Information and Guidance about Global Travel on Cruise Ships, Including River Cruises, due to Coronavirus Disease 2019 (COVID-19)

The Centers for Disease Control and Prevention (CDC) recommends all persons defer any travel on cruise ships, including river cruises, worldwide because of the increased risk of SARS-CoV-2 transmission onboard ships. Deferring travel is especially important for older adults and all people with serious chronic medical conditions (such as heart disease, diabetes or lung disease), because of their increased risk for severe disease. This health update provides information to clinicians and state and local health departments about the current coronavirus disease 2019 (COVID-19) situation and the risks associated with travel on cruise ships, including river cruises.

Background
Cruise ship passengers, including those who take river cruises, are at increased risk of exposure to SARS-CoV-2, the virus that causes COVID-19. In the past month, there have been reports of outbreaks of COVID-19 among passengers and crew on cruises. Recent examples include 696 cases and 8 deaths on the Diamond Princess cruise ship in Japan, 28 cases on the Grand Princess cruise ship in the United States, and at least 60 cases in 15 states associated with multiple Nile River voyages in Egypt as of March 14, 2020. Illness onset occurred both onboard ships and after passengers returned to the United States. The proximity of passengers and crew on small ships and boats traveling on rivers may result in an even higher number of COVID-19 infections.

Recommendations for Clinicians
Ask all patients about their planned or recent cruise ship travel, including river cruises.

  1. Pre-travel advice
    1. Advise patients to defer all cruise ship travel, including river cruises, worldwide.
    2. Explain that their return travel to the United States may be impacted, and formal quarantine procedures may be implemented if confirmed cases are identified on board.
    3. Explain that appropriate medical care or medical evacuation may not be available internationally.
    4. Explain that some countries may refuse docking or disembarkation if there are known or suspected cases on board.
    5. For patients who still intend to cruise, advise them to
      1. Stay in their cabin and notify the onboard medical center immediately if they get sick with fever, new or worsening cough, or trouble breathing during their cruise.
      2. Stay home for 14 days after returning from travel, practice social distancing, and monitor their health both during travel and after they return. Social distancing means staying out of crowded places, avoiding group gatherings, and maintaining distance (approximately 6 feet or 2 meters) from others, when possible.
  2. Post-travel management
    1. Tell patients to follow CDC’s guidance on steps to prevent the spread of COVID-19 (https://www.cdc.gov/coronavirus/2019-ncov/about/steps-when-sick.html) if they develop acute febrile or respiratory illness after travel.
    2. Implement recommended infection prevention and control practices (https://www.cdc.gov/coronavirus/2019-ncov/infection-control/control-recommendations.html) if you suspect a patient has COVID-19.
    3. Immediately notify the local health department (https://www.naccho.org/membership/lhd-directoryexternal icon) if a patient meets clinical and epidemiologic criteria for a person under investigation (PUI) (https://www.cdc.gov/coronavirus/2019-nCoV/hcp/clinical-criteria.html) for COVID-19 and test as appropriate.

Recommendations for State and Local Health Departments
Check The Epidemic Information Exchange (Epi-X) notification system for information on COVID-19 cases on cruise ships and river cruises. In accordance with the Level 3 travel warning (https://wwwnc.cdc.gov/travel/notices/warning/coronavirus-cruise-ship) for cruise ships, cruise travelers should stay home for 14 days after returning from travel, monitor their health, and practice social distancing.

For More Information
State and local health departments can contact CDC’s Emergency Operations Center (EOC) at 770-488-7100 for assistance with obtaining, storing, and shipping appropriate specimens to CDC for testing, including after hours, weekends, or holidays.