Advice for those going on Cruises
The cruise ship industry has expanded considerably in recent decades from 17 million passengers in 2009 to 24 million in 2016. Cruise itineraries include all continents and vary in length from on average one week to many months. The average age of a passenger is over 50 and cruises attract older travellers with chronic conditions. Most on-board visits to the doctor are made by over 65s and the most common problems are respiratory tract infections, injuries, sea sickness and gastrointestinal illness.
Pre Existing Medical Conditions
There is a perception that cruises are restful but this is often far from the case. The schedule of events and activities on board and excursions in port can be tiring and arduous and travellers are advised to be as fit as possible prior to embarking on a cruise.
Immobility and use of wheelchairs on board can be an issue for cruise companies and many ships have a strict quota of wheelchair users allowed per cruise (usually about 6). Passengers are sometimes allowed to bring their own wheelchair for ‘tour use’ only. All arrangements must be pre-authorised and booked in advanced.
The supply of medicines on board is limited and individuals should take their own regular medications with them, at least enough to cover the duration of the trip. It is also useful to bring a copy of any current repeat prescriptions as a back up.
Although primary and emergency care is provided on board a cruise ship, there is no fully equipped hospital for ‘in patient’ care. Typically there will be a doctor and two nurses who provide walk in clinic services and out-of-hours emergency services. The medical services on a ship is private. It costs to consult with a doctor or nurse. There is also added expense for medication, blood tests, dressings, X-rays etc.
Seriously ill of injured passengers are evacuated off the ship either by helicopter, or at the next available port. This is worth considering when choosing the type of cruise and destinations to be visited.
Having appropriate travel insurance is very important and this should cover repatriation – it is estimated that a helicopter evacuation from a ship costs approximately £6,000.
Complicated vaccination schedules are usually unnecessary unless overnight stays on shore are anticipated. During the pre-travel consultation it is important to explore all the destinations and potential activities before vaccinations can be planned. Travellers are still advised to ideally see the doctor or nurse 6 – 8 weeks prior to departure where possible.
Influenza is a recognised problem on cruises where large numbers of people are living in close proximity. Vaccination should be considered especially for the elderly and others with underlying medical conditions. For these groups pneumococcal vaccine may also be considered if not received previously.
Determining the risk of yellow fever or necessity for a yellow fever vaccination certificate can be tricky for cruise travel. During the risk assessment it is essential to consider all countries to be visited, and importantly, the order in which they are visited. The mosquito that spreads yellow fever bites during the day, so day excursions in risk areas may necessitate vaccination. In addition, even if not at risk of yellow fever during port calls, there may be a yellow fever vaccination certificate requirement. Taking a detailed itinerary with you to the pre-travel health consultation will greatly help your health practitioner advise you.
Cruise ship companies sometimes have requirements that differ from those of the country to be visited, so be sure to check the recommendations of the cruise line also. Unvaccinated passengers going to risk areas may not be allowed ashore. In high risk yellow fever areas disease may be a risk for those venturing into rural and jungle areas but is unlikely to be contracted by those staying on board.
Where there are multiple destinations, each port must be assessed in turn for malaria risk. The malaria risk is normally very small in ports of central and south east Asia, and South and Central America (with the possible exception of Manaus in Brazil where urban outbreaks sometimes occur).
Overnight exposure is unusual (as the ship is normally back at sea) therefore many cruise travellers will not need antimalarial chemoprophylaxis although advice on awareness of risk, avoidance of mosquito bites, and prompt diagnosis of fever will still be required.
The risk of malaria may be significant when entering ports in infected countries in sub-Saharan Africa especially if berthed overnight. Your healthcare practitioner can advise you on whether antimalarial tablets are needed.
Mosquito bites should be avoided not just to reduce the risk of malaria but of other diseases such as dengue fever and zika virus. Accommodation on cruise ships is usually excellent with air-conditioning and well screened lounges and bars etc. Passengers should always be aware when they may have been exposed, however small the risk, so that they can seek medical attention should any fever occur.
Gastro-enteritis and Norovirus
Gastroenteritis is a risk due to the very close proximity of passengers. The risks can be reduced by strict personal hygiene measures such as regular hand washing and the use of alcohol gels.
It is essential to report any episodes of diarrhoea or vomiting immediately to the medical team on board to help prevent onward transmission to other passengers and crew.
Norovirus is a major cause of acute gastroenteritis and diarrhoea.
- Norovirus circulates widely in the population and outbreaks can occur in semi closed communities such as on a cruise ship.
- Usually spread from person to person or from contaminated surroundings.
- Infection is spread easily.
- Once infected symptoms usually occur within 15 to 48 hours.
- Symptoms include vomiting, diarhhoea, nausea and stomach cramps.
- Vomit is highly infectious and can contaminate the environment creating an infection risk for others.
- Risk of transmitting norovirus is highest during early phase of illness and becomes less after 48hours.
- Illness is more serious in the elderly or those with pre-existing disease.
- There is no specific treatment other than relief of symptoms and rehydration.
- Prevention of onward spread is very important and ships have strict protocols on prevention and the treatment of those affected.
- Promotion of scrupulous personal hygiene and isolation in own cabin until clear of symptoms for 48 hours will be advised; some cruise companies will also isolate the cabin companion.
Historically ships have been one of the safest forms of transport due to strict international security regulations.
Travellers can be exposed to extremes of heat and cold depending on itineraries. Suitable clothing is advised. Sun exposure may be under estimated on a ship especially with the cooling effect of sea breezes. Protective measures such as covering up and the use of a high factor sunscreen are advised.
Increased alcohol can result in risk-taking behaviour, increasing the risk of sexually transmitted infections. Moderation of alcohol and safe sex practices are advised.
Tips for travellers:
- Consult your doctor/dentist or travel clinic well in advance; if you have an underlying medical condition check before booking.
- Know your limitations.
- Arrange adequate travel insurance.
- Give some thought to the language, climate, airports and medical facilities in countries to be visited.
- Although medical care is available, this is not the same as at home
- Don’t forget your medication.
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