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Norovirus outbreaks on cruise ships surge to decade-high levels: How to avoid the stomach bug

In 2023, a decade-high number of cruise ships have reported an unwelcome passenger on board: norovirus.

Outbreaks of the stomach bug have surged on cruise ships this year, reaching the highest levels seen in 10 years. Since January 2023, there have been 13 confirmed norovirus outbreaks on cruise ships under U.S. jurisdiction — that's more outbreaks in six months than there have been during any full year since 2012, according to data from the U.S. Centers for Disease Control and Prevention .

After a lull during the COVID-19 pandemic, cases of the highly contagious virus that causes diarrhea and vomiting, aka stomach flu, spiked this winter and spring on land. As post-pandemic travel surges and millions of Americans return to cruise ships, an increasing number of cruise lines are reporting outbreaks at sea.

Norovirus outbreaks on cruise ships

Most recently, a norovirus outbreak in June on the Viking Neptune sickened 110 passengers (over 13% of the ship's guests) and nine crew members with vomiting, diarrhea and abdominal cramps, according to the CDC . The CDC has tracked outbreaks of gastrointestinal illness on cruise ships through its Vessel Sanitation Program (VSP) since 1994.

Several weeks prior, a Celebrity Summit cruise ship reported an outbreak of norovirus that sickened more than 150 passengers and 25 crew members, per the CDC . It was the third norovirus outbreak on a Celebrity Cruises vessel this year. Another popular cruise line, Royal Caribbean International, has reported four outbreaks since January.

Cruise ships are required to report cases of gastrointestinal illness to the CDC before arriving at any U.S. port, and the CDC will notify the public about outbreaks if they meet certain criteria, including: the ship is carrying 100 or more passengers, the voyage is three to 21 days long, and 3% or more of passengers or crew report symptoms, per the CDC .

The number of outbreaks in the first six months of 2023 is higher than the yearly total during every year since 2012, when there were 16 outbreaks on cruise ships reported to the CDC.

Norovirus can spread year-round, but it tends to have a wintertime seasonality and peak during the colder months. Outbreaks are most common between November and April, TODAY.com previously reported.

"It's a virus we typically see all throughout spring, so it’s not unusual to be see cases in April and May, (and) we are continuing to see many cases now," Dr. Luis Ostrosky, an infectious disease specialist at UTHealth Houston and Memorial Hermann in Houston, tells TODAY.com.

However, as travel surges this summer, travel-related illnesses are expected to surge, as well. “I think our travel frenzy after COVID is partially fueling this continued spread (of norovirus),” says Ostrosky.

What should people know about norovirus and how to avoid getting sick on cruise ships this summer?

Norovirus symptoms and treatment

The most common symptoms of norovirus are vomiting, nausea, diarrhea and abdominal pain, Dr. Albert Ko, infectious disease physician and professor of public health, epidemiology and medicine at Yale School of Public Health, tells TODAY.com.

Less commonly, norovirus may cause a headache, muscle aches, or a low-grade fever — symptoms usually develop within one to two days after exposure to the virus,  per the CDC .

In the vast majority of people, norovirus symptoms will last several days and resolve on their own.

There’s no specific treatment or antiviral for norovirus, according to Ostrosky, but most cases can be managed at home with supportive care like hydration and rest. Sick people should also isolate until their symptoms resolve, the experts emphasize.

Some people are at higher risk of developing severe norovirus symptoms — these include infants, the elderly, and people with compromised immune systems, Ostrosky noted.

How does norovirus spread?

Norovirus is highly contagious and can spread directly through sick people and contaminated surfaces, food, or drinks.

Transmission often occurs when tiny virus particles in feces or vomit from an infected person end up in another person's mouth through direct contact or by touching contaminated surfaces and putting unwashed hands in the mouth or nose, TODAY .com previously reported .

Norovirus can also get into food before, during or after preparation, and it's the top germ causing foodborne illness in the U.S., per the CDC . Virus particles can contaminate drinking water that isn't treated properly or pools when people poop in the water.

It only takes a small number of virus particles for norovirus to spread, which is why norovirus causes so many explosive outbreaks, Ko previously told TODAY.com.

Exposure to less than 100 norovirus particles can make someone sick, and infected people typically shed billions of particles, according to the CDC.

Most people are infectious from symptom onset until about two or three days after recovering, but some people can remain contagious for weeks, Ko notes. People can get infected with norovirus multiple times in their lifetime.

Is norovirus common on cruise ships?

Certain environments are more conducive to the virus spreading. According to the CDC , the most common settings for norovirus outbreaks are health care facilities, restaurants or catered events, schools, day cares and, of course, cruise ships.

Cruise ships are often associated with norovirus because of the enclosed spaces, close living quarters, communal dining and high turnover of passengers, experts note. That said, outbreaks of acute gastrointestinal illnesses are relatively infrequent on cruise ships compared to settings on land, the CDC notes .

How to avoid norovirus on a cruise

Hand hygiene is key to prevent the spread of the highly contagious virus — but the way you clean your hands matters, experts note. It has to be with soap and water, because alcohol-based hand sanitizers are not effective against norovirus.

“Norovirus is one of the few viruses that doesn’t get deactivated by alcohol. You actually need to use soap and water to physically destroy it and remove it from your hands,” Ostrosky previously told TODAY.com.

It's important to wash your hands with soap and clean water frequently, but especially after using the bathroom or changing diapers, before eating and before touching your face.

Surfaces or objects that are contaminated with norovirus can be cleaned with a high-level disinfectant like bleach, per Ostrosky.

On cruise ships, avoid sick people if you can. Passengers who experience norovirus symptoms like vomiting and diarrhea should notify staff and follow recommended precautions, per the CDC .

Caroline Kee is a health reporter at TODAY based in New York City.

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Norovirus Outbreaks on Cruise Ships: How to Avoid Getting Sick on Vacation

• There have been 13 norovirus outbreaks on cruise ships in 2023.
• Experts note that the highly congested environment, as well as the fact that people have not been exposed to as many illnesses due to the COVID-19 pandemic, are likely the reason for the increased norovirus numbers.
• Experts recommend maintaining proper hygiene habits and contacting the ship’s medical facility as soon as you don’t feel well in order to avoid spreading illnesses while at sea.

Multiple cruise lines are experiencing norovirus outbreaks.

There have currently been 13 norovirus outbreaks on cruise ships in 2023. The most recent outbreak occurred on a Viking Cruises ship, which traveled from Iceland and docked in New York City. About 13% of its passengers and several crew members became ill with the virus while on board.

With more than 31 million passengers worldwide expected to set sail this year, experts told Health that these highly-congested environments—along with the fact that people have not been exposed to a normal amount of illnesses due to the pandemic—could be the reasons for the increased numbers.

“Loosening of restrictions after the COVID-19 pandemic makes us more susceptible to picking up viruses after several years in seclusion,” Sanjiv Shah, MD, MPH , an infectious disease specialist and chief medical officer for MetroPlusHealth, New York City’s public health insurance program, told Health.

“Children who have been able to avoid the virus during the pandemic are now being exposed to viruses that tend to peak during the school year,” he said. “While norovirus is higher this year, the numbers are not a big outlier compared to pre-pandemic levels.”

Getty Images / Michael Dunning

What Is Norovirus?

Norovirus is the most common cause of gastroenteritis and foodborne illness . Though people often call it the “ stomach flu ,” it has nothing to do with flu, Brian Labus, PhD, MPH, REHS , an expert in infectious diseases, told Health .

“You have to swallow the virus to get sick,” Labus, an assistant professor in the Department of Epidemiology and Biostatistics at the UNLV School of Public Health, said. “That can be through consuming contaminated food or touching a contaminated surface and then touching your mouth or not washing your hands before you eat.”

Norovirus, which causes inflammation of the stomach or intestines, typically causes diarrhea , vomiting, nausea, and stomach pain Bernadette Boden-Albala, DrPH, MPH , director and founding dean of the Program in Public Health at the University of California Irvine told Health . Other symptoms can include fever, headache, and body aches.

Typically, norovirus lasts for one to three days, though you can spread the illness for a few days after.

“Infected people spread the virus widely and make it difficult for public health officials to contain the virus,” Boden-Albala said.

Why the Number of Norovirus Outbreaks Increased

The exact cause for the increase in the number of norovirus cases is not clear, but the increasing demand for cruises could be one explanation for the rise in reported cases, said Labus.

During COVID, the options for cruises were limited, but now that restrictions have been lifted , more people are deciding to take that cruise they had been putting off.

People also are more likely to get sick now since pandemic restrictions have been lifted. For the past few years, people have not been exposed to as many common viruses and illnesses and now that exposure is rising, illnesses are bound to rise as well.

It also is possible the numbers for norovirus on cruise ships appear more alarming than they truly are.

On cruise ships, health officials are legally required to track any illnesses that occur, while this same reporting is not required on land. For this reason, the Centers for Disease Control and Prevention note that outbreaks are reported more frequently on sea than on land.

“The risk of getting norovirus each year is about 1 in 15 [but] a cruise passenger has about a 1 in 5,500 risk of getting norovirus,” Sally Andrews, vice president of strategic communications and public affairs for the Cruise Lines International Association told Health .

Environments Where Norovirus Spreads Quickly

According to Shah, norovirus spreads rapidly anywhere there are large groups of people, like school classrooms, family gatherings, and weddings.

Cruise ships in particular have many of the conditions that make people susceptible to norovirus—close quarters, enclosed spaces, communal dining, and high turnover of passengers.

“The virus is often associated with cruise travel simply because health officials are required to track illnesses on ships,” Shah said. “The CDC estimates only about 1% of annual U.S. norovirus cases happen on cruise ships. Rates are much higher in schools, nursing homes, hospitals, and restaurants, which collectively account for about 91% of cases.”

Minji Kang, MD, an assistant professor and infectious disease specialist in the Department of Internal Medicine at UT Southwestern Medical Center added that norovirus can also be brought onboard by contaminated food or water, or passengers who were infected while ashore.

Yes, Cruise Ships Have Strategies to Prevent Outbreaks

Because norovirus outbreaks can flare up in the close quarters of a ship, the cruise industry has had norovirus prevention programs in place for nearly 20 years, Labus said. “They have the right chemicals needed to control it and the plans and training for how to use them appropriately.”

Cruise ships also have plans for how to deal with ill guests to ensure that they are not infecting other passengers, he said. “It’s important to let the ship’s medical staff know if you are sick so that they can protect the rest of the passengers.”

According to the American College of Emergency Physicians (ACEP), every cruise ship must have a place to isolate any passengers who have a contagious disease. This step helps them minimize the risk of spreading the disease to others.

What’s more, the CDC has established a rigorous Vessel Sanitation Program (VSP) to help prevent the overall spread of illnesses on cruise ships. Not only do they inspect a cruise ship’s medical center, but they also monitor their portable water systems, dining rooms, housekeeping procedures, heating, ventilation, air conditioning (HVAC) systems, and more.

If a cruise ship does not do well on its inspection—or gets an 85% or lower—it cannot set sail until it corrects the issues.

Staying Healthy While on a Cruise

While there have been 13 outbreaks of norovirus on cruise ships this year, Labus explained that not every cruise passenger is going to be exposed to the virus. Still, taking certain steps to prevent the likelihood of getting sick is never a bad idea.

“The most important measure to prevent the spread of norovirus is to wash your hands with soap and water for at least 20 seconds,” said Kang. “This should be done before eating and drinking, brushing one’s teeth, and after going to the bathroom, touching high-hand contact surfaces, and taking care of a sick person.”

She noted that hand sanitizers do not work well against norovirus and that they are not a substitute for handwashing.

For extra peace of mind, you can also research your cruise line prior to booking.

To see how your specific cruise line performed on its VSP inspections, you can visit the CDC website and search their portal. This site also lists any corrective actions taken to remedy any issues. You can even look for cruise lines that have scored a perfect 100.

If you do happen to get sick while on a cruise, Boden-Albala recommends that you follow CDC guidelines and report your illness to the ship’s medical facility as soon as possible. “[You also should] rest and drink plenty of water to rebuild your immunity system and prevent dehydration.”

Even though you may be tempted to conceal your illness, you would be doing a great disservice to the other passengers and the crew on the cruise by keeping it a secret.

“While staying in your cabin [for a day or two] may not make for the best vacation,” Shah said, “it’s important to take precautions to avoid infecting others.”

Centers for Disease Control and Prevention. Outbreak updates for international cruise ships .

Cruise Lines International Association. State of the cruise industry 2023 .

Centers for Disease Control and Prevention. Symptoms of norovirus .

Centers for Disease Control and Prevention. Facts about noroviruses on cruise ships .

Cruise Lines International Association. Norovirus on cruise ships .

American College of Emergency Physicians. Healthcare guidelines for cruise ship medical facilities .

Centers for Disease Control and Prevention. Vessel sanitation program: inspection infographic .

Centers for Disease Control and Prevention. Advanced cruise ship inspection search .

Centers for Disease Control and Prevention. Cruise ship inspection scored 100 .

Related Articles

Cruise ship barred from docking in Mauritius amid outbreak of stomach illness

Officials in the island nation of Mauritius blocked a Norwegian Cruise Line ship from docking there Sunday after more than a dozen passengers were stricken with a stomach illness.

Around 15 passengers aboard the Norwegian Dawn remain in isolation because of an undisclosed "health risk" and are undergoing testing, according to the Mauritius Ports Authority .

"The decision not to allow the cruise ship access to the quay was taken in order to avoid any health risks," the authority said in a statement.

The sick guests “experienced mild symptoms of a stomach-related illness,” Norwegian Cruise Line said in a statement Sunday. The cause of the outbreak has not been released.

“Due to additional testing being required by local authorities before being allowed entry, the government of Mauritius has delayed disembarkation for the current cruise and embarkation for the next cruise by two days,” the Norwegian statement said.

It’s expected that the ship will be allowed to dock Tuesday, the cruise line said, after results of tests conducted Sunday become available.

The Norwegian Dawn has more than 2,100 passengers and 1,000 crew on board. About 2,000 of those travelers were set to complete their journey on Sunday by disembarking in Mauritius, in the Indian Ocean just east of Madagascar, the Ports Authority said. Then more than 2,200 new passengers were scheduled to board.

The authority said that the passengers who were due to start their cruise Sunday would not be able to do so that day and that they would have to be relocated to available hotels.

Norwegian Cruise Line said the ship's "management team met with local authorities to confirm precautions and actions were being taken to ensure the wellbeing of all on board."

Gastrointestinal illnesses are often identified on cruise ships for a few reasons , according to the Centers for Disease Control and Prevention: The ships' close living quarters make it easier for viruses to spread, and the regular addition of new passengers creates opportunities to introduce illness. However, because public health officials track illness cases on cruise ships, such outbreaks may also be reported more often than ones on land.

Last month, an outbreak of norovirus — a common stomach bug that causes vomiting and diarrhea — sickened 92 passengers and eight crew members on a Celebrity Cruises ship.

Senior Breaking News Reporter

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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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Norovirus Cases Are Rising on Cruises. Here’s How You Can Stay Safe

Keep hands clean as stomach bug cases rise.

Larry Bleiberg,

Just as travel has begun to bounce back after the pandemic, cruise ship passengers are facing another threat to their vacation: norovirus .

Thirteen ships so far this year have reported outbreaks of the highly contagious stomach bug, the most since 2012, according to the  U.S. Centers for Disease Control and Prevention (CDC) . Nearly 1,700 passengers have come down with the virus, which causes vomiting, nausea, diarrhea and stomach pain. Not only does it take the joy out of vacation, keeping passengers confined to their stateroom, but for older travelers, there’s a concern of dehydration, doctors say.

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The  bug thrives in crowded conditions  and is spread through food and by touching contaminated surfaces. The easiest way to avoid the ailment is to wash your hands with soap and water after using the bathroom, before eating and after touching surfaces touched by others.

Samuel Mathis, M.D., an assistant professor in the University of Texas Medical Branch Department of Family Medicine, says the resilient virus can live for days and there are plenty of places for it to linger on cruise ships: “Door handles, stairway banisters, tongs for food at the buffet, things that a lot of people touch that aren’t cleaned between each use.”

And washing your own hands isn’t enough. Mathis says older passengers and others traveling with family face a risk from others in their party. For example, if grandchildren aren’t careful hand-washers, they can easily infect their grandparents and others.

Mathis, who works in Galveston, Texas, a cruise port, has seen passengers with norovirus. He says that while the virus itself is uncomfortable, it isn’t typically dangerous. “The biggest risk for almost everyone — but especially for seniors — is actually the risk of dehydration: losing all that fluid through nausea, vomiting and diarrhea.”

Symptoms of dehydration  include extreme thirst, lack of urination and dizziness when standing, Mathis says.

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If passengers come down with a stomach bug, they should contact the ship’s medical clinic, which will monitor for dehydration. In addition, they should stay in their cabin away from people until they are symptom-free for at least 24 hours, Mathis says. “That can be really rough because you’re missing your cruise.”

The most recent norovirus outbreak was reported on the  Viking Neptune  cruise ship. During its June 6 to June 20 voyage, 110 of the ship’s 838 passengers, or 13.1 percent, were infected. In addition, nine of the 455 crew members were infected.

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“We believe the gastrointestinal illness originated from a shoreside restaurant in Iceland where a group of guests dined during their free time,” the cruise line said in a statement. After docking in New York, the ship was thoroughly cleaned and disinfected, and continued its scheduled sailings.

The CDC regularly inspects cruise ships and monitors the number of outbreaks. This year, norovirus also has been reported on cruises operated by Royal Caribbean International, Celebrity Cruises, Princess Cruises, Holland America and P&O Cruises. The worst year for norovirus was 2006, when 32 ships reported infections, according to the CDC.

Cruise experts say several factors may be contributing to the rise in cases. For one, cruising has soared this year, with the number of passengers expected to surpass the total that sailed in 2019, according to the Cruise Lines International Association.

Letting down their guard

Ashley Kosciolek, senior cruise writer at The Points Guy, a consumer travel website, says that after years of COVID-related precautions, passengers may have let their guard down. 

“People are just so happy to be back, but they’ve gotten a little lax with hygiene. I personally have seen lots of people using the women’s room and not washing their hands. I don’t know if it’s subconscious rebellion or if they don’t realize what could happen.”

Kosciolek says she has made it a practice to wash her hands before going to the buffet, and then washing them again before she eats, since buffet implements aren’t sanitized after each passenger touches them.

Mathis says it might even make sense for passengers to avoid the buffet and dine only at their ship’s sit-down restaurants.

That said, the chances of catching the bug on a cruise ship aren’t particularly high. According to the  Cruise Lines Industry Association , the risk each year of getting laboratory-confirmed norovirus during a ship outbreak is about 1 in 5,500. The most common settings for norovirus aren’t even at sea. Over half of all cases originate in long-term health care facilities, according to the CDC, while less than 1 percent of all norovirus cases come from cruise ships.

Kosciolek notes that while cruise ships are required to report outbreaks, many land-based cases go unreported. “It is easy for someone who has never cruised to see these news reports and say, ‘Oh my goodness, I’m never going to cruise because I’m going to get sick.’ ”

Likewise, Mathis says vacationers shouldn’t let the fear of norovirus keep them from taking a vacation.

“I do not suggest that people don’t go on cruises. When proper safety precautions are taken, cruises are fantastic opportunities for individuals to relax, to spend time with friends or family and meet new people. It really just comes down to recognizing there are risks.”

Virginia native Larry Bleiberg is president of the Society of American Travel Writers, a frequent contributor to  BBC Travel  and the creator of  CivilRightsTravel.com .​​

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Cruise Ship Travel

While cruising is a popular way to travel, there are some health concerns to be aware of. Find out more about health issues on cruises and steps you can take to stay safe and healthy during your trip.

If you are feeling sick before your voyage, do not travel and ask your cruise line about rescheduling or reimbursement options. If you feel sick during your voyage, report your symptoms to the ship’s medical center and follow their recommendations.

Common Health Concerns During Cruise Travel and What You Can Do to Prevent Illness

• Respiratory viral illnesses like COVID-19 ,  flu , and RSV :  Follow core prevention strategies to protect yourself and others. Get your annual flu shot , stay  up to date on your COVID-19 vaccines , and check if you're eligible for an RSV vaccine . Check directly with your cruise line before travel about any health requirements. If you have a weakened immune system , talk with your healthcare provider about your cruise travel plans. Wash your hands frequently or use hand sanitizer . Stay home and away from others if you have respiratory virus symptoms. Do not travel until your symptoms are improving and you have not had a fever for 24 hours (without meds). For 5 additional days, take precautions including covering your nose and mouth with a tissue to prevent spreading germs when you cough or sneeze. Consider wearing a mask in crowded or poorly ventilated indoor areas or avoiding those areas all together.
• Gastrointestinal illness:  Symptoms of vomiting and diarrhea, primarily caused by outbreaks of norovirus , have been reported. To prevent gastrointestinal illness, wash your hands with soap and water before eating and after using the bathroom, changing diapers, or touching things that other people have touched, such as stair railings. Avoid touching your face. For more information, visit CDC’s  Vessel Sanitation Program  website.
• Seasickness:  Cruise ship passengers may experience seasickness or motion sickness. If you know you get seasick or think you may be likely to get seasick, talk to your healthcare provider about medicine to reduce your symptoms. Some common medications, including some antidepressants, painkillers, and birth control pills, can make seasickness worse.
• Sunburns:  Apply sunscreen with SPF 15 or higher when traveling. Protecting yourself from the sun isn’t just for tropical beaches—you can get a sunburn even if it’s cloudy or cold.
• Bug bites:  On your trip, use insect repellent and take other steps to avoid bug bites. Bugs, including mosquitoes and ticks, can spread diseases such as malaria, yellow fever, Zika, dengue, chikungunya, and Lyme. Many ships visit ports where these diseases are a concern.

Before Your Trip

Check CDC’s destination pages for travel health information . Check CDC’s webpage for your destination to see what vaccines or medicines you may need and what diseases or health risks are a concern at your destination.

Make sure you are up to date with all of your routine vaccines . Routine vaccinations protect you from infectious diseases that can spread quickly in groups of people. Outbreaks of chickenpox, flu, and COVID-19 have been reported on cruise ships.

Many diseases prevented by routine vaccination are not common in the United States but are still common in other countries. Crew members and fellow travelers often board a cruise ship from destinations where some diseases are more common than in the United States or where vaccination is not routine.

Make an appointment with your healthcare provider or a travel health specialist  that takes place at least one month before you leave. They can help you get destination-specific vaccines, medicines, and information. Discussing your health concerns, itinerary, and planned activities with your provider allows them to give more specific advice and recommendations.

Plan for the Unexpected

Prepare for any unexpected issues during your cruise ship travels with the following steps:

Prepare a  travel health kit  with items you may need, especially those items that may be difficult to find at your destination. Include your prescriptions and over-the-counter medicines in your travel health kit and take enough to last your entire trip, plus extra in case of travel delays. Depending on your destination you may also want to pack a mask ,  insect repellent , sunscreen (SPF 15 or higher), aloe, alcohol-based hand sanitizer, water disinfection tablets, and your health insurance card.

Get travel insurance.  Find out if your health insurance covers medical care abroad. Travelers are usually responsible for paying hospital and other medical expenses out of pocket at most destinations. Make sure you have a plan to  get care overseas , in case you need it. Consider buying  additional insurance  that covers health care and emergency evacuation, especially if you will be traveling to remote areas.

If you need medical care abroad, see Getting Health Care During Travel .

After Travel

If you traveled and feel sick, particularly if you have a fever, talk to a healthcare provider and tell them about your travel. Avoid contact with other people while you are sick.

More Information

• Cruise Ship Travel in CDC Yellow Book
• Tips for Healthy Cruising
• Maritime Guidance

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Public Health Responses to COVID-19 Outbreaks on Cruise Ships — Worldwide, February–March 2020

Weekly / March 27, 2020 / 69(12);347-352

On March 23, 2020, this report was posted online as an MMWR Early Release.

Please note: This report has been corrected .

Leah F. Moriarty, MPH 1 ; Mateusz M. Plucinski, PhD 1 ; Barbara J. Marston, MD 1 ; Ekaterina V. Kurbatova, MD, PhD 1 ; Barbara Knust, DVM 1 ; Erin L. Murray, PhD 2 ; Nicki Pesik, MD 1 ; Dale Rose, PhD 1 ; David Fitter, MD 1 ; Miwako Kobayashi, MD, PhD 1 ; Mitsuru Toda, PhD 1 ; start highlight Paul T. Cantey, MD 1 ; end highlight Tara Scheuer, MPH 3 ; Eric S. Halsey, MD 1 ; Nicole J. Cohen, MD 1 ; Lauren Stockman, MPH 2 ; Debra A. Wadford, PhD 2 ; Alexandra M. Medley, DVM 1 ,4 ; Gary Green, MD 5 ; Joanna J. Regan, MD 1 ; Kara Tardivel, MD 1 ; Stefanie White, MPH 1 ; start highlight Clive Brown, MD 1 ; end highlight Christina Morales, PhD 2 ; Cynthia Yen, MPH 2 ; Beth Wittry, MPH 1 ; Amy Freeland, PhD 1 ; Sara Naramore, MPH 3 ; Ryan T. Novak, PhD 1 ; David Daigle, MPH 1 ; Michelle Weinberg, MD 1 ; Anna Acosta, MD 1 ; Carolyn Herzig, PhD 1 ; Bryan K Kapella, MD 1 ; Kathleen R. Jacobson, MD 2 ; Katherine Lamba, MPH 2 ; Atsuyoshi Ishizumi, MPH, MSc 1 ; John Sarisky, MPH 1 ; Erik Svendsen, PhD 1 ; Tricia Blocher, MS 2 ; Christine Wu, MD 3 ; Julia Charles, JD 1 ; Riley Wagner, MPH 1 ; Andrea Stewart, PhD 1 ; Paul S. Mead, MD 1 ; Elizabeth Kurylo, MCM 1 ; Stefanie Campbell, DVM 1 ; Rachel Murray, MPH 1 ; Paul Weidle, PharmD 1 ; Martin Cetron, MD 1 ; Cindy R. Friedman, MD 1 ; CDC Cruise Ship Response Team; California Department of Public Health COVID-19 Team; Solano County COVID-19 Team ( View author affiliations )

What is already known about this topic?

Cruise ships are often settings for outbreaks of infectious diseases because of their closed environment and contact between travelers from many countries.

What is added by this report?

More than 800 cases of laboratory-confirmed COVID-19 cases occurred during outbreaks on three cruise ship voyages, and cases linked to several additional cruises have been reported across the United States. Transmission occurred across multiple voyages from ship to ship by crew members; both crew members and passengers were affected; 10 deaths associated with cruise ships have been reported to date.

What are the implications for public health practice?

Outbreaks of COVID-19 on cruise ships pose a risk for rapid spread of disease beyond the voyage. Aggressive efforts are required to contain spread. All persons should defer all cruise travel worldwide during the COVID-19 pandemic.

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An estimated 30 million passengers are transported on 272 cruise ships worldwide each year* ( 1 ). Cruise ships bring diverse populations into proximity for many days, facilitating transmission of respiratory illness ( 2 ). SARS-CoV-2, the virus that causes coronavirus disease (COVID-19) was first identified in Wuhan, China, in December 2019 and has since spread worldwide to at least 187 countries and territories. Widespread COVID-19 transmission on cruise ships has been reported as well ( 3 ). Passengers on certain cruise ship voyages might be aged ≥65 years, which places them at greater risk for severe consequences of SARS-CoV-2 infection ( 4 ). During February–March 2020, COVID-19 outbreaks associated with three cruise ship voyages have caused more than 800 laboratory-confirmed cases among passengers and crew, including 10 deaths. Transmission occurred across multiple voyages of several ships. This report describes public health responses to COVID-19 outbreaks on these ships. COVID-19 on cruise ships poses a risk for rapid spread of disease, causing outbreaks in a vulnerable population, and aggressive efforts are required to contain spread. All persons should defer all cruise travel worldwide during the COVID-19 pandemic.

During February 7–23, 2020, the largest cluster of COVID-19 cases outside mainland China occurred on the Diamond Princess cruise ship, which was quarantined in the port of Yokohama, Japan, on February 3 ( 3 ). On March 6, cases of COVID-19 were identified in persons on the Grand Princess cruise ship off the coast of California; that ship was subsequently quarantined. By March 17, confirmed cases of COVID-19 had been associated with at least 25 additional cruise ship voyages. On February 21, CDC recommended avoiding travel on cruise ships in Southeast Asia; on March 8, this recommendation was broadened to include deferring all cruise ship travel worldwide for those with underlying health conditions and for persons aged ≥65 years. On March 13, the Cruise Lines International Association announced a 30-day voluntary suspension of cruise operations in the United States ( 5 ). CDC issued a level 3 travel warning on March 17, recommending that all cruise travel be deferred worldwide. †

Diamond Princess

On January 20, 2020, the Diamond Princess cruise ship departed Yokohama, Japan, carrying approximately 3,700 passengers and crew ( Table ). On January 25, a symptomatic passenger departed the ship in Hong Kong, where he was evaluated; testing confirmed SARS-CoV-2 infection. On February 3, the ship returned to Japan, after making six stops in three countries. Japanese authorities were notified of the COVID-19 diagnosis in the passenger who disembarked in Hong Kong, and the ship was quarantined. Information about social distancing and monitoring of symptoms was communicated to passengers. On February 5, passengers were quarantined in their cabins; crew continued to work and, therefore, could not be isolated in their cabins ( 6 ). Initially, travelers with fever or respiratory symptoms and their close contacts were tested for SARS-CoV-2 by reverse transcription–polymerase chain reaction (RT-PCR). All those with positive test results were disembarked and hospitalized. Testing was later expanded to support a phased disembarkation of passengers, prioritizing testing of older persons, those with underlying medical conditions, and those in internal cabins with no access to the outdoors. During February 16–23, nearly 1,000 persons were repatriated by air to their home countries, including 329 persons who returned to the United States and entered quarantine or isolation. § , ¶

The remaining passengers who had negative SARS-CoV-2 RT-PCR test results,** no respiratory symptoms, and no close contact with a person with a confirmed case of COVID-19 completed a 14-day ship-based quarantine before disembarkation. Those passengers who had close contact with a person with a confirmed case completed land-based quarantine, with duration determined by date of last contact. After disembarkation of all passengers, crew members either completed a 14-day ship-based quarantine, were repatriated to and managed in their home country, or completed a 14-day land-based quarantine in Japan.

Overall, 111 (25.9%) of 428 U.S. citizens and legal residents did not join repatriation flights either because they had been hospitalized in Japan or for other reasons. To mitigate SARS-CoV-2 importation into the United States, CDC used temporary “Do Not Board” restrictions ( 7 ) to prevent commercial airline travel to the United States, †† and the U.S. Departments of State and Homeland Security restricted travel to the United States for non-U.S. travelers.

Among 3,711 Diamond Princess passengers and crew, 712 (19.2%) had positive test results for SARS-CoV-2 ( Figure 1 ). Of these, 331 (46.5%) were asymptomatic at the time of testing. Among 381 symptomatic patients, 37 (9.7%) required intensive care, and nine (1.3%) died ( 8 ). Infections also occurred among three Japanese responders, including one nurse, one quarantine officer, and one administrative officer ( 9 ). As of March 13, among 428 U.S. passengers and crew, 107 (25.0%) had positive test results for COVID-19; 11 U.S. passengers remain hospitalized in Japan (median age = 75 years), including seven in serious condition (median age = 76 years).

Grand Princess

During February 11–21, 2020, the Grand Princess cruise ship sailed roundtrip from San Francisco, California, making four stops in Mexico (voyage A). Most of the 1,111 crew and 68 passengers from voyage A remained on board for a second voyage that departed San Francisco on February 21 (voyage B), with a planned return on March 7 (Table). On March 4, a clinician in California reported two patients with COVID-19 symptoms who had traveled on voyage A, one of whom had positive test results for SARS-CoV-2. CDC notified the cruise line, which began cancelling group activities on voyage B. More than 20 additional cases of COVID-19 among persons who did not travel on voyage B have been identified from Grand Princess voyage A, the majority in California. One death has been reported. On March 5, a response team was transported by helicopter to the ship to collect specimens from 45 passengers and crew with respiratory symptoms for SARS-CoV-2 testing; 21 (46.7%), including two passengers and 19 crew, had positive test results. Passengers and symptomatic crew members were asked to self-quarantine in their cabins, and room service replaced public dining until disembarkation. Following docking in Oakland, California, on March 8, passengers and crew were transferred to land-based sites for a 14-day quarantine period or isolation. Persons requiring medical attention for other conditions or for symptoms consistent with COVID-19 were evaluated, tested for SARS-CoV-2 infection, and hospitalized if indicated. During land-based quarantine in the United States, all persons were offered SARS-CoV-2 testing. As of March 21, of 469 persons with available test results, 78 (16.6%) had positive test results for SARS-CoV-2. Repatriation flights for foreign nationals were organized by several governments in coordination with U.S. federal and California state government agencies. Following disinfection of the vessel according to guidance from CDC’s Vessel Sanitation Program, remaining foreign nationals will complete quarantine on board. The quarantine will be managed by the cruise company, with technical assistance provided by public health experts.

On February 21, five crew members from voyage A transferred to three other ships with a combined 13,317 passengers on board. No-sail orders §§ were issued by CDC for these ships until medical logs were reviewed and the crew members tested negative for SARS-CoV-2.

Additional Ships

The Diamond Princess and Grand Princess had more than 800 total COVID-19 cases, including 10 deaths. During February 3–March 13, in the United States, approximately 200 cases of COVID-19 were confirmed among returned cruise travelers from multiple ship voyages, including the Diamond Princess and Grand Princess, accounting for approximately 17% of total reported U.S. cases at the time ( 10 ). Cases linked with cruise travel have been reported to CDC in at least 15 states. Since February, multiple international cruises have been implicated in reports of COVID-19 cases, including at least 60 cases in the United States from Nile River cruises in Egypt ( Figure 2 ). Secondary community-acquired cases linked to returned passengers on cruises have also been reported (CDC, unpublished data, 2020).

Public health responses to COVID-19 outbreaks on cruise ships were aimed at limiting transmission among passengers and crew, preventing exportation of COVID-19 to other communities, and assuring the safety of travelers and responders. These responses required the coordination of stakeholders across multiple sectors, including U.S. Government departments and agencies, foreign ministries of health, foreign embassies, state and local public health departments, hospitals, laboratories, and cruise ship companies. At the time of the Diamond Princess outbreak, it became apparent that passengers disembarking from cruise ships could be a source of community transmission. Therefore, aggressive efforts to contain transmission on board and prevent further transmission upon disembarkation and repatriation were instituted. These efforts included travel restrictions applied to persons, movement restrictions applied to ships, infection prevention and control measures, (e.g., use of personal protective equipment for medical and cleaning staff), disinfection of the cabins of persons with suspected COVID-19, provision of communication materials, notification of state health departments, and investigation of contacts of cases identified among U.S. returned travelers.

Cruise ships are often settings for outbreaks of infectious diseases because of their closed environment, contact between travelers from many countries, and crew transfers between ships. On the Diamond Princess, transmission largely occurred among passengers before quarantine was implemented, whereas crew infections peaked after quarantine ( 6 ). On the Grand Princess, crew members were likely infected on voyage A and then transmitted SARS-CoV-2 to passengers on voyage B. The results of testing of passengers and crew on board the Diamond Princess demonstrated a high proportion (46.5%) of asymptomatic infections at the time of testing. Available statistical models of the Diamond Princess outbreak suggest that 17.9% of infected persons never developed symptoms ( 9 ). A high proportion of asymptomatic infections could partially explain the high attack rate among cruise ship passengers and crew. SARS-CoV-2 RNA was identified on a variety of surfaces in cabins of both symptomatic and asymptomatic infected passengers up to 17 days after cabins were vacated on the Diamond Princess but before disinfection procedures had been conducted (Takuya Yamagishi, National Institute of Infectious Diseases, personal communication, 2020). Although these data cannot be used to determine whether transmission occurred from contaminated surfaces, further study of fomite transmission of SARS-CoV-2 aboard cruise ships is warranted.

During the initial stages of the COVID-19 pandemic, the Diamond Princess was the setting of the largest outbreak outside mainland China. Many other cruise ships have since been implicated in SARS-CoV-2 transmission. Factors that facilitate spread on cruise ships might include mingling of travelers from multiple geographic regions and the closed nature of a cruise ship environment. This is particularly concerning for older passengers, who are at increased risk for serious complications of COVID-19 ( 4 ). The Grand Princess was an example of perpetuation of transmission from crew members across multiple consecutive voyages and the potential introduction of the virus to passengers and crew on other ships. Public health responses to cruise ship outbreaks require extensive resources. Temporary suspension of cruise ship travel during the current phase of the COVID-19 pandemic has been partially implemented by cruise lines through voluntary suspensions of operations, and by CDC through its unprecedented use of travel notices and warnings for conveyances to limit disease transmission ( 5 ).

Acknowledgments

Staff members responding to COVID-19 outbreaks on cruise ships; Japan’s Ministry of Health, Labour and Welfare; California Department of Public Health; cruise ship passengers; Princess Cruises; Christina Armantas, Matthew Bacinskas, Cynthia Bernas, Brandon Brown, Teal Bullick, Lyndsey Chaille, Martin Cilnis, Gail Cooksey, Ydelita Gonzales, Christopher Kilonzo, Chun Kim, Ruth Lopez, Dominick Morales, Chris Preas, Kyle Rizzo, Hilary Rosen, Sarah Rutschmann, Maria Vu, California Department of Public Health, Richmond and Sacramento; Ben Gammon, Ted Selby, Solano County Public Health; Medic Ambulance Service; NorthBay HealthCare; Sutter Solano Medical Center; Kaiser Permanente Vallejo Medical Center; Kaiser Permanente Vacaville Medical Center start highlight ; field teams at repatriation sites; National Institute of Infectious Diseases, Japan end highlight .

CDC Cruise Ship Response Team

Casey Barton Behravesh, CDC; Adam Bjork, CDC; William Bower, CDC; Catherine Bozio, CDC; Zachary Braden, CDC; Mary Catherine Bertulfo, CDC; Kevin Chatham-Stephens, CDC; Victoria Chu, CDC; Barbara Cooper, CDC; Kathleen Dooling, CDC; Christine Dubray, CDC; Emily Curren, CDC; Margaret A. Honein, CDC; Kathryn Ivey, CDC; Jefferson Jones, CDC; Melissa Kadzik, CDC; Nancy Knight, CDC; Mariel Marlow, CDC; Audrey McColloch, CDC; Robert McDonald, CDC; Andrew Klevos, CDC; Sarah Poser, CDC; Robin A. Rinker, CDC; Troy Ritter, CDC; Luis Rodriguez, CDC; Matthew Ryan, CDC; Zachary Schneider, CDC; Caitlin Shockey, CDC; Jill Shugart, CDC; Margaret Silver, CDC; Paul W. Smith, CDC; Farrell Tobolowsky, CDC; Aimee Treffiletti, CDC; Megan Wallace, CDC; Jonathan Yoder, CDC.

California Department of Public Health COVID-19 Team

Pennan Barry, California Department of Public Health; Ricardo Berumen, III, California Department of Public Health; Brooke Bregman, California Department of Public Health; Kevin Campos, California Department of Public Health; Shua Chai, California Department of Public Health; Rosie Glenn-Finer, California Department of Public Health; Hugo Guevara, California Department of Public Health; Jill Hacker, California Department of Public Health; Kristina Hsieh, California Department of Public Health; Mary Kate Morris, California Department of Public Health; Ryan Murphy, California Department of Public Health; Jennifer F. Myers, California Department of Public Health; Tasha Padilla, California Department of Public Health; Chao-Yang Pan, California Department of Public Health; Adam Readhead, California Department of Public Health; Estela Saguar, California Department of Public Health; Maria Salas, California Department of Public Health; Robert E. Snyder, California Department of Public Health; Duc Vugia, California Department of Public Health; James Watt, California Department of Public Health; Cindy Wong, California Department of Public Health.

Solano County COVID-19 Team

Meileen Acosta, Solano County Department of Public Health; Shai Davis, Solano County Department of Public Health; Beatrix Kapuszinsky, Solano County Department of Public Health; Bela Matyas, Solano County Department of Public Health; Glen Miller, Solano County Department of Public Health; Asundep Ntui, Solano County Department of Public Health; Jayleen Richards, Solano County Department of Public Health.

Corresponding author: Leah F. Moriarty, [email protected] , 770-488-7100.

1 CDC COVID-19 Response Team; 2 California Department of Public Health; 3 Solano Public Health, Fairfield, California; 4 Epidemic Intelligence Service, CDC; 5 Sutter Medical Group of the Redwoods, Santa Rosa, California.

All authors have completed and submitted the International Committee of Medical Journal Editors form for disclosure of potential conflicts of interest. No potential conflicts of interest were disclosed.

* Not including river cruises.

† Warning level 3: avoid non-essential travel due to widespread ongoing transmission: https://wwwnc.cdc.gov/travel/notices/warning/novel-coronavirus-china .

§ Quarantine was used for persons who were exposed; isolation was used for persons who had positive test results for SARS-CoV-2.

¶ Movement for one person with resolved COVID-19 was not restricted.

** Based on Japanese testing procedures, which at the time included taking one oropharyngeal swab.

†† Travel restrictions were lifted when persons had either completed a 14-day monitoring period without symptoms or had met clinical criteria for release from isolation. https://japan2.usembassy.gov/pdfs/alert-20200227-diamond-princess.pdf .

§§ CDC has the authority to institute a no-sail order to prevent ships from sailing when it is reasonably believed that continuing normal operations might subject newly arriving passengers to disease.

• Cruise Lines International Association. 2019 cruise trends & industry outlook. Washington, DC: Cruise Line International Association; 2019. https://cruising.org/news-and-research/-/media/CLIA/Research/CLIA-2019-State-of-the-Industry.pdf
• 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;22:306–11. CrossRef PubMed
• World Health Organization. Coronavirus disease (COVID-2019) situation reports. Geneva, Switzerland: World Health Organization; 2020. https://www.who.int/emergencies/diseases/novel-coronavirus-2019/situation-reports/
• CDC COVID-19 Response Team. Severe outcomes among patients with coronavirus disease 2019 (COVID-19)—United States, February 12–March 16, 2020. MMWR Morb Mortal Wkly Rep 2020. Epub March 18, 2020. CrossRef
• Cruise Lines International Association. CLIA announces voluntary suspension in U.S. cruise operations. Washington, DC: Cruise Line International Association; 2020. https://cruising.org:443/news-and-research/press-room/2020/march/clia-covid-19-toolkit
• Kakimoto K, Kamiya H, Yamagishi T, Matsui T, Suzuki M, Wakita T. Initial investigation of transmission of COVID-19 among crew members during quarantine of a cruise ship—Yokohama, Japan, February 2020. MMWR Morb Mortal Wkly Rep 2020;69:312–3. CrossRef PubMed
• Vonnahme LA, Jungerman MR, Gulati RK, Illig P, Alvarado-Ramy F. Federal travel restrictions for persons with higher-risk exposures to communicable diseases of public health concern. Emerg Infect Dis 2017;23:S108–13. CrossRef PubMed
• Ministry of Health, Labour and Welfare. About new coronavirus infections [Japanese]. Tokyo, Japan: Ministry of Health, Labour and Welfare; 2020. https://www.mhlw.go.jp/stf/seisakunitsuite/bunya/0000164708_00001.html
• Mizumoto, K., Kagaya, K., Zarebski, A. and Chowell, G. Estimating the asymptomatic proportion of coronavirus disease 2019 (COVID-19) cases on board the Diamond Princess cruise ship, Yokohama, Japan, 2020. Eurosurveillance 2020;25. CrossRef
• CDC. Coronavirus disease 2019 (COVID-19): cases in U.S. Atlanta, GA: US Department of Health and Human Services, CDC; 2020. https://www.cdc.gov/coronavirus/2019-ncov/cases-in-us.html

Abbreviation: N/A = not applicable.

FIGURE 1 . Cumulative number of confirmed coronavirus disease 2019 (COVID-19) cases* by date of detection — Diamond Princess cruise ship, Yokohama, Japan, February 3–March 16, 2020

Source: World Health Organization (WHO) coronavirus disease (COVID-2019) situation reports. https://www.who.int/emergencies/diseases/novel-coronavirus-2019/situation-reports/ .

* Decline in cumulative number of cases on February 13 and February 25 due to correction by WHO for cases that had been counted twice.

FIGURE 2 . Cruise ships with coronavirus disease 2019 (COVID-19) cases requiring public health responses — worldwide, January–March 2020

Suggested citation for this article: Moriarty LF, Plucinski MM, Marston BJ, et al. Public Health Responses to COVID-19 Outbreaks on Cruise Ships — Worldwide, February–March 2020. MMWR Morb Mortal Wkly Rep 2020;69:347-352. DOI: http://dx.doi.org/10.15585/mmwr.mm6912e3 .

MMWR and Morbidity and Mortality Weekly Report are service marks of the U.S. Department of Health and Human Services. Use of trade names and commercial sources is for identification only and does not imply endorsement by the U.S. Department of Health and Human Services. References to non-CDC sites on the Internet are provided as a service to MMWR readers and do not constitute or imply endorsement of these organizations or their programs by CDC or the U.S. Department of Health and Human Services. CDC is not responsible for the content of pages found at these sites. URL addresses listed in MMWR were current as of the date of publication.

All HTML versions of MMWR articles are generated from final proofs through an automated process. This conversion might result in character translation or format errors in the HTML version. Users are referred to the electronic PDF version ( https://www.cdc.gov/mmwr ) and/or the original MMWR paper copy for printable versions of official text, figures, and tables.

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• P&O Cruises faces legal action after norovirus outbreak affects...

P&O Cruises faces legal action after norovirus outbreak affects hundreds

A cruise operator is currently facing demands for refunds and compensation following a widespread illness outbreak on board one of its vessels .

500+ passengers aboard P&O Cruises UK 's ship Ventura were reportedly affected by a norovirus outbreak during a 2-week cruise around the Canary Islands that departed from Southampton (England) in May.

Legal representatives pursuing compensation on behalf of affected passengers suggest that the number of those impacted could be in the thousands across multiple cruises.

In response, P&O stated that it has established protocols to address health issues on its ships, asserting that less than 1% of passengers on the voyage had fallen ill.

However, a subsequent Freedom of Information request to the Southampton port health authority revealed that at the peak of the outbreak, 519 passengers - equating to 12.3% of those on board - were affected.

In a statement P&O said:

"We are aware that some guests unfortunately reported gastrointestinal symptoms, reflecting higher rates seen in England this summer. "Gastrointestinal related illnesses are very common in England and Wales and predominantly spread by person-to-person transmission in environments such as hotels, schools and restaurants. "We work with global, national and regional public health authorities on proven protocols across our ships in order to protect the health and wellbeing of all on board".

For more P&O Ventura incidents and accidents see the ship's CruiseMinus page .

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What if the name on my identification does not match my reservation due to a legal name change, married name, or other reason?

Everyone will need to present an accepted form of identification to board the ship.

It’s important that the name on your reservation appears exactly as it does on the government issued identification document(s) that you use to board the ship.

If your name has changed since your document was issued, you will either need to update the name on that document, or bring an additional, official supporting document to help explain why the name is different. This can include one of the following:

• State, county or province-issued marriage license
• Divorce decree
• Government-issued name change document
• Official adoption papers

U.S. citizens who are able to present a birth certificate plus a government ID for their itinerary, should keep in mind that the name on BOTH of these documents must match each other, and match the reservation. If they don’t, you’ll need a supporting document as listed above.

Guests who do not bring required documents may be denied boarding.

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Which cruise brand is best for you? A guide to the most popular lines

Thinking about booking your first cruise? The sheer range of choices can be daunting. There are more than two dozen lines marketing to North Americans — no two alike.

The list of brands includes everything from giant companies such as Royal Caribbean and Carnival Cruise Line, which are household names, to lesser-known small operators such as Windstar Cruises.

Some of the brands — Royal Caribbean, MSC Cruises and Norwegian Cruise Line, in particular — operate massive vessels that are like giant floating resorts with deck-top water parks and other over-the-top amusements . Others specialize in intimate, boutique hotel-style ships.

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

Some lines, such as Carnival, are aimed at a budget crowd. Others operate vessels that are as luxurious as any upscale resort found on land. A few small luxury players such as Regent Seven Seas Cruises have ships with lavish suites that'll cost you as much as $11,000 a day .

Where should you start your search for the perfect cruise for you? Below, you'll find our quick guide to some of the most popular cruise brands. As you'll see, it's not meant to be an in-depth review of the lines. It's just a short overview — enough to give you a sense of which particular cruise operator might best appeal to you.

Once you've narrowed down the choices to a few brands that you think best fit your style, do a deeper dive into them and their specific ships, their itineraries and home ports and their comparable costs (either on your own or with the help of a cruise-savvy travel agent ). Note that TPG has many guides to individual lines, which you can find by clicking on our cruise line hub pages linked in each segment below.

Related: TPG's ultimate guide to picking a cruise line

With just four ships, each holding fewer than 700 passengers, Azamara is one of the smallest players in the cruise business. But it has a loyal following of travelers who appreciate the upscale ambience of its vessels, the inclusive amenities it offers (including gratuities and alcoholic drinks) and its destination focus.

The line prides itself on offering longer stays in ports, including multi-day visits. Its ships have an intimate, boutique-hotel feel. Pricing is higher than at the big, mass-market lines but not quite as high as you'll find at luxury lines.

Related: 5 things to love about Azamara's newest ship

Carnival Cruise Line

The self-described "fun ship" line is the king of short, affordable, fun-focused cruises from U.S. ports to the Caribbean, the Bahamas, Mexico and beyond.

The choice of roughly one in five cruisers, Carnival Cruise Line' s ships are notoriously lively, flashy and packed with fun features such as water parks with multiple waterslides. Just don't expect anything too fancy .

Related: The ultimate guide to Carnival Cruise Line

Celebrity Cruises

Designed to be a cut above mainstream options such as Carnival while remaining relatively affordable, this Miami-based "premium" line is known for some of the most stylish big ships at sea.

Expect high-end design, cutting-edge art and trendy restaurants. In short, Celebrity aims for sophisticates, not the party crowd (although it's not a luxury product).

Celebrity's four newest ships, Celebrity Edge , Celebrity Apex , Celebrity Beyond and Celebrity Ascent, feature "infinite veranda" cabins that are open to the sea in a way we haven't seen with other ocean ships. They boast a glass wall that opens from the top to create a balcony-like effect.

Crystal Cruises

This much-beloved luxury line recently restarted operations under new owners after shutting down for 18 months. For years, it was considered the ultimate luxury cruise operator, and our take after sailing on Crystal Serenity after its relaunch is that the line is even better than before. Initially, Crystal has returned to operations with just two ships. But it recently announced plans to expand rapidly with four more ships over the next six years.

A storied line with roots that go back to the 1800s, this three-ship brand is perhaps best known for its 2,695-passenger flagship, Queen Mary 2. The ship lives up to its billing as a true ocean liner with semiregular, transatlantic service between Southampton, England, and New York.

Cunard fans love the line's relatively formal vibe (including nightly dress codes) and other nods to ocean liner tradition, including evenings with ballroom dancing. A fourth Cunard ship called Queen Anne is set to debut in 2024.

Related: Why I was wrong about transatlantic cruises

Disney Cruise Line

Meet-and-greets with Disney characters, Disney-themed shows and the most extensive kiddie fun zones on the high seas are just a few of the family-friendly allures of a Disney cruise . If you're a Disney fan, nothing quite compares.

If Disney isn't your thing, well, this probably isn't the line for you. The biggest downside of the brand? As with Disney's parks on land, it doesn't come cheap.

Related: A first-look photo tour of Disney's newest ship, Disney Wish

Holland America

Tradition long has been a touchstone for this storied line, which dates to 1873 and is known for carefully crafted, globe-circling itineraries on midsize ships.

However, Holland America has been shaking things up in recent years with lively new venues such as B.B. King's Blues Club. Couples and retirees are the market for this line. Families with kids might want to look elsewhere.

MSC Cruises

A giant of cruising in Europe, Switzerland-based MSC Cruises is making a big play for North Americans with newer, bigger ships sailing year-round from Florida to the Caribbean and Bahamas. It also offers sailings from New York City.

Like Royal Caribbean and Norwegian, MSC Cruises operates big, resort-like vessels that appeal to a broad audience. Among the highlight of its cruises in North America are stops at its new private island in the Bahamas, the Ocean Cay MSC Marine Reserve .

Norwegian Cruise Line

Multistory waterslides, ropes courses and even go-kart race tracks are among the gee-whiz attractions atop Norwegian Cruise Line 's giant, resort-like ships. The vessels also are packed with eateries, bars, casinos and showrooms.

The brand is known for its entertainment, including big Broadway shows such as "Beetlejuice." If you're looking for a Las Vegas-style resort at sea, this is your line.

Oceania Cruises

Oceania has carved out a niche with relatively small, upscale ships that offer a significant upgrade from mass-market vessels but aren't quite as fancy (or pricey) as luxury offerings.

Its seven ships feature a relaxed, country club-like ambience and inspired dining that appeal to a mostly older crowd.

Itinerary-wise, Oceania is known for destination-intensive voyages that typically are 10 nights or more in length, with some globe-circling trips as long as 180 days.

Related: Take a look at Vista, Oceania's stunning new ship

This France-based line is a specialist in expedition cruising , a type of cruising that involves traveling to remote, hard-to-reach places on small, hardy vessels that carry their own landing craft.

Operating a fast-growing fleet of tough but upscale expedition ships (none carrying more than 264 passengers), Ponant is known for voyages to places like Antarctica and the Arctic.

If you're looking for waterslides and laser tag, this is not the cruise line for you.

Related: This epic Ponant trip will take you to the North Pole

Princess Cruises

Popular with middle-aged couples, retirees and multigenerational families, the "Love Boat" line's ships aren't as flashy (or big, for the most part) as those of Royal Caribbean and Norwegian, and that's just the way its customers like it.

Princess Cruises ' customers also like its wide range of itineraries, including voyages in Asia and Australia, as well as closer-to-home places like the Caribbean. It's long been one of the dominant lines in the Alaska cruise market.

Related: The ultimate guide to Princess Cruises

Regent Seven Seas Cruises

This Miami-based luxury line operates some of the most opulent vessels at sea, including three recently unveiled Explorer-class ships billed as the most expensive luxury vessels ever built on a cost-per-berth basis.

Regent Seven Seas Cruises is particularly known for some of the most over-the-top suites at sea (including some bigger than the average American home ), some of the most inclusive fares in the cruise business and high levels of service. The only catch: You'll pay a pretty penny for it. Rooms on Regent ships start at around $1,000 per person per day and can cost as much as $5,500 per person per day.

Royal Caribbean

For megaresort fans, there's nothing quite like a Royal Caribbean vessel.

The line's biggest ships are more than 20% bigger than almost any others afloat (only MSC Cruises has ships that come close in size) and feature every type of amusement imaginable, from rock climbing walls and surfing pools to Broadway shows and ice skating rinks.

Families, in particular, will love this line, due to all the family-friendly activities and venues on its vessels. Royal Caribbean ships sail everywhere in the world, but the line's heaviest presence is in the Caribbean and Europe.

Related: The ultimate guide to Royal Caribbean

Another leader in luxury cruising, this seven-ship brand offers all-suite vessels, top-notch service and elegant cuisine.

As with other luxury lines, Seabourn offers a wide range of itineraries around the globe. It also recently jumped into more adventurous, expedition-style cruising with two new 264-passenger vessels designed to operate in polar regions such as Antarctica and the Arctic.

Silversea Cruises

Exquisite service, refined dining and well-appointed accommodations are hallmarks of this Monaco-based luxury line with 12 vessels. Silversea Cruises is also known for its industry-leading array of off-the-beaten-path itineraries.

Its growing fleet of small expedition ships will take you everywhere from the Arctic to Papua New Guinea in style.

The Ritz-Carlton Yacht Collection

Fans of upscale hotel chain Ritz-Carlton will feel at home on one of this line's yacht-like vessels. Or, at least, that's the idea.

The cruising arm of Ritz-Carlton has been in operation for just a bit over a year, and the jury still is out on where it ranks in the pantheon of luxury cruise brands. The line notably struggled to get off the ground after years of construction delays for its first and only ship.

Dubbed Evrima, the line's only operating ship is a 298-passenger vessel designed to appeal to Ritz-Carlton regulars with an elegant, residential look. A second, bigger ship called Ilma that's already open for bookings debuts later this year.

Related: The ultimate guide to the Ritz-Carlton Yacht Collection

This fast-growing line has dominated the world of river cruising for North Americans for years, and in the last few years, it's become a significant player in upscale ocean cruising as well. Viking 's 80 river ships operate on just about every major river in the world, and its 10 ocean ships (up from just one in 2015) can be found in a growing number of destinations, too.

Viking is known for impeccably designed vessels with modern Scandinavian interiors and offering unusual, port-intensive itineraries. They also operate with a mostly all-inclusive format, as Viking long has subscribed to a "no nickel-and-diming" philosophy. Just don't bother booking the family. Kids under 18 aren't allowed on Viking.

Related: The ultimate guide to Viking cruises

Virgin Voyages

This relatively new cruise line, backed by Richard Branson's Virgin Group, is reinventing mainstream cruising with a hipper, more inclusive, younger vibe (though not too young; its ships are adults-only). Think tattoo shops, karoake booths and no upcharges for tips or eateries.

Virgin Voyages ' first three ships ( Scarlet Lady , Valiant Lady and Resilient Lady ) have suites by acclaimed designer Tom Dixon. Destinations include the Dominican Republic, Mexico and a private beach club in the Bahamas, as well as parts of Europe and Australia.

Related: I've been on more than 150 cruise ships; here's why I loved my first Virgin sailing

Windstar Cruises

If the idea of sailing on a big ship makes you cringe, small-ship specialist Windstar could be the answer.

Its six vessels carry just 148 to 342 passengers — fewer than fit on a single big-ship lifeboat — and are wonderfully intimate.

Romantic types will love Windstar's three vessels with sails — a relative rarity. Foodies can choose one of the James Beard-themed cruises, which include market tours and cooking demonstrations with a James Beard Award-winning chef.

More guides that will help you plan a cruise:

• The 5 most desirable cabin locations on any cruise ship
• The 8 worst cabin locations on any cruise ship
• 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
• Guide to picking a cruise line

Passengers on a round-the-world cruise now stuck at port have to get off every evening and stay at hotels while the company tries to 'reactivate' the vessel

• Villa Vie Residences' Odyssey cruise ship was set to embark on a round-the-world voyage in May.
• But the vessel has been undergoing repair work at a shipyard in Belfast, Northern Ireland.
• Villa Vie Residences said the ship could start sailing again this week.

Passengers looking to embark on a 3 ½-year around-the-world voyage on Villa Vie Residences' Odyssey cruise ship have been left hanging for the past three months.

On the planned 1,301-day journey , the cruise liner is set to visit 147 countries across seven continents, including destinations such as France, Mexico, and Japan, according to Villa Vie's itinerary.

In December, the company announced it had purchased a vessel from Fred Olsen Cruise Lines. The more than 30-year-old ship was initially scheduled to set sail in May.

But mechanical problems — such as issues with the aging ship's rudder stocks and recertification — have left Odyssey stuck in Belfast, Northern Ireland , instead.

Sebastian Stokkendal, a marketing manager for Villa Vie, told the Associated Press that the company was "humbled by the scale of what it takes to reactivate a 30-year-old vessel from a four-year layup."

The vessel is now docked at Belfast's Harland and Wolff shipyard, which is best known for being where the ill-fated Titanic ocean liner was built.

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The need for repairs means Odyssey's passengers have also been stuck in Belfast.

Residents can spend their days on the ship but aren't allowed to stay overnight yet. Mikael Petterson, the founder and CEO of Villa Vie, told BI in August that the company is providing would-be residents with shuttles to and from the ship, food, drinks, and lodging — or a daily per diem for those who "choose to do their own thing."

Would-be passengers Lanette Canen and Johan Bodin told BI that Villa Vie had also sent them on various excursions, including a trip to the Canary Islands and a cruise to the Norwegian fjords.

In the interim, they say the food on Odyssey has been good — especially the barbecue. They've also enjoyed onboard amenities like the spa, a live band, and an open bar.

"We understand there are hiccups," Bodin told BI. "They're schmoozing us a bit to keep us happy. They're almost being too serviced-minded. I don't need to be pampered all the time."

Stokkendal told the AP that Villa Vie anticipates to launch its ship in the first week of September.

Representatives for Villa Vie Residences didn't immediately respond to a request for comment from Business Insider sent outside regular business hours.

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