On a cruise ship, a confined community of people from around the world travels to exotic locations, increasing the risk of contagious diseases such as influenza and norovirus infections. The pre-cruise travel health consultation should include risk assessment, appropriate immunisation, advice on a personal medical kit and preventing and treating common problems.

The number of people going on cruises is growing around the world, with Australian cruise passengers increasing by about 20% annually for the past 10 years.1 In 2016, almost one in every 18 Australians went on a cruise.2 Read on to discover common health risks on cruises and the issues to cover in a pre-travel health consultation.

Health risks on cruise ships

The modern cruise ship is larger than an aircraft carrier and may carry more than 6000 passengers and 2000 crew. Cruise ships are semi-closed communities, where large numbers of passengers and crew from around the world are confined in a relatively small space, consume the same sources of food and water and travel to exotic and remote locations. All these factors increase the risk of contagious diseases. In addition, cruise ships offer a wide range of on-board activities that may lead to injury, particularly in inexperienced, unfit passengers, including rock climbing, roller skating, ice skating, water sliding, flow riding and skydiving simulators.

Most visits to medical clinics on cruise ships are due to acute illnesses, including dental problems.3 Almost all patients are managed on-board, with only 5% requiring medical evacuation or transfer to land-based health facilities.3 Urgent or emergency treatment is required by 3 to 11% of patients. The most common diagnoses are respiratory illnesses, seasickness, injuries and gastrointestinal illness (Table 1).3

Influenza is the most common vaccine-preventable illness on cruise ships. As crews and passengers come from all over the world, influenza outbreaks occur year-round, caused by strains circulating in different regions. Legionnaire’s disease, although not common on cruise ships, has caused intermittent outbreaks. Norovirus is responsible for more than 90% of outbreaks of gastroenteritis with a confirmed diagnosis on cruise ships. Between 2010 and 2015, eight to 16 outbreaks of norovirus infection occurred on cruise ships annually.3

Many crew members on cruise ships come from developing countries with low immunisation rates. Despite health screening of crews, outbreaks of measles, rubella, meningococcal disease and varicella have been reported on cruise ships.3 About 50% of passengers whose medical care on cruise ships are older than 65 years.3 Death rates for cruise ship passengers range from 0.6 to 9.8 deaths per million passenger-nights, mostly from cardiovascular events.3

Table 1. Common reasons for visits to medical clinics on cruise ships3

Respiratory illnesses19 to 29%
Seasickness10 to 25%
Injuries from slips, trips12 to 18% or falls
Gastrointestinal illnesses9 to 10%


Pre-cruise travel health consultation

As for other travellers, the pre-travel medical consultation for prospective cruise passengers should take place well before departure. Medical expertise, vaccines and malaria chemoprophylaxis may not be available on cruise ships, and vaccinations may require time to become effective. Points to cover in the pre-travel consultation include:

Risk assessment

  • Discuss itinerary, including season, duration of travel and on-shore activities
  • Review your medical and immunisation history, allergies and special health needs
  • Discuss travel-specific health hazards
  • The doctor should provide documentation to the traveller on their medical history, allergies, immunisations and medications

Immunisation and risk management

  • Discuss immunisations – routine, recommended and required
  • Discuss food and water precautions and insect-bite prevention
  • Provide blood group and Rhesus factor information
  • Travel insurance that covers medical evacuation and repatriation should be secured
  • The doctor will discuss the keeping a supply of medications in their original containers in hand luggage, with a backup supply in your suitcase 
  • For older travellers, especially those with a history of heart disease, the doctor should provide a copy of a baseline ECG to facilitate on-board or overseas care
  • Your doctor will pre-arrange and liaise with cruise ship company medical units for special requirements, such as wheelchairs, continuous positive airway pressure (CPAP) machines and oxygen supplies
  • The doctor will also advise the traveller to arrange powers of attorney where appropriate (and to leave a copy with emergency contacts)

Personal medical kit

  • Advise on contents of a personal medical kit*
  • Provide prescriptions where required

* Most dedicated travel clinics stock a range of medical kits.


Cruise passengers should be up to date with the following vaccinations:

Routine vaccinations (depending on age)

  • Tetanus/diphtheria/whooping cough
  • Poliomyelitis
  • Measles, mumps, rubella
  • Chickenpox

Recommended vaccinations

  • Influenza (perhaps the single most important vaccination for cruise passengers)
  • Hepatitis A (generally indicated if visiting developing countries)
  • Typhoid (destination specific, often optional)

Required vaccinations for specific destinations

  • Yellow fever
  • Poliomyelitis.

Other vaccinations may be indicated depending on the patient’s itinerary, specific medical conditions and personal preferences. These include hepatitis B, meningococcal, pneumococcal, Japanese encephalitis and rabies vaccinations

Personal medical kit

A personal medical kit should be individualised according to each passenger’s medical conditions and itinerary. Recommended essential items in addition to the passenger’s regular medications include:

Nonprescription items

  • Oral analgesics (e.g. paracetamol and/or ibuprofen)
  • Antidiarrhoeal agents (e.g. loperamide)
  • Rehydration salts
  • Antihistamines (e.g. loratadine)
  • Antiseptic solutions (e.g. povidone- iodine)

Prescription items (ideally supervised by the ship’s medical team)

  • Antibiotics for bacterial dysentery (e.g. azithromycin or ciprofloxacin)
  • Antibiotics for respiratory infections (e.g. roxithromycin or cefalexin)
  • Antiemetics (e.g. ondansetron wafers)
  • Optional:
    • other antibiotics (e.g. soframycin drops)
    • antiviral medication (e.g. oseltamivir)
    • tinidazole (for giardiasis)

This list is not exhaustive. Although passengers are recommended to carry a supply of commonly required antibiotics, empirical self-treatment with antibiotics on a cruise can sabotage efforts to control outbreaks. Ship’s doctors generally prefer pre-travel health providers to instruct passengers not to take antibiotics empirically; self-treatment of a condition such as norovirus gastroenteritis for two to three days before presentation can increase the risk of a large outbreak on board. You should report any vomiting and diarrhoea to the ship’s medical centre immediately at any time of the day or night.

Regular medications

Passengers should take with them an adequate supply of their usual medications for the entire cruise. The specific medication (or an appropriate substitute) may not be available on board or in ports. Generally, ship’s doctors do not have prescription authority in local ports. It is almost impossible to obtain controlled medication on cruises. Passengers should carry in their hand luggage all medications in the original containers, along with a copy (ideally both paper and digital) of the prescription and/or an accompanying letter from their medical practitioner. They should take a back-up supply of critically indispensable medication in their suitcase.

Cost of medical services on cruise ships

The cost of medical services varies between ships but is generally expensive and is almost never covered by Medicare or private health insurance, even on cruises within Australian waters. All medical expenses are added to the room service bill and are payable before disembarkation. The importance of premium travel insurance cannot be over emphasised, ideally covering any pre-existing medical conditions.


  1. Business Research & Economic Advisors. Cruise tourism’s contribution to the Australian economy 2016-7. Sydney: Cruise Lines International Association Australasia; 2018. Available online at: www.cruising.org.au/Tenant/ C0000003/5677_CLIA_Economic_Impact_ Statement_Web.pdf (accessed October 2018).
  2. Cruise Lines International Association (CLIA) Australasia. Cruise industry ocean source market report – Australia 2017. Sydney: Cruise Lines International Association Australasia; 2018. Available online at: www.cruising.org.au/Tenant/C0000003/Cruise%20Industry%20Source%20Market%20 Report%20(1).pdf (accessed October 2018).
  3. Regan JJ, Tardivel K, Lippold SA, Duong KK. Cruise ship travel. In: Centers for Disease Control and Prevention. CDC yellow book 2018: health information for international travel. New York: Oxford University Press; 2017. pp. 521-526. Available online at: wwwnc.cdc.gov/travel/yellowbook/2018/ conveyance-transportation-issues/cruise-ship-travel (accessed October 2018).