Many of the tips for foreign travel apply to cruise ship travel. Injuries are one of the most common reason passengers need medical care on cruise ships, but illnesses can also occur. While most passengers recover if injured or ill while on board, about 20 people die each year while on cruise ships. Heart attacks are the most common cause of death.

The American College of Emergency Physicians promotes standards and has created guidelines for emergency care on cruise ships. In addition, the cruise ship industry has taken many steps to promote higher standards of health care, especially following numerous news stories of thousands of cruise-ship passengers becoming ill from viruses. (However, some ships are registered under foreign countries, and the standards are not necessarily enforceable in those countries, so it may be wise to check with the cruise line you are sailing with or the embassy of the country of registration.) 

In addition, before you take a cruise, ask:

• What kinds of resources and medical facilities are available for emergency care?  Is the ship equipped to deal with serious illnesses, such as heart attack or stroke?
• Is there an emergency physician on board to oversee care? 

If you have any chronic medical conditions, such as chronic obstructive pulmonary disease, inform the cruise line four to six weeks before you leave. The cruise line will need a letter from your doctor, a brief medical history, and your current oxygen prescription. You'll need to make prior arrangements to have your oxygen units delivered directly to the cruise ship before you depart.

Also, special cruises are now available for travelers who have certain medical conditions, such as people who need dialysis.

Avoid Travelers’ Diarrhea:

Dos

• Wash you hands frequently and always before eating.
• Eat items that require little handling in preparation.
• Eat only well-cooked and hot foods. If eating at a buffet, eat early before foods cool, or insects arrive.
• East only fresh fruits and vegetables you have peeled or seen prepared in front of you.
• Drink hot beverages, such as coffee or tea, and make sure they were not prepared with local tap water. 
• Drink bottled water or name-brand carbonated beverages.
• Wipe off any bottle before drinking or pouring.
• Tie a colored ribbon around the bathroom faucet in your room as a reminder not to drink the tap water.

Don’ts

• Never drink tap water. Don’t brush your teeth with tap water.
• Never drink fresh water or standing water.
• Avoid bottled water not opened in front of you.
• Avoid ice cubes. If you must have a cool drink, place ice cubes in a small, clean, leak-proof bag and place the bag in your drink. Carry bags with you.
• Avoid food from street vendors.
• Avoid shellfish, any uncooked seafood or raw meat.
• Avoid uncooked vegetables and salads.
• Avoid dairy products.
• Avoid juices not prepared in front of you. Tap water may have been added.
• Minimize swimming (except in well-chlorinated pools) and avoid swallowing water.

Avoid Hepatitis When Traveling Abroad

Travelers to developing countries, especially pregnant women, are at risk of hepatitis A virus (HAV), the hepatitis E virus (HEV) and other forms of hepatitis. You should be vaccinated at least four weeks ahead of time against hepatitis A if you are traveling for long periods of time to countries where epidemics occur. In addition, you should take the following precautions while on your trip:

• Wash your hands with soap and water, especially after using the toilet, changing a diaper or before eating or preparing food. The hepatitis A virus can survive for as long as four hours at room temperature in fecal matter on someone’s hand or on a hard surface like a bathroom door handle.
• Clean contaminated surfaces. Use household bleach (10 parts water to one part bleach) to clean surfaces contaminated with feces, such as a diaper changing table.
• Peel all fresh fruit and vegetables yourself and use bottled water to wash them.
• Avoid raw or undercooked meat and fish.
• Do not use ice cubes in your drinks.
• Only bottled water should be used for brushing teeth and drinking.
• If bottled water is not available, tap water should be boiled for 10 minutes.
• Don’t share needles, razors or toothbrushes.
• Practice safe sex. Hepatitis A also can be spread through unsafe sex.

Know the Signs and Symptoms of Hepatitis

• Some forms of hepatitis have no signs or symptoms.
• If symptoms are present, they usually occur soon after infection and may include fever, tiredness, loss of appetite, nausea, hives, abdominal discomfort, dark urine, altered sense of taste or smell, and jaundice (yellowing of the skin and eyes).If present, symptoms usually last less than two months; a few persons are ill for as long as six months.
• Hepatitis A symptoms usually appear within 28 days (range is 15-50 days) after a person has been infected.

Get Tested

If you suspect you may have contracted hepatitis or if you are pregnant, ask your doctor to test you for the virus. The earlier you are diagnosed, the more likely you can prevent spreading the disease to others and better manage your health.