Cyclospora Cayetanensis Outbreak
Holland America Line Amsterdam
April 2 To April 24, 2009
While the entire world was fearing the H1N1 Swine Flu on cruise ships and cruise ships were becoming infected with Norovirus, Holland America Line was quietly taking a germ cruise ships had not seen before, right into eight nations.
Holland America Line's Amsterdam is the first cruise ship to report a new threat to passengers. The infection Cyclospora Cayetanensis has been reported on the April 2, 2009 to April 24, 2009 sailing.
The CDC says that 135 (10.24%) of 1,318 passengers contracted the germ and that 25 (4.17%) of 600 crew member also became ill on the voyage.
Cyclospora Cayetanensis is not transmitted through touch, cough or sneeze unlike Norovirus. The CDC site says:
"Cyclospora is spread by people ingesting something, such as food, water, that was contaminated with feces (stool). Cyclospora needs time (days or weeks) after being passed in a bowel movement to become infectious for another person. Therefore, it is unlikely that Cyclospora is passed directly from one person to another."
In order to pass the germ, an infected person would have to transfer the germ from their own feces to their hands then onto food others would eat.
Holland America Line's Amsterdam was in Santiago, Valparaiso, Chile on April 2, 2009 when the first case was thought to have emerged. Given the germ does not effect symptoms immediately, the first case may have originated after visiting Argentina or Uruguay in mid to late March.
Amsterdam was on a repositioning cruise to begin the season of cruises to Alaska. Calls were in South America, Central America, Mexico (April 14), San Diego, California then onto British Columbia, Canada and Seattle, Washington (April 24) before dry dock.
Infected people with poor hygiene habits could have transmitted the germ to eight nations, or more.
The most likely origin of the germ was in fresh fruits or vegetables that originated in South America. Workers at produce growing operations are typically known for not having good access to bathrooms nor water in the fields. After having a bowel movement, if hands are not washed properly, feces can be transferred to picked foods.
In addition, pickers working in the fields taking bowel movements near the fields may contaminate entire crops when heavy rain transfers the bacteria to entire fields.
The germ than can transfer from fruit to fruit within harvesting containers. Cross contamination can take place where the fruit is later mixed with other fruits during storage.
Outbreaks have been growing in number with two outbreaks per year in the 1970s, sixteen outbreaks per year in the 1990s.
In 1996, an outbreak that covered the United States and Canada resulted in approximately 850 cases of laboratory-confirmed Cyclospora infection in persons residing in the United States and Canada whose onset of illness was in May and June 1996 were reported to CDC and Health Canada.
The actual number of infections, considering those not treated by a physician and confirmed by laboratory testing could have been in the tens of thousands.
Approximately 14% of all cases were reported from Ontario, Canada; nearly all (approximately 99%) of the other cases were reported from states east of the Rocky Mountains within fourteen states.
Fifteen case-patients were hospitalized, but no deaths were reported.
In that outbreak, the suspected origin was consumption of raspberries that were grown in Guatemala.
The outbreak, and all outbreaks of Cyclospora can be avoided by only consuming thoroughly washed or cooked fruit and vegetables.
With the high cost of many fruits and vegetables, many cruise ship passengers consume large amounts of produce on cruises via the ship's buffets, thinking they are getting more value for their cruising dollars.
This also puts them at higher risk for ecoli and salmonella strains transmitted through various fruits and vegetables. From there, with poor hygiene after intestinal upset, Norovirus can be the next wave aboard.
Never assume any fruit has been thoroughly washed before being served, if it is raw. Cooked fruit is much less likely to contain germs that can make people ill.
NOTE: Cases reported in this category only reflect those reported to the infirmary. Many passengers do not seek medical care aboard a ship, due to the high expense.
