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When people think of health issues on cruise ships, their minds usually go to outbreaks of norovirus. That’s a highly contagious virus, typically spread by the fecal-oral route, which causes gastrointestinal symptoms such as diarrhea, vomiting, nausea and stomach pain.

However, it’s not just communicable diseases that can potentially make people sick on a cruise ship. Anything that can have an effect on public health – food handling, a ship’s potable water system, certain maintenance issues, ventilation, care of bodies of water such as pools and hot tubs, proper cleaning of uniforms and costumes, and the list goes on and on – can all affect the well-being of a cruise ship’s passengers and crew.

Obviously, the CDC wants to ensure passengers’ safety on cruise ships departing from U.S. ports. Not surprisingly, so does the cruise industry since each company wants to keep its reputation clean. So, the two entities have developed a Vessel Sanitation Program (VSP) and a VSP Operations Manual.

HHS/CDC established the Vessel Sanitation Program (VSP) in the 1970s as a cooperative activity with the cruise ship industry. VSP helps the cruise ship industry prevent and control the introduction and spread of environmentally associated illnesses and hazards on cruise ships. VSP operates under the authority of the Public Health Service Act (Section 361 of the Public Health Service Act; 42 U.S.C. 264, “Control of Communicable Diseases”). Regulations found at 42 CFR 71.41 (Foreign Quarantine—Requirements Upon Arrival at U.S. Ports: Sanitary Inspection; General Provisions) state that carriers arriving at U.S. ports from foreign areas are subject to sanitary inspections to determine potential rodent, insect, or other vermin infestations; contaminated food or water; or other sanitary conditions requiring measures to prevent introduction or spread of communicable diseases.

Most people know about the CDC’s involvement in the health of passengers on cruise ships when there’s an outbreak of “something” (norovirus, COVID-19, etc.). However, the CDC also inspects each cruise ship twice a year. These inspections include checking common spaces such as kitchens, hot tubs, and children’s activity centers.

Obvious issues, such as vermin and improperly stored foods, will remove X points. Less obvious but equally important issues, such as buffet handwashing stations with light sources less than 110 lux or the swimming pool’s hair and lint strainer not being disinfected frequently enough, will also result in point removal.

These inspections are converted into a score that shows how well they follow the VSP requirements.

How are they scored?

Ships are scored on a scale of 1 to 100 for how well they’re keeping up with the standards set in the VSP Operations Manual. They’re also given recommendations for addressing any issues.  It’s very much like an inspection restaurants are given by the local Board of Health, but on a larger scale. Any score that’s 85 or below is considered “not satisfactory.”

What sort of things do they find on ships that are not satisfactory?

These are some examples; names of ships withheld to protect the guilty 😉

• Ten flies were found on a buffet deck…One fly was resting on cheese slices and flying around other burger toppings
• Slimy black residue accumulated in areas of peeling and recessed caulk
• filter sand for the three whirlpools has never been changed since the ship was delivered by the shipyard in 2022
• Several live and dead insects, a dead bird, and live maggots were found in various food areas onboard the vessel
• a nonfood employee classified as a GI reportable case had a cabin mate missing a record of close contact follow-up details. There were also no secondary notes indicating if follow-ups were made for this person.

The scores

The CDC has inspected 120 cruise ships so far in 2024. Nineteen got perfect scores of 100; the majority scored somewhere around 95, 10 got less than 90 and 1 failed. Here are the average scores for each cruise line, in numerical order: