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Investigation Update on the Carnival Legend

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Investigation Update - December 1, 2003

Since October 2002, the Centers for Disease Control and Prevention’s Vessel Sanitation Program (VSP) has been following or investigating a number instances of gastrointestinal illness aboard cruise ships. Outbreaks of gastrointestinal illness continue to be reported throughout the U.S. and subsequently, we continue to see an increase in the number of passengers with gastrointestinal illness on some cruises.

Cruise vessels sailing to U.S. Ports are required to notify the CDC of every case of gastrointestinal illness reported to the ships’ medical staff, for each cruise. This report must be filed 24 hours prior to arrival at a U.S. port, from a foreign port. If the number of passengers or crew ill reaches 2% during the cruise, the vessel is required to file a special report. The CDC continues to closely monitor these illness reports on a daily basis. An “outbreak” of gastrointestinal illness is defined as having 3% or more of either passengers or crew reported with a gastrointestinal illness.

Cruise vessels currently being closely monitored are:

Carnival Legend (Carnival Cruise Lines) reported an increase in the number of cases of gastrointestinal illness for the cruise completed on November 29, 2003 (11/21-29/2003) that sailed out of Port Everglades, Florida.

On Nov. 23, VSP staff was contacted by Carnival to report that the ship's medical staff was observing an unusual number of passengers with gastrointestinal illness. On November 28, the number of passenger ill exceeded 3% and as of 11:17 pm on November 28, 73 of 2378 passengers (3.1%) and 4 of 913 crew (0.4%) had reported ill. Predominant symptoms are vomiting and diarrhea. The clinical presentation is consistent with a viral etiology. Stool specimens have been collected for laboratory analysis by the CDC.

CDC and Carnival Cruise Lines have developed and distributed a passenger questionnaire to ascertain more precisely, the extent of illness, as well as risk factors that may have been associated with the outbreak. The CDC is currently monitoring cleaning and disinfection activities.

Daily reports are being submitted to the Vessel Sanitation Program throughout the next cruise.

General Information

Cruise ship travelers are reminded that simple hygienic practices, such as frequent and thorough hand washing and avoiding contact with other passengers when ill, are important measures to prevent the spread of disease.

Additional information about CDC’s Vessel Sanitation Program is available at

Additional information on gastrointestinal diseases is available at

Information on Norwalk-like viruses is available at

CDC protects people’s health and safety by preventing and controlling diseases and injuries; enhances health decisions by providing credible information on critical health issues; and promotes healthy living through strong partnerships with local, national, and international organizations.

For more information, CDC’s Vessel Sanitation Program can be reached at