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Investigation Update on the Carnival Legend

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Investigation Update – November 19, 2003

Since October 2002, the Centers for Disease Control and Prevention’s Vessel Sanitation Program (VSP) has been following or investigating several 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 current cruise (11/13-21/2003) sailing out of Port Everglades, Florida.

On Nov. 17, VSP staff were contacted by Carnival to report that the ships’ medical staff were seeing an unusual number of passengers and crew with gastrointestinal illness. On November 18, the number of crew ill exceeded 3% and as of noon on November 19, 41 of 900 crew (4.6%) and 52 of 2160 passengers (2.4%) had reported ill. Predominant symptoms are vomiting and diarrhea. The clinical presentation is consistent with a viral etiology. Stool specimens have been collect for laboratory analysis by the CDC.

CDC staff will board the vessel in Port Everglades on November 21 to conduct an inspection of the vessel, consult with on-board medical staff, and observe cleaning and disinfection activities.

Daily reports are being made to the Vessel Sanitation Program for the duration of this cruise, and throughout the next cruise.

General Information

Cruise ship travelers are reminded that simple hygienic practices, such as frequent and thorough hand washing with warm water and soap, 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

Information on Norwalk-like viruses is available at: and

Additional information on gastrointestinal diseases 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