cruise ship vaccine requirements

Do You Need to Be Vaccinated to Cruise? It Depends on the Ship and Destination

While most cruise lines have scrapped covid vaccine and testing requirements, some companies and international cruise ports still have vaccination and testing rules in place..

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If you’re planning on sailing with Viking anytime soon, you’d better track down that COVID-19 vaccine certificate.

Courtesy of Viking

When cruising restarted in spring 2021, after a nearly 15-month pandemic-spurred shutdown imposed by the U.S. Centers for Disease Control and Prevention (CDC), cruisers faced a barrage of rules, including strict requirements for COVID-19 vaccinations and precruise COVID-19 testing. Later, the rules started to go by the wayside, and it was hard to keep track of who was requiring what. Not anymore.

Most cruise lines have now dropped or are soon dropping rules for both vaccinations and precruise testing, with at least one notable exception. Viking —on its river, ocean, and expedition ships—still requires everyone on board be fully vaccinated .

Another line that was still requiring COVID vaccinations, small-ship line Windstar Cruises, will be scrapping its vaccine mandate as of June 1, 2023. “We’ve invested in and improved our health and safety processes, including upgrading the HVAC systems on all of our ships, which has led to a cleaner and safer environment on board,” says Windstar president Christopher Prelog. “When combined with the widespread availability of vaccines and medical treatments, the risk factors are considerably lower now, giving us the confidence to lift the requirement.”

Are COVID vaccinations and testing still required for cruises?

Most cruise lines have dropped both their vaccine and testing requirements. Those that have lingered into 2023—mostly lines operating smaller ships—have been quietly scaling back their requirements.

The result: While there was a time after cruising restarted that you could be assured that your fellow passengers, at least those age 12 and up, were both fully vaccinated and tested for COVID-19 before getting on the ship, that is not the case anymore.

That said, specific countries have their own requirements, and several countries still require that cruise ship passengers are vaccinated and/or tested before arrival. If you are doing an itinerary outside of the Caribbean or Europe (where most vaccine and testing requirements have been dropped)—including to select countries in Central and South America or to Australia—you still have to read your cruise line’s precruise health and safety information carefully to make sure you comply with the latest requirements.

Contact your cruise line or check the U.S. State Department’s travel advisories for the latest.

What to know before you cruise

Vaccine and pretrip testing requirements can be confusing, especially if you are cruising internationally. Cruise lines have their own rules; countries have their own rules.

Before your trip, you will need to review your cruise line’s health and safety protocols. If a precruise test is required by a certain country, you will find that noted. In this case, you may be required to arrive at your ship with a negative COVID-19 test result in hand or not. (If testing is required, it can typically be either a PCR test or tele-health-monitored antigen test , paid for by the passenger. The cruise line may also require a test at the pier, paid for by the cruise line.)

If being fully vaccinated is required, that means having received the original series of vaccines at least 14 days prior to your cruise, or the original series plus a booster shot or shots.

As was the case even before the pandemic, you will be asked at embarkation to fill out a questionnaire inquiring about your current health status and whether you currently have any symptoms of illness.

You are free to pack and wear masks on your cruise. Most cruise lines suggest you do wear masks in crowded indoor situations—but it’s not enforced.

A quick cruise line guide to COVID requirements

Here’s a rundown of the basic rules for some leading cruise lines. Note: There may be additional requirements if you are traveling internationally. Be sure to review the latest requirements prior to boarding.

American Queen Voyages

On American Queen Voyages’ river, ocean, Great Lakes, and expedition ships, there are no longer any precruise testing or vaccinations required. Face coverings are optional, though masks may be required of any passengers showing symptoms.

Precruise testing is no longer required for vaccinated guests sailing with Azamara , except in ports where testing is required. No vaccination is necessary for cruises departing from or returning to the United States or Europe. In Australia, all guests 12 years and older must be fully vaccinated at least 14 days before sailing with all required COVID-19 vaccine doses (including a booster shot). Children under 12 years old are not required to be vaccinated.

Celebrity Cruises

No vaccination or testing is required on the majority of Celebrity Cruises sailings. Destinations with stricter requirements include: the Galápagos, Australia and New Zealand, transatlantic crossings, and select Central and South America itineraries. Unvaccinated guests need to be tested in Brazil, Chile, and Colombia.

As of April 23, 2023, on the Queen Mary 2 and Queen Victoria , and as of June 8, 2023, on the Queen Elizabeth , vaccinations and testing will no longer be required by Cunard (until then, testing and vaccination requirements apply).

Disney Cruise Line

For sailings embarking from the United States, which are the bulk of Disney Cruise Line’s sailings, no vaccination or testing is required. Disney recommends all guests be vaccinated before sailing and take a test for COVID-19 two days prior to their cruise. There are additional requirements on repositioning cruises and in Australia, so it is important to check the line’s website before your cruise.

Holland America Line

There are no precruise testing or vaccination requirements on most Holland America Line itineraries. There are requirements on select voyages (you can look up a specific voyage’s requirements on the line’s website).

Lindblad Expeditions

For voyages embarking on or after May 11, 2023, Lindblad Expeditions will no longer require guests to be fully vaccinated, although the line recommends guests be fully vaccinated (for cruises prior to that time, all passengers age five and up must be vaccinated). Lindblad recommends, but does not require, passengers take a predeparture COVID-19 test within five days of the start of their expedition.

Oceania Cruises

Vaccine requirements are purely dependent on the destinations being visited on each Oceania cruise. Passengers are advised to be up to date on the latest regulations for all destinations on their cruise itinerary.

Paul Gauguin Cruises

Effective April 2023, Paul Gauguin Cruises no longer requires that passengers are vaccinated or tested for COVID prior to embarkation, but it continues to encourage vaccination. “Paul Gauguin Cruises’ officers, staff and crew will remain fully vaccinated,” the line states. Travelers will need to present a health declaration form at embarkation.

Regent Seven Seas Cruises

Vaccines and precruise testing are generally not required to sail with Regent Seven Seas Cruises . There are some requirements in place based on local health regulations in a specific country a ship is visiting. Regent notifies guests approximately 30 days prior to sailing of any country-specific protocols.

Royal Caribbean

No vaccine or precruise testing is required on the majority of Royal Caribbean itineraries, with a few exceptions: Cruises from Australia, transpacific and transatlantic sailings, and cruises from Hawai‘i to Vancouver.

No vaccine or testing required except on certain Seabourn itineraries where a country may have specific requirements.

No vaccination is required for Silversea passengers except as designated by the destination. Precruise testing is not required except when specified by a destination.

Viking Cruises

All passengers and crew are required to be vaccinated on Viking’s river, ocean, and expedition ships—without exception. Viking strongly recommends passengers receive a booster dose before departing. Viking recommends but does not require a predeparture COVID-19 test (except if required by a destination).

Virgin Voyages

Virgin Voyages has no precruise testing or vaccination requirements. Masks may be required at select times.

Windstar Cruises

Beginning June 1, 2023, Windstar will no longer require guests to be vaccinated. Crew will continue to be vaccinated. Masks are optional, with the line highly recommending guests wear masks in indoor public spaces. All guests fill out a health questionnaire on embarkation. A precruise COVID-19 test is not required unless you show symptoms.

This article was originally published in May 2022; it was most recently updated on April 19, 2023, with current information.

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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CDC Eases Vaccination Rules for Cruise Ships

The CDC will now classify ships with a 90% or higher vaccination rate as "highly vaccinated".

The Centers for Disease Control and Prevention relaxed its definition of what it means to be a highly vaccinated cruise ship this week, lowering the percentage of passengers required to get the shot.

Going forward, the CDC will consider cruise ships where 90% of passengers are vaccinated to be "Highly Vaccinated" ships, according to the agency. That is lower than the previous requirement of 95% to meet that definition.

Currently, the CDC classifies cruise ships under three categories: "Not Highly Vaccinated," which includes ships where less than 90% of passengers and 95% of the crew are fully vaccinated; "Highly Vaccinated," which includes ships where at least 90% of passengers and 95% of crew are fully vaccinated, but less than that includes people with up to date COVID-19 boosters; and the third category is having a "Vaccination Standard of Excellence," which means at least 90% of passengers and 95% of the crew are vaccinated and up to date with their COVID-19 vaccines.

"This update is based on modeling data," CDC spokesperson Tom Skinner told USA Today . "Getting vaccinated is the best way to slow the spread of COVID-19, and CDC continues to recommend that passengers and crew are up to date with their COVID-19 vaccines before cruise travel."

As of Friday, 92 cruise ships had opted into the CDC's COVID-19 program and were all classified under the "Highly Vaccinated" category, according to the agency. No ships were classified under the "Vaccination Standard of Excellence."

The classifications apply to commercial, foreign-flagged passenger-carrying ships with at least 250 passengers.

The CDC first created these classifications after allowing its Conditional Sail Order to expire in January and making its guidance optional for cruise lines. In March, the agency then dropped its warning against cruise ship travel for the first time in two years, telling Americans to "make their own risk assessment when choosing to travel on a cruise ship, much like they do in all other travel settings."

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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Royal caribbean international’s vaccine policies.

For cruises departing from any U.S. port, Royal Caribbean requires all guests 12 years of age and older to be fully vaccinated. Younger travelers (2-11 years old), who are unvaccinated, can sail if they bring a negative PCR test result and test negative at boarding, and they must follow certain health and safety protocols.

Vaccine requirements are one of the multilayered measures that safeguard the well-being of our guests, our crew and the communities we visit. Additional health and safety measures include our fully vaccinated crew, testing, the robust onboard ventilation system and enhanced cleaning.

In collaboration with multiple national, state and local health and government authorities around the world, including the U.S. Centers for Disease Control and Prevention, our priority is to maintain everyone’s well-being while complying with federal, state and local laws as we always have. Royal Caribbean will continue to evaluate and update its health and safety measures as circumstances evolve.

Guests and travel advisors looking for information on our measures can visit the Royal Caribbean website . Our current vaccine policies, which are in line with local regulations, are the following:

• Cruises from the U.S.* : Guests who are 12 years of age and older must be fully vaccinated against COVID-19. This includes cruises departing from Florida and visiting The Bahamas and/or U.S. Virgin Islands, which require all cruise guests to be fully vaccinated.
• Cruises from Barbados: Guests 12 years of age or older must be fully vaccinated against COVID-19. Younger travelers (2-11 years old), who are unvaccinated, are required to bring negative test results. 
• Cruises from the U .K. : Sailing UK residents 18 and older must be fully vaccinated against COVID-19, and those under the age of 18 are required to receive negative test results.
• Cruises from Spain, Italy and Cyprus : Guests 18 and older must be fully vaccinated against COVID-19, and those under the age of 18 are required to receive negative test results.
• Cruises from Singapore : Sailing Singapore residents 12 and older are required to be fully vaccinated and follow the protocols outlined by the Singapore government.
• Cruises from Hong Kong : Sailing Hong Kong residents 12 and older must be fully vaccinated against COVID-19. Younger guests are required to receive negative test results.

*Until further notice for all sailings from the U.S .: Guests 2 and older – regardless of their vaccination status – must present negative test results when arriving to check in.

Do I need a COVID vaccine to cruise? A line-by-line guide

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Editor’s note: This post has been updated with new information.

When the first cruises allowing Americans restarted in spring 2021, all major lines were sailing with at least 90% of passengers vaccinated against COVID-19. That meant they required just about everyone on board to have their shots, with only a few exceptions allowed for young children and people who can’t be vaccinated due to medical conditions or religious beliefs.

Since then, the Centers for Disease Control and Prevention has withdrawn its opt-in guidance for cruise lines, and most are now allowing unvaccinated passengers to sail. In fact, most aren’t even checking to see if cruisers are vaccinated or not.

However, with cases picking up seasonally and new booster vaccines rolling out, will you need a vaccine to cruise? Click on your favorite cruise line above, under “Jump to Section,” to find out.

For more cruise news, reviews and tips, sign up for TPG’s new cruise newsletter .

Note: In order to be considered “fully vaccinated,” passengers must have received their final shot (not including boosters) at least 15 days prior to embarkation. Most lines only accept vaccines (or a combination of vaccines) recognized and approved by the World Health Organization and the CDC. Generally, proof of inoculation must include your name, the type of vaccine you received and the dates on which you received all required doses.

Booster shots are not required unless specifically noted. However, keep in mind that the rules may vary by country, with some lines requiring boosters for international departures due to local regulations or for extra-long sailings like ocean crossings when port calls are few or nonexistent. Passengers who have their boosters are considered “up to date” rather than merely “fully vaccinated.”

For general information on testing, please refer to our article on cruise testing requirements .

AmaWaterways

Vaccine required no.

AmaWaterways no longer requires proof of vaccination for passengers. However, cruisers are responsible for meeting the requirements of the countries in which they’ll be traveling. If they do not, standard cancellation fees will apply. Pre-cruise testing is not required. Should passengers become ill during their cruise, AmaWaterways will assist in procuring testing and other medical services, which will be the financial responsibility of those guests.

American Cruise Lines

American Cruise Lines does not have a vaccine requirement for all passengers on any of its sailings. Pre-cruise testing is no longer required.

American Queen Voyages

Vaccines are not required to sail with American Queen Voyages , and pre-cruise testing is no longer required.

Related: What happens if someone tests positive for COVID-19 on your cruise

Atlas Ocean Voyages

Vaccination is not mandatory for Atlas cruises, but passengers must comply with regulations in countries on their scheduled itinerary, which could require that they be up to date on their shots. Additionally, pre-cruise testing is no longer a requirement.

Avalon Waterways

Avalon Waterways no longer requires proof of vaccination or a negative test prior to passenger boarding. However, mandatory testing and proof of vaccination could still be required in some countries the line visits.

Azamara recommends that passengers follow local regulations and the latest guidance from government health organizations when determining which vaccines to obtain prior to travel. The line also does not require negative test results in order to board unless mandated by local governments in the ports where the line’s ships sail.

Carnival Cruise Line

Neither vaccines nor pre-cruise testing is required for Carnival sailings. However, the line recommends that anyone 5 years or older be up to date on their shots and carry proof. It also suggests that cruisers test themselves no further than three days from their sailing date to make sure they’re in good health.

Celebrity Cruises

Celebrity does not mandate vaccination or testing for any passenger on any sailing unless required by regulations in the ports its ships are visiting.

Related: Cruise ship contact tracing: How the world’s major lines are tracking COVID-19 exposure

Celestyal Cruises

Celestyal continues to require all crew members to be fully vaccinated, but passengers don’t have to be. The line recommends anyone 12 and older be up to date on their inoculations. Testing is also no longer necessary in order to board Celestyal ships.

Cunard Line

Although Cunard suggests that travelers be fully vaccinated and current with their boosters, proof of immunization is not required, nor is pre-cruise testing for any of the line’s sailing unless required by law.

Disney Cruise Line

Disney Cruise Line encourages — but does not require — all passengers to be fully vaccinated before sailing. It also recommends pre-cruise testing, no more than two days prior to embarkation, for anyone who doesn’t have their shots.

Emerald Cruises

Emerald Cruises suggests that all passengers be vaccinated, but it no longer checks for proof. Pre-cruise testing is also no longer required, but the line advises travelers to check local regulations in the places they’ll be visiting.

Grand Circle Cruise Line

Vaccine required yes.

Grand Circle has mandated that all passengers must be fully vaccinated at least 14 days prior to embarkation as a condition of carriage, and proof must be provided before boarding. Passengers who are not fully vaccinated will have to return home at their own expense. Boosters are not mandatory. Pre-cruise testing might be required, depending on your port of embarkation. (The line will send you that information prior to your sailing.)

Hapag-Lloyd Cruises

Hapag-Lloyd does not require vaccinations or pre-cruise testing as a condition of sailing. However, the line recommends both to passengers as precautions. It also advises that cruisers are responsible for knowing and adhering to all local guidelines and regulations.

Holland America

Holland America now allows unvaccinated passengers to sail and does not make pre-cruise testing compulsory unless either of these is required by local regulations in the areas its vessels sail. Booked cruisers can search for requirements specific to their individual sailings by using this tool .

Hurtigruten

Vaccine required sometimes.

On expedition cruises with Hurtigruten , passengers are not required to show proof of vaccination, except on 2023 and 2024 voyages to Antarctica and the Northwest Passage or West Africa sailings departing from and returning to Dakar. Immunization is also not necessary for the line’s non-expedition itineraries, but it is recommended for both coastal voyages and expedition cruises. Neither type of cruise requires negative test results as a condition of embarkation. Passengers with reservations can check specific protocols for their specific bookings using this tool .

Lindblad Expeditions

Lindblad passengers no longer need to provide proof of vaccination in order to cruise, and pre-cruise testing is no longer required, including at embarkation. Exceptions might apply for departures from certain destinations. The line urges passengers to follow government recommendations for masking, testing and vaccination.

Related: Why I feel safer now on a cruise ship than in my hometown

MSC Cruises

Vaccination and testing are no longer terms of carriage when sailing with MSC Cruises . The line still recommends that passengers receive their shots and notes that it’s each passenger’s responsibility to comply with local regulations in the places their sailing visits.

Norwegian Cruise Line

In early August 2022, Norwegian Cruise Line became the first major cruise line to roll back its vaccination requirements. Proof of immunization is no longer required, nor is testing in order to board for any voyage.

Oceania Cruises

Upscale cruise line Oceania does not check vaccination records for passengers, nor does it require pre-cruise testing for its sailings.

P&O Cruises

There are no vaccination or testing mandates in place for any of P&O Cruises ‘ voyages.

Ponant ‘s website simply reads, “when you visit certain destinations, vaccines can be recommended,” but they are not required by the line. Ponant also says it will alert passengers to their specific requirements after they have booked a voyage. Testing is also not needed in order to board.

Princess Cruises

Following an industry-wide rollback of protocols, Princess passengers no longer have to show proof of a COVID-19 vaccine, nor proof of a negative test result, unless either is required by local regulations. Passengers are responsible for knowing the requirements for the places their ships will visit.

Regent Seven Seas Cruises

Regent doesn’t check the vaccination status of any of its passengers unless required by local protocols. Testing requirements vary by location and might depend on whether or not you are up to date on your shots. If vaccination or testing is required, the line will alert cruisers approximately 30 days prior to their sailing date.

Royal Caribbean

To board Royal Caribbean ships, you don’t have to be vaccinated or provide test results. However, the line advises staying up to date on inoculations and following guidelines issued by federal health authorities.

Saga has rolled back its vaccination and testing requirements, which is significant, given that the line only allows passengers 50 and older to sail on its vessels. They will only be required if local authorities dictate them.

Scenic Luxury Cruises & Tours

Passengers embarking on river and ocean voyages with Scenic will not need to be fully immunized prior to sailing. Testing is not required by the line but might be needed to enter the country in which you’re embarking on your sailing. Passengers are responsible for meeting entry requirements.

For cruises with luxury line Seabourn , there are no line-enforced regulations for vaccination or testing unless required by local authorities in the countries on which its vessels call. To see if your booked sailing requires either of these, check out the line’s search tool .

Luxury brand Silversea does not require shots for its passengers or pre-cruise tests unless they’re needed to meet local regulations.

Star Clippers

Star Clippers has eliminated all vaccine checks and testing protocols for all passengers on all voyages.

For all voyages through 2023, Tauck requires passengers 12 and older to be fully vaccinated and have at least one booster dose and/or show proof of recovery from COVID-19. Passengers 11 years old and younger are not required to be fully vaccinated. If they aren’t fully vaccinated or don’t have a booster, they must provide proof of a negative PCR or antigen test result from a test taken no more than three days prior to embarkation. For sailings in 2024, vaccination and testing requirements will be waived for all passengers.

UnCruise Adventures

All UnCruise passengers are exempt from vaccine and testing requirements. The line will continue to monitor the effects of new variants, as well as CDC recommendations and will adjust its policies accordingly.

Uniworld Boutique River Cruise Collection

Testing requirements are determined by the countries the ships visit, but the line itself has no vaccine or testing mandates of its own. You can check the protocols for the places on your itinerary for the most up-to-date information by visiting the protocols page on Uniworld’s website .

All Viking passengers, whether on a river sailing or an ocean voyage, must be fully vaccinated for sailings departing on or before Oct. 31, 2023. It will not be required for cruisers embarking on or after Nov. 1, 2023. Testing is no longer required unless passengers are exhibiting symptoms and seek medical assistance.

Virgin Voyages

Virgin Voyages will not check proof of immunization or a negative COVID-19 test prior to boarding.

Windstar Cruises

Windstar no longer mandates shots for passengers of any age. Testing is not required by the line but might be necessary based on local regulations, which with passengers must comply.

Planning a cruise? Start with these stories:

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• A quick guide to the most popular cruise lines
• 21 tips and tricks that will make your cruise go smoothly
• 15 ways cruisers waste money
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• What to pack for your first cruise

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Cruise Ship Travel

While cruising is a popular way to travel, there are some health concerns to be aware of. Find out more about health issues on cruises and steps you can take to stay safe and healthy during your trip.

If you are feeling sick before your voyage, do not travel and ask your cruise line about rescheduling or reimbursement options. If you feel sick during your voyage, report your symptoms to the ship’s medical center and follow their recommendations.

Common Health Concerns During Cruise Travel and What You Can Do to Prevent Illness

• Respiratory viral illnesses like COVID-19 ,  flu , and RSV :  Follow core prevention strategies to protect yourself and others. Get your annual flu shot , stay  up to date on your COVID-19 vaccines , and check if you're eligible for an RSV vaccine . Check directly with your cruise line before travel about any health requirements. If you have a weakened immune system , talk with your healthcare provider about your cruise travel plans. Wash your hands frequently or use hand sanitizer . Stay home and away from others if you have respiratory virus symptoms. Do not travel until your symptoms are improving and you have not had a fever for 24 hours (without meds). For 5 additional days, take precautions including covering your nose and mouth with a tissue to prevent spreading germs when you cough or sneeze. Consider wearing a mask in crowded or poorly ventilated indoor areas or avoiding those areas all together.
• Gastrointestinal illness:  Symptoms of vomiting and diarrhea, primarily caused by outbreaks of norovirus , have been reported. To prevent gastrointestinal illness, wash your hands with soap and water before eating and after using the bathroom, changing diapers, or touching things that other people have touched, such as stair railings. Avoid touching your face. For more information, visit CDC’s  Vessel Sanitation Program  website.
• Seasickness:  Cruise ship passengers may experience seasickness or motion sickness. If you know you get seasick or think you may be likely to get seasick, talk to your healthcare provider about medicine to reduce your symptoms. Some common medications, including some antidepressants, painkillers, and birth control pills, can make seasickness worse.
• Sunburns:  Apply sunscreen with SPF 15 or higher when traveling. Protecting yourself from the sun isn’t just for tropical beaches—you can get a sunburn even if it’s cloudy or cold.
• Bug bites:  On your trip, use insect repellent and take other steps to avoid bug bites. Bugs, including mosquitoes and ticks, can spread diseases such as malaria, yellow fever, Zika, dengue, chikungunya, and Lyme. Many ships visit ports where these diseases are a concern.

Before Your Trip

Check CDC’s destination pages for travel health information . Check CDC’s webpage for your destination to see what vaccines or medicines you may need and what diseases or health risks are a concern at your destination.

Make sure you are up to date with all of your routine vaccines . Routine vaccinations protect you from infectious diseases that can spread quickly in groups of people. Outbreaks of chickenpox, flu, and COVID-19 have been reported on cruise ships.

Many diseases prevented by routine vaccination are not common in the United States but are still common in other countries. Crew members and fellow travelers often board a cruise ship from destinations where some diseases are more common than in the United States or where vaccination is not routine.

Make an appointment with your healthcare provider or a travel health specialist  that takes place at least one month before you leave. They can help you get destination-specific vaccines, medicines, and information. Discussing your health concerns, itinerary, and planned activities with your provider allows them to give more specific advice and recommendations.

Plan for the Unexpected

Prepare for any unexpected issues during your cruise ship travels with the following steps:

Prepare a  travel health kit  with items you may need, especially those items that may be difficult to find at your destination. Include your prescriptions and over-the-counter medicines in your travel health kit and take enough to last your entire trip, plus extra in case of travel delays. Depending on your destination you may also want to pack a mask ,  insect repellent , sunscreen (SPF 15 or higher), aloe, alcohol-based hand sanitizer, water disinfection tablets, and your health insurance card.

Get travel insurance.  Find out if your health insurance covers medical care abroad. Travelers are usually responsible for paying hospital and other medical expenses out of pocket at most destinations. Make sure you have a plan to  get care overseas , in case you need it. Consider buying  additional insurance  that covers health care and emergency evacuation, especially if you will be traveling to remote areas.

If you need medical care abroad, see Getting Health Care During Travel .

After Travel

If you traveled and feel sick, particularly if you have a fever, talk to a healthcare provider and tell them about your travel. Avoid contact with other people while you are sick.

More Information

• Cruise Ship Travel in CDC Yellow Book
• Tips for Healthy Cruising
• Maritime Guidance

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A Royal Caribbean-owned cruise line just announced a vaccine requirement. These are all the cruise lines that will require COVID-19 vaccinations for guests and crew.

• The return of cruising still remains in limbo for many cruise lines.
• Companies including Royal Caribbean and Norwegian have announced vaccine requirements.
• These are all the cruise lines that have COVID-19 vaccine requirements for guests or crew.

Several cruise lines have started announcing vaccination requirements for guests and crew members as the industry looks to restart after the the COVID-19 pandemic.

Last year, cruise ships that were mid-trip began facing COVID-19 related turmoils as the virus began trickling around the world, leaving passengers stuck, infected, or dead. Shortly after, the US Centers for Disease Control and Prevention issued a no-sail order, which was later replaced by its "Framework for Conditional Sailing Order," a compilation of protocols needed for cruising to resume again by November 1.

This sailing order was again updated on April 2. These new guidelines didn't reflect the cruise industry's hope of a sailing return by July , but did recommend cruise lines to establish a timeline for crew and port workers to get the vaccine.

Despite this updated framework — and pent-up demand for  highly anticipated cruise ships and trips — the official return of cruising still remains in limbo. Presently, no major US cruises will be welcoming passengers until May, but companies are constantly extending this pause on sailing .

But as the COVID-19 vaccine continues to be distributed across the globe, this could soon change.

"If we start to see vaccines become more widely available, and if the vaccines are being administered in a far more efficient manner than they have been, I think it would be reasonable for the cruise lines to say a vaccine is required," Henry Harteveldt, a travel industry analyst and president of the Atmosphere Research Group, told Insider in an interview.

However, vaccine rollout and accessibility has been a notorious struggle around the world. As a result, Harteveldt notes that it may be "counterproductive" for major cruise lines like Carnival and Norwegian to require its guests to receive the vaccine if sailings actually resume in the next few months instead of later in the year, say July.

But over the last month, cruise lines have become increasingly vocal about the vaccine. While some companies — such as Carnival and its Holland America line — are "reviewing" the different vaccines , several others have already announced vaccination protocols for guests and crew members.

These are all the cruise lines with vaccine-related mandates so far:

Saga Cruises

On January 21, United Kingdom-based Saga Cruises announced that it would require all of its passengers to be fully vaccinated against COVID-19 two weeks before a trip. Saga primarily caters to passengers over 50-years-old.

Royal Caribbean

Royal Caribbean expects to require its crew members to receive the vaccine before sailings return, a spokesperson told Insider.

On March 1, the cruise line also announced its first "fully vaccinated" cruise aboard the Odyssey of the Seas, which will be sailing in May from Israel. Both crew members and guests over 16 years old will have to be vaccinated against COVID-19 in order to sail on the upcoming cruise.

"Royal Caribbean's decision to come to Israel is a significant expression of  confidence in our policy ," Prime Minister Benjamin Netanyahu said in the press release announcing the cruise . "Just as we made Israel the world champion in vaccines, we will make it the world champion in economics and tourism in the post-coronavirus era."

On March 19 , Royal Caribbean announced a similar series of seven-night sailings from July to August aboard its Adventure of the Seas ship. These summertime cruises will bring guests from Nassau, Bahamas to islands like the Grand Bahama, Cozumel, Mexico, and Royal Caribbean's Perfect Day at CocoCay.

Like the Israel-based Odyssey of the Seas sailings, every adult passenger interested in this upcoming Adventure of the Seas collection will have to be vaccinated against COVID-19. Guests under 18-years-old will instead have to test negative for the virus.

"The vaccines are clearly a game-changer for all of us, and with the number of vaccinations and their impact growing rapidly, we believe starting with cruises for vaccinated adult guests and crew is the right choice," Michael Bayley, president and CEO of Royal Caribbean International, said in a press release . "As we move forward, we expect this requirement and other measures will inevitably evolve over time."

On March 23 , Royal Caribbean announced another set of seven-night summer cruises, this time from Bermuda aboard the Vision of the Seas ship. Like its previous announcements, these new cruises — which will sail from June 26 through August — will require crew members and adult guests to be vaccinated against COVID-19 "at this time." Passengers under 18 years old will instead have to test negative for the virus. 

Guests aboard this recently announced "fully vaccinated" summer cruise will get a full day at Perfect Day at CocoCay and an overnight stay in Bermuda.

One day later, the mega cruise line announced another set of fully vaccinated seven-night cruises, this time from Limassol, Cyprus. These cruises, which will sail from July 10 through October, will bring guests around Cyprus and Greece, including tourist hotspots like Athens, Mykonos, and Santorini. The same crew, adults, and guests under 18 years old health protocols from the prior two Royal Caribbean announcements apply to this sailing as well. 

Crystal Cruises

On February 18, Crystal Cruises said it would require guests to receive both doses of the COVID-19 vaccine at least 14 days before a cruise. The cruise line is also requiring a negative coronavirus test result from travelers and crew members, among other health protocols.

"We know that peace of mind is the greatest luxury, and the vaccine requirement is simply the best way to ensure the safest possible Crystal Experience for all on board," Jack Anderson, the cruise line's interim president and CEO, said in a press release .

Hornblower Group's "overnight" cruise lines

Hornblower Group's American Queen Steamboat Company and Victory Cruise Lines have both announced requirements for guests and crew members to receive the COVID-19 vaccine for sailings starting July 1.

Related stories

According to John Waggoner, CEO and founder of American Queen Steamboat Company, requiring the vaccine will ensure the " safest cruising experience possible ." However, the cruise lines is are still looking to resume sailing in April, prior to this vaccination deadline. 

Norwegian Cruise Line and its Oceania and Regent Seven Seas Cruises brands

Norwegian Cruise Line and its Regent Seven Seas Cruises have announced COVID-19 vaccine requirements for crew members prior to boarding. However, the cruise lines are still "exploring all options" in regards to vaccination requirements for its guests, according to the cruise lines' statements previously sent to Insider.

Now, it seems like Norwegian has made up its mind regarding guest vaccination mandates. On April 5, Norwegian Cruise Line Holdings announced that its three cruise brands — Norwegian, Oceania, and Regent Seven Seas Cruises — will be requiring both guests and crew members to be fully vaccinated.

"Norwegian Cruise Line Holdings shares the CDC's view that vaccinations are the primary vehicle for Americans to get back to their everyday lives," Frank Del Rio, president and CEO of Norwegian Cruise Line Holdings, said in a press release. "We believe that through a combination of 100% mandatory vaccinations for guests and crew and science-backed public health measures ... we can create a safe, 'bubble-like' environment for guests and crew."

Now, Norwegian is hoping the CDC will allow it to bypass the Conditional Sailing Order, therefore bringing the cruise line's sailings from US ports back by July 4. 

Virgin Voyages

Richard Branson's adults-only cruise line, Virgin Voyages, has announced it will be making the COVID-19 vaccine mandatory for both guests and crew in order to "provide the safest travel experience," Tom McAlpin, Virgin Voyages' CEO, said in an email statement sent to Insider.

"The is a step towards the safe return to sailing and is the right decision for Virgin Voyages," McAlpin said in the statement. "We're really encouraged by the latest rollout plans in the May time frame from the new administration, and we know the future is about vaccinations. Our business makes us uniquely set up to do this with testing and vaccine travel requirements."

P&O Cruises

On March 17, P&O Cruises — owned by Carnival Corp — announced a summertime Ultimate Escape cruise collection that will sail along the UK coast. However, the cruises will only be available to UK residents who have been fully vaccinated against COVID-19 at least seven days before the trip.

The decision to make COVID-19 vaccinations mandatory for guests was based on the "advanced progress of the UK vaccination program and strong expressed preference on the part of our guests," P&O said in a press release.

Celebrity Cruises

On March 19, Royal Caribbean's Celebrity Cruises announced seven-night Caribbean sailings departing from June 5 to August aboard the Celebrity Millennium ship. 

Like its parent company's sailings , all crew members and adult guests interested in Celebrity's summer Caribbean cruises will have to be vaccinated against COVID-19. People under 18 years old will instead have to receive a negative PCR test result within 72 hours of the trip.

Windstar Cruises

On March 30, US-based Windstar Cruises announced a COVID-19 vaccine requirement for its guests and crew. 

Guests interested in sailing with the small cruise line — which oversees six ships — must be fully vaccinated at least 14 days before sailing. Proof of the vaccination and a negative COVID-19 PCR test will then have to be presented in order to board the ship.

Windstar's crew will also have to be vaccinated "as soon as the vaccine is available to them," according to the cruise line .

Cunard will resume sailing with cruises around the UK aboard the Queen Elizabeth ship from July to October. However, don't consider booking a trip unless you're a UK resident that's been vaccinated against COVID-19. 

Guests interested in Cunard's summer cruises must be fully vaccinated at least seven days before sailing, and will be required to show proof. 

Seabourn 

On April 6, Seabourn — owned by Carnival Corporation — announced its new seven to 14-day Mediterranean sailings to and from Athens, Greece starting July 3. From there, passengers will get to see tourist hotspots like Mykonos and Agios Nikolaos, Greece and Limassol, Cyprus.

About two weeks later, it unveiled seven-day cruises beginning July from Barbados to the Caribbean, including destinations like Grenada and St. Maarten.

Like other cruise lines, Seabourn is requiring all guests and crew interested in this upcoming summer cruise series to be fully vaccinated at least 14 days before cruising. 

Viking 

The same day Seabourn announced its new fully vaccinated sailings, Viking also unveiled three new eight-day summer cruises, all with a vaccine mandate. These new itineraries will each sail around three different locations starting June: Bermuda, the UK, and Iceland.

Despite the guest vaccine requirement, guests and crew will still have to take a PCR test as well.

"We believe there will be no safer way to travel the world than on a Viking voyage," Torstein Hagen, Viking's chairman, said in the press release ."

On April 8, Royal Caribbean-owned Silversea announced it would require guests and crew — with the exception of those sailing aboard its cruises from Australia — to be fully vaccinated. That same day, Silversea also unveiled its plans to resume sailing on June 18 with 10-day Mediterranean cruises from Greece aboard the Silver Moon ship.

"Vaccinations will play a critical role in ensuring the health and safety of our guests, crew, and the communities we visit, which we prioritize above all else," Roberto Martinoli, president and CEO of Silversea Cruises, said in a press release .

Are you a cruise industry employee or have a cruise industry story to share? Contact this reporter at [email protected].

Watch: The coronavirus could affect the accuracy of the 2020 census — and that could decide who gets a vaccine

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VACCINATION STATUS REQUEST

Your sailing is fast approaching, and we're looking forward to welcoming you onboard. We would appreciate if you could take a moment to provide your COVID-19 vaccination status before your cruise. Please complete the short form below.

NOTE: All Royal Caribbean guests aged 12 and older must present proof of COVID-19 vaccination with the final dose of their vaccine administered at least 14 days before sailing. While vaccination is not required for guests under 12, we kindly ask that you fill in their status below. Feel free to visit our  FAQs  for full details on vaccination requirements.

For more information on protocols specific to your sailing, visit  Getting Ready to Cruise .

Sailing Information

Guest information.

How do you count the 14 days for full vaccination, exactly? The 14 day time period starts on the day that you get your last dose. That’s Day 1. After 14 days pass, you can get onboard on Day 15. For example, if you received your final dose on 1 October, your 14-day countdown starts on 1 October, and you would be permitted to board the ship on 15 October or later.

HEALTH, TRAVEL & RISK ACKNOWLEDGEMENT

As part of the Australian Federal and State Government protocols, all guests must review and accept the Health, Travel & Risk Acknowledgement . Please review this document and acknowledge acceptance via the tick box below.

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Guidance for Cruise Ships on Management of Acute Respiratory Illness (ARI) due to Viral Infection

What to know.

Outbreaks of COVID-19, seasonal influenza, respiratory syncytial virus (RSV) infection, and other viral respiratory infections can occur at any time of the year among cruise ship passengers and crew members. Many cruise ship travelers are older adults or have underlying medical conditions that put them at increased risk of complications from these respiratory virus infections. Early detection, prevention, and control of such acute viral respiratory infections are important, not only to protect the health of passengers and crew members on cruise ships, but also to avoid spread of these viruses into communities.

This document provides guidance for cruise ships originating from or stopping in the United States to help prevent, diagnose, and medically manage acute respiratory illness (ARI) caused by SARS-CoV-2 (the virus that causes COVID-19), seasonal influenza virus, or RSV. This guidance will be updated as needed. As cruise ships travel worldwide, cruise ship personnel need to maintain awareness of, and be responsive to, local jurisdictional situations and requirements. Cruise ship management and medical staff need to be flexible in identifying and caring for people with ARI. The healthcare provider's assessment of a patient's clinical presentation and underlying risk factors is always an essential part of decision-making about the need for further medical evaluation, testing, and treatment.

This document also provides guidance for preventing spread of ARI during and after a voyage, including use of personal protective measures for passengers and crew members and strategies for controlling outbreaks.

Describing and defining passengers and crew with acute viral respiratory illness (ARI)

Signs and symptoms of ARIs can include acute onset of some or all of the following:

• fever or feeling feverish
• nasal congestion
• sore throat
• shortness of breath
• difficulty breathing
• muscle or body aches
• fatigue (tiredness)
• loss of taste or smell

For cruise ship surveillance purposes, CDC defines ARI as an illness of presumed viral etiology with at least two of the following symptoms : fever/feeling feverish, cough, runny nose, nasal congestion, or sore throat and excluding:

• Confirmed acute respiratory infection diagnoses other than COVID-19 A , influenza B , or RSV infection C (e.g., Streptococcal pharyngitis, Epstein-Barr virus infection), D
• Diagnoses of bacterial pneumonia: either clinical or test-positive (e.g., by urine Legionella antigen, urine Streptococcus pneumoniae antigen), and
• Non-infectious conditions as determined by the ship's physician (e.g., allergies)

Fever (a temperature of 100.4°F [38°C] or higher) will not always be present in people with COVID-19, influenza, or RSV infection. Cruise ship medical personnel should consider someone as having a fever if the sick person feels warm to the touch, gives a history of feeling feverish, or has an actual measured temperature of 100.4°F (38°C) or higher.

Reducing the spread of viral respiratory infections

Commercial maritime travel is characterized by the movement of large numbers of people in enclosed and semi-enclosed settings. Like other close-contact environments, these settings can facilitate the transmission of respiratory viruses from person to person through droplets and small particles or potentially through contact with contaminated surfaces.

Efforts to reduce the spread of respiratory viruses on cruise ships should focus on encouraging crew members and passengers:

• 6 months and older to get vaccinated annually for seasonal influenza
• 6 months and older to stay up to date with their COVID-19 vaccines
• who are eligible to discuss and consider RSV vaccination with their healthcare provider
• to avoid contact with ill people before scheduled cruising
• to postpone travel if sick with ARI (passengers)
• to take steps to protect themselves and others while traveling

Cruise ship management should include:

• Encouraging good hand and respiratory hygiene and cough etiquette
• Optimizing ventilation via use of outdoor areas and improving air quality of indoor spaces
• Early identification and isolation of crew members and passengers with ARI, consistent with CDC's respiratory virus guidance
• Use of antiviral medications for treatment of people with suspected or confirmed COVID-19 or influenza with severe or complicated illness, or at increased risk of severe illness or complications
• Use of antivirals for post-exposure prophylaxis (PEP) or during influenza outbreaks, if indicated, for people at increased risk of complications

Vaccination of crew and passengers

All passengers and crew are recommended to be up to date with all routine vaccines including vaccines for COVID-19, influenza, and RSV, when indicated. In addition to the protection vaccines for respiratory infections provide to individual travelers in preventing severe illness or death, having a high proportion of travelers on board who are up to date with these vaccines reduces the likelihood that cruise ships' medical centers will be overwhelmed by cases of ARI.

COVID-19: All people 6 months of age and older should stay up to date with their COVID-19 vaccines. For more information on COVID-19 vaccine recommendations, see COVID-19 Vaccination Interim Clinical Considerations FAQs and COVID-19 Vaccination Clinical and Professional Resources .

Seasonal Influenza : All people 6 months of age and older should be vaccinated each year with the seasonal influenza vaccine. Crew members should be vaccinated yearly. Vaccination of passengers, especially those at increased risk for influenza complications, is recommended at least 2 weeks before cruise ship travel, if the seasonal influenza vaccine is available and the person has not already been vaccinated with the current year's vaccine. For more information on seasonal influenza vaccine recommendations, see Seasonal Influenza Vaccination Resources for Health Professionals .

RSV : Eligible travelers should discuss RSV vaccination with their healthcare provider prior to cruise travel. For more information, see Clinical Overview of RSV .

Viral ARI screening procedures for embarking passengers

Cruise ship operators can consider:

• screening embarking passengers for viral ARI symptoms
• performing viral testing (e.g., COVID-19, influenza, RSV) for passengers with ARI symptoms before they embark. Ships that choose to use COVID-19 antigen tests should follow FDA guidance .
• denying boarding for passengers who test positive for infectious viral etiologies during pre-embarkation screening. If boarding is permitted, see guidance for isolation and other measures

If the cruise ship operator chooses to test for other infectious etiologies and testing identifies an alternate etiology (e.g., Legionella , Epstein-Barr virus, Streptococcal pharyngitis) through laboratory testing, routine infection control precautions specific to the diagnosis should be followed.

Managing cruise travelers with ARI and contacts while on board

Travelers with ARI who board, as well as those who become sick with ARI onboard, should be identified and tested as soon as possible to minimize transmission of respiratory viruses. The table below provides recommendations for management of persons on board with COVID-19, influenza, or RSV infection, and those exposed (i.e., contacts).

1 During the isolation period, these individuals should have in-cabin dining (with food trays placed and collected outside of cabins) and also wear a respirator or well-fitting mask inside their cabin if any person other than a cabinmate (such as a crew cleaning staff) enters the cabin. During the 5 days after isolation, these individuals should be encouraged to follow additional precautions, such as taking additional steps for cleaner air , hygiene , masks , and physical distancing .

2 Crew members with ARI, even if mild, should take the following additional steps—regardless of their COVID-19, influenza, or RSV vaccination status:

• Notify their supervisors
• Report to the medical center for evaluation and testing, if indicated, according to shipboard protocols
• Continue to take precautions for 5 days after returning to work

3 Contacts with increased risk of influenza complications should be identified in order to offer post-exposure prophylaxis (PEP).

Managing passengers or crew with ARI upon disembarkation

Disembarking cruise ship passengers or crew members who have ARI should continue to take precautions after disembarkation. If a passenger or crew member with viral ARI is transferred from the ship's medical center to a healthcare facility off the ship, the facility should be informed before arrival. Medical transport providers should also be notified in advance.

Medical evaluation and management

Medical centers on cruise ships can vary widely depending on ship size, itinerary, length of cruise, and passenger demographics.

• Cruise ship medical centers are recommended to follow the operational guidelines published by the American College of Emergency Physicians (ACEP) as well as disease-specific clinical guidelines (see Additional Resources).
• PPE: surgical masks and NIOSH Approved® N95® filtering facepiece respirators or higher, eye protection such as goggles or disposable face shields that cover the front and sides of the face, and disposable medical gloves and gowns
• Antiviral agents and other therapeutics for COVID-19 , influenza , and RSV infection (if commercially available), and other antimicrobial medications
• Antipyretics (e.g., acetaminophen and ibuprofen), oral and intravenous steroids, supplemental oxygen
• Onboard capacity to conduct viral tests for SARS-CoV-2 and influenza, and RSV, as well as other infections that may be in the differential diagnosis (e.g., group A Streptococcus , Streptococcus pneumoniae, Legionella )
• Medical center staff should adhere to standard and transmission-based precautions when healthcare personnel are caring for patients with suspected or confirmed COVID-19, influenza, RSV, or other communicable diseases.

For more information, read updated resources for clinicians and guidance on the medical evaluation and management of people with COVID-19 , seasonal influenza , or RSV .

Diagnostic tests for acute viral respiratory illness (ARI)

Respiratory specimens for ARI testing should be collected immediately upon illness onset, with the understanding that repeat testing may be indicated based on the viral etiology or epidemiology of circulating respiratory viruses. In general, molecular tests are recommended over antigen tests because of their greater sensitivity; multiplex assays are available that can detect SARS-CoV-2, influenza A and B, and RSV.

Healthcare providers should understand the advantages and limitations of rapid diagnostic tests, and proper interpretation of negative results of any antigen diagnostic tests. Rapid antigen diagnostic tests have a lower sensitivity compared with molecular tests, and false negative results can occur frequently. In symptomatic persons, negative rapid antigen diagnostic test results do not exclude a diagnosis of COVID-19, influenza, or RSV; clinical diagnosis of these illnesses should be considered. However, positive test results are useful to establish a viral etiology and to provide evidence of infection in passengers and crew members aboard ships.

Respiratory and hand hygiene

People with ARI should be advised of the importance of covering coughs and sneezes and keeping hands clean because respiratory viruses may be shed after the isolation period ends.

Cruise operators should ensure passengers and crew have access to well-stocked hygiene stations with soap and water and/or hand sanitizer, tissues, paper towels, and trash receptacles.

Respirators or well-fitting masks should be readily available. After ending isolation, passengers and crew recovering from ARI should be encouraged to take precautions when outside their cabins.

Passengers and crew members should be reminded to wash their hands often with soap and water, especially after coughing or sneezing. If soap and water are not available, they can use an alcohol-based hand sanitizer that contains at least 60% alcohol.

Used tissues should be disposed of immediately in a disposable container (e.g., plastic bag) or a washable trash can.

Outbreak control

A combination of measures can be implemented to control ARI outbreaks, including initial isolation of symptomatic people, increased infection prevention and control efforts, antiviral chemoprophylaxis of influenza-exposed people, crew member and passenger notifications, and active surveillance for new cases.

Recommendations when a voyage's crew or passenger ARI attack rate reaches 3% E

• Provide all crew members with respirators or well-fitting masks and provide crew with information on how to properly wear, take off , and clean (if reusable) them.
• Maximize the introduction of outdoor air and adjust HVAC systems to increase total airflow to occupied spaces; move activities outside whenever possible. For additional information on ventilation, see Ventilation in Buildings .
• Consider outbreak notification letters to passengers and crew to allow for individual risk assessment and decision-making.
• Cancel nonessential face-to-face employee meetings as well as group events (such as employee trainings) and social gatherings.
• Maximize air circulation in crew outdoor smoking areas.
• Close indoor crew smoking areas.
• Eliminate self-serve dining options at all crew and officer messes.
• Reduce the dining cohort size for crew, and shorten dining times to avoid crowding.
• Consider contact tracing for focused testing and/or additional mitigation measures for those at highest risk.
• For crew outbreaks, consider serial viral (antigen or molecular) screening testing of crew every 3–5 days. The onboarding of additional laboratorians may be needed to facilitate the testing process.
• Perform contact tracing.
• Consider antivirals for prevention of influenza in exposed people, depending on their risk for complications, or all identified contacts onboard.

Considerations for suspending passenger operations

In some circumstances, additional public health precautions, such as returning to port immediately or delaying the next voyage, may be considered to help ensure the health and safety of onboard travelers or newly arriving travelers.

A ship should consider suspending operations based on the following factors:

• 15% or more of the passengers have met ARI criteria; or
• 15% or more of the crew have met ARI criteria; or
• 15% or more of total travelers have met ARI criteria F
• Shortages of supplemental oxygen or other medical supplies related to management of patients with ARI, or
• 3 or more deaths due to ARI in passengers and/or crew during a voyage
• Evaluate symptomatic travelers and their close contacts,
• Conduct appropriate testing of travelers,
• Conduct routine medical checks of travelers in isolation, or
• Conduct contact tracing of close contacts, if applicable
• Testing equipment,
• Antipyretics (fever-reducing medications such as acetaminophen and ibuprofen),
• Antivirals and other therapeutics for COVID-19, influenza, and RSV infection (if commercially available),
• Oral and intravenous steroids, or
• Supplemental oxygen
• Inadequate onboard capacity to fulfill minimum safe manning or minimal operational services, including but not limited to housekeeping and food and beverage services
• A new respiratory virus, strain, or variant with potential for increased severity or transmissibility identified among cases on board

CDC requests that cruise ships submit a cumulative ARI report (even if no ARI cases have occurred) preferably within 24 hours before arrival in the U.S. G , and sooner if a voyage's crew or passenger ARI attack rate reaches 3% H . These reports are requested by completing the Cruise Ship Cumulative Acute Respiratory Illness (ARI) Reporting Form. Access to the online reporting form has been provided to cruise lines by CDC. Cruise lines that do not have access may contact CDC (email [email protected] ).

In addition, CDC emphasizes that any deaths—including those caused by or suspected to be associated with influenza, COVID-19, RSV infection, or ARI—that occur aboard a cruise ship destined for a U.S. port must be reported to CDC immediately. Report ARI deaths by submitting an individual Maritime Conveyance Illness or Death Investigation Form for each death.

Vessel captains may request assistance from CDC to evaluate or control ARI outbreaks as needed. If the ship will not be arriving imminently at a U.S. seaport, CDC maritime staff will provide guidance to cruise ship officials regarding management and isolation of infected people and recommendations for other passengers and crew members. CDC staff may also help with disease control and containment measures; passenger and crew notifications; surveillance activities; communicating with U.S. state, territorial, or local public health authorities; obtaining and testing laboratory specimens; and provide additional guidance as needed.

Infection prevention and control

Infection prevention and control (IPC) are critical to reducing the spread of ARI. Each cruise ship should maintain a written Infection Prevention and Control Plan (IPCP) that details standard procedures and policies that specifically address infection prevention and control and cleaning/disinfection procedures to reduce the spread of ARI.

To reduce the spread of ARI, cruise ship operators should include the following as part of a written IPCP:

• Duties and responsibilities of each department and their staff for all passenger and crew public areas
• A graduated approach for escalating infection prevention and control measures in response to ARI cluster or outbreaks during a voyage with action steps and criteria for implementation
• Procedures for informing passengers and crew members that a threshold of ARI has been met or exceeded, and of any recommended or required measures to prevent spread of infection
• Crew members entering cabins or other areas where people with ARI are should be limited, and crew should wear an NIOSH Approved® N95® filtering facepiece respirator or higher in accordance with the Occupational Safety and Health Administration's (OSHA) Respiratory Protection standard (29 CFR 1910.134 )
• Disinfectant products or systems used, including the surfaces or items the disinfectants will be applied to, concentrations, and required contact times
• Safety data sheets (SDSs)
• PPE recommendations for crew, which may include surgical masks or NIOSH Approved® N95® filtering facepiece respirators or higher, eye protection such as goggles or disposable face shields that cover the front and sides of the face, and disposable medical gloves and gowns in addition to those recommended by the disinfectant manufacturer in the SDS; for information on health hazards related to disinfectants used against viruses, see Hazard Communication for Disinfectants Used Against Viruses .
• Health and safety procedures to minimize respiratory and dermal exposures to both passengers and crew, when recommended
• Graduated procedures for returning the vessel to normal operating conditions after a threshold of ARI has been met, including de-escalation of cleaning and disinfection protocols

Frequent, routine cleaning and disinfection of commonly touched surfaces with an Environmental Protection Agency (EPA)-registered disinfectant is recommended.

Additional resources

• Respiratory Virus Guidance
• COVID-19 Treatments and Medications
• Seasonal Influenza Prevention
• Seasonal Influenza Treatment: What You Need to Know
• Infectious Diseases Society of America guidelines for controlling institutional influenza outbreaks
• Symptoms of RSV (Respiratory Syncytial Virus)
• How RSV Spreads

Attribution Statement

N95 and NIOSH Approved are certification marks of the U.S. Department of Health and Human Services (HHS) registered in the United States and several international jurisdictions.

• Confirmed COVID-19 means laboratory confirmation for SARS-CoV-2, the virus that causes COVID-19, by viral test.
• Confirmed influenza means laboratory confirmation for influenza A or B by viral test.
• Confirmed RSV means laboratory confirmation for RSV by viral test.
• Other respiratory viruses—for which point-of-care diagnostic tests are not available—may also cause ARI (e.g., rhinovirus, adenovirus, enterovirus, human parainfluenza viruses, human metapneumoviruses).
• Sources of data should include medical center records and other established surveillance systems for passengers and crew (e.g., employee illness reports).
• These thresholds are subject to change based on the characteristics of the circulating respiratory virus.
• For international voyages with >1 U.S. port (e.g., Canada to multiple Alaskan ports), please submit report to CDC within 24 hours before arrival in the final U.S. port.
• For international voyages with >15 days prior to arrival in the U.S., the time period for calculating this attack rate begins at day 15 prior to arrival at a U.S. port.

CDC works with partners to protect the health of people exposed to a contagious disease during travel and their communities from contagious diseases that are just a flight away.

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