Acute Gastroenteritis (AGE) on Cruise Ships, 2008-2014

AGE illness infographic

People often associate cruise ships with AGE illnesses, but AGE illness is relatively infrequent on cruise ships.

From 2008 to 2014, 74 million passengers sailed on cruise ships in VSP’s jurisdiction. Only 129,678 passengers met the VSP case definition for AGE illness and only a small proportion of those AGE cases (1 in 10) were part of a norovirus outbreak.

The rate of AGE illness on cruise ships has decreased over time, as has the number and severity of outbreaks by year except 2012, when a new strain of norovirus emerged.

VSP defines AGE illness as

  • Three or more loose stools within a 24-hour time period or what is more than normal for the individual, OR
  • Vomiting along with one of the following symptoms:
    • diarrhea, or
    • bloody stool, or
    • muscle ache, or
    • headache, or
    • abdominal cramps, or
    • fever.
Illness Prevention Infographic

Fewer and less-severe AGE outbreaks on cruise ships are likely a result of several factors:

  • Earlier detection of illnesses.
  • Cruise industry diligence in
    • developing and implementing their Outbreak Prevention and Control Plans as required by VSP,
    • using processes and disinfectants that are effective against a norovirus surrogate, and
    • proactively looking for ways to use the most current science and limit AGE spread.

You can help limit the spread of AGE by

  • Reporting your illness if you’re sick.
    • Call the ship’s medical facility as soon as possible and follow the medical staff’s recommendations. Reporting your illness
      • allows ship management know if they need to increase cleaning and
      • lets VSP know if there is an outbreak on the ship.
  • Washing your hands often, especially after using the toilet and before eating or drinking.
  • Taking care of yourself.
    • Get plenty of rest and drink plenty of water.
      • Resting helps rebuild your immune system.
      • Drinking water helps prevent dehydration.
  • Leaving the area if you see someone get sick (vomiting or diarrhea).
    • Report it to cruise staff if they are not already aware.
Related Links

Freeland AL, Vaughan GH Jr, Banerjee SN. Acute gastroenteritis on cruise ships—United States, 2008–2014. MMWR. 2016;65(1):1–5.

Cramer EH, Blanton C, Browne L, Vaughan G, Bopp C, Forney D. Epidemiology of gastroenteritis on cruise ships, 2001-2004: the impact of norovirusesExternal. Am J Prev Med. 2006;30(3):252–7.

Cramer EH, Gu DX, Durbin RE, Vessel Sanitation Program Environmental Health Inspection Team. Diarrheal disease on cruise ships, 1990–2000: the impact of environmental health programsExternal. Am J Prev Med. 2003;24(3):227–33.

Page last reviewed: October 15, 2018