PhotoMarilyn came into the pharmacy and told the pharmacist that she and her husband were planning to take a Caribbean cruise with a few stops in South America. But, she has heard so much on the news about outbreaks of sickness on cruise ships that she has become anxious about the entire vacation. The pharmacist gave her two bits of advice: wash your hands a lot and get the shots you need before you set sail.

The pharmacist explained that the reason why “cruise ship epidemics” are featured so prominently in the news is because of the drama associated with a confined population in the middle of nowhere vomiting overboard and spending sunny Caribbean days tending to their diarrhea.

In reality, the viruses that cause these outbreaks, called noroviruses, are very common, occurring only slightly less frequently than the common cold. You are just as likely to get this gastrointestinal illness at your county fair from eating inadequately cooked food, or grabbing a shopping cart handle at the supermarket.

These viruses are not airborne the same way rhinoviruses – the bugs that cause the common cold – are spread. Rather they are transmitted by direct contact – either the food you ate was prepared by someone who had the virus, or you shook hands or otherwise touched someone who was already infected.

The best way to sidestep this conundrum is to use hand sanitizer that is at least 60% alcohol. Better yet, wash your hands with soap and water. Avoid raw, unwashed foods from street vendors and make sure the ice in your drinks comes from bottled and not local water which may be contaminated.

Cruise ships get the bad press because the Centers of Disease Control and Prevention (CDC) require that all such outbreaks are documented. And even though the CDC has guidelines in place to sanitize ships, close living conditions can be ideal for rapid spread, and new passenger arrivals may bring the virus to other passengers and crew. Once you disembark your ship at your destination, the same cautionary rules for hand washing, well-cooked food and clean water apply.

Don’t forget your vaccines.

The pharmacist also told Marilyn that all vaccines should be up-to-date. This means everything from pneumococcal and diphtheria-tetanus-pertussis vaccines (dTap) to your annual flu shot.

Other countries require current vaccination documentation for diseases that are native to their regions. For example, some countries may mandate that you get hepatitis A, hepatitis B, yellow fever, typhoid, and/or polio inoculations. Go to for a disease directory listed by country. Ask your doctor about malaria, for which a vaccine does not yet exist. However, there are pills you can take before, during and after your trip to prevent infection from this mosquito-borne illness. Do your homework.

If these recommendations are followed, the pharmacist advised Marilyn, then she should be able to enjoy her trip. Don’t forget the sunscreen and bug repellent! And bring back some cute souvenirs, not a disease that you picked up from a foreign land.


Ron Gasbarro, PharmD is a registered pharmacist, medical writer, and principal at Write him with any ideas or comments at

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