Executive Travel Health: Cruise ships and cruises
During the last decade, the cruise industry has been the tourism sub-sector with the highest growth rate. In spite of the Titanic, Zebrugge & Estonia disasters, the travellers on high standard luxury liners are usually quite safe.
Of the 1,326 million(1.326 billion) international tourist arrivals in 2017, the highest growth in international tourist arrivals in seven years since 2010, up 7% on 2016, about 27.2 million cruise ship passengers are estimated to sail in 2018.
The types of cruises include Family, Adventure, River, Transatlantic and World cruises. The average age of a passenger is gradually declining, now 45-50 years of age, however cruises of longer duration attract older travellers who are more likely to have chronic health conditions such as heart and lung disease. The most commonly reported on board health problems are respiratory tract infections, injuries, motion sickness and gastrointestinal illness.
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. The sheer magnitude of cruise ships and the number of passengers can approach the size of a small town with all its attendant health problems.
They may range from as little as five-people cruises on a small sailing boat where medical facilities will be zero, to large ‘city’ ships where a doctor and other key medical staff are available but medical services are still limited and in some cases for example blood transfusion, surgery. Medical evacuation will be needed and is dependent upon the ship’s position at sea, the sailing itinerary and the next port of call.
That is why you should prepare yourself properly for such trips by consulting your travel health consultant or family physician before the trip. Ensure you have adequate supplies of your medication before you board the ship and appropriate travel insurance which should cover repatriation. Also carry along a summary of your condition and a copy of your prescription with a letter from your practitioner attesting to your need for the medicines.
Most cruise ships do not have assigned space for a dental office and very few have resident dentists. Cruises are increasingly becoming popular in allowing for adventure along with good accommodation, food, security and many other facilities. Ships’ movements are inherently unstable due to sea swells and currents. Accidents are common due to falls on deck and staircases (wet surfaces).
People tend to drink alcohol excessively and are more prone to accidents both on deck and in the pool. Passengers tend to put on weight because of the easily available and abundant excellent food. In hot and tropical regions especially, try to avoid sunburn and UV Light reflection from water as well as from the direct sun, this being more likely at sea. Extremes of heat and cold (including cooling effects of sea breeze) depending on itineraries can occur. Suitable clothing is advised. Try to drink a lot of non- alcoholic fluids to prevent dehydration.
Because some cruise ships are not suitable for frail, elderly or handicapped travellers, try to ascertain the suitability of the ship before you book your trip. Make sure special facilities are available on board for your condition. Over indulgence in alcohol, food and lack of exercise can worsen heart conditions. Over exposure to the sun can increase the possibility of stroke. The elderly with poor balance are at higher risk of injury from falls especially in rough weather, due to their slower reaction time and reduced agility. Check your vaccination status with your travel consultant depending on the regions you are visiting.
In cruises outside Europe and North America, Hepatitis A vaccination is usually necessary for the non-immune because hepatitis A is so easily spread(most Nigerians will not need this).
Food on cruise ships is usually safe because great care is taken to prevent outbreak of food poising, but rarely contaminated food may be taken on board during stopovers. If you eat when you go onshore at a stopover, take care to avoid risky foodstuff and contaminated water. Remember that stopovers may have more risk than being on board and insect bites with the accompanying diseases (like malaria) and infections can be picked up. Because a large number of people are together in close proximity, influenza outbreaks can occur.
The elderly and those with medical conditions that can be made worst with an influenza infection should be vaccinated. They should also receive pneumococcal vaccines if not previously given. A very popular outbreak of disease amongst passengers is the ‘epidemic vomiting disease’ often due to the Norovirus. It is spread via the respiratory route and through fomites and is very difficult to control.
Large number of passengers may be infected but the illness is usually mild and self-limiting. Practise good personal hygiene to reduce the spread of the virus and other faeco-oral diseases.
More than 100 disease outbreaks have been identified in the past 30 years. This is probably an understatement because many outbreaks are not reported or detected. Outbreaks of measles, rubella, varicella, meningococcal meningitis, hepatitis A, legionellosis and other respiratory and gastrointestinal illness amongst ship passengers have been reported. A valid yellow fever certificate of vaccination may be needed for cruises to the Caribbean, South and Central America and sub-Saharan Africa or you might not be allowed into the ship if you do not have one.
Consult your doctor on possible malaria risk and take necessary precautions if the need arises. It is not necessary for most cruises. Sexually transmitted diseases from casual sexual relationships among passengers and among passengers and crew are reportedly quite common. It is better to abstain, and if you must have sex, practice safe sex to prevent HIV infection, Hepatitis B, Herpes.
Have a fun Cruise. Don’t forget your fully charged roaming mobile phone. Whatever you do, don’t fall overboard into the ocean (Laugh). The next topic will be the traveller with Asthma.
Visit reference sites below.
https://wwwnc.cdc.gov/travel/
Dr Ade Alakija
Q-Life Advisory Services