The Cruise Ship Holidays That Could Put You at Risk — What Every Passenger Should Know

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The MV Hondius has been making headlines for all the wrong reasons this week. Three people are dead, a British national is in intensive care in South Africa, and health authorities across more than a dozen countries are racing to track passengers who dispersed around the world before anyone fully understood the scale of the hantavirus outbreak on board. It’s a nightmare scenario — and it’s raised an uncomfortable question for the millions of people who book cruises every year: just how safe are you on a ship?

Why Cruise Ships Are Uniquely Vulnerable

A cruise ship is, in a lot of ways, a floating city. It has restaurants, bars, theatres, swimming pools, gyms, shops and hundreds of cabins — all packed into a sealed environment that passengers share 24 hours a day. That’s great for the holiday experience. It’s also, from a public health perspective, about as ideal a disease-spreading environment as you can get.

The combination of high population density, shared dining areas, frequent contact with common surfaces and limited ventilation in enclosed spaces creates conditions where infections can move fast. Add to that the fact that cruise passengers come from dozens of different countries — bringing different exposure histories and immunity profiles with them — and you have a genuinely complex public health challenge.

Medical facilities on cruise ships are also limited by design. They’re set up to provide first aid, basic treatment and short-term care, not to manage a full-scale outbreak of a serious infectious disease. Once something gets going on a ship at sea, the options for response are significantly narrower than on land.

The Diseases Most Commonly Linked to Cruise Ships

Norovirus is by far the most frequent offender. Researchers reviewing published studies found 127 reports of norovirus outbreaks on cruise ships. Often called the ‘vomiting bug,’ norovirus spreads through contaminated food, surfaces and person-to-person contact, which makes buffet dining in particular a real risk factor. Having a symptomatic cabin mate turned out to be the single biggest risk factor in outbreak investigations. Symptoms typically resolve within one to three days and are rarely dangerous, but they can put you in bed for a large chunk of your holiday.

Legionnaires’ disease is a more serious concern, and one that’s been linked to cruise ships for decades. The Legionella bacteria thrive in water systems — particularly whirlpool spas and complex plumbing networks — and can cause a severe form of pneumonia when inhaled as a fine aerosol. Ships can struggle to fully sterilise these systems, and outbreaks linked to hot tubs on board have been documented going back to the 1990s.

COVID-19 brought cruise ships into sharp public focus in early 2020. The Diamond Princess outbreak — in which 619 passengers and crew tested positive — became a case study in how quickly a respiratory virus can spread in a confined shipboard environment, and how much earlier intervention could have limited the damage.

Hantavirus on a cruise ship, as seen on the MV Hondius, is actually extremely rare. Outbreaks on ships have not been documented before at this scale. The current situation appears to have originated from a passenger who was exposed on land in South America before boarding, rather than from rodents actually on the ship — though the route of transmission is still being investigated.

Expedition Cruises: A Different Kind of Risk

It’s worth noting that not all cruises carry the same risk profile. The MV Hondius was not a conventional Caribbean or Mediterranean cruise ship. It was an expedition vessel — smaller, more remote, and visiting far less regulated environments than a mainstream cruise itinerary. With accommodation for around 196 passengers and a crew of 72, it’s a fraction of the size of the mega-ships many people picture when they think of cruises.

Expedition cruises by nature take passengers to remote areas — Antarctica, the South Atlantic, the Amazon, Arctic territories — where exposure to unusual pathogens is a genuine consideration, medical evacuation is logistically complicated, and the nearest major hospital can be many thousands of miles away. If you’re booking this type of cruise, the risk calculus is simply different from a week in the Med.

What Questions Should You Actually Ask Before You Sail?

Most mainstream cruises are genuinely well-regulated. Cruise lines operating in major markets are subject to regular health inspections and are required to report outbreak data to public health authorities. That said, there are questions worth asking before you book.

Find out how the ship handles illness reporting. Are passengers encouraged or even required to report symptoms? Is there a clear process for isolating sick passengers? On the MV Hondius, the delayed understanding of what was happening was one of the complicating factors — several passengers had already disembarked at Saint Helena before the extent of the outbreak was known.

Ask about the medical facilities on board. How is the sick bay equipped? What is the evacuation protocol if someone needs hospital-level care? On a large Caribbean cruise ship close to major ports, this is a fairly straightforward question. On an expedition cruise to a remote ocean territory, it’s a much more significant one.

Check the ship’s recent inspection history. In the US, the CDC’s Vessel Sanitation Program publishes inspection scores for cruise ships operating in American waters. The UK’s Maritime and Coastguard Agency performs similar checks. Scores below a certain threshold are a flag worth paying attention to.

Practical Steps That Actually Help

Wash your hands thoroughly and often — especially before eating and after using shared spaces. Sanitiser stations on cruise ships are there for a reason, and using them consistently makes a real difference with norovirus and similar infections.

Be cautious around buffets. Use the serving utensils provided, avoid touching surfaces unnecessarily, and if you’re not feeling well, skip the buffet and eat in your cabin. One infected person moving through a buffet line can set off a chain reaction.

Avoid hot tubs if you have any open cuts or skin conditions, or if you’re immunocompromised. The Legionnaires’ risk from whirlpool spas is real and documented.

If you feel unwell on board, report it to the ship’s medical team promptly rather than waiting to see if it passes. Early reporting not only gets you treated faster — it can prevent the infection spreading to dozens of other passengers before anyone knows there’s a problem.

Should You Cancel Your Cruise?

Almost certainly not, unless you’re booked on an expedition voyage to remote South America, in which case it’s reasonable to have a conversation with the operator about current risk assessments. For mainstream cruise holidays, the statistical reality is that the vast majority of voyages complete without any significant disease event.

The MV Hondius situation is genuinely alarming, but it’s also genuinely unusual. A remote expedition ship, a previously undetected exposure in one of the most isolated regions on earth, a virus strain with a long and unpredictable incubation period — these are not the conditions of a typical cruise holiday. The story is worth understanding, and the questions it raises about cruise ship health protocols are worth asking. But it’s not a reason to swear off cruising altogether.

What it is, actually, is a good reminder to be an informed passenger rather than a passive one — to know what the protocols are, know where the medical facilities are, and know how to report a problem if one comes up. That’s good practice on any holiday, not just at sea.