Cruise Etiquette: How to Avoid Getting Sick on a Cruise

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If you’ve been on a cruise recently, you may have noticed the great lengths to which crew members go to remind passengers to wash their hands. On Royal Caribbean’s Icon of the Seas, staff dressed as hot dogs and pizza slices stand by the food hall imploring guests to disinfect before eating. On some ships, crew stationed in the bathroom repeat “washy washy" on loop while others sing catchy jingles and dole out hand sanitizer like candy.

While this may seem overkill, healthy hand washing habits can make the difference between the vacation of a lifetime and a travel horror story. From norovirus outbreaks to pandemic quarantines, it’s no secret that cruise ships are not immune (pun intended) to the occasional health scare—to the point that they’ve developed a bit of a reputation among germaphobes.

Unfortunately, the close quarters of cruise ships can make the vessels good environments for spreading a variety of ailments. But the good news is that cruise ships follow stringent health regulations and reporting requirements, and are subject to random sanitation inspections in the US.

But what can travelers do to avoid getting sick on a cruise? Sally Andrews, vice president of strategic communications and public affairs for the Cruise Lines International Association (CLIA), the world’s largest cruise industry trade association, advises that passengers exercise the same sensible health practices that they do on land. “This includes thorough and frequent hand washing, protecting the health of others if they start to not feel well, and contacting the ship’s medical staff as they would at home based on their individual health needs,” she tells Condé Nast Traveler.

For those looking for more in-depth guidance, the US Centers for Disease Control and Prevention (CDC) maintains a set of health guidelines specifically for cruise passengers. Some of the CDC’s suggestions are simply good travel advice that isn’t particularly cruise-related, like keeping up-to-date on regular vaccinations, checking with a doctor or travel health specialist if any additional vaccines or boosters might be necessary based on the itinerary's ports of call, and staying home if you feel sick in the days immediately leading up to the cruise. (Most cruise line and third-party travel insurance providers will cover cancellations if a medical provider advises you not to travel.)

Specific to cruising, the CDC recommends frequent hand washing and hand sanitizing (more often than on shore) and wearing a mask in crowded or poorly ventilated areas. Hand washing and sanitizing is particularly effective, the CDC notes, in preventing norovirus, which causes a gastrointestinal illness characterized by vomiting, stomach cramps, and diarrhea.

CLIA says that norovirus is rare on cruise ships when compared to the general risk in the US, but outbreaks do seem to be reported with some frequency. In 2023, there were 14 reports of gastrointestinal outbreaks onboard cruise ships arriving in the US (out of thousands of sailings), and all but one was attributed to norovirus.

Captain Luis Rodriguez, the acting chief of the CDC Vessel Sanitation Program, notes that the CDC reported more cruise ship outbreaks in 2023 than 2022, but there was also an increase in shoreside cases during this time. Rodriguez, who holds a graduate degree in public health, explains that the CDC directly “tracks illnesses on cruise ships, so cases are found and reported more quickly on a cruise ship than on land” (which relies on state and local health departments to collect data and report to the agency separately).

“Norovirus outbreaks commonly occur in crowded living accommodations or communities where persons are physically close,” Rodriguez says. “Pathogens that cause norovirus outbreaks can spread quickly in closed and semi enclosed environments, such as a cruise ship.” In short, any crowded space comes with higher transmission risks, and since the reporting requirements of illnesses on cruise ships are so stringent, outbreaks can appear more common than they actually are.

The rules of pool chair saving, how to determine a ship's “space ratio,” and locating zones reserved for special cabin categories.

In order to help prevent and control the spread of gastrointestinal illnesses on cruises, all ships are subject to inspection by the CDC when operating in US ports and territorial waters. The inspection results (including every nitty gritty detail) are publicly available on the CDC website—curious passengers can check out how their ship performed during past inspections by using the site's search function.

Because cruise line medical staff track the number of illnesses and likely causes, it’s important that travelers alert the onboard medical team when they feel unwell. This not only allows for accurate reporting to authorities, it also gives onboard teams a chance to prevent disease from spreading by beefing up sanitation protocols during the sailing.

But even passengers who take precautions to avoid transmittable illnesses can be subject to the oldest of seagoing maladies—the old mal de mer, or seasickness, chief among them. Thankfully, most modern cruise ships have sophisticated stabilizer systems which significantly curtail pitch and roll, even in rough seas—leaving many would-be sufferers almost unaware of any movement from the ship at all.

Seasickness is caused by an imbalance between the perception and realities of motion, and conventional wisdom is to keep the horizon in the line of sight. Travelers particularly prone to motion sickness or worried about being affected might prefer balcony staterooms for this reason. There are also a number of over-the-counter medications, available in pill or patch form, that travelers can take with them to treat seasickness. If a bout of nausea catches a passenger by surprise, ship medical staff generally carry a generous supply on board.

If you do get sick on a cruise, rest assured that international maritime law requires virtually all passenger ships to employ a medical doctor onboard. The 50-plus major cruise lines that belong to CLIA go a step further and are required to train clinical staff members in advanced life support, and additionally have defibrillators, cardiac monitors, X-ray machines, and lab equipment onboard.

At the end of the day, cruise ship crew members and passengers each do their part to keep everyone on board happy and healthy during their sailing. Just remember, washy washy!

Condé Nast Traveler does not provide medical advice, diagnosis, or treatment. Any information published on this website or by this brand is not intended as a substitute for medical advice, and you should not take any action before consulting with a healthcare professional.

Originally Appeared on Condé Nast Traveler