Several years ago, Beth Lugara, 44, was one of 1,800 enthusiastic passengers to board an 11-day Caribbean cruise that left from New York. But the trip resulted in some unexpected memories for the Scotch Plains resident and patent law paralegal.

"Within the first few days, the captain announced that a few people on board were sick and that steps were being taken to contain the spread," she said.

While Lugara fortunately was not among those who got ill, she watched as more than 100 other passengers infected with a contagious norovirus were quarantined to their rooms.

Among the preventative measures taken, "the ship closed the buffet, shut down the hot tubs, and everyone was encouraged to wash their hands frequently, while the crew continuously cleaned counter tops, door handles, bathrooms, elevator buttons and other common surfaces and dispensed hand sanitizer everywhere," she said.

The ship was completely disinfected when it returned to port, she added.

"The crew handled it very well, and I'd go again. But I can see how someone who got sick might be reluctant to take another cruise," Lugara said.

Impacting hundreds of cruises in the past decade and already reported on a handful of cruises in 2014, the spread of norovirus has made its share of media headlines.

Dr. Alfred DeLuca, a board-certified specialist in internal medicine and infectious disease at CentraState Medical Center in Freehold Township, said the viral illness thrives in the intestinal tract.

Spread by fecal or oral transmission through airborne droplets in food, water, contaminated surfaces and fomites (any object or substance that can carry infectious organisms, such as towels), "just one or two people who have it and don't wash their hands after using the bathroom can cause many infections, which can result in muscle aches, fever, headache, vomiting and diarrhea," DeLuca said.

While he noted that it usually passes within two to three days, "people infected with norovirus can be contagious and not know it, so preventative measures are vital."

Because noroviruses can move quickly through any population in close quarters, such as cruises, college dorms and prisons, "they can be challenging to treat," DeLuca said. "On a ship, you need to isolate infected patients from the rest of the population by quarantining them to their rooms so as not to spread viral particles, and they may be treated with anti-diarrheals or IV fluids if they're dehydrated."

To minimize exposure for the rest of the population, who may unknowingly touch infected individuals or contaminated objects, "people need to wash their hands and all environmental surfaces should be cleaned constantly to contain the occurrence of secondary cases," for which young children, the elderly and people with other underlying illnesses can be most susceptible.

Cruises under most scrutiny

With more than 400 ships sailing to thousands of international destinations every year, the occurrence of noroviruses may be inevitable, but that's more the exception than the rule, according to Ira Kaplan, owner of Cruise Holidays, a Marlboro-based travel agency he's operated with wife, Helene, since 1988.

"Some of the largest ships contain as many as 7,500 passengers and crew and are like floating cities, containing a mall, ice rink, zip-lines, casinos, basketball facilities, and various lounges and dining halls — in addition to all of the staterooms," he said. "They're like resorts on the water."

But unlike other means of transportation, such as airplanes, he said, cruises are under intense regulatory scrutiny when it comes to health issues.

"With populations of that size on board, there's a hospital or infirmary on all ships, and they're obligated to report any kind of outbreak to the CDC," Kaplan said.

"In fact," he added, "the CDC sends health inspectors on cruise ships randomly to inspect cleanliness, food-serving practices, etc., so the cruise industry is inspected much more frequently and vigorously than other arms of the travel industry."

Though these issues do arise from time to time, Kaplan said they don't stop people from traveling and haven't affected the cruise industry.

"Twenty million people cruise annually and the market is growing by 2 percent to 3 percent per year because cruises are still one of the most fun, glamorous and convenient ways to travel," he said.

Protecting yourself

DeLuca and Kaplan share their best tips to avoid cruisin' for bruisin':

Hand hygiene:

"Because the world simply isn't a sterile place, you have to pay extra attention to hand hygiene on cruises," said DeLuca, who recommends "washing your hands before and after you eat, after using the bathroom, after exposure to common areas like the gym, and after excursions." He also advises bringing portable alcohol-based hand sanitizer on your trip.

Red flags:

While ships may do their best to clean areas thoroughly and enforce hygienic rules, "avoid obvious violations, like dirty bathrooms or pools where you see a child in a diaper," DeLuca said. "In addition, try to use the bathroom in your own stateroom rather than using public restrooms on the ship."

Do your homework:

You can review the health-related and cleanliness ratings of all cruise ships through the CDC's Green Sheet Report at, Kaplan said. Most of the reputable cruise lines rate in the mid-high 90s because they wouldn't be in business if they didn't."

Invest in insurance:

Noting that sick people often get on cruises anyway because they don't want to lose their investment, Kaplan said that "it's important to buy travel insurance in today's market so that you can opt out of a trip for medical reasons if necessary.

Provided that you have the proper documentation," he said, "you can get your money back" and make more considerate choices on behalf of yourself and your fellow passengers.


In addition to minimizing your risk of contracting a norovirus on a cruise, Dr. Alfred DeLuca offers tips for protecting yourself from other cruise hazards:

Sea sickness:

A vestibular imbalance caused when the inner ear gets disoriented by a ship's motion, DeLuca suggests taking Dramamine, an antihistamine that can prevent the nausea, vomiting and dizziness, which may accompany motion sickness. Or he suggested using a Scopolamine patch, which is worn behind the ear starting before the cruise and then changed every three days. And while "the seas would have to be enormously turbulent for people to feel sea sickness on a big ship," he said, "it helps to focus on a fixed point such as the horizon rather than moving points like ocean waves."

Slips and falls:

"All sorts of injuries are possible and you can't necessarily guarantee your safety anywhere," DeLuca acknowledged. But with such activities as rock climbing, water sports, basketball and other potentially high-impact attractions offered on cruises, "use good judgment and know your limitations," he advised.


DeLuca reiterated that the rules of good judgment apply to everyone, young and old, when it comes to balancing on a ship. "Be deliberate in your movements," he said, "and older people who might feel unsteady should walk with a walker."


More tips for protecting yourself from cruise hazards,


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