Cruising? Take health precautions to keep from getting sick

A dozen passengers on two different cruise ships got Legionnaires’ disease, a type of pneumonia that in the case of 10 of them was so severe they were hospitalized. Now experts say the likely source of the outbreaks was private balcony hot tubs.
As the New York Post put it, “They got more than they paid extra for.”
Cruise ships are like floating communities and that creates the possibility that illnesses will spread. Sometimes the community members bring an illness with them, too. But there are steps that passengers can take to make sure their focus stays on the food, the entertainment and carefree travel to far-off locations.
Legionnaires takes its name from an outbreak in 1976 that sickened more than 600 members of the American Legion staying at a motel in Philadelphia for their annual convention. The then-mysterious illness was marked by fever and pneumonia and at least 25 people died. That type of pneumonia is technically called legionellosis, but it’s more often simply referred to as Legionnaires now, while the bacteria that causes it is legionella.
It’s a waterborne bacteria and can show up in odd places, like swamp coolers that aren’t cleaned regularly and the water changed or even in windshield wiper fluid tanks, per the Centers for Disease Control and Prevention, which says never to use just water, but rather use “genuine windshield cleaner fluid and follow the vehicle manufacturer recommendations.”
Treatment requires antibiotics. Even healthy people who get sick may end up hospitalized, so it’s really dangerous for older folks, those with chronic health conditions and those who are immune-compromised. As many as one in 10 of those infected get complications and die.
The CDC recently published a study that deemed it likely the water in the hot tubs had been unmoving and warm long enough to allow the legionnella bacteria to grow. Then use of the hot tubs and inhalation of aerosolized droplets let the bacteria infect people. The hot tubs were being maintained as required for a cruise ship, but the maintenance is less stringent than the requirements for a public hot tub, per the CDC.
Testing on the two ships found that six of 10 private balcony hot tubs on the first ship had legionella bacteria, as did all eight of the private balcony hot tubs on the other ship, according to the report. The illnesses occurred sporadically over more than a year.
Legionnaires’ outbreaks aren’t the only risk on cruise ships, where being in very close proximity can lead to illness, as became clear during the COVID-19 pandemic.
The CDC reported that last month, 180 passengers and three crew members on one cruise line developed a gastrointestinal illness that included diarrhea and abdominal cramps.
Respiratory illnesses are the most common medical complaint on a cruise. Passengers can spread colds, flu, RSV and other respiratory illnesses.
Gastrointestinal illnesses are also possible, though fairly rare. The best way to avoid that is regularly washing one’s hands with soap and water, especially before eating and after using the restroom.
Destinations can also increase risk if no precautions are taken. Some ports of call may feature vectorborne — think mosquito and tick bites — disease like dengue, malaria, yellow fever, Zika and Japanese encephalitis, especially where those are endemic. And there’s risk of new diseases, too. The CDC example is chikungunya, which first appeared in the Caribbean a decade ago and spread.
It’s important to follow vaccine guidance if you’re cruising somewhere such disease is common.
Among other ways to stay safe, based on CDC guidance: