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Advice for those going on Cruises

Cruises are increasingly popular and allow adventure at the same time as the security of good accommodation, food and other facilities.

Diet and weight gain

Food on cruises is frequently excellent and provided in abundance. Many passengers put on a lot of weight even during short cruises.

Ship movement and accidents

Ships are inherently unstable due to sea swell and currents and accidents are common due to falls on deck and staircases. Excessive drinking of alcohol is common.

Sunburn

Care must be taken to avoid sunburn and UV light reflection from the water as well as from the sun make this more likely at sea. Dehydration can be prevented by drinking abundant non-alcoholic fluids.

The elderly and those with medical conditions

Some cruise ships are unsuited for frail, elderly and handicapped travellers. Suitability, therefore, should be ascertained pre booking particularly if special facilities are required. Heart problems may be exacerbated by over indulgence in food and alcohol and lack of exercise. Over exposure to the sun increases the possibility of stroke. Accidents may occur as a reult of over indulgence in alcohol. Older people with poor balance are more likely to sustain injury while walking around the ship in rough weather since they tend to be less agile and have slower reaction times.

Medical facilities

Health care is usually available on board ship but regardless of the quality of primary medical care a ships infirmary is often unable to provide immediate backup services such as surgery, blood transfusion, detailed laboratory or radiological investigations. Medical evacuation in emergency is dependent upon the ship’s position at sea, the sailing itinerary and next port of call.

Medication

Supplies of medications on board ship are likely to be limited and shortfalls in medication cannot always be met. Ensure that sufficient supplies of drugs are obtained pre travel. Those with existing illnesses or who are on medication should obtain a summary of their condition(s) and a copy of current prescriptions from their doctor before departure.

Infections and Vaccinations

Complicated vaccination schedules are usually unnecessary unless overnight stays on shore are anticipated in less than ideal accommodation.

Great care is normally taken to prevent outbreaks of food poisoning on cruise ships but rarely contaminated food may be taken on board during stopovers. Those who choose to eat ashore must take care to avoid contaminated water and risky foodstuffs. Because hepatitis A is so easily spread vaccination against this disease may be appropriate for those cruising outside Europe and North America. If a passenger is likely to take risks when ashore, in addition to hepatitis A vaccination, typhoid vaccine and poliomyelitis boosters may be considered if recommended for the countries being visited.

Influenza is a recognised problem on cruises where large numbers of people are living in close proximity. Vaccination should be considered especially for the elderly and others with medical conditions making complications of influenza more likely. For these groups pneumococcal vaccine may also be considered if not received previously.

Another problem which can result from large numbers of people living together is 'epidemic vomiting disease' often due to the norovirus (previously called Norwalk virus). This is very difficult to control and is spread through fomites and the respiratory route. Large number of passengers may be involved but the illness is usually mild and self-limiting. Good personal hygiene may help to reduce spread.

Certificates: passengers may be asked by the cruise company to carry a valid certificate of vaccination against yellow fever - this is an immigration requirement for some countries especially in the Caribbean, South and Central America and sub-Saharan Africa. Unvaccinated passengers may not be allowed ashore. In these areas yellow fever disease itself may be a risk for those venturing into rural and jungle areas but is unlikely to be contracted by those staying on board or visiting only urban areas.

Post-exposure rabies vaccination is usually available on larger cruise ships for those unlucky enough to have a dog bite while ashore.

Malaria

The risk is normally very small in ports in the Middle East, central and east Asia, the Caribbean, South and Central America with the possible exception on Manaus in Brazil where urban outbreaks sometimes occur. Accommodation on cruise ships themselves is usually excellent with air-conditioning and well screened lounges and bars etc. Overnight exposure is unusual since most passengers only venture off the cruise ships during daylight hours.

However the risk of malaria may be significant when entering ports in infected countries in sub-Saharan Africa especially if berthed overnight.

Mosquito bites should be minimized not just to reduce the risk of malaria but of other diseases such as dengue fever. If prophylaxis is used Malarone has an advantage in that it only needs to be taken for 7 days after exposure, so the scenario of having to take 4 weeks tablets after an overnight stop, for example, in the Gambia is now unnecessary. Prophylaxis may be more important for those with medical conditions and for the elderly when an attack of malaria may be more serious.

Passengers should always be aware when they may have been exposed, however small the risk, so that they can seek medical attention should any fevers occur.

Sexually Transmitted Diseases

Casual sexual relationships among passengers on cruises are reportedly quite common including sex with crew members who may be from countries where infections such as gonorrhea, herpes and syphilis are common. 'Safer sex' practices are important to prevent these and also HIV infection and hepatitis B.
     
     
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