Ruby Princess - Norovirus Outbreak

[PrincessLuver]

11 hours ago, PescadoAmarillo said:

What part of the article was incorrect?  Unfactual?  There was no fear, discontent or other histrionics in what I read. 

 

Agree the article was factual, truthful and accurate.  We have been on Princess ships, TA last year, when Covid and Noro have been rampant and passengers sick and it was never reported. Appreciate the posting of the article.

Edited March 9, 2023 by PrincessLuver

[memoak]

Noro has been on ships since I started sailing in 1991. This is not really NEWS

[TexasBrit]

7 hours ago, VibeGuy said:

Purell VF Plus is the proprietary 85% ethanol formula.  This paper specifically discusses how it inactivates norovirus, leaving it unable to infect gastric cells. 
 

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7756425/

 

Here’s another paper comparing it to BAK:

 

https://www.frontiersin.org/articles/10.3389/fmicb.2022.869087/full

 

The previous cruise ship strength formula was VF481, a 70% ethanol/6% isopropanol formula with a modified pH and a copper salt - it was the first to be substantially better than 70% ethanol gels which are literally 10-20x better than isopropanol scrubs. 
 

Food Code compliant refers to model food code Section 2 301.16 - which is both an efficacy claim on particular foodborne pathogens and that the ingredients are food safe without rinsing the hands afterwards.  
 

I was not on team gel prior to the development of VF481 specifically because of their lousy performance on non-enveloped viruses.  Two things changed my mind - one was a move away from whether gels reduced viral loads as measured by PCR to tests based on reductions of infectious capability - you can PCR the DNA in a Dorito really easily but you can’t plant one and harvest corn on the cob later. Better cell culture techniques make infectivity testing a better choice for evaluating sanitizer claims.  
 

The other thing that changed my mind was the very rapid improvement in the gel performance, due in part to research sponsored by the cruise lines - they’re tired of the association of Noro with ocean vacations, when it is endemic in childcare and healthcare environments shoreside.  While a 3.3log decrease isn’t particularly impressive on, say, fecal coliform species, it’s darned impressive on such a tenacious virus as Noro.  99.97% reduction in infectivity, when used properly, is enough to prevent a lot of cases.  The old formula was good enough to convince me to use it as an adjunct, the new formula is demonstrably better. 

I would like to see the automated systems on more ships - they’re effective and the sanitizers can be updated/swapped as new threats emerge.  Until then, I’m just going to assume that literally every other guest has infectious fecal matter on their hands and add an additional kill step after touching shared utensils, even though my hands are usually still damp with sanitizer when I’m touching said utensils.  I’m not a germaphobe.  I’ve literally consumed chicken sashimi.  I just don’t trust the hand hygiene of people who can’t be fired for improper handwashing when it comes to food. 

 

 

Thank you for posting this useful information. As a retired research scientist I appreciate real scientific factual data and information rather than the uninformed opinions of people who don't know what they are talking about. I knew the usual 65% EtOH hand sanitizer that is available everywhere (because it is effective against COVID-19) was not effective against norovirus due to the protein capsid but hadn't yet heard of the stronger version. We will be sure to bring and use the 85% EtOH formula sanitizer on our next cruise on this ship.

[TexasBrit]

1 hour ago, memoak said:

Noro has been on ships since I started sailing in 1991. This is not really NEWS

Yes Norovirus has been on the ships often in the past. What is new, and news, is the recent large outbreak on one particular ship. I have been on 4 cruises since the restart and did not see or hear about any cases of Norovirus on those ships. There were none of the precautions that I had seen previously when there had been some outbreaks, such as the frequent cleaning of surfaces, and plates being handed out in the buffets as you enter, rather than picking them up off the  large stack, etc. which we are now hearing about on Ruby. Of course people were more concerned with COVID precautions, some of which may have helped the Norovirus situation as well.

Complacency is one of the problems that lead to these outbreaks.

[SargassoPirate]

2 hours ago, memoak said:

Noro has been on ships since I started sailing in 1991. This is not really NEWS

But, since the pandemic and cruise ships were all over the news at the start, anything cruise ship related gives the media a chance to sensationalize and exploit the story for clicks and ratings.

 

Personally, I know how to keep myself safe and wouldn't hesitate to board a ship with a noro problem anymore than an airplane, a bus, a taxi, or sit in any restaurant or bar.

 

Or, I could stay home with the covers over my head.

[Guest ldtr]

On 3/6/2023 at 2:52 PM, Married15 said:

Yes, Norovirus is going around everywhere. I have been caring for my husband and daughter who have been sick since last week and still not well. My older daughter and grandson had it also. Somehow, I managed to escape it (knock on wood).  If I were on a cruise ship now, I would wear a mask, avoid close quarters (crowded elevators) and wash my hands a lot as well as use sanitizing wipes. I think the above is what kept me from getting it.   

Masking does no good for noro. It is strictly transmitted by hand to mouth transmission.  You get it on your hands when touching a contaminated surface, then it gets transfered to you mouth while eating. Hand washing, minimizing touching surfaces, using utensils instead of hands when eating, etc. are the ways to avoid noro.

[Guest ldtr]

56 minutes ago, TexasBrit said:

Yes Norovirus has been on the ships often in the past. What is new, and news, is the recent large outbreak on one particular ship. I have been on 4 cruises since the restart and did not see or hear about any cases of Norovirus on those ships. There were none of the precautions that I had seen previously when there had been some outbreaks, such as the frequent cleaning of surfaces, and plates being handed out in the buffets as you enter, rather than picking them up off the  large stack, etc. which we are now hearing about on Ruby. Of course people were more concerned with COVID precautions, some of which may have helped the Norovirus situation as well.

Complacency is one of the problems that lead to these outbreaks.

Keep in mind that Noro is widespread on land during this time of year. Cruise ships do a better job of containing it that most land facilities. In the US about 6% of the population will get it during any given year.

[PescadoAmarillo]

22 minutes ago, ldtr said:

Keep in mind that Noro is widespread on land during this time of year. Cruise ships do a better job of containing it that most land facilities. In the US about 6% of the population will get it during any given year.

And anyone who wasn’t immediately dismissive of that news article would have read that it suggests just that. 

[cruisingrob21]

On 3/6/2023 at 9:48 AM, SalishSea said:

Per the CDC for the sailing ending yesterday 3/6 although the numbers have not been updated since 3/3:

 

Number of passengers who reported being ill during the voyage out of total number of passengers onboard: 199 of 2,881 (6.61%)

Number of crew who reported being ill during the voyage out of total number of crew onboard: 20 of 1,159 (1.73%)

 

For anyone currently on board, I would like to know how the ship and crew are handling this. What is different, and what are you surprised is not different? I'll be on the sailing after, and am interested in knowing what you are observing. Thank you!

 

I always recall my conversation with a crew member a few years back and he would bring up norovirus.  At that time on a different line (maybe still the case), crew that was out sick wouldn't get paid for their shift which was really good incentive for crew to wash their hands as much as possible.  He pointed out that the number of passengers that would use the restroom and not wash hands, or not wash hands before eating (or both!) was probably why there was such a difference between crew and passenger norovirus infection rates.

[Guest ldtr]

24 minutes ago, PescadoAmarillo said:

And anyone who wasn’t immediately dismissive of that news article would have read that it suggests just that. 

I was not dismissive of the article.  I was just responding to the individual that talked about that something was unique with the Ruby since it had a much larger outbreak than any of their 4 cruises.

 

Each year  you get a small number of cruise ship outbreaks that reach CDC reporting levels  This happens in spite of protections taken.  If I recall correctly Princess implements higher levels of protections when the number of cases exceeds 7 cases on board.

 

So a single ship hitting hitting the reporting threshold is by itself not unusual during this time of year.   Seeing several from one cruise line might be indicutive of a problem, but not with a single ship having a single incident.

 

The higher the passenger density, the longer the cruise the more likely it is for the reporting threshold to be reached.  If a reporting threshold is reached on one cruise the odds that their might be an outbreak on the next cruise is also statistically higher, even if enhanced cleaning is done between cruises. 

 

It is all in the stats.

 

so far this year you have

 

Princess Cruises Ruby Princess 2/26 – 3/5 Unknown

Royal Caribbean International Jewel of the Seas 1/28 – 2/3Unknown

Royal Caribbean International Brilliance of the Seas 1/16 – 1/21Unknown

P&O Cruises Arcadia 1/3 – 4/13 Norovirus

 

In 2019 there were 10.  If anything the numbers have been lower since the restart, probably due to lower passenger density.

 

Edited March 9, 2023 by ldtr

[fatbird]

We were on this cruise and it was the first time in more than 25 cruises that we've caught Noro. We figured our luck finally ran out. I caught it on day 3 and my spouse 30 hours later. We're very good about washing hands and not touching things,but as of today the count for ill people is 281. This is probably low since not everyone-myself included, calls down to Medical and tells them they are feeling ill. I bring my own medication to take care of times like this just in case. Our cabin steward called for someone to disinfect the room after each of us became ill. The second time he did it himself because they were too busy to come.

     We ate as little as possible in the buffet and didn't mind being served. It's cleaner than self serve. Hand washing stations would be better than the hand sanitizer being offered before meals.

     The salt and pepper shakers, and sugar containers were removed from the buffet,but not the Club Class section of the dining room.

     I first thought I had just eaten something that my system didn't like. It's happened before-lasts a few hours and goes away. This wasn't like that at all. When the captain announced that we were a Noro virus outbreak probably brought onboard I knew what I had.

     Next time I'll take stronger hand sanitizer, use more forks and stay away from the buffet. I was very thankful I didn't get ill right  before we were to drive home. I couldn't have driven 5 hours feeling as badly as I did the first day I was sick.

     Thanks for all the information. Good luck to all who are going on the Ruby in the next couple of weeks.

[VibeGuy]

7 hours ago, Bobbiegentry said:

 @Vibeguy, what specific hand sanitizer do you feel does the best job?

 

The one with the research backing it is the stuff in the onboard dispensers - Purell VF Plus. 

[memoak]

The clue that your ship has Noro is when all the salt and pepper shakers disappear from the tables

[PescadoAmarillo]

1 hour ago, ldtr said:

I was not dismissive of the article. 

 

I understand that, and wasn’t suggesting you were. ☮️

[TexasBrit]

3 hours ago, ldtr said:

I was not dismissive of the article.  I was just responding to the individual that talked about that something was unique with the Ruby since it had a much larger outbreak than any of their 4 cruises.

 

 

 

so far this year you have

 

Princess Cruises Ruby Princess 2/26 – 3/5 Unknown

Royal Caribbean International Jewel of the Seas 1/28 – 2/3Unknown

Royal Caribbean International Brilliance of the Seas 1/16 – 1/21Unknown

P&O Cruises Arcadia 1/3 – 4/13 Norovirus

 

In 2019 there were 10.  If anything the numbers have been lower since the restart, probably due to lower passenger density.

 

There were no outbreaks on my 4 cruises that I knew about or heard about. I am sure if there had been a substantial number of cases we would have known about it and would have seen some precautions put in place.

By contrast there were almost 300 people hit on the Ruby 2/26-3/5, which brought about the introduction of precautions and also a deep cleaning before the next cruise, which does makes it unique in that regard.

 

I am guessing you wrote unknown for this cruise because the actual causative agent has not been conclusively identified so far, but it doesn't take a Nobel prize winner to figure out what caused it.

 

Lower passenger density so far since restart is one contributing factor to the lower numbers compared to 2019, although two of the cruises I was on were almost at capacity, but also probably due to the extra care passengers were taking with precautions, including hand washing,  in order to prevent COVID. And also we are barely into the third month of 2023, so who knows what the entire year will look like. I know that masks and the standard 65% ETOH hand sanitizer are ineffective against Norovirus. I suspect that now the worry about COVID has substantially lessened, so has the vigilance to stay safe.

 

[TexasBrit]

2 hours ago, VibeGuy said:

The one with the research backing it is the stuff in the onboard dispensers - Purell VF Plus. 

FYI, Walgreen's (and maybe other retailers) have the 85% sanitizer. It's called Purell PRIME DEFENSE. I just picked up the  last 4 oz bottle at my local store and will be looking for another one when they restock.

[sammyjoanne]

Going on the emerald in a few weeks time, so I am forewarned thanks to this thread.

Will definitely take some soap, maybe a nail scubber and bring own shampoo shower gel products.

I know sanitizer doesnt do much for noro, but will take it anyway when on trips.

[TexasBrit]

11 minutes ago, sammyjoanne said:

Going on the emerald in a few weeks time, so I am forewarned thanks to this thread.

Will definitely take some soap, maybe a nail scubber and bring own shampoo shower gel products.

I know sanitizer doesnt do much for noro, but will take it anyway when on trips.

It is the common 65% ethyl alcohol sanitizer that is ineffective. But the 85% ethyl alcohol sanitizer that Purell sells is effective. It is hard to find but Walgreen's had some, see my earlier post. I see you are in UK, so I don't know where you can get it there. But I expect someplace will sell it, perhaps Boots?

Edited March 10, 2023 by TexasBrit
added more text

[Cruise Raider]

1 hour ago, TexasBrit said:

 I suspect that now the worry about COVID has substantially lessened, so has the vigilance to stay safe.

 

That was clearly evidenced by the jerks that trying cramming into our elevator during disembarkation on our last cruise and they clearly didn’t fit.  The guy was an inch away from my DH’s face and we kept telling him the elevator was full … 

then, he has the nerve to tell us to squeeze in so there was room for him!  Unbelievable!  We were just about to our deck and his backpack hits all the buttons on the elevator so we had to go all the way back up to deck 16, stopping at every deck in order to get back down to deck 7.  Seriously .. 

I even had to ask him if he’s ever heard of CoVid before.  Nope .. just crammed right in without regard for anybody else.  

[CalLuvsCrusingToo]

1 hour ago, TexasBrit said:

FYI, Walgreen's (and maybe other retailers) have the 85% sanitizer. It's called Purell PRIME DEFENSE. I just picked up the  last 4 oz bottle at my local store and will be looking for another one when they restock.

 

Thanks Texasbrit.

If you can't find it,  Purell Prime Defense on amazon, got 5 larger pumpers set for $35.

We will replace our small hand sans with PPD, for purses, pockets.

Bringing large pumper for our cabin, and for Refills.

Plus our usual N95 masks for outside our cabin.😉

 

[PaperSniper4]

12 hours ago, TexasBrit said:

.....But the 85% ethyl alcohol sanitizer that Purell sells is effective. It is hard to find but Walgreen's had some.....

Amazon has the 85% Purell available also <3/10/2023>.

 

 Doug

[mbglib]

On 3/7/2023 at 9:50 AM, mibright said:

We were on this sailing and my spouse got sick. We generally consider ourselves to be very communicable-disease aware since COVID (hand sanitizer, masking in crowded spaces, using elbows to push buttons, etc.) however I thought I would share some things we have learned during our experience over the last few days.

Things we would prepare for next time:

- Norovirus is not killed by usual alcohol-based hand sanitizers. Surfaces (including fabrics) can still harbor the virus for up to 2 weeks. Microban sanitizing spray specifically mention killing norovirus on their label.

- Next time we will store toiletries outside of the bathroom. Once my spouse got sick I considered anything in the bathroom contaminated with airborne particles. My tiny Lysol travel spray was not enough for what was out. I threw away our toothbrushes and bought new ones at the "gift shop." Everything else was put in a Ziplock back for sanitation once we got home.

- In retrospect, we should have reconsidered or cancelled our shore excursions when they notified us of an outbreak. The tour operators seemed to operate as usual including snorkeling and self-serve buffets. When we asked, the operators said items were sanitized but now we are questioning that.

- I'm not sure what medical was issuing for vomiting, but we were given generic imodium for diarrhea and were charged quite a bit for it. We usually bring it, but they dropped it off before we realized what it was. I was also grateful Pedialyte packets are also on our usual packing list. They came in handy.

- We were required to fill out a food/drink/activity survey for the 5 days prior to symptoms. We will try to take pictures next time in case we need to document it again.

 

Other items to note:

- Early on we observed there was not much in the way of ongoing sanitization (wiping down surfaces) compared to other cruises we have been on. Even towards the end of the sailing there  seemed to be medium effort.

- One staff member we interacted with regularly that got sick and had only a few hours off (current OSHA guidelines say return to work after 48 hours of no symptoms). This person was handing us menus, serving food and drinks, etc. We might not have even known they was sick if we hadn't interacted with them several times up until that point and noticed their absence and asked.

- Once we notified medical of the illness, a cleaning team arrived hours that sanitized the bathroom, replaced towels, and wiped down a few walls. I did not have any symptoms and was not offered any alternative arrangements to use another bathroom or otherwise protect me from getting it. 

- Communication with the staff about our instructions for disembarkation was delayed and inconsistent. I would think 3 years since COVID this type of thing would be somewhat more organized.

- We were some of the very last people to get off the ship and were escorted by medical personnel and in very small groups. By then all shuttles, taxi's, ubers, etc. were long gone. We had to wait a while for something to finally come, but there were others who had earlier flights that were panicking.

 

We have another cruise scheduled for later this summer, but this experience has put a big damper on our enthusiasm to book again. 

I am recovering from Norovirus (not from a cruise) and absolutely needed IV therapy for severe dehydration.  Do you know if they offered anything like this?  Is that why you bring the Pedialyte packs?  Thank you.

[Guest ldtr]

On 3/9/2023 at 3:57 PM, TexasBrit said:

There were no outbreaks on my 4 cruises that I knew about or heard about. I am sure if there had been a substantial number of cases we would have known about it and would have seen some precautions put in place.

By contrast there were almost 300 people hit on the Ruby 2/26-3/5, which brought about the introduction of precautions and also a deep cleaning before the next cruise, which does makes it unique in that regard.

 

I am guessing you wrote unknown for this cruise because the actual causative agent has not been conclusively identified so far, but it doesn't take a Nobel prize winner to figure out what caused it.

 

Lower passenger density so far since restart is one contributing factor to the lower numbers compared to 2019, although two of the cruises I was on were almost at capacity, but also probably due to the extra care passengers were taking with precautions, including hand washing,  in order to prevent COVID. And also we are barely into the third month of 2023, so who knows what the entire year will look like. I know that masks and the standard 65% ETOH hand sanitizer are ineffective against Norovirus. I suspect that now the worry about COVID has substantially lessened, so has the vigilance to stay safe.

 

 Actually unknown is how it is classified on the CDC listing of outbreaks. The info I posted was directly from the CDC listing.  It will only be changed if the lab results positively confirm the cause.  In some cases it is confirmed in a couple of weeks after the lab results come back.  In others it never is, because there are several different causes for such outbreaks in addition to Noro.  Half of those outbreaks last year remain unknown with no clear identification.  About 30% of 2019 events remain unknown.

 

Noro is the Northern  hemisphere  is usually between November to April.  While you can have some cases at other times the majority of cases occur during those months.

 

Consequently we are approaching the end of the high risk period so looking at a prorated estimate on the number of outbreaks expected the normal high risk period is about 6 months of the.  As of now we have gone through almost half of that period so one would expect that we might end up with 8 or 9.

 

Last year there were 4 outbreaks during the entire year.  A year when many cruises were relatively low occupancy.

 

Compare that to the 3 years prior to Covid, when ships were certainly sailing full 2017 11. 2018 11, 2019 10.

 

So at this point we are running at a rate less than the pre-covid outbreak rates.  With no trend showing unusual outbreaks tied to any particular cruise line.  So to put it simply these kinds of outbreaks happen, even with best practices.  The rate for last year was considerable low than normal.  This year seem to be slightly lower, but certainly returning towards historic patterns.

Edited March 12, 2023 by ldtr

[TenneSea]

On 3/7/2023 at 9:07 AM, SargassoPirate said:

Norovirus is spread by the fecal-oral route, so it's easy to tell who didn't wash their hands before touching their food or sticking their fingers in their mouth.

 

I take the approach that every surface in the world is contaminated with germs, viruses, and bacteria and if I've touched anything before I touch my food, I wash and/or sanitize. 

 

All of the procedures such as the crew serving in the buffet and no common use containers on the tables is theater since there are many other surfaces to touch and pick up noro.  How about when you grab the bottom of your chair to pull it in - for example?

 

 

Yes, probably the biggest spreaders are the chair backs and seat and the menus in the main dining room.  How do you wash your hands after you pull your chair in?  Hand sanitizer does not kill Norovirus.  It will kill Covid, but not Noro.  Masks are not effective in preventing any virus.  Virus particles are too small, plus when a person removes the mask to place it somewhere, the exterior of the mask is usually touched so the person now has any bacteria or germ that the mask "caught" on their hands.

[chengkp75]

42 minutes ago, TenneSea said:

How do you wash your hands after you pull your chair in?

The simple way to break the chain is to not eat anything with your fingers.  If your hands are "contaminated" from the chair back, but you never touch the food with your hands, then the chain is broken.  So, those french fries, or burger, or pizza gets cut up with knife and fork.