November 2011

November 2011: Health Note - Are You Cruising For A Bruising?

Author: Paula Hart

Cruise ship travel is a popular and ever-increasing way for travelers to see the world. With the holidays and winter months not far away, many people are thinking of cruises as a way to see exotic places, meet interesting people, indulge in good food and wine, experience a plethora of different activities and escape the cold.

A typical cruise is about seven days long and includes on average 3,000 passengers and 1,000 crew members. More recently, we are seeing much longer cruises that extend over several weeks with passengers embarking and disembarking from foreign ports. That means that both passengers and crew from around the world bring not only cultural differences, but also medical risk factors and risky behaviors with them.

Here are some of the health concerns you may encounter on a cruise along with advice on reducing the risks:

RESPIRATORY INFECTIONS
Respiratory infections are the most common cause of illness on cruise ships due to close proximity to others. Outbreaks of flu can occur year-round despite the season at destination and usually occur from embarking passengers and crew. The infection is spread through coughing, sneezing and exposure to respiratory secretions.

Prevention: Unless contraindicated, you should get an annual flu vaccine before travel. If you are over age 65 (or under 65 with certain health conditions), you should also be current with your pneumonia vaccine.

Legionnaire’s Disease is another respiratory illness that can lead to pneumonia. Although contaminated ship’s whirlpool spas and potable water supply systems are the most common sources of these outbreaks, exposure to other sources i.e. ventilation systems have been targeted.

Prevention: Both improvements in ship design and standardization of spa and water disinfection have reduced the risk of legionnaire’s disease. It is wise, however, to drink bottled water in your cabin and avoid drinking directly from the bathroom tap.

INJURIES
Injuries make up the second most common cause for a passenger to seek medical care. These include sprains, bruises and superficial wounds. Unexpected rough seas, unfamiliar surroundings and alcohol consumption are contributing factors.

SEASICKNESS
Seasickness accounts for almost 10 percent of shipboard infirmary visits. Obviously being aware of the situations that trigger the symptoms and planning ahead can help reduce or eliminate this “trip spoiler.”

Prevention: There are both drug- and non-drug interventions to help prevent or manage motion sickness. Antihistamines, patches and other drugs can be used to prevent nausea, although sedation is a primary side effect of all effective drugs. Perhaps if you are that seasick, being “conked” out for some hours may not necessarily be so bad! You should check with your own physician as to the best and safest drug to use. Eating ginger, drinking caffeinated beverages along with medication, lying prone, looking at the horizon or shutting your eyes may also help manage motion sickness. Seeking the center most part of the ship can also help.

GASTROINTESTINAL ILLNESSES
In recent years, outbreaks of GI illnesses on cruise ships have increased despite good health and cleaning standards. According to CDC, most of these outbreaks are due to norovirus. Reasons prompting an outbreak include easy person-to-person transmission, a low infective dose and the ability of the virus to survive routine cleaning procedures. Outbreaks are particularly associated in settings where people are living in close quarters and can easily infect each other over several days. Risk is present anywhere food is prepared in an unsanitary manner. Target foods for infection include “ready-to-eat” cold foods such as sandwiches, salads and raw shellfish.

Prevention: To prevent spreading these infections, prompt isolation of a passenger experiencing symptoms of GI illness (nausea, vomiting, diarrhea) is recommended, along with frequent and thorough hand washing particularly before eating; being alert to possible contaminated food and water as transmission occurs primarily through the fecal-oral route; careful cleanup of fecal material or vomit especially between people traveling together; cleaning and disinfecting contaminated surfaces such as toilet areas.

DESTINATION PRECAUTIONS
Seeking pre-travel consultation is helpful in determining what health risks are present at ports and other destinations. Yellow fever and/or malaria may be present with certain destinations. Your itinerary, what activities may be included at port stops, length of time in port and season of travel are all considerations in helping to reduce risk.

CHRONIC HEALTH CONDITIONS
Passengers embarking on cruise ships should be aware of the health facilities and capabilities offered on that ship. Is a full-time physician readily available, and what plan is in place if a medical emergency arises? You should carry a current list of any medications you are taking and have it within easy reach. Are you diabetic, asthmatic, severely allergic? Are there any other chronic health conditions? Where would you be medically evacuated to if you needed to have care? Should you consider medical evacuation insurance before traveling?

Seeking pre-travel advice will help ensure safe travels, reduce anxiety and reduce bruising while cruising!

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