Reveiws




In 2004, 10.8 million people took North American cruise vacations, and cruising is expected to continue to gain popularity, with an estimated 20.7 million cruise travelers in 2010. Since 1980, the North American cruise industry, which makes up the majority of the global cruise market, has experienced an average annual passenger growth rate of 8.1%. Cruise capacity also increased by 450% over the same period, with 225,714 beds available in 2004. U.S. ports handle about 75% of global embarkations, and 77% of the passengers are U.S. residents. The North American cruise industry has had overall passenger occupancies at full capacity in recent years, with top destinations being the Caribbean, the Mediterranean, Alaska, Europe, and the west coast of Mexico. Cruise itineraries are ever expanding to include continents and areas not easily accessible by other means of travel, permitting travelers to visit multiple global destinations in the comfort typically offered by cruise ships.

Cruise ships and all ocean-going vessels engaged in international commerce fly flags of registry, which are required for operation in international waters. Cruise lines often choose to register either in their country of ownership or ship production or in countries that provide open maritime registration, or “Flags of Convenience.” Ships are most often registered in the United Kingdom, Liberia, Panama, Norway, the Netherlands, the Bahamas, and the United States. Flag registry states provide comprehensive maritime expertise and administrative services, require annual safety inspections before issuance of a passenger vessel certificate, and monitor vessel compliance with international maritime laws, as well as flag state standards. The World Health Organization’s International Health Regulations stipulate health and sanitation requirements for international conveyances. In the United States, the U.S. Coast Guard enforces maritime safety requirements, and CDC has regulatory responsibilities for sanitation and public health on cruise ships bound for a U.S. port from a foreign port.

Today’s large cruise ships can serve as a gathering place for the global community, where passengers and crew from around the world bring together a diversity of cultures, as well as medical and immunization backgrounds and health risk behaviors. Cruise voyages can last from several hours (e.g., gambling cruises) to several months (e.g., around-the-world and semester-at-sea cruises); however, the average duration of cruise travel is about 7 days. This time period permits ample opportunity for passengers and crew to come into repeated and prolonged contact through shared activities, such as games and dining, and through resources such as food and water, resulting in opportunities for exposure and transmission of communicable diseases. In addition, as cruise ships make multiple port stops, where differences may exist in sanitation standards and disease exposure risks, embarking passengers and crew can import and spread communicable diseases onboard. Detecting and preventing infectious diseases acquired during cruises are important not only to protect the health of cruise travelers but to avoid global dissemination of diseases in home communities through disembarking passengers and crew members.


 



Cruise Ship Medical Facilities

In 2000, the Cruise Ship and Maritime Medicine Section of the American College of Emergency Physicians (ACEP) published ACEP Health Care Guidelines on Cruise Ship Medical Facilities, a consensus report on appropriate facilities and staffing able to provide basic medical and emergency services aboard cruise ships, within the recognized limitations of the offshore environment. These guidelines include provisions for medical facility design on cruise ships, including guidelines for an isolation room to manage communicable diseases, diagnostic and emergency medical equipment, formulary, staff number and qualifications, and a health, hygiene and safety program for medical personnel. Large cruise lines that operate in the United States or are members of the International Council for Cruise Lines (ICCL) meet or exceed the ACEP guideline standards. Medical facilities on ICCL member vessels can be equated to community urgent care centers, with the ability to perform basic diagnostics such as blood chemistries, complete blood counts, urinalyses, chest x-rays, and EKGs. An estimated 95% of illnesses seen in cruise ship medical facilities can be treated onboard; however, passengers with serious problems such as myocardial infarction or cerebrovascular accidents need to be transferred to shoreside hospitals after stabilization. Cruise travelers should note that ACEP guidelines for large cruise lines may not be followed by smaller ships or those run by independent operators; on such ships there may be no medical provisions onboard. Cruise ship travelers with chronic diseases or those who may require comprehensive medical care during travel should consult with their health-care providers and notify the cruise line of special needs before travel.






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