Investigation Update on the Amsterdam

Cruise Line: Holland America Line

Cruise Ship: Amsterdam

Voyage Dates: 4/2-4/24

Number of passengers who have reported being ill during the voyage out of total number of passengers: 135 of 1318 (10.24%)

Number of ill crew who have reported being ill during the voyage out of total number of crew: 25 of 600 (4.17%)

Predominant symptoms: diarrhea and vomiting

Actions: In response to the outbreak, Holland America Line and the crew aboard the ship took the following actions:

• increased cleaning and disinfection procedures,
• notified passengers aboard the ship
• notified oncoming passengers,
• sent a corporate medical staff member to the ship for additional support,
• collected stool specimens for analysis,
• staffed the ship with an additional cleaning crew in Seattle.
• CDC initially analyzed 20 stool specimens for common enteric bacteria, Enterotoxigenic E. coli, and Norovirus, based on an analysis of the symptoms reported and the ship's itinerary, and only 2 of those were positive (one specimen for geno group 1 Norovirus and one specimen for geno group 2 Norovirus) - one positive specimen each from 2 different geno groups does not confirm Norovirus as a cause for the outbreak
• CDC's parasitic laboratory analyzed the samples again following a passenger report of lab confirmed Cyclospora cayetanensis (intestinal protozoan parasite) and 7/20 were positive for this pathogen
• Health Canada is the lead public health agency investigating this outbreak, which is ongoing, and any findings are pending at this time

Holland America Line is making daily reports to VSP and will continue to do so until the number of ill people returns to expected levels. Health Canada plans to board the ship on April 23rd in Victoria, British Columbia. The ship entered a scheduled dry dock maintenance following this cruise, then began a new Alaska itinerary where the gastrointestinal illness rates have returned to expected levels.