International Influenza Monitoring Respiratory Illness at Tourist Resorts Including Cruise Ships

Updated: February 26, 1999

Health Canada continues to monitor influenza outbreaks worldwide. Now, at the height of the flu season, many countries in the Northern Hemisphere are reporting large scale influenza outbreaks in a variety of settings, e.g., general population, nursing homes, etc. One frequently overlooked area is the occurrence of influenza in tourist resorts where people from many geographic regions congregate for short periods of time. One venue involves cruise ships.

Health Canada is aware of a number of reported febrile respiratory illnesses on board several cruise ships in the Caribbean region. At present, it appears that these respiratory illnesses are due to influenza activity. This occurrence is not unexpected given that the influenza season is usually from November to March in the northern hemisphere and that outbreaks of influenza have been reported with travel on trains, aircraft and ships in the past. Ships, like many other tourist resorts, provide a closed setting where influenza can easily be transmitted.

For Canadians travelling in the Caribbean on cruise ships at this time, Health Canada does not recommend any specific precautions for the average traveller younger than 65 years and in good health. However, the elderly (persons 65 years and older) , and adults and children with chronic cardiac or pulmonary disorders severe enough to require regular medical follow-up or hospital care, have a higher risk of serious consequences from influenza infection. These travellers should consult their personal physician to assess their individual risk prior to travel. Immunization with the current 1998-99 influenza vaccine is recommended for high-risk individuals. Individuals who wish to decrease their chances of acquiring flu during their vacation on cruise ships or at other tourist resorts may also choose to be vaccinated.

Target groups for influenza and pneumococcal vaccination overlap considerably. Health care providers should take the opportunity to vaccinate eligible persons against pneumococcal disease during the same visit at which influenza vaccine is given.

Persons at highest risk for serious consequences of influenza infection may also discuss with their personal physician the possibility of obtaining a prescription for amantadine, which they can fill and take with them on their voyage. Amantadine is an antiviral agent that is 70%-90% effective in preventing illness caused by type-A influenza viruses if commenced within 48 hours of the onset of symptoms. However, because amantadine can be associated with side effects, it is recommended that travellers first consult with the medical staff onboard ship before taking the medication, either as prophylaxis or for treatment.