Cruise Ship Norovirus Outbreak Response SOP

Standard operating procedure for responding to suspected norovirus or acute gastroenteritis events onboard a cruise ship, including trigger thresholds, enhanced cleaning, CDC Vessel Sanitation Program notification, galley control measures, isolation/quarantine coordination, and passenger communication.

Steps

• The medical officer verifies that the case count meets the outbreak threshold
  The medical officer verifies that the case count meets the outbreak threshold: ≥2 confirmed cases with symptom onset within 72 hours in the same location (cabin deck, dining venue, or crew area). Record case count, onset dates, and affected locations in the outbreak log. If threshold not met, document the event and continue monitoring.
• The hotel director activates the outbreak response team
  Notify the medical officer, sanitation manager, food and beverage manager, guest services manager, security lead, and communications lead. Assign a single incident coordinator and open the outbreak response log. Confirm communication channels and reporting intervals.
• The sanitation manager initiates enhanced cleaning and disinfection
  Deploy outbreak cleaning teams to affected cabins and common areas. Clean and disinfect high-touch surfaces, shared restrooms, and any contaminated areas using the approved contact time. Replace cleaning cloths and dispose of waste as biohazard waste per ship procedure. Record areas cleaned and time completed.
• The medical officer isolates symptomatic guests and crew
  Identify symptomatic passengers and crew from the case line list. Coordinate cabin confinement or designated isolation, symptom monitoring, and meal delivery arrangements. Instruct affected persons to avoid public areas until cleared by medical staff. Document each isolation decision and follow-up interval.
• The food and beverage manager applies galley control measures
  Remove symptomatic food handlers from duty and notify medical staff. Reinforce hand hygiene, glove changes, and separation of raw, ready-to-eat, clean, and dirty zones. Restrict self-service items if required by the outbreak plan. Verify sanitizer concentration and document any menu or service modifications.
• The incident coordinator notifies CDC Vessel Sanitation Program
  Prepare the outbreak summary, including case counts, symptom onset dates, affected areas, and control measures initiated. Submit notification to CDC Vessel Sanitation Program through the required reporting channel. Save confirmation details in the outbreak log and retain all supporting documentation.
• The guest services manager issues passenger communication
  Distribute approved passenger notices through onboard channels. Explain symptom reporting, handwashing expectations, cabin confinement instructions if applicable, and any dining or venue changes. Use plain language, avoid identifying affected individuals, and provide a contact point for questions.
• The medical officer monitors for additional cases
  If the threshold is not met, continue active surveillance for gastrointestinal symptoms among passengers and crew. Review medical visits, cabin reports, and crew health reports at the defined interval. Escalate immediately if the threshold is reached or if cases cluster in a shared location.
• The incident coordinator documents the non-conformance and closes the shift report
  Confirm that the incident log, line list, cleaning records, notification records, and passenger communication copies are complete. Record any deviations, corrective actions, and open follow-up items. Handoff unresolved items to the next shift or designated owner.