VSP Outbreak Investigations

The Vessel Sanitation Program (VSP) monitors our surveillance system to observe illness patterns for gastrointestinal illness on cruise ships.

VSP conducts outbreak investigations when 3% or more of the ship’s passengers or crew members report they are sick with symptoms of gastrointestinal illness. We may also conduct an outbreak investigation if an unusual gastrointestinal illness pattern or characteristic is found (even if the illness rate is less than 3%).

VSP conducts outbreak investigations on ships sailing in the United States or within 15 days of arriving to a U.S. port.

What does VSP do in an outbreak investigation?

During an outbreak investigation, VSP works with cruise ship staff and the cruise line to determine the cause of illness.

When an outbreak occurs, we ask for logs and records, including gastrointestinal illness surveillance logs, so we can closely examine the reported cases. The surveillance logs include information such as specific symptoms and the date and time the illness occurred. By reviewing the logs, we are able to determine the following:

• Amount of illness throughout the ship.
• Distribution of illness among the passengers and crew.
• When the illness first began.
• Distribution of illness during each day of the voyage.
• Profiles of the ill people’s symptoms.

The objectives of an investigation are to

• Determine the magnitude of illness aboard the ship.
• Identify the pathogen causing the illness.
• Identify risk factors associated with the illness.
• Formulate control measures to prevent or stop the spread of illness.

By determining the cause of an outbreak, VSP can help the cruise line develop effective intervention strategies to prevent a recurrence of the outbreak.

VSP staff may board the cruise ship to do one or more of the following:

• Epidemiological assessment to examine the distribution of gastrointestinal illnesses, interview passengers and crew members, and distribute and analyze questionnaires.
• Targeted environmental health assessment to investigate specific areas on the vessel to check for exposure and routes of transmission of the illness and to monitor the ship’s OPRP procedures. This assessment is based on preliminary findings from the epidemiological review. For example, if water is suspected to be the source of the illness, more attention will be given to reviewing the water source.
• Laboratory investigation: Medical staff may collect stool, vomit, or blood specimens to send to a land-based lab to confirm the cause of illness.

What does VSP require cruise lines to do during outbreaks?

Cruise lines are required to activate their Outbreak Prevention and Response Plans and make every effort to gain control of the outbreak. These plans

• Indicate trigger points that initiate a ship’s response to cases of illness.
• Identify overall outbreak management strategies.
• Include detailed infection control procedures for each area of the ship.

Control measures include the following:

• Increase daily cleaning and disinfection frequencies.
• Stop high-risk activities, such as self-service buffets and handshaking.
• Isolate ill people.
• Collect clinical and/or environmental specimens for analysis.
• Provide daily updates to VSP that include case counts and reports of what the ship has done to establish control.
• Alert passengers and staff of the illness.
• Provide information about proper handwashing.
• Notify new passengers about the outbreak before embarkation.

VSP may also ask cruise lines to

• Notify port authorities.
• Delay embarkation of the next voyage.
• Establish cleaning and disinfection procedures in terminal buildings.

Where can I find information about a specific outbreak?

We post all outbreak summaries on our website.

Learn about VSP’s gastrointestinal illness surveillance.

How can I protect myself from gastrointestinal illness?

• Use proper handwashing techniques throughout your voyage, but especially after using the bathroom and before eating.
• Avoid any food or water that you think may be contaminated.
• Avoid raw or undercooked shellfish.
• Avoid unnecessary direct hand contact with surfaces such as public toilet room door handles.
• Avoid unnecessary close contact with ill persons.
• See our cruising tips.