As many as 125 passengers and crew members aboard a cruise ship fell ill due to an outbreak of norovirus during a 20-day trip, forcing the vessel to return to San Francisco.

The Ruby Princess, a Princess Cruises ship, was on its voyage from San Francisco to Canada and Alaska when dozens of passengers and crew members became sick with the highly contagious gastrointestinal disease.

A total of 102 passengers and 23 crew members reported being ill during the voyage, according to the U.S. Centers for Disease Control and Prevention (CDC).

The vessel, which set sail on June 12, was carrying 3,032 passengers and 1,144 crew members.

The CDC said that the outbreak was caused by norovirus, with all infected patients experiencing symptoms such as diarrhea and vomiting.

The cruise arrived at San Francisco’s Pier 35 on the morning of July 2, according to an SFGATE report.

The CDC said its Vessel Sanitation Program (VSP) was informed about the outbreak on June 28.

Citing a statement by Princess Cruises, AP News reported that the ship’s crew responded promptly and implemented “enhanced sanitation protocols across the ship.”

The company has increased cleaning and disinfection procedures according to its outbreak prevention and response plan, the CDC said.

Princess Cruises crew collected stool specimens from gastrointestinal illness cases for testing and isolated infected passengers and crew.

The CDC said the company has also consulted with VSP about sanitation cleaning procedures and reporting ill cases.

VSP is remotely monitoring the outbreak, including reviewing the ship’s response and sanitation methods.

There have been seven illness outbreaks reported on cruise ships so far this year in the CDC’s jurisdiction, primarily from norovirus, according to AP.

What is Norovirus?

Highly contagious, norovirus is often referred to as the “stomach flu” or “stomach bug.”

While it is not related to the flu, norovirus causes acute gastroenteritis, which causes inflammation of the stomach or intestines, according to the CDC.

Patients typically develop symptoms 12 to 48 hours after being exposed to the virus, including the following:

Common symptoms: Diarrhea, vomiting, stomach pain, nausea
Other symptoms: Fever, body aches, headache

Most individuals suffering from norovirus begin recovering within one to three days, according to the CDC. However, they can still spread the virus for two weeks or more after they feel better.

The virus spreads in the following ways:

Having direct contact with someone affected by norovirus.
Eating food or drinking liquids that are contaminated with the virus.
Touching contaminated surfaces or objects and placing unwashed hands in your mouth.

The CDC warned that oysters and other filter-feeding shellfish, when eaten raw, can contain viruses and bacteria that can result in illness or death. Anyone who consumes raw shellfish is at risk of contracting norovirus.

Each year, the U.S. reports roughly 2,500 norovirus outbreaks, per the CDC.