Cruise Ship Outbreak Updates Vessel Sanitation Program

Table Of Content

• FDA finds Legionnaires’ disease on American Cruise Lines’ ships
• Nearly 30 Silversea cruise passengers get sick in gastrointestinal illness outbreak
• Legionnaires' disease on a cruise ship linked to the water supply system: clinical and public health implications
• Legionnaires’ Exposure at the Viva Wyndham Fortuna Beach Hotel in Freeport, Bahamas
• Legionella previously found on American Cruise Lines vessels
• Cruise Passenger Tampers With Cabin Water Bottle By Refilling

FDA expressed concerns with these laboratory results not being representative nor sufficient to determine whether Legionella is still present and your use of these and the field test kit results to justify ending notification of passengers. Specifically, FDA collected 14 bulk water and 10 biofilm swab samples; you collected (b)(4) bulk water and (b)(4) biofilm swab samples for the laboratory tests. You did not evaluate most of the bulk water and biofilm swab locations that were positive from FDA’s sampling. In addition, one of the biofilm swabs you took was from a (b)(4) that was negative from FDA’s sampling.

FDA finds Legionnaires’ disease on American Cruise Lines’ ships

Add to this, the number of people living on these ships, usually for 1-2 weeks at a time, using these water systems can increase the risk of a potential Legionella outbreak. The CDC has developed a comprehensive site with much information on Legionellosis, including diagnosis and collection techniques and a questionnaire for use in investigation of suspected or confirmed cases onboard. We should always keep in mind that the source may be from an unsuspected site such as respiratory therapy equipment brought on board by a guest, or from a hotel cooling tower in a port along the way.

Nearly 30 Silversea cruise passengers get sick in gastrointestinal illness outbreak

In the meantime, the cruise line has started conducting additional extensive Legionella testing and mitigation measures that will be completed before the next cruise departs. The testing includes all devices and fixtures that use water, including whirlpools onboard, spas, showers, and faucets. The disease can be treated with antibiotics, and while most people diagnosed have to seek medical care in a hospital, they make a full recovery.

Legionnaires' disease on a cruise ship linked to the water supply system: clinical and public health implications

Include an explanation of each step being taken to prevent the recurrence of violations, as well as copies of related documentation. If you cannot complete corrective actions within 15 working days, state the reason for the delay and the time within which you will do so. If you believe that your products are not in violation of the Act, include your reasoning and any supporting information for our consideration.

It is believed the disease is likely underreported due to the similarity of symptoms with other illnesses. The disease can be contracted at any time of year, but is more common in summer and early fall. As soon as the cruise line was notified, extra sanitation protocols were implemented aboard Celebrity Ascent. This would include extra cleaning of vulnerable surfaces and equipment as needed, and changes to operational protocols to limit any potential spread. A letter sent to recent Celebrity Cruises guests has informed them of a confirmed diagnosis of Legionella from two prior guests onboard the brand new Celebrity Ascent. "Most healthy people do not get Legionnaires’ disease after being exposed to Legionella," the agency said.

FDA investigates cases of Legionnaires disease on cruise ships - Food Safety News

FDA investigates cases of Legionnaires disease on cruise ships.

Posted: Mon, 27 Feb 2023 08:00:00 GMT [source]

Although cruise ships do not have public health authority, to reduce the risk of introducing communicable diseases, some ships conduct medical screening during embarkation to identify ill passengers, prevent them from boarding, or require isolation if permission to board is given. Medical facilities on cruise ships can vary widely depending on ship size, itinerary, cruise duration, and passenger demographics. Generally, shipboard medical centers can provide medical care comparable to that of ambulatory care centers; some are capable of providing hospitalization services or renal dialysis. Although no agency officially regulates medical practice aboard cruise ships, the American College of Emergency Physicians (ACEP) published consensus-based guidelines for cruise ship medical facilities in 1995, and updated the guidelines in 2013.

Legionella previously found on American Cruise Lines vessels

On July 14, 2022, FDA notified them of the positive findings regarding Legionella onboard the vessel. Subsequently, they provided notifications to each passenger on the voyage departing July 16, 2022, of the presence of Legionella in the potable water system. The firm also provided notifications to passengers onboard the vessel previously that departed on June 18, 2022, June 25, 2022, July 2, 2022, and July 9, 2022.

Legionella Experts in Puerto Rico Support Water Management and Infection Control Programs on Cruise Ships - WebWire

Legionella Experts in Puerto Rico Support Water Management and Infection Control Programs on Cruise Ships.

Posted: Mon, 08 Apr 2024 20:35:03 GMT [source]

Legionnaire's Disease Cases Connected to American Cruise Lines

The culture technique has a relatively long history and many operators are familiar with the test. Various regulations and guidance documents are available, providing useful information to help operators assess their results. A significant disadvantage is that the test is slow, requiring several days to process and then for the lab to provide a report. Common turn-around times are in the range of 10 to 14 days, meaning it is not possible to use the data for routine operational changes. Legionnaire’s disease is a type of pneumonia (lung infection) that is caused by the bacteria Legionella. Between April and August 2022, FDA inspectors tested the drinking water on the American Star and American Heritage and found ongoing evidence of Legionella bacteria.

Cruise Passenger Tampers With Cabin Water Bottle By Refilling

The Engineering Manager stated that disinfection was performed once from March 2021 to March 2022 and (redacted) during (redacted) from (redacted). During disinfection, cabin outlets were allowed to run for approximately (redacted). No specific sequence was given to the crew in the galley, crew quarters, and various other cabins for turning on the faucets, taps, showerheads, and other locations to run the disinfectant. Vessels collect water from various locations; it is essential for the vessel to know what disinfectant such as chloramine or chlorine is being used by the potable water source being onloaded to the vessel. For example, if you take on water that is disinfected with chloramine, you would need to monitor both free chlorine and total chlorine. According to the Port Engineer, cabin outlets were allowed to run for approximately (b)(4) during (b)(4) disinfection when the vessel (b)(4).

Laboratory Analysis of those samples identified Legionella pneumophilia serogroup 1 and Legionella spp. (hereinafter collectively called Legionella) in the potable water system of the vessels. FDA investigators also observed insanitary conditions related to the potable water systems onboard the vessels.

Historically, influenza has been among the most often reported VPDs occurring on cruise ships. Because passengers and crew originate from all regions of the globe, shipboard outbreaks of influenza A and B can occur year-round, with exposure to strains circulating in different parts of the world (see Sec. 5, Part 2, Ch. 12, Influenza). Thus, anyone planning a cruise should receive the current seasonal influenza vaccine ≥2 weeks before travel if vaccine is available and no contraindications exist.

You did not change your procedures regarding potable water after CDC notified you on November 5, 2021, that one of your passengers was diagnosed with Legionnaires’ disease. For example, you did not change your procedures for flushing or disinfection and did not perform environmental sampling. Subsequently, after FDA notified you of its detection of Legionella onboard your vessel (June 2, 2022), you disinfected the vessel’s potable water system on (b)(4).

Legionella is a genus of bacteria that is found widely in aquatic environments, particularly in constructed water systems with warm temperatures and stagnant sections. Legionella are responsible for causing Legionnaires’ disease, a severe and potentially fatal pneumonia, as well as Pontiac Fever, a less severe infection. Legionnaires’ disease was first identified following an outbreak that occurred at an American Legion convention in Philadelphia in 1976. Centers for Disease Control and Prevention (CDC) identified Legionella pneumophila as the cause of the outbreak, which was estimated to have resulted in more than 200 infections and 29 deaths.

First, if cells are stressed, whether through exposure to biocide or through lack of nutrients, they may enter a viable but not culturable (VBNC) state. This means that the cells are alive, potentially still capable of causing infection, but will not grow by culture method. Additionally, the BCYE agar favours the growth of Legionella pneumophila over other species, which may also cause infections. These hosts provide a hospitable environment, sheltering Legionella from biocides, while also providing nutrients. Culture tests may often fail to detect Legionella that are growing within these hosts. Despite problems with Legionella contamination and illnesses, the FDA said that American Cruise Lines failed to take adequate stops to treat the ships’ water supply.

The firm restarted passenger notifications and provided them from July 9, 2022, to July 30, 2022. On (redacted), the firm collected additional samples and notified FDA of negative results on Aug. 16, 2022. On Sept. 20, 2022, FDA submitted additional follow-up questions regarding the vessel’s sampling process, laboratory results, and future disinfection process. The agency found evidence of legionella bacteria, which causes the illness, in the potable water systems of the line's American Star and American Heritage vessels after inspecting them periodically between December 2021 and August 2022, according to the Jan. 24 letter. The agency addressed the letter to the line's executive vice president, Paul E. Taiclet.