Cruise Ship Blues: The Underside of the Cruise Ship Industry (13 page)

DOES A PERFECT SCORE MEAN PERFECTION?

An inspection of Radisson's Seven Seas Navigator conducted March 29,

2001, under the Vessel Sanitation Program is instructive. The ship received

a perfect score of 100 — but the report indicated a range of violations,

including:

•    the bacteriological kits [used to test potable water] were not of an approved type

•    the potable water lines to the spray hose and pulper [in the Lido pot wash] were not fitted with backflow prevention devices

•    backflow prevention devices were not provided on the ware washing units [at the pool grill]

•    the precautions and risks sign [at the spa] did not caution immunocompromised individuals

•    a large wheel of cheese that had been sliced was not dated

•    cold cuts [at the Lido buffet] were tested at 47° F. [The recommendation is that] potentially hazardous food shall be maintained: (1) at 60° C (140° F) ... or above; or (2) at 5° C (41°

F) or less

cockroach had been seen in an oven, and that a pest-control device located in the galley posed a risk of food contamination. This information was more descriptive and helpful than was the overall score.

Canada conducts sanitary inspections similar to those done in the United States. In the United Kingdom, the Food Standards Agency announced in May 2001 its plan to give health officials the statutory right to enter and inspect cruise ships. This followed an increase of food poisoning cases among cruise passengers and a report by the UK Consumers’ Association that in the previous two years it had received complaints about 14 cruise ships, with passengers contracting illnesses ranging from salmonella poisoning to the potentially fatal Legionnaire’s disease.
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•    the ware washing units [at the Pool Grill] were not provided with data plates

•    the main dishwasher [in the galley] did not have a data plate

•    the main dishwasher temperature gauges were 30 to 60° out of calibration

•    none of the pot wash staff knew the new halogen sanitizing time requirements

•    some clean bread baskets [in the Lido dining room] were soiled with bread crumbs

•    the clean storage racks [at the Pool Grill] were soiled

•    some mold was noted in the technical space underneath the sink [at the Pool Grill]

•    training was not documented in the IPM [integrated pest management] plan

•    the cleaning schedule for the air handling ventilation units did not include the condensate collection system.

Source:
Centers for Disease Control, Vessel Sanitation Program website
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Note: To remain as accurate as possible to the actual report, the language used in the Vessel Sanitation Program inspection report has been retained. Each point listed above summarizes a separate violation, including its nature and site. The full report includes recommendations to the cruise line.

Is the Food Safe to Eat?

In December 2001 a cruise ship worker told me about an investigation done in the UK following a gastrointestinal outbreak on a cruise ship. Inspectors had taken samples from food products onboard and determined a common contact source for all food that showed contamination. The cause? A baker in the galley had not been washing his hands after using the washroom.

Sanitary inspection scores are not a reliable indicator of risk. Certainly, there are cases where a ship fails its sanitation inspection immediately following an outbreak of disease. But there have also been disease outbreaks within weeks of ships passing their inspec-tion,
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as well as cases of ships with no reported illness despite a failing score. In July 2001 the
Arcadia
was issued a no-sail order following several warnings and finally being given a failing score of 59 on its sanitation inspection. The CDC cited poor food refrigeration, a dirty kitchen, and failure to guarantee potable water.

SOURCES OF FOODBORNE ILLNESS

Inadequate time and temperature during food storage and preparation — refrigeration and cooking — are contributing factors to foodborne illness. A related article in the
Cruise Industry News Quarterly
presented historical data collected from the United States, Canada, and England, with a breakdown of the relative frequency of key factors:
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•    63% — inadequate cooling and cold holding [refrigeration]

•    29% — preparing food ahead of schedule

•    27% — inadequate pot holding

•    26% — poor personal hygiene; infected person

•    25% — inadequate reheating

•    9% — inadequate cleaning of equipment

•    5% — inadequate cooking or heat process

•    4% — [storage] containers adding toxic chemicals

•    2% — contaminated raw ingredients

•    2% — intentional chemical additives

•    1% — incidental chemical additives

•    1% — unsafe sources

Take some solace in the fact that disease outbreaks are relatively infrequent — in 1997 there were a mere 2.1 outbreaks for every ten million passenger days. That’s four times lower than between 1975 and 1979, when the rate of outbreak was 8.1 per ten million passenger days. Regardless, the risk is still present and real.

What Unseen Risk Is in Your Food?

The two most common causes of foodborne illness are food contamination and the Norwalk-like virus. In comparison the incidence of enterotoxigenic
Escherichia coli (E. coli)
and
Shigella
is relatively low.

However, an April 2000 article warns that
E. coli
is an increasing risk to those on cruise ships. After a study of outbreaks of gastrointestinal disease on three cruises in 1997-98, researchers determined that in each case the source of
E. coli
appeared to be contaminated water taken on the ship in foreign ports. The 1,300 affected passengers had been infected by drinking beverages with ice cubes or by consuming unbottled water. Although cruise ships have water treatment plants designed to avoid these problems, it was believed that the shipboard water treatment system “had briefly failed.”
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In the year 2000 the CDC studied four outbreaks of gastroenteritis on ships based in American ports, two of which were traced to bacterial contamination of shrimp and other seafood. All indications were that the contamination of the shrimp had occurred in the factory rather than on the cruise ship.
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The other two outbreaks were attributed to the Norwalk-like virus, but in neither case was the source identified. In one case, the investigation noted deficiencies that, although not directly responsible for transmission of the virus, could have allowed its survival.
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In the other case, the relatively low number of unaffected passengers and crew made it difficult to identify a single point of contamination. Investigators suggested both drinking water and cut fruits and vegetables washed in the drinking water as possible sources.
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Other than the no-sail order issued for the
Arcadia
in 2001, only one media report that year involved foodborne illness on a cruise ship. In August 2001 the Liberian-registered
Switzerland
(owned by a subsidiary of Swissair and leased to Leisure Cruises),

on a cruise beginning in the Netherlands, had a salmonella outbreak that affected more than 100 of the 600 passengers and sent 20 people to hospital.

NORWALK-LIKE VIRUS DEFINED

Among the most common causes of foodborne illness, the Norwalk virus and/or Norwalk-like virus (named after Norwalk, Ohio, where the first outbreak was documented in a school cafeteria) belong to a family of unclassified, small, round-structured viruses that cause a mild and brief illness with nausea, vomiting, diarrhea, abdominal pain, and sometimes also a headache and low-grade fever. Symptoms begin one to two days after eating contaminated food or water and last for another couple of days. The Norwalk virus can be transmitted through water, shellfish (eating raw or insufficiently steamed clams and oysters poses a high risk of infection by the Norwalk virus), salad ingredients, and anything prepared by an infected food handler.

Several ships in recent years have had serious Norwalk virus outbreaks. In 1997 there were outbreaks on three successive cruises of Norwegian Cruise Line's
Royal Odyssey.
Following a "Recommendation Not to Sail" by the Centers for Disease Control (CDC), the
Royal Odyssey
was pulled from service a week earlier than planned, sanitized, and refit as the
Norwegian Star.
In 1998 Princess Cruises'
Regal Princess
had three successive cruises with gastrointestinal illness traced to the Norwalk virus. The ship was pulled from service for a week and completely sanitized. In 2000 Clipper Cruise Line's
Nantucket Clipper
was taken from service following an outbreak on two cruises. It was cleaned, returned to service, and had another outbreak on the first cruise, requiring it to again be pulled from service, and again sanitized.
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Onshore Catering and Foodborne Illness

An Australian study published in January 2001 reported on risks associated with food eaten by cruise ship passengers while ashore. It found that passengers who ate onshore had a significantly higher risk of developing diarrhea than those who did not. In addition, passengers who ate while on a tour were at greater risk than those

who did not go on a tour. The study supported a 1996 report in the
Journal of the American Medical Association
which estimated that one-third of gastrointestinal outbreaks on cruise ships might be prevented if onshore caterers were not used for off-ship excursions. The Australian study suggests that meals served as part of a ship-sponsored shore excursion are a greater risk than those purchased on your own.
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An Unhealthy Environment?

The most common non-foodborne illnesses on a cruise ship are colds and flu. The cruise ship is an ideal incubator for these common afflictions. It provides a confined area, and people are engaged in almost nonstop socializing. During the 1998 season more than 2,100 cases of flu were reported among passengers and crew on Alaska cruises.
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There have been some large-scale flu outbreaks. In several cases the initial fear was for Legionnaire’s disease, but that was ultimately ruled out in a 1997 influenza outbreak striking passengers on successive sailings of Holland America Line’s Westerdam.
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It was also eliminated the following year as the cause of a large gastrointestinal disease outbreak on the
Regal Princess
— the cause was found to be the Norwalk-like virus.
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Legionella
(the bacterium that causes Legionnaire’s disease) was also eliminated as the cause of two passengers dying from illness contracted on P&O’s
Fair Princess
in September 2000, but the exact cause of the deaths and of dozens falling ill remains a mystery.

Legionnaire’s Disease

According to a 1998 article, more than 100 cases of Legionnaire’s disease, resulting in ten deaths, have been linked to ships — mostly cruise ships.
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The most widely known outbreak was on Celebrity Cruises’
Horizon
in 1994. On ten different cruises on that ship, 16 passengers were confirmed to have Legionnaire’s disease and another 34 cases were suspected. One person died and four people required intensive treatment on ventilators. The source was traced to the outdoor whirlpool spa.
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One year later the same ship had an outbreak of salmonella that struck 220 passengers.
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