Travel Risk Map 2016. Cruise ship vessel sanitation inspections

By David Tykol
This item appears on page 2 of the March 2016 issue.
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Three condors perched above Colca Canyon in Peru. Photo: ©Vitaliy Markov/123rf

Dear Globetrotter:
Welcome to the 481st issue of your monthly foreign travel magazine.
With this issue, we begin our 41st year of publication!
Thank you, all of you — subscribers, advertisers, business associates and friends — who have made it possible for ITN to never miss a deadline.
With your continued help, we’ll keep the travel news coming.

Here’s an information source that you might find of interest.
A world map that shows travelers, at a glance, the levels of each and every nation’s overall health and safety risks was released in December by International SOS, a “medical and travel security services company,” and Control Risks, a “global risks consultant.”
Evaluations took into account endemic diseases, environmental risks, road and security conditions and the quality and availability of health care and emergency services plus factors like political violence, social unrest and crime.
Called the Travel Risk Map 2016, it uses color-coding to indicate the availability of medical care (ranging from green for countries with readily available, quality medical care to red for countries with inadequate or difficult-to-get care). And it uses alphabetical notations to show the level of risk from violence or sociopolitical instability, ranging from “I” for insignificant to “E” for extreme.
A PDF of the map and an infographic can be downloaded from the International SOS website, www.internationalsos.com/risk-outlook.
Next to the Travel Risk Map is an interactive webmap that provides, when clicking on any country, a summary with details about the availability of medical and dental care services.
Content was gathered from public data sources and the firsthand knowledge of International SOS regional medical directors.
International SOS helps members of its assistance program to get the best medical care available worldwide, through International SOS-certified and -managed clinics, doctors and dentists. Though business travelers are the focus of the company, people who travel for leisure or learning can also become members (priced per year [from $435] or per trip; phone 215/942-8226). Members receive basic coverage, assistance, referrals and information.
Some examples from the map — the countries incurring the lowest travel risk and the highest availability of medical care are all of the countries in Western Europe plus Israel, Taiwan, South Korea, Japan, Australia, New Zealand, South Africa, Uruguay, Chile, Canada and the US.
Eastern European countries, along with Mexico and most countries in Central America and the Caribbean, were ranked in the middle for medical care and, for the most part, were considered “Medium” for travel risks.
Much of Africa rated “High” to “Extreme” for inadequate or difficult-to-access medical care and, overall, has high travel risk, as do Iraq, Syria, Afghanistan and North Korea.
Places with variable and rapidly changing medical care, colored brown on the map, include Russia, countries of Central Asia, India, China, Brazil and Argentina. While medical care in these places might be of good quality and widely available in cities, it may not be available at all in the vast spaces between cities.

Cruise lovers, how does your favorite ship score with the CDC?
Random inspections of 231 cruise ships that dock in US ports are conducted by the US Centers for Disease Control (CDC) as part of their Vessel Sanitation Program (VSP). In the VSP, each ship is rated from 1 to 100 based on a number of criteria, including food sanitation (in storage and preparation), potable water storage and handling, the hygiene of personnel and the cleanliness of the ship.
On Feb. 1, 2015, the ms Eurodam of Holland America Line (HAL) scored its ninth perfect health inspection score in a row. On June 5, the HAL ship Statendam aced its third health inspection, having also achieved scores of 100 during inspections in June 2014 and February 2015. In all of 2015, Holland America ships scored 10 perfect inspections, including the Zuiderdam, Nieuw Amsterdam, Noordam, Ryndam and Veendam.
The lowest score that any of the 13 HAL ships that were inspected in 2015 received (of the line’s 15 ships, total) was a 90, earned by the ms Zaandam on June 3, but that ship righted course with a 97 on an Oct. 7 inspection.
In the calendar year 2015, the commercial passenger ships of 61 companies underwent a total of 223 VSP inspections (some more than once), and 31 of them (about 14%) earned perfect scores. Let me name the rest of them, then I’ll talk about a few ships that didn’t do so well.
Carnival Cruise Lines, with 23 out of 24 of its ships inspected, ranked second to HAL, with all ships passing and five earning perfect scores: Carnival Sunshine, Carnival Ecstasy, Carnival Triumph, Carnival Pride and Carnival Miracle.
Following with four ships rated perfect were three lines: Royal Caribbean International (18 of 21 inspected, one not passing), with Brilliance of the Seas, Enchantment of the Seas, Radiance of the Seas and Serenade of the Seas; Princess Cruises (15 out of 18 inspected, all passing), with Golden Princess, Island Princess, Regal Princess and Ruby Princess, and Celebrity Cruises (9 out of 11 ships inspected, all passing), with Celebrity Equinox, Celebrity Infinity, Celebrity Millennium and Celebrity Summit.
Norwegian Cruise Line (10 out of 13 ships inspected and passing) had three top scores, earned by Norwegian Breakaway, Norwegian Jewel and Norwegian Sky.
Disney Cruise Line (all four ships passing) had two ships scoring 100: Disney Dream and Disney Fantasy.
The lines each having one perfect score were Sea Dream Yacht Club (both of its ships passing), with its Seadream I, and Regent Seven Seas Cruises, with its Seven Seas Navigator (the line’s only ship inspected in 2015, out of 4).
A CDC VSP rating of 85 or less is considered unacceptable. From Jan. 1 to Dec. 31, 2015, five ships received such ratings.
In May, Silversea Cruises’ Silver Shadow got an 82 for, among other things, improper food preparation and storage and a lack of anti-entrapment drain guards in the pool.
In June, Celebration Cruise Lines’ Grand Celebration scored an 80 for failing to meet standards on potable water storage and for having an inadequate disease-outbreak “prevention and response” plan, and Royal Caribbean International’s Adventure of the Seas scored an 84 in October for having food kept and served at unsafe temperatures plus an accumulation of dust and debris in food-storage areas.
The lowest score of 2015, a 69, belonged to Bahama Mama, operated by Balearia Caribbean, Ltda. The ship was penalized for having excessive dust and debris in food-preparation areas, poor pest-management procedures and, frighteningly, a complete lack of a gastroenteritis-outbreak-response plan.
In fact, the medical staff on board Bahama Mama was found to be “not familiar with reportable case definition.” In other words, they didn’t know they had to report incidents of gastroenteritis to onboard staff in order to help prevent a ship-wide outbreak.
The VSP does not take into account illness outbreaks when rating a ship. Even on a ship with high cleanliness and proper procedures, a passenger cannot be prevented from bringing a virus, especially the dreaded norovirus, on board, though strict hygiene and planning can help to limit the outbreak.
The CDC does investigate all reported illness outbreaks aboard cruise ships that dock in the US. In 2015 there were 12 such outbreaks, 11 of which were found to be norovirus (the 12th, as of press time, was still under investigation). Ships with perfect inspection scores that also had illness outbreaks were the Veendam, Celebrity Equinox and Celebrity Infinity.
You can search VSP inspection results by cruise line, ship and/or year and read detailed reports at wwwn.cdc.gov/inspectionquerytool/InspectionSearch.aspx.

CORRECTIONS to note —
• Susan Hayes wrote, “It was nice to see my letter, ‘Peru with Tara Tours,’ in the December 2015 issue (page 23). In rereading it, I noticed that in the list of items included in the cost of our customized trip with Tara (www.taratours.com), details of the ‘transfers’ were not included. The transfers weren’t insignificant.
“The Cuzco-Puno transfer was a day-long trip that included sightseeing at four locations along the way plus lunch. And the Puno-Chivay-Arequipa transfer (including a half-day tour to Colca Canyon) was spread over two days, each segment taking most of the day, with brief photo op stops and lunch.”
• In Ellen Jacobson’s article on Japan in the January 2016 issue, she wrote that the guide Michie Taylor travels to Japan twice a year (page 22). After reading the article, Michie wrote to ITN to share that she actually leads groups to Japan three times per year, in the spring and fall for the Fukuoka tour and in May to tour central Japan and Tokyo.
• I was delighted to print the letter from David De Mille about a scenic drive to Ma˘lda˘res¸ti, Romania, where he stayed at a conacul, or manor house. But I was appalled to learn from him that we had misprinted his starting destination as Budapest, Hungary, instead of Bucharest, Romania. Believe me, it’s a much shorter drive from Bucharest.

In my December 2015 column, Gene Dougher wondered out loud whether or not a traveler should tip his travel agent and, if so, what an appropriate tip would be.
Keith D. Jackson of Parksville, BC, Canada, wrote, “For eight years in the 1990s I worked as a travel consultant, arranging international air travel, land tours, cruises, etc., and personally delivered documents to my clients’ homes or businesses. Never did I receive or expect to receive any tips from my clients. I’m the one who gave them various items, such as wine, wristbands, No-Jet-Lag mints, tote bags, etc. I have never heard of tipping a travel agent.”
Not even cookies?

People have certain assumptions about travel insurance. To make everyone aware of what they might be surprised to find they are NOT covered for in certain situations, we would like to gather and print a number of subscribers’ experiences.
In regard to travel outside of the US, tell us about a time when you submitted a claim to a travel insurance company and expected reimbursement but had your claim denied. We’re looking for any example of a particular problem, situation, incident or event — medical or nonmedical — that was NOT covered under a travel insurance policy.
We will not be printing the names of any travel insurance companies; we want only general accounts.
Describe the situation or what occurred. Include where and approximately when (year) this took place. Tell us what you thought you were covered for but were not. As closely as possible, tell us the insurer’s reason(s) for rejecting your claim.
In addition, what did you learn from your experience? What do you now make sure you’re covered for when purchasing travel insurance? What “buzz words” in the fine print do you look for and why?
Email editor@intltravelnews.com or write to Travel Insurance Claim Denied, c/o ITN, 2116 28th St., Sacramento, CA 95818. We’ll print responses in a future issue.

Another request — for our “Where in the World?” page, located at the tail end of each issue, if you have a picture of a special landmark, scene, structure or well-known object located outside of the US, consider submitting it for our ongoing contest.
A photo of something other than a statue or public art piece would be preferred, unless it is of a historical nature or nationally recognized in some way. A creative challenge would be an extreme (but identifiable) close-up of something well known by international travelers. Any landscapes should be undeniably one of a kind.
While we have a drawing and award a prize each month to one of the people who correctly identify the location where a mystery photo was taken, we offer only lasting fame and our undying gratitude to those whose photos we print.

While I’m on the subject of submitting photos, here are some guidelines.
We can accept color photos or black-and-white prints of any size as well as slides and transparencies. If you have a choice, submit color because all pictures get posted on our website in color.
Of course, most people shoot digital pictures these days. Be aware, however, that many Web-based photo-sharing services — such as Picasa and OneDrive — will automatically compress and resize the original image files, and, while the pictures look fine on a computer screen, the resulting files may not be of sufficient size or resolution for publication in this magazine.
Instead, save the original photo files directly to your computer’s desktop or onto a CD, without any editing or alteration of photo sizes. If the photo file is larger than 500 kB,
then it probably is acceptable for printing.
Note: We cannot use photos embedded within text, such as in the body of an email or document file. Pictures need to be sent or attached as separate files.
Lastly, and just as important, in your cover email, don’t forget to include a caption for each picture. What are we looking at, approximately where was the picture taken, and who snapped the picture? Precede each caption with the photo file number or name so there’s no confusion about which captions go with which photos.
Let’s see what you’ve got!

The last day of this month, March, is the deadline for submitting your “Where Were You in 2015?” entry, after which we’ll tally the results and have our prize drawing.
If you are an ITN subscriber, write up a list of all of the nations you visited in 2015 (outside of your country of residence) and email it to editor@intltravelnews.com or address it to Where Were You in 2015?, c/o ITN, 2116 28th St., Sacramento, CA 95818. Include your mailing address, where you receive ITN.
The information we gather from this informal poll will help us in wooing potential advertisers and will also be of interest to our editorial staff. So take a moment to recall your travel destinations from last year, send us a quick email, then continue reading the magazine.
In the June 2016 issue, I’ll announce the results of our poll and the names of the prize winners.

The following subscribers submitted their 2015 lists and added kudos:
Bill Kocar, San Diego — “Thanks for the great travel news magazine you publish every month. I truly enjoy getting a lot of valuable travel information.”
Margo Mata, Carlsbad, CA — “ITN continues to be a great source of info, and a great read, which I do from cover to cover. Thanks for the best periodical of all my subscriptions!”
Ellen Shea, Henderson, NV — “I love ITN. Thank you for A Celebration of Travel each month.”
Let’s keep the celebration going!

Please login or subscribe to ITN to read the entire post.
Three condors perched above Colca Canyon in Peru. Photo: ©Vitaliy Markov/123rf

Dear Globetrotter:
Welcome to the 481st issue of your monthly foreign travel magazine.
With this issue, we begin our 41st year of publication!
Thank you, all of you — subscribers, advertisers, business associates and friends — who have made it possible for ITN to never miss a deadline.
With your continued help, we’ll keep the travel news coming.

Here’s an information source that you might find of interest.
A world map that shows travelers, at a glance, the levels of each and every nation’s overall health and safety risks was released in December by International SOS, a “medical and travel security services company,” and Control Risks, a “global risks consultant.”
Evaluations took into account endemic diseases, environmental risks, road and security conditions and the quality and availability of health care and emergency services plus factors like political violence, social unrest and crime.
Called the Travel Risk Map 2016, it uses color-coding to indicate the availability of medical care (ranging from green for countries with readily available, quality medical care to red for countries with inadequate or difficult-to-get care). And it uses alphabetical notations to show the level of risk from violence or sociopolitical instability, ranging from “I” for insignificant to “E” for extreme.
A PDF of the map and an infographic can be downloaded from the International SOS website, www.internationalsos.com/risk-outlook.
Next to the Travel Risk Map is an interactive webmap that provides, when clicking on any country, a summary with details about the availability of medical and dental care services.
Content was gathered from public data sources and the firsthand knowledge of International SOS regional medical directors.
International SOS helps members of its assistance program to get the best medical care available worldwide, through International SOS-certified and -managed clinics, doctors and dentists. Though business travelers are the focus of the company, people who travel for leisure or learning can also become members (priced per year [from $435] or per trip; phone 215/942-8226). Members receive basic coverage, assistance, referrals and information.
Some examples from the map — the countries incurring the lowest travel risk and the highest availability of medical care are all of the countries in Western Europe plus Israel, Taiwan, South Korea, Japan, Australia, New Zealand, South Africa, Uruguay, Chile, Canada and the US.
Eastern European countries, along with Mexico and most countries in Central America and the Caribbean, were ranked in the middle for medical care and, for the most part, were considered “Medium” for travel risks.
Much of Africa rated “High” to “Extreme” for inadequate or difficult-to-access medical care and, overall, has high travel risk, as do Iraq, Syria, Afghanistan and North Korea.
Places with variable and rapidly changing medical care, colored brown on the map, include Russia, countries of Central Asia, India, China, Brazil and Argentina. While medical care in these places might be of good quality and widely available in cities, it may not be available at all in the vast spaces between cities.

Cruise lovers, how does your favorite ship score with the CDC?
Random inspections of 231 cruise ships that dock in US ports are conducted by the US Centers for Disease Control (CDC) as part of their Vessel Sanitation Program (VSP). In the VSP, each ship is rated from 1 to 100 based on a number of criteria, including food sanitation (in storage and preparation), potable water storage and handling, the hygiene of personnel and the cleanliness of the ship.
On Feb. 1, 2015, the ms Eurodam of Holland America Line (HAL) scored its ninth perfect health inspection score in a row. On June 5, the HAL ship Statendam aced its third health inspection, having also achieved scores of 100 during inspections in June 2014 and February 2015. In all of 2015, Holland America ships scored 10 perfect inspections, including the Zuiderdam, Nieuw Amsterdam, Noordam, Ryndam and Veendam.
The lowest score that any of the 13 HAL ships that were inspected in 2015 received (of the line’s 15 ships, total) was a 90, earned by the ms Zaandam on June 3, but that ship righted course with a 97 on an Oct. 7 inspection.
In the calendar year 2015, the commercial passenger ships of 61 companies underwent a total of 223 VSP inspections (some more than once), and 31 of them (about 14%) earned perfect scores. Let me name the rest of them, then I’ll talk about a few ships that didn’t do so well.
Carnival Cruise Lines, with 23 out of 24 of its ships inspected, ranked second to HAL, with all ships passing and five earning perfect scores: Carnival Sunshine, Carnival Ecstasy, Carnival Triumph, Carnival Pride and Carnival Miracle.
Following with four ships rated perfect were three lines: Royal Caribbean International (18 of 21 inspected, one not passing), with Brilliance of the Seas, Enchantment of the Seas, Radiance of the Seas and Serenade of the Seas; Princess Cruises (15 out of 18 inspected, all passing), with Golden Princess, Island Princess, Regal Princess and Ruby Princess, and Celebrity Cruises (9 out of 11 ships inspected, all passing), with Celebrity Equinox, Celebrity Infinity, Celebrity Millennium and Celebrity Summit.
Norwegian Cruise Line (10 out of 13 ships inspected and passing) had three top scores, earned by Norwegian Breakaway, Norwegian Jewel and Norwegian Sky.
Disney Cruise Line (all four ships passing) had two ships scoring 100: Disney Dream and Disney Fantasy.
The lines each having one perfect score were Sea Dream Yacht Club (both of its ships passing), with its Seadream I, and Regent Seven Seas Cruises, with its Seven Seas Navigator (the line’s only ship inspected in 2015, out of 4).
A CDC VSP rating of 85 or less is considered unacceptable. From Jan. 1 to Dec. 31, 2015, five ships received such ratings.
In May, Silversea Cruises’ Silver Shadow got an 82 for, among other things, improper food preparation and storage and a lack of anti-entrapment drain guards in the pool.
In June, Celebration Cruise Lines’ Grand Celebration scored an 80 for failing to meet standards on potable water storage and for having an inadequate disease-outbreak “prevention and response” plan, and Royal Caribbean International’s Adventure of the Seas scored an 84 in October for having food kept and served at unsafe temperatures plus an accumulation of dust and debris in food-storage areas.
The lowest score of 2015, a 69, belonged to Bahama Mama, operated by Balearia Caribbean, Ltda. The ship was penalized for having excessive dust and debris in food-preparation areas, poor pest-management procedures and, frighteningly, a complete lack of a gastroenteritis-outbreak-response plan.
In fact, the medical staff on board Bahama Mama was found to be “not familiar with reportable case definition.” In other words, they didn’t know they had to report incidents of gastroenteritis to onboard staff in order to help prevent a ship-wide outbreak.
The VSP does not take into account illness outbreaks when rating a ship. Even on a ship with high cleanliness and proper procedures, a passenger cannot be prevented from bringing a virus, especially the dreaded norovirus, on board, though strict hygiene and planning can help to limit the outbreak.
The CDC does investigate all reported illness outbreaks aboard cruise ships that dock in the US. In 2015 there were 12 such outbreaks, 11 of which were found to be norovirus (the 12th, as of press time, was still under investigation). Ships with perfect inspection scores that also had illness outbreaks were the Veendam, Celebrity Equinox and Celebrity Infinity.
You can search VSP inspection results by cruise line, ship and/or year and read detailed reports at wwwn.cdc.gov/inspectionquerytool/InspectionSearch.aspx.

CORRECTIONS to note —
• Susan Hayes wrote, “It was nice to see my letter, ‘Peru with Tara Tours,’ in the December 2015 issue (page 23). In rereading it, I noticed that in the list of items included in the cost of our customized trip with Tara (www.taratours.com), details of the ‘transfers’ were not included. The transfers weren’t insignificant.
“The Cuzco-Puno transfer was a day-long trip that included sightseeing at four locations along the way plus lunch. And the Puno-Chivay-Arequipa transfer (including a half-day tour to Colca Canyon) was spread over two days, each segment taking most of the day, with brief photo op stops and lunch.”
• In Ellen Jacobson’s article on Japan in the January 2016 issue, she wrote that the guide Michie Taylor travels to Japan twice a year (page 22). After reading the article, Michie wrote to ITN to share that she actually leads groups to Japan three times per year, in the spring and fall for the Fukuoka tour and in May to tour central Japan and Tokyo.
• I was delighted to print the letter from David De Mille about a scenic drive to Ma˘lda˘res¸ti, Romania, where he stayed at a conacul, or manor house. But I was appalled to learn from him that we had misprinted his starting destination as Budapest, Hungary, instead of Bucharest, Romania. Believe me, it’s a much shorter drive from Bucharest.

In my December 2015 column, Gene Dougher wondered out loud whether or not a traveler should tip his travel agent and, if so, what an appropriate tip would be.
Keith D. Jackson of Parksville, BC, Canada, wrote, “For eight years in the 1990s I worked as a travel consultant, arranging international air travel, land tours, cruises, etc., and personally delivered documents to my clients’ homes or businesses. Never did I receive or expect to receive any tips from my clients. I’m the one who gave them various items, such as wine, wristbands, No-Jet-Lag mints, tote bags, etc. I have never heard of tipping a travel agent.”
Not even cookies?

People have certain assumptions about travel insurance. To make everyone aware of what they might be surprised to find they are NOT covered for in certain situations, we would like to gather and print a number of subscribers’ experiences.
In regard to travel outside of the US, tell us about a time when you submitted a claim to a travel insurance company and expected reimbursement but had your claim denied. We’re looking for any example of a particular problem, situation, incident or event — medical or nonmedical — that was NOT covered under a travel insurance policy.
We will not be printing the names of any travel insurance companies; we want only general accounts.
Describe the situation or what occurred. Include where and approximately when (year) this took place. Tell us what you thought you were covered for but were not. As closely as possible, tell us the insurer’s reason(s) for rejecting your claim.
In addition, what did you learn from your experience? What do you now make sure you’re covered for when purchasing travel insurance? What “buzz words” in the fine print do you look for and why?
Email editor@intltravelnews.com or write to Travel Insurance Claim Denied, c/o ITN, 2116 28th St., Sacramento, CA 95818. We’ll print responses in a future issue.

Another request — for our “Where in the World?” page, located at the tail end of each issue, if you have a picture of a special landmark, scene, structure or well-known object located outside of the US, consider submitting it for our ongoing contest.
A photo of something other than a statue or public art piece would be preferred, unless it is of a historical nature or nationally recognized in some way. A creative challenge would be an extreme (but identifiable) close-up of something well known by international travelers. Any landscapes should be undeniably one of a kind.
While we have a drawing and award a prize each month to one of the people who correctly identify the location where a mystery photo was taken, we offer only lasting fame and our undying gratitude to those whose photos we print.

While I’m on the subject of submitting photos, here are some guidelines.
We can accept color photos or black-and-white prints of any size as well as slides and transparencies. If you have a choice, submit color because all pictures get posted on our website in color.
Of course, most people shoot digital pictures these days. Be aware, however, that many Web-based photo-sharing services — such as Picasa and OneDrive — will automatically compress and resize the original image files, and, while the pictures look fine on a computer screen, the resulting files may not be of sufficient size or resolution for publication in this magazine.
Instead, save the original photo files directly to your computer’s desktop or onto a CD, without any editing or alteration of photo sizes. If the photo file is larger than 500 kB,
then it probably is acceptable for printing.
Note: We cannot use photos embedded within text, such as in the body of an email or document file. Pictures need to be sent or attached as separate files.
Lastly, and just as important, in your cover email, don’t forget to include a caption for each picture. What are we looking at, approximately where was the picture taken, and who snapped the picture? Precede each caption with the photo file number or name so there’s no confusion about which captions go with which photos.
Let’s see what you’ve got!

The last day of this month, March, is the deadline for submitting your “Where Were You in 2015?” entry, after which we’ll tally the results and have our prize drawing.
If you are an ITN subscriber, write up a list of all of the nations you visited in 2015 (outside of your country of residence) and email it to editor@intltravelnews.com or address it to Where Were You in 2015?, c/o ITN, 2116 28th St., Sacramento, CA 95818. Include your mailing address, where you receive ITN.
The information we gather from this informal poll will help us in wooing potential advertisers and will also be of interest to our editorial staff. So take a moment to recall your travel destinations from last year, send us a quick email, then continue reading the magazine.
In the June 2016 issue, I’ll announce the results of our poll and the names of the prize winners.

The following subscribers submitted their 2015 lists and added kudos:
Bill Kocar, San Diego — “Thanks for the great travel news magazine you publish every month. I truly enjoy getting a lot of valuable travel information.”
Margo Mata, Carlsbad, CA — “ITN continues to be a great source of info, and a great read, which I do from cover to cover. Thanks for the best periodical of all my subscriptions!”
Ellen Shea, Henderson, NV — “I love ITN. Thank you for A Celebration of Travel each month.”
Let’s keep the celebration going!