Cruise Ship Travel
The continued popularity of cruise travel, along with the expansion of cruise itineraries to areas not easily accessible otherwise, promotes the exposure of travelers to multiple global destinations in a short period of time. Passengers and crew from around the world bring together a diversity of cultures, medical risk factors, and health risk behaviors.
- About 12 million passengers worldwide took a cruise vacation in 2007, a 7% increase over 2006.
- The North American cruise industry makes up the majority of the global cruise market and since 1980 has had an average annual passenger growth rate of 8.1%.
- U.S. ports handle about 75% of all embarkations.
- The Caribbean is the top cruise destination, followed by the Mediterranean, Europe, Alaska, and Mexico.
- A typical cruise is about 7 days long and includes 3,000 passengers and 1,000 crew members.
- Approximately 78% of cruise passengers are U.S. residents. About 50 nationalities are represented among crew members, most of whom are from developing countries.
Challenges of Cruise Ship Travel and Infectious Diseases
- Densely populated, semi-enclosed cruise ship environments may permit repeated and prolonged exposure to communicable diseases, resulting in their transmission between passengers and crew members.
- Differences in sanitation standards and disease prevalence between seaports may also lead to communicable disease exposure and spread.
- The risk of acquiring an infectious disease during cruise travel is difficult to quantify due to the diverse activities of crew and passengers, as well as the wide range of potential disease exposures.
- Senior citizens (an estimated one-third of cruise travelers) and travelers with underlying chronic health problems are at increased risk of illness from infections such as influenza, Legionella, and noroviruses.
- Early detection and prevention of infectious diseases are important, not only to protect the health of cruise travelers, but also to avoid global dissemination of diseases in home communities through disembarking passengers and crew members.
Medical Care Aboard Cruise Ships
Medical facilities on cruise ships can vary, depending on the size of the ship, its itinerary, number of crew and passengers, and the mean age and health status of passengers. The American College of Emergency Physicians (ACEP) Health Care Guidelines for Cruise Ship Medical Facilities is a consensus report on appropriate facilities and staffing requirements for basic shipboard medical and emergency services, given the recognized limitations of offshore environments. Shipboard health care recommended in these guidelines includes provision of—
- A medical infirmary with licensed medical staff (physician and registered nurse) on call 24 hours per day
- One intensive care unit (ICU) room
- One bed per 1,000 passengers and crew members
- One isolation room or the capability to isolate patients with communicable diseases
- Emergency and portable medical equipment, such as a bag valve mask, oxygen tank, endotracheal tube, defibrillator, and a cardiac monitor or external cardiac pacer
- Medications to handle medical emergencies
- Basic diagnostic and laboratory supplies for blood chemistry analyses, complete blood counts, urinalyses, chest x-rays, and electrocardiograms (EKGs)
- A medical record and communication system
- Health, hygiene, and safety program for medical personnel
Large cruise lines that operate in the United States or are members of Cruise Lines International Organization (CLIA) meet or exceed ACEP guideline standards. However, medical care on these ships should be equated to that of community urgent-care centers, not full-service hospitals. Small ships or those run by independent ship operators may not follow the ACEP guidelines. Therefore, on such ships, medical provisions might not be available onboard.
