HAL Makes List With Most Noro Outbreaks

[drgrinch]

Oh no - I'm type O!

 

I wash very often, with lots of soap and warm water. I don't touch railings and use elbows for doors if possible. I carry wipes with me, and wipe my hands after ordering anything (How many other hands have touched your menu before you?)

 

I carry a small can of Lysol onto the ship and spray the cabin often.

 

I read somewhere that the Purell-type hand sanitizer does nothing for Noro, as Noro is a virus and sanitizers kill primarily bacteria. So it's good for keeping away many other types of illness but not Noro.

 

According to CDC the last time I checked, Hand sanitizer will deal with most bugs, but not the Noro Virus. Additionally, it takes a relatively few Noro virus particles to produce an infection whereas it can take hundreds or thousands for other diseases. Noro is just one of the toughest customers out there.

 

With a thousand or more cruisers getting on the ship at each port, it is inevitable that something is going to hitch a ride. The only reliable defense is diligent personal hygiene and the avoidance of likely-to-be-contaminated surfaces.

[GeriatricNurse]

Official Norovirus Outbreaks - as defined by the CDC - are a numbers and percentages game.

2% of passengers on a small ship on a long cruise is very different from 2% of passengers on a big ship on a short cruise.

 

A small ship on a long voyage can have just one or two cases a day and still hit 2% to qualify for an official outbreak.

A big ship on a 7-day cruise can have dozens of cases every day and still not hit 2% before the cruise ends.

 

USA has more yearly cases of Norwalk virus than any other country.

Ships that leave from US ports usually carry more Americans; this increases the chances of more NLV cases brought onboard.

 

Many studies report that NLV is most likely to infect people with Type O Blood.

Who has Type O Blood? Primarily Anglo-Saxons.

That may help to explain why USA, Canada, Australia, UK, and Germany have higher percentages of Norwalk outbreaks than most other countries.

If your ship is carrying a high percentage of people from those countries, the odds of infection increase.

 

Those same studies suggest that people with Blood Types A, B, and AB - although not immune - are very unlikely to become infected with NLV, even when exposed.

Who has these blood types? Many Asians.

Ships carrying primarily Asian passengers rarely have NLV problems. It can still happen, but just far less likely.

 

I'm Anglo-Saxon (Canadian) & I have Type AB+ Blood! ;)

[getupgo]

I was curious about HAL so looked at this board. I sail Carnival and NCL. It is almost impossible to not touch the handrails on the way to the dining room or buffet. Both those cruise lines have someone stationed at the door to sanitize hands.

Edited April 17, 2015 by getupgo

[RDC1]

One should take into account the relative size of each cruise lines fleet. If you normalize for the size of the fleet you get.

 

Celebrity 15 incidents/ 11 ships 1.36

Princess 15 incidents/ 18 ships .83

Cunard 4 incidents/ 3 ships 1.33

Royal 10 incidents/ 24 ships .41

Holland 10 incidents/ 16 ships .62

 

Since Norwalk has a fairly high incidence rate across the population. For example about 6% of the US population will contract it each year with similar numbers in many other countries, some higher some lower percentages, but not extremely so. The incident numbers normalized by fleet size would give one a better idea of where one might be more likely to encounter it. With Celebrity and Cunard standing out.

 

I would suspect that if one really looked at this using statistics (number of passengers, time of year, background cases reported, etc. in the end they would probably find that the relatively few incidents compared to the number of sailings and passengers is not statistically significant for any of the cruise lines and would fall into the range of random luck.

[RDC1]

For the same time period

 

NCL 4 incidents / 14 ships .28

Carnival 2 incidents/ 24 ships .08

[RDC1]

Official Norovirus Outbreaks - as defined by the CDC - are a numbers and percentages game.

2% of passengers on a small ship on a long cruise is very different from 2% of passengers on a big ship on a short cruise.

 

A small ship on a long voyage can have just one or two cases a day and still hit 2% to qualify for an official outbreak.

A big ship on a 7-day cruise can have dozens of cases every day and still not hit 2% before the cruise ends.

 

USA has more yearly cases of Norwalk virus than any other country.

Ships that leave from US ports usually carry more Americans; this increases the chances of more NLV cases brought onboard.

 

Many studies report that NLV is most likely to infect people with Type O Blood.

Who has Type O Blood? Primarily Anglo-Saxons.

That may help to explain why USA, Canada, Australia, UK, and Germany have higher percentages of Norwalk outbreaks than most other countries.

If your ship is carrying a high percentage of people from those countries, the odds of infection increase.

 

Those same studies suggest that people with Blood Types A, B, and AB - although not immune - are very unlikely to become infected with NLV, even when exposed.

Who has these blood types? Many Asians.

Ships carrying primarily Asian passengers rarely have NLV problems. It can still happen, but just far less likely.

 

Just because America has the most cases of the countries that reports does not mean the highest percentage of population that gets the illness each year. According to the CDC approx 20 million out of a population of 322 million or about 6.2%. The last numbers I saw in a 2010 paper indicated that Australia had about 1.83 million cases per year out of a population of 22 million or about 8.3% of the population.

[Hlitner]

What is interesting about the statistics is that HAL is the only cruise line that plays their silly "Code Orange" game. Apparently this inconvenient policy (the first couple of days of any cruise) does not seem to do a lot of good.

 

We should mention that DW and I have done our share of cruising (more than 3 1/2 years on cruise ships as passengers) and never had Noro (or other GI bugs) on any ship. Perhaps we are just lucky, but we attribute our "good luck" to a couple of very simple precautions. 1. We wash our hands with soap and water as often as practical. and 2. We avoid touching our face (especially near eyes, mouth, nose) with our hands unless they have just been washed with soap and water.

 

What we do not do is obsess about the issue (other than the frequent handwashing). We do not try to sterilize our cabin (as soon as any steward enters your cabin this is for naught). We also avoid using elevators as much as possible (more to protect from airborne viruses/germs) since being in a tightly closed place with lots of folks is just asking to catch whatever they have.

 

Hank

[Susie51]

Thanks for sharing.

 

Is there a port that the ships that get Noro have in common?

 

Interesting info about blood types.

Edited April 18, 2015 by Susie51

[POA1]

Thanks for sharing.

 

Is there a port that the ships that get Noro have in common?

 

Interesting info about blood types.

It's more a time of year thing. I have a friend who is an epidemiologist. The current thinking is that highway rest stops and airports are some of the biggest infection vectors. The people passing through rarely end up in the same place for the same amount of time though. If we all went over the river and through the wood to the same grandmother's house, it would probably be the Norovirus capital of the world.

 

http://en.m.wikipedia.org/wiki/Over_the_River_and_Through_the_Wood

[iancal]

On our last cruise we moved twice while attending events in the showroom.

 

People coughing, hacking, sneezing beside us and behind us.

 

I am actually surprised that there is not more Noro on the ships.

 

I think that the bigger problem is cruisers, not the cruise line.

Edited April 18, 2015 by iancal

[Cruising-along]

On our last cruise we moved twice while attending events in the showroom.

 

People coughing, hacking, sneezing beside us and behind us.

 

I am actually surprised that there is not more Noro on the ships.

 

I think that the bigger problem is cruisers, not the cruise line.

 

I agree. We noticed the same thing on our cruise last week. Not only hacking and sneezing, but a gastrointestinal bug (not Noro).

 

That said, we managed to keep from getting sick the entire 18 days we were traveling. Coming home on the plane was more of a worry, and you can't change seats then! Of course the worst hackers and sneezers were seated right next to us. Not that it matters in a plane with the circulating air.

 

Someone said earlier that it's impossible to not use the handrails, I disagree. I always slide my elbow along the rail for balance (and quick access if I do lose my balance). No need to put your hands on the rail, at least not for me.

[Debz62]

Very interesting. Thanks for sharing

 

I like everyone else have been surprised by the number of people I have seen who leave the rest room with out washing their hands or by running a bit of water over their hands like they are rinsing the germs away. We were always told to recite the ABC's and when you are done your hands will be clean!

 

I work in the healthcare industry and you'd be amazed at how many physicians and nurses don't wash their hands properly. Singing Twinkle Twinkle Little Star while washing your hands does it too. From what I've learned, washing your hands is by far superior to any sanitizing gel or wipe you can use. :)

[Hlitner]

On our last cruise we moved twice while attending events in the showroom.

 

People coughing, hacking, sneezing beside us and behind us.

 

I am actually surprised that there is not more Noro on the ships.

 

I think that the bigger problem is cruisers, not the cruise line.

 

We do try to avoid coughers/sneezers as much as reasonable which is another reason why we prefer to walk the stairs rather than get trapped in a small elevator (not the place to be when somebody coughs or sneezes). That being said , this thread is about Noro which is not generally spread by coughing and sneezing. With Noro its all about touching.

 

Hank

[donaldsc]

I guess as a retired DDS I am stuck with sanitizing everything. Lysol spray works great in our cabin. We wipe down everything. In the Lido I use wipes to hold onto serving spoons, we always wash hands prior to eating, and remember the condoments on the tables you need to watch those also. We always wash hands after eating, never touch handles on doors or banisters. Never have gotten sick even when there was a Norvo on board. Call it luck!

I am sure others will laugh at this, but it works for us!

 

I do none of these things except for routine cleanliness and I also have never gotten Noro even though I have been on red alert cruises. As you well know as a medical professional, the fact that you did stuff and something did not happen did not happen proves nothing. Probably did not hurt but it may or may not have helped.

 

DON

[cbr663]

We do try to avoid coughers/sneezers as much as reasonable which is another reason why we prefer to walk the stairs rather than get trapped in a small elevator (not the place to be when somebody coughs or sneezes). That being said , this thread is about Noro which is not generally spread by coughing and sneezing. With Noro its all about touching.

 

Hank

 

Some people are very tactile and need to touch nearly everything around them. Most people have a fascination with touching their face. Some researchers claim that we touch our faces with our hands about 3 times per hour, but I have found that if you sit and watch people you will see a number much higher than that. Most are not even aware of how often they do it. People routinely rub their noses, squeeze their noses, rub their eyes, and rub their chins and mouths.

[bwaz]

For the same time period

 

NCL 4 incidents / 14 ships .28

Carnival 2 incidents/ 24 ships .08

 

So do you think that the reason that Carnival and NCL rate well is that they offer more short cruises and fewer long ones? I would think that the rate of hand washing is pretty even across lines

 

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[perditax]

I haven't cruised yet, but I'm a compulsive researcher. When I went through the "oh god norovirus" phase of cruise researching, I read that a hand sanitizer called Zylast is effective against noro, and it's currently on my Amazon shopping list for my upcoming cruise. Clorox makes one too. I believe it was pretty much those two. (I understand that soap and water is the best defense, just mentioning the info for info's sake.)

[TATraveler]

Oh no - I'm type O!

 

I read somewhere that the Purell-type hand sanitizer does nothing for Noro, as Noro is a virus and sanitizers kill primarily bacteria. So it's good for keeping away many other types of illness but not Noro.

 

Maybe you're thinking of antibacterials?

 

Hand sanitizers and other alcohol based products destroy cell membranes for both bacteria and viruses. However, that said, hand washing is the gold standard. Hand sanitizing should be used when you don't have access to soap and water.

[BruceMuzz]

Hand Sanitizers with high alcohol content all claim to be effective - at least to some degree - against virus spores.

But very few people here bother to read the fine print in those claims.

 

When we talk about killing bacteria and viruses with various chemicals, there is a critical factor called "Dwell Time".

 

Dwell Time describes the length of time that the chemical remains in liquid form and is most effective in killing the bugs.

 

The more alcohol you have in a hand sanitizer, the faster it evaporates.

Faster evaporation equals shorter Dwell Time.

Shorter Dwell Time equals less effect on the virus.

 

If you read the fine print on all the studies done on the Hand Sanitizers, you will find that they claim to kill most viruses, IF (a really big IF) the dwell time is several minutes.

 

How many of you have managed to keep your hands wet with hand sanitizer for several minutes?

The answer is - NONE.

 

Everybody I see applying hand sanitizer is trying to get it to evaporate as quickly as possible - thereby defeating the very purpose they used it for in the first place.

 

Anyone who does manage to keep their hands wet with high alcohol content sanitizer, several times a day, is going to have some serious skin damage problems before the cruise ends.

 

Wouldn't is just be easier - and more healthy - to properly wash your hands ???

Why do we need to make this so complicated and difficult ??

[Kamloops50]

I work in the healthcare industry and you'd be amazed at how many physicians and nurses don't wash their hands properly. Singing Twinkle Twinkle Little Star while washing your hands does it too. From what I've learned, washing your hands is by far superior to any sanitizing gel or wipe you can use. :)

 

There some chlorine based hand sanitizers on the market. They deal with Nora.

 

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[RDC1]

So do you think that the reason that Carnival and NCL rate well is that they offer more short cruises and fewer long ones? I would think that the rate of hand washing is pretty even across lines

 

Sent from my LG-D801 using Forums mobile app

 

Not sure if it is related to the length of the cruise or not. It might be because you have less time for it to spread, on the other hand you get more turn over and more people going on the ship and a greater chance that an infected individual gets on board. As mentioned earlier the short cruise might impact the calculations to get to the 3% reported incident level (at 2% it must be reported to CDc, but 3% is the level where it is reported in the public database). Though a number of the reported incidents were for 7 day cruises.

 

Also Celebrity and Royal also tend towards shorter cruises, similar to NCL.

Edited April 19, 2015 by RDC1

[Kamloops50]

Not sure if it is related to the length of the cruise or not. It might be because you have less time for it to spread, on the other hand you get more turn over and more people going on the ship and a greater chance that an infected individual gets on board. As mentioned earlier the short cruise might impact the calculations to get to the 3% reported incident level (at 2% it must be reported to CDc, but 3% is the level where it is reported in the public database). Though a number of the reported incidents were for 7 day cruises.

 

Also Celebrity and Royal also tend towards shorter cruises, similar to NCL.

 

Norovirus can live on a hard surfaces for ten days and still be infectious. As to HAL there is an older population on board. Many not all of them don't wash their hands properly. I have seen this with my Dear Dad.

 

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[Blue Mudshark]

Maybe you're thinking of antibacterials?

 

Hand sanitizers and other alcohol based products destroy cell membranes for both bacteria and viruses. However, that said, hand washing is the gold standard. Hand sanitizing should be used when you don't have access to soap and water.

Viruses don't have cell membranes.

[RDC1]

Norovirus can live on a hard surfaces for ten days and still be infectious. As to HAL there is an older population on board. Many not all of them don't wash their hands properly. I have seen this with my Dear Dad.

 

Sent from my SGH-I317M using Forums mobile app

 

As far as hand washing goes I doubt that you can mark down any age group as better or worse.

 

Older might mean potentially more immune compromised individuals.

 

However, when looked at the number of incidents normalized by fleet size HAL's numbers are not bad at all. I would expect that you would not have statistical significance between any of the cruise lines when considering the number of passengers, number of cruises, compared to the incidence in the general population. If anything the incidence rate on cruise ships is pretty low, with relatively few reported outbreaks, compared with high density populations in general (schools, hospitals, nursing homes, office buildings, etc). Of course those other locations do not report in a public database.

[RDC1]

To put the Noro issue in perspective. Between NCL, RCL, Carnival, Celebrity, Princess, Cunard and HAL there was at total of 60 incidents with the population exceeding 3% between 2010 and 2015. If you look at total fleet sizes and usinf an assumption of 10 day average cruise lengths (it could be lower or higher but 10 seemed like a reasonable number.) Then with the total number of ships in those lines being 110 and there being a total of approximately 1800 days (rounded down) in that five year period, you would get 19,800 10 day cruises. That would mean that your chance of being on one of those reported cruises would be less than 1/3 of 1 percent (.30%). On HAL it comes out .34% or right around the average rate.

 

Note that if you have 6% of the US population contracting Noro during any given year then spread out over the entire population any one individual would have a .16% change of contracting Noro during any given 10 day period. Now the real number would vary quite a bit by time of year and location (concentrations around health care facilities, schools, etc), but it should be sufficient to show that ones chance of encountering it on a cruise ship is not significantly different then encountering it somewhere else.