The cruise industry continues to grow rapidly, with approximately 37.1 million passengers expected to set sail in 2025, according to Cruise Lines International Association (CLIA). However, alongside this growth, another troubling statistic has emerged. Data from the U.S. Centers for Disease Control and Prevention (CDC) reveals that 2024 has seen the worst year for gastrointestinal outbreaks on cruise ships in over a decade.

Norovirus Outbreaks at Sea

The majority of gastrointestinal outbreaks on cruise ships in 2024 have been linked to norovirus, a highly contagious stomach bug. In December alone, five ships, including those from Cunard Line, Holland America, and Princess Cruises, reported widespread illness, with hundreds of passengers affected. The CDC considers an outbreak when 3% or more of a ship’s passengers and crew exhibit gastrointestinal symptoms.

Norovirus has long been associated with cruise ships due to the confined nature of these vessels, which makes it easier for the virus to spread. Dr. William Schaffner, an infectious disease expert at Vanderbilt University, notes that norovirus is “known obviously as the cruise ship virus.” The virus can spread quickly in close quarters, and even a small amount of the virus can cause illness. It also lingers on surfaces, making it easy for passengers to contract the virus if they touch contaminated areas.

A More Severe Season

Norovirus tends to peak during the winter months, but this season has been particularly severe, both on land and at sea. Dr. Schaffner attributes the high number of outbreaks in December 2024 to this more intense seasonal occurrence.

Despite this, the cruise industry maintains that gastrointestinal incidents on board are extremely rare. The Cruise Lines International Association emphasized in a statement that these outbreaks are reported more quickly on cruise ships than on land, thanks to strict reporting protocols. On average, the CDC records 19-21 million cases of norovirus in the U.S. annually.

Other Causes of Outbreaks

While norovirus dominated the 2024 outbreaks, other causes of gastrointestinal illness have been reported as well. In September 2024, a salmonella outbreak was reported on Royal Caribbean’s Radiance of the Seas. Additionally, an E. coli outbreak occurred on Silversea Cruises’ Silver Nova earlier in the year, and the cause of another outbreak on Royal Caribbean’s Allure of the Seas remains unknown.

Rising Outbreak Numbers

In total, the CDC recorded 16 gastrointestinal outbreaks on cruise ships in 2024, the highest number in over a decade. By comparison, there were 14 outbreaks in 2023. However, a CDC spokesperson cautioned that while recent years have seen higher numbers of outbreaks than in the years before the pandemic, it is still unclear whether this represents a new trend. The period between 2020 and 2022 saw fewer outbreaks, largely due to the cruise industry’s shutdown during the COVID-19 pandemic.

Guidelines for Staying Healthy Onboard

The CDC advises passengers to report any symptoms of stomach illness immediately and follow medical staff recommendations to help prevent further spread. Hand hygiene is also crucial, and passengers are encouraged to wash their hands thoroughly after using the toilet and before eating or drinking. While cruise ships take extensive measures to control outbreaks—such as quarantining ill passengers and increasing cleaning protocols—the highly infectious nature of norovirus means that these measures are not always fully effective.

Dr. Schaffner adds that despite the best efforts of cruise lines, norovirus is so contagious that it is likely to spread beyond these preventive measures. He suggests that travelers who feel ill should stay home and rebook their cruise, and be particularly vigilant about hand hygiene, using soap and water instead of hand sanitizers, which are less effective against norovirus.

Looking Ahead

Experts remain uncertain about whether the surge in norovirus cases will continue into 2025. Dr. Schaffner notes that predicting the future of norovirus outbreaks is difficult, and it’s best to “wait and see.” In the meantime, passengers should prioritize hygiene and health while aboard, ensuring they follow all safety guidelines provided by the cruise line.

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A major recall of organic carrots has been issued following a deadly E. coli outbreak, affecting multiple brands and stores across the United States, Puerto Rico, and Canada. Here’s a breakdown of the key details:

Key Facts About the Outbreak

• Cause: Organic carrots contaminated with E. coli O121

  .

• Impact:
  • 39 infections across 18 states.
  • 15 hospitalizations.
  • 1 confirmed death.

States Affected:

Washington, Minnesota, New York, California, Oregon, South Carolina, New Jersey, Texas, North Carolina, Missouri, Pennsylvania, Arkansas, Colorado, Massachusetts, Michigan, Virginia, Wyoming.

Recalled Products

The recall involves organic whole and baby carrots packaged by Grimmway Farms and sold under various brands. Key details:

• Whole Carrots: No printed best-if-used-by dates; sold between Aug. 14 and Oct. 23, 2024.
• Baby Carrots: Best-by dates ranging from Sept. 11 to Nov. 12, 2024.

Brands Affected

1. Whole Organic Carrots:
   • Bunny Luv, Cal-Organic, Compliments, Full Circle, Good & Gather, GreenWise, Marketside, Nature’s Promise, O-Organics, President’s Choice, Simple Truth, Trader Joe’s, Wegmans, Wholesome Pantry.
2. Baby Organic Carrots:
   • Bunny Luv, Cal-Organic, Compliments, Full Circle, Good & Gather, GreenWise, Grimmway Farms, Marketside, Nature’s Promise, O-Organics, President’s Choice, Raley’s, Simple Truth, Sprouts, Trader Joe’s, Wegmans, Wholesome Pantry.

Symptoms and Risks of E. coli Infection

E. coli O121

can cause:

• Severe stomach cramps.
• Bloody diarrhea.
• Vomiting.

Symptoms typically appear 3–4 days after exposure and can last up to a week. In severe cases, complications like kidney damage may require hospitalization.

Steps for Consumers

1. Dispose or Return:
   Discard any recalled carrots immediately or return them for a refund.
2. Sanitize:
   Clean surfaces that may have come into contact with the contaminated products.
3. Seek Medical Attention:
   If experiencing symptoms, consult a healthcare provider and inform them about recent food consumption.

Background

The recall is one of several E. coli-related incidents in recent years, underscoring the need for vigilance. The FDA and CDC have identified Grimmway Farms as the common supplier linked to the outbreak.

Stay updated on recalls and food safety alerts to minimize risk.

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Several experts emphasize that they generally avoid certain raw fruits and vegetables prone to contamination, including sprouts, bagged salad greens, and cantaloupe. Federal officials investigating the recent outbreak suspect it may have originated from prewashed, slivered onions served raw on McDonald’s Quarter Pounders.

Rutgers University food science professor Don Schaffner explains that every step of handling and processing food—from slicing to prewashing—increases the chances of bacterial contamination. “The more manipulation you do, the more potential there is for bacteria,” Schaffner says. Raw fruits and vegetables, which aren’t cooked to kill bacteria, have been implicated in past E. coli outbreaks, such as a 2006 outbreak linked to packaged spinach and various cases linked to sprouts and cantaloupe.

Darin Detwiler, a professor at Northeastern University specializing in food regulatory policy, notes that E. coli outbreaks are often associated with produce. Meat outbreaks have declined over the decades due to stricter regulations and better cooking standards.

Barbara Kowalcyk, director of the Institute for Food Safety and Nutrition Security at George Washington University’s Milken Institute School of Public Health, advises against bagged greens and sprouts. She prefers to buy whole heads of lettuce and remove any torn or damaged leaves, thoroughly washing and drying them with clean paper towels. “Friction from drying helps remove bacteria,” she says.

Sprouts present a specific risk due to warm conditions that promote bacterial growth during sprouting, says Schaffner. Cut melons, especially cantaloupe with its bacteria-trapping rind, are also a high risk. Detwiler emphasizes that cantaloupe’s pH makes it particularly prone to contamination, and its rough rind is difficult to clean effectively.

E. coli spreads from animal or human waste, contaminating food and water. While agriculture improvements have helped, E. coli remains a risk, especially for vulnerable groups like young children, seniors, and people with compromised immune systems.

Kali Kniel, professor of microbial food safety at the University of Delaware, highlights E. coli’s low infectious dose, noting that only a few cells can make someone very ill. Many experts also avoid undercooked meat, poultry, fish, and eggs, as well as unpasteurized milk.

When dining out, food safety experts recommend checking for cleanliness cues. Detwiler, for example, judges a restaurant’s hygiene by inspecting the restroom first. However, fast-food restaurants like McDonald’s generally maintain stringent food safety protocols, according to Detwiler, who says the chain has “a long history of food safety leadership.”

The Centers for Disease Control and Prevention (CDC) notes that raw onions have not previously been linked to this particular strain of E. coli, though onions have caused salmonella outbreaks in recent years. Experts anticipate food safety measures will continue to improve as a result of this outbreak.

Schaffner acknowledges that completely avoiding foodborne illnesses is impossible. “If you stopped eating foods linked to outbreaks, you’d have little left to eat,” he adds. “Not eating still carries more risks than eating.”

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