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DocLightning
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Norovirus outbreak aboard Oasis of the Seas

Fri Jan 11, 2019 2:01 am

https://www.nbcnews.com/news/us-news/ne ... se-n957221

(Fair Use Excerpt): Nearly 300 passengers aboard the Royal Caribbean's Oasis of the Seas cruise ship were sickened with a stomach virus since it departed Port Canaveral in Brevard County, Florida, on Sunday.


The ship has been docked in Jamaica today but passengers were not permitted to disembark and the ship will be returning to Port Canaveral, where the cruise will terminate.

Norovirus (formerally known as the Norwalk virus, Norwalk-like virus, or Norwalk agent) is a member of the viral family caliciviridae. In humans, norovirus most commonly causes acute-onset nausea, vomiting and/or diarrhea, usually with abdominal pain or at least abdominal discomfort. Fever, body aches, and generalized malaise are common, as is loss of appetite. Sometimes, we see patients also exhibiting mild upper respiratory symptoms (congestion, cough, runny nose). The disease usually lasts 2-7 days before resolving. It's rarely fatal in developed countries, but it's very unpleasant. This particular virus is quite interesting to me as a physician with a graduate degree in molecular biology because of just how effective it is as a molecular parasite and also just how stubborn it is as a virion (virus particle).

The illness is often called "stomach flu" although norovirus is not related to influenza virus. I discourage the use of this misnomer and prefer "winter vomiting disease." The proper medical term is "acute gastroenteritis," or "AGE."

Image

*The disease itself is extremely contagious. During the peak of the illness, a single gram of diarrhea or vomitus can contain a staggering one trillion virus particles. However, it takes as few as 18 particles to make someone ill. (GRAPHIC SENTENCE) Because vomiting can be forceful, microscopic droplets of vomitus containing at least 18 particles can be suspended in the air for several minutes and travel several meters, infecting individuals on the other side of a restaurant (for example).

*30% of people infected with norovirus show no symptoms but continue to shed virus for several days. Moreover, even those who do develop symptoms can shed virus for 24-48 hours prior to the illness and shedding has been reported as long as 7 days later.

*The virus particles themselves are extremely robust. They can survive on surfaces (especially when protected from sunlight) for weeks and in still water for perhaps years. They can survive heating above 60°C and most common disinfectants won't inactivate them. Basically, boiling, bleach, and incineration are the only effective ways to destroy the virus particles. Oasis's interior will need to be thoroughly wiped down with bleach.

*Immunity to norovirus after infection is incomplete with as many as 30% of patients having no detectable antibodies. In addition, when immunity develops, it is short-lived, lasting 4-7 years. The virus seems to employ a number of molecular tricks to evade immune surveillance.

*There is no specific treatment for norovirus, although two vaccine candidates (one oral and one injected) are in clinical trials. Anti-nausea meds can assist with oral hydration. I usually advise my patients to avoid artificial red dyes as these may be confused for blood in vomitus or diarrhea and trigger an unnecessary visit to an emergency room (and a lot of parental anxiety... I always say: "let's not make this any harder than it has to be"). I don't recommend anti-diarrheal medications; best to get the disease out rather than holding it in.

Hoping that those aboard Oasis stay well and have a safe trip home. I think of those flying home from Port Canaveral and really hope that none of them develop acute gastroenteritis mid-flight. That would be terrible.
-Doc Lightning-

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casinterest
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Re: Norovirus outbreak aboard Oasis of the Seas

Fri Jan 11, 2019 2:10 am

Uggghhh, Time to hug a toilet for those people.
Older than I just was ,and younger than I will soo be.
 
Okie
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Re: Norovirus outbreak aboard Oasis of the Seas

Fri Jan 11, 2019 2:36 am

Geez Doc, Thanks for the Analysis but:

I am envisioning Dr Rumack (Leslie Nielson) talking to Captain Oveur (Peter Graves) about the food poisoning.

Okie
 
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VTKillarney
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Re: Norovirus outbreak aboard Oasis of the Seas

Fri Jan 11, 2019 2:40 am

So what happens when they get on airplanes to fly home?
 
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WarRI1
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Re: Norovirus outbreak aboard Oasis of the Seas

Fri Jan 11, 2019 3:28 am

After friends experienced this and told me of the horrible time they had with it. I made the decision to skip cruises. Too many people in too little space and some people have terrible hygiene habits. :shakehead:
It is better to die on your feet, than live on your knees.
 
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DocLightning
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Re: Norovirus outbreak aboard Oasis of the Seas

Fri Jan 11, 2019 4:31 am

VTKillarney wrote:
So what happens when they get on airplanes to fly home?


It’ll get interesting.

Especially because the onset of symptoms is often quite abrupt. You feel fine and five minutes later it’s an emergency and you need a toilet RIGHT. THIS. INSTANT.
-Doc Lightning-

"The sky calls to us. If we do not destroy ourselves, we will one day venture to the stars."
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TTailedTiger
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Re: Norovirus outbreak aboard Oasis of the Seas

Fri Jan 11, 2019 5:32 am

Yeah they'll need that extra day in port to get the ship back in shipshape condition.
 
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Berevoff
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Re: Norovirus outbreak aboard Oasis of the Seas

Fri Jan 11, 2019 4:04 pm

I had the pleasure of having Noro on cruise in the late 90's and I was amazed at how much fluid can come out of your body while still remaining alive. 24 hours later and it was like it never happened.
 
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casinterest
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Re: Norovirus outbreak aboard Oasis of the Seas

Fri Jan 11, 2019 4:06 pm

Berevoff wrote:
I had the pleasure of having Noro on cruise in the late 90's and I was amazed at how much fluid can come out of your body while still remaining alive. 24 hours later and it was like it never happened.


It always amazes me how water seems toxic to my body for about 24 -36 hours You have to force yourself to sip it or gatorade, and pray it isn't enough that you go back into it all again.
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dtw2hyd
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Re: Norovirus outbreak aboard Oasis of the Seas

Fri Jan 11, 2019 4:33 pm

Hope they have enough Home Depot buckets and bio bags.
 
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VTKillarney
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Re: Norovirus outbreak aboard Oasis of the Seas

Fri Jan 11, 2019 4:39 pm

I used to get really upset at the jackass that boarded with the virus. But it sounds like you can board and not even know that you are infected. That's pretty scary. An approved vaccine can't come soon enough.
 
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casinterest
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Re: Norovirus outbreak aboard Oasis of the Seas

Fri Jan 11, 2019 4:43 pm

VTKillarney wrote:
I used to get really upset at the jackass that boarded with the virus. But it sounds like you can board and not even know that you are infected. That's pretty scary. An approved vaccine can't come soon enough.

Not sure a vaccine can work with such a quick acting virus.
A few years ago.
I laid down on the couch one night to watch football ( after some family members had had it 2 weeks prior) . I thought I had escaped.

But right at 15 minutes into the game, my stomach started feeling really full, and I felt nauseous. I got up, got some paper towels, a water bottle, pillow and blanket, and extra TP and set up shop in the bathroom with bleach. for the night.
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DocLightning
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Re: Norovirus outbreak aboard Oasis of the Seas

Sat Jan 12, 2019 5:09 am

casinterest wrote:
Not sure a vaccine can work with such a quick acting virus.


Yes it can because you don't take the vaccine after exposure. You take it before exposure.
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scbriml
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Re: Norovirus outbreak aboard Oasis of the Seas

Sat Jan 12, 2019 12:58 pm

Nasty, nasty, nasty.

Our younger daughter had this one Christmas and it was horrible. She was visiting us and her mother followed her around the house and sanitsed everything she touched within an inch of its life! Thankfully none of the rest of us contracted it, but she was wiped out for about three days.
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Berevoff
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Re: Norovirus outbreak aboard Oasis of the Seas

Sat Jan 12, 2019 1:08 pm

DocLightning wrote:
casinterest wrote:
Not sure a vaccine can work with such a quick acting virus.


Yes it can because you don't take the vaccine after exposure. You take it before exposure.


Is a Noro vaccine a thing?
 
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Jouhou
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Re: Norovirus outbreak aboard Oasis of the Seas

Sat Jan 12, 2019 3:26 pm

Berevoff wrote:
DocLightning wrote:
casinterest wrote:
Not sure a vaccine can work with such a quick acting virus.


Yes it can because you don't take the vaccine after exposure. You take it before exposure.


Is a Noro vaccine a thing?


No, I think the good doc was just saying that of vaccines in general. Although I think toxoid vaccines can be used after exposure.
 
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readytotaxi
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Re: Norovirus outbreak aboard Oasis of the Seas

Sat Jan 12, 2019 3:35 pm

I guess they get a refund as the cruise is cut short, and hopefully a deep clean before the next lot of souls get onboard.
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ltbewr
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Re: Norovirus outbreak aboard Oasis of the Seas

Sat Jan 12, 2019 5:10 pm

It is possible that the virus was contacted on a land stop. I believe from news reports that this ship has stopped in a port in Haiti before the virus went, well, viral onboard.
 
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DocLightning
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Re: Norovirus outbreak aboard Oasis of the Seas

Sat Jan 12, 2019 10:35 pm

ltbewr wrote:
It is possible that the virus was contacted on a land stop. I believe from news reports that this ship has stopped in a port in Haiti before the virus went, well, viral onboard.


We can't know that, really. It could have been brought aboard by someone who was asymptomatic at the start of the cruise, too. There are so many possible sources of the infection that it's just impossible to tell without going through a whole sequencing process, collecting local samples from each stop, etc. And even so, what would that give us? Nothing.

Norovirus is the cause of ~95% of acute viral gastroenteritis in the USA now that rotavirus is on the way out thanks to the vaccine.
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OA260
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Re: Norovirus outbreak aboard Oasis of the Seas

Sun Jan 13, 2019 10:32 am

readytotaxi wrote:
I guess they get a refund as the cruise is cut short, and hopefully a deep clean before the next lot of souls get onboard.


RCI will thoroughly clean everything from handrails to chairs basically every part of the ship that needs deep cleaned. Usually they have teams for each section and check lists. Unfortunately they are used to this operation. It does alarm me sometimes the things I see onboard cruise ships with regards to peoples personal hygiene.
 
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Re: Norovirus outbreak aboard Oasis of the Seas

Sun Jan 13, 2019 2:45 pm

In Seattle one of our high end restaurants 'got the disease'. They did a high end clean up, checked the staff, all seemed well. Well it wasn't. Second time around one of the cruise lines worked with them and they re-opened about a week later. Cruise lines do know how to handle this virus, but it is a stalwart enemy. Halfway, hell 99% measures will not fix it. Statistically your chances of not catching Noro are excellent. I don't like cruises but we have done family reunion on one, and I would do it again.
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einsteinboricua
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Re: Norovirus outbreak aboard Oasis of the Seas

Sun Jan 13, 2019 5:18 pm

Maybe we need to record a sequel to this.

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Re: Norovirus outbreak aboard Oasis of the Seas

Tue Jan 15, 2019 6:34 am

I'm doing a cruise with the whole family on her sister ship Harmony of the Seas in June, and I've been pleased to see how RCI has taken what were once just hand sanitizer dispensers at the entryways to restaurants into full-on hand-washing stations before entering.
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DocLightning
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Re: Norovirus outbreak aboard Oasis of the Seas

Wed Jan 16, 2019 5:28 am

Berevoff wrote:
DocLightning wrote:
casinterest wrote:
Not sure a vaccine can work with such a quick acting virus.


Yes it can because you don't take the vaccine after exposure. You take it before exposure.


Is a Noro vaccine a thing?


Not yet. But they're working on it. Two candidates are in Phase III clinical trials.

Jouhou wrote:
Although I think toxoid vaccines can be used after exposure.


All vaccines can be used after exposure. Rabies immunization is usually given after exposure. They vary as to how good they are at preventing the disease they target.

The point of a norovirus vaccine would be to give it to everyone before they got norovirus. An ounce of prevention...
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Dieuwer
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Re: Norovirus outbreak aboard Oasis of the Seas

Thu Jan 17, 2019 2:30 am

Now you know why some people call cruises "Floating Coffins".
Norovirus is one thing. Just imagine someone brings Ebola onboard...
 
Ken777
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Re: Norovirus outbreak aboard Oasis of tSeas

Thu Jan 17, 2019 4:31 am

Dieuwer wrote:
Now you know why some people call cruises "Floating Coffins".
Norovirus is one thing. Just imagine someone brings Ebola onboard...


The ones that call them that are pretty ignorant. Cruise lines are far more aggressive than airlines or other means of mass transportation. I've been o[n RCC and their efforts to get customers to use those hand sanitizer at every time you turn around is admirable, As far as an Ebola patient gets on board any ship or plane various national health organizations will be very fast to respond. You can't hide from everything and going to Disney World can be just as dangerous.

One odd thought that just hit me. I served a 4 year enlistment in the Navy. Lots of boots from different backgrounds and we quickly fell in line as far as hygiene. Same when we we're assigned to various ships. There were no hand sanitizers, or similar programs, but we were fine with the Navy's standards in the food handlers areas. Once we had 50 days at sea and the only medical problems were those related to the bar girls before we left port.
 
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Re: Norovirus outbreak aboard Oasis of the Seas

Thu Jan 17, 2019 11:33 am

OA260 wrote:
readytotaxi wrote:
Unfortunately they are used to this operation. It does alarm me sometimes the things I see onboard cruise ships with regards to peoples personal hygiene.


It's not just on cruise ships. Just pay attention to your colleagues when visiting the loo. I am continually surprised at how many adults answer natures call (call number 1 or call number 2), and then walk out without washing their hands. At my last job you had to walk through the kitchen/pantry to get to the toilets. Unsurprisingly, many colleagues settled into a habit of going to the loo, and then getting a snack/drink.
 
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readytotaxi
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Re: Norovirus outbreak aboard Oasis of the Seas

Thu Jan 17, 2019 12:25 pm

Is the virus as prevalent on aircraft, but because you don't spend 24hrs and more together no one knows that a lot of people have become unwell afterwards?
you don't get a second chance to make a first impression!
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