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O
ne of the most enjoyable aspects
of liveaboard dive boats, cruises
and group dive travel is the social
environment. You can meet
some terrific people with diverse
backgrounds and sit around in the evenings sharing
stories of the day’s adventures and previous great
dives. Some of the new friendships may last long
past the time spent at sea. Unfortunately, with the
good may come the bad — and sometimes the ugly.
Communicable diseases can be passed among people
who share confined living spaces such as those found
on cruise ships, liveaboards and commercial aircraft.
While working at Duke University Medical Center
in the mid-1990s, I was in the microbiology lab one
holiday weekend when a large bag of specimens from
more than 35 patients unceremoniously arrived from
the student infirmary. The order slip for each specimen
read “check for bacteria, ova and parasites,” a routine
request for patients with severe gastrointestinal (GI)
complaints. The patients had been examined by various
medical providers, none of whom were aware of the
larger picture of the incident. It turned out that all
the ill students were women who had spent the past
few days going through sorority rush. An examination
of a representative sample of the specimens with an
electron microscope identified the responsible pathogen
as a virus that commonly causes such outbreaks of
gastroenteritis. No antibiotics were necessary, and all
of the ill students were reassured that their recoveries
would be swift and complete.
You would have to be living in a media vacuum
to have missed the large number of
reports of disease outbreaks on cruise
ships in the past several years. Some
were so severe that the cruise had to
be cut short and medical assets had
to be deployed from shore. Reports
and images of passengers enduring
difficult conditions were broadcast
by the media and made quite an
impression on the public. Nearly all of
these illnesses were caused by viruses
belonging to the norovirus family,
viruses in the same group as those responsible for the
Duke sorority rush outbreak.
There is nothing about these viruses that makes
them any more likely to cause disease at sea —
wherever there are large groups of people living
together for days at a time, the risk of communicable
GI and respiratory infections is significant. The
additional variable of food service increases the risk.
SHARED LIVING SPACES
The most common diseases spread among people
who share living spaces are those that cause upper-
respiratory-tract infections (the common cold) and those
that cause GI problems. These diseases are typically
spread from person to person via respiratory droplets or
direct or indirect contact with oral fluids. Fortunately,
most of these diseases are self-limited and cause relatively
minor symptoms. In rare instances, however, they
may cause severe disability or even death. Despite the
generally non-life-threatening nature of most of these
afflictions, they tend to put an end to the activity that
may be the entire reason for the trip: diving.
Viral diseases are by far the most common in close-
quarters settings, but bacterial pathogens are also a
hazard. Some bacterial pathogens cause disease directly,
while others produce toxins that make people ill. This
article will provide an overview of the contagious
diseases you’re most likely to encounter in close or
confined living spaces (such as those found on boats),
give suggestions for managing or treating them and,
perhaps most important, offer suggestions for avoiding
these nasty bugs altogether.
B Y J I M C A R U S O , M . D .
TIPS FOR STAYING HEALTHY AT SEA
Communicable Diseases
and Close Quarters
STEPHEN FRINK
