While many turn to cruise ships for a relaxing and luxurious experience, having that many people in an isolated and, with the exception of the deck areas, largely confined environment creates a heightened risk of disease outbreak.
That is why outbreaks of norovirus, measles, and different types of gastrointestinal illness are more common on cruise ships. The Centers for Diseases Control and Prevention (CDC) regularly warns about contagions that may be a small and calculated risk for healthy travelers but pose serious dangers for more vulnerable populations.
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Certain parts of the cruise ship can also carry higher risks. The latest report from the CDC found approximately a dozen outbreaks of Legionnaire's Disease tied to private hot tubs aboard ships between November 2022 and June 2024.
Legionnaire's is a term for a specific type of severe pneumonia that causes severe coughing, high fevers and risk of damage to the lungs.
'Hot tubs offer favorable conditions for growth and transmission'
While not naming specific cruise ship companies, the CDC said that various "sampling results identified private hot tubs on selected cabin balconies as the most likely exposure source" on the outbreaks it studied.
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Private hot tubs are defined as those within the cabin or in a suite's balcony — while viewed as extremely luxurious and a major upgrade of one's cruising experience, the CDC warns that they may not always be cleaned as thoroughly as public hot tubs in the deck and pool areas that many fear as being disease carriers.
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"Hot tubs offer favorable conditions for Legionella growth and transmission when maintained and operated inadequately, regardless of location," the national health agency writes in the report. "Private hot tubs on cruise ships are not subject to the same maintenance requirements as are public hot tubs in common areas.”
One analysis found that six of the 10 samples from private balcony hot tubs on a given cruise ship were found to have Legionella bacteria. On a different cruise ship, 10 out of the 12 passengers who fell ill from the Legionella bacteria experienced symptoms so bad they had to be hospitalized.
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This is what you need to know about cruise ship cleanliness and hot tubs
The study authors who examined the outbreak numbers warned that it is "important" for cruise ship staff to "assess and adapt public hot tub maintenance and operations protocols for use on private outdoor hot tubs."
A running list from the CDC also identifies cruise ships based on cleanliness examined over the last two years; last month, Carnival (CCL) was identified as having the most cruise ships at the bottom of its cleanliness rating.
The cruise line's Elation, Miracle and Breeze ships scored a respective 89, 88 and 86 points while anything below 85 is considered non-satisfactory by the agency. That said, the ratings are still relatively high considering that Hapag-Lloyd Cruises’ Hanseatic Inspiration ship received the bottom score of 62 — Carnival's Panorama and Spirit ships also both scored perfect scores of 100.
In response to these scores, Carnival issued a statement saying that it "continually strive[s] for the highest sanitation standards and implement[s] immediate corrective action [from] the outcomes of these inspections."
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