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.
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