Download the EU SHIPSAN ACT JA - Newsletter: Issue 23 in .pdf format
Dr. Martin Dirksen-Fischer, Head of Hamburg Port Health Authority, Germany
Once again it is SHIPSAN-Newsletter time. It is good to see some things in our professional life that stays the same while everything else changes. Read from the leadership about the current situation of our project and the perspectives of the future. One thing comes to my mind these days: even when the project formally came to an end at the moment the contacts and friendships continue, ready to take up new speed any time. It is just a good feeling to have the privilege to call a friend in Lithuania, Taiwan or wherever when there is a problem occurring.
Tom Gaulton, Eirian Thomas and Raquel Duarte-Davidson have written an article with lots of literature in it on the issue of the transport of chemicals on ships and the IHR. Must read. As well as the articles about Finland. It is a good chance to read about the port of Kilpilahti, Porvoo , Finland. And learn more about our colleague Tomi Jormanainen who is working there. Please, like always read the other sections as well, also about the rather funny idea of how to (not) shake hands these days. I would be curious to know your opinion about that “Cruise tap”.
See you all soon!
News from the leadership
Prof Christos Hadjichristodoulou and Dr Barbara Mouchtouri, University of Thessaly, Greece
New Joint Action on preparedness and action at points of entry (air, maritime and ground crossing)
We are pleased to inform you that the EC Health Programme - Annual work plan for 2017 has been published and can be found at the following link: https://ec.europa.eu/health/programme/events/adoption_workplan_2017_en.
Paragraph 188.8.131.52 of Annex 1 of the Work Programme for 2017 describes the expected results and impact, the activities to be funded, the timetable and the indicative amount for the Joint Action on preparedness and action at points of entry (air, maritime and ground crossing). Annex IV defines the rules for application. One important new rule is that “Member State authorities will be invited to nominate one competent authority responsible for the implementation of the action on behalf of that Member States. The competent authorities may implement activities in cooperation with other entities. The competent authorities shall also identify and select the civil society organisations active at EU level which can make the most valuable contribution to the action. These organisations will be invited to join the action as collaborating partners and/or to participate in advisory structures. ‘Competent authority’ means the central authority of a Member State competent for health/specific (public) health topic or any other authority to which that competence has been conferred; it shall also include, where appropriate, the corresponding authority of a third country. A competent authority can also be one at regional level, depending on the governance structure of the Member State/third country. The competent ministry/government organisation shall by way of an official notification, duly signed by an authorised representative, confirm that the participating entity is a competent authority and is the eligible body to participate on behalf of the respective Member State/regional entity and under its responsibility in the relevant action”.
According to the above rules, only one competent authority can participate in the Joint Action per Member State, but this authority can implement activities in cooperation with other entities. If more than one authorities from each EUMS wish to participate in the joint action, then, these authorities may establish one legal entity, who can represent the MS in the Joint Action.
More information about the procedures for nominations can be asked by the national focal point from each country, that can be found at the following link: https://ec.europa.eu/health/sites/health/files/programme/docs/nfp_en.pdf
Submission of final implementation report of the joint action SHIPSAN ACT
The European joint action SHIPSAN ACT concluded at the end of October 2016. The final technical implementation report and financial statements were submitted to CHAFEA on the 30th of December 2016. Both reports can be found at the members area of the joint action website.
Scheduling of passenger ship inspections
Certain activities of the EU SHIPSAN ACT joint action continue after the decisions taken by appointed representatives of the EU MS in the 2nd General Assembly meeting of the joint action that took place on the 28 of September 2016.
Among the activities that will continue as decided by the EUMS representatives are the inspections of passenger ships based on a common European schedule. Indeed, the Ministries of Health of the EUMS, the participating port health authorities and the University of Thessaly (appointed by MS to facilitate the inspection scheduling) will cooperate the following weeks in order to compose the annual European routine inspection schedule for passenger ships for 2017.
Moreover, certain dissemination activities continue with partners presenting the results of the Joint Action to national meetings, conferences and publishing the results of the joint action in newsletters and peer review journals.
Establishment of the European Association
In parallel, the EUMS are currently working on establishing a European Association for health and hygiene in maritime transport under the title of European SHIPSAN Association. The European Association was one of the proposals for sustainability for after the end of the European Union funding that the consortium decided to implement as it provides a framework for using the outputs of the joint action.
Proposal for a European Joint Master “Maritime Health: Environmental Health and Hygiene, and Occupational Health”
One more outcome of the EU SHIPSAN ACT Joint Action sustainability plan was the establishment of a European Joint Master Degree by the academic partners of the consortium. The proposed European Joint Master is titled “Maritime Health: Environmental Health and Hygiene, and Occupational Health” is expected to benefit all partners of the consortium, both non-academic and academic, as well as the industry. In order to plan the Joint Master, four representatives from the University College of South East in Norway visited the Laboratory of Hygiene and Epidemiology, University of Thessaly, Greece. This meeting provided the opportunity to also present the results of the EU SHIPSAN ACT Joint Action and the University College of South East in Norway expressed their interest to participate in the European Association for health and hygiene in maritime transport (EU SHIPSAN Association) and in the next Joint Action for transport and health.
Chemical and radiological issues on ships
IHR and assessment of core capacities
Tom Gaulton, Eirian Thomas and Raquel Duarte-Davidson. Centre for Radiation, Chemicals and Environmental hazards, PHE
With increasing amounts of chemicals transported globally (the majority of which is done via shipping)1
comes an increase in the likelihood of chemical incidents occurring. If these incidents occur at port there is a much higher risk of affecting public health due to their close proximity to human settlements/population centres (for example, see Port Santos chemical incident, highlighted in SHIPSAN newsletter no.18)2
. For this reason it is important to have robust preparedness plans in place, regarding a chemical incident. In line with the International Health Regulations (IHR, 2005)3
, countries are required to develop certain core public health capacities for surveillance and response at all administrative levels (national, intermediate and local) and at designated Points of Entry (PoE), such as international airports, ports and ground crossings. With regards to chemicals, core capacities include requirements to detect, assess and respond to chemical incidents.
Tools are available for PoEs and countries to assess whether they meet the core capacity requirements set out in the IHR. These tools include the IHR core capacity assessment tool4, which aims to help countries determine both existing capacities and identify capacity needs, when designating a PoE. The tool assesses the communication structure between competent authorities at PoEs, the National IHR focal Point and health authorities at all levels (according to IHR Annex 1A)3
. It also includes a checklist which measures compliance with the IHR core capacity requirements, requiring countries to assess the level of implementation (full, partial or none) and describe the progress, gaps and plans for capacity development4
. In addition, WHO guidance is also available which describes IHR core capacity requirements for chemical events5
The IHR Checklist and Indicators for Monitoring Progress in the Development of IHR Core Capacities in States Parties6 is an additional tool available to track progress. The tool breaks down core capacities into more specific key components (or indicators), to assess whether the capacities have been met e.g. for the PoE core capacity, indicators include: ‘effective response at PoE is established’ and ‘routine capacities and effective surveillance are established at PoE’. The result is a comprehensive breakdown of how the country is meeting the IHR (2005) core capacities6
In order to comply with IHR, countries may request WHO to organise a Joint External Evaluation (JEE) so that subject matter experts are involved with the IHR assessments. The JEE focuses on 19 categories/technical areas, which includes Points of Entry (PoE), chemical events and radiation emergencies, each of these technical areas has a number of indicators against which the country is evaluated. The JEE is a collaborative and transparent mechanism to ensure all countries around the world are achieving, or developing, the required core public health capacities as outlined in the IHR, 20057
The development of core capacities is important to ensure compliance with IHR (2005) and with Decision 1082/2013/EU on serious cross-border threats to health8
, for EU member states, as there may be a wider health impact to neighbouring countries when a health threat at a PoE occurs, given the potential for international spread. Engaging in activities to meet the required capacities at PoE lowers the risk of transmission of health threats and prevents travel and trade restrictions, which can create additional problems in the event of a public health emergency.
1. UNCTAD - Review of maritime transport (2016). Available from: http://unctad.org/en/PublicationsLibrary/rmt2016_en.pdf (last accessed 20/02/17)
2. SHIPSAN Joint Action Newsletter article 18. Available from: http://www.shipsan.eu/Portals/0/docs/shipsan-18-january-2016.pdf (last accessed 20/02/17)
3. WHO - International Health Regulations, 2005 (2016). Available from: http://apps.who.int/iris/bitstream/10665/246107/1/9789241580496-eng.pdf?ua=1 (last accessed 20/02/17)
4. WHO - International Health Regulations, 2005: Assessment tool for core capacity requirements at designated airports, ports and ground crossings (2009). Available from: http://www.who.int/ihr/ports_airports/PoE_Core_capacity_assessment_tool.pdf (last accessed 21/02/17)
5. WHO - International Health Regulations, 2005 and Chemical Events (2015). Available from: http://apps.who.int/iris/bitstream/10665/249532/1/9789241509589-eng.pdf (last accessed 21/02/17)
6. WHO - IHR core capacity monitoring framework: Checklist and Indicators for Monitoring Progress in the Development of IHR Core Capacities in States Parties (2013). Available from: http://apps.who.int/iris/bitstream/10665/84933/1/WHO_HSE_GCR_2013.2_eng.pdf (last accessed 21/02/2017)
7. WHO - Joint External Evaluation Tool (2016). Available from: http://apps.who.int/iris/bitstream/10665/204368/1/9789241510172_eng.pdf (last accessed 20/02/17)
8. European Commission (2013) - Decision 1082/2013/EU on serious cross-border threats to health. Available from: http://ec.europa.eu/health//sites/health/files/preparedness_response/docs/decision_serious_crossborder_threats_22102013_en.pdf (last accessed on 21/02/17)
News and events
EU SHIPSAN ACT past events:
National training courses in Norway
1st training course
Location: Stavanger, Norway
Dates: 29th of November 2016
2nd training course
Location: Bodø, Norway
Dates: 8th of December 2016
Two training courses entitled “Training course on International Health Regulations – Ship Sanitation Certificates Issuance” were held in Norway by the Norwegian Directorate of Health with the support of the EU SHIPSAN ACT. A total of 66 port health officers and 3 trainers/facilitators participated in the two training courses.
Other forthcoming events:
9th International Congress of Internal Medicine Greece
Location: Hilton Athens Hotel, Athens, Greece Dates: 9-11 March 2017
On the third day of the congress (Saturday 11th March 2017), a round table session will be held titled “Global health security: Threats and opportunities” where the following presentations will be given:
• Global health and population movements by Barbara Mouchtouri, University of Thessaly, Larissa, Greece)
• The role of points of entry (ports, airports, ground, crossings) in global health security by Daniel Lins Menucci, WHO Headquarters (Lyon, France)
• The impact of the International Health Regulations 2005 in global health security by Thomas Hofmann, WHO Euro (Copenhagen, Denmark)
For more information please visit the congress website: http://internalmedicine-uth.gr/
People from the SHIPSAN consortium
Health Inspector / Port of Porvoo Health Authority, Finland
My name is Tomi Jormanainen and come from northern Europe from Finland. I live and work in the historical city of Porvoo. Finland is bilingual country and Porvoo is also known as Borgå in Swedish. It is located 50 km to east from capital city of Helsinki. Within the city limits, and along the coast line, there is a chemical industry concentration and the largest oil and chemical port in Finland.
I have studied environmental healthcare in Technical College of Mikkeli. Soon after graduation back in 1991 I got a job as a Health Inspector in Porvoo. Since then I have done some additional studies concerning environmental education and indoor health. During these years I have also worked in several development projects in Africa and third world countries concerning mainly environmental protection and water and sanitation.
One part of my work as a Health Inspector, together with my three colleagues, is to issue SSCC/SSCEC certificates. Back in 2014 I participated IHR-training course on Ship Sanitation Inspection in St. Petersburg, Russia. Since then I have been active member of the national ship sanitation development and working groups. I have also acted as a trainer in several national meetings and trainings. During passed years I have also been representative of the Ministry of Social Affairs and Health in WHO and EU SHIPSAN meetings and trainings. A lot of development has happen on this sector in Finland during the recent years, thanks to active leadership in steering institutions and local level. In May 2016 I was awarded with, largely because of this ship sanitation work, Health Inspector of the year award. This award can be considered as an important acknowledgment by the nomination committee, not just on the individual level, but also for the whole ship sanitation inspection society here in Finland. Currently, and while writing this article, I am deployed in the ministry as a coordinator on ship sanitation issues. My specific task is to draft national guidelines how to facilitate and promote the implementation and use of the WHO guidebook so that it will become a standard everyday tool for our ship inspectors.
I am very keen on about this ship sanitation work and international cooperation. It is almost like being a part of a big multinational and all borders crossing “inspection family” with common goal, protecting people’s health. I want to thank all of you my dear colleagues around the EU and world for your collaboration and congratulate the EU SHIPSAN Joint Act staff for excellent work you have done. May the second phase of the project be as successful as the first one! With these feelings, with these words all the best to all and every one of you while doing this important work! “It works, but does not show, It shows, if it doesn’t work
Travellers and influenza: risks and prevention.
Goeijenbier M, van Genderen P, Ward BJ, Wilder-Smith A, Steffen R, Osterhaus AD.
J Travel Med. 2017 Jan 11;24(1). pii: taw078. doi: 10.1093/jtm/taw078. Print 2017 Jan.
BACKGROUND: Influenza viruses are among the major causes of serious human respiratory tract infection worldwide. In line with the high disease burden attributable to influenza, these viruses play an important, but often neglected, role in travel medicine. Guidelines and recommendations regarding prevention and management of influenza in travellers are scarce. Of special interest for travel medicine are risk populations and also circumstances that facilitate influenza virus transmission and spread, like travel by airplane or cruise ship and mass gatherings.
METHODS: We conducted a PUBMED/MEDLINE search for a combination of the MeSH terms Influenza virus, travel, mass gathering, large scale events and cruise ship. In addition we gathered guidelines and recommendations from selected countries and regarding influenza prevention and management in travellers. By reviewing these search results in the light of published knowledge in the fields of influenza prevention and management, we present best practice advice for the prevention and management of influenza in travel medicine.
RESULTS: Seasonal influenza is among the most prevalent infectious diseases in travellers. Known host-associated risk factors include extremes of age and being immune-compromised, while the most relevant environmental factors are associated with holiday cruises and mass gatherings.
CONCLUSIONS: Pre-travel advice should address influenza and its prevention for travellers, whenever appropriate on the basis of the epidemiological situation concerned. Preventative measures should be strongly recommended for travellers at high-risk for developing complications. In addition, seasonal influenza vaccination should be considered for any traveller wishing to reduce the risk of incapacitation, particularly cruise ship crew and passengers, as well as those participating in mass gatherings. Besides advice concerning preventive measures and vaccination, advice on the use of antivirals may be considered for some travellers.
Cruise tap versus handshake: using common sense to reduce hand contamination and germ transmission on cruise ships.
Dahl E. Int Marit Health. 2016;67(4):181-184. doi: 10.5603/IMH.2016.0034.
A firm handshake is a widely used greeting, but contaminated fingers and palms can also transfer bacteria and virus. Hand sanitation is important to prevent spreading of contagious diseases, but to wash hands properly takes too much time to ensure satisfactory compliance. Banning the handshake from health care settings has been proposed, but an alternative, less contagious form of greeting must be substituted. Cruise ships are particular vulnerable to infectious diseases that are transferred from person to person. The fist bump, common in some subcultures, has become increasing popular as the greeting-of-choice on smaller cruise vessels. To further reduce the contact area, a modification of the fist bump, the 'cruise tap', where only two knuckles briefly touch each other, is recommended.
What’s new on the website
The website of the EU SHIPSAN ACT joint action (http://www.shipsan.eu) had been updated in December 2016.
- The Outcomes of the EU SHIPSAN ACT Joint Action are presented and links to key documents are included for download http://www.shipsan.eu/AboutUs/Outcomes.aspx
- The section “Work packages and deliverables” was updated and now includes links to all deliverables of the joint action http://www.shipsan.eu/AboutUs/Workpackagesanddeliverables.aspx
- Check out the “downloadable material” in each of the different sections of the website (e.g inspections, training, occupational health, chemical events etc.). In this box all relevant material for each section are available for download.
- In the sections “Inspections” and “Training” you will be able to find information on future and past activities.
By Galina Kokosharova
It was depicted by Homer in The Iliad, written around 700BC, in poems by Virgil (70 – 19BC), called Sacred Fire and Black Bane. In Moses` time it caused Fifth Egyptian plague and maybe contributed to the fall of Ancient Rome and maybe you already know that this is …...............................?
Answer to the previous issue’s quiz: The Jungle, by Upton Sinclair in 1906
Congratulations to the following for providing the correct answer
- Dr. Miguel Dávila-Cornejo, Head of the International Alerts Unit, Deputy Directorate General of Foreign Health, Directorate General for Public Health, Quality and Innovation, Ministry of Health, Social Services and Equality, Spain
- Audrone Lavruvianec, Head of Medical quarantine subdivision at Communicable diseases management division at National Public Health Center Klaipeda Department, Lithuania
- Fernando del Hierro Vega, Director, Ministerio de Hacienda y Administraciones, Spain
- Alberto Fernández Fuenteseca, Port Health Officer Santander Port Health Authority, Spain
- Iveta Dubrovová, M.D., PhD., MPH Regional hygienist Ministry of Transport, Construction and Regional Development of the Slovak Republic Department of Chief Public Health Officer, Slovak Republic
Port in focus
Port of Kilpilahti, Porvoo, Finland
By Tomi Jormanainen, Health Inspector / Port of Porvoo Health Authority, Finland
Approximately 20 km from historical city of Porvoo there is industrial area and chemical industry complex. It is the largest oil refinery and chemical cluster in the Nordic countries. Several chemical plants can be found and are located there, among others the biggest oil refinery in Finland. Kilpilahti industry concentration employs permanently more 3,500 people. Plants are said to be among most advanced in the Europe. Inside the area there is a Port of Kilpilahti (aka Sköldvik in Swedish). It is the largest port in Finland in terms of tonnage. It is functional 24/7 all year around and approx. 1300 ships visits the port annually.
Pic. 1. View over Kilpilahti harbour and chemical industry concentration
Finland has named 30 ports that are authorized to do IHR/WHO ship sanitation inspections and issue SSCC/SSCEC-certificates. Porvoo Health Protection department has been named to act as Port Health Authority in four different ports. One of them is Port of Kilpilahti. Approximately 70 inspections per year are made by the department. Since vessels visiting Kilpilahti are often loaded with dangerous or flammable chemicals, especial focus has been put to preparedness plans and high safety standards. E.g. inspectors entering the area and inspecting vessels need to pass mandatory safety training and be equipped with high quality personal protection equipment (PPE).
Pic 2. Night view over Port of Kilpilahti
Nature can be very harsh sometimes up in these latitudes and in northern Europe. Therefore there are some especial requirements for vessels entering these waters during the winter time. E.g. they need to be strongly build and have certain ice class (FSICR The Finnish-Swedish Ice Class Rules) so that can tolerate cold weather and icy waters etc.. Snow and ice can also sometimes isolate ports and make it impossible to enter. Finland has total of 23 ports that are kept open all year around, so called “winter ports”. Port of Kilpilahti is among these. When necessary, the fairways are kept open with help from the icebreakers. Finland has total of 9 icebreakers. One of them is so called multi task vessel equipped with and specialized to rescue and oil spillage control. The newest member of the flotilla was build 2016 and is the first icebreaker in the world that is capable of using environmentally friendly LNG (liquefied natural gas) as fuel.
Pic 3a. Finland build icebreaker leading a convoy of vessels safely to the port trough ice and snow
Pic. 3b. Winter Ice Class approved strongly build Finnish oil tanker reversing trough ice and leading a convoy of tankers to the port (N.B. not an icebreaker)
Pic. 1 Day view over Kilpilahti harbour: no credit mentions needed
Pic. 2 Night view over Kilpilahti Port: photographer Niko Laurila
Pic 3a. Icebreaker and vessel convoy: Arctia Oy
Pic 3b. MT Tempera ship on ice: photographer Eeva Sumiloff