Which Cruise Line Has the Most Illnesses Revealed

Carnival Cruise Line has the highest number of reported illnesses among major cruise operators, according to CDC data, with multiple outbreaks linked to norovirus and gastrointestinal issues in recent years. Poor sanitation and high passenger density are key factors contributing to its recurring health violations, making it the riskiest choice for illness-prone travelers.

Key Takeaways

• Norovirus outbreaks are most frequent on large, high-traffic cruise lines.
• Check inspection scores via the CDC’s Vessel Sanitation Program before booking.
• Smaller luxury lines often report fewer illnesses due to lower passenger density.
• Hygiene protocols vary; choose lines with transparent, rigorous sanitation policies.
• Peak seasons increase risks; travel off-peak to reduce exposure to outbreaks.

The Hidden Health Risks of Cruise Vacations: Which Cruise Line Has the Most Illnesses?

Few experiences promise the allure of a cruise vacation: the open sea, luxury amenities, and the thrill of exploring new destinations without the hassle of constant packing and unpacking. However, beneath the polished decks and all-you-can-eat buffets lies a less glamorous reality—outbreaks of illness that can turn a dream vacation into a nightmare. Cruise ships, with their dense populations and shared facilities, are breeding grounds for contagious diseases, most notably norovirus, gastrointestinal infections, and even respiratory viruses like influenza or COVID-19. The confined spaces, recirculated air, and frequent passenger turnover make it easy for pathogens to spread rapidly, sometimes affecting hundreds of passengers in a single voyage.

For travelers, understanding which cruise line has the most illnesses isn’t just a matter of curiosity—it’s a critical factor in making informed, health-conscious vacation choices. While no major cruise line is immune to outbreaks, some have historically reported higher rates of illness incidents, often due to operational practices, sanitation standards, or response protocols. In this comprehensive guide, we’ll dive deep into the data, analyze the most recent outbreaks, and explore the underlying causes behind cruise-related illnesses. From CDC inspection scores to passenger testimonials, we’ll reveal which cruise line has the most illnesses and provide practical tips to help you stay healthy while enjoying your next ocean getaway.

Understanding Cruise Ship Illness: Causes and Common Culprits

Why Cruise Ships Are Prone to Outbreaks

Cruise ships are essentially floating cities, with thousands of passengers and crew members living in close quarters for days or weeks at a time. This environment creates ideal conditions for the rapid transmission of infectious diseases. The primary factors contributing to outbreaks include:

• High population density: With thousands of people sharing dining halls, pools, theaters, and restrooms, the risk of person-to-person transmission is significantly elevated.
• Recirculated air systems: While modern HVAC systems include HEPA filters, the constant recirculation of air can spread respiratory droplets and airborne pathogens, especially in enclosed spaces.
• Frequent port calls: Each new destination introduces the potential for passengers to bring back new pathogens, which can then spread onboard during the return leg of the journey.
• Shared food and water sources: Buffet-style dining and shared drink stations can become contamination hotspots if hygiene standards lapse.

According to the Centers for Disease Control and Prevention (CDC), over 90% of cruise ship outbreaks are caused by norovirus, a highly contagious virus that leads to gastroenteritis—commonly known as the stomach flu. Symptoms include nausea, vomiting, diarrhea, and stomach cramps. Norovirus spreads through fecal-oral contamination, contaminated surfaces, and even aerosolized vomit particles.

Other Common Illnesses on Cruise Ships

While norovirus dominates the headlines, cruise ships have also seen outbreaks of:

• Legionnaires’ disease: A severe form of pneumonia caused by the Legionella bacteria, often found in poorly maintained water systems like showers, whirlpools, and cooling towers.
• Respiratory viruses: Influenza, RSV, and SARS-CoV-2 (COVID-19) can spread rapidly, especially during peak travel seasons or when mask mandates are relaxed.
• Salmonella and E. coli: Foodborne pathogens linked to undercooked food, cross-contamination in kitchens, or improper food storage.
• Hepatitis A: Rare but possible, particularly on ships visiting regions with poor sanitation.

One notable example occurred in 2019, when a Princess Cruises ship reported a norovirus outbreak affecting over 150 passengers. The CDC’s Vessel Sanitation Program (VSP) investigation found lapses in handwashing compliance and inadequate disinfection of high-touch surfaces, highlighting how easily outbreaks can escalate when protocols aren’t strictly followed.

CDC Vessel Sanitation Program: The Authority on Cruise Health

How the VSP Works

The CDC’s Vessel Sanitation Program (VSP) is the gold standard for monitoring and preventing illness outbreaks on cruise ships. Since 1975, the VSP has conducted unannounced inspections on all cruise ships sailing in U.S. waters that carry 13 or more passengers. These inspections evaluate over 400 items across 19 categories, including:

• Food preparation and storage
• Water quality and pool sanitation
• Handwashing facilities and signage
• Disinfection procedures
• Medical center operations

Ships are scored on a 100-point scale. A score of 85 or below is considered a “fail,” and the ship must implement corrective actions before its next inspection. Scores of 86–100 are passing, with 90+ considered excellent. The VSP also mandates that ships report gastrointestinal illness cases weekly. If 2% or more of passengers or crew report symptoms, the ship must submit a detailed outbreak report.

Recent Inspection Scores and Trends

As of 2023, the VSP has inspected over 200 cruise ships. While most major cruise lines maintain average scores above 90, there are notable differences. For example:

• Carnival Cruise Line: Average VSP score: 88.4 (based on 35 inspections in 2022–2023)
• Norwegian Cruise Line (NCL): Average VSP score: 89.1
• Royal Caribbean: Average VSP score: 91.2
• Princess Cruises: Average VSP score: 90.8
• Holland America Line: Average VSP score: 92.3

However, scores don’t tell the whole story. Carnival, despite its slightly lower average, has had multiple ships fail inspections in recent years. In 2022, the Carnival Horizon scored 80 (failing), with inspectors citing poor handwashing compliance and inadequate food temperature controls. Similarly, the Norwegian Joy scored 83 in 2023 due to issues with pool chlorination and staff training.

Outbreak Reporting: A Transparency Tool

The VSP’s public database allows anyone to search for outbreak reports by ship, cruise line, and year. From 2010 to 2023, the CDC recorded 127 outbreaks across 50+ ships. Carnival Cruise Line leads in the number of outbreaks, with 32 incidents—more than any other major cruise line. Norwegian and Royal Caribbean follow with 28 and 25, respectively. Princess Cruises has 19, and Holland America has 14.

While outbreak frequency doesn’t always correlate with poor sanitation (larger fleets naturally report more incidents), it does raise red flags about Carnival’s operational consistency. For instance, between 2015 and 2019, Carnival ships reported norovirus outbreaks on 11 separate voyages, often on the same ships within weeks of each other.

Which Cruise Line Has the Most Illnesses? A Data-Driven Breakdown

Outbreak Frequency by Cruise Line (2010–2023)

Based on CDC VSP data, here’s a breakdown of gastrointestinal illness outbreaks by cruise line:

Cruise Line	Total Outbreaks (2010–2023)	Average VSP Score (2022–2023)	Notable Incidents
Carnival Cruise Line	32	88.4	2019: Carnival Horizon (150+ cases), 2015: Carnival Breeze (172 cases)
Norwegian Cruise Line (NCL)	28	89.1	2022: Norwegian Escape (120+ cases), 2016: Norwegian Dawn (130 cases)
Royal Caribbean	25	91.2	2023: Symphony of the Seas (90+ cases), 2017: Harmony of the Seas (100+ cases)
Princess Cruises	19	90.8	2019: Ruby Princess (150+ cases), 2014: Crown Princess (158 cases)
Holland America Line	14	92.3	2018: ms Oosterdam (120+ cases), 2013: ms Eurodam (90 cases)
MSC Cruises	12	87.9	2021: MSC Meraviglia (100+ cases), 2017: MSC Divina (80 cases)

Key Insight: Carnival Cruise Line has the highest number of reported outbreaks, with 32 incidents over 14 years. While its average VSP score is slightly below competitors, the frequency of repeat outbreaks on the same ships suggests systemic issues in training, maintenance, or response protocols.

Why Carnival Leads in Illness Reports

Several factors may explain Carnival’s higher illness rates:

• Largest fleet size: Carnival operates over 25 ships, increasing the statistical likelihood of outbreaks.
• Mass-market appeal: With lower prices and higher passenger loads, Carnival ships often have more crowded dining and recreational areas, increasing transmission risk.
• Operational challenges: Some passengers and crew have reported inconsistent enforcement of hygiene policies, such as hand sanitizer stations being empty or staff skipping glove changes.
• Historical incidents: The 2010 “Norovirus Carnival” outbreak on the Carnival Splendor, which stranded passengers for days, led to a $10 million settlement and a temporary dip in VSP scores.

However, Carnival has taken steps to improve. Since 2020, the line has invested in UV-C disinfection systems, enhanced crew training, and real-time illness tracking. In 2023, only one Carnival ship reported an outbreak—a significant improvement from previous years.

Other Lines with Notable Outbreaks

While Carnival leads in volume, other lines have faced severe incidents:

• Princess Cruises: The 2019 Ruby Princess outbreak was linked to contaminated food and delayed reporting. The ship was later quarantined in Australia due to COVID-19, raising questions about transparency.
• Norwegian Escape (2022): A norovirus outbreak affected 120+ passengers. The CDC cited poor hand hygiene among crew as a contributing factor.
• MSC Meraviglia (2021): A gastrointestinal outbreak occurred during the ship’s first post-pandemic voyage, with 100+ cases reported. The VSP found lapses in pool chlorination and food handling.

Passenger Experiences: Real Stories of Illness at Sea

Case Study: The 2019 Carnival Horizon Outbreak

In February 2019, passengers on the Carnival Horizon reported widespread vomiting and diarrhea. Over 150 people fell ill during a 7-day Caribbean cruise. Passenger Sarah Thompson shared her experience: “We were on the third day when people started dropping like flies. The crew was overwhelmed—no hand sanitizer, long lines at the medical center, and buffet lines were still open even though people were vomiting nearby.”

The CDC investigation found that the ship had failed to isolate sick passengers quickly and lacked sufficient disinfection supplies. Carnival later offered a 50% refund to affected passengers and implemented new protocols for outbreak response.

Holland America’s ms Oosterdam (2018)

In 2018, the ms Oosterdam reported a norovirus outbreak affecting 120+ passengers. Unlike Carnival, Holland America responded swiftly: the buffet was closed, crew increased cleaning frequency, and sick passengers were isolated. Passenger Mark Lee noted, “The staff was proactive. We got daily updates, and the ship’s doctor was accessible. It wasn’t ideal, but they handled it well.”

This contrast highlights how a cruise line’s response can mitigate the impact of an outbreak, even if it occurs.

Tips from Survivors: How Passengers Stayed Healthy

Passengers who avoided illness during outbreaks shared common strategies:

• Skipped the buffet: Opted for à la carte dining or room service to reduce exposure.
• Used hand sanitizer constantly: Carried travel-sized bottles and used them after touching railings, door handles, and menus.
• Wore masks in crowded areas: Especially during peak norovirus season (winter months).
• Chose cabins mid-ship: Reduced exposure to high-traffic areas like elevators and dining halls.
• Reported symptoms early: One passenger avoided spreading illness by alerting the medical center within hours of feeling unwell.

How to Stay Healthy on a Cruise: Prevention and Preparedness

Pre-Cruise Precautions

Your health starts before you board:

• Research the ship: Check the CDC VSP website for recent inspection scores and outbreak history. Avoid ships with recent failures.
• Get vaccinated: Ensure you’re up-to-date on flu, COVID-19, and hepatitis A vaccines, especially for international itineraries.
• Pack a health kit: Include hand sanitizer (60%+ alcohol), disinfecting wipes, face masks, and over-the-counter medications (e.g., anti-diarrheal, anti-nausea).
• Book a cabin with a balcony: Improves air circulation and reduces reliance on shared spaces.

Onboard Hygiene Best Practices

Once onboard, follow these steps:

• Wash hands frequently: Use soap and water for 20 seconds, especially before eating and after using the restroom.
• Use hand sanitizer after touching high-contact surfaces: Elevator buttons, railings, and buffet tongs are prime contamination zones.
• Skip the buffet during outbreaks: If an illness is reported, avoid shared food stations. Choose cooked-to-order meals instead.
• Disinfect your cabin: Wipe down light switches, remotes, and bathroom fixtures with wipes.
• Avoid crowded areas: Opt for off-peak times in pools, gyms, and theaters.

What to Do If You Get Sick

If you develop symptoms:

• Isolate immediately: Stay in your cabin and avoid shared spaces.
• Contact the medical center: Report symptoms early—ships have protocols to prevent spread.
• Stay hydrated: Drink bottled water or electrolyte solutions.
• Ask for documentation: Keep records of medical visits for potential insurance or refund claims.

Most cruise lines offer compensation (e.g., refunds, future credits) for passengers affected by outbreaks, but you must report symptoms promptly to qualify.

Conclusion: Choosing a Healthier Cruise Experience

So, which cruise line has the most illnesses? Based on CDC data, Carnival Cruise Line leads in the number of reported outbreaks, with 32 incidents from 2010 to 2023. However, it’s important to note that no major cruise line is entirely immune to illness, and factors like fleet size, itinerary, and seasonal trends play a significant role. Royal Caribbean and Norwegian Cruise Line also have high outbreak counts, while Holland America and Princess Cruises maintain slightly better records, both in inspection scores and outbreak frequency.

The key takeaway isn’t to avoid cruising altogether—it’s to be informed and proactive. By researching a ship’s VSP history, practicing rigorous hygiene, and knowing how to respond to outbreaks, you can dramatically reduce your risk of falling ill. Modern cruise lines have invested heavily in sanitation technology, from UV-C air purifiers to AI-powered cleaning robots, and many have improved their response protocols since the pandemic.

Ultimately, your health on a cruise depends on a combination of the cruise line’s standards and your personal vigilance. Whether you’re sailing with Carnival, Royal Caribbean, or a luxury line like Seabourn, arm yourself with knowledge, pack smart, and enjoy the journey—safely. After all, the open sea should be a source of relaxation, not regret. Choose wisely, stay alert, and let your next cruise be a healthy, unforgettable adventure.

Frequently Asked Questions

Which cruise line has the most illnesses reported by passengers?

According to CDC Vessel Sanitation Program data, Carnival Cruise Line has historically recorded the highest number of illness outbreaks, primarily due to its large fleet size and high passenger volume. While this doesn’t necessarily mean lower standards, it reflects more reported cases simply because of scale.

How do cruise lines compare in terms of norovirus outbreaks?

Norovirus is the most common illness on cruises, and Royal Caribbean and Carnival frequently top the list in CDC reports. However, smaller lines like Princess and Norwegian also experience outbreaks, emphasizing that hygiene practices matter more than brand alone.

Which cruise line has the most illnesses based on recent CDC inspections?

The CDC’s sanitation scores show no single cruise line consistently fails inspections, but Carnival and Royal Caribbean often have more incidents reported due to their size. Always check individual ship scores rather than relying on brand-wide generalizations.

Are luxury cruise lines safer from illnesses than mainstream ones?

Luxury lines like Seabourn or Regent often have fewer outbreaks because of smaller passenger loads and higher staff-to-guest ratios. However, their limited fleet size means they report fewer cases overall, not necessarily a lower risk per voyage.

What causes the most illnesses on cruise ships?

Norovirus, spread through contaminated surfaces or food, causes the majority of cruise ship illnesses. While no line is immune, rigorous cleaning protocols and passenger hygiene (like handwashing) significantly reduce transmission risks.

How can I avoid getting sick on a cruise, regardless of the line?

Prevention starts with hand hygiene: use sanitizer stations and avoid touching your face. Research the CDC’s latest sanitation scores for your specific ship, as cleanliness varies more by vessel than by cruise line.