Are cruise ship hot tubs safe?

Before you take a relaxing soak, read our quick guide.

Few cruise rituals are more relaxing than sinking into a steaming hot tub as the waves roll in. Endless ocean views, massage jets, cocktail in hand – this is the picture of relaxation at sea. While the foam invites you to relax and unwind, experts warn that cruise ship hot tubs can carry risks ranging from itchy rashes to severe respiratory illnesses.

Hot tubs are marketed as both relaxing and luxurious: You can find them on the sunny pool deck, in adults-only lounges, and even in private balcony suites. However, the same features that make them attractive—warm water, constant use, and shared space—also create prime conditions for harmful bacteria and fungi.

Skin problems you may not expect

“Hot tubs are safe if properly maintained and disinfected,” says Michelle Green, MD., a board-certified dermatologist in New York City. “However, many skin diseases can be caused by pollution.”

The most common one is folliculitis, often called “hot tub rash.” This inflammation of the hair follicles appears as red, itchy bumps and, as Dr. Green explains, “can be caused by a bacterial infection, e.g. Pseudomonas aeruginosaor fungal infections, including tinea versicolor or Malassezia“.

Other potential issues include:

– Dermatitis: High chlorine or bromine levels can cause dry, itchy or burning skin.
– Fungal outbreak: Warm, moist conditions can worsen a yeast infection or athlete's foot.
– Exacerbation of chronic disease: “People with eczema or psoriasis may want to avoid using cruise ship hot tubs,” Dr. Green warns, as exposure to hot tubs can exacerbate the condition.
– Risk of infection from cuts or wounds: Even the smallest scrape or scratch can become an entry point for bacteria.

Beyond the rash: Legionnaires' disease

Skin problems are not the only problem. October 2024, Centers for Disease Control (CDC) report There have been multiple outbreaks of Legionnaires' disease associated with cruise ships. Investigators found 12 cases on the two ships between November 2022 and June 2024, 10 of which required hospitalization.

The real twist: The culprit wasn't the public hot tub on the deck, but the private whirlpool tub in the cabin. Found in select suites on lines such as Royal Caribbean, Celebrity Cruises, Regent Seven Seas, Norwegian and MSC Cruises, these private hot tubs are typically maintained by the crew – regularly drained and sanitized during the voyage. Unlike public bathtubs, they are less regulated and have been linked to health issues when protocols are inadequate. As the CDC found, this gap allows Legionella to thrive.

What is Legionnaires' disease?

according to CDCLegionnaires' disease is a severe form of pneumonia caused by inhaling contaminated water droplets Legionella bacteria. Hot tubs are especially dangerous because bubbling jets atomize the water into a fine mist.

Symptoms usually appear 2 to 10 days after exposure and include cough, fever, muscle pain and shortness of breath. If left untreated, the disease can be life-threatening in older adults, smokers and people with weakened immune systems.

While outbreaks are rare compared to the number of people who cruise on cruise ships each year, the CDC findings highlight how flaws in the design and maintenance of private bathtubs can turn luxury into liability.

How Cruise Lines Handle Hot Tubs

Public hot tubs fall under the jurisdiction of the CDC Ship Sanitation Planinspect recreational water facilities such as swimming pools and whirlpools during routine inspections. Most ships disinfect these tubs daily, sometimes multiple times a day, to control bacterial growth.

However, private balcony bathtubs are not subject to the same oversight. In the wake of the outbreak, the CDC urged cruise lines to inventory all hot tub-style equipment, review sanitation protocols and even consider redesigning tubs to limit aerosols and bacterial growth. Still, there has been no public confirmation that cruise lines are widely removing private balcony tubs on new construction or restricting their use.

Who should skip soaking

Hot tubs are not for everyone. While most healthy adults can enjoy them with minimal risk, certain groups should be cautious or avoid them altogether:

– Pregnant travelers: High water temperatures can increase core body temperature, which is unsafe during pregnancy.
– Senior passengers: Age-related health conditions and a weakened immune system increase the risk of infection and overheating.
– Immunocompromised travelers: Cancer patients, transplant recipients, or anyone with a suppressed immune system are more susceptible to infection.
– People with asthma or chronic lung disease: Conditions like chronic obstructive pulmonary disease (COPD) or severe asthma make it more difficult to fight off respiratory illnesses like Legionnaires' disease.
– Toddlers: Children, including infants and toddlers, are particularly susceptible to overheating and use of hot tubs is generally discouraged.
– People with skin conditions or open wounds (such as eczema)psoriasis, and even minor cuts can provide easy entry points for bacteria and fungi.

Tips for smart travelers

You can reduce your risk while enjoying your ocean immersion by taking a few precautions:

– Like public hot tubs: These are more likely to be inspected, tested and chlorinated regularly.
– Avoid using private balcony bathtubs: Unless the cruise line provides clear evidence of regular sanitation, it's safer to stick with the main deck spa.
– Check the water: Green recommends avoiding tubs that look cloudy, muddy or neglected. Clear, odorless water is a safer option.
– Restricted Soaking: Dermatologists recommend keeping treatments to 15-20 minutes to protect the skin's natural barrier.
– Before and after showering: A quick rinse helps reduce exposure to bacteria and chemicals.
– Don’t ignore symptoms: “If you develop a rash after a cruise hot tub, it's best to consult a board-certified dermatologist for appropriate treatment,” says Dr. Green.

Cruise ship hot tubs can be part of the fantasy of living at sea, but they don't come without risks. With a little awareness and a willingness to ask questions, you can safely enjoy a hot soak under the stars and go home with great memories.