Happy New Year!

December 31, 2012

Looking back over my posts for this year, I realize that I haven’t been a very prolific blogger. Frankly, I can’t understand how some folks have the time to keep their blogs so current! I have, however, continued to keep up my regular column for Adirondac magazine, most of which reads like a blog anyway. Check out the publication link for some of these.

With winter coming on, the Caribbean cruise industry is in full swing. I suspect that most readers of this blog don’t spend too much time on vessels like the Queen Mary II, but there is actually a very nice wilderness medicine connection.

December was a bad month for cruise ships. In addition to rather flagrant violation of basic Leave No Trace principles (http://www.foe.org/cruise-report-card), there have been a number of very high profile outbreaks of intestinal infection on some luxury liners:


How would you like to spend 10 grand or more for a cruise, and wind up puking on the floor of your cabin with the staff forbidden to enter your room? These are hardly isolated incidents; the Centers for Disease Control and Prevention has a nice summary of reports over the decade:


Most of these outbreaks in which the cause could be established were related to Norovirus, a well-described cause of epidemic gastroenteritis. In addition, however, virtually every other infectious cause of gastroenteritis (including giardiasis) appears on this list.

Where’s the backcountry connection? Believe it or not, there are actually some biologic similarities between cruise ships and backcountry treks. Both situations take a group of individuals from different backgrounds and locales and put them together for a prolonged period sharing close spaces, eating together, and sharing toileting facilities.

Epidemiologists have long recognized that such environments are a prime condition for the hand-to-mouth spread of intestinal infections. Poor hygiene on the part of cruisers leads to surfaces on the ship becoming contaminated, spreading infection. While this certainly can happen in other public venues such as restaurants and hotels, these do not keep the same group of people in the same environment for several days at a time. Cruise ships do not spend a lot of time worrying about their drinking water; instead, they are compulsive about cleaning surfaces and encouraging their clients to pay attention to personal hygiene. When outbreaks do occur, the CDC invariably implicates hand-to-mouth spread.

Except in developing countries with no sanitation infrastructure, water is not a very efficient means of spreading intestinal infections. As the cruise ship experience demonstrates, however, breakdown in personal sanitation is the major way in which such infections spread.

So, whether your winter travels will be in the Caribbean on a cruise or in the Wind River Range on a trek, enjoy and stay healthy. In either place, be sure to wash your hands!