SHIP SANITATION TRAINING NETWORK No

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1 SHIP SANITATION TRAINING NETWORK No Christos Hadjichristodoulou SHIPSAN TRAINET Project leader Workshop on Generic Preparedness (GP) projects Luxemburg, 30 September 1 October 2009 European Commission DG SANCO Executive Agency for Health and Consumers

2 Content The SHIPSAN project Objectives Outcomes The SHIPSAN manual The Inspection Programme The SHIPSAN Network The partnership vision

3 The problem Ships vehicle of translational transmission of communicable diseases Outbreaks and diseases on board reported mainly to countries with specific surveillance systems: US VSP, Sydney, EU-EWGLI, EWGLI, DIVINET Increasing numbers of cruise ships & ferries in the EU: 66 cruise lines, 192 cruise ships (119( in US) Modern cruise liners designed to carry many more passengers and crew (some 5-10,000), 5 19 decks, 30 restaurants Approximately 320 million ferry passengers passed through EU-27 ports in 2007 Surveillance of disease associated with ships is inadequate Quality of hygiene inspections of ships varies enormously between countries in Europe, even within countries, even within the same port

4 When we first realized the problem In 2001, during the preparation for the 2004 Olympic games - Hellenic vessel sanitation program 2005 SHIPSAN 2007 SHIPSAN TRAINET

5 The EU Shipsan Project

6 DG Health & Consumers Public Health Programme ASSESSING THE USEFULNESS OF AN EU SHIP SANITATION PROGRAMME AND COORDINATED ACTION FOR THE CONTROL OF COMMUNICABLE DISEASES IN CRUISE SHIPS AND FERRIES Project Leadership: National School of Public Health, Athens, Greece Scientific Coordination : University of Thessaly, Larissa, Greece Started: December 2006 Ended: December 2008 Duration: 24 months

7 The SHIPSAN project Addresses passenger ships sailing in European waters sea-going and inland navigation ships on international and on national voyages Target group 1 Consumers (Passengers & crew members) Target group 2 Industry Passenger shipping companies Involves communicable diseases and outbreak reporting response and management hygiene inspections Target group 3 MS officers Port Health Authorities

8 The SHIPSAN partnership 14 EU Member States 9 associated 5 collaborative European Centre for Diseases Prevention and Control World Health Organization CDC Vessel Sanitation Program International Maritime Organization 1 passenger ship company 2 passenger ship associations 1 professional association

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10 The SHIPSAN added value Integrated surveillance of communicable diseases on passenger ships across the EU by the EU Port Health Authorities Communication and sharing of information among port health authorities Comparability of data across the EU Standardization and coordination of hygiene inspections Avoiding overlapping and duplication of inspections Cooperate with shipping industry to deal with communicable diseases on passenger ships when they occur Supporting and advice to shipping industry to apply European legislation on passenger ships

11 The benefits from SHIPSAN Consumers Healthier voyages Advice for behaviour Health authorities Regular training Guidance in emergencies Standards to work with Harmonization of practices Scientific and technical support SHIPSAN Shipping companies Harmonization of standards Recognition of certificates in all EU countries Provide a gold standard certificate Support in emergencies A pool of expertise for consultation

12 What the SHIPSAN has achieved Within 24 months The most appropriate programme for the EU (based on best practice, experience, existing programmes etc) was explored Communicable diseases and outbreaks have been published from 1970 to 2006 on passenger ships were collated and included in the State of the Art report The European passenger ships market was examined and EU MS were categorized in four groups A study was conducted in the 32 countries and 176 authorities Identified the EU, national and international legislation applied by competent authorities in the EU Description of the current situation in the EU based on study findings (needs, gaps) Established a partnership which consists of experts scientists and intends to expand it Developed synergies with ECDC, authorities, the industry, key stakeholders and internationally recognized programmes

13 CD ROM including the study results

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17 The SHIPSAN TRAINET project

18 DG HEALTH & CONSUMER PROTECTION PUBLIC HEALTH PROGRAM Priority Area Responding to health threats rapidly and in a co-ordinated manner (HT 2007) Action Health security and strategies relevant to communicable diseases control Duration : 30 months Start : November 2008 End: May 2011 Project Leadership : Scientific Coordination : University of Thessaly, Larissa, Greece National School of Public Health, Athens, Greece

19 THE PARTNERSHIP 18 EU Member States (11 associated, 7 collaborative) 4 Euromed countries: Jordan, Lebanon, Israel, Turkey European Centre for Diseases Control and Prevention World Health Organization CDC Vessel Sanitation Program International Maritime Organization 5 passenger ship companies 2 passenger ship associations 1 professional association

20 Associated Partners 11 EU countries Health Protection Surveillance Centre, IRELAND Health Protection Agency, Centre for Infections, UNITED KINGDOM Hamburg Port Health Centre, GERMANY The National Board of Health and Welfare, Unit of Communicable Disease Prevention and Control, SWEDEN Health Protection Inspectorate, ESTONIA Klaipeda Public Health Centre, LITHUANIA Medical university of Gdansk, Interfaculty of Maritime and Tropical Medicine, POLAND National Centre for Epidemiology, SPAIN Ministry of Health, Section of Communicable Diseases Surveillance, BULGARIA Institute of Public Health of the Republic of Slovenia, SLOVENIA Technological Institute of Athens, Faculty of Health and Caring Professions, GREECE Consulting Management Training (C.M.T.) Prooptiki Athens, GREECE

21 17 Collaborating Partners 9 country authorities, 5 associations, 5 shipping companies European Centre for Diseases Control and Prevention World Health Organization CDC Vessel Sanitation Program International Maritime Organization Association of Port Health Authorities, UNITED KINGDOM Passenger Shipping Association, UNITED KINGDOM National Institute for Public Health and the Environment, THE NETHERLANDS Centre of Environment, FINLAND Carnival Cruise Lines, UNITED KINGDOM Ministry of Public Health, BELGIUM Jordan Israel Ministry of Health, Department of alert, response and preparedness, Ministry of Health and Social Solidarity, GREECE Turkey FRANCE ANEK Ferries, GREECE Lebanon Ministry of Health - Department of Preventive Hygiene, ITALY Hellenic Centre for Infectious Diseases Control, GREECE Ministry of Health, PORTUGAL Spanish Ministry of Health, SPAIN MINOAN Lines, GREECE Bluestar Ferries, Superfast Ferries, GREECE Hellenic Association of passenger ships, GREECE Ministry of Health, Medical and Public Health Services, CYPRUS

22 Aim The overall aim of the project is to: Cover the gaps on a common European strategy and training network on: ship sanitation inspections outbreak investigations surveillance and control of communicable diseases on board cruise ships and ferries. Facilitate the practical implementation of the International Health Regulations (IHR) (2005) in order to enhance the common EU policy on the prevention of communicable disease related to cruise ships and ferries.

23 General Objectives 1. To promote and establish the integrated European ship sanitation strategy,, based on the SHIPSAN project results and on the requirements of the IHR (2005). 3. To develop a European training network regarding ship sanitation and control of communicable diseases on board cruise ships and ferries. 2. To strengthen existing public health structures aiming to safeguard the public health and prevent the spread of communicable diseases among passengers and crew members 4. To produce an integrated training programme among EU Member States regarding ship sanitation, outbreak management, surveillance and control of communicable diseases related to cruise ships and ferries. 5. To provide training on the implementation of the IHR (2005) on issues related to cruise ships and ferries.

24 SHIPSAN TRAINET specific objectives Common standards Common training Communication Manual for surveillance and inspections EU SHIPSAN Integrated Programme Web-based Port to port Communication Training material and Training modules for port health professionals and seafarers Training network with expert scientists

25 Methodology Working Group Meetings SHIPSAN Outputs State of the Art Site Visits Questionnaires Pilot Testing Web Based Network Communication Strategy Coordination Strategy Evaluation Strategy Dissemination Strategy

26 What the SHIPSAN TRAINET project will deliver An integrated programme for communicable diseases control and passenger ship hygiene Enhanced harmonised surveillance of disease and outbreak detection and investigation for the EU port health authorities A manual for inspection Training across Europe A network for sharing surveillance data and inspection results Technical support upon request

27 Timeline for main deliverables Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Training material 6 months pilot network Project Handbook Manual Communication plan TM1 TM2 TM3 TM4 TM5 Dissemination & Exploitation plan State of the Art report Web site Evaluation plan

28 The SHIPSAN NETWORK Ship registry data Surveillance data Outbreak detection data SHIPSAN COMMUNICATION NETWORK Inspection data Corrective action data Contact details port health authorities inspectors shipping companies

29 SHIPSAN communication network Objectives To create a communications system that can improve consumers (passengers and crew) protection through: implementation of the EU Port Health Authorities surveillance and response system (using web based standardized diseases reporting forms for passenger ships) facilitating the exchange of information between ports during outbreak investigation sharing of information on hygiene inspections share epidemiological information among professional groups, competent authorities, and international organizations in a standardized and confidential way creating an alert system to ensure that outbreaks and other public health events can be investigated and controlled in a timely manner without over reaction facilitating communication by creating registries including contact details for ships, Port Health Authorities and inspectors

30 Communication Needs

31 Databases handled by the SHIPSAN Communication Network Competent Authorities Industry

32 Example: Ports of Italy Contact details of ports

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34 Network web based form

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36 Access to SHIPSAN Web based tool NFP National Health Authority WHO DG SANCO ECDC EWRS SHIPSAN Secretariat SHIPSAN Web based tool Port Health Authority Ship

37 Alert generation by national or international surveillance National Surveillance System International Surveillance System SHIPSAN Web based tool National Public Health Authority SHIPSAN Secretariat Is there an alert? If no Port Health Authority PHA will inspect / contact ship PHA alert form Trigger alert or Confirm no alert

38 Case / Outbreak / alert route 1 Ship Outbreak Initial report (when event/outbreak comes to light) SHIPSAN web based tool PHA Notification of National or International Surveillance which needs alert status Triggers active incident status Is alert status necessary? 2 Case initial report (when a case comes to light) Yes No Alert notified 3 Outbreak Update report (not less than 4hrs before arriving to the next port of call) Alert next port-ofcall Update PHA inspects or checks progress PHA notifies next port -of-call (if it does not have access to SHIPSAN web based tool) 4 5 Outbreak Update report (before each port-of-call) Case/Outbreak final report Active status closed No further communication to PHAs Update PHA inspects or checks progress PHA notifies next port -of-call (if it does not have access to SHIPSAN web based tool) PHA Alert (final) Closing the alert

39 Recommendations of SHIPSAN on surveillance and response Integrated surveillance system Specific outbreak definitions Specific guidelines for prevention and management of GI diseases (Norovirus etc.) General guidelines on outbreak management

40 SHIPSAN reporting forms 1. Case/Outbreak report form 2. Routine surveillance form 3. Maritime Declaration of Health They are completed by the ship 4. Ship registry form 5. Health port registry form 6. Inspector registry form 7. SHIPSAN inspection 8. Port Health Authority Alert form 9. Network reporting form They are completed by Port Health Authorities or collected by LOYD s

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45 Surveillance section of the Manual

46 Pilot testing of the Network and the Surveillance System The following countries have agreed to participate: Greece United Kingdom France Netherlands Germany Spain Poland Estonia Two ferries industries in Greece, two big and one small companies from cruise industry will participate voluntary. In the second phase two more countries, Turkey and Italy, might be added.

47 Recommendation for events/outbreaks management coordination Initial event/outbreak alert Next port-of-call Provide update alert report Coordinating Centre Support Next port-of-call Final event/outbreak alert report

48 Passenger ships web based communication tool Submit Case/Event/Outbreak Reporting Form Submit Communicable Disease Routine Surveillance Reporting Form View Analyze Choose format of Archives Cases Events Outbreaks Syndromes

49 Port Health Authorities web based communication tool Ferries & Cruise ships Port Health Authorities Registries Inspectors Ship companies Other contacts (European, international) Create alert & communicate outbreak management data Exchange epidemiological information View for ship or for port Submit inspection reports View current events View archives Draft inspection report Final inspection report Alerts Cases/events/outbreaks Epidemiological information Inspection reports

50 SHIPSAN Databases & Reports Inspectors in Competent authorities SHIPSAN TRAINET Inspection programme components Manual for inspections Communication network

51 Manual for inspections

52 Scope of the SHIPSAN Manual Description of standards for passenger ships in the EU: Communicable diseases reporting requirements Hygiene standards Administrative issues Outbreak management guidelines Operational guidelines

53 Target audience for the final Manual Shipping industry Port health authorities Network participants National and regional authorities of EU Member States surveillance inspections Scientific community/ Public

54 SHIPSAN Manual Food safety Potable water safety Hygiene inspections Swimming Pools Pest management Waste management Housekeeping and facilities Aim Consumers Protection Hazardous substances

55 SHIPSAN Manual references Administrative issues Food safety: Standards EU Directives and National Catering Guides Specific for ships Yes Waste management: EU Directive & IMO conventions Yes Potable water safety: Pest management: Hazardous and/or inedible substances: EU Directive & WHO guidelines for Water Safety Plans EU Directive & IMO recommendation EU Directive & WHO guidelines No No No Housekeeping and facilities: No EU legislation Recreational water safety: No EU legislation

56 Manual layout

57 The SHIPSAN TRAINET inspection network DATABASE future development Port health authorities Submit an inspection report Targeting a ship for inspection Inspection reports history Passenger shipping companies Submit corrective actions Port directory Port Health Authorities Contact details Inspectors Ferries and Cruise ships directory Cruise ships and ferries companies directory

58 Administrative issues Inspectors Trained and certified in common standards Continuing professional development working in competent authorities of MS Using a common EU Manual for inspections Communicate frequently Exchange data, information, knowledge through a webbased database Competent authorised officers who have undertaken training should conduct the inspections Selection criteria for the inspectors will be defined

59 Training Standardisation of inspections Frequent communication Written inspection procedures Administrative issues Check list and scoring during inspections Statistical analysis of inspection results Auditing of personnel inspection activities Inspections Different inspections categories Frequency of inspections Corrective action Publication of inspection results Fees Revision and amendments

60 Inspection Check list Instructions to inspectors Scheme for Inspection Scores

61 Pilot training modules 2 train the trainers modules 2 training modules for health professionals 2 training modules for cruise ships crew members 1 training module for ferry crew members 17 trainees for each training module 5 days each training module

62 Training network The partnership will initially determine: Criteria for trainers Conditions for membership in the training network The criteria and the membership conditions will be validated by the steering committee The partnership will seek for experts: An announcement will be published in SHIPSAN TRAINET website & Eurosurveillance Experts from international and other organizations will be invited to apply WHO IMO CDC VSP ECDC Working group meeting To select the trainers A checklist will be internally used to cross check the trainers qualifications with the selection criteria and the membership conditions

63 SHIPSAN Partnership strategic plan

64 8. Development of the means for long term funding Strategic aims 1. Work to secure political commitment and support 2. Implementation of a plan for improved communications with stakeholders and the general public 3. Engagement of qualified best experts for different core activities 4. Development of trust based relations with collaborators and stakeholders 5. Establishment of a virtual reference centre for providing training, advice and guidance 6. Contribution to scientific knowledge of public health on passenger ships 7. Provision of a State of the Art programme suggesting a holistic approach to the public health problem

65 The SHIPSAN project partnership vision All travellers on passenger ships sailing in European waters will be protected from communicable diseases through the implementation of coordinated evidence based actions taken by European and international authorities, competent port health authorities of the European countries, shipping industries and travellers.