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Editor: Rod Sullivan
Profession: Maritime Attorney

Category: Cruise Ship Injuries and Accidents

A really detailed history of outbreaks of contagious diseases on cruise ships can be found CruiseJunkie.com.

CDC reports on the 2002 M.S. Amsterdam outbreak can be found at the CDC site.

Here is an abbreviated history, focusing on known or suspected norovirus outbreaks:

November 1968 Historically, noroviruses are named after the places where the first outbreak occurs. In Norwalk, Ohio, in November 1968, an outbreak of acute gastroenteritis occurs among children at an elementary school. In 1972, immune electron microscopy on saved stool samples identified the virus, which was called Norwalk virus.

April 26, 1986 Holiday (Carnival Cruise Line): 392 (25%) of 1,550 passengers and 30 (4%) of 679 crew who completed questionnaires developed gastroenteritis.

May 3, 1986 Holiday (Carnival Cruise Line): 321 (22%) of 1,470 passengers and 48 (7%) of 658 crew developed gastroenteritis. A sanitation inspection initiated by CDC on May 3 revealed deficiencies related to water chlorination record-keeping, food preparation and holding, and potential contamination of food.

May 3, 1986 Rotterdam (Holland American Cruise Line): 405 (37%) of 1,108 passengers and 35 (6%) of 554 crew who completed questionnaires had a gastrointestinal illness.

May 10, 1986 Rotterdam: CDC inspection reveals numerous deficiencies related to food and water sanitation; the sanitation inspection score was 16 out of a possible 100 points.

May 10, 1986 Holiday: The final vessel sanitation inspection score was 18 out of a possible 100 points (passing = 85).

June 1998 Regal Princess: At least 270 became ill with the Norwalk virus over the course of three Regal Princess cruises to Alaska.

June 15, 2002 Disney Magic is inspected by the CDC and rates a 99 out of 100.

July 2002 Ryndham (Holland America): Holland American pulls the Ryndham from service to be sanitized after 388 passengers fall ill during an Alaska cruise.

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November 16, 2002 Disney Magic: 312 people to become sick on a seven-day cruise.

November 23, 2002 Disney Magic: 69 guests and 16 crew members fall ill. The 2,400-passenger ship had been disinfected that day because a similar gastrointestinal outbreak.

November 27, 2002 Disney Magic: Currently reporting 104 cases of gastrointestinal illness in passengers, and their passenger complement s 2,485 passengers. They are reporting 19 cases in the crew out of a crew complement of 1,003.

November 30, 2002 Disney Magic: sailing of Disney's Magic is canceled. Scheduled passengers are offered a full refund and 50 percent discount on a future Disney cruise.

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Sequence of 6 M.S. Amsterdam Cruises affected by three different strains of Norovirus which were re-introduced onto the ship after it had been disinfected. The CDC investigation reported in January 2005 the following:

The genetic sequences detected on cruises 1 and 2 were identical in regions [two different restaurants aboard the M.S. Amsterdam sailing out of Seattle which did not share the same galley] B and C and belonged to a lineage of NoV within genogroup II (GII), cluster 4 (Figure 2), which has been provisionally described as the Farmington Hills strain (6). Five of the 8 NoV-positive specimens on cruise 3, which sailed after sanitization, contained 3 different sequences (X, Y, and Z). Sequence X was found in 1 sample and was identical to the sequence detected on cruises 1 and 2, which suggested that this strain may have persisted onboard despite cleaning. Sequence Y was found in 3 samples and differed from sequence X by 3 nucleotides (nt) in region C, which suggested that it was the predominant strain and probably newly introduced by passengers or crew at the start of cruise 3. Sequence Z was detected in 1 sample and belonged to the same lineage of NoV as the strain found on cruises 1 and 2 but to a different cluster (cluster 3), which suggested that it was also newly introduced onto cruise 3. Single stool samples from persons on cruises 5 and 6 contained a sequence that differed from the Farmington Hills strain by 3 nt and 1 nt, respectively, which suggested probable continuous reintroductions of closely related viruses aboard the ship.

Oct. 1st - 22nd, 2002 M.S. Amsterdam. First Cruise, 196 passengers and a dozen crew contract the Norwalk like virus.

The ship was disinfected, scrubbed and cleared to embark on its next voyage.

Oct. 22nd - Nov. 1, 2002 M.S. Amsterdam. Second cruise, had an outbreak as well, with 41 passengers and 8 crewmembers becoming ill from Norwalk-like viral infection.

Nov. 1st -11, 2002 M.S. Amsterdam. Third cruise, the staff of Holland America distributes a printed notice to passengers, informing them that the previous cruise had been disinfected. Despite adhering to CDC's disinfection and sanitation measures, the outbreak continues with 163 passengers and 18 crewmembers confirmed ill. It was reported that the common greeting among passengers was to rub elbows to avoid direct hand-to-hand contact.

Nov. 11, 2002 M.S. Amsterdam Fourth cruise. Yet again an outbreak develops, with 36 people offloaded for symptoms associated with Norwalk.

November 21, 2002 M.S. Amsterdam (Holland American Cruise Line): taken out of service for decontamination.

November 25, 2002 M.S. Amsterdam: A number of those affected by the virus on the four prior Caribbean cruises join in a class-action lawsuit against Holland-America Cruise Lines alleging the company "knew or should have known" that passengers could contract a contagious virus and should have immediately removed the ocean liner from service to sanitize her and eliminate the prospect of causing more passengers to fall ill.

Holland America institutes new safety procedures. Salt and pepper shakers are removed from dining room tables; staff begin wearing gloves to serve buffet food; hand shaking is discontinued at the Captain's Cocktail Party; hot tubs and children's pool are drained; hand sanitation wipes are made available at the Internet café; plastic gloves made available to Casino gamblers.

December 1, 2002 M.S. Amsterdam returns to sea.

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November 2002 In the first 11 months of 2002, the Centers for Disease Control (CDC) received reports of 21 food borne illness outbreaks on a total of 17 cruise ships. Most occurred from July through December

Dec. 4, 2002 Disney Magic: At least 60 passengers fall ill with the virus aboard the Disney cruise ship Magic in Florida. This comes just days after the ship was thoroughly cleaned when 275 passengers fell ill in a similar outbreak.

Dec. 16, 2002 Conquest (Carnival Corporation): A Norwalk-like virus strikes more than 200 passengers.

November 2003 M.V. Aurora (P & O Lines) During a cruise around the eastern Mediterranean Sea about 1,000 passengers suffer stomach infections caused by the highly-contagious Norwalk virus. The ship was denied docking at Piraeus Greece. The ship was permitted to dock in Gibraltar but the Spanish government decided to close the border between Gibraltar and Spain, on advice from its health ministry

November 29, 2003 Carnival Legend arrived back in Fort Lauderdale with a highly contagious Norwalk-type virus. This was Legend's second consecutive trip through the southern Caribbean in which passengers fell ill. On this latest voyage, the Associated Press reported that 73 of the 2378 passengers and four of the 913 crew members aboard had been affected by the stomach illness.

February 2004 Carnival Celebration: More than 300 passengers are stricken with the stomach malady while November 1968 Historically, noroviruses are named after the places where the first outbreak occurs. In Norwalk, Ohio, in November 1968, an outbreak of acute gastroenteritis occurs among children at an elementary school. In 1972, immune electron microscopy on saved stool samples identified the virus, which was callon a Valentine's cruise to Mexico.

January 2005 Veendam: Norwalk Virus Incident: 230 fall ill

July 2006 Mariner of the Seas (Royal Caribbean): Norwalk Virus Incident: 200 Passengers Plus Crew Members Succumb on Mariner of the Seas

November 2006 Carnival Liberty (Carnival Cruise Line): Norwalk Virus Incident: 700 Fall Ill on Carnival Liberty, among largest outbreaks ever, according to the Center for Disease Control.

December 2006 Freedom of the Seas (Royal Caribbean Cruise Line):. Norwalk Virus Incident: 400 Struck on Freedom of the Seas, the largest ship at sea. The ship has a passenger capacity of 3600.