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CDC Telebriefing Transcript

Outbreak of Gastrointestinal Illness Aboard Cruise Ships

November 27, 2002

CDC MODERATOR: Thank you, Cathy, and good afternoon everyone. We are having this teleconference this afternoon in order to update the situation with the gastrointestinal illness outbreaks on cruise ships. 

This afternoon, joining us on the call, we have Dave Forney, the chief of CDC's Vessel Sanitation Program and joining him also will be Dr. Marc Alain Widdowson. Dr. Widdowson is an epidemiologist with the CDC. He will be joining us in order to answer questions generally about Norwalk outbreaks, in general. Dave Forney will be joining us in order to provide an update of the situation with the cruise vessels and to provide some prevention information about helping to control or prevent a person from contracting Norwalk virus. 

So I would now like to turn it over to Dave Forney in order to give us that update.

MR. FORNEY: Thank you, Bernadette, and good afternoon. We'd like to do a brief update on some of the issues that many of you have been asking about and we'll start with the Disney cruise lines. As of noon this afternoon, we did receive an update on the numbers for the current Disney Magic cruise, which began last Saturday in Port Canaveral. 

Currently, they're reporting 104, that's one zero four, cases of gastrointestinal illness in passengers, and their passenger complement right now is 2,485 passengers. Two four eight five. And they're reporting 19 cases in the crew--that's one nine--out of a crew complement of 1,003. That's one zero zero three. So that is the current report as of noon today. 

They continue to do their cleaning and disinfection that is based on a protocol that we have put together with them, and that's really about all we have to say on Disney at this time. 

We continue to monitor the activities onboard the vessel and will continue to discuss the numbers with them as they come in. 

The second issue is the Holland America ship, the Amsterdam, which is in Port Everglades, Fort Lauderdale, Florida, that has been idle, without passengers since the 21st of November. 

They continue their cleaning and disinfection on that ship. They have been reporting to us on a daily basis on their progress. We have had staff onboard at least every other day to monitor the cleaning and disinfection that's going onboard, and as of this morning they were reporting zero illness among the crew who have been staying onboard the vessel. 

The other issue I wanted to address is we've had several questions about another Holland America ship sailing out of San Diego, and that ship is the Statendam. We've had many questions, wanting to know why we were not conducting an outbreak investigation on the Statendam. 

The answer is relatively simple. There is no outbreak of gastrointestinal illness going on on the Statendam. They have had some cases of GI illness, but those numbers have been very, very low, in the ten to fifteen range. They did have a cruise several weeks ago, it was a 15-day cruise sailing from Hawaii to San Diego, but over the 15-day period they reported 38 cases of gastrointestinal illness. 

It's Holland America's policy, is when they do have any increase in the number of GI illness, they initiate special cleaning and disinfection, and they did so on that ship, not only on the ship but during the turnaround day when it came into San Diego. 

I think that initiated some of the concern. Again, we have been getting daily reports on that vessel and there is no outbreak going on as far as we're concerned. 

In addition to that, on Monday, we did board the ship with two of our environmental health officers. 

This was a routine, unannounced operational inspection that we conduct twice a year. The previous inspection was six months ago, so it was their time for an inspection. I don't have the final inspection report but they did pass, I believe the score was up in the 90's, and, again, our officers reviewed medical records and all of the issues that we would normally look at related to food and water onboard the vessel and they found no evidence that any outbreak had taken place. 

A couple of the messages that we would like to pass on, that we think are very, very important, and I think Dr. Widdowson will talk about some of these points as well, and that is we're dealing with--oh, the other--let me back up. 

On the Disney, we did confirm last night that the stool specimens that were collected on ill passengers for the cruise last week--these were samples that were picked up by our staff on Saturday and delivered to the CDC laboratory here, in Atlanta, for analysis. The results of that analysis came back last night and it is confirmed to be Norwalk virus, and so what would just like to reiterate, that Norwalk virus is a very common cause of nonbacterial gastroenteritis in the United States. 

It is not new to cruise ships. We had similar outbreaks on multiple vessels up in the Alaska waters last summer. We've had reports of significant outbreaks in Europe and in South America and other parts of the world as well.

We continue to work very, very closely with the cruise lines. The standard by which they're held for sanitation is the highest in the world and continues to be the highest in the world. What we're dealing with here, though, is a situation where we feel strongly this is predominantly person to person spread through hand-to-mouth activity, and all this makes it a little more difficult to control. But that it is perfectly safe to go on the cruise ships. Because we're dealing with person to person contact and spread, the best preventive measure that we can advise passengers to take is frequent and thorough handwashing with warm water and soap, wiping your hands off, and keeping your hands out of your mouth. 

And I think that's the major points that I wanted to come across with Bernadette.

CDC MODERATOR: We would now like to open it up for questions, and again, we ask that if you have a question more geared towards just general questions on Norwalk virus, Dr. Widdowson is on the line and will be able to respond to those.

Cathy, could we go ahead with questions now please?

AT&T MODERATOR: Ladies and gentlemen, if you'd like to ask a question, please press the 1 on your touchtone phone. You'll hear a tone indicating you've been placed in queue. If you pressed 1 prior to this announcement, we ask that you please do so again at this time. You may remove yourself from queue at any time by pressing the pound key, and if you're using a speaker phone, please pick up your handset before dialing.

Our first questions come from Andrew Revkin [ph] with the New York Times. Please go ahead.

QUESTION: Hi. Thanks for holding the briefing. I wanted to check to see--is there something in particular about cruise ships as opposed to other places where people congregate for periods of days that makes them more apt to spread a virus like this? In other words, have you seen similar outbreaks of Norwalk virus at, say, hotels, resorts, places where the same kinds of people gather for the same lengths of time?

CDC MODERATOR: Dr. Widdowson, would you like to respond?

DR. WIDDOWSON: Yes, good afternoon. That's absolutely correct. We do often see outbreaks of Norwalk-like virus when people are congregated for anything up, you know, for more than 2 or 3 days together. And we--classically we see it in schools, hotels, often camps, and nursing homes, hospitals. Anywhere where people are together, we often see it. So cruise ships are not special in any way.

QUESTION: And that's borne out statistically in other words?

DR. WIDDOWSON: Absolutely. I mean we find--it also depends where you look for it. With this virus, wherever we look for it, we find it. For instance, in the UK they have an enormous number of hospital outbreaks, and certainly in the U.S. we often find outbreaks in nursing homes, et cetera. And we've got those documented.

QUESTION: Okay, thank you.

CDC MODERATOR: Next question, please.

AT&T MODERATOR: That will come from the line of Susan Candiatti [ph] with CNN. Go ahead, please.

QUESTION: Hi, thank you very much. Before I ask my question, Dr. Wittinger, could you please spell your name?

DR. WIDDOWSON: Yes, it's actually Widdowson. It's W for William, I for Ian, D for Derek, D for Derek, O for Oliver, W for William, S for Sharon, O for Oliver, N for Neal.

QUESTION: Thank you very much. And that was my question. Thank you and have a nice day. No, I'm kidding. Thank you. Thanks to both you, Dave and you, Dr. Widdowson.

Could you please tell me what steps you are taking in reference to the Disney Cruise Line, as to whether you will advise them to continue with a cruise that would go out the next go around when this one returns on Saturday? Have you made the decision yet? What will go into making that decision? And when do you expect that decision to be made along with Disney, of course?

MR. FORNEY: Well, we are in constant communication with the Disney Cruise Line staff, both on board the ship and at corporate headquarters. They are--they've been very up front with providing us the information on the counts in passengers and crew and the ongoing cleaning and disinfection processes that are going on board.

We continue to monitor those numbers as they come in, looking at are the numbers continuing to increase? Do the numbers stabilize and go back down? And those numbers again we look at on an ongoing basis. We have not come up with a final deadline for making that decision. We will continue to discuss the numbers every time they come in with their staff.

QUESTION: And can you update us--I'm sorry I have a quick follow up regarding the questionnaires that were sent out from last week. Have you gotten anywhere with those, Dave or Dr. Widdowson?

MR. FORNEY: I think I can answer that the two epidemiologists that were on board continue to work at the data entry and looking at the analysis of that data, but that will take some time.

CDC MODERATOR: Next question, please.

AT&T MODERATOR: Thank you. Our next question is from David Brown with the Washington Post. Please go ahead.

QUESTION: Hi, I have a couple questions. First of all, I assume that this is a fecal/oral route of transmission, and so my question is am I right? And also is the feeling that it's probably crew to guest or guest to guest, and if it is crew to guest, is there any surveillance of the crew to see if they are carrying Norwalk virus? And actually also, is there a carrier state for Norwalk virus?

MR. FORNEY: I'll let Dr. Widdowson talk about the carrier state. But as it relates to Disney and looking at what we suspect, highly suspect the transmission to be, not on Disney, but the same was for the Amsterdam and also for the Ryandam last summer. We highly do suspect that it is a person to person transmission, and more than that, probably a better description would be hand to mouth activity. We suspect that people are probably coming on board--again, we don't know where the index case is--but that people come on board with the virus that may do inappropriate hand washing or inadequate hand washing, and they do have the virus on their hands. And on a cruise ship, people don't go there to sit in their cabins. They're out and about in very public areas, and so we have this depositing the virus on various surfaces that then would be easily picked up by others, and then they put their hands in their mouth, and would ingest the organism.

We have looked very closely at both all of the food handling practices on board these vessels from how the food is stored when it's brought on board all the way through to how it's prepared, served and how the dishes are washed, and have found no deficiencies in either one of these vessels that would point to a food-borne outbreak or a problem with that side of the house.

We've also looked very closely at the portable water systems, and looking at the protection of those systems and the level of chlorine throughout the systems, and we have found no problems with that as well.

We also look at the distribution of illness in passengers versus crew, and I think we're really finding a disproportionate number of passengers that are ill, which would I think lead to support the passenger to passenger transmission.

We've also even looked at the types of crew that have come down ill, and the general trend is that they tend to be more in crew who have more passenger to passenger contact. I mean that's not 100 percent, but the trend seems to be that way.

QUESTION: Okay. How about the carrier state question?

DR. WIDDOWSON: Right. I guess I can answer that. We don't--classically with Norwalk-like virus we don't see a carrier state in the same sense that we see it for bacteria, for instance. The classic case was Typhoid Mary. But what we do see is that people who are infected with Norwalk-like virus, first they can be asymptomatically infected, so they wouldn't have symptoms, but they would still be shedding the virus. And in people who are infected with it symptomatically or asymptomatically we can find virus in the stools for up to 2 weeks after their recovery, in the case of symptomatic infections, 2 weeks after their recovery, we can find virus in the stool. After that, they generally clear the infection. We have no cases of anyone carrying it for longer than that, as would be the case of classic carrier cases for bacteria.

CDC MODERATOR: Next question, please.

QUESTION: Gentlemen, hi. I guess what you're generally saying to most people out there who might be going on a cruise then, that there is nothing really they can do except wash their hands and hope that they don't get this bug while they're on vacation. You know, the fact that it's taken ahold of these ships and gained so much publicity makes it sound like it's a lot worse of a problem than you're actually saying it is.

But still, it seems rather simple to say that there's nothing that can be done about it, and then, you know, just go and enjoy your vacation, and wash your hands. I'm asking you, Is that all you can tell people to do here?

MR. FORNEY: I think there's two things that go into it. One is what an individual can do to decrease the chance of them coming in contact or actually getting ill, and that's the handwashing point. The other that we really have tried to tell passengers on these cruise ships is if you do become ill, it's extremely important that you report to the medical facility, because I think we've had it reported to us that there are passengers that have said, "I'm not reporting to the medical facility," because if they do, "they're going to tell me i have to stay in my cabin. I've paid for this cruise. I'm going to go out and have a good time as best I can."

And so in that case you do have passengers who are quite possibly shedding the virus out on the general population on the ship and they're contributing to the ongoing problem. So it's just not washing hands. It's making sure that if you do get ill, you don't continue to be out in the general population and complicate or extend the problem as it exists.

And then you have the other side that the cruise lines are very much involved with, and that is making sure that they do everything they can to eliminate any virus that may be on surfaces in the ship, that people may come in contact with, and they have set up roving teams to go around and clean and disinfect the public areas, and especially those touched surfaces such as handrails and chair handrails, and elevator buttons and poker chips, and that if there are accidents on board where a person does vomit in a public area, or in a public restroom, or have a fecal accident, that those issues are cleaned up, the area is cordoned off and those issues are cleaned up appropriately without other people becoming exposed.

So it's a combination of all those, that will be effective, in most cases, in eliminating these outbreaks.

QUESTION: There's no regulatory body out there that can essentially tell the cruise lines to stay in port?

MR. FORNEY: CDC is not a regulatory agency but we have the authority to recommend to a ship that they not take on passengers or sail, or if we feel that it's an eminent public health threat to the individuals, we can issue an order that is issued from the director of CDC, as the chief quarantine officer, to the U.S. Coast Guard, to go out and actually detain that vessel.

So, yes, we do have the authority to do so under certain circumstances.

CDC MODERATOR: Next question, please.

AT&T MODERATOR: Thank you. That is from Kerry Sanders with NBC. Please go ahead.

QUESTION: A couple questions. First of all on the numbers. On the Disney Magic ship, 104 cases. Is that passengers or is that total? So it's 104 plus the 19 crew members? or does the 104 include those 19 crew members?

MR. FORNEY: It's 104 passengers, 19 crew.

QUESTION: Okay. Next question is Dave, I believe in an interview yesterday, you were talking to Terry Pickard [ph] with NBC News, and as part of the interview, you thought that if we actually did year to year comparisons of passengers on cruise ships, we might actually show that statistically there were, percentage-wise, fewer that are getting ill on cruise ships this year versus last year, even though this all seems to be happening at once.

Do you have any hard data, available today, to tell us whether your gut was right there, or are you still researching that?

MR. FORNEY: We're still putting that together. We've actually done some of that for some publications that we're going to have later on. But if we look at a number of passenger days, with the tremendous increase in number of passengers over the last couple years, versus the illness and the number of outbreaks, that those numbers have gone down.

QUESTION: But we don't have a number that we can use? Down X percent?

MR. FORNEY: No. I don't have that for you.

QUESTION: Okay. And I guess the last question I have is have you suggested to the cruise lines any procedural changes in the way that they're providing contact? I know at least one passenger told us that on board the ship they were on, when they went to the all-you-can-eat buffet, that rather than them being able to serve themselves, as they had done previously, somebody was now serving the food to them.

I don't know whether that's something that the CDC's recommending, so that you don't have the same spoon passed person to person, or what. Or is that just a cruise decision?

MR. FORNEY: No; it's one of our general recommendations and this has become one of the standard practices when you have increases in gastrointestinal illness on the ships, is they really want to eliminate any of that person to person potential transmission.

So the self-service buffets are basically shut down. The buffets still exist but they will have staff that actually serve you. In fact some of these ships, you will not even be able to pour yourself a cup of coffee. That will be served to you.

CDC MODERATOR: All right. Next question, please.

AT&T MODERATOR: Thank you. That will come from Adam Marcus with HealthScout. Please go ahead.

QUESTION: Hi. I'd like to know when the last time the Disney Magic ship was inspected by CDC prior to, I guess it's penultimate voyage, ten days ago or so, or however many it was.

And also is the risk of Norwalk virus in an enclosed space like a cruise ship greater or less than the risk of, say, getting on the New York City subway and touching all the exposed metal, getting to your office and scratching your nose or something?

CDC MODERATOR: Would you like to field that first question, and then Dr. Widdowson, you take over?

MR. FORNEY: Disney Magic was inspected on June 15th of 2002 and scored a ninety-nine.

QUESTION: Out of a hundred?


MR. FORNEY: And Dr. Widdowson, would you like to respond to the follow-up question.

DR. WIDDOWSON: Sure. I think the difference between the subway and the cruise ship is that on the subway people are there very transiently, so you don't get a build-up of cases who can then infect other cases over a period of time.

But, again, with other closed settings such as camps and nursing homes, et cetera, we do see that the risk is the same as it would be on a cruise ship.

QUESTION: Thank you.

MR. FORNEY: All right. Next question, please.

AT&T MODERATOR: Thank you. That will come from Denise Grady [ph] with the New York Times. Go ahead, please.

QUESTION: Thank you. A couple of questions. Is it known how long this virus can live on surfaces, and although you are saying this is person to person, you believe in these cases, is it also possible that even after everybody gets off the ship, there is some reservoir of the virus somewhere in the ship that can start things all over again?

I mean, if it's person to person, what good does all the disinfecting do?

MR. FORNEY: Dave, would you like to take both of those?

MR. FORNEY: I think that's more in Dr. Widdowson's side.

DR. WIDDOWSON: Sure. I missed the first part of the question.

QUESTION: The first part of the question is how long can this virus live on surfaces.

DR. WIDDOWSON: Right. And actually we don't know is the simple answer to that. It could easily be several weeks, and you're right in the sense that--the reason that these cruise ships are being disinfected, and why, in other similar outbreaks, enclosed settings, we disinfect, is because we do think it persists in the environment.

Unfortunately, it's a bit of a--we don't really know much about this virus's persistence because it's very difficult to detect it, and it's only recently that we've been able to have the tools to start to look for it in the environment. So though the epidemiology suggests that, you're right, environments get contaminated and they do act as a reservoir, we know little more than that.

QUESTION: Okay. May I ask one follow-up then, please. You're saying it's fine to go on these ships, but in any of these closed situations, then, should people who may be immunocompromised be thinking twice?

I'm thinking about people in chemotherapy, people with HIV, people who recently finished chemo. Should there be nobody who is extra cautious? I mean, people bring babies on these ships.

DR. WIDDOWSON: I can answer that. There's no specific data to suggest that people who have any sort of specific, you know, compromised, or specific immunocompromised life state, are actually any more at risk than anyone else.

Certainly, what we do see, though, is that people who are elderly, or frail, for other reasons--because this virus can cause quite severe vomiting and diarrhea, and ensuing dehydration, if you're already water-stressed or frail for some reason, then that's likely to have more of an impact. But there's little evidence, no evidence that I know of that a specific immunocompromised state will worsen the disease.

QUESTION: Okay; thank you.

MR. FORNEY: Thank you. Next question, please.

AT&T MODERATOR: Thank you. That will come from Kathleen Dohany [ph] with the LA Times. Please go ahead.

QUESTION: Thank you. When I talked to the folks at Holland America yesterday, they said the Amsterdam was set to set sail again December 1st, and can you explain how that decision is arrived at, both in that case, and just more generally.

Is it a joint decision between the cruise lines and the CDC after an outbreak?

MR. FORNEY: Really, there's no decision for us to make, and we are, we really are not a part of that decision. The ship has been cleaned and disinfected. We've been on board on a regular basis, throughout the ten-day period, to monitor that they are actually doing what they said they were going to do, and other than cleaning and disinfecting, there is little else they can do and no reason why we would consider, at all, not letting them sail.

QUESTION: Thank you.

MR. FORNEY: Next question, please.

AT&T MODERATOR: Thank you. That comes from Curtis Krieger [ph] with the St. Petersburg Times. Go ahead, please.

QUESTION: I just wanted to ask, if you have a cruise booked or you're considering booking a cruise, is there any reason, at this time, to delay it?

MR. FORNEY: Not from our perspective.


MR. FORNEY: All right. Next question, please.

AT&T MODERATOR: Thank you. That will be a follow-up from Susan Candiatti [ph] with CNN. Please go ahead.

QUESTION: Thank you. Maybe I can have two follow-ups. Why not? I'll follow up on that last question and ask my mine. If you have a cruise booked, you don't, you say you don't, you shouldn't have to change it. Why not?

MR. FORNEY: Well, in the case of--I mean the sheer numbers. If you look at how many people are on board the Disney Magic right now, there are 2,485 passengers. Of those, one hundred are ill. There's a lot of people who are out there having a good time, and are not getting ill.

The cruise lines are well aware of the risks. They are doing everything they can to minimize the risk of coming in contact with this gastrointestinal illness. There are no guarantees but they're doing everything they can to make sure that this is not an issue.

QUESTION: Thanks. My question then is, let's see, a decision, you told me yesterday, I think, Mr. Forney, that you were going to recommend, or you were recommending to the Amsterdam, to Holland America, that it not cruise again, that they take the ship out of service for ten days, and Holland America went along with that advice. That was following four outbreaks. What--

MR. FORNEY: In the case--we again had ongoing discussions with Holland America, and I mean they decided, they called us and said we think it's time to take the ship out of service because--I mean, it was done jointly, but they're the ones that actually came out with the decision, so--

QUESTION: I understand that. All right. Then therefore, let's see, after a couple of outbreaks here with the Norwalk virus, what is it about taking the ship out of service for a week to ten days, that, in your view, would help eliminate the virus, and why not just go ahead and do it after a couple of outbreaks with this one, if the numbers go up?

I understand you're monitoring the numbers in the case of Disney.

MR. FORNEY: Well, as you said, we are monitoring what Disney and--at this point in time, we can't say whether or not it's going to continue to sail next week or not. That decision has not been made. At least not in conjunction with us.

We have found in past, that where ongoing cleaning and disinfection of the vessel with passengers on board has not been effective, we have examples in the past where we have suggested that the ship be taken out of service, and as a result of cleaning and disinfection and no additional passengers or unaffected individuals coming on board, they have been very successful, in each one of these cases, in eliminating this as a problem on board that vessel.

The most recent example of that is the Ryndam back in August. But after a series of successive cruises with several hundred people ill on each cruise, Holland America took the vessel out of service in Vancouver, canceled a seven-day Alaska cruise, cleaning and sanitizing as they're doing now, and they've had no subsequent problems on that vessel.

We had a similar situation with the Regal Princess, also up in Alaska, about three years ago, and the Royal Odyssey down in Miami about five or six years ago.

It's a drastic measure to take, but the combination, again, of keeping people off the ship, cleaning and disinfecting--I think it's a combination of cleaning and disinfection, and, again, allowing whatever virus that may still be on those surfaces, to really be hit with the disinfects is very effective.

QUESTION: So if the numbers go up, would you think that that would be, just make sense to go ahead and take it out? That would be your advice? And knock it out?

MR. FORNEY: If the numbers continue to rise, we'll have some serious discussions with Disney on whether or not it's appropriate to do that at this time.

QUESTION: Okay. Thank you very much. But as you said, the numbers in the past seem to indicate that--oh, what did you just say? That historically speaking, the number of sick passengers now is lower, historically speaking, than it has been in past years.

I understand you don't have the specifics yet. You're still putting that together.

MR. FORNEY: That's correct.

QUESTION: Okay. Andrew Revkin with the New York Times. Please go ahead.

QUESTION: Very quickly. I was wondering if you--this might be for Dr. Widdowson. Do you have--can you provide an example of a path shore side outbreak that is essentially similar and perhaps to one of the ones where you had sort of, in this case, where on the cruise ship you had kind of ongoing reinfections?

And the other question is, is there any particular disinfection technique that is seen as superior, and have they tried anything like, or do they need to try anything you think like the chlorine dioxide gassing that was used in the Hart Senate Office Building?

DR. WIDDOWSON: Right. There are many examples of closed environment outbreaks on the shore. We're investigating--well, I'm trying to think. We're investigating a couple at the moment in nursing homes, but I'd be [inaudible] to be a bit more specific than that, but certainly in some nursing homes, I would say at least every month we would get a nursing home outbreak that we're investigating, either directly or indirectly, indirectly by the lab by doing the testing for the sick cases.

As for disinfection, again, because we know very little about sort of how this virus survives in the environment, one of the things that also you deal with is inspectors trying to get rid of the virus. We can't--it's difficult for us to detect, to know if the disinfectants are actually working or not. We know that chlorine works, and we know that some other--using proxy viruses we know that some of the other disinfectants that we recommend would be likely to work. So at this moment in time the recommendations that we give are based on chlorine base. Things like chlorine dioxide would be expected to work, as all the other disinfectants we recommend, but I would have to imply that we don't know for sure if they do because of the technical difficulties in detecting the virus on surfaces.

QUESTION: Right, thank you.

CDC MODERATOR: I would like to ask Cathy do we have any additional questions in the queue?

AT&T MODERATOR: Yes, we do.

CDC MODERATOR: If we can get the next question, please?

AT&T MODERATOR: That would be from Adam Marcus with Healthscope. Please go ahead.

QUESTION: One question was just answered. But I'd like, if you would please, just to clarify the diagnosis here. You have Norwalk for the first half of this Disney cruise or the last one, but the current one, do you know for sure? And then the Holland America from earlier this month is also Norwalk or is Norwalk-like or are they interchangeable?

MR. FORNEY: Well, the terminology I'll let Dr. Widdowson talk about, but we do have confirmed Norwalk on the Amsterdam, and we did confirm Norwalk on those samples collected for the Disney cruise that ended last Saturday.

Again, for us to make that laboratory determination, you have to have stool specimens collected from ill passengers. You have to be where you can collect those from the ship and then actually bring those up to Atlanta to the lab. So stool samples may be--I understand are being collected this week during this cruise, but they have not been submitted to a laboratory for analysis.

CDC MODERATOR: Dr. Widdowson?

DR. WIDDOWSON: Yes, as regards the terminology. Actually, the name is Norwalk-like viruses. So there's a group of viruses called Norwalk-like viruses. And the reason they're called Norwalk-like viruses is because within that group there's one prototype, the original strain, which is officially Norwalk virus. So Norwalk virus has many very similar viruses related to it, and the whole group of viruses which included the Norwalk virus, are called Norwalk-like viruses.

QUESTION: Thank you. And, sir, could you spell your first name?

DR. WIDDOWSON: Yes. M-a-r-c.

QUESTION: Thank you.

CDC MODERATOR: Next question, please.

AT&T MODERATOR: Thank you. That is from Alicia Caldwell with St. Petersburg Times. Please go ahead.

QUESTION: Yes. How many passengers and crew total have been infected on the Amsterdam and Magic? I've seen different numbers in different places.

MR. FORNEY: I'm sorry, but I don't have those numbers in front of me.

CDC MODERATOR: You can call the press office once this call has concluded, and we will attempt to assist you in getting that information.

QUESTION: Thank you.

CDC MODERATOR: Next, please.

AT&T MODERATOR: We'll now move on to David Brown with the Washington Post. Please go ahead.

QUESTION: Thanks. You say that you investigated some of the illness in the cruise from Hawaii to San Diego, and concluded it was not an outbreak. Was that because you found multiple pathogens, because there was no evidence of passenger to passenger spread, just based on the sort of epidemiology, or how did you reach that conclusion?

And what is it--how can there be 38 cases and not have it be an outbreak sort of definitionally?

MR. FORNEY: Okay. We did not investigate. We did not send anybody out there to investigate those 38 cases. There are gastrointestinal illness cases reported on many, many cruises. Cruise ships that have--that are in our program, those are cruise ships that have international itineraries and call on U.S. ports--when those cruise ships come to a U.S. port from a foreign port, they are required to report to us, 24 hours prior to arrival, the number of passengers on board, the number of crew on board, and the numbers of passengers and crew who report to the ship's medical facility with gastrointestinal illness, even if that number is zero.

So we have an electronic reporting system that collects that information every time one of these ships come in to a U.S. port from a foreign port. So we monitor that. In those reports, when they file that 24-hour report, or if at any time during the cruise 2 percent of the passengers or crew--I mean they hit a 2 percent level, they must file a special report with us, which precipitates a phone call between our staff and the cruise line to say, "You just sent in a special report. You're at 2 percent in the passengers. What are you seeing?"

And we will begin discussion. We'll begin talking about what they think it might be. Are we looking at a point source? Are we looking at multiple sources? But it does not mean that we actually go out and board the ship and take any samples whatsoever.

In the case of the Statendam--again, these 2 percent rules, they've been in CDC policy for many, many, many years with the Vessel Sanitation Program, and they are based on 7-day cruises. So when we have a cruise ship coming in from a 15-day cruise that reports 38, which I believe was right at 2 percent, we did not get unduly alarmed because number one, it was only 38 cases and it was a 15-day cruise, so the diagnosis was gastrointestinal illness. As far as I know of, there were no stool specimens taken. But this is not unusual for cruise ships throughout our jurisdiction to report ill passengers during almost every cruise.

CDC MODERATOR: We have time for one final wrap-up question.

AT&T MODERATOR: Thank you. That will come from Terry Sanders with NBC. Go ahead, please.

QUESTION: Did I follow this correctly out at the Port Everglades in Fort Lauderdale, that the virus itself survives only for about 5 days on an inanimate object like a door handle or something? So if that's the case, why are they taking it offline and doing all the disinfecting? Why don't they just shut it up, wait 5 days, and then return and it's gone

DR. WIDDOWSON: I can answer some of that. We don't know if it lasts only 5 days. It could well last longer.

QUESTION: Thank you.

CDC MODERATOR: All right, ladies and gentlemen, this concludes this afternoon's telebriefing. If you have any follow-up questions, we ask that you please call the CDC Media Relations Office at 404-639-3286.

There will be a transcript available on our website at If you go to the In the News Link, which is the Media Relations page, that should be available around the 4 o'clock hour.

Thank you again for joining us, and this concludes our telebriefing.

Listen to the telebriefing

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