Cruising Around the World

With increased access to destinations across the world comes the opportunity to fly and cruise. Not a new concept but one which is increasingly more popular. With the spring and summer months approaching in the southern hemisphere so are the increasing number o0f cruises sailing for periods of up to several months.

These cruise ships sail to new destinations overnight and provide opportunities for shore-side trips and shorter stays.

So, what are the potential risks and pitfalls to travellers. Well lets’ look at this from the position of traveller.

1. Travel to the destination- travelling to another country such as the USA may have conditions such as motion sickness to be considered by various types of transport including plane, ship or on land.
2. On board- ships crews attempt to make the journey as comfortable as possible; however, there is always the possibility of an outbreak and recently ships have been quarantined following infections from contaminated food and water (typhoid, hepatitis A) or respiratory conditions (influenza, covid).
3. Shore based trips- some areas may have yellow fever infections, potential contact with animals and other mosquito diseases such as dengue.

So, what seems to be plain-sailing may require a little more thought about protection during the travel. Under maritime law cruise ships will have a staffed medical centre who can deal with 95% of illnesses, but for the ones that cannot be managed then they will be disembarked at the next destination for repatriation. This is why it is so important to have adequate insurance for cruise ships.

Starting by packing personal medication is an important consideration and special storage requirements for products. Your local pharmacy or travel clinic will be able to advise you how to safely carry medicines. In some cases, specific medicines (often called controlled substances) will require a letter of authority from your doctor to carry these into other countries. Further details can be found at https://www.incb.org/incb/en/travellers/index.html.

Once on board consider the risk from potential cross contamination from food (typhoid, hep A), water-spas and hot tubs (legionella), respiratory (Covid, flu).  The incidence of these is low however when travelling for longer periods on time it is a known that travellers attention to self-protection reduces and this can increase risk to others. If advised, consider having booster injections for:

• Tetanus, diphtheria and polio
• Hepatitis A
• Typhoid

These vaccinations will also help to protect you if eating ashore away from the ship at local food venues.

When ashore the risks of infection change but are still in many cases considered to be low due to the short space of time on land. However, risks can still occur from vaccinable and non-vaccinable diseases. Vaccinable diseases can include rabies, yellow fever, and dengue for example:

• Rabies is a virus that can be transmitted from any animal via bite, scratch or lick on an open wound. The virus causes 60,000 deaths a year, mainly in lower income countries where the treatment is not always available. In these types of trips ashore it is wise to consider all animals may have lower care standards than in a higher income country and potentially could carry the virus. Top tips are to avoid feeding any local animal, including monkeys: don’t attempt to stroke or pet an animal and be aware of animals protecting owners homes or businesses.
• Yellow Fever is a disease spread by a day-time feeding mosquito that can also spread other diseases such as dengue, chikungunya and zika.
• Dengue – this condition is also known as broken-bone disease due to the severity of pain. Insect repellents containing DEET, picaridin or oil of lemon eucalyptus and bite avoidance measures need to be used between dawn and dusk to reduce the risk from being bitten.
• Malaria– this is a night-time feeding mosquito and not usually a problem when cruising overnight away from shore. If close to land, then consider using the same bite avoidance measures as above.

Vaccines available for protection

• Rabies vaccine- 3 doses pre-travel, if bitten treatment a further 2 doses. If bitten without vaccination, then intense treatment using an expensive vaccine called an immunoglobulin plus additional rabies vaccines. Further information can be found at: https://www.fitfortravel.nhs.uk/advice/disease-prevention-advice/rabies
• Yellow Fever– this vaccine can be considered for all ages of traveller. Those over the age of 60 years are at a higher risk of side effects (bit not blocked from having it) and the risks of these serious side effects needs to be balanced the risk of contracting the disease at the destination. CityDoc have practitioners with experience of assessment and balance of risk. https://www.fitfortravel.nhs.uk/advice/disease-prevention-advice/yellow-fever
• Dengue – a newly introduced vaccine that is effective against the serotypes of the disease. Patients with additional medical risks are more at risk to this infection which is spread by a day-time feeding mosquito. Some areas of the world are currently experiencing endemic outbreaks of this disease.

Insect repellents

Many articles have been written regarding insect repellents. Currently the WHO licenses 3 which are frequently available in the UK. These 3 repellents have medical evidence of prevention when applied in the advised amounts and reapplied according to the instructions. Other historical repellents should not be considered.

The 3 effective repellents available in the UK contain the active ingredients of

• DEET
• Icaridin or Picardin (sometimes known sold as Saltidin)
• Oil of lemon eucalyptus

Further reading:

CDC Yellow Book- Cruise Ship Travel

FitForTravel- Cruise Travel Advice

Insect repellents