GI outbreak on the Sirena

[Lacruisers613]

We are on the cruise ending today in PC. Bring Imodium as it’s difficult to get on board. The Dr. won’t give it without a consult which can lead to additional complications. We had “issues” but not enough to interfere with our daily activities. Agreed, poor communication; daily boilerplate announcement from the captain, followed by the cruise director giving false hope that everything would return to normal soon. 

[Techno123]

Prevention is always better than cure and the thing with norovirus is that hand sanitiser doesn't work particularly well, so it's handwashing, handwashing, handwashing then don't touch anything other people may have touched - door handles, banister rails, elevator buttons etc. because you can be sure there will be people onboard who don't do handwashing.
It might not save you completely but you have a far better chance of avoiding catching the lurgy 😁

[zodiacsign]

Did they publicly identify the cause? The OP said NOT Noro…,

[kibutzer]

Sadly few are using the hand sanitizing stations, and in the Fall last year I saw far too many folks trying to serve themselves. Please remember these protocols are designed to help limit the spread of things like this. 

[pinotlover]

One would hope that at a minimum all the service counters are fully wrapped in cellophane to keep all those hands and arms out from under the glass. I’ve never understood why some insist upon sticking their arms or hands under the glass shields!! 🤬

[njhorseman]

52 minutes ago, kibutzer said:

Sadly few are using the hand sanitizing stations, and in the Fall last year I saw far too many folks trying to serve themselves. Please remember these protocols are designed to help limit the spread of things like this. 

Most hand sanitizers are alcohol and of little or no use in killing norovirus and other viral infections. Washing your hands with soap and water is the preferred way of limiting the spread of the virus.

In almost forty years of cruising on about a dozen different cruise lines, the only time we've gotten noro is on Oceania. Having the crew serve you in the buffet isn't all it's cracked up to be as a preventative measure because the crew members serving you can spread the virus. In fact I'm reasonably sure that's how we got noro. The server who we went to for our eggs every morning came down with noro just before we did and I suspect that's how we got it. One morning she wasn't there and the next day we were ill. she came back to work the day before we were released from quarantine and told us she had been ill.

[JYDCruise]

On 3/16/2024 at 7:17 AM, WildWanderers said:

Butt seriously, if you have yet to take your trip, consider asking your doctor for a just-in-case filled prescription of ciprofloxacin.  We never travel without it.

 

Cheers from Greg of the WildWanderers

IANAD, but am extremely surprised that a doctor would prescribe an antibiotic to be taken at the patient's discretion on a cruise. Is the plan that in event of a problem, you confirm the need for an antibiotic with the ship's medical personnel, and then have the mediation already at hand? Overuse of antibiotics is a major world health issue, and part of why antibiotics lose their effectiveness over time.

[ORV]

16 hours ago, Tr1v1alCru1ser said:

We’ve been on board when they had a really bad outbreak of Norovirus.  People who had it wouldn’t stay in their cabins until they were over it, so the poor staff were cleaning 24/7.  Eventually, they had to take their room cards away and you had to show your card to enter any of the dining venues.  We even spoke to a couple who got on the ship knowing they had it, and just carried on as normal. 

 

14 hours ago, oceansandseas said:

You were probably on the same cruise as DH and I were on. Even though we were very careful with cleaning hands, I came down with noro. They kept us in our cabin, with the door taped with red tape, for 5 days and gave us very little food on plastic plates. When we got out we had to show card to get into restaurants. Never want to go through that again. Hope it is not that bad for those on board now.

What cruise lines were this?

[WildWanderers]

1 hour ago, JYDCruise said:

IANAD, but am extremely surprised that a doctor would prescribe an antibiotic to be taken at the patient's discretion on a cruise. Is the plan that in event of a problem, you confirm the need for an antibiotic with the ship's medical personnel, and then have the mediation already at hand? Overuse of antibiotics is a major world health issue, and part of why antibiotics lose their effectiveness over time.

Hi @JYDCruise,

 

Thanks for your concern.  We have the take or not take decision in hand.

 

Totally understand that this will not fly in some jurisdictions.

 

Cheers,

Greg from the WildWanderers

[Tr1v1alCru1ser]

It was on Oceania @ORV.  They covered the buffet with cling wrap and there were still idiots trying to stick their hands behind to grab food.  On one occasion in The Terrace, the staff had to remove a whole new tray of food, and I shouted at someone who was just about to stick his hand on the food.  He was surprised, but honestly, when the ship are doing everything to stop the spread, I didn’t care if he was offended.  

 

Lots of people complaining because they had to wait 2 minutes for the tables to dry after being thoroughly cleaned and sprayed, it was just unreal that people were acting that way.

 

That wasn’t even the worst of it, we were denied port access in to the Bahamas, so headed straight on for Miami to disembark a day early. Oceania organised hotels for everyone in Miami (or alternative flights home).  Dinner was in The Terrace only, and one passenger assaulted a waitress because they didn’t get her coffee quickly enough.  I don’t know what happened to the passenger but I hope they were banned from O.  

[Techno123]

@Tr1v1alCru1ser I looked for the 😱button but there wasn't one. Some people are just selfish beyond belief but the worst is, they don't think they are doing anything wrong.

[Kay S]

1 hour ago, Tr1v1alCru1ser said:

Dinner was in The Terrace only, and one passenger assaulted a waitress because they didn’t get her coffee quickly enough.  I don’t know what happened to the passenger but I hope they were banned from O.  

This is the sort of thing that gets filmed on Carnival ships and posted on YouTube.  Nice  to see O is "equal opportunity." 🙂 (Disclaimer: I have been on Carnival ships where this never happened.)  I like the staff-served buffet.  They do that on HAL.  I don't know exactly how effective it is at controlling disease, but I like the idea that no one is manhandling my food before I get to it.

[clo]

13 hours ago, Lacruisers613 said:

our daily activities

And what were those please?

[clo]

5 hours ago, JYDCruise said:

antibiotic

And why would one take an antibiotic for a virus? Or are we not talking about a virus now?

[clo]

5 hours ago, pinotlover said:

One would hope that at a minimum all the service counters are fully wrapped in cellophane to keep all those hands and arms out from under the glass. I’ve never understood why some insist upon sticking their arms or hands under the glass shields!! 🤬

Because some people are arrogant morons?

[JYDCruise]

2 minutes ago, clo said:

And why would one take an antibiotic for a virus? Or are we not talking about a virus now?

That's the point. The poster to whom I was responding is arming him/herself with antibiotic "just in case", and apparently will self-diagnose as to whether they have a viral or bacterial infection, or something else, and then pop pills (or not). That's not a good plan, IMO, in any jurisdiction, and is part of why bacteria develop resistance so quickly to the few new antibiotics being developed.

[clo]

10 minutes ago, JYDCruise said:

That's the point. The poster to whom I was responding is arming him/herself with antibiotic "just in case", and apparently will self-diagnose as to whether they have a viral or bacterial infection, or something else, and then pop pills (or not). That's not a good plan, IMO, in any jurisdiction, and is part of why bacteria develop resistance so quickly to the few new antibiotics being developed.

If I could agree with you more than 100% I would. It's one of those medical things that makes me NUTS! NUTS, do you hear? It shouldn't take a rocket scientist to know that an antibiotic just might be for bacteria? Arghhhhh.

[clo]

23 minutes ago, JYDCruise said:

part of why bacteria develop resistance so quickly to the few new antibiotics being developed.

I would guess a big part.

[Vertygo]

3 hours ago, clo said:

And why would one take an antibiotic for a virus? Or are we not talking about a virus now?

Here’s Cornell’s algorithm for Travelers Diarrhea. Kaiser, my med ins co, has a travel dept & always prescribes Cipro to take as needed, as well as recommending any OTC meds.

Apologies for the length, but hope it “clears” things up.

 

Travelers’ Diarrhea
Traveling to areas of high risk (developing countries in Latin America, Africa, Middle East, Asia) and/or to areas of intermediate risk (countries in southern Europe or some Caribbean islands)?
    Educate
YES
 Self-Treatment: antimotility drugS
Does diarrhea respond to use of antimotility drug within 3-6 hours?
NO
Self-treatment: empiric antibioticS
NO
  Educate traveler regarding:
• Risks from eating and drinking local food and beverages.
• Strategies for obtaining reliable drinking water.
• How to self-diagnose TD, and dietary management if TD occurs.
• Importance of oral rehydration and use of ORS if needed
• Lack of need for antibiotic prophylaxis for TD except in rare circumstances
• Lack of need for vaccine prophylaxis for TD except in rare circumstances (not available in the U.S.)
 • Advise regarding potential self-treatment with antimotility drugs (contraindicated for persons < 3 years of age):
◦ Take 4 mg loperamide.1 If mild diarrhea continues, take additional 2 mg loperamide every 6 hours, not to ex- ceed 8 mg/day for over-the-counter use or 16 mg/day for prescription use.2
◦ Do not use if there is blood or pus in the stool.
◦ Stop use if symptoms continue after 48 hours of treatment. • Advise regarding hydration:
◦ If no clinical symptoms of dehydration, take regular fluids by mouth and eat salty crackers. ◦ If profuse diarrhea or symptoms of dehydration, use ORS.
 No additional intervention necessary.
  YES
      • In most cases, a single dose of a quinolone antibiotic (ciprofloxacin, levofloxacin, and ofloxacin are equivalent for TD) is likely to be adequate, even for severe diarrhea. If symptomatic after 24 hours, continue antibiotic for 2 more days.
◦ Azithromycin4 should be considered if quinolone is contraindicated or if TD is acquired in areas with high rates of quinolone resistance (e.g., Thailand, India). A single dose is likely to be adequate even for severe diarrhea. If symp- tomatic after 24 hours, continue antibiotic for 2 more days. A full 3-day course of treatment is required for dysentery (bloody diarrhea).
◦ Rifaximin is an alternate therapy if E. coli is the most likely pathogen and there is no fever or bloody diarrhea.
• Although 1 dose of antibiotic is usually effective, prescribe adequate quantity for full 3-day course of treatment.
• If no response to 3 days of antibacterial therapy or if significant clinical worsening before 3 days, consider parasitic eti- ology and seek medical care.
1 For children > 3 years of age, if lopermide is to be used, dose at ≤ 0.25 mg/kg/day. (See Travelers’ Diarrhea and Children and Travel.) 2 Taking higher than the recommended dose of loperamide can cause cardiac adverse events. Significant overdoses may result in death.
3 What constitutes “severe” diarrhea is subjective; however, knowing that antibiotic use contributes to antibiotic-resistant infections may encourage travelers to adhere
to preventive measures and recommended symptom management. For bloody diarrhea azithromycin should be started and medical attention sought immediately.
4 Exercise caution when prescribing azithromycin, especially in persons with cardiac conditions given the possibility of QT prolongation and its recent link to cardiac-
related deaths.
Consider use of empiric antibiotics for severe diarrhea.3
 Educate travel

[clo]

16 minutes ago, Vertygo said:

Here’s Cornell’s algorithm for Travelers Diarrhea. Kaiser, my med ins co, has a travel dept & always prescribes Cipro to take as needed, as well as recommending any OTC meds.

Apologies for the length, but hope it “clears” things up.

 

Travelers’ Diarrhea
Traveling to areas of high risk (developing countries in Latin America, Africa, Middle East, Asia) and/or to areas of intermediate risk (countries in southern Europe or some Caribbean islands)?
    Educate
YES
 Self-Treatment: antimotility drugS
Does diarrhea respond to use of antimotility drug within 3-6 hours?
NO
Self-treatment: empiric antibioticS
NO
  Educate traveler regarding:
• Risks from eating and drinking local food and beverages.
• Strategies for obtaining reliable drinking water.
• How to self-diagnose TD, and dietary management if TD occurs.
• Importance of oral rehydration and use of ORS if needed
• Lack of need for antibiotic prophylaxis for TD except in rare circumstances
• Lack of need for vaccine prophylaxis for TD except in rare circumstances (not available in the U.S.)
 • Advise regarding potential self-treatment with antimotility drugs (contraindicated for persons < 3 years of age):
◦ Take 4 mg loperamide.1 If mild diarrhea continues, take additional 2 mg loperamide every 6 hours, not to ex- ceed 8 mg/day for over-the-counter use or 16 mg/day for prescription use.2
◦ Do not use if there is blood or pus in the stool.
◦ Stop use if symptoms continue after 48 hours of treatment. • Advise regarding hydration:
◦ If no clinical symptoms of dehydration, take regular fluids by mouth and eat salty crackers. ◦ If profuse diarrhea or symptoms of dehydration, use ORS.
 No additional intervention necessary.
  YES
      • In most cases, a single dose of a quinolone antibiotic (ciprofloxacin, levofloxacin, and ofloxacin are equivalent for TD) is likely to be adequate, even for severe diarrhea. If symptomatic after 24 hours, continue antibiotic for 2 more days.
◦ Azithromycin4 should be considered if quinolone is contraindicated or if TD is acquired in areas with high rates of quinolone resistance (e.g., Thailand, India). A single dose is likely to be adequate even for severe diarrhea. If symp- tomatic after 24 hours, continue antibiotic for 2 more days. A full 3-day course of treatment is required for dysentery (bloody diarrhea).
◦ Rifaximin is an alternate therapy if E. coli is the most likely pathogen and there is no fever or bloody diarrhea.
• Although 1 dose of antibiotic is usually effective, prescribe adequate quantity for full 3-day course of treatment.
• If no response to 3 days of antibacterial therapy or if significant clinical worsening before 3 days, consider parasitic eti- ology and seek medical care.
1 For children > 3 years of age, if lopermide is to be used, dose at ≤ 0.25 mg/kg/day. (See Travelers’ Diarrhea and Children and Travel.) 2 Taking higher than the recommended dose of loperamide can cause cardiac adverse events. Significant overdoses may result in death.
3 What constitutes “severe” diarrhea is subjective; however, knowing that antibiotic use contributes to antibiotic-resistant infections may encourage travelers to adhere
to preventive measures and recommended symptom management. For bloody diarrhea azithromycin should be started and medical attention sought immediately.
4 Exercise caution when prescribing azithromycin, especially in persons with cardiac conditions given the possibility of QT prolongation and its recent link to cardiac-
related deaths.
Consider use of empiric antibiotics for severe diarrhea.3
 Educate travel

Thanks. I have a medical background so could whiz through it 🙂 But aren't we  talking about noroVIRUS?

[Vertygo]

57 minutes ago, clo said:

Thanks. I have a medical background so could whiz through it 🙂 But aren't we  talking about noroVIRUS?

OP stated it’s not Norovirus.

[oceansandseas]

ORV...This was on the Riviera (90% sure it was Riviera and not Marina) and February of probably 2016 (maybe 2017 as we went B2B to Caribbean every year). We were on B2B and could not get off in Miami at turnaround as we were quarantined. We were quarantined for 5 days, Doctor gave me Pepto Bismal and also antibiotics. After I got home I found out that I am allergic to some antibiotics...they give me diarrhea. I know the difference between viral and bacterial, but doctor on Oceania said I was to take the antibiotics for this.

 

I am sure people on cc will remember this cruise happening. Those on the cruise will never forget it.  Things got worse on the second cruise. Lots sick. When it was announced that we were heading back to Miami and ending the cruise 2 days early, there was quite a commotion. They flew in people from Head Office to explain it to us. Everyone talking and complaining in atrium. The ship had to be deep cleaned, so our cruise was over..

 

We had B3 so were put up at a DoubleTree in Miami for 2 nights. Higher up cabins were given better hotels. We were out by a highway with no restaurants around. Had Oceania air so had to wait for the day of our flights.

 

That is the cruise we were on.

[1985rz1]

2 hours ago, Vertygo said:

Kaiser, my med ins co, has a travel dept & always prescribes Cipro to take as needed, as well as recommending any OTC meds.

Our physician also prescribed cipro as as backup on our foreign journeys as a precaution, especially in the more exotic places where bacterial infections could occur.  For our recent cruise, he pescribed paxlovid as a precaution should we contract covid.  We filled the prescriptions and took them with us, but we are aware that we need to be cautious when deciding they are needed.

[JYDCruise]

2 hours ago, Vertygo said:

Here’s Cornell’s algorithm for Travelers Diarrhea. Kaiser, my med ins co, has a travel dept & always prescribes Cipro to take as needed, as well as recommending any OTC meds.

Apologies for the length, but hope it “clears” things up.

 

 

Well, I learn something new every day. Thanks! Increasing antibiotic resistance is a massive concern, though, but I assume that's part of the calculus in their recommendation.

 

We went to the travel medicine group of our medical provider before our very recent trip to South America, and got an encyclopedia's worth of warnings (and, eventually, Yellow Fever and Hep A vaccines) but I don't recall any discussion about pre-prescribing antibiotics.

 

[vaitape]

Semper Paratus