Editorial
Dr Carmen Varela Martinez, Spain
Dear readers,
A new season of the SHIPSAN ACT Newsletter is starting, together with the beginning of spring. I will be its editor for a year, replacing Dr. Mauro Dionisio who has done a very good job.
As you may know, a measles outbreak on a cruise ship sailing through the Mediterranean (France, Italy and Spain) has occurred at the end of February. Tourists from different European countries were travelling on the ship.
The European Centre for Disease Prevention and Control (ECDC) prepared a Rapid Risk Assessment (RRA) for the outbreak, on the 5th of March 2014. According to this RRA some options for mitigation could be considered for passengers and crew: inform them; advise them to seek medical attention if they show symptoms indicative of measles; and ask them to review their vaccination status, offering them vaccination or immunoglobulin when need it.
Moreover, on 14th of March, Italy published a preliminary outbreak report showing that 27 measles cases were identified: 21 crew members, four passengers and two cases not specified whether crew or passenger.
In connection with this outbreak I would like to remind all of you that within the SHIPSAN projects a Communication Network platform has been developed for facilitating communications from ship to port, from port to ship, from port to port and from port to national authorities. This Network is intended to complement and to strengthen existing systems and not to duplicate work or to hamper systems already functioning. In fact both SHIPSAN Communication Network and Early Warning and Response System, from the European Commission, have been used on this outbreak. More information related to this outbreak and to the contribution of SHIPSAN tools to it, is presented in an article in this Newsletter.
Finally I would like to mention that a review of the literature from 1990 showed only two articles on measles and ships. An article related to a measles outbreak in a Spanish region involving two crew members of a ferry going from Morocco to Spain in 2008; and a study on a cluster of measles, rubella, and varicella, with three measles cases among the crew of a cruise ship sailing from United States to the Caribbean in 2006.
News from the leadership
Prof. Christos Hadjichristodoulou, SHIPSAN ACT Joint Action Coordinator
Dr Barbara Mouchtouri, SHIPSAN ACT Joint Action Manager
Joint Meeting of the Chief Medical, Chief Nursing and Chief Dental Officers, 4th March 2014
The Greek Ministry of Health organised a session in the framework of the Greek Presidency 2014 Chief Medical Officers’ Meeting titled “Sustainability of the EU SHIPSAN ACT Joint Action – Focus on the essential components to be supported: hygiene and health inspections, training of port health authorities and communication platform”.
The meeting took place on the 4
th of March 2014 in Athens, Greece. In this meeting, the Chief Medical, Chief Nursing and Chief Dental Officers of 28 EU countries participated as well as representatives from the EU SHIPSAN ACT Sustainability Working Group.
As part of this meeting, the EU SHIPSAN ACT Joint Action and its main activities were presented. In particular, the following presentations were delivered as part of the session:
· Introduction of the EU Decision on serious cross-border threats to health and the Joint Action policy relevance (John Ryan, DG SANCO C3 Head of Unit, acting Public Health Director)
· The EU SHIPSAN ACT Joint Action (Prof. Christos Hadjichristodoulou, Joint Action Coordinator)
· Experiences of Member States from SHIPSAN ACT activities - Focus on the work packages results:
o Communication tool example of outbreak management (Dr Karoline Fernadez, Spain)
o Seafarers’ health (Dr Martin Dirksen-Fischer , Germany)
o Inspections and SHIPSAN Manual (Dr Mauro Dionisio, Italy)
o Training: International Health Regulations/Ship Sanitation Certificates/SHIPSAN Manual (Dr Peter Otorepec, Slovenia)
o Chemical and radiological threats risk assessment (Prof Raquel Duarte Davidson, United Kingdom)
o Strategy paper for sustainable implementation of the EU SHIPSAN ACT Joint Action (Christopher Bartlett, Co-chair of the SHIPSAN ACT Joint Action Sustainability Working Group)
o Next steps for the sustainability of the Joint Action (Giuseppe Ruocco, Ministry of Health- Directorate General for Health Prevention, Co-chair of the SHIPSAN ACT Joint Action General Assembly)
This session contributed successfully in the dissemination of the SHIPSAN ACT Joint Action results and discussions were fruitful for the sustainability options of the Joint Action activities.
5th meeting of the Coordination Team, 4th March 2014
The 5th meeting of the Coordination Team took place on the 4th of March 2013. The group discussed the sustainability options taking into consideration the proposals and conclusions of the meeting of the Chief Medical Officers. In addition, participants reported the progress of work for each work package and planning for 2014.
3rd meeting of the Sustainability Working Group, 8th March 2014
The 3rd meeting of the Sustainability Working Group took place on the 8th of March 2014 in Athens, Greece.
the meeting, members of the Sustainability Working Group and representatives from the Cruise Line International Association (CLIA) participated. Members explored how the activities of SHIPSAN will operate sustainably and improved. In particular, the use of communication platform in the measles outbreak management gave the opportunity to identify how the communication channels can work more effectively. Members also discussed about the promotion of the implementation of the European Manual for hygiene standards and communicable diseases surveillance on passenger ships. A strategy paper has been drafted and the partnership will be asked soon for input. Finally, the group discussed about the options for a legal framework for sustainability of activities. CLIA representatives appreciated the fact that SHIPSAN invited representatives to participate in ad hoc in the Sustainability Working Group and the General Assembly. CLIA will continue supporting and participating in the inspection activities and would like to see SHIPSAN activities carrying on in the long term.
Training course on “Inspection of Hygiene and Health Standards on Passenger Ships” in Piraeus, March 2014
The training course was held from 5th of March till 7th of March 2014, Greece on board the cruise ship Louis Olympia which was docked at the port of Piraeus, Greece. The training course was organized by the EU SHIPSAN ACT Joint Action. Click here to download the course brochure.
A total of 113 trainees participated in the training course:
- 52 seafarers from the industry (cruise ship and ferry companies, and consultancy companies)
- 61 port health officers: 55 trainees from 19 EU MS and 6 trainees from 4 Non EU countries (Brazil, Israel, Montenegro and Turkey)
Training syllabus:
1. The International Health Regulations (2005) legal framework for competent authorities at ports and for ship operators.
2. The EU legislation for reporting formalities – Maritime Declaration of Health.
3. Responding to public health events on passenger ships.
4. How to design a water safety plan (industry participants).
5. How to audit a water safety plan (port health officers).
6. How to audit management policies and plans on the ship to prevent, respond and control infectious diseases.
7. How to collect and analyse/assess information through observation, interviews and review of records and documents during the inspection (port health officers).
8. How to assess hazards and hazardous events related to food, water, hygiene condition of the ship including housekeeping and infection control issues, communicable diseases, vectors, waste, ballast water, air handling, and medical facilities.
9. Communication skills: adapting communication style and content so they are appropriate to the needs of the intended audience (port health officers).
10. How to write and prepare inspection report according to guidelines set (objective descriptions of findings, correct terminology etc.) – port health officers.
Training methods:
Different training methods were adopted so as to address better the needs of the each target group.
Theoretical session: Lectures by internationally recognized, on the subject matter, experts.
Case studies session: Structured teaching, emphasising the need for good decision making skills. During the session trainees were able to identify and analyse specific hygiene problems and to demonstrate that they can apply the appropriate preventive or control measures and practices in conjunction with ongoing assessment.
Practical session for Port Health Officers: Interactive methods - problem based learning: examples of good inspection practices, simulation exercises in ship inspection, and practices of inspection skills. Participants worked in 5 groups in rotation.
“European ports” session for seafarers: Interactive methods: problem based learning, quizzes, small group discussions, Q&A, question cards, debates, competitions and demonstration. Participants worked in 5 groups in rotation.
Evaluation results of the training course:
The training course met its objectives, since pre and post assessment scores of knowledge showed an increase of 65% for the professional seafarers and 52% for the port health officers.
An evaluation of the training course for both professional seafarers and port health officers was conducted using a four-level scale (excellent- very good-good-poor). The level of satisfaction of port health officers and professional seafarers’ daily expectations are given in Figure 1 and Figure 2, respectively.
· In the overall course evaluation, port health officers rated:
o the course content with excellent (53.5%) and good (46.5%)
o the course material with excellent (43.2%) and good (50.0%)
o the relevance to their job with excellent (61.9%) and good (33.3%)
· In the overall course evaluation, professional seafarers rated:
o the course content with excellent (41.7%) and good (55.6%)
o the course material with excellent (43.2%) and good (48.6%)
o the teaching methods with excellent (48.6%) and good (48.6%)
· All participants of both groups would recommend the training course to others. All except two of responding trainees (port health officers and professional seafarers) said that the course met their expectations.
The organisers would like to express their gratitude to all the trainers and to Louis Cruises company for the excellent collaboration and assistance.
Results and evaluation of the SHIPSAN ACT Joint Action pilot inspections 2013
Inspections were conducted on board passenger ships sailing in European countries that participated voluntarily. Inspections were conducted by port health officers working at the health authorities at ports, having the responsibility to conduct inspections on ships and accompanied by a trainer.
Objective
To carry out pilot inspections to achieve the objectives set out in work package 5 of the Joint Action which seeks to improve the quality of inspections and bring a consistent and proportionate approach to the inspection of all ship types. This will be achieved by providing on the job training, issuing yearly inspection schedule and operating information tools for recording/sharing of inspection results.
Inspection results
From May until November 2013, 48 full inspections and 2 re-inspections were conducted on board 43 cruise ships and 5 ferries.
Forty eight full inspections were carried out by the inspection teams. These inspections revealed in total 517 deficiencies, including 84 non-compliances with EU legislation, 360 non-compliances with European Manual recommended standards and 73 notations. Corrective actions statements were received by 31 Captains/crew of ships out of the 46 inspection reports requiring corrective action statement.
Evaluation results
A total of 249 questionnaires were disseminated to 97 inspectors, seven trainers, 48 Captains/ship crew and 14 shipping companies that participated in the pilot inspections. Among the 48 inspections conducted, at least one completed evaluation questionnaire was received.
A total of 109 completed questionnaires were received. Response rates were: 65.7% (23/35) for SHIPSAN inspectors, 81.1% (43/53) for trainers, and 37.5% (18/48) for Captains/ship crew. Six out of nine participating cruise shipping companies completed the evaluation questionnaires and there were no respondents from the ferry shipping companies.
Evaluation questionnaires were completed following inspections. At least one completed evaluation questionnaire was received for 31 inspections by inspectors, 40 inspections by trainers and 18 inspections by ship crew.
The following aspects were evaluated via the evaluation questionnaires: (a) Usefulness of inspections, (b) Inspection process, (c) Inspectors performance, (d) Trainers’ skills, (e) Crew members’ knowledge and cooperation, (f) Learning process, (g) SHIPSAN materials.
All inspectors and ship crew reported that SHIPSAN inspections were more effective and rigorous than the inspection conducted preciously in the same port. All inspections except one reported to be useful to identify problematic areas by Captains/crew members. In 10 out of the 18 inspections, responding crew reported that they learn new things in relation to public health issues on board passenger ships that could improve their performance. Inspectors’ abilities and skills were appraised in more than 80% of inspections as satisfactory and excellent by the majority of the responding trainers and ship crew. In all inspections, all responding trainers and ship crew reported that inspectors were honest, fair, open-minded, courteousness, self-confident and helpful. The European manual for hygiene standards and communicable diseases surveillance and all other inspection tools (SHIPSAN platform, outlines of inspections, inspections report) were highly rated by the responders.
Conclusions and recommendations for improvement of the next year’s inspections
All indicators of the evaluation plan of the Joint Action were achieved in the first year’s inspections. The usefulness of SHIPSAN inspections was clearly demonstrated and reported by responders. It is recommended that future training courses need to address correct description of inspection findings in the inspection report, writing skills, familiarization of inspectors with the European Manual and time management.
Useful points were made by inspectors and trainers about the content of the European Manual and some respondents also highlighted some public health risks that are not currently part of the European Manual. All these remarks will be brought to the attention of the working group who will oversee the revision of the European Manual.
Thematic Sections
Infectious diseases on ships
Outbreak of measles on board a passenger's ship. The usefulness of the SHIPSAN Communication Network in view of the implementation of the National Single Window.
Dr. Miguel Dávila-Cornejo, Ministry of Health, Social Services and Equality, Spain
Dr Mauro Dionisio, Ministry of Health, Italy
INTRODUCTION
At the end of February a passengers’ ship sailing the Mediterranean Sea has been involved in an outbreak of measles. The ship travelled in a seven-day cruise between the ports of Civitavecchia, La Spezia and Savona (Italy), Marseille (France), and Barcelona and Palma de Mallorca (Spain). Passengers from different EU countries were on board.
This paper describes the general aspects of the event, but its main goal is to highlight the need of communication between ports in a rapid and an effective manner, in order to manage these situations properly.
In this sense, we focus our attention on a communication system called SHIPSAN COMMUNICATION NETWORK, developed during the previous phase of the Joint Action SHIPSAN ACT. This useful tool allows Port Health Authorities (PHAs) to share information immediately and is available for all EU countries.
The communication system is currently updated, in view of the implementation of the Directive 2010/65/EU which purpose is “to simplify and harmonize the administrative procedures applied to maritime transport by making the electronic transmission of information standard and by rationalizing reporting formalities”. According to this Directive, Member States shall accept the fulfilment of reporting formalities in electronic format and their transmission via a National Single Window (NSW). One of those formalities is the Maritime Declaration of Health (MDH). In this sense, a health subgroup was set up in the scope of DG MOVE and EMSA to develop the business rules for the reporting of the MDH through the National Single Window, and SHIPSAN was suggested to pilot test those business rules.
A number of partners have suggested that a data base for recording the MDH submitted to European ports will allow authorities at local and national level to view the information related to events and control measures, which are submitted by the ship and therefore facilitating the risk assessment and event management timely.
THE EVENT
In this case, the SHIPSAN COMMUNICATION NETWORK was initially used by the Spanish PHA at the port of Palma de Mallorca to communicate the event and was subsequently updated by the PHAs involved in the itinerary. By creating an alert into the tool, the information related to the situation on board, as well as the recommended measures to be implemented, were entered into the system and shared with the rest of the ports.
As the number of cases increased, at arrival at Civitavecchia port the Italian Public Health Authorities posted an EWRS message and communicated to the IHR National Focal Points. Then, at European Commission request, the European Centre for Disease Prevention and Control (ECDC) prepared a specific guideline to assess the risk associated with the outbreak and propose mitigation options for its containment(1). These options included advice for passengers and crew having disembarked in the past seven days, as well as for those who were still on board and for incoming passengers and crew. According to the guideline, suspected cases should be isolated as well as their close contacts if their vaccination status was ‘unknown’ or ‘unvaccinated’; information should be given to passengers and crew about their potential exposure to measles during the cruise; immediate vaccination should be offered for those whose vaccination status was ‘unknown’ or ‘unvaccinated’; administration of human normal immunoglobulin should be offered if they belonged to a risk group; and they were advised to seek medical attention if they presented with symptoms indicating measles.
Symptomatic passengers and their close contacts were disembarked and either hospitalised or put in isolation to prevent further transmission (2). A total number of 27 measles cases were identified by using the European Union case definition for measles (21 crew members and 4 passengers. For 2 cases the status crew or passenger was unknown). 22 of them were laboratory-confirmed and the remaining 5 were classified as probable cases. Information of the country of origin was available for 19 of 27 cases: Italy (6), India (5), Philippines (3), Honduras (2), Austria (1), Brazil (1), and Indonesia (1). A total number of 820 crew members and 8 passengers were vaccinated with measles-mumps-rubella (MMR) vaccine. Vaccination was also offered to newly embarked passengers and crew members if needed.
The cruise continued according to schedule and was investigated in Marseille, Barcelona and Palma de Mallorca by national authorities. No additional measles cases were identified on board throughout the new cruises and the SHIPSAN COMMUNICATION NETWORK was updated by the corresponding PHAs. A total number of 13 updates were made by PHAs involved, describing the results of situation assessment and control measures implemented, and active surveillance of new cases is still ongoing.
DISCUSSION
Passengers’ ships are considered as closed environments where a large number of people are in close contact in a limited space. In these settings, the spread of communicable diseases can easily occur and different countries can be involved.
According to the International Health Regulations-2005 (3), communication in a rapid and effective manner is a key point when dealing with events that could transmit internationally. In this sense, the possibility of putting at PHAs’ disposal a communication system that allows them to share information rapidly is crucial. The importance of this subject was already identified by SHIPSAN and a communication platform was developed during the previous phases of the project. The platform is designed to facilitate communications from ship to port, from port to ship, from port to port and from port to national authorities, in such a way that all the ‘actors’ involved in the assessment and response could be informed in time. The system is easy to use and all the information can be entered in a few minutes.
This tool is not intended to replace the already existing communication systems but to complement them. This experience has helped us to improve the network, involving always the National Focal Points. From my point of view, in situations like this, the problem starts on board the ship and the initial assessment and recommendations must be done by the PHAs involved, so that they must be perfectly informed from the very beginning. The SHIPSAN COMMUNICATION NETWORK is an excellent tool that comes to solve the delays and possible lack of communication between PHA and provides them with the most important information in real time. It doesn’t impede that other systems like EWRS can be used simultaneously and work together in the same direction. In my understanding, both systems can run in parallel and a link between the SHIPSAN COMMUNICATION NETWORK and EWRS should be considered in order to share all the information in advance, avoiding oversights and loss of information.
REFERENCES
(1) ECDC RAPID RISK ASSESSMENT. Measles on a cruise ship, Italy. 28 February 2014. Available at, http://www.ecdc.europa.eu/en/publications/Publications/rapid-risk-assessment-measles-cruise-ship-Mediterranean-5-March-2014.pdf
(2) Eurosurveillance, Volume 19, Issue 10, 13 March 2014. Available at, http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=20735
(3) International Health Regulations-2005. Available at, http://www.who.int/ihr/publications/9789241596664/en/
Environmental health and hygiene on ships - The Galey
Martin Walker, Port Health Officer, Suffolk Coastal Port Health Authority, Felixstowe, England
Key Message: The importance of hand washing for good personal hygiene, the SHIPSAN ACT recommended technique and facilities required.
At the recent joint Seafarers/Port Health Officers SHIPSAN ACT course held in Piraeus, both groups covered the issue of hand washing in relation to food handlers. Whilst it may seem to be an obvious issue of good personal hygiene to wash your hands at certain points (and particularly when handling food), there are a range of other important issues that need to be considered to ensure that effective handwashing is carried out and that food is handled safely, to prevent the spread of micro-organisms or other contaminants.
Equipment and facilities
Hand washing facilities and the equipment needed is specified in the SHIPSAN Manual1 where item 3.5.27 refers the reader to section 7.2 in the Housekeeping and facilities section. Hand washing facilities should be supplied in food handling areas under 3.5.27 and 7.2.4 specifies that they should include hot and cold running water, single service paper or cloth towel dispenser or drying device, suitable liquid soap or detergent and a waste bin. Item 3.2.18 recommends that wash hand basin taps are operated by arm, elbow or foot contact to minimise hand contact.
The equipment required is to a different standard than that specified in the WHO Technical Handbook2 (which will apply to all vessels undertaking international voyages) which requires one dedicated hand washing station preferably in the galley, with soap (not necessarily liquid soap), means for hand drying (preferably disposable paper towels) and a waste towel receptacle. The item in the WHO Technical Handbook is 2.2.1. Can you see what else is not specifically mentioned here? Perhaps this might be an interesting discussion point.
SHIPSAN ACT Handwashing method
This can be found at Annex 14 of the SHIPSAN Act Manual and is reproduced below:
During the training course, it was particularly good to see the professional seafarers using the practical way of ensuring that they spent the requisite 20 seconds using all the techniques above by referring to singing the Happy Birthday song twice to measure the time for steps 1-10. It is an important general point to inspectors that anything that you can do to communicate messages in a way that target audiences can readily understand is a key competency. There are other suggestions of useful techniques available to communicate hand washing messages 3.
By practising this technique, the areas of the hand most frequently missed for effective handwashing will be addressed:
When to wash your hands
This is clearly set out in item 3.2.18 of the SHIPSAN Manual. The absolute requirement is as frequently as necessary. For this, professional awareness (or as we like to say in the UK, “common sense” has to be used). By knowing the risks this will largely determine when hand washing is required to control those risks. Item 3.2.18 further specifies situations when hand washing must always take place.
The inspection process – a trick of the trade
What is the easiest way to see if the facilities comply? As an inspector, before I enter the galley, I ask to wash my hands first. There are 3 reasons for this. Firstly, I am entering a food producing area and I do not wish to contaminate food or equipment (this is a key competency that an inspector must act ethically). Secondly, it lays down a marker that I am washing my hands before starting work (item 3.2.18). Thirdly, it is the first stage of my checks to see if a vessel complies with these basics, both for the availability and location of a hand washing station and it’s location together with the equipment available.
In the next issue, I will feature another relevant food safety issue in the Galley. If you have any good examples of cases that you would like to share with SHIPSAN ACT readers, please email details to me at martin.walker@suffolkcoastal.gov.uk
References:
World Health Organization, International Health Regulations 2005, available through http://whqlibdoc.who.int/publications/2008/9789241580410_eng.pdf
1European Manual for Hygiene Standards and Communicable Diseases Surveillance on Passenger Ships (EU Ship Sanitation Training Network)
2 World Health Organization, 2011 Handbook for Inspection of Ships and Issuance of Ship Sanitation Certificates available through http://www.who.int/ihr/publications/handbook_ships_inspection/en/
3 http://hetv.org/programmes/hand-washing-songs.htm
Chemical and radiological issues on ships
Alison Jones, Public Health England, UK
Key Message: The Centre for Radiation Chemical and Environmental Hazards (CRCE) of Public Health England (PHE) has the responsibility to develop best practice guidance for competent authorities to support risk assessment and response for managing chemical and radiological incidents on ships, where passengers or cargo may be affected and where there is a need to protect public health. This article discusses the role of CRCE in radiation protection.
PHE has the responsibility in the UK to protect people from radiation hazards and the PHE functions in relation to radiation are fulfilled by CRCE. PHE provides advice through its research and development activities, coordination and involvement in networks of radiation protection advisers and the provision of advice and specialist support during emergencies. In the event of an emergency caused by a radiation incident, scientists at CRCE have a duty to provide radiological protection advice and information, carry out radiological assessments and undertake environmental and personal monitoring of individuals that may have been contaminated by radioactive materials.
As part of its responsibilities to protect people in the UK, PHE has published reports to estimate the levels of radiation doses (reported in millisieverts, mSv[1]) to which members of the UK population may be exposed. PHE estimates that on average each person in the UK receives a radiation dose of 2.7 mSv per year.
As shown in the figure, within the UK, it is estimated that 85% of a person’s exposure is from natural sources. This exposure can be attributed to radon (a gas that comes from rocks and soils), cosmic rays, gamma rays from the ground and buildings and from food and drink. The remaining 15% of exposure to radiation is from man-made sources, usually as a result of patient exposure from x-rays, CT scans and nuclear medicine. A very small percentage of exposure comes from discharges of radioactive waste from nuclear power stations, fallout from historic nuclear weapons testing, occupational exposure and from consumer products.
PHE routinely publishes surveys of the normal transport of radioactive material carried by sea to and from the UK. A report by Hughes and Harvey (2009) provided information on shipments made between 2006 and 2008, and provided an estimation of the resulting radiation doses to workers and members of the public. The highest annual radiation dose to any dock worker or ship crew member was found to be 0.2 mSv. In the UK the legal limit for occupational exposure is 20 mSv per year. For public exposure the legal limit for exposure is 1 mSv (ICRP, 2007); this excludes occupational and medical exposures and exposure to natural radiation.
Around 30,000 packages were transported annually by sea during the period of 2006-2008 (Hughes and Harvey, 2009). The vast majority of the radioactive material transported was for medical use and a small proportion was for the sterilization of medical and surgical equipment and certain foodstuffs. Other goods transported included equipment for industrial processes such as well-logging and industrial radiography or the bulk shipment of smoke alarms each of which contain a small radioactive source. Most of these packages were transported by cargo ship or ferry and only a small proportion were taken by passenger ferry. Special arrangements are made for the transport of nuclear material which is only permitted to be transported by special cargo ships to and from designated ports.
Since 1958 there have been 68 incidents or accidents involving packages transported on ships in the UK. Around 25% of these incidents resulted in packages being damaged, but there were no radiological consequences to workers at the port or members of the public from these damaged packages.
References:
Hughes JS and Harvey MP (2009). A survey into the radiological impact of the normal transport of radioactive material by sea. HPA-RPD-050.
ICRP (2007). The 2007 recommendations of the International Commission on Radiological Protection. Annals of the ICRP, Publication 103.
[1] millisievert (mSv) is one-thousandth of sievert which is the SI unit of dose, the unit is joules per kilogram (J kg-1) (ICRP 103, 2007).
People from the project
My name is Mario Cassar and I am from Malta. I started my career as a Health Inspector about 30 years ago, having successfully completed a three year Diploma course. Initially my duties involved the responsibility of a district, enforcing food and environmental health legislation. I was transferred to Port Health Services in 1995.
I proceeded with my studies and in 1986 I obtained a Diploma in Mathematics, Computing and Logic, B.Sc Hons (Env. Hlt.) degree in 2002 and M.Sc (Env. Hlt) in 2005.
Presently I hold the position of Senior Principal Environmental Health Officer and am in charge of Port Health Services and Burials Administration Unit.
Malta started issuing the Ship Sanitation Certificates from 15th June 2007 and preparation had started from February of that year. The guidelines issues by WHO assisted in evaluating the requisites for the issue of the certificates.
The SHIPSAN projects established a modus operandi on inspection of ships through the European Manual for Hygiene Standards and Communicable Diseases Surveillance on Passenger Ships, issue of publications and provided the required training. Such gained knowledge is continuously disseminated to Port Environmental Health Officers including the requirements according to the International Health Regulations 2005.
Recent Publications
Influenza Surveillance on Cruise Ships
Teal R. Bell, MPH, Krista Kornylo Duong, MPH, CPH, Lyn Finelli, DrPH, MS, Douglas D. Slaten, MD, MPH
Am J Prev Med 2014;46(3):327–329
Read more: http://www.sciencedirect.com/science/article/pii/S0749379713005874
Self-Reported Stomach Upset in Travellers on Cruise-Based and Land-Based Package Holidays
Launders NJ, Nichols GL, Cartwright R, Lawrence J, Jones J, et al. (2014) PLoS ONE 9(1): e83425. doi:10.1371/journal.pone.0083425
Abstract
Background: International travellers are at a risk of infectious diseases not seen in their home country. Stomach upsets are common in travellers, including on cruise ships. This study compares the incidence of stomach upsets on land- and cruise-based holidays.
Methods: A major British tour operator has administered a Customer Satisfaction Questionnaire (CSQ) to UK resident travellers aged 16 or more on return flights from their holiday abroad over many years. Data extracted from the CSQ was used to measure self-reported stomach upset in returning travellers.
Results: From summer 2000 through winter 2008, 6,863,092 questionnaires were completed; 6.6% were from cruise passengers. A higher percentage of land-based holiday-makers (7.2%) reported stomach upset in comparison to 4.8% of cruise passengers (RR = 1.5, p,0.0005). Reported stomach upset on cruises declined over the study period (7.1% in 2000 to 3.1% in 2008, p,0.0005). Over 25% of travellers on land-based holidays to Egypt and the Dominican Republic reported stomach upset. In comparison, the highest proportion of stomach upset in cruise ship travellers were reported following cruises departing from Egypt (14.8%) and Turkey (8.8%).
Conclusions: In this large study of self-reported illness both demographic and holiday choice factors were shown to play a part in determining the likelihood of developing stomach upset while abroad. There is a lower cumulative incidence and declining rates of stomach upset in cruise passengers which suggest that the cruise industry has adopted operations (e.g. hygiene standards) that have reduced illness over recent years.
News and forthcoming days
EU SHIPSAN ACT Advanced training course on water safety
When: 17-19 June 2014 Where: Athens, Greece
WHO Collaborating Centre for the International Health Regulations: points of entry.
The Department of Hygiene and Epidemiology of the University of Thessaly, Greece is designated as a WHO Collaborating Centre for the International Health Regulations: points of entry as of the 17th February 2014. The areas of collaboration (Terms of Reference) include the following:
1. To provide support to WHO for the establishment, coordination and maintenance of a roster of experts – trainers in the field of ship sanitation and points of entry (specifically ports).
2. Assisting WHO - HSE/GCR/SID- PAG Team in training activities related to ship sanitation and event management on ships and at points of entry/ international travel and transport
For further information please visit the WHO collaborating center database: http://apps.who.int/whocc/Detail.aspx?cc_ref=GRE-27&cc_code=gre&
What’s new on the website www.shipsan.eu
Inspector’s corner: Environmental Cleaning Monitoring – Adenosine Triphosphate (ATP) Testing on board a cruise ship - A communication from Mr Alan Johnson, Senior Environmental Health Officer, Harlow District Council, England.
Click here to read the article.
Quiz
By Mario Cassar, Senior Principal Environmental Health Officer (Reg. No. 047), Units & Legislation, Environmental Health Directorate, Health Inspectorate Services, Malta
What was the name of the infected conveyance that could have been the cause of the origin of the outbreak of Plague in the island of Malta in 1813?
Please send your answers to info@shipsan.eu
Answer to Issue 6 quiz:
The term “quarantine” comes from the Italian words quaranta giorni, which mean “forty days”. The practice of quarantine, as we know it, began during the 14th century in an effort to protect coastal cities from plague epidemics. Ships arriving from plague-infected areas to the port of Ragusa (now Dubrovnik), at the time under the control of the Venetian Republic, were required to sit at anchor for 40 days before they could unload passengers or cargo.
http://www.who.int/whr/2007/whr07_en.pdf
http://www.cdc.gov/quarantine/HistoryQuarantine.html
http://en.wikipedia.org/wiki/Quarantine
Congratulations to:
· Emer McShea, Port Health Inspector at Killybegs Port, Senior Environmental Health Officer
Donegal District Hospital, Donegal Town, Co. Donegal, Ireland
Port in focus
Port of Hamburg – Germany’s Gateway to the World
Justine Tanoey, MPH. Institute for Occupational and Maritime Medicine (ZFAM), Hamburg, Germany
Dr. med. Thomas von Münster. Institute for Occupational and Maritime Medicine (ZFAM), Hamburg, Germany
Dr. med. Martin Dirksen-Fischer, Hamburg Port Health Center, Institute for Hygiene and Environment, Hamburg, Germany
Dr. med. Marcus Oldenburg, Institute for Occupational and Maritime Medicine (ZFAM), Hamburg, Germany
Prof. Dr. med. Volker Harth, Director of the Institute for Occupational and Maritime Medicine (ZFAM), Hamburg, Germany
Dating back from the 9th century, the Port of Hamburg has developed into a leading international transportation hub in shipping industry. It is currently one of the top three ports in Europe and ranked as the second largest European container ports in 2011. The port witnesses traffic of approximately 10,000 ships every year and handles warehousing and transportation of approximately 140 million tons of cargo of all kinds. On shore up to 30% of all cargo and more than 70% of all containers are distributed by rail. The port is located 115 kilometers away from the mouth of the River Elbe, a 1,165 km long river originating from the Czech Republic pouring into the North Sea.
The port was officially granted its rights to conduct a customs-free market trade in 1189 by Kaiser Friedrich Barbarossa. Throughout centuries the port has experienced building, expansion, economical setbacks, destruction, rebuilding, and modernization into how it is today. The port occupies a tenth of Hamburg area, expanding over 7,200 hectares. It serves as a strategic entry and exit point from the world, mainly countries in the Far East, to Northern, Central, and Eastern European regions in continental Europe and to the Baltic Sea through the Kiel Canal and Elbe-Lübeck Canal.
The port is a universal port dealing with all types of shipments, but its main specialty is container-handling. It is currently the third largest container port in Europe. Its trading volume has been continuously rising in the last decade and an up-to 25 million TEU (20-feet standard containers) of container-handling is expected in the future.
The port plays a major role in the economy of Hamburg in terms of trade and employment. Up to 40,000 jobs are generated by the port. The Hamburg Port Authority (HPA) is responsible for the management and development of the port. It is presently investing in projects to support the world’s ever-growing trading demands.
At the same time, the Port of Hamburg is committed in protecting the environment. The HPA and the port’s logistic partners are striving to ensure sustainable environment protection methods. They have set specific targets to achieve this goal by implementing strategies to lower emission rates and reduce energy consumption such as establishing its own onshore electric supply, alternating to more environmentally-friendly energy sources, and incorporating more efficient and innovative energy saving technology.
Certain challenges remain as the port has enormous quantity of operations. In order to ensure access for larger vessels, the Elbe has been dredged in the last century from 3-4 m to 14.9 m in depth in 1999. Three years later another proposal to deepen the river to 15.9 m to ensure access for the next generation of vessels was put forth, and the ensuing discussion between the HPA and the environmentalists still continues.
The shipping traffic through the port also brings about numerous of seafarers from all over the world requiring a safe haven near their ships during their free time. A famous club for seafarers called The Duckdalben offers an opportunity to unwind, socialize with peers and family back home, and fulfill their religious needs.
The surrounding port areas, Speicherstadt and Hafencity, are also a well-known tourist attraction. Here important landmarks in the maritime history may be found, as well as the Elbphilharmonie Hamburg, a spectacular concert hall due to be open in the near future. Tourists can also take boat tours along the Elbe, overlooking the port, the fish market, and the city. The Port of Hamburg celebrates its birthday during the first weekend of May with extravagant festivities including a parade of boats, open tours in galleons and cruise ships, music events, markets, ending with fireworks at night.
Photo: Private collection, Hamburg Port 2011
References
- http://www.hamburg-port-authority.de/en/the-port-of-hamburg/facts-and-figures/Seiten/default.aspx
- http://epp.eurostat.ec.europa.eu/statistics_explained/index.php/Maritime_ports_freight_and_passenger_statistics
- http://www.portofhamburg.com/en
- http://en.wikipedia.org/wiki/Port_of_Hamburg
- http://www.hk24.de/en/economic/347688/port.html
- http://www.duckdalben.de/#/page/we/