cruise guidelines covid

Have Fun. Be Safe.

• Have Fun. Be Safe. Guidelines

Cruising with Carnival is easy! Vaccines and testing are not required for most U.S. and European departures.*

Guests sailing to and from Australia must visit the Australia Have Fun. Be Safe. page for protocols specific to those cruises.

VACCINATION & TESTING

Although vaccines are not required, we encourage all guests, 5 years of age and older, to be up to date with their COVID-19 vaccines, when eligible, and carry proof of vaccination. Testing is not required for either vaccinated or unvaccinated guests. However, we encourage all guests, 5 years and older, to take a pre-cruise COVID-19 test within three days of their cruise.

*Carnival Luminosa - 9/14/2023: This Carnival Journeys Transpacific voyage will be calling on certain destinations (including Australia) which are still observing COVID-19 protocols. Below are more details regarding vaccination and testing requirements for this voyage:

• Guests, aged 12 years and older, must be fully vaccinated to sail. Additionally, we strongly recommend that guests get a booster, if eligible.
• All guests, aged two years and above, regardless of vaccination status, are required to take a self-administered Rapid-Antigen Test (RAT) within 24 hours of boarding or a PCR test within 48 hours prior to boarding. Evidence of a negative result is required to cruise.
• Vaccine exemptions are required for guests, aged 12 years and older, with medical conditions preventing vaccination. If you, or a member of your party, meet the criteria for a vaccine exemption, you may apply here .
• Full details regarding vaccination and testing requirements and FAQs are available on the Australia Have Fun. Be Safe. page .

DESTINATION REQUIREMENTS

We will continue to monitor the protocols and requirements of the destinations we visit and will update our guests directly and this page of any changes.

Have questions? Check out our Have Fun. Be Safe. FAQs for all sailings, except Carnival Luminosa’s 09/14/2023 voyage.

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With the relaxation of travel requirements around the world, we’re thrilled to welcome all guests back on our ships to cruise freely to the places they’ve been dreaming of – regardless of vaccination status and with no testing requirements.

Destination specific requirements will still need to be met. For specific country requirements, please visit Cruise Travel Requirements by Country .

Benefits of 100% Vaccination Requirements*

• Cruise Mask-free**

Breathe freely and witness smiles everywhere you go!

• No Social Distancing Required

Get up close and personal with confidence, everyone on board is vaccinated.

• All Restaurants & Experiences Are Fully Open

Dine in any of our restaurants mask-free, including our self-service buffet. Plus enjoy all entertainment options.

• No Restrictions on Shore Excursions †

Feel Free to take the shore excursion you’ve been dreaming of or explore on your own!

• No Capacity Restrictions

Appreciate the full Norwegian experience — all venues and experiences are entirely open.

• Surround Yourself in Safety

Peace of mind knowing all guests and crew on board are fully vaccinated.

*As government regulations evolve, our health and safety protocols will evolve as needed to ensure compliance. This may mean different protocols from ship to ship based on local requirements. For additional information, please visit Cruise Travel Requirements by Country .

**On Europe sailings only, currently local government regulations requires all guests to wear masks onboard. Refer to FAQs section for complete details.

† Due to local government regulations, guests are required to take a Norwegian Cruise Line shore excursion while visiting Colón, Panama; St. Kitts and ports in Italy as guests will not be allowed to explore on their own.

Safety FOR OUR GUESTS & CREW

Safety aboard our ships, safety ashore.

We have developed a comprehensive and multi-layered set of health and safety protocols that span the entire cruise journey, guided by the expert advice from our Healthy Sail Panel. We will continuously refine and improve these protocols as science, technology and our knowledge of the virus improve and will provide guests with all relevant information or any changes to protocols prior to setting sail.

We will initially control the guest capacity onboard each ship to provide even more space per guest and allow for physical distancing while onboard.

Contactless food and beverage service will be provided across all ships with service staff stationed ship-wide, including all restaurants and lounges.

All guests will be required to engage in frequent handwashing and hand sanitizer will be prominently placed and easily accessible throughout the ship.

Daily temperature checks and ongoing symptom screening will be practiced so you can feel confident your fellow guests aren’t fellow carriers. But don’t worry, looking hot is still okay.

Safety Aboard our Ships

With Sail Safe, our industry leading Health & Safety Programme, we will continue to put our guests and our crew members first by keeping everyone safe and healthy on board our ships and in the communities we visit. In addition to requiring our crew to be up-to-date with all their vaccinations, we will continue to evolve our already robust science-backed programme to broaden our cleaning, sanitation and air filtration technologies across our fleet.

With Sail Safe, our industry leading Health & Safety Program, we will continue to put our guests first by keeping you safe and healthy on board our ships. Here’s what we’re doing.

Continuous Ship-Wide Cleaning & Disinfection Measures

Upgraded medical-grade air filters, enhanced onboard medical teams & health services.

We constantly monitor the health environment across the globe and will modify or cancel itineraries to affected areas as needed.

We’re partnering with our local destinations and tour operators to extend our comprehensive health & safety protocols to shore.

Guests are free to explore ports of call on their own, according to protocols in each specific port, and can purchase shore excursions as they wish. Face coverings may be required in certain settings to comply with local requirements, for example in terminals for embarkation and disembarkation or at ports of call. We will continue to monitor public health guidance, including from the CDC, at the time of your voyage and modify requirements accordingly.

*Due to local government regulations, guests may be required to take a Norwegian Cruise Line shore excursion in select ports. For additional information on this and other destination specific requirements, please visit the Cruise Travel Requirements by Country page.

SAIL SAFE FREQUENTLY ASKED QUESTIONS

Pre-cruise and onboard frequently asked questions.

• Individuals that test positive within 90 days of their scheduled embarkation date are exempted from the pre-arrival testing.
• They must have one of the below acceptable forms of COVID-19 Recovery (dated no less than 10 days and no more than 90 days (US) & 180 days (EU) before the date of embarkation) available during check-in.
• For European Citizens, this would include an EU Green Pass or comparable certificate. 
• For all others unable to present an EU Green Pass (i.e., US Citizens) a doctor’s note, plus a laboratory-confirmed PCR test result with the proper information (i.e., Name, Date, Date of Birth, Positive Result, etc.)
• COVID-19 Recovery must be dated no less than 10 days and no more than 90 days (US embarkation) & 180 days (EU embarkation), documentation must be available during check-in.
• Bermuda government does not allow certificate of recovery in lieu of negative test result.

In order to facilitate pre-cruise testing requirements, Norwegian has partnered with Inspired Diagnostics lab to ensure that guests have access to a quick, efficient and easy way to access the required FDA-approved proctored in-home antigen test prior to embarkation from the comfort of their own home. Inspired Diagnostics is a subsidiary of Inspire Health Alliance, a leader in best-in-class health services. Testing at home is safe, simple, and convenient. Purchasing in-home testing kits is simple.

• Sign up on the testing site https://inspirediagnostics.com/ncl/
• Receive the test kit(s) by UPS
• Timetable an on-line proctoring consultation
• Receive certified results via email

Additionally, the following services offer a verified third party or medically supervised at home testing: eMed or BioReference-Scarlett Concierge testing service – BioReference sends a trained Scarlet Health Professional to your home to collect your COVID-19 test specimen.

Should you need to locate a testing provider prior to beginning travel or whilst travelling prior to your cruise, please visit TestForTravel.com , an easy-to-use online tool for locating COVID-19 testing providers around the world. Simply enter your postcode, or city and country, and the website will display locations, contact information, and testing hours. It also allows you to search by test type – PCR or Antigen.

Effective for sailings 10/4/22 and beyond, all guests regardless of vaccination status are able to sail and with no testing requirements. This does not supersede country specific requirements - Travel Requirements by Country

Local regulations may have booster requirements to enter certain countries – make sure to check Travel Requirements by Country to understand country specific requirements.

Local regulations may have vaccine requirements to enter certain countries – make sure to check  Travel Requirements by Country  to understand country specific requirements about accepted vaccines

As of August 8, 2022, effective for sailings September 3, 2022 and beyond, vaccines will not be required to sail. However, requirements will vary for unvaccinated guests and guests must still adhere to country specific requirements. Refer to Will all guests be required to be vaccinated prior to the cruise? ” and Travel Requirements by Country page.

Hawaii Cruisetours

For sailings through and including September 2, 2022:

For sailings beginning September 3, 2022:

Guests age 11 and younger, and vaccinated guests age 12 and over who have purchased a pre-cruise Cruisetour in Hawaii with Norwegian Cruise Line are not required to be tested prior to the sailing. Unvaccinated guests age 12 and over must provide proof of a medically supervised negative PCR or antigen taken no more than 72 hours prior to embarkation. This test will be facilitated and paid for by Norwegian Cruise Line.

Alaska Cruisetours

Guests age 5 and over who have purchased a pre-cruise Cruisetour in Alaska with Norwegian Cruise Line will undergo a COVID-19 antigen during their program. This test will be paid for by Norwegian Cruise Line. Further details will be outlined by your Tour Manager while on the program.

At this time, our Cruisetour vendors do not require any pre-tour Covid-19 testing; however, Norwegian Cruise Line still recommends all guests participating take a test prior to joining the Cruisetour. Please note that for unvaccinated children ages 2 through 11, the pre-embarkation testing requirements as listed on Sail Safe and Travel Requirements by Country are required to be met.

If a Cruisetour guest receives a positive COVID-19 result when testing at the pier upon arrival, they will be denied boarding and will likely be required to quarantine by local officials. Norwegian Cruise Line will assist with expenses related to any mandatory quarantine that are not covered by their travel insurance only if the guest provides proof of negative COVID-19 NAAT test (I.e. PCR) or antigen test taken within 48 hours prior to Cruisetour start date.

Guests age 2 and over who are unable to provide proof of a negative test taken within 48-hours of their Cruisetour start date will not qualify for reimbursement should the applicable expenses not be covered by their travel insurance. Proof of negative COVID-19 NAAT test (I.e. PCR) or antigen test taken within 48-hours of Cruisetour start date must show guest name, date of birth and date the test was taken in order to be eligible.

Please visit https://www.ncl.com/refund-and-cancellation-policy-covid-19 for the most up to date information on refund eligibility including how to request a refund should you or your travel companions qualify.

Yes, we welcome all guests to sail with us, regardless of vaccination status and age, and with no testing or masking requirements. This does not supersede country specific requirements - Travel Requirements by Country .

Unvaccinated children under the age of 12 traveling with vaccinated parents will be welcomed at all venues not restricted by age requirements. Children will be prohibited from adults-only venues, such as Vibe Beach Club.

For sailings through September 2, 2022:

Guests age 12 and older must acknowledge vaccination status prior to their sailing and bring proof of vaccination to the terminal for their cruise. Preferred proof form is the original vaccination record document issued by either the country's health authority that administered the vaccination or the guest's medical provider that completed the vaccine administration, however, photo of vaccination record document will also be accepted. Electronic vaccination records will be accepted for residents of countries where electronic documentation is the standard issued form. Confirmation email of vaccination appointment will not be accepted.

All guests are advised to monitor and comply with applicable travel restrictions.

Guests can expect to provide the following:

• Any documentation required from the country where the guest is embarking. This could include but is not limited to proof of a specific negative COVID-19 test result or Booster. These requirements will vary by country and is the responsibility of the guest and supersede our policy. Please refer to  Cruise Travel Requirements by Country
• Completed health questionnaire (prior to embarkation);
• Standard travel documents, including passport or any visas as required

We are closely monitoring the evolving global public health environment and to the extent any itineraries are affected, we will notify impacted guests in a timely fashion and update our booking requirements. Additional travel restrictions for certain nationalities or countries may arise based on the quickly evolving public health environment. All guests are strongly advised to monitor current travel requirements and advisories for their home countries.

For additional information, please visit Cruise Travel Requirements by Country .

We will comply with all local regulations at all destinations we visit. These regulations are continuously evolving and if an additional test is required at a port of call we will provide advanced notice to all guests. For additional information, please visit Cruise Travel Requirements by Country .

*Please note, in the event a port included as part of an itinerary requires additional COVID-19 testing in order for guests to disembark, Norwegian Cruise line will facilitate the testing onboard.

All guests are required to accept the terms and conditions in our guest ticket contract. In addition, guests will be required to agree to abide by all of the cruise line's health and safety protocols and acknowledge the risks associated with COVID-19 during their voyage and shoreside experiences. Guests who fail to agree to these terms and conditions will not be permitted to board.

Antigen Tests

COVID-19 antigen tests prior to disembarkation will be administered on board and paid for by the Cruise Line for those guests who require a test to return home.

Effective for all disembarkations beginning January 8, 2022, PCR tests will only be available onboard to confirm a positive antigen test, or to test a symptomatic patient. Those guests requiring a PCR test to return home will be responsible for expense and must obtain the test shoreside after the disembarkation either at a company designated facility, at the airport prior to flying out, or at a nearby clinic of their choice. At all US disembarkation ports, Norwegian Cruise Line has engaged a vendor to administer PCR testing at the terminal for those guests requiring a PCR test to return home. If guests choose this service, the guests will proceed to a designated area in the terminal for their PCR test at the guests' expense which varies by port, then proceed with their travel plans as they await their test results which will be sent electronically approximately 90 minutes after the test.

In non-U.S. ports availability may be available for PCR testing prior to flying home in the terminal, however guests are free to book their PCR test at the airport or a local clinic at their convenience. Please allow the proper time in your travels to obtain the result before flying home.

Estimated PCR test costs by port are as follows:

• All current US departure ports (except those listed below) - $125 per person
• New Orleans - $180 per person
• New York - $250 per person
• San Juan - $150 per person
• All current Europe departure ports - $125 per person

We will continue to update as additional services become available.

If a guest booked a post-cruise hotel, it is the responsibility of the guest to make their own arrangements to get re-tested at their own expense.

Italy Disembarkation Testing:

In order to best comply with local regulations, all guests disembarking in Italian ports (Civitavecchia and Trieste) who require proof of a negative COVID-19 test in order to return to their home country, will now have the following options:

• Purchase an easy-to-use telemedicine kit onboard
• Test at your convenience at the Rome-Fiumicino International Airport or Trieste Airport
• Visit a local clinic

For sailings September 3, 2022 and beyond:

Guests age twelve and over will be allowed to board unvaccinated. Unvaccinated guests age twelve and over will be required to show proof of a medically supervised negative PCR or Antigen test taken no more than 72 hours prior to embarkation.

We will initially control the guest capacity onboard each ship to provide even more space per guest.

All onboard venues and activities will be available unless staffing or other challenges onboard prevent normal operations.

No, we do not currently have any restrictions or limitations for guests with pre-existing health conditions. All guests should assess their individual risk level and consult with their doctor if needed prior to sailing.

Safety Aboard Our Ships Frequently Asked Questions

Guests who have symptoms of COVID-19 whilst onboard should immediately contact the onboard medical centre for further instruction. Onboard medical consultations and treatments are provided at a charge for all respiratory illnesses. Medical centres will be equipped to test for COVID-19 onboard and if a positive case is identified, contact tracing for that individual will begin immediately and occur at the same time as treatment.

We have also enhanced our onboard medical capabilities with additional staffing and enhanced facilities. This includes an increase in intensive care unit capacity, new and upgraded equipment, onshore medical institution partnerships, telemedicine capabilities and additional robust consultation and treatment options. Onboard medical centres are also abundantly stocked with common prescription medications, remedies, and virus-testing equipment as available.

Onboard medical consultations and standard treatments are provided for COVID-19-related illness at a charge. If a guest follows health and safety protocols and tests positive during their cruise, the Cruise Line will help coordinate necessary onboard COVID-19-related medical consultation, standard/common prescription drugs, and required land-based quarantine.

Please note: Anti-viral COVID-19 therapeutics are readily available onboard and will be charged to the guests' account. Whilst the Cruise Line will assist with arranging land-based quarantine accommodations if required, payment for all expenses incurred during any mandatory isolation period, including hotel stay, is the responsibility of the guest. We encourage all guests to file a claim with their travel insurance carrier for reimbursement enquiries. Norwegian Cruise Line will review reimbursement submissions in the event your insurance carrier denies the claim or you do not have travel insurance.

We have improved our onboard medical capabilities with additional staffing directly related to sailing capacity, new and upgraded equipment and enhanced facilities. All vessels will have COVID-19 testing capabilities on board and results onsite. We have increased intensive care units (ICU) capacity onboard and ICUs are equipped with infusion pumps, IV treatments, cardiac monitors, defibrillators, cardiac pacemakers and ventilators.

Should the need arise, we also have partnerships with onshore medical institutions in place to provide clinical advice and assistance as needed. Vessels are equipped with an onboard laboratory, which can administer Complete Blood Counts (CBC), Blood Chemistry, Coagulation tests, and Influenza tests. Onboard medical centres are also abundantly stocked with common prescription medications and remedies.

Other Frequently Asked Questions

As delivering the best experience for our guests is always a top priority, after working closely with our destination partners, we anticipate that guests will be free to explore certain ports of call on their own. Please keep in mind that this is largely dependent on the local health authorities and the evolving regulations, which are subject to change. In order to keep our guests as safe as possible, we highly recommend taking our company organised shore excursions as a more controlled environment for you to enjoy your time in each of the destinations.

Guests requiring proof of a negative COVID-19 test to return to their home country are directed to visit a clinic near the disembarkation terminal or airport. For an easy to use online tool for locating COVID-19 testing providers around the world, please visit www.testfortravel.com.

Norwegian does not require a disembarkation test. However, this does not supersede home country requirements. Effective 6/12/22, guests will no longer be required to show proof of negative Covid test to return to the United States.

Guests requiring a proof of negative COVID-19 test to return to their home country are directed to visit a clinic near the disembarkation terminal or airport.

Norwegian does not require a disembarkation test. However, this does not supersede home country requirements.

Disembarkation Testing for all Norwegian Dawn and Jade sailings beginning June 12, 2022 and beyond and for all Norwegian Epic, Escape, and Gem sailings beginning June 17, 2022 and beyond:

In order to best comply with local regulations, all guests who require proof of a negative COVID-19 test in order to return to their home country, will now have the following options:

• Purchase an easy-to-use telemedicine kit onboard (subject to availability)
• Visit a local clinic nearby or at the airport

For an easy-to-use online tool for locating COVID-19 testing providers around the world, please visit  www.TestForTravel.com .

For other vessels, if a guest requires an antigen disembarkation test to return home, this test will be administered onboard and cost will be covered by Norwegian Cruise Line. Note, there will be no PCR tests available to guests onboard unless required to confirm a positive antigen test or for symptomatic guests.

At all US disembarkation ports, Norwegian Cruise Line has engaged a vendor to administer PCR testing at the terminal for those guests requiring a PCR test to return home. If guests choose this service, the guests will proceed to a designated area in the terminal for their PCR test at the guests' expense which varies by port, then proceed with their travel plans as they await their test results which will be sent electronically approximately 90 minutes after the test.

No, guests will not be required to take a COVID-19 antigen test before continuing on the second leg of a back-to-back sailing unless symptomatic, unvaccinated or if a specific country requires it.

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Every Cruise Line's Requirements for COVID Vaccines, Testing

A guide to every major cruise line's health requirements for safe sailing.

Cruise lines have shifted their requirements for passengers, making cruising accessible to practically everyone. Many popular cruise lines have eliminated the vaccine and pre-embarkation test as the industry is beginning to shift away from mandatory vaccines and testing.

The changes began shortly after the CDC ended a pandemic-era policy of publicly displaying COVID-19 cases onboard, different cruise lines to the public in July 2022. For those looking to check current COVID-19 trends onboard the CDC urges direct contact with the cruise line, and the organization will continue to monitor and offer guidelines to ships.

Below, we break down each line's list of regulations to sail as well as what travelers need to know to plan.

Avalon Waterways

Where they sail: These small-ship river cruises sail throughout Europe, Asia, South America, and down the Nile River in Egypt.

Who needs the vaccine: All international travelers from the U.S. must be fully vaccinated before boarding. Beginning March 2023 the vaccine is no longer required (but strongly encouraged).

What other safety measures are in place: All guests will undergo a health screening upon arrival and luggage will be disinfected. Avalon will provide COVID-19 testing for travelers who need to show proof of a negative test to return home at no extra cost. Depending on the location of the cruise a pre-departure COVID-19 test may or may not be required.

Find out more: Avalon Waterways

Where they sail : Azamara sails mid-size ships all over the world, to all seven continents.

Who needs the vaccine : All guests and crew 12 and older will be required to be fully vaccinated at least two weeks before boarding a ship. Beginning Dec. 1, 2022, the company plans to drop the vaccine requirement for departures from the U.S. and Europe.

What other safety measures are in place : Depending on the port of embarkation guests may or may not to pre-test to travel. For a full list of ports and whether they require a test guests can check online .

Azamara's ships have been upgraded with new HVAC filtration systems, and EPA-certified disinfectants are used to clean the ship.

Find out more : Azamara

Carnival Cruises

Where they sail: Carnival sails large ships around the world, including popular trips to the Caribbean. The company sailed its maiden voyage on the Mardi Gras out of Florida in July.

Who needs the vaccine: All guests are encouraged to be vaccinated but unvaccinated travelers, or vaccinated guests without proof of vaccination, will have to present the negative results of a PCR or antigen test taken no earlier than 3 days before sailing.

What other safety measures are in place: For cruises five days or less, there will no longer be pre-cruise testing for vaccinated passengers unless a specific port requires it. Itineraries including Bahamas, Bermuda, or Grand Cayman will still be required to test. All guests will also be required to fill out a health screening 72 hours before embarkation and undergo health screenings prior to boarding. Unvaccinated travelers on a cruise to Bermuda will be required to purchase travel insurance (children under 12 are exempt as long as they are traveling with vaccinated parents).

Both vaccinated and unvaccinated guests who have recovered from COVID-19 within three months of their sailing date, do not need the required pre-cruise COVID test before embarkation, only if they are at least 10 days past their COVID-19 infection, have no symptoms and present documentation of recovery from COVID-19 from their healthcare provider.

Find out more: Carnival Cruise Line

Celebrity Cruises

Where they sail: Celebrity Cruises sails all over the world.

Who needs the vaccine: The vaccine is no longer required to sail on cruises from the U.S. and Europe. A vaccine is required for sailings visiting Canada.

What other safety measures are in place: A pre-embarkation test is no longer required for vaccinated guests on sailings nine days or less. Unvaccinated passengers will still be required to test three days prior to sailing. Self-tests are acceptable from European and U.S. ports that don't stop in Bermuda or Canada.

Find out more : Celebrity Cruises

Where they sail: Cunard, which sails all over the world, is known for its transatlantic journeys aboard the Queen Mary 2.

Who needs the vaccine: All guests 18 and older must be fully vaccinated. Unvaccinated passengers under 18 will be required to undergo a PCR test within 72 hours of their departure.

What other safety measures are in place: Cunard has "enhanced" their onboard ventilation systems and implemented mandatory mask-wearing policies indoors. All guests aged 4 and older are required to have a negative COVID-19 test before boarding. Crew will be tested regularly while on board. Guests who have certain pre-existing medical conditions, including those who are on supplementary oxygen, will not be allowed to board.

Disney Cruise Line

Where they sail: Disney sails family-friendly journeys including to the Caribbean, Europe, and Alaska.

Who needs the vaccine: Vaccination is no longer required by highly suggested.

What other safety measures are in place: Unvaccinated guests must provide results of a COVID-19 test taken 1 to 2 days before sail date, at home tests are not accepted, this requirement will end Nov. 14. The Cruise line also has a full list of enhanced cleaning protocols.

Find out more: Disney Cruise Line

Grand Circle Cruise Line

Where they sail: Grand Circle Cruise Line sails small ships and river cruises all over the world, including an extensive list of European itineraries. The company plans to start sailing again in August, including to Greece, Turkey, and Italy.

Who needs the vaccine: All guests and crew are required to be fully vaccinated with the booster shot.

What other safety measures are in place: All ships have been equipped with High Efficiency Particular Air (HEPA) filters and buffets have been eliminated. The cruise line states some itineraries will require proof of a negative COVID-19 test prior to travel , and that instructors will be sent out 30 days prior to travel.

Find out mor e: Grand Circle Cruise Line

Holland America

Where they sail: Holland America sails large ships all over the world, including to the Mediterranean, Caribbean, Europe, and more.

Who needs the vaccine: Unvaccinated guests are welcome but will be required to self-test three days before cruising.

What other safety measures are in place: Vaccinated passengers traveling on ships for less than 16 days excluding itineraries with the Panama Canal, trans-ocean, and other selected itineraries will no longer be required to test.

Lindblad Expeditions

Where they sail: Lindblad Expeditions is known for its adventurous trips to hard-to-reach destinations like Antarctica and the Russian Far East, partnering with National Geographic to add to the experience.

Who needs the vaccine: All guests 12 and older need to be vaccinated before boarding. Boosters are recommended but not required.

What other safety measures are in place: Pre-departure testing will not be required unless for a specific destination.

Margaritaville at Sea

Where they sail: Margaritaville at Sea offers 3-day cruises to Grand Bahama Island departing from the port of Palm Beach. The cruise line also offers the opportunity to take the ship one way to the Bahamas to allow guests to stay at the Margaritaville resort, and then take the ship back to the Bahamas at a later date.

Who needs the vaccine: All guests are welcome regardless of vaccination status, according to the cruise line.

What other safety measures are in place: All crew members must be vaccinated for COVID-19 and the cruise line states there are vaccination requirements on board (but does not specify).

Find out more: Margaritaville at Sea

MSC Cruises

Where they sail: MSC Cruises sails large ocean cruises around the world, including throughout Europe, South America, the Persian Gulf, and the Caribbean. In August, the company started sailing to the Bahamas with a stop at its private island, Ocean Cay.

Who needs the vaccine: Vaccinations are recommended but no longer required.

What other safety measures are in place: Fully-vaccinated passengers are no longer required to show proof of a negative test unless it is required of the destination. Unvaccinated children must show proof of a negative PCR test.

Norwegian Cruise Line

Where they sail: Norwegian sails big ocean cruises all around the world, including popular itineraries all throughout the Caribbean and Greece.

Who needs the vaccine: All passengers may sail regardless of vaccination status.

What other safety measures are in place: Testing is no longer required for any passenger regardless of vaccination status with the exception of local government mandates.

Find out more : Norwegian Cruise Line

Oceania Cruises

Where they sail: Oceania Cruises sails all over the world, including offering several World Cruise itineraries.

Who needs the vaccine: All passengers regardless of vaccination status are allowed to sail.

What other safety measures are in place: Only unvaccinated guests will be required to show proof of a negative PCR or antigen test taken 72 hours prior to boarding. Unvaccinated children aged 12 years and younger are exempt.

P&O Cruises

Where they sail: The UK-based cruise line sails around Europe, including to the Canary Islands, as well as to the Caribbean from Southampton in the UK.

Who needs the vaccine: Although P&O Cruises' policy states that passengers over the age of 15 are required to be vaccinated, the latest update on its website says guests will be contacted directly in regards to vaccination protocol.

What other safety measures are in place: All guests are required to undergo a COVID-19 test at the terminal. Masks will be required on board indoors, and all shore excursions will be with vetted operators.

Princess Cruises

Where they sail: The global cruise line sails large ocean ships all around the world, from Australia to Alaska.

Who needs the vaccine: All guests are welcome on board, but unvaccinated passengers will be required to test and may need an additional medical exemption at some ports.

Regent Seven Seas Cruises

Where they sail: Regent Seven Seas offers all-inclusive luxury cruises around the globe, which include perks like free airfare, free excursions, and complimentary unlimited drinks on board.

Who needs the vaccine: All guests are now welcome. Unvaccinated passengers will be required to test 3-days before embarkation.

What other safety measures are in place: Pre-departure testing may not be necessary depending on the port. Currently cruises leaving from Bermuda, Canada, and Greece will require a test.

Royal Caribbean International

Where they sail: Royal Caribbean sails large ocean ships all over the world, including many popular itineraries throughout the Caribbean and Asia.

Who needs the vaccine: Everyone is welcome regardless of vaccination status, passengers traveling to Bermuda or Canada are required to be vaccinated.

W hat other safety measures are in place: On Royal Caribbean, unvaccinated travelers 12 and older leaving from a U.S. or Caribbean port still have to get tested within three days of embarkation,  according to the cruise line , vaccinated guests are exempt.

Royal Caribbean will accept a variety of tests as proof to board, including simply taking a photo of a self-administered home test.

Find out more : Royal Caribbean International

Where they sail: The British cruise line, exclusively for guests 50 and older, sails both ocean and river cruises around the globe.

Who needs the vaccine: All guests must be fully vaccinated, including a booster shot at least 14 days before boarding a ship. Saga was the first major cruise line to implement this vaccination policy.

What other safety measures are in place: Ocean Cruise guests will be required to get tested for COVID-19 in the terminal. Masks are required on bus transfers, in hotels, and on excursions.

Find out more : Saga

Where they sail: Seabourn's mid-size luxury cruises head all around the world, from Alaska to the Caribbean.

Who needs the vaccine: Vaccinations are not required on most cruise itineraries, unvaccinated guests will be required to present a negative test taken within three days of embarkation.

What other safety measures are in place: Masks are recommended onboard in most indoor venues and the casinos are frequently sanitized.

Where they sail: Silversea brings guests all around the world in luxury and style , including to the Galapagos and Antarctica .

Who needs the vaccine: All guests are welcome, however, unvaccinated guests may not be welcome on all sailings depending on local regulations.

What other safety measures are in place: Vaccinated guests do not need a pre-departure test unless local regulations such as cruises leaving from Australia, Bermuda, Canada, or Greece require it. Unvaccinated travelers will need a negative COVID-19 test within 72 hours of embarkation.

UnCruise Adventures

Where they sail: This small-ship company is known for its Alaska journeys as well as adventures in places like the Galapagos and island hopping in Hawaii.

Who needs the vaccine: As of April 7, all guests are welcome on board regardless of vaccination status.

What other safety measures are in place: Guests will no longer be required to present proof of vaccination or a COVID-19 test prior to, or during any point of sailing and the cruise line will no longer be running at limited capacity. These measures go into effect on April 7, until then guests 12 and older must provide proof of vaccination, and itineraries may sail at less then full capacity.

Masks are required in public spaces, according to the company "bandana" and "buff" face masks will not be accepted.

Victory Cruise Lines

Where they sail: Victory Cruise Lines is known for its Great Lakes cruises, providing all-inclusive sailings to see breathtaking sights from Niagara Falls to the iconic architecture of Chicago from Lake Michigan. Beyond the U.S., Victory Cruise Lines sails to Mexico's Yucatán Peninsula.

Who needs the vaccine: All guests and crew will be required to be vaccinated before boarding, and will be required to show physical proof prior to boarding.

What other safety measures are in place: Testing is no longer required on any river cruise.

Luggage is then disinfected before being brought onto the ship and staterooms cleaned with electrostatic fogging. Masks will be required during the embarkation process and while riding a shore excursion bus, but will not be required on board.

Viking Cruises

Where they sail: Viking sails ocean and river cruises all over the world, including throughout Europe. This summer, Viking will sail several voyages, including around England for UK residents, to Bermuda, and to Iceland in June.

Who needs the vaccine: All guests must be fully vaccinated to board a ship. Guests who are eligible must have a booster.

What other safety measures are in place: In addition to vaccines, all guests may be required to undergo a saliva PCR test at embarkation as well as "frequent" testing throughout the journey. All staterooms are equipped with independent air handling units.

Virgin Voyages

Where they sail: The brand-new cruise line is launching mini sailings from England for UK residents, and has cruises throughout the Caribbean, and transatlantic options.

Who needs the vaccine: All are welcome regardless of vaccination status, the cruise line removed all vaccine and testing requirements for all its ships in late October,  according to the company .

What other safety measures are in place: Virgin Voyages was the first cruise line to eliminate pre-departure testing for vaccinated guests. The cruise line will continue to work with an advisory board to help ensure health and safety on board at all times, including the use of air filtration systems and sanitization of high touch surface areas.

Find out more : Virgin Voyages

Windstar Cruises

Where they sail: Windstar operates small-ship cruises and several sailing vessels all around the globe, including to places like Central America .

Who needs the vaccine: All guests will be required to be fully vaccinated at least 14 days before boarding one of Windstar's yachts. Boosters are highly encouraged and are recommended to be administered at least one week prior to travel.

What other safety measures are in place: Guests no longer need a pre-embarkation test unless a specific destination requires it.

Alison Fox is a contributing writer for Travel + Leisure. When she's not in New York City, she likes to spend her time at the beach or exploring new destinations and hopes to visit every country in the world. Follow her adventures on Instagram .

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If you’re currently booked on a cruise vacation with us and have provided an email address, you will be advised of the latest health and safety guidance leading up to departure. Be sure to update your guest account so that we may reach you.

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Holland America Line Simplifies COVID-19 Procedures

Streamlined protocols meet public health goals while giving greater access for guests who are excited to cruise  

Seattle, Wash., Aug. 15, 2022  — Holland America Line is updating its “Travel Well” COVID-19 protocols and procedures, including requirements for vaccinations and pre-cruise testing that meet public health goals while recognizing the evolving nature of the COVID-19 situation. These changes will go into effect for cruises departing on or after Sept. 6, 2022.

Under the simplified procedures, for most voyages up to 15 nights, vaccinated guests will no longer have to test before cruising and unvaccinated guests will be welcomed with a self-test within three days of sailing. The new protocols do not apply to itineraries for countries where local regulations may vary, including Canada, Australia and Greece. 

“Our guests have been excited to return to cruising, and these changes will make it easier for more guests to explore the world in a safe and enjoyable environment,” said Gus Antorcha, president of Holland America Line. “The new, simplified protocols recognize the evolving nature of COVID-19 while still ensuring we protect the health of our guests, team members and the communities we visit.”

Key changes for cruises up to 15 nights (Ages 5 and older, not including full Panama Canal transits, trans-ocean and designated remote voyages):

• Vaccinated guests must provide evidence of vaccination status prior to embarkation. Pre-cruise testing is no longer required. 
• Unvaccinated guests are welcomed aboard and must provide results of a negative medically supervised or self-test taken within three days of embarkation. 

Protocols for cruises 16 nights or longer (plus full Panama Canal transit, trans-ocean and designated remote voyages, ages 5 and older):

• All guests will be required to submit a medically supervised COVID-19 test with written negative result. The test must be taken within three days of embarkation.
• Guests must be vaccinated or request an exemption.    

Guests on longer voyages will be provided additional information about protocols based on ports visited. Guests can continue to submit documents electronically ahead of embarkation for a simple and faster check-in process. Holland America Line recommends that guests visit the TravelWell section of the company’s website for updates prior to cruise departure, as well as instructions on how to provide results of a negative test. 

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Our focus remains on operating our ships in a responsible way that continues to create magic for all on board. We are resuming sailing in a gradual, phased approach that emphasizes multiple layers of health and safety measures, developed in consideration of guidance from the US Centers for Disease Control and Prevention and other medical experts. Visit  Know Before You Go  to learn more about COVID-19 protocols and sailing requirements.

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Coronavirus Updates

Cdc drops its covid-19 risk advisory for cruise ship travel.

Jonathan Franklin

The Norwegian Gateway cruise ship is moored at PortMiami on Jan. 7 in Miami. The Centers for Disease Control and Prevention dropped its advisory warning Wednesday for cruise travel after more than two years of warning Americans. Joe Raedle/Getty Images hide caption

The Norwegian Gateway cruise ship is moored at PortMiami on Jan. 7 in Miami. The Centers for Disease Control and Prevention dropped its advisory warning Wednesday for cruise travel after more than two years of warning Americans.

The Center for Disease Control and Prevention has lifted its risk advisory for cruise ship travel Wednesday following two years of issuing warnings to travelers about the possibility of contracting COVID-19 onboard a cruise.

In an update posted online, the agency removed its "Cruise Ship Travel Health Notice," a notice that recommended individuals against traveling onboard cruise ships. Three months ago, the CDC increased its travel warnings for cruises to Level 4 — the highest level — following investigations of ships that had COVID outbreaks.

While the CDC has lifted its travel health notice, officials say it's up to the passengers to determine their own health risks before going onboard a cruise ship.

"While cruising will always pose some risk of COVID-19 transmission, travelers will make their own risk assessment when choosing to travel on a cruise ship, much like they do in all other travel settings," the agency said in a statement to NPR.

People should avoid cruise travel regardless of their vaccination status, the CDC says

The agency says it will continue to provide guidance to the cruise ship industry in order for cruise lines to operate in a way that will provide "safer and healthier" environments for crews, passengers and communities.

News of the CDC's decision to remove its travel health notice was praised by the Cruise Lines International Association, the industry's largest trade organization.

"Today's decision by the U.S. Centers for Disease Control and Prevention (CDC) to altogether remove the Travel Health Notice for cruising recognizes the effective public health measures in place on cruise ships and begins to level the playing field, between cruise and similarly situated venues on land, for the first time since March 2020. From the onset of the pandemic, CLIA's cruise line members have prioritized the health and safety of their guests, crew, and the communities they visit and are sailing today with health measures in place that are unmatched by virtually any other commercial setting."

A luxury cruise ship rerouted to the Bahamas over an arrest warrant for unpaid fuel

The CDC emphasizes that travelers should make sure they're up to date with their COVID-19 vaccines before taking a cruise, in addition to following their ship's requirements and recommendations against the virus.

Travelers are urged to check their cruise ship's COVID case levels and vaccination requirements online before traveling, the agency says.

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On Cruise Ships, Omicron Puts Safety Protocols to the Test

Many lines are adjusting their masking, testing and vaccine rules, while criticism is mounting about the lack of transparency in reporting positive cases to passengers and crew members.

By Ceylan Yeginsu

By the time the Norwegian Breakaway cruise ship docked in New Orleans on Dec. 4, after a weeklong cruise that included stops in Belize, Honduras and Mexico, 17 coronavirus cases had been identified on the ship, including a case of the new Omicron variant. The local and federal health authorities were notified — but not all the disembarking passengers.

“I only found out after I got home and saw it on the news,” said Betsy Rodriguez, a retired veterinarian who took the Caribbean cruise with her daughter. “We felt pretty safe knowing everyone on the ship was vaccinated, but I guess it would have been good to know people tested positive so we could have been more careful.”

Since the cruise industry restarted operations in the United States this June, its efforts to keep the coronavirus at bay — or at least contained, unlike the major outbreaks experienced in 2020 — have been largely successful. Most cruise companies mandate full vaccinations for crew and most passengers, and have implemented strict health and safety protocols to swiftly identify coronavirus cases onboard and reduce their spread.

But in recent months, as new and highly contagious variants have emerged and case numbers steadily increase worldwide, these measures are being put to the test. Many lines are adjusting their masking, testing and vaccine rules, while criticism is mounting about the lack of transparency in reporting positive cases to passengers and crew members during sailings.

A crew member on the Breakaway, who spoke on the condition of anonymity because he was not permitted to speak to the news media, said he first heard about the outbreak from a friend and fellow employee. When he contacted management, they neither shared the number of positive cases nor identified who was infected.

“I would like to know who tested positive because this new variant spreads very quickly and I have a medical condition which means I need to be very careful and protect myself,” he said, voicing concern that if he became sick, he could be sent back to his home country. “I can’t afford that because I need to take care of my family at home.”

Most cruise companies do not publicly announce the number of coronavirus cases identified during sailings, but all cruise ships operating to and from U.S. ports must submit daily numbers to the Centers for Disease Control and Prevention, which uses a color-coded system to inform the public whether the number of cases is above or below the agency’s threshold for an investigation. Sharing this data is one of many requirements in the Framework for Conditional Sailing Order, a series of C.D.C. guidelines that cruise companies must follow to operate in U.S. waters.

The 17 cases on board the Norwegian Breakaway were first publicly reported by the Louisiana State Department of Health on Dec. 4. All passengers and crew members — more than 3,200 people — onboard were fully vaccinated, following the company’s policy.

Norwegian declined to comment on its policies for reporting cases on board its ships or whether any additional Breakaway crew members tested positive after passengers disembarked.

“All the identified cases onboard were asymptomatic,” a company spokesman said in a statement. “We implemented quarantine, isolation and contact tracing procedures for identified cases and tested all individuals on Norwegian Breakaway before disembarkation.” In addition, he said, passengers were given “post-exposure and quarantine public health guidance” as laid out by the C.D.C.

Reporting to the C.D.C.

The coronavirus wreaked havoc on the cruise industry in the early stages of the pandemic , infecting hundreds of cruise passengers and workers, and requiring the sector to shut down for 18 months. To begin sailing, cruise ships had to agree to the C.D.C.’s Conditional Sailing Order, which is valid until Jan. 15.

Among the safety measures the order requires — beyond submitting the daily number of coronavirus cases — is a prevention and control plan for each cruise ship. The plan, said Bari Golin-Blaugrund, a spokeswoman for the Cruise Line International Association trade group, includes “procedures for informing passengers and crew members that a threshold of Covid-19 has been met or exceeded.”

“The reporting requirements and practices of the cruise industry are practically unmatched compared to other sectors in the United States, especially within the travel and tourism sector,” she said.

In a C.D.C. report of coronavirus data published last month, cruise operators had reported 1,359 positive cases between June 26 and Oct. 21. During that time, 49 hospitalizations, 38 medical evacuations and one death occurred because of coronavirus infections detected onboard cruise ships.

The report highlighted several large outbreaks, including one in which a symptomatic passenger who tested positive on a ship in July was linked to 20 additional cases over two sailings. One ship reported 58 positive between July 24 and Aug. 28 and another reported 112 cases over four consecutive voyages, which ended on Sept. 7. Most of the cases were breakthrough infections in fully vaccinated passengers.

While the C.D.C. relies on data reported by the cruise companies, the agency also carries out inspections to make sure that cruise ships are in compliance.

With the rise of Delta and Omicron variants, and as the virus surges across the world, cruise lines have been adjusting their health and safety protocols, reinstating measures like mask mandates and requiring additional testing from passengers. Starting Jan. 13, Disney Cruise Line will require all children over the age of 5 to be fully vaccinated against the coronavirus.

Demand remains high

Despite the new restrictions and risks posed by new variants, demand for future cruises remains high. Carnival, the world’s largest cruise company, reported that its bookings for the second half of 2022 have surpassed bookings for 2019. Royal Caribbean said the Delta variant had hit bookings in 2021 and 2022, but not for 2023.

“I think what people have been saying is, I want to get out there, but I don’t want to do it too soon. I want to make sure that things have stabilized,” Richard D. Fain, chairman and chief executive of Royal Caribbean Cruises, said in the company’s last earnings call in October.

Miranda Gibson, 63, an avid cruiser from Tampa, Fla., took two cruises this summer, but then canceled three cruises she had planned for the rest of the year because of her concerns over the Delta variant.

“The first cruise I took in June in the Caribbean was heaven because everyone was vaccinated, Covid was under control and it was the first time in so long that we could have some carefree fun,” she said.

“Now with the variants everything is prickly again and you can’t really get a true relaxing cruise experience when you are worrying about Covid and masks and rules,” she explained. “I’m booked in June 2022 and I know I’ll be tempted to go before then but I’m going to wait until it’s safer.”

Others believe cruise ships are among the safest vacation environments, because of the vaccine requirements and testing protocols.

“When you’re on a plane, or in a hotel or at a theme park you don’t know who has Covid around you,” said Timothy Ryan, 67, a retired financial trader from Miami who has 16 cruises booked through 2022. “On a cruise, it’s detected right away and the positive cases are isolated, so you can continue your vacation in a Covid-free bubble. I really don’t know a safer way to travel.”

52 Places to Love in 2021

We asked readers to tell us about the spots that have delighted, inspired and comforted them in a dark year. Here, 52 of the more than 2,000 suggestions we received, to remind us that the world still awaits.

Follow New York Times Travel on Instagram , Twitter and Facebook . And sign up for our weekly Travel Dispatch newsletter to receive expert tips on traveling smarter and inspiration for your next vacation.

Ceylan Yeginsu is a London-based reporter. She joined The Times in 2013, and was previously a correspondent in Turkey covering politics, the migrant crisis, the Kurdish conflict, and the rise of Islamic State extremism in Syria and the region. More about Ceylan Yeginsu

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Dipping Their Toes: Younger generations of travelers are venturing onto ships for the first time . Many are saving money.

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Cruise Ship Travel

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Cruise Ship Medical Capabilities

Illness & injury, infectious disease health risks, noninfectious health risks, travel preparation.

Cruise ship travel presents a unique combination of health concerns. Travelers from diverse regions brought together in the often crowded, semi-enclosed shipboard environment can facilitate the spread of person-to-person, foodborne, and waterborne diseases. Outbreaks on ships can be sustained over multiple voyages by crewmembers who remain onboard, or by persistent environmental contamination. Port visits can expose travelers to local diseases and, conversely, be a conduit for disease introduction into shoreside communities.

Some people (e.g., those with chronic health conditions or who are immunocompromised, older people, pregnant people) merit additional considerations when preparing for a cruise. Because travelers at sea might need to rely on a ship’s medical capabilities for an extended period, potential cruise passengers with preexisting medical needs should prepare accordingly by calling the cruise line’s customer service center to learn what type and level of health care services are (and are not) available on specific ships.

Medical facilities on cruise ships can vary widely depending on ship size, itinerary, cruise duration, and passenger demographics. Generally, shipboard medical centers can provide medical care comparable to that of ambulatory care centers; some are capable of providing hospitalization services or renal dialysis. Although no agency officially regulates medical practice aboard cruise ships, the American College of Emergency Physicians (ACEP) published consensus-based guidelines for cruise ship medical facilities in 1995, and updated the guidelines in 2013. ACEP guidelines , which most major cruise lines follow, state that cruise ship medical facilities should be able to provide quality medical care for passengers and crew; initiate appropriate stabilization, diagnostic, and therapeutic maneuvers for critically ill or medically unstable patients; and assist in the medical evacuation of patients in a timely fashion, when appropriate.

Cruise ship medical centers deal with a wide variety of illnesses and injuries; ≈10% of conditions reported to cruise ship medical centers are an emergency or require urgent care. Approximately 95% of illnesses are treated or managed onboard, with the remainder requiring evacuation and shoreside consultation for dental, medical, or surgical issues. Roughly half of all passengers seeking medical care are >65 years old.

Medical center visits are primarily the result of acute illness or injury. The most frequently reported diagnoses include respiratory illnesses (30%–40%); injuries from slips, trips, or falls (12%–18%); seasickness (10%); and gastrointestinal (GI) illness (10%); 80% of onboard deaths are due to cardiovascular events.

Infectious Disease Outbreaks

The most frequently reported cruise ship outbreaks involve GI infections (e.g., norovirus), respiratory infections (e.g., coronavirus disease 2019 [COVID-19], influenza), and other vaccine-preventable diseases (VPDs), such as varicella. Although cruise ships do not have public health authority, to reduce the risk of introducing communicable diseases, some ships conduct medical screening during embarkation to identify ill passengers, prevent them from boarding, or require isolation if permission to board is given.

Before travel, to help limit the introduction and spread of communicable diseases on cruise ships, prospective cruise ship travelers and their clinicians should consult the Centers for Disease Control and Prevention (CDC) Travelers’ Health website for updates on outbreaks and destination-specific travel health notices. People who become ill with a communicable disease before a voyage should consult their health care provider and delay their travel until they are no longer contagious. When booking a cruise, travelers should check the trip cancellation policies and consider purchasing trip cancellation insurance (see Sec. 6, Ch. 1, Travel Insurance, Travel Health Insurance & Medical Evacuation Insurance ).

Travelers who become ill during a voyage should seek care in the ship’s medical center; the onboard staff will provide clinical management, facilitate infection-control measures, and take responsibility for reporting potential public health events. For information on how to report travelers who become ill with suspected communicable diseases after they return home from a cruise, see Sec. 8, Ch. 8, Airplanes & Cruise Ships: Illness & Death Reporting & Public Health Interventions .

Gastrointestinal Illnesses

During 2006–2019, rates of GI illness among passengers on voyages lasting 3–21 days fell from 32.5 to 16.9 cases per 100,000 travel days. Despite the decrease, outbreaks continue to occur. CDC assists the cruise ship industry to prevent and control the introduction, transmission, and spread of GI illnesses on cruise ships. See information on cruise ship GI illnesses and updates on GI illness outbreaks involving ships with US ports of call, specifically.

On cruise ships, >90% of GI illness outbreaks with a confirmed cause are due to norovirus. Characteristics of norovirus that facilitate outbreaks include a low infective dose, easy person-to-person transmissibility, prolonged viral shedding, absence of long-term immunity, and the ability of the virus to survive routine cleaning procedures (see Sec. 5, Part 2, Ch. 16, Norovirus ). For international cruise ships porting in the United States during 2006–2019, an average of 12 norovirus outbreaks occurred each year.

Other Sources of Gastrointestinal Illness

GI outbreaks on cruise ships also have been caused by contaminated food or water; most outbreaks were associated with  Campylobacter ,  Clostridium perfringens , or enterotoxigenic  Escherichia coli .

Protective Measures

Travelers can reduce the risk of acquiring a GI illness on cruise ships by frequently washing hands with soap and water, especially before eating and after using the restroom. Travelers should call the ship’s medical center promptly, even for mild symptoms of a GI illness, and strictly follow cruise ship guidance regarding isolation and other infection-control measures.

Respiratory Illnesses

Respiratory illnesses are the most common medical complaint on cruise ships. During the pretravel visit, evaluate whether vaccines or boosters (e.g., COVID-19, influenza) are needed and emphasize the importance of practicing good respiratory hygiene and cough etiquette while onboard. As with GI illnesses, cruise ship passengers should report respiratory illness to the medical center promptly and follow isolation recommendations as instructed.

Coronavirus Disease 2019

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus that causes COVID-19, spreads more easily between people in close quarters, and multiple studies have concluded that transmission rates of SARS-CoV-2 among travelers on ships are much greater than in other settings. Cruise ship COVID-19 outbreaks can tax onboard medical and public health resources. Ship-to-shore medical evacuations to facilities capable of providing higher levels of medical care can present logistical challenges and pose additional risks to ill patients.

Cruise passengers and crewmembers who are not up to date with their COVID-19 vaccines are at increased risk for severe illness, hospitalization, medical evacuation, and death. Since cruising will always pose some risk of SARS-CoV-2 transmission, ensure that people planning cruise ship travel are up to date with their vaccinations, and assess their likelihood for developing severe COVID-19. For people at increased risk of severe COVID-19 regardless of their vaccination status (e.g., pregnant people, people who are immunocompromised), discuss the potential health hazards associated with cruise ship travel. CDC has developed recommendations and guidance designed to help cruise ship operators provide a safer and healthier environment for crewmembers, passengers, port personnel, and communities.

Historically, influenza has been among the most often reported VPDs occurring on cruise ships. Because passengers and crew originate from all regions of the globe, shipboard outbreaks of influenza A and B can occur year-round, with exposure to strains circulating in different parts of the world (see Sec. 5, Part 2, Ch. 12, Influenza ). Thus, anyone planning a cruise should receive the current seasonal influenza vaccine ≥2 weeks before travel if vaccine is available and no contraindications exist. For people at high risk for influenza complications, health care providers should discuss chemoprophylaxis and how and when to initiate antiviral treatment.

See additional guidance on the prevention and control of influenza on cruise ships .

Legionnaires’ Disease

Less common on cruise ships, Legionnaires’ disease is nevertheless a treatable infection that can result in severe pneumonia leading to death (see Sec. 5, Part 1, Ch. 9, Legionnaires’ Disease & Pontiac Fever ). Approximately 10%–15% of all Legionnaires’ disease cases reported to CDC occur in people who have traveled during the 10 days before symptom onset. Clusters of Legionnaires’ disease associated with hotel or cruise ship travel can be difficult to detect, because travelers often disperse from the source of infection before symptoms begin. Data reported to CDC during 2014–2015 included 25 confirmed cases of Legionnaires’ disease associated with cruise ship exposures.

In general, Legionnaires’ disease is contracted by inhaling warm, aerosolized water containing the bacteria,  Legionella . Transmission also can sometimes occur through aspiration of  Legionella -containing water. Typically, people do not spread  Legionella  to others; a single episode of possible person-to-person transmission of Legionnaires’ disease has been reported. Contaminated hot tubs are commonly implicated as a source of shipboard  Legionella  outbreaks, although potable water supply systems also have been culpable. Improvements in ship design and standardization of water disinfection have reduced the risk for  Legionella  growth and colonization.

Diagnosis & Reporting

People with suspected Legionnaires’ disease require prompt antibiotic treatment. When evaluating cruise travelers for Legionnaires’ disease, obtain a thorough travel history of all destinations during the 10 days before symptom onset to assist in identifying potential sources of exposure, and collect urine for  Legionella  antigen testing. Most cruise ships have the capacity to perform this test, which detects  L. pneumophila  serogroup 1, the most common serogroup.

Perform culture of lower respiratory secretions on selective media to detect non– L. pneumophila  serogroup 1 species and serogroups. Culture also is used for comparing clinical isolates to environmental isolates during an outbreak investigation. Notify CDC of any travel-associated Legionnaires’ disease cases by sending an email to [email protected]. Quickly report all cases of Legionnaires’ disease to public health officials, who can determine whether a case links to previously reported cases and work to stop potential clusters and new outbreaks.

Other Vaccine-Preventable Diseases

Although most cruise ship passengers come from countries with routine vaccination programs (e.g., Canada, the United States), many of the crew are from low- or middle-income countries where immunization rates can be low. Outbreaks of hepatitis A, measles, meningococcal disease, mumps, pertussis, rubella, and varicella have all been reported on cruise ships. The majority (82%) of these outbreaks occur among crewmembers; prior to the COVID-19 pandemic, varicella was the most frequently reported VPD. Other VPDs (e.g., pertussis) occur more often among passengers.

Each cruise line sets its own policies regarding vaccinations for its crew; some have limited or no requirements. Thus, all passengers should be up to date with routine vaccinations before travel, as well as any required or recommended vaccinations specific for their destinations. People of childbearing age should have documented immunity to measles, rubella, and varicella (either by vaccination or titer) before cruise ship travel.

Vectorborne Diseases

Some cruise ship ports of call include destinations where vectorborne diseases (e.g., dengue, Japanese encephalitis, malaria, yellow fever, Zika) are known to be endemic. In addition, new diseases can surface in unexpected locations; chikungunya was reported for the first time in the Caribbean in late 2013, with subsequent spread throughout the region and numerous other North, Central, and South American countries and territories. Zika was first reported in Brazil in 2015, and subsequently spread across the Caribbean and Latin America, sparking concern because of its association with microcephaly and other congenital abnormalities in the fetus. For disease-specific information, see the relevant chapters of Section 5.

For guidance on how to avoid bites from mosquitoes and other disease-transmitting arthropod vectors, both onboard and while on shore at ports of call, see Sec. 4, Ch. 6, Mosquitoes, Ticks & Other Arthropods . For specific details on yellow fever vaccination and malaria prevention, see Sec. 2, Ch. 5, Yellow Fever Vaccine & Malaria Prevention Information, by Country .

Stresses of cruise ship travel include varying weather and environmental conditions, and unaccustomed changes to diet and levels of physical activity. Despite modern stabilizer systems, seasickness is a common complaint, affecting up to 25% of travelers (see Sec. 8, Ch. 7, Motion Sickness ). Note that travel is an independent risk factor for behaviors such as alcohol and illicit drug use and misuse (see Sec. 3, Ch. 5, Substance Use & Substance Use Disorders ), and unsafe sex (see Sec. 9, Ch. 12, Sex & Travel ).

Cruise ship travelers have complex itineraries due to multiple short port visits. Although most port visits do not include overnight stays off ship, some trips offer travelers the opportunity to venture off the ship for ≥1 night. These excursions can complicate decisions about exposures and the need for specific antimicrobial prophylaxis, immunizations, and other prevention measures.  Boxes 8-04  and  8-05  summarize recommended cruise travel preparations and healthy behaviors during travel for health care providers and cruise ship travelers.

Box 8-04 Healthy cruise travel preparation: a checklist for health care providers

Risk assessment & risk communication.

☐ Discuss itinerary, including season, duration of travel, and activities at ports of call. ☐ Review the traveler’s medical and immunization history, allergies, and any additional health needs. ☐ Discuss relevant travel-specific health hazards and risk reduction. ☐ Provide travelers with documentation of their medical history, immunizations, and medications.

VACCINATION & RISK MANAGEMENT

☐ Provide routinely recommended (age-specific), required (yellow fever), and recommended vaccines. ☐ Discuss safe food and water precautions. ☐ Discuss insect bite prevention. ☐ Provide older travelers with a baseline electrocardiogram, especially those with coronary artery disease.

MEDICATIONS BASED ON RISK & NEED

☐ Consider prescribing malaria chemoprophylaxis if itinerary includes stops in malaria-endemic areas. ☐ Consider prescribing motion sickness medications for self-treatment.

Box 8-05 Healthy cruise travel preparation: a checklist for travelers

☐ Carry prescription drugs in original containers with a copy of the prescription and a physician’s letter. ☐ Check the Centers for Disease Control and Prevention (CDC) Outbreak Updates for International Cruise Ships website for gastrointestinal outbreaks. ☐ Consider purchasing additional insurance coverage for overseas health care and medical evacuation. ☐ Consult medical and dental providers before cruise travel. ☐ Consult CDC Travelers’ Health website for travel health notices . ☐ Defer travel while acutely ill. ☐ Evaluate the type and length of the planned cruise in the context of personal health requirements. ☐ Notify the cruise line of additional health needs (e.g., dialysis, supplemental oxygen, wheelchair). ☐ Pack Environmental Protection Agency (EPA)–registered insect repellent; consider treating clothes and gear with permethrin. ☐ Pack sunscreen.

DURING TRAVEL

☐ Avoid contact with people who are ill. ☐ Follow safe food and water precautions when eating off ship at ports of call. ☐ Maintain good fluid intake and avoid excessive alcohol consumption. ☐ Practice safe sex. ☐ Report all illnesses to ship’s medical center and follow their recommendations. ☐ Use insect bite precautions during port visits, especially in vectorborne disease–endemic areas or areas experiencing outbreaks of vectorborne diseases (e.g., Zika, yellow fever) ☐ Use sun protection. ☐ Wash hands frequently with soap and water; if soap and water are not available, use ≥60% alcohol–based hand sanitizer.

POST TRAVEL

☐ See CDC’s latest post-cruise health guidance regarding coronavirus disease 2019.

Travelers with Additional Considerations

Travelers with chronic illnesses and travelers with disabilities who have additional needs (e.g., dialysis, supplemental oxygen, wheelchairs) should inform their cruise line before traveling. Highly allergic travelers and travelers with underlying medical conditions should carry a file that contains essential, pertinent health information (e.g., allergies, blood type, chest radiograph [if abnormal], chronic conditions, electrocardiogram, medication list, primary and/or specialty care provider contact information). Travelers also should bring any medications recommended by their health care provider (e.g., an epinephrine auto-injector) to help facilitate care during a medical emergency. For detailed information on preparing travelers who have additional considerations for international travel, including severe allergies, chronic illness, disabilities, or immune compromise, see Section 3.

Pregnant Travelers

Most cruise lines have policies that do not permit people to board after their 24th week of pregnancy. Contact cruise lines directly for specific guidance before booking. For additional information on preparing pregnant people for international travel, see Sec. 7, Ch. 1, Pregnant Travelers .

Insurance Coverage

All prospective cruise travelers should verify coverage with their health insurance carriers and, if not included, consider purchasing additional insurance to cover medical evacuation and health services received onboard cruise ships and in foreign countries (see Sec. 6, Ch. 1, Travel Insurance, Travel Health Insurance & Medical Evacuation Insurance ).

The following authors contributed to the previous version of this chapter: Kara Tardivel, Stefanie B. White, Krista Kornylo Duong

Bibliography

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Jenkins KA, Vaughan GHJ, Rodriguez LO, Freeland AL. Acute gastroenteritis on cruise ships—United States, 2006–2019. MMWR Morb Mortal Wkly Rep. 2021;70(6):1–19. 

Kordsmeyer A-C, Mojtahedzadeh N, Heidrich J, Militzer K, von Münster T, Belz L, et al. Systematic review on outbreaks of SARS-CoV-2 on cruise, navy and cargo ships. Int J Environ Res Public Health. 2021;18(10):5195. 

Millman AJ, Kornylo Duong K, Lafond K, Green NM, Lippold SA, Jhung MA. Influenza outbreaks among passengers and crew on two cruise ships: a recent account of preparedness and response to an ever-present challenge. J Travel Med. 2015;22(5):306–11. 

Mouchtouri VA, Lewis HC, Hadjichristodoulou C. A systematic review for vaccine-preventable diseases on ships: evidence for cross-border transmission and for pre-employment immunization need. Int J Environ Res Public Health. 2019;16(15):2713. 

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Watch CBS News

Passengers flock to cruise ships as pandemic fears abate

By Khristopher J. Brooks

Edited By Anne Marie Lee , Alain Sherter

May 30, 2023 / 3:41 PM EDT / MoneyWatch

Americans are booking trips on cruise ships at rates not seen since before the pandemic, a sign travelers are more comfortable boarding vessels that were once vectors for coronavirus.

Florida-based Royal Caribbean  said earlier this month that the load factor, or percentage of seats filled, of its cruise ships rose to an average of 102% in the first quarter of 2023. By comparison, the occupancy rate was 57% a year ago and 107% in 2019 just before pandemic lockdowns. 

Norwegian Cruise Line reported an average 101% occupancy rate during the first quarter, compared to 48% last year and 105% in 2019. The jump in cruise goers is helping revive the industry, which lost billions of dollars during the pandemic.

"COVID has dissipated as a concern for a lot of travelers" Wall Street Journal reporter Jacob Passy told CBS News. "People are raring to get out there, and cruises are a great way to see multiple locations (and) multiple countries."

Cruise lines are reporting more than 100% capacity because passengers are piling more than the suggested two people per cabin, Passy said. Cruise tickets this year are running between $130 and $260 a day depending on the ship, cabin type and destination, according to online price tracker Cruzely.  

Overbooked ship cabins serve as visual proof of the industry's rebound. Cabin occupancy rates will stay in the triple digits between now and into 2026,  fueled mostly by millennial travelers , the Cruise Lines International Association (CLIA)  estimated . 

"Cruising is back and is one of the fastest growing segments of tourism, outpacing the recovery of international tourism arrivals," CLIA spokesperson Sally Andrews said. "Consumer intent to cruise is also higher than it was in December of 2019( pre-pandemic) among both experienced cruisers and those who have never cruised before."

In 2021, the U.S. Centers for Disease Control and Prevention advised travelers to stay away from cruise ships  after a number of ships reports COVID-19 outbreaks. Bookings plunged, forcing companies such as Royal Caribbean and Norwegian to furlough workers. Cruise companies globally saw their income sink from $24 billion in 2019 to $8 billion in 2021, according to the most recent CLIA  data . 

The CDC ended its warning about cruise ships last year and is no longer requiring companies to only host passengers who have been vaccinated against the virus.

One of the biggest problems cruise operators faced during the pandemic was passengers booking trips, then backing out weeks before the departure due to health safety concerns, Passy said. These days, cruise lines are more likely to overbook travelers because they're still expecting some to change their minds last minute.

"The issue right now is fewer people are canceling because of COVID, so they're having to readjust that algorithm a bit to account for the fact that more people are just going no matter what," Passy said. 

• Cruise Ship
• Royal Caribbean

Khristopher J. Brooks is a reporter for CBS MoneyWatch. He previously worked as a reporter for the Omaha World-Herald, Newsday and the Florida Times-Union. His reporting primarily focuses on the U.S. housing market, the business of sports and bankruptcy.

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More than 60 Virgin Voyages passengers get sick with salmonella, E. coli

More than 70 people on a Virgin Voyages cruise got sick during a recent sailing.

The Centers for Disease Control and Prevention said 66 of the 2,198 guests on the line’s Scarlet Lady ship reported being ill during the cruise that ended Friday, along with seven crew members. Their predominant symptoms were abdominal cramps, vomiting and diarrhea.

The health agency listed salmonella and E. coli as the cause. The ship was on a round-trip Riviera Maya cruise that departed from Miami on Oct. 8, according to CruiseMapper .

“Our medical team isolated these travelers, and we immediately enacted enhanced sanitization procedures including additional cleaning of cabins and high-contact areas around the ship,” Virgin Voyages' COO Michelle Bentubo said in an email. “We are working closely with the CDC and their medical professionals. There is currently no impact to the upcoming voyage’s departure time or ports of call.”

Gastrointestinal illness cases on cruises plummeted during the COVID-19 pandemic, but cases have ticked upward as operations bounced back.

The CDC has logged 14 outbreaks on cruise ships that met its threshold for public notification this year, more than any year between 2017 and 2019. Norovirus was listed as the causative agent in all other 2023 outbreaks.

Norovirus cases are up: Should travelers worry?

While norovirus is frequently associated with cruises, Ben Lopman, a professor of epidemiology at Emory University’s Rollins School of Public Health, told USA TODAY in February that cruises make up a "tiny minority of norovirus outbreaks.” He said the majority occur in health care settings like nursing homes.

Nathan Diller is a consumer travel reporter for USA TODAY based in Nashville. You can reach him at [email protected].