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Canada’s top health official is warning Canadians about going on cruise ships after new cases of COVID-19 have been linked to a single cruise liner.

“I am asking Canadians to think twice before going on cruise ships, especially those [people] in the older age group and those with underlying medical conditions,” Chief Public Health Officer Dr. Theresa Tam said.

“Cruise ships present environments where COVID-19 can spread easily given close contact between passengers [that are together] for significant periods of time.” Tweet This

She also said cruise ship passengers could be subject to quarantine procedures put in place by other national authorities.

Her comments came before U.S. Vice President Mike Pence revealed that 21 positive cases of COVID-19 have been found on the Grand Princess cruise ship that was sailing to Hawaii but was ordered to return to San Francisco.

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Forty-six of the 3,500 passengers, including 235 Canadians, were initially tested, but Pence said all passengers will now be tested before they can disembark.

Out of the 21 new cases, 19 are linked to crew members and two to passengers, though where they are from is not known yet. Twenty-four tested negative and one test was inconclusive, Pence said.

The cruise ship undertook the initial test after learning that 10 passengers on a previous trip the same ship made to Mexico, from February 11-21, got the virus. One of those diagnosed, a Sacramento-man, died from the disease, with seven other cases linked to passengers from Northern California and three to Canadians — one from Alberta and a couple from Ontario.

1:57 235 Canadians on cruise ship held off coast of California 235 Canadians on cruise ship held off coast of California

Some passengers on the February cruise remained on the ship for the Hawaii cruise and were among the 46 initially tested for the virus.

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There were more than 260 Canadians on the Grand Princess cruise in February that launched and docked in San Francisco. Dr. Tam said that Canadian health officials have the passenger manifesto and are tracking down the passengers.

Canada currently has 51 confirmed cases of the virus, including the three on the Grand Princess cruise in February.

Cruise ships have emerged as a breeding ground for the fast-spreading virus. Earlier in February, the Diamond Princess cruise ship was quarantined for two weeks in Yokohama, Japan because of the virus. Ultimately, about 700 of the 3,700 people aboard became infected with the virus, while 129 Canadians were quarantined.

READ MORE: Grand Princess cruise ship passengers await coronavirus test results

Total cases of COVID-19 have now surpassed 100,000 worldwide, with more than 3,400 deaths.

–With files from Leslie Young, the Associated Press and the Canadian Press