Centers for Disease Control and Prevention

Hundreds Get Sick on Cruises Despite Industry Improvements

Martha and Michael Riordan were celebrating their daughter’s graduation on a cruise earlier this year when they got sick.

“It was interesting because it was like, ‘I think I had to throw up right now.’ Like there was not a lot of warning,” Martha said.

The Riordans were among the nearly 600 passengers and crew members who reported getting sick on Royal Caribbean’s Oasis of the Seas; which is promoted online as one of the world’s largest cruise ships. 

“It’s like you see a tornado across the street and you see it hitting another house and you are like ‘Man, I’m glad it’s not us.’ And then all the sudden you are on your basement praying for relief,” Michael said.

The CDC or Center for Disease Control and Prevention says the culprit was a norovirus outbreak – the first outbreak reported on the ship which first started sailing in 2008. 

“We were quarantined, it was not fun. (We drank) A lot of ginger ale,” Michael said.

The outbreak impacted seven percent of the passengers and crew on board, but it was the second largest outbreak on a ship in a decade.

In a statement, the company said: “The safety and health of our guests is our greatest concern. We support the Centers for Disease Control and Prevention’s (CDC) program to inspect our ships and manage the vessel sanitation program as a standard procedure. We also maintain a vigorous Outbreak Prevention Plan (OPP) and have a firm public health plan in place.”

There were almost as many cases reported in this one outbreak as the total reported on all cruise ships last year.

“When you have 8,000 on the ship, one person gets sick and you are in a confined environment. It’s going to explode, there’s going to be an explosion” said nautical attorney Michael Winkleman.

Under the CDC’s Vessel Sanitation Program (VSP), cruise ships are required to log and report the number of passengers and crew members who say they have symptoms of gastrointestinal illness, including diarrhea, nausea, muscle aches, fever, headache and abdominal cramps.

The VSP posts information about outbreaks that occur on ships carrying 100 or more passengers, involve three percent (or more) of passengers or crew, and/or are of “public health significance.” 

NBC 6 found there have been 118 outbreaks of this kind reported to the CDC in the last decade. But the agency says these incidents are rare and have been declining over time, from a high 16 in 2012 to nine so far this year. Records show one cruise ship had back-to-back outbreaks in 2019. 

In an email, Lieutenant Commander Keisha Houston, VSP’s senior field epidemiologist, said "fewer and less-severe" outbreaks on ships can be attributed to the cruise industry’s diligence in developing and implementing outbreak prevention and control plans, “using processes and disinfectants that are effective against a norovirus surrogate,” and proactively looking for ways to limit the spread of acute gastroenteritis illness.

Stewart Chiron, also known as the “Cruise Guy,” is a Miami-based industry expert and the owner of a travel agency.

“It’s so inconsequential and I can tell having being on the ships where there have been outbreaks, you’ll notice that the crew will do anything possible,” Chiron said when asked about disease outbreaks on cruise ships.

Chiron says he’s been on over 273 ships across the world and has never gotten sick during an outbreak.

“I have never contracted the norovirus,” he said.

Norovirus is the most common cause of disease outbreaks on cruise ships but the CDC says those account for only one percent of the reported outbreaks linked to the virus overall. 

On its website, the agency states that less than one percent of the passengers who sailed on cruises from 2008 to 2014 in the Vessel Sanitation Program’s jurisdiction met the program’s definition for gastrointestinal illness and only a small proportion of those cases, one in 10, were part of a norovirus outbreak. 

Legal Challenges

While rare, disease outbreaks can still impact hundreds of passengers every year but taking their case to court could be a challenge.

“It’s often difficult to prove that they got the virus on the ship versus perhaps bringing it with them beforehand,” Winkleman said.

While the CDC investigates the cause of outbreaks reported to the agency, records show investigators are not always able to identify the cause, which is noted in some reports as “unknown.”

“A lot of times it’s someone who just had a bad experience, they were in the cabin for three days, things of that nature and those are often cases that we generally turn down,” he said because they aren’t easy to win and wouldn’t make much money for the client or attorney.

When asked what passengers should do if they get sick on board, Winkleman says number one: keep good records, “take a lot of photos” and talk to an attorney. Number two: talk to the cruise line.

“They often offer future credit or refund or something like that,” he said.

Royal Caribbean, which has reported only one outbreak this year, gave the passengers of Oasis of the Seas a refund. 

“I think they did everything they could possibly do,” Martha Riordan said.

The Riordans say they will be back on a cruise this January, despite their experience.

“People are like ‘Oh wow, you were on that cruise.’ We have five great days and then one bad day so,” Michael said. “Had they (Royal Caribbean) reacted differently, we would be having a different conversation.”


As part of the Vessel Sanitation program, the CDC conducts unannounced inspections on cruise ships twice a year. They are scored on a 100-point scale and the ship needs an 86 or more to pass.

The CDC inspections are only conducted on cruise ships that carry 13 or more passengers and have a foreign itinerary with U.S ports. 

Houston says cruise ships that fail to report cases of gastrointestinal illness get points deducted from the ship's subsequent operational inspection.

NBC 6 reviewed two years (2017-2019) of inspections and found multiple crew members failed to report or didn’t receive immediate attention while experiencing symptoms of the illness.

At least three were identified in the inspections as food handlers. That’s considered a violation because of the contagious nature of the disease and the potential impact on a cruise.

CDC Inspectors also noted other violations related to food and pest management:

• ”Brown water discharged” from two water hoses at a ship’s medical center. A crew member told inspectors “they (crew) see brown water in their shower that is used at least twice daily.” 

• “Excessively soiled” and “pink and black debris” on food-contact surfaces on another ship. 

• Flies in galleys, pantries and food service areas on multiple ships. During one inspection, “no less than 15 small flies on the bagels and bread” were seen on three bowls placed for self-service during breakfast. In another, “at least 10 fruit flies were observed between the right side of the pizza oven and the bulkhead while the galley was in operation.” 

• “Many dead pests were identified in food packaging in the dry storage,” “several small, brown dead insects inside a package of lentil flour pappadums” and “speckled organic material on the margarine packaging and the food product inside wet packaging.” 

Keisha Houston said the CDC conducts these inspections to determine “how well ships are operating and maintaining sanitation standards in accordance with the current VSP Operations Manual.

There have been 131 inspections conducted on ships so far this year and only five have received a failing score.

Carnival Fantasy, which departs from Mobile, Alabama, got the lowest score this year, a 77. It was the second time the cruise line received that score during an inspection in a three-year period.

“There are different ships over a three year period,” Chiron told us when we showed him Carnival’s inspection records, “It’s not something to be concerned about.”

Records from the CDC show there have been 117 inspections conducted on Carnival cruise ships in that time period and they have passed 110 of them.

Houston said that ships that fail operational inspections are re-inspected “within a reasonable time period” while they are in an U.S. port.

In a statement, Carnival told us, “The safety and well-being of our guests and crew members is our top priority. Our comprehensive shipboard protocols, especially in food handling and preparation, are of the highest quality and we are always committed to delivering an exceptional experience to our guests.”

The company went on to say the “results for Carnival Fantasy’s previous inspection are not reflective of our robust standards and dedicated commitment to our guests’ health and safety. Historically, Carnival Cruise Line ships, including Carnival Fantasy, have earned high marks on the USPH inspections with many ships earning perfect 100 scores.”

“Not Enough Bite”

“I think the inspections are effective. I think the problem is there is not enough bite to it if they failed,” Winkleman said.

The attorney says cruises should be inspected and sanctioned as restaurants.

“With the cruises, if there’s a failing grade, they don’t shut it down,” he said.

The CDC can issue “no sail” orders for ships who fail inspections (if there are imminent public health risks) and they don't follow the agency's "no sail" recommendation. These orders are enforced by the U.S. Coast Guard.

Houston said VSP may also issue a “no sail” order “during an infectious disease outbreak where continuing normal operations may subject newly arriving passengers to disease” and the cruise line refuses to follow the agency's "no sail" recommendation.

But these orders are extremely rare. Houston says the CDC has only handed down one and that was in 2001.

Winkleman believes there should be stronger regulation for cruises.

“I think If there was a stronger bite, then I think cruises will be generally cleaner and a little healthier from the sanitation perspective they are currently,” he added.

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