here are the author’s alone, not those of any bank, credit card issuer, airlines or hotel chain, and have not been reviewed, approved or otherwise endorsed by any of these entities.

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Cruise lines dropped COVID-19 rules. How did that affect cases? We got numbers from the CDC.

David Hancock spent his September vacation doing things he'd never done. He went on a cruise for the first time, hugged a sloth at an animal park in Honduras, and at some point during the trip, likely contracted COVID-19.

The 36-year-old firefighter had avoided infection for two years, but tested positive the morning after he and his wife, Melissa, who had been celebrating their 15th wedding anniversary, returned home to Savannah, Tennessee.

But not even COVID-19 could put a damper on their Royal Caribbean International sailing. "I went all that time since COVID began without getting it ... so I went and got it on a cruise ship," he told USA TODAY.

"But because I was vaccinated and boosted, my symptoms were mild," he said, adding that he would definitely go on a cruise again.

Cruise lines change COVID-19 rules: Royal Caribbean, Disney Cruise Line further lift requirements

'Was it worth the risk? I don't think so': What it's like to cruise with fewer COVID rules

Many recent cruise line policy changes reflect a shifting approach to the pandemic. Major cruise lines, including Royal Caribbean, Carnival Cruise Line, and Norwegian Cruise Line International dropped their vaccine requirements for many sailing in early September and eased testing rules, about two weeks before Hancock left for his seven-night voyage.

However, after the Centers for Disease Control and Prevention ended its COVID-19 Program for Cruise Ships in July and stopped updating its related webpage , COVID-19 spread amid the more relaxed approaches has been a relative mystery.

But data from the CDC obtained by USA TODAY through a Freedom of Information Act request shed some light on the numbers cruise lines reported to the agency after the rules were changed.

What COVID-19 case numbers did cruise lines report to the CDC?

The numbers also only represent new COVID-19 cases identified by positive viral tests on cruise ships entering or leaving from the U.S. The data does not show the test positivity rate or the number of passengers on the sailings.

►Norwegian began welcoming all passengers regardless of vaccination status on Sept. 3 and dropped all pre-cruise testing requirements for vaccinated passengers 12 and older. In the weeks that followed, the cruise line reported similar numbers to the weeks leading up to the rule change. The week beginning Sept. 4, the cruise line reported 138 new cases, and reported another 161 the following week. For the week of Sept. 18, two weeks after dropping requirements , Norwegian reported 204 new cases, and just 25 the following week.

The cruise line had previously reported 234, 164 and 184 cases in the three weeks leading up to the change, respectively.

►Carnival made similar changes on Sept. 6, scrapping its requirement for unvaccinated passengers to apply for a vaccine exemption  and further easing its pre-cruise testing rule for vaccinated passengers on many sailings.

The cruise line reported 193 new cases for both the weeks of Sept. 11 and the following week and another 144 during the week beginning Sept. 25.

Carnival had previously reported 214, 265, and another 214 new cases in the three weeks leading up to the change, respectively, including the week of Sept. 4.

►Royal Caribbean also began welcoming all travelers regardless of vaccination status and further eased pre-cruise testing for vaccinated passengers for many sailings on Sept. 5.

The line reported 341 new cases the week of Sept. 11, and 306 the week after. The line then reported another 237 new cases for the week of Sept. 25. In the weeks preceding the change, Royal Caribbean had reported 448, 311, and 348 new cases, respectively, including the week of Sept. 4.

Dr. Peter F. Rebeiro, an assistant professor of medicine in the Division of Infectious Diseases at Vanderbilt University Medical Center, said,   generally speaking, if unvaccinated passengers who test negative – as they were required to at the time – are mixed in with a mostly-vaccinated group, the "overall risk is not going to spike a huge amount,"   he said. However, he noted that vaccinated passengers can still spread the virus.

Rebeiro also noted that if transmission among the general population is lower at the time a passenger boards a cruise, the likelihood they will spread the virus is lower.

Anne Madison, a spokesperson for the Cruise Lines International Association, the industry's leading trade group, emphasized the safety of cruise travel.

"CLIA-member cruise lines have a strong track record for effectively managing COVID-19 by making science-driven and medically informed decisions – and continue to have health protocols in place that exceed those of nearly any other venue or travel sector outside of healthcare settings," she said in an emailed statement.

Madison added that as a condition of their membership, cruise lines must keep up certain protocols, including "maintaining elevated public health measures to mitigate the introduction or spread of COVID-19 on board ships" and sailing with high vaccination levels among passengers and crew members, among others.

Story continues below.

What does that mean for passengers?

The data did not show a consistent pattern in new cases for other major cruise lines, including Celebrity Cruises, Princess Cruises, or Holland America Line, either. Celebrity made similar changes on Sept. 5, while Princess and Holland America did so on Sept. 6.

During roughly the same period, the weekly COVID-19 case rate per 100,000 people steadily declined in the U.S., from 209 the week of Aug. 17 to 96.5 the week of Oct. 5, according to CDC data .

The "CDC has determined that the cruise industry has access to the necessary tools to prevent and mitigate COVID-19 on board," CDC spokesperson Tom Skinner said in an emailed statement. "While CDC provides guidance for cruise ships operating in U.S. waters under CDC’s jurisdiction, individual cruise lines will determine their own specific COVID-19-related requirements for cruise travel. Any decrease in the volume or frequency of routine screening testing of crew by cruise lines may result in lower counts of asymptomatic cases."

Victoria Alvarez knew Carnival had eased its protocols by the time she got on her Caribbean cruise in late September. Living in Florida, she said, she was used to more relaxed rules .

But the risk of getting COVID-19 did cross her mind during the trip. The 27-year-old business administration manager said the ship was crowded, particularly in the dining and entertainment venues.

Alvarez, who is vaccinated and boosted, said she and her friends took some extra precautions of their own, such as eating outside when they could and avoiding the pools, which were packed. "We just saved our swimming for the islands," she said.

"I don't know if I just haven't been in crowds like that in a while, but it was just, like, it's a lot," she added of the experience.

What precautions can people take?

Anna Bershteyn, an assistant professor in the Department of Population Health at New York University Grossman School of Medicine, said that there may be other factors the data does not reflect, "but it doesn't seem that this policy (change) had any consistent effect across cruise lines."

While there are still many COVID-19-related deaths across the country each day, she said, many people have been assessing their own risk tolerance. "It comes to this decision, what are the precautions that people should take versus going back and living life?" Bershteyn said.

Cruises will return to Japan: Country reopens to international cruise ships for first time since the pandemic

Sailing then and now: Holland America's anniversary transatlantic crossing highlights how cruising has changed

While not all passengers have felt completely safe on cruises since many lines relaxed their rules, Hancock said he and his wife are planning on taking another cruise with Royal Caribbean, even as it has further rolled back requirements .

"I feel as though COVID's not going to be going anywhere," Hancock said "It's kind of with us for the long haul. It's just a matter of preparations people take and what risks they're willing to take."

Bershteyn recommended travelers take steps to protect themselves, first by staying up to date on all the vaccine doses they are eligible for. She also recommended they make a plan with their doctor in case they do get sick, and contact the cruise line to see what options they would have.

If travelers have taken those steps, she said, she would advise travelers who want to take a cruise to go ahead. "We can't put our life on hold indefinitely, but we do want those safety nets in place in case something happens," she said.

Bershteyn also recommended travelers look for opportunities to take extra precautions when doing so "is not going to take away" from the experience, which she noted may be different for each traveler. In her case, she wears a face mask when she is in crowded places such as airports, while others may opt to eat outdoors when possible.

Have you gone on a cruise recently? What was your experience like?

This article originally appeared on USA TODAY: CDC data shows COVID-19 numbers on cruises after vaccine rules dropped

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More cruise ships are under CDC investigation following COVID-19 outbreaks on board

The Associated Press

Carnival Cruise Line's Carnival Horizon cruise ship is shown docked at PortMiami in April. The Centers for Disease Control and Prevention is investigating more cruise ships due to new COVID-19 cases aboard. Wilfredo Lee/AP hide caption

Carnival Cruise Line's Carnival Horizon cruise ship is shown docked at PortMiami in April. The Centers for Disease Control and Prevention is investigating more cruise ships due to new COVID-19 cases aboard.

MIAMI — The U.S. Centers for Disease Control and Prevention is investigating more cruise ships due to new cases of COVID-19 as the omicron variant drives extremely high infection levels in the industry hub of Florida.

The CDC said 88 vessels are now either under investigation or observation, but it did not specify how many COVID-19 cases have been reported. Four other vessels are also being monitored by the CDC as well.

Florida hit a new record for daily cases on Tuesday with 46,900 new cases in a day. Since Christmas, the state's 7-day average of daily cases has surpassed previous records set during last summer's surge, rising to 29,400 infections.

Coronavirus hospitalizations in the state have also risen from about 1,200 patients two weeks ago to about 3,400 on Wednesday. But that is still less than one-fifth the number of hospitalizations reported in late August due to the delta wave.

Democratic Sen. Richard Blumenthal is calling for the CDC and cruise lines to again halt cruise travel, six months after the industry mounted its comeback.

"Our warnings have proved sadly prescient and continuously compelling. Time for CDC and cruise lines to protect consumers, again pause — docking their ships," the Connecticut senator posted on Twitter.

Cruise lines have not announced any plans to halt cruising. And the CDC did not say it would adopt any changes, adding it still had plans to allow for the expiration of a set of rules that cruises must follow to sail during the pandemic. The regulation, called a conditional sailing order, is scheduled to expire on Jan. 15 to become a voluntary program.

Coronavirus Updates

Covid-19 outbreaks hit 3 cruise ships as florida breaks record for new cases.

"CDC acknowledges that it is not possible for cruising to be a zero-risk activity," CDC spokesperson Jasmine Reed said in an emailed statement.

Most lines require adult passengers to show proof of vaccination against COVID-19. Cruise ships are allowed to relax measures such as mask use if at least 95% of passengers and 95% of crew are fully vaccinated.

The federal agency recommends that people avoid cruise travel if they are at increased risk of severe illness, regardless of vaccination status.

None of the ships so far appear to have so many cases that they would overwhelm medical resources on board and require a return to port. But some have been denied entry at some foreign ports.

Several Florida-based ships have reported outbreaks. The Carnival Freedom was denied entry to Aruba and Bonaire after an undisclosed number of passengers and crew aboard caught the virus.

Some cruise ships have not been allowed to disembark in Mexican ports due to cases reported, bringing to memory the early days of the pandemic when cruise lines negotiated docking plans as ships were being turned away by officials worried about the virus's spread.

The Mexican government said Tuesday it would allow cruise ships with reported coronavirus cases to dock. The country's Health Department said passengers or crew who show no symptoms will be allowed to come ashore normally, while those with symptoms or a positive virus test will be quarantined or given medical care.

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• Section 8 - Road & Traffic Safety
• Section 8 - Motion Sickness

Cruise Ship Travel

Cdc yellow book 2024.

Author(s): Kara Tardivel, Stefanie White, Aimee Treffiletti, Amy Freeland

Cruise Ship Medical Capabilities

Illness & injury, infectious disease health risks, noninfectious health risks, travel preparation.

Cruise ship travel presents a unique combination of health concerns. Travelers from diverse regions brought together in the often crowded, semi-enclosed shipboard environment can facilitate the spread of person-to-person, foodborne, and waterborne diseases. Outbreaks on ships can be sustained over multiple voyages by crewmembers who remain onboard, or by persistent environmental contamination. Port visits can expose travelers to local diseases and, conversely, be a conduit for disease introduction into shoreside communities.

Some people (e.g., those with chronic health conditions or who are immunocompromised, older people, pregnant people) merit additional considerations when preparing for a cruise. Because travelers at sea might need to rely on a ship’s medical capabilities for an extended period, potential cruise passengers with preexisting medical needs should prepare accordingly by calling the cruise line’s customer service center to learn what type and level of health care services are (and are not) available on specific ships.

Medical facilities on cruise ships can vary widely depending on ship size, itinerary, cruise duration, and passenger demographics. Generally, shipboard medical centers can provide medical care comparable to that of ambulatory care centers; some are capable of providing hospitalization services or renal dialysis. Although no agency officially regulates medical practice aboard cruise ships, the American College of Emergency Physicians (ACEP) published consensus-based guidelines for cruise ship medical facilities in 1995, and updated the guidelines in 2013. ACEP guidelines , which most major cruise lines follow, state that cruise ship medical facilities should be able to provide quality medical care for passengers and crew; initiate appropriate stabilization, diagnostic, and therapeutic maneuvers for critically ill or medically unstable patients; and assist in the medical evacuation of patients in a timely fashion, when appropriate.

Cruise ship medical centers deal with a wide variety of illnesses and injuries; ≈10% of conditions reported to cruise ship medical centers are an emergency or require urgent care. Approximately 95% of illnesses are treated or managed onboard, with the remainder requiring evacuation and shoreside consultation for dental, medical, or surgical issues. Roughly half of all passengers seeking medical care are >65 years old.

Medical center visits are primarily the result of acute illness or injury. The most frequently reported diagnoses include respiratory illnesses (30%–40%); injuries from slips, trips, or falls (12%–18%); seasickness (10%); and gastrointestinal (GI) illness (10%); 80% of onboard deaths are due to cardiovascular events.

Infectious Disease Outbreaks

The most frequently reported cruise ship outbreaks involve GI infections (e.g., norovirus), respiratory infections (e.g., coronavirus disease 2019 [COVID-19], influenza), and other vaccine-preventable diseases (VPDs), such as varicella. Although cruise ships do not have public health authority, to reduce the risk of introducing communicable diseases, some ships conduct medical screening during embarkation to identify ill passengers, prevent them from boarding, or require isolation if permission to board is given.

Before travel, to help limit the introduction and spread of communicable diseases on cruise ships, prospective cruise ship travelers and their clinicians should consult the Centers for Disease Control and Prevention (CDC) Travelers’ Health website for updates on outbreaks and destination-specific travel health notices. People who become ill with a communicable disease before a voyage should consult their health care provider and delay their travel until they are no longer contagious. When booking a cruise, travelers should check the trip cancellation policies and consider purchasing trip cancellation insurance (see Sec. 6, Ch. 1, Travel Insurance, Travel Health Insurance & Medical Evacuation Insurance ).

Travelers who become ill during a voyage should seek care in the ship’s medical center; the onboard staff will provide clinical management, facilitate infection-control measures, and take responsibility for reporting potential public health events. For information on how to report travelers who become ill with suspected communicable diseases after they return home from a cruise, see Sec. 8, Ch. 8, Airplanes & Cruise Ships: Illness & Death Reporting & Public Health Interventions .

Gastrointestinal Illnesses

During 2006–2019, rates of GI illness among passengers on voyages lasting 3–21 days fell from 32.5 to 16.9 cases per 100,000 travel days. Despite the decrease, outbreaks continue to occur. CDC assists the cruise ship industry to prevent and control the introduction, transmission, and spread of GI illnesses on cruise ships. See information on cruise ship GI illnesses and updates on GI illness outbreaks involving ships with US ports of call, specifically.

On cruise ships, >90% of GI illness outbreaks with a confirmed cause are due to norovirus. Characteristics of norovirus that facilitate outbreaks include a low infective dose, easy person-to-person transmissibility, prolonged viral shedding, absence of long-term immunity, and the ability of the virus to survive routine cleaning procedures (see Sec. 5, Part 2, Ch. 16, Norovirus ). For international cruise ships porting in the United States during 2006–2019, an average of 12 norovirus outbreaks occurred each year.

Other Sources of Gastrointestinal Illness

GI outbreaks on cruise ships also have been caused by contaminated food or water; most outbreaks were associated with  Campylobacter ,  Clostridium perfringens , or enterotoxigenic  Escherichia coli .

Protective Measures

Travelers can reduce the risk of acquiring a GI illness on cruise ships by frequently washing hands with soap and water, especially before eating and after using the restroom. Travelers should call the ship’s medical center promptly, even for mild symptoms of a GI illness, and strictly follow cruise ship guidance regarding isolation and other infection-control measures.

Respiratory Illnesses

Respiratory illnesses are the most common medical complaint on cruise ships. During the pretravel visit, evaluate whether vaccines or boosters (e.g., COVID-19, influenza) are needed and emphasize the importance of practicing good respiratory hygiene and cough etiquette while onboard. As with GI illnesses, cruise ship passengers should report respiratory illness to the medical center promptly and follow isolation recommendations as instructed.

Coronavirus Disease 2019

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus that causes COVID-19, spreads more easily between people in close quarters, and multiple studies have concluded that transmission rates of SARS-CoV-2 among travelers on ships are much greater than in other settings. Cruise ship COVID-19 outbreaks can tax onboard medical and public health resources. Ship-to-shore medical evacuations to facilities capable of providing higher levels of medical care can present logistical challenges and pose additional risks to ill patients.

Cruise passengers and crewmembers who are not up to date with their COVID-19 vaccines are at increased risk for severe illness, hospitalization, medical evacuation, and death. Since cruising will always pose some risk of SARS-CoV-2 transmission, ensure that people planning cruise ship travel are up to date with their vaccinations, and assess their likelihood for developing severe COVID-19. For people at increased risk of severe COVID-19 regardless of their vaccination status (e.g., pregnant people, people who are immunocompromised), discuss the potential health hazards associated with cruise ship travel. CDC has developed recommendations and guidance designed to help cruise ship operators provide a safer and healthier environment for crewmembers, passengers, port personnel, and communities.

Historically, influenza has been among the most often reported VPDs occurring on cruise ships. Because passengers and crew originate from all regions of the globe, shipboard outbreaks of influenza A and B can occur year-round, with exposure to strains circulating in different parts of the world (see Sec. 5, Part 2, Ch. 12, Influenza ). Thus, anyone planning a cruise should receive the current seasonal influenza vaccine ≥2 weeks before travel if vaccine is available and no contraindications exist. For people at high risk for influenza complications, health care providers should discuss chemoprophylaxis and how and when to initiate antiviral treatment.

See additional guidance on the prevention and control of influenza on cruise ships .

Legionnaires’ Disease

Less common on cruise ships, Legionnaires’ disease is nevertheless a treatable infection that can result in severe pneumonia leading to death (see Sec. 5, Part 1, Ch. 9, Legionnaires’ Disease & Pontiac Fever ). Approximately 10%–15% of all Legionnaires’ disease cases reported to CDC occur in people who have traveled during the 10 days before symptom onset. Clusters of Legionnaires’ disease associated with hotel or cruise ship travel can be difficult to detect, because travelers often disperse from the source of infection before symptoms begin. Data reported to CDC during 2014–2015 included 25 confirmed cases of Legionnaires’ disease associated with cruise ship exposures.

In general, Legionnaires’ disease is contracted by inhaling warm, aerosolized water containing the bacteria,  Legionella . Transmission also can sometimes occur through aspiration of  Legionella -containing water. Typically, people do not spread  Legionella  to others; a single episode of possible person-to-person transmission of Legionnaires’ disease has been reported. Contaminated hot tubs are commonly implicated as a source of shipboard  Legionella  outbreaks, although potable water supply systems also have been culpable. Improvements in ship design and standardization of water disinfection have reduced the risk for  Legionella  growth and colonization.

Diagnosis & Reporting

People with suspected Legionnaires’ disease require prompt antibiotic treatment. When evaluating cruise travelers for Legionnaires’ disease, obtain a thorough travel history of all destinations during the 10 days before symptom onset to assist in identifying potential sources of exposure, and collect urine for  Legionella  antigen testing. Most cruise ships have the capacity to perform this test, which detects  L. pneumophila  serogroup 1, the most common serogroup.

Perform culture of lower respiratory secretions on selective media to detect non– L. pneumophila  serogroup 1 species and serogroups. Culture also is used for comparing clinical isolates to environmental isolates during an outbreak investigation. Notify CDC of any travel-associated Legionnaires’ disease cases by sending an email to [email protected]. Quickly report all cases of Legionnaires’ disease to public health officials, who can determine whether a case links to previously reported cases and work to stop potential clusters and new outbreaks.

Other Vaccine-Preventable Diseases

Although most cruise ship passengers come from countries with routine vaccination programs (e.g., Canada, the United States), many of the crew are from low- or middle-income countries where immunization rates can be low. Outbreaks of hepatitis A, measles, meningococcal disease, mumps, pertussis, rubella, and varicella have all been reported on cruise ships. The majority (82%) of these outbreaks occur among crewmembers; prior to the COVID-19 pandemic, varicella was the most frequently reported VPD. Other VPDs (e.g., pertussis) occur more often among passengers.

Each cruise line sets its own policies regarding vaccinations for its crew; some have limited or no requirements. Thus, all passengers should be up to date with routine vaccinations before travel, as well as any required or recommended vaccinations specific for their destinations. People of childbearing age should have documented immunity to measles, rubella, and varicella (either by vaccination or titer) before cruise ship travel.

Vectorborne Diseases

Some cruise ship ports of call include destinations where vectorborne diseases (e.g., dengue, Japanese encephalitis, malaria, yellow fever, Zika) are known to be endemic. In addition, new diseases can surface in unexpected locations; chikungunya was reported for the first time in the Caribbean in late 2013, with subsequent spread throughout the region and numerous other North, Central, and South American countries and territories. Zika was first reported in Brazil in 2015, and subsequently spread across the Caribbean and Latin America, sparking concern because of its association with microcephaly and other congenital abnormalities in the fetus. For disease-specific information, see the relevant chapters of Section 5.

For guidance on how to avoid bites from mosquitoes and other disease-transmitting arthropod vectors, both onboard and while on shore at ports of call, see Sec. 4, Ch. 6, Mosquitoes, Ticks & Other Arthropods . For specific details on yellow fever vaccination and malaria prevention, see Sec. 2, Ch. 5, Yellow Fever Vaccine & Malaria Prevention Information, by Country .

Stresses of cruise ship travel include varying weather and environmental conditions, and unaccustomed changes to diet and levels of physical activity. Despite modern stabilizer systems, seasickness is a common complaint, affecting up to 25% of travelers (see Sec. 8, Ch. 7, Motion Sickness ). Note that travel is an independent risk factor for behaviors such as alcohol and illicit drug use and misuse (see Sec. 3, Ch. 5, Substance Use & Substance Use Disorders ), and unsafe sex (see Sec. 9, Ch. 12, Sex & Travel ).

Cruise ship travelers have complex itineraries due to multiple short port visits. Although most port visits do not include overnight stays off ship, some trips offer travelers the opportunity to venture off the ship for ≥1 night. These excursions can complicate decisions about exposures and the need for specific antimicrobial prophylaxis, immunizations, and other prevention measures.  Boxes 8-04  and  8-05  summarize recommended cruise travel preparations and healthy behaviors during travel for health care providers and cruise ship travelers.

Box 8-04 Healthy cruise travel preparation: a checklist for health care providers

Risk assessment & risk communication.

☐ Discuss itinerary, including season, duration of travel, and activities at ports of call. ☐ Review the traveler’s medical and immunization history, allergies, and any additional health needs. ☐ Discuss relevant travel-specific health hazards and risk reduction. ☐ Provide travelers with documentation of their medical history, immunizations, and medications.

VACCINATION & RISK MANAGEMENT

☐ Provide routinely recommended (age-specific), required (yellow fever), and recommended vaccines. ☐ Discuss safe food and water precautions. ☐ Discuss insect bite prevention. ☐ Provide older travelers with a baseline electrocardiogram, especially those with coronary artery disease.

MEDICATIONS BASED ON RISK & NEED

☐ Consider prescribing malaria chemoprophylaxis if itinerary includes stops in malaria-endemic areas. ☐ Consider prescribing motion sickness medications for self-treatment.

Box 8-05 Healthy cruise travel preparation: a checklist for travelers

☐ Carry prescription drugs in original containers with a copy of the prescription and a physician’s letter. ☐ Check the Centers for Disease Control and Prevention (CDC) Outbreak Updates for International Cruise Ships website for gastrointestinal outbreaks. ☐ Consider purchasing additional insurance coverage for overseas health care and medical evacuation. ☐ Consult medical and dental providers before cruise travel. ☐ Consult CDC Travelers’ Health website for travel health notices . ☐ Defer travel while acutely ill. ☐ Evaluate the type and length of the planned cruise in the context of personal health requirements. ☐ Notify the cruise line of additional health needs (e.g., dialysis, supplemental oxygen, wheelchair). ☐ Pack Environmental Protection Agency (EPA)–registered insect repellent; consider treating clothes and gear with permethrin. ☐ Pack sunscreen.

DURING TRAVEL

☐ Avoid contact with people who are ill. ☐ Follow safe food and water precautions when eating off ship at ports of call. ☐ Maintain good fluid intake and avoid excessive alcohol consumption. ☐ Practice safe sex. ☐ Report all illnesses to ship’s medical center and follow their recommendations. ☐ Use insect bite precautions during port visits, especially in vectorborne disease–endemic areas or areas experiencing outbreaks of vectorborne diseases (e.g., Zika, yellow fever) ☐ Use sun protection. ☐ Wash hands frequently with soap and water; if soap and water are not available, use ≥60% alcohol–based hand sanitizer.

POST TRAVEL

☐ See CDC’s latest post-cruise health guidance regarding coronavirus disease 2019.

Travelers with Additional Considerations

Travelers with chronic illnesses and travelers with disabilities who have additional needs (e.g., dialysis, supplemental oxygen, wheelchairs) should inform their cruise line before traveling. Highly allergic travelers and travelers with underlying medical conditions should carry a file that contains essential, pertinent health information (e.g., allergies, blood type, chest radiograph [if abnormal], chronic conditions, electrocardiogram, medication list, primary and/or specialty care provider contact information). Travelers also should bring any medications recommended by their health care provider (e.g., an epinephrine auto-injector) to help facilitate care during a medical emergency. For detailed information on preparing travelers who have additional considerations for international travel, including severe allergies, chronic illness, disabilities, or immune compromise, see Section 3.

Pregnant Travelers

Most cruise lines have policies that do not permit people to board after their 24th week of pregnancy. Contact cruise lines directly for specific guidance before booking. For additional information on preparing pregnant people for international travel, see Sec. 7, Ch. 1, Pregnant Travelers .

Insurance Coverage

All prospective cruise travelers should verify coverage with their health insurance carriers and, if not included, consider purchasing additional insurance to cover medical evacuation and health services received onboard cruise ships and in foreign countries (see Sec. 6, Ch. 1, Travel Insurance, Travel Health Insurance & Medical Evacuation Insurance ).

The following authors contributed to the previous version of this chapter: Kara Tardivel, Stefanie B. White, Krista Kornylo Duong

Bibliography

Hill CD. Cruise ship travel. In: Keystone JS, Kozarsky PE, Connor BA, Nothdurft HD, Mendelson M, editors. Travel medicine, 4th edition. Philadelphia: Saunders Elsevier; 2019. pp. 377–82. 

Jenkins KA, Vaughan GHJ, Rodriguez LO, Freeland AL. Acute gastroenteritis on cruise ships—United States, 2006–2019. MMWR Morb Mortal Wkly Rep. 2021;70(6):1–19. 

Kordsmeyer A-C, Mojtahedzadeh N, Heidrich J, Militzer K, von Münster T, Belz L, et al. Systematic review on outbreaks of SARS-CoV-2 on cruise, navy and cargo ships. Int J Environ Res Public Health. 2021;18(10):5195. 

Millman AJ, Kornylo Duong K, Lafond K, Green NM, Lippold SA, Jhung MA. Influenza outbreaks among passengers and crew on two cruise ships: a recent account of preparedness and response to an ever-present challenge. J Travel Med. 2015;22(5):306–11. 

Mouchtouri VA, Lewis HC, Hadjichristodoulou C. A systematic review for vaccine-preventable diseases on ships: evidence for cross-border transmission and for pre-employment immunization need. Int J Environ Res Public Health. 2019;16(15):2713. 

Payne DC, Smith-Jeffcoat SE, Nowak G, Chuwkwuma U, Geibe JR, Hawkins RJ, et al. SARS-CoV-2 infections and serologic responses from a Sample of U.S. Navy service members—USS Theodore Roosevelt, April 2020. MMWR Morb Mortal Wkly Rep 2020;69(23):714–21. 

Peake DE, Gray CL, Ludwig MR, Hill CD. Descriptive epidemiology of injury and illness among cruise ship passengers. Ann Emerg Med. 1999;33(1):67–72. 

Rice ME, Bannerman M, Marin M, Lopez AS, Lewis MM, Stamatakis CE, et al. Maritime varicella illness and death reporting, U.S., 2010–2015. Travel Med Infect Dis. 2018;23:27–33. 

Rocklöv J, Sjödin H, Wilder-Smith A. COVID-19 outbreak on the Diamond Princess cruise ship: estimating the epidemic potential and effectiveness of public health countermeasures. J Travel Med. 2020;27(3):taaa030. 

Stamatakis CE, Rice ME, Washburn FM, Krohn KJ, Bannerman M, et al. Maritime illness and death reporting and public health response, United States, 2010–2014. J Travel Med Inf Dis. 2017;19:16–21.

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Celebrity Summit May 2024

At a glance.

Learn about the gastrointestinal illness outbreak on Celebrity Cruises ship Celebrity Summit in May 2024, including outbreak details and actions taken in response.

Outbreak details

Cruise Line: Celebrity Cruises

Cruise Ship: Celebrity Summit

Voyage Dates: May 24–May 31, 2024

Voyage number: 58044

Number of passengers who reported being ill during the voyage out of total number of passengers onboard: 68 of 2,264 (3%)

Number of crew who reported being ill during the voyage out of total number of crew onboard: 5 of 943 (0.53%)

Predominant symptoms: diarrhea and vomiting

Causative agent: norovirus

Actions in response to the outbreak

In response to the outbreak, Celebrity Cruises and the crew aboard the ship reported the following actions:

• Collected stool specimens from gastrointestinal illness cases for testing.
• Isolated ill passengers and crew.
• Staged disembarkation for active cases to limit the opportunity of illness transmission to well guests.
• Sanitation of terminal and transport infection control procedures.

VSP remotely monitored the situation, including review of the ship's outbreak response and sanitation procedures.

Tips for healthy cruising

Learn how passengers can protect themselves .

More information

Gastrointestinal illness is a commonly used term for acute gastroenteritis (AGE). Cruise ships report cases that meet our case definition for AGE. We define a reportable case of AGE as

• Three or more loose stools within a 24-hour period or what is more than normal for that person OR
• Vomiting along with one of the following symptoms: diarrhea, muscle ache, headache, abdominal cramp, or fever.

Case totals

Cases reported are totals for the entire voyage. It does not mean all people are sick at the same time, such as when they arrive or leave a port or ship.

The Vessel Sanitation Program helps the cruise ship industry prevent and control the introduction and spread of gastrointestinal illnesses on cruise ships.

For Everyone

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Nearly 70 Celebrity Cruises guests sick in norovirus outbreak

• Nearly 70 passengers and five crew members got sick in a norovirus outbreak on a Celebrity Cruises ship.
• The ship is currently sailing week-long Alaska voyages between Vancouver and Seward.
• The illness is frequently associated with cruise ships, but those outbreaks account for just 1% of all outbreaks reported, according to the CDC.

Nearly 70 Celebrity Cruises passengers got sick in a norovirus outbreak during a recent cruise.

The Centers for Disease Control and Prevention said 68 of Celebrity Summit’s 2,264 guests reported being ill during a cruise that ended on Friday, along with five crew members. Their main symptoms were diarrhea and vomiting.

The ship is currently sailing week-long Alaska voyages between Vancouver and Seward, according to CruiseMapper . In response to the outbreak, the cruise line isolated sick guests and crew and collected samples for testing, among other steps, the health agency said. 

There were an isolated number of cases on board and the impacted guests are no longer on the ship, according to Nathaniel Derrenbacher, a spokesperson for Celebrity’s parent company Royal Caribbean Group. Summit was also sanitized.

The news follows another norovirus outbreak on Celebrity Constellation in January that left nearly 100 guests sick. The CDC has logged seven outbreaks of gastrointestinal illness on cruises that met its threshold for public notification so far this year. Norovirus was listed as the causative agent in all but one.

Cruise ship medical facilities: What happens if you get sick or injured (or bitten by a monkey)

The illness is frequently associated with cruise ships, but those outbreaks account for just 1% of all outbreaks reported, according to the CDC. Dr. Sarah E. Hochman, a hospital epidemiologist and the section chief of infectious diseases at NYU Langone Health’s Tisch Hospital, told USA TODAY in April that those happen in communities on land, too.

“There's not something special or unique about cruise ships,” she said at the time. “It's really any type of congregate setting, but it's also happening out in the community on a much smaller scale among households and household contacts. It just doesn't come to the attention of public health as much as it does for larger congregate settings.”

Nathan Diller is a consumer travel reporter USA TODAY based in Nashville. You can reach him at [email protected].

The Key Points at the top of this article were created with the assistance of Artificial Intelligence (AI) and reviewed by a journalist before publication. No other parts of the article were generated using AI. Learn more .

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Ukraine-Russia war latest: Vladimir Putin repeats warning he could send weapons to adversaries of the West

Speaking at the St Petersburg International Economic Forum, Vladimir Putin also says he does not see the conditions for the use of nuclear weapons as set out in Russia's nuclear doctrine - but adds he could not rule out a change to it.

Friday 7 June 2024 17:15, UK

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• Big picture:  Everything you need to know about the war right now
• Your questions answered: Are there any signs of an underground resistance in Russia?

Thank you for reading.

We will be back soon with more updates from the war in Ukraine.

Vladimir Putin has said he does not see the conditions for the use of nuclear weapons as set out in Russia's nuclear doctrine - but added he could not rule out a change to the doctrine.

"We have a nuclear doctrine which states that the use of nuclear arms is possible in an exceptional case, when the sovereignty and territorial integrity of our country is threatened," he told the St Petersburg International Economic Forum.

"But the doctrine can be changed.

"The same applies to nuclear tests. We will carry out tests if needed, but so far there is no such need."

Russia could send weapons to adversaries of the West, Vladimir Putin has warned for a second time.

The Russian president repeated the warning from earlier this week during the St Petersburg Economic Forum.

He did not say what countries or entities he was referring to, and he stressed that Moscow is not doing it currently.

"If they supply (weapons) to the combat zone and call for using these weapons against our territory, why don't we have the right to do the same?" he told the crowds. 

"But I'm not ready to say that we will be doing it tomorrow, either."

On Wednesday, Putin told international journalists that Russia could provide long-range weapons to others to strike Western targets in response to NATO allies allowing Ukraine to use their arms to attack Russian territory.

He also reaffirmed Moscow's readiness to use nuclear weapons if it sees a threat to its sovereignty.

Joe Biden has apologised to Volodymyr Zelenskyy for the recent delay in approving new US aid for Ukraine.

Last month, following months of political disagreements, the Senate passed $95bn (£76.2bn) in war aid to Ukraine, Israel and Taiwan .

"I apologise for those weeks of not knowing," the US president said.

"Some of our very conservative members [of Congress] were holding it up. 

"But we got it done, finally. We're still in - completely, totally." 

The Ukrainian president thanked his counterpart for American assistance.  

"It's very important that you stay with us," he said. 

"It's very important that in this unity, the United States of America, all American people stay with Ukraine, like it was during World War Two - how the United States helped to save human lives, to save Europe." 

The two men were speaking in Paris, the day after D-Day commemorations in Normandy.

Russia needs to boost its use of non-Western currencies, Vladimir Putin said as he addressed the St Petersburg International Economic Forum.

He also said his country needs to reduce imports while calling for a major expansion of its domestic financial markets.

Trade with Asia is soaring, he told delegates, adding that almost two fifths of Russian external trade is now in roubles.

The share conducted in US dollars, euros and other Western currencies has declined.

Russia will try to boost the share of settlements conducted in the currencies of BRICS countries - which include Brazil, Russia, India, China and South Africa, Mr Putin said.

"Last year, the share of payments for Russian exports in the so–called 'toxic' currencies of unfriendly states halved, while the share of the rouble in export and import transactions is growing - it is approaching 40% today," the president said.

Russia has referred to nations that imposed sanctions on it as "unfriendly".

 The session begins with an address by the Russian president. 

Vladimir Putin says there is a race among world powers to establish sovereignty. 

He speaks of the need for countries to both establish partnerships and also to look internally to tackle challenges presented by the current global economic landscape. 

Despite all the "obstacles and illegitimate sanctions", Russia remains one of the world's economic leaders, he says. 

He adds that "friendly countries" - those that have not joined sanctions against Moscow - account for three quarters of Russia's mutual trade turnover, and praises them for that. 

Countries including India and China have strengthened economic ties since Mr Putin launched his war in Ukraine. 

Vladimir Putin has taken to the stage in St Petersburg to address the International Economic Forum there.

He's joined by Zimbabwean President Emmerson Mnangagwais and Bolivian President Luis Alberto Arce Catacora. 

Chairing the session is Sergey Karaganov - a Russian political scientist. 

We'll bring you any key lines here in this live blog. 

A T-shirt is on sale at the St Petersburg International Economic Forum printed with a phrase attributed to Vladimir Putin, Sky News has discovered. 

"If a fight is inevitable, throw the first punch," it says.

The Russian president reportedly said it in 2015.

He apparently explained that it was something he had learned while growing up on the streets of Leningrad - a former name of St Petersburg. 

The Russian defence ministry has accused Ukraine of injuring 20 people, including children, in a missile attack on the Russian-controlled eastern Ukrainian city of Luhansk, using US-supplied ATACMS missiles.

Four of five missiles were shot down by air defence systems, the ministry said in a statement.

However, one of the missiles damaged two residential apartment blocks, it added, claiming it was deliberate.

Sky News is unable to verify the allegations.

There has been no immediate comment from Ukraine. 

The European Commission supports starting EU accession talks with Ukraine, the country's prime minister has said.

Denys Shmyhal said the commission had confirmed in a report that Kyiv had fulfilled the remaining steps required to start negotiations. 

"Now we expect our European partners to take the next step - to start negotiations on European Union membership this month," Mr Shmyhal said on Telegram. 

Earlier (7.43am post) we reported that the commission was reportedly ready to recommend that accession talks get underway.

It is part of an attempt to signal support for Kyiv before Hungary takes over the rotating presidency of the EU next month, the Financial Times reported.

The EU announced earlier this year that it was sending an additional £42bn in aid to Ukraine - but only after  weeks of resistance from Hungary , which reportedly has concerns about minority rights in Ukraine. 

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