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Swine Flu a Potential Problem for Cruise Ships

CDC offers guidance for crews and passengers

May 3, 2009

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Being sick at sea is no fun, but with the H1N1 swine flu spreading rapidly around the world, it's likely to become a problem on at least some cruise ships.

The U.S. Centers for Disease Control and Prevention (CDC) is developing guidelines for cruise ships and their passengers and will regularly update its H1N1 Webpage.

Here are the CDC's preliminary recommendations:

Stay Home If You Are Sick

If you get sick, stay home and limit contact with others to keep from infecting them. If you are sick you should not board the ship.

Hand Washing

Wash your hands often with soap and warm water for at least 20 seconds, especially after you cough or sneeze. Alcohol-based hand cleaners are also effective. Avoid touching your eyes, nose or mouth because germs spread that way.

Cough Etiquette

Cover your nose and mouth with a tissue when you cough or sneeze. Throw the tissue in the trash after you use it. If you don't have a tissue, cough or sneeze into your upper sleeve, not your hands.

Gloves

Crew members should wear impermeable, disposable gloves if they need to have direct contact with ill passengers or potentially contaminated surfaces, rooms, or lavatories used by ill passengers. They should avoid touching their face with gloved or unwashed hands. Improper use of gloves may actually increase transmission.

Surgical Masks and Respirators

People with symptoms of influenza-like illness should not leave home or travel. Crew members or passengers who develop symptoms of influenza-like illness should wear a surgical mask to reduce the number of droplets coughed or sneezed into the air. Personnel assisting an ill person with symptoms of influenza ideally should wear a NIOSH-certified disposable particulate respirator, rated N-95 or better for which they have been fit-tested in the context of a respiratory protection program.

Surgical masks provide barrier protection against droplet and contact transmission of the virus, but they do not protect against inhalation of airborne particles. Droplets are still considered to be the primary route of influenza virus transmission, but airborne transmission can not be ruled out at this time. Disposable surgical masks and respirators should not be reused; once removed they should be discarded.

Ill Crew Members and Passengers

If a crew member or passenger is displaying signs and symptoms of an influenza-like illness prior to the cruise, they should not board the ship. If a passenger or crew member develops influenza-like symptoms en route, they should be medically evaluated and confined to their cabin quarters for the duration of the illness. Ill people should cover their nose and mouth when coughing or sneezing, use tissues to contain respiratory secretions and dispose of used tissues in the nearest waste receptacle after use. If tolerated they should wear a surgical mask to reduce the number of droplets coughed or sneezed into the air. Hands should be washed after contact with respiratory secretions or contaminated objects or materials.

Healthcare personnel aboard the ship should follow the recommendations for healthcare personnel described at this Web site..

Manager of Passenger or Crew Members with Flu Symptoms

• Cruise ship personnel should be aware of the possible symptoms of novel influenza A (H1N1) virus including fever, cough, sore throat, body aches, headache, chills, fatigue, and in some cases, diarrhea and vomiting. Visit CDC’s novel H1N1 flu website:(http://www.cdc.gov/h1n1flu/)
• Minimize the number of personnel directly exposed to the ill person.
• Separate the ill person from others as much as possible (at least 6 feet). o Move the sick person to an isolated area such as their cabin quarters. They should remain in their cabins for the duration of their illness. o Consider isolating the sick person with a family member or companion if necessary for control, comfort, or compliance. The companion should take appropriate precautions to protect themselves.
• Have the ill person wear a surgical mask in common areas, if it can be tolerated, to reduce the number of droplets coughed or sneezed into the air. Surgical masks should not be reused.
• If a surgical mask can not be tolerated, provide tissues and ask the ill person to cover his or her mouth and nose when coughing or sneezing.
• Wash hands for 20 seconds with soap and warm water before tending to the sick person and after handling garbage, touching commonly touched surfaces, contacting respiratory secretions or tending to the sick person.
• Wash hands before removing a respirator and after removing gloves and a respirator.
• Use waterless, alcohol-based hand gels when soap is not available and hands are not visibly soiled.
• Personnel tending to the ill person or contacting potentially infectious materials should use impermeable, disposable gloves. Gloves are not intended to replace proper hand hygiene. Gloves should be carefully removed and discarded and hands should be cleaned immediately after activities involving contact with body fluids. Gloves should not be washed or reused.
• Personnel having close contact with an ill person ideally should wear a NIOSH-certified particulate respirator, rated N-95 or better, as described previously. Respirators should not be reused.
• Dispose of soiled material, gloves, items contaminated with body fluids, and disposable respirators in a sturdy plastic bag that should be tied shut and not reopened, and disposed of according to state solid waste regulations.
• Ensure that the cruise ship is adequately cleaned and disinfected by personnel wearing appropriate PPE appropriate PPE.

If a suspect H1N1 influenza case is identified aboard a ship the captain is required by law to report the illness to the CDC Quarantine Station in the jurisdiction of the U.S. port where the ship is expected to arrive.

If the ship will not be arriving imminently at a U.S port, Quarantine health authorities will assist ship officials with the management and isolation of the suspect case and the recommendations for other passengers and crew members.

When the ship arrives in a U.S. port, Quarantine officials will work with the cruise ship industry and local and state health departments to assist with medical transportation of the patient upon arrival, disease control and containment measures, passenger and crew notification and surveillance activities, communicating with local public health authorities, and cruise ship disinfection procedures.

Management of Crew Following Exposure

Crew members who may have been exposed to a passenger or coworker suspected of having influenza should monitor their health for 7 days after the exposure. If they become ill with influenza-like symptoms, including fever, body aches, runny nose, sore throat, nausea, or vomiting or diarrhea they should immediately take the following steps:
• Notify their supervisor
• Report to the shipboard dispensary
• Report to the shipboard dispensary
• Follow the current recommendations for the use of antiviral medications (see http://www.cdc.gov/swineflu/recommendations.htm)
• If the crew member is taken to a health care facility off the ship, inform the facility before visiting about the possible exposure to influenza.
• Limit contact with others as much as possible. When not alone or in a public place, wear a surgical mask to reduce the number of droplets coughed or sneezed into the air.

Find out everything you need to know about swine flu.

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