Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2014 Jan 10;9(1):e83425.
doi: 10.1371/journal.pone.0083425. eCollection 2014.

Self-reported stomach upset in travellers on cruise-based and land-based package holidays

Naomi J Launders  1 , Gordon L Nichols  2 , Rodney Cartwright  3 , Joanne Lawrence  4 , Jane Jones  4 , Christos Hadjichristodoulou  5
Affiliations

Self-reported stomach upset in travellers on cruise-based and land-based package holidays

Naomi J Launders et al. PLoS One. .

Abstract

Background: International travellers are at a risk of infectious diseases not seen in their home country. Stomach upsets are common in travellers, including on cruise ships. This study compares the incidence of stomach upsets on land- and cruise-based holidays.

Methods: A major British tour operator has administered a Customer Satisfaction Questionnaire (CSQ) to UK resident travellers aged 16 or more on return flights from their holiday abroad over many years. Data extracted from the CSQ was used to measure self-reported stomach upset in returning travellers.

Results: From summer 2000 through winter 2008, 6,863,092 questionnaires were completed; 6.6% were from cruise passengers. A higher percentage of land-based holiday-makers (7.2%) reported stomach upset in comparison to 4.8% of cruise passengers (RR = 1.5, p<0.0005). Reported stomach upset on cruises declined over the study period (7.1% in 2000 to 3.1% in 2008, p<0.0005). Over 25% of travellers on land-based holidays to Egypt and the Dominican Republic reported stomach upset. In comparison, the highest proportion of stomach upset in cruise ship travellers were reported following cruises departing from Egypt (14.8%) and Turkey (8.8%).

Conclusions: In this large study of self-reported illness both demographic and holiday choice factors were shown to play a part in determining the likelihood of developing stomach upset while abroad. There is a lower cumulative incidence and declining rates of stomach upset in cruise passengers which suggest that the cruise industry has adopted operations (e.g. hygiene standards) that have reduced illness over recent years.

PubMed Disclaimer

Conflict of interest statement

Competing Interests: All authors work in Public Health Microbiology or Epidemiology. Professor Cartwright has undertaken paid work on behalf of the Travel Industry to investigate outbreaks. Professor Hadjicristodoulou rans an EU funded project called SHIPSAN TRAINET that was involved with passenger ship hygiene and Professor Nichols has also contributed to this project. This does not alter the authors' adherence to all the PLOS ONE policies on sharing data and materials.

Figures

Figure 1
Figure 1. Age distribution of reported stomach upset on cruises.
Figure 2
Figure 2. Trends in reports of stomach upset over time.
Where S = Summer and W = Winter. Regression line for cruise-related stomach upset per year: R2 = 0.8984; regression line for land-based holiday-related stomach upset: R2 = 0. 7686.
Figure 3
Figure 3. Incidence and estimated number of cases of stomach upset in travellers (both cruise- and land-based) in the period from Jan 2001 to Dec 2008.
Figure 4
Figure 4. Seasonal distribution of prevalence of reported stomach upset in cruise passengers on cruises departing Spain and Egypt.
S = Summer and W = Winter.
See this image and copyright information in PMC

References

    1. Mouchtouri VA, Nichols G, Al GR (2010) State of the art: public health and passenger ships. Int Marit Health 61: 53–98. - PubMed
    1. Soto SM (2009) Human migration and infectious diseases. Clin Microbiol Infect 15 Suppl 1: 26–28. - PMC - PubMed
    1. Evans MR, Shickle D, Morgan MZ (2001) Travel illness in British package holiday tourists: prospective cohort study. J Infect 43: 140–147. - PubMed
    1. Pitzurra R, Steffen R, Tschopp A, Mutsch M (2010) Diarrhoea in a large prospective cohort of European travellers to resource-limited destinations. BMC Infect Dis 10: 231. - PMC - PubMed
    1. Redman CA, Maclennan A, Wilson E, Walker E (2006) Diarrhea and respiratory symptoms among travelers to Asia, Africa, and South and Central America from Scotland. J Travel Med 13: 203–211. - PubMed

Publication types