Recent outbreaks of illness aboard cruise ships are raising concerns about traveler safety, infectious disease preparedness, and whether weakened federal oversight continues leaving travelers more vulnerable at sea.
On May 13, Dr. Kartik Cherabuddi, Chief epidemiologist at Tampa General Hospital; Dr. Sten Vermund, Dean of the USF College of Public Health; Dr. Thomas Unnasch, now-retired Prof. USF public health; and Jacob Munch, a board-certified Maritime and civil trial attorney, all joined MidPoint to examine the risks to cruise passengers and crews following reports of a hantavirus outbreak aboard the Dutch expedition cruise ship M.V. Hondius and a separate norovirus outbreak involving more than 100 passengers on a Princess cruise departing from Port Canaveral, FL.
The MidPoint conversation explored how cruise ships – despite being marketed as relaxing getaways – can quickly become high-risk environments for the transmission of infectious diseases.
Threats
The hantavirus outbreak aboard the M.V. Hondius stood out because the disease is not typically associated with cruise travel. Hantavirus is a rare but potentially fatal family of viruses. Most strains (like most of those in the U.S.) do not spread from person to person. However, the Andes virus strain found in South America can spread between humans. The illness begins with flu-like symptoms (fever, muscle aches, fatigue), which can then progress into severe respiratory distress as the lungs fill with fluid. The mortality rate can be very high, ranging between 20% to 40%.
Hantavirus is linked to exposure to certain infected rodents, particularly exposure to contaminated mice droppings, urine, or saliva in enclosed environments. Unlike more common respiratory illnesses, human-to-human transmission is considered extremely rare in most strains.
Public awareness of the disease greatly increased recently after the reported death from hantavirus of Betsy Arakawa, the wife of actor Gene Hackman, in New Mexico, drawing attention to how dangerous hantavirus infections can be. With the outbreak aboard the M.V. Hondius cruise resulting in 3 deaths thus far, public interest and concern about hanatvirus exposure has intensified.
Hantavirus is difficult to diagnose in its early stages because the symptoms are non-specific. Dr. Vermund said: “Unfortunately, hantavirus looks a lot like influenza, and influenza looks a lot like coronavirus, and coronavirus looks like a whole host of other respiratory pathogens.”
Dr. Unnasch explained that there is no vaccine for hantavirus because it’s mostly an accidental, rare infection. So, there hasn’t ever been “a real impetus to develop a vaccine.”
To date, 18 U.S. passengers who were on the MV Hondius cruise ship remain in federal quarantine as doctors and the Centers for Disease Control and Prevention figure out when they can safely go home. At least seven Americans who got off the ship earlier are said to be quarantining at home in multiple states, where health departments have said they are in regular contact with passengers as they monitor for symptoms. None of those passengers is in Florida.
Why Cruise Ships Are Vulnerable
Cruise ships create almost ideal conditions for the transmission of illness. Norovirus remains one of the most common causes of cruise-related outbreaks because it spreads easily and stays longer on surfaces. Thousands of passengers share indoor spaces, common dining areas, elevators, handrails, swimming pools, and entertainment venues, making containment difficult once an illness begins spreading.
Experts also raised sanitation concerns about hantavirus, including the possibility of rodent exposure on certain vessels, particularly expedition-style ships operating in remote locations. Unfortunately, as the doctors noted, when you have a large, confined community with many people in close contact, a disease that is spread by close contact with airborne particles is difficult to prevent once it is present. There has been speculation that the initial passenger’s hantavirus death was preceded by his individual excursion on a bird-watching trip to a landfill where he may have been exposed. Circumstances suggest the best prevention from an outbreak of hantavirus is avoidance of an initial exposure, and similar protocols to those encouraged during the Covid-19 epidemic, such as distancing, ventilation, and sanitation, are recommended.
Questions About Federal Oversight
The MidPoint conversation also turned to the current state of public health oversight. With key federal health leadership positions either vacant or in transition – including the CDC director, FDA commissioner, and U.S. Surgeon General – questions were raised about whether our public health infrastructure is equipped to respond effectively.
Concern centered on the CDC’s Vessel Sanitation Program, which has historically inspected cruise ships and monitored outbreaks of illnesses. Reports of staffing cuts and restructuring have caused concern that oversight has weakened at a time when cruise travel continues to rebound.
If public health monitoring systems are reduced, experts suggested, outbreak response could become slower and less effective.
Legal Problems for Sick Passengers
For travelers who die, become seriously ill, or are injured on board, the first step in determining whether the cruise line has any legal responsibility often begins with the ticket itself. Cruise bookings typically come with extensive terms and conditions – often dozens of pages long – that most travelers quickly accept without closely reviewing them, even though those documents can determine important legal rights, including specifying the jurisdictions where claims must be filed.
Maritime attorney Jacob Munch explained that cruise ticket contracts often specify where passengers can file legal claims, sometimes requiring litigation in foreign jurisdictions depending on the ship’s registration.
For the M.V. Hondius, operated by a Dutch company, legal claims would likely need to be made in the District Court of Middelburg in the Netherlands.
For major U.S.-based cruise operators such as Royal Caribbean, Carnival, and Norwegian Cruise Line, lawsuits are generally handled in federal court in Miami.
Safety
Is It Safe? That was the question listeners kept returning to throughout the program.
While experts did NOT suggest avoiding cruises altogether, they pointed out that risk depends on the ship, the destination, onboard sanitation practices, and personal health factors.
Cruise vacations remain a major part of the tourism industry, but health emergencies at sea can become far more complicated than travelers expect, with limited medical care aboard, complicated legal protections, and uncertain public health oversight once a ship leaves port.
The takeaway is simple: understand the risks before going cruising.
You can listen to this entire MidPoint show on demand from the archive here, on the WMNF app, or as a WMNF MidPoint podcast on Spotify or Apple Music.
