Oh god … in the cruise industry there’s always something. Now that passengers aboard two Princess ships have Norovirus, it’s time to re-run this helpful article.

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I can’t imagine how awful it is to get violently sick on my vacation and wondered why cruise ships seem to be associated with Norovirus most often, at least in the media.

So I asked Brian Rosenthal, MD, MPH (Master of Public Health), who teaches at Columbia University’s Mailman School of Public Health in New York.  He’s also an avid cruiser who has sailed the world aboard all types of cruise ships.

As a public health physician who has sailed aboard dozens of cruise ship,  Dr. Rosenthal’s advice is timely.

AC:  Who is responsible when passengers get sick aboard ship?

DR: There are times when an infectious agent has been isolated on a ship and the cruise line is responsible.  An example is Legionnaires Disease, which is rare.

And, there is always the potential for bacterial food contamination such as e-coli but due to the CDC’s stringent inspections, it hasn’t been reported in many years.  Cruise Lines have become very vigilant about waterborne and shipborne diseases so the reported incidences is rare.   People used to get sick on ships all the time but we just didn’t know what the organisms were.  Now that we know, the media has a heyday with it.

But in the instance of Norovirus, passengers bear the brunt of passing the disease along.

AC: Why Do Outbreaks of Norovirus Happen Aboard Ship So Often?

DR. I don’t think this is a new illness but that we’re hearing about it more often.  I’m sure the outbreaks aboard ship aren’t any higher than they are on land.   There just hasn’t been much coverage of the disease on land.

The thing about ships is that because you’re in a confined space the rate of exposure is statistically greater.  Contrast Disney World.  People aren’t staying in the same hotels or eating in the same restaurants as they are aboard a cruise ship.

AC:  How Can We Avoid Getting a shipborne illness?

DR: There are certain universal precautions that are even more important when you’re aboard a ship.  As important as washing your hands, you have to learn to KEEP YOUR HANDS AWAY FROM YOUR EYES, NOSE AND MOUTH. This is a normal human condition.  If you sit at a restaurant and watch people eat for five minutes you’ll see what I mean.  Most viruses are not spread by hand to hand contact alone.  They are spread by hand  to hand to mouth (or eyes or nose).  If you had it just on your hands, you wouldn’t get sick.

Shaking hands with the Captain or anyone else won’t get you sick assuming you have no cuts on your hands.  Of course one must be careful about where one puts one’s hands.   If you’re able-bodied, don’t use the banisters or railings if you don’t need to.   This is true in any public space, not just ships …. Train stations, malls. 

If you have children it’s an entirely different matter.  All kids put their hands in their mouth — that’s what children do.  And when they play in groups beit a nursely school or a ship, it’s problemmatic.  If your child does become sick, take a lot of precautions that he or she is the only patient in the family.

And, it is as important that you wash BEFORE you eat as it is after you go to the bathroom which is why the hand sanitizers in food lines are a great idea.

AC: Does the Fear of a Shipborne Illness stop you from Cruising?

DR: Absolutely not!  Everytime out go outside your home is a rish.  You must weigh this against the benefits of having a wonderful time and sharing experiences with family and friends.

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Ending a cruise can be an unpleasant reality check: the folks who pampered you for a week or more kick you off the ship the moment the vessel docks. Not really, but they want you out of your stateroom by 8:00 a.m. and to vacate the ship shortly after. Add to that your return flight home doesn’t depart until 4:00 so with a big suitcase and carry-on bag the only option is sitting around the airport for half a day.

Celebrity Cruises offers an alternative to that scenario with the new “Extend Your Stay” option that lets you hang out on the ship until 90 minutes before departure.

Extend Your Stay is being offered for the remainder of the current Europe season on Celebrity Constellation, Celebrity Equinox, Celebrity Solstice and the brand-new Celebrity Silhouette. The program also will be available for future Europe seasons. The program is available for purchase at the Guest Relations desk on-board. The cost of the program is $59 per adult, $29.50 per child ages 3 to 12, and free for children under three years of age.

The $59 charge is outrageous for just hanging around a ship lounge. To partially offset sticker shock, the program includes a full line-up of benefits including non-alcoholic specialty coffees and teas from Café al Bacio; a meal in the creperie-focused specialty restaurant, Bistro on Five; the opportunity to watch a first-run movie in one of the ship’s theaters; and access to the pool, fitness center and locker rooms. The AquaSpa will be available for spa services at an additional charge. Bar purchases can be made on the last day of the cruise using a credit card.

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No matter how many alternative restaurants with added service charges there are on today’s new mega ships, the one thing you could count on was that the food in the main dining room always was included in your fare.

Well you can’t count on that any longer.

And maybe that’s the start of an unfortunate trend – another item in the growing list of a la carte add-ons that could run up the tab for your cruise vacation.

Adding a la carte menu items began last year when Royal Caribbean tacked $15 on to your dinning bill if you wanted New York strip steak served in Allure of the Seas’ main dining room. Regrettably, now Celebrity Cruises is following suit of its parent company by adding new menu options that will carry a rather hefty surcharge.  On all ships in Celebrity’s fleet, you’ll find Kosher menu options that will lighten your wallet anywhere from $5 to 20.

Currently, all cruise lines offer kosher food, which usually is listed in the category of “Special Dietary Needs,” along with special preparations for those who prefer vegetarian, Indian, low cholesterol, salt-free, low-fat or allergen-free dining choices.  The big difference is Celebrity is the first to charge extra for kosher food.  Celebrity’s new “premium” kosher meals are Glatt Kosher certified and provided by the same outside source Carnival Cruise Lines uses for its kosher cuisine, where it is available at no extra charge.  In both instances you must notify the cruise line a month before departure if you request kosher meals.

In order to justify the extra charge, Celebrity labels its Kosher food “premium.”    Entrees include roasted salmon, BBQ quartered chicken, beef brisket and glazed chicken breasts and are priced at $19.    Kosher breakfast items include lox and bagels, Belgian waffles, omelets or pancakes priced at $13, while baked goods carry an extra $3 charge.   For lunch you may dine on corn beef, roast beef and pastrami sandwiches (on a baguette) for $15 per meal and add soup for $5.00 extra.

For now, Royal Caribbean/Celebrity are the only cruise lines charging extra for food served in the dining rooms of its ships.    Let’s hope it stays that way.

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Normally I advise cruisers drop luggage in the cabin to run to the spa to book beauty treatments once they board.   But if you’re cruising with Celebrity Cruises you won’t have to do that any longer.

Celebrity is adding spa, salon and personal fitness appointments to onboard activities that may be reserved prior to the cruise to be booked online in advance of the departure.  Over 100 AquaSpa, salon and fitness offerings such as massages, facials, men’s barber services and hair styling

Like other cruise lines, Celebrity is adding to the roster of services and activities which may be booked at their website.  These include beverage packages, shore excursions, specialty dining reservations, and complimentary “Celebrity Select Dining” main dining room preferences.

By mid-November, guests will be able to book spa, salon and personal fitness appointments prior to their cruise on six of the nine Celebrity ships that will offer this option. The first ship to offer this option is Celebrity Solstice, the flagship of the premium cruise line’s stylish new Solstice Class ships. Guests sailing on Celebrity Solstice can currently book and pay for spa, salon and personal fitness appointments up to four days prior to their sailing date. Guests booked on voyages departing on August 21 or later on Celebrity’s newest Solstice Class ship, Celebrity Eclipse, can also book these appointments. On August 26, guests sailing on Celebrity Equinox’s voyages of September 9 or later can book these appointments. The rollout will continue through 2011, when Celebrity Cruises will launch its fourth Solstice Class vessel, Celebrity Silhouette.

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* Holland America’s new 86,000-ton Nieuw Amsterdam was christened in Venice yesterday by Queen Maxima of The Netherlands before setting sail on its inaugural Mediterranean voyage.    A sister ship of the popular Eurodam, the vessel boasts a new feature,  a chef’s table, available for 18 guests nightly. It’s priced at $89 and includes many courses of fancy food with accompanying wines.   The ship also boasts a $3 million art collection ranging from antiques by traditional Dutch masters to creations by renowned contemporary artists.  Adorning the ceiling of Nieuw Amsterdam is an abstract sculpture of the New York skyline made from clear translucent blocks that hang upside-down.   Following a season in the Med, the ship repositions to Fort Lauderdale and a series of seven- and 14-day Caribbean voyages.  On April 3, 2011, Nieuw Amsterdam sails from Fort Lauderdale to Barcelona to resume Mediterranean cruising.   Check out Fran Golden’s on-the-scene report by clicking here.

* Passengers boarding Celebrity Cruises’ newest ship, Celebrity Eclipse, in Southampton described the ship as “stylish and brilliant”.  The cruise line is targeting  upscale, sophisticated cruisers and, like sister ships Solstice and Equinox, has added  features like the Hot Glass Show, a glassblowing show and studio developed with The Corning Museum of Glass; 10 dining venues; Celebrity iLounge, a hip computer center stocked with Apple products, including 26 MacBook Pros; suites with concierge service; “AquaClass” staterooms with spa amenities and access to the healthy dining restaurant Blue and A freshly manicured lawn on the highest deck of Celebrity Eclipse. Following its European season, Celebrity Eclipse heads to Miami where, starting in November, it commences a series of alternating 7- night Eastern and Western Caribbean voyages through April 2011.   See Anita Durham-Potter’s report by clicking here.

* Luisa Frey Gaynor is my pick as the best authority on cruising with kids and gives invaluable tips on Hawaii family vacation including recommending shore excursions, when to go, which age groups are best (leave infants and toddlers at home!),  sightseeing you can do independently, how to save money and family photo ops.   See her invaluable advice by clicking here.

I don’t know about you, but seeing cruise deals makes me want to pack my bag.  Here are a few I found today trolling the internet:

*  Celebrity Solstice Eastern Caribbean cruise sailing round-trip from Fort Lauderdale starts at $599 per person, double occupancy, balconies start at $799, on the Sept. 19, Oct. 17 and 31 departures.   Ports of call are San Juan, St. Thomas and St. Maarten.  For details visit Cruises Only.

* MSC Cruises is offering a 13-night fall foliage cruise, sailing round-trip from New York,  for less than $70 per day or $899 per person (plus government fees and taxes, GFTs) through August 31. Best of all, kids under 17 sail free.   See your travel agent.

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Celebrity Cruises’ new Solstice-class ships  are so popular that the cruise line is adding several of their most distinctive features to other vessels in the fleet.   Celebrity Constellation just emerged from a 15-day drydock boasting a Tuscan Grille steakhouse; the Bistro creperie; a Martini Bar; a Cellarmasters wine bar and Gelateria.  The ship’s staterooms were refurbished with flat screen TV’s, new furniture, bedding and carpeting.

Celebrity’s four Solstice-class vessels include Solstice, Eclipse, Equinox and Silhouette (entering service in 2011).

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If you’ve ever wanted to try one of Celebrity Cruises newer Solstice-class ships,  the 2011-12 Caribbean season will present a wealth of opportunity.  The cruise line has announced that four of the ships will cruise the Caribbean, including the new Celebrity Silhouette which will winter in Bayonne, NJ and sail longer Caribbean itineraries.

From November 2011 to April 2012, Celebrity Silhouette (entering service in 2011) will sail from Bayonne on 14 alternating Southern and Eastern Caribbean voyages of 12 nights in length. The Southern Caribbean itineraries will visit St. Thomas, St. Kitts, Antigua, St. Lucia and St. Maarten. Celebrity Silhouette’s Eastern Caribbean cruises include visits to San Juan, Labadee (Celebrity’s private-island destination in Haiti), St. Croix, St. Thomas, Antigua and St. Maarten.

Celebrity Solstice will return to South Florida to offer roundtrip seven-night Caribbean cruises out of Fort Lauderdale in the winter of 2011-12. These will be a series of 25 alternating Eastern and Western Caribbean itineraries, including a special eight-night Eastern Caribbean holiday sailing on December 18 that will feature an extra sea day.   Celebrity’s third Solstice-class ship, Celebrity Eclipse will return for the Caribbean for a second consecutive winter season in 2011-12, offering seven-night Eastern Caribbean cruises roundtrip out of Miami.

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According to USA Today’s Cruise Log, Celebrity Mercury has cut out a port call and will return to home port Charleston early because of a third large outbreak of Norovirus.   On the Feb. 15 voyage, 411 out of 1830 passengers (22%) became ill with the gastrointestinal disease.  According to the Centers of Disease Control,  some 182 cruisers fell ill on the February 26 cruise.  And, according to CDC’s website, in 2009 there were two outbreaks aboard Celebrity Mercury.

Cruise Log’s Gene Sloan reports that a Celebrity spokeswoman that the current outbreak has affected 342 passengers aboard the ship.

While the incidence of Norovirus was on the decline, in the first three months of 2010 the CDC has confirmed eight outbreaks aboard cruise ships calling in the United States.   Additional episodes have been reported on Celebrity Millennium (2/22); RCI’s Jewel of the Seas (2/22); Cunard’s Queen Victoria (1/04 and 2/12); Holland America’s Maasdam (2/19) and the Balmoral (1/05).

To learn how to reduce the chances of getting the Norovirus, see our previous story “Cruise Doc Offers Tips For Avoiding Noroviruses Aboard Ship

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Azamara Cruises has announced sweeping upgrades and enhancements to its on-board program plus the addition of more overnight stays in port and unique shore excursions.  And to launch the upgrades, the cruise line also has a new name: Azamara Club Cruises.

Starting April, 2010, passengers sailing aboard the 694-passenger Azamara Journey and Azamara Quest will find gratuities, house wine at lunch and dinner, specialty coffees, soda, bottled water and shuttlebus service to and from port communities included in the cruise price.  In addition, suite passengers will have complimentary dining in the ship’s two alternative restaurants.

Azamara, which is an upscale division of Celebrity Cruises and owned by Royal Caribbean International,  has taken these steps to create greater competition with Oceania Cruises.  Both cruise lines operate identical small ships that were previously operated by now defunct Renaissance Cruises.  The cruise line’s president and CEO Larry Pimentel says that while fares will increase “This is about taking an already great product and making it exceptional.”

Like Oceania, Azamara Club Cruises schedules overnight stays in port, allowing passengers to get a more in-depth experience ashore.

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After Royal Caribbean announced a flexible dining option for ships in its fleet, it was only a matter of time that its subsidiary, Celebrity Cruises, would follow suit. Today Celebrity introduced a flex dining option that allows passengers to choose when they dine — in open, single seating or the traditional assigned seating — in the main dining room onboard or on a day-by-day basis. And you may select your specific program prior to departure at the cruise line’s website.

Celebrity’s passengers can go online to choose their desired dining time – anytime between 6 and 9:30 pm – for each day of their cruise, up to four days prior to boarding. Reservations also can be made onboard with the main dining room’s Maitre d’. Pre-cruise reservations are strongly encouraged in order to ensure the best possible dining experience. Guests can pre-book their dining times online. All dining times are subject to availability, and guests who elect Celebrity Select Dining must pay gratuities.

Guests sailing on Celebrity’s newest ship, the 2,850-guest Celebrity Equinox, beginning with the September 26, 2009 sailing, will be the first to experience Celebrity Select Dining. Online booking for pre-cruise day-by-day dining reservations for this sailing opened today. Guests who are already booked on Celebrity Equinox’s sailings taking place on or after September 26 can choose to switch to Celebrity Select Dining.

The new flexible dining program will be available on the following ships:

Celebrity Solstice – January 10, 2010 sailing
Celebrity Constellation – January 17, 2010 sailing
Celebrity Century – January 23, 2010 sailing
Celebrity Millennium – February 1, 2010 sailing
Celebrity Summit – February 13, 2010 sailing
Celebrity Mercury – February 15, 2010 sailing
Celebrity Infinity – February 28, 2010 sailing

Individuals who elect to take advantage of Celebrity Select Dining before cruising will be required to pay (before cruising) Celebrity’s recommended gratuity amounts for their waiter, assistant waiter, dining room management and stateroom attendants. If guests wish to choose to change from traditional dining to Celebrity Select Dining after they have boarded, they can do so within the first 24 hours of their cruise, on a space-available basis. Guests who choose Celebrity Select Dining while onboard or who are otherwise not eligible to be charged prior to sailing will automatically have gratuities added to their onboard portfolio account.

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