Download the EU SHIPSAN ACT JA - Newsletter: Issue 20 in .pdf format

Editorial

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Dr. Martin Dirksen-Fischer, Head of Hamburg Port Health Authority, Germany

Dear Readers,

And again it is my pleasure to introduce the next edition of the SHIPSAN-Newsletter to You. I guess we all have our favourite radio stations, be it that we live in Iceland, Taiwan, the Netherlands…wherever. But there is one “Grand old Lady” in the field of radio broadcasting: The BBC World service. Well received in all of Europe and where our friends and partners “out there” may live. So with great joy I heard a BBS World service program featuring Professor Christos Hadjichristodoulou on the dangers of Zika recently. He introduced the work of our SHIPSAN ACT Joint Action very well for lay people. If you want to listen yourself: here you go: http://www.shipsan.eu/downl/act/BBC_Interview_Zika_5_2016.WMA with the short version.

Absolutely timely like always you will find another article from our colleague Martin Walker on integrated “Vector Management Plans” on ships. It adds up to his further publications and makes good reading like always. One of the things I enjoy most while being involved with SHIPSAN is the fact that you always meet interesting people from all parts of the world. So, please learn more about Zadar and its beauty from our colleague Danira Širinić. And of course: Read also about the port of Kavala in Greece.

When you read this edition of the newsletter, like always including sections like “News of the leadership” and “New publications” and other information as well we will have concluded our meeting of the coordination team and sustainability working group in Athens. It is our task to suggest the next steps to be taken on the way to sustainability of our project. We will report on these meetings for sure.

For now: Be safe. Enjoy life. Write an article for the next edition of this newsletter!

Yours
M.DF

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News from the leadership 

 
Prof Christos Hadjichristodoulou, SHIPSAN ACT Joint Action Coordinator
Dr Barbara Mouchtouri, SHIPSAN ACT Joint Action Manager

We are pleased to share with you the following information about the European Transport Workers' Federation (ETF) and The European Community Shipowners’ Associations (ECSA) Joint Declaration on the risks of the Zika virus, which welcomes the EU SHIPSAN ACT recommendations and encourages the competent authorities and ship operators to follow the guidance prepared by the EU SHIPSAN ad hoc working group. More information can be found in the press release: http://www.etf-europe.org/etf-press-area.cfm/pressdetail/11349.
  
The EU SHIPSAN ACT Joint Action held a two day meeting on the 23rd and 24th of May 2016 in Athens, Greece where the evaluation team, the coordination team and sustainability working group had the opportunity to discuss and decide on the final evaluation methodology of the Joint Action, all activities to be implemented until October 2016 and the sustainability plan.
Moreover, the European annual schedule for the short notice (48hrs) inspections on passenger ships sailing in EU on an international voyage is currently under development. The EU SHIPSAN ACT facilitates the development of this annual schedule of short notice inspections working with the port health authorities and the ministries of health in each of the participating countries.

Finally, the EU SHIPSAN ACT consortium has started the preparations for the Final Conference and 2nd General Assembly meeting of the EU SHIPSAN ACT Joint Action which will be held on the 27th – 28th September 2016.

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Thematic Sections 

Environmental health and hygiene on ships: 

Integrated Vector Management Plans

Martin Walker, Port Health Officer, Suffolk Coastal Port Health Authority, Felixstowe, England

 

Key Message: Applying Integrated Vector Management Plans on board ship.

Introduction

In the last article, I covered the issue of standing water on board vessels and it’s importance in relation to disease spread by vectors. This article will look at  an integrated approach towards all types of vectors and their management. It is an area that may often be overlooked by inspectors, particularly in the more temperate countries of Europe as some of the major disease causing vectors are less prominent here. However, vector surveillance at ports and on-board vessels is a vital part of the process of preventing the risk of spread of international disease as well as meeting obligations under the International Health Regulations 2005 (IHR)¹. This role has been strengthened by the recent publication of a World Health Organization (WHO) handbook for vector surveillance and control at ports.²


Source: World Health Organization

What are the key vectors of concern?
The WHO vector surveillance handbook2 identifies the most important vectors as being mosquitoes, rodents, fleas, sandflies, houseflies and cockroaches. This does not exclude other potential vectors (e.g. ticks and bugs) of being of concern or needing control as there is also reference to these. Information is given about various species, their characteristics and risks to health. Pages 17-18 of the handbook also give a useful guide as to the level of risk at points of entry (POE) of various disease vectors which can be particularly useful in allocating resources to potential problems.

The role of Integrated Vector Management Plans
Integrated Vector Management (IVM) is defined by WHO as “a rational decision making process to optimize the use of resources for vector control”.3 This means that using evidence and an integrated approach will see a range of measures (alone or in combination) selected and applied upon the basis of local knowledge about the vectors, diseases and disease determinants, to control the disease threat from vectors.4 In a maritime environment, the local knowledge may be derived from both the crew and/or the advice and assistance of the Port Health inspector or other relevant expertise that is available.

In a conceptual form, WHO sees IVM with the following elements⁵:

Application in the Maritime sector
Whilst we can take some of key elements and apply them rationally, in day to day shipping terms, this is likely to require a more practical and pragmatic approach to application for individual ships. A huge amount of paperwork and certification can already be found kept on vessels and something that is not seen to have practical value is unlikely to be welcomed.
Two examples that I have seen that are actively applied are from Kandla Port in India and New Zealand. At Kandla port, they take an active role in surveillance of all ships calling at their ports. This is because Kandla is based in Gujarat, a plague endemic state of India. All ships coming from plague endemic countries are also carefully checked for any evidence of rodents before port operations commence. India has regular National Inter State Plague Co-ordination Committee meetings, hosted by the National Center for Disease Control (NCDC) but involving all of the Port Health Organisations. Yearly Rodent Ectoparasites surveillance training events are carried out at all major ports; at Kandla, the number of rodents caught has dropped from 4500 in 2007 to 1-200 per year.

I am grateful to my colleague Dr. S. Senthil Nathan of Kandla Port reports; “During our screening of these vessels from 2008 to 2012 we found that the ships were not aware of the importance of the preventive measures to be undertaken for all Vectors during their Port Operations, lack a Vector Management Plan, lack all the necessary Vector control sprays, pesticide, equipment like Rat Guards with lock system, Rat Traps, Rat Baits, Pyrethrum based insecticide for Mosquitoes, Personal protection for mosquito bites etc. About 15-20 vessels visiting Plague Endemic Countries as their last port of call were screened every month with 1-2 vessels were found with Rodent evidence. In addition, mosquitoes breeding, potential mosquito breeding sites, vessels infested with Cockroaches and Bed bugs were also found in 2-5 vessels on average in a month.

The release of the “Guide to Ship Sanitation 3rd Edition” and “Handbook for Inspection of Ships and issuance of Ship Sanitation Certificates” in 2011 helped us to educate and regulate the ships on the preparation of Vector Management Plans and improving the basic preventative measures as a routine by giving them Rodent Control Guidelines. The Pre Arrival Port Entry Preparation that the Ships Master has to undertake and Pest Log (Rodent Log) maintenance was strictly advocated.
We started to implement this strictly for all ships before arrival to Gujarat ports by their compliance report through email with pictures for granting clearance from 2013-2014 onwards.
In the past 2 years we have seen a drastic reduction in the number of vessels coming here with any evidence of rodents to only 1-2 per year. There is a positive networking effect of being followed at other ports by the same ships. The ships which learn these preventative measures then duplicate them in their sister ships which indirectly help prevention of the international spread of vectors.”
Kandla port health has been active in publicising their pre-arrival notices for ships. They have also produced sanitary guidelines for vessels arriving from Yellow Fever infected areas, including practical advice. These can be found on their website.6
New Zealand have also taken a practical approach to Integrated Pest Management for ships. John Gardner, of the Ministry of Health in New Zealand has shared with me the template developed by Toi Te Ora Public Health Service, Tauranga that they have produced which can be used by vessels to apply and record checks together with detailing any action taken. Their template identifies the core components of an integrated pest management plan as:

• Identification
• Preventative Practices
• Monitoring
• Mechanical Controls
• Pesticides

Identification
Identification refers to deciding which organisms are pests that must be controlled, and which are not. For example, mosquitoes must be controlled as they can spread serious infections and therefore present a significant health threat.
Identification should be conducted by <the shipping company> and communicated to all crews to ensure the scope is understood and the plan is conducted effectively.

Preventative Practices
For example:
• Appropriate storage of garbage that may attract pests
• regular cleaning of the vessel
• removing standing water

Monitoring
For example:
• regular inspections of areas likely to harbour pests
• encouraging crew to report sightings of pests

Mechanical controls
For example:
• Deployment of rat guards
• Rat traps
• Door and window screens

Appropriate Pesticide Use
For example:
• Rat poison
• Insecticide sprays
• S-methoprene

The template then includes a log for the Chief Officer/Master to complete on an appropriate frequency (weekly is suggested which often fits in with standard inspections by the Master).
The template is likely to be available on PAGNet⁷ soon.

Conclusions
IVM is a wide subject area and there is a wealth of information available to Port Health inspectors. It’s application though, needs to be both locally assessed and commensurate with the risks that individual ports and vessels may face. This article can serve to introduce the subject and steer the reader to further sources of information and assistance.

References:

1.  “International Health Regulations 2005”, World Health Organization, http://www.who.int/ihr/publications/9789241596664/en/ 
2. “Vector Surveillance and Control at Ports, Airports and Ground Crossings”, World Health Organization, http://www.who.int/ihr/publications/9789241549592/en/ 
3. “WHO position statement on integrated vector management”, http://apps.who.int/iris/bitstream/10665/69745/1/WHO_HTM_NTD_VEM_2008.2_eng.pdf 
4. “Handbook for Integrated Vector Managment”, World Health Organization, http://apps.who.int/iris/bitstream/10665/44768/1/9789241502801_eng.pdf 
5. “Global Strategic Framework for Integrated Vector Managment”, World Health Organization, http://www.who.int/neglected_diseases/vector_ecology/ivm_concept/en/
6. https://sites.google.com/site/porthealthkandla/ 
7. “PAGNet”, World Health Organization, https://extranet.who.int/pagnet/home 

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Occupational health on ships:

Workshop on medical aspects of Inland navigation in Germany
Dr. med. Martin Dirksen-Fischer, Institute for Hygiene and Environment, Hamburg, Germany.

At the 24th of June in Hamburg, Germany, there will be a workshop under the auspices of the Deutsche Geselschaft für Maritime Medizin, the interdisciplinary German Maritime Medicine Society, Head: Dr.med. Klaus-Herbert Seidenstücker. It is up to him to welcome participants from the Public Health authorities of Germany as well as representatives of the industry and others like the Seamen mission for Inland navigation. The invited members of this workshop will exchange their views on the most pressing questions in the field of Inland navigation. When looking at inland navigation we must divide the issue into at least two fields: Inland cruise ships and inland commercial traffic of other intentions.

As the readers of this newsletter know, we do have a focus as SHIPSAN on the inland navigation shipping industry. Within work package 4 we (Tanoey J., von Münster T., Oldenburg, M. Harth V. and the author of this article, all Hamburg, Germany) looked at the very specific aspects of this part of maritime medicine. The final report will be published later. Though: we can for sure say that we are talking about a “silent industry”, meaning that there is not too much public or scientific attention paid to this field. But when we talk about silent industries we must accept some facts that should catch our attention.

As an example: On modern inland navigation vessels sometimes only two crew members are on board. What will happen if one of them will fall into the water? What are the modern strategies for dealing with drinking water problems on inland navigation cruise liners? Which technical advice can we give to the industry concerning materials to be used in dealing with drinking water?

Also: what are the most pressing issues concerning the fitness of the crew? What tests are necessary to find out any diseases? And most of all: Which cooperation exists between the Public Health Authorities in this field? Do they work together as they should?

Some of these questions will be answered at this meeting in Hamburg, Germany mentioned above. We will share the results with the bigger SHIPSAN ACT Joint Action community.

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News and Events

EU SHIPSAN ACT forthcoming events:

Final Conference and 2nd General Assembly Meeting
Save the date: 27th and 28th September 2016

The EU SHIPSAN ACT Final Conference and 2nd General Assembly Meeting will be held on the 27th and 28th of September 2016, respectively.

The objectives of the Final Conference are to disseminate the results of the Joint Action to stakeholders. The objectives of the 2nd General Assembly meeting are to appraise the outcomes of the EU SHIPSAN ACT Joint Action activities and to plan for the sustainability of activities and the future actions.

EU SHIPSAN ACT past events:
Training course for Nordic countries on International Health Regulations - Ship Sanitation Certificates
Monday 11th – Wednesday 13th April 2016, Esbjerg, Denmark
The training course which was co-organised by the World Health Organization-EURO, the EU SHIPSAN ACT Joint Action, and the Centre of Maritime Health and Society, Denmark was designed for employees responsible for conducting ship inspections and for issuance of ship sanitation certificates according to the International Health Regulations.

A total of 33 port health officers (PHO) and professional seafarers and 5 trainers/facilitators participated in the training course.

Webinars on the 2^nd Edition of the European Manual
Two webinars were organised in May 2016 on the second edition of the European Manual for Hygiene Standards and Communicable Disease Surveillance on Passenger Ships. The first webinar (delivered on 11/05/2016) was scheduled in order to present the second edition of the European Manual with representatives from the passenger shipping industry and the second webinar (delivered on 18/05/2016) was targeted to personnel at public health authorities at collaborating ports that have completed previously face to face training and will be responsible for conducting inspections according to the European Manual on passenger ships sailing in EU on an international voyage. 

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People from the project

Danira Širinić
My name is Danira Širinić. I was born in Rijeka, Croatia but I’ve spent my whole life living in Zadar. In my opinion Zadar is the most beautiful city in the world. (About the port and the beauty of the city I wrote in SHIPSAN newsletter no.3 August 2013 – Port of the month).
  
I have finished my studies at University of Zagreb, Faculty of Food Technology and Biotechnology. I completed an internship in a well-known company which produces and sells liquor, alcoholic and soft drinks Maraska lnc. in Zadar. Maraska is also known for its many products and if you ask me, I’d recommend Maraschino liqueur which is our famous brand and Pelinkovac which is made of 11 kinds of herbs and it has healing properties.

I have been working as a sanitary inspector since 2000. In 2012 I’ve became a border sanitary inspector at the Ministry of Health. I love my job.

In March 2014, I was included in the EU SHIPSAN ACT Joint Action project. I fully support SHIPSAN project and in September 2014 I conducted the 1st, and in September 2015 another two pilot inspections according to the European Manual for Hygiene Standards and Communicable Disease Surveillance on Passenger Ships. I am very happy to be involved in the EU SHIPSAN ACT Joint Action and I’m looking forward to the future cooperation.

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Recent Publications

Handbook for management of public health events on board ships
Authors: WHO
http://www.who.int/ihr/publications/9789241549462/en/

Overview
As set out in the IHR (2005), competent authorities at ports are responsible for managing events that pose a risk to public health. These events – which may be caused by biological, chemical or radiological agents – may vary greatly in terms of severity, requiring different degrees of response.
This document aims to provide technical advice to competent authorities at the port level for management of public health events on board ships; it complements other WHO publications addressing risk assessment at the national level, contingency planning at ports, airports and ground crossings, and establishment of capacities and application of emergency plans at the port level.








Vector surveillance and control at ports, airports, and ground crossings
Authors: WHO
http://www.who.int/ihr/publications/9789241549592_eng/en/


Overview
The purpose of this handbook is to provide guidance to Member States on the practical aspects of maintaining sanitary standards at international borders at ports, airports, and ground crossings (points of entry) as set out in the International Health Regulations (2015). It provides technical advice for developing a comprehensive programme for systematic monitoring of disease vectors and integrated vector control at points of entry This including standardizing procedures at points of entry and ensuring a sufficient monitoring and response capacity with the necessary infrastructure for surveillance and control of vectors. In addition, this handbook to serves as reference material for port health officers, regulators, port operators, and other competent authorities in charge of implementing the IHR (2005) at points of entry and on conveyances.

European Union SHIPSAN ACT Joint Action publishes interim guidance on maritime transport and Zika virus disease
Eurosurveillance, Volume 21, Issue 16, 21 April 2016
VA Mouchtouri, C Hadjichristodoulou for the EU SHIPSAN ACT Joint Action
http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=21453 

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What’s new on the website

Interim guidance on maritime transport and Zika virus disease
The interim guidance developed by an ad hoc working group consisting of partners of the EU SHIPSAN ACT Joint Action and other subject matter experts is available in the EU SHIPSAN ACT website. http://www.shipsan.eu/Home/Zikavirus.aspx

European Manual for Hygiene Standards and Communicable Disease Surveillance on Passenger Ships, 2nd Edition, April 2016
http://www.shipsan.eu/Home/EuropeanManual.aspx 

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Quiz

Answer to the previous issue quiz:
The great and last big cholera outbreak occurred in Hamburg in 1892.

Congratulations to the following for providing the correct answer:

• Fernando del Hierro Vega, Director, Ministerio de Hacienda y Administraciones, Spain 
• Iveta Dubrovová, M.D., Ministry of transport, construction and Regional Development of the Slovak Republic Department of Chief Public Health Officer, Slovak Republic

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Port in focus

Port of Kavala, Greece
By: Dr. Christos Papadopoulos, Director of Public Health Authority, Kavala, Greece
Photos: Myrto Mpaltatzi, Public Health Inspector, Kavala, Greece

Kavala is a 27 century-old historic town and is located to the Northeast of Greece, in the region known as Eastern Macedonia and Trace. It is inhabited by 54,000 residents and it is 680km far from Athens, the capital of Greece. Its geographical location, as a route that joins East and West, makes Kavala nodal point for communication between cultures. Moreover, its proximity to the Kavala International Airport “Megas Alexandros“ (30km) and to Greek-Bulgarian borders (90km), combined with numerous beaches and mountain routes, classify Kavala as a great travel destination.

History of the port
The bay formed in Kavala’s west coast of the peninsula (Panagia) was used as a port since ancient times. The port held open the roads around the Greek world of Aegean and Asia Minor, through which arrived in town not only people and goods, but also the spiritual message of St. Paul in 50 A.C. who establishes here the first church of the new religion in Europe.
During the 16th and 17th century, the port of Kavala plays an important role in the region with the primary administrative and fiscal control of neighbouring mining region, and the trade of local agricultural products (wheat , cotton , timber etc). Between 18th and early 20th century is a special period of prosperity for the city of Kavala and its harbour and the first consular authorities of France and Venice are installed. The port is mainly export trade and huge quantities of manufactured tobacco are shipped to other major ports of Europe. Since the 1920s the refugee populations from Asia introduced the methods of intensive fishing of coastal areas and the port became the center of a remarkable fishing economy. The current port was constructed in 1929, but the leeward pier lengthened after the World War II.

“St. Paul’s” Central port
Nowadays, “St. Paul’s” Central port of Kavala is situated at Lat. 40o56”00 N. and Long. 24o24”40 E and operates as a passenger ship port. Since 2002, because of the increased traffic, commercial ship operations transferred to the second port "Philip II", 8km far from the city.
“St. Paul’s” Central port has facilities in order to serve ridership, tourism, fishing fleet and water sports. The main eastern wharf length of port is 350m (8,5m in depth) and it is used by ferry lines and cruisers. The southern windward pier which serves also as breakwater has a total length of 640m (9 m in depth). The port accepts cruise ships up to 350 m long. Some of the services provided to ship traffic are anchorage, towage, water supply, electricity, management of solid and liquid waste, health emergency station, newly built passenger terminal, two marinas etc.
In conclusion, St. Paul’s Central port is a significant reason for Kavala’s tourism development with a total ridership of 501,245 passengers in 2015. The ever growing cruise ship traffic contributes to the city’s progress and draws international attention to Kavala’s port industry.

Note: Kavala is an authorized port under the International Health Regulations 2005 for the issuance of SSCC & SSCEC extensions. Inspectors from Kavala’s Public Health Department also conduct routine inspections in cruise ships according to the European Manual for Hygiene Standards and Communicable Disease Surveillance on Passenger Ships.

References:
http://www.portkavala.gr
http://www.kavalagreece.gr/tourismos/touristikes-plirofories/periigisis/limani/
http://www.yen.gr