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By Laurie Sullivan.

Aussies love cruise ship travel. At least part of the attraction is that it holds few health risks. 
It’s not all fair sailing. In recent years, cruises have been plagued by much-publicised outbreaks of the gastro bug, norovirus.
In fact, the most common shipboard ailments are respiratory tract infections (29.1%), followed by injuries (18.2%), seasickness (9.1%), and gastrointestinal (GI) illnesses (8.9%), according a major retrospective study of 172 voyages conducted by a US company. The researchers found that around 1-in-250 passengers required medical attention for a ship-board illness, while half of all infirmary visits were made by passengers aged over 65.
However, the cruise travel is changing. Today’s passengers are a more adventurous ‘crew’ and cruise companies are responding by adding more exotic stop-overs. Even cruises based in Australian waters are including daytrips to destinations like Papua New Guinea and the Indonesian island of Bali.

‘Low risk’, not ‘no risk’

So, in terms of their health, what does spending a few hours or whole day ashore in PNG or Bali mean for a cruise passenger?
“You couldn’t say that these day trips hold no chance of being infected,” said Dr Eddy Bajrovic, Medical Director of Travelvax Australia.
“That’s especially so when it comes to common diseases like flu, Hepatitis A, measles, and the many bugs that cause traveller’s diarrhoea. They are mainly spread by contaminated food or drinks and, like travellers everywhere, cruise passengers like to sample the local fare when they go ashore.”
“But, these viruses and bacteria can also be spread by touching everyday items an infected local person may have touched. When you handle them and then touch your mouth, nose or eyes, you could transfer the germ and become infected yourself.
“Besides considering the protection of vaccination – which is a good idea if you travel fairly regularly – it’s also important to wash your hands before eating or after using the toilet.”

Mozzies present in and around ports

The same goes for insect-borne diseases – especially those spread by mosquitoes that bite by day in urban settings.
“Even though PNG is generally considered a high-risk destination for malaria, the mosquitoes that spread it are night feeders,” Dr Bajrovic said.
“Day-trippers are normally safely back on the ship before nightfall and anti-malaria medication would not usually be recommended for a day or overnight stop-over. In the case of Bali, the island is generally considered to be free of malaria, although other popular islands nearby are not.”
However, mozzie diseases like dengue, Chikungunya, or the ‘newer’ Zika virus are a very different story. 

Tropical disease outbreaks more common

“The incidence of these diseases in tropical and subtropical regions has skyrocketed in recent years,” Dr Bajrovic said.
“At any given time, outbreaks may be occurring in cruise destinations. The daytime-feeding Aedes mosquitoes that spread dengue and Chikungunya are found in the ports themselves and in other urban areas passengers might visit.
“In fact, a major outbreak of Chikungunya is currently underway in French Polynesia. If a cruise passenger was to go ashore for any length of time – even a few hours – in a port in the Pacific, Asia, the Caribbean, Latin America or Africa, they could be bitten and, potentially at least, infected.
“So, while the risk is much lower than for someone spending a week or two there, cruise passengers can’t afford to be blasé. They still need to prevent mozzie bites while ashore, especially using an effective personal insect repellent before leaving the ship and carrying it ashore to reapply – especially later in the day when mozzie are about.” 

Our tips for healthy cruising

Here are more tips for health cruise travel:
FIRST, VISIT YOUR DOCTOR: See your doctor at least four weeks before your departure. Ask about necessary immunisations, particularly for disease risks in ports of call. Review your prescriptions and ensure you have extra medication to allow for unexpected delays. If you have a chronic health issue, such as diabetes or heart disease, discuss the risk of travel in detail – before you book your berth. Have a written profile of your medical condition including current treatments, medications, and dosages that you can provide to the ship’s doctor, if needed. On the topic of medication, it’s more convenient (and far cheaper) to bring your own supply of over-the-counter items, such as insect spray, sunscreen, pain reliever, motion sickness medication, hand sanitiser gel or wipes, and anti-diarrhoea products.
WASH YOUR HANDS – REGULARLY: A cruise ship is a confined, crowded place. Respiratory and gastro bugs that some passengers and crew almost inevitably will bring aboard can spread quickly, leaving you feeling, well, becalmed. You’ve heard this advice before, but it bears repeating: Wash your hands using warm water and soap for a minimum of 20 seconds before and after eating, after using the toilet, after visiting the ship's common areas, or touching doorknobs or guard rails where germs can lurk. I may sound heartless, but if illness breaks out, try to stay away from sick passengers. Eat in a separate area or in your cabin.
FOOD AND WATER – MAKE SAFER CHOICES: Cruise ships pride themselves on their fare – the main risk is usually overindulging! So, it’s easy to forget the dos and don’ts of safe food and water when you go ashore. Eating undercooked food (particularly shellfish) or unwashed vegetables and fruits could put you at risk for gastroenteritis, Hepatitis A and Typhoid. Onboard or ashore, ensure hot food is served hot and cold food is served cold. Don't drink tap water ashore; stick strictly to bottled water. 
STEADY AS SHE GOES: If you experience seasickness, focus on the horizon or lie down in an air-conditioned cabin, keeping your eyes closed and your head still. You may also find that sipping fruit juice helps. As a last resort, oral medications and injections are generally available from the ship’s infirmary.
STAY COOL: Onboard or on shore, use sun protection, wear a hat and drink plenty of water to avoid sunburn and heat-related illness. The sun is hotter in the tropics and sunburn not seasickness is the most common health problem – especially for kids. In popular tropical cruise destinations like the Pacific islands, Asia, or Latin America the summer sun is directly overhead and its rays are being reflected off the ocean’s surface. In addition, there is almost no haze to filter out UV rays, further increasing exposure. Even in temperate climates, the sun’s radiation is not tempered by lower temperatures or cooling breezes, and can deliver a nasty dose of sunburn. Use sunscreen with an SPF of 30 or above and reapply every 2-3 hours or immediately after swimming. 
DRINK IN MODERATION: It’s tempting to drink too much. Excessive alcohol consumption can leave you high and dry (dehydrated, that is) as well as (a) hung over, (b) injured, and/or (c) embarrassed. Remember, it much harder to hide on a ship if you do something really stupid while intoxicated.
PRACTICE SAFE SEX: For singles, shipboard romances are the stuff of legend. Take along a supply of condoms to avoid sexually transmitted diseases
INSURANCE IS A MUST: Around 95% of shipboard illnesses can be treated onboard but medical services can be VERY expensive. Take out travel insurance that covers the cost of medical treatment and evacuation. Most shipboard accidents actually occur on embarking and disembarking, although steep stairs, wet decks and unfamiliar surrounds can cause problems for passengers of any age and at any stage of their trip. On shore, riding motorbikes, parasailing, swimming at unpatrolled beaches, and uneven road surfaces and footpaths, are just some of the hazards, while the local medical services may be very basic indeed. (It’s worth noting that insurance policies have exclusions, such as an existing medical condition, intoxication, drug abuse, driving or riding on shore, and activities like parasailing and scuba diving. Always check the fine print before you buy insurance.)

Setting sail soon? Call Travelvax Australia’s travel health information service on 1300 360 164 (toll free from landlines within Australia) for more healthy advice.

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