Newsletter. Issue No 9. July 2014 In this issue News from the leadership Thematic sections Chemical and radiological issues on ships Occupational health on ships Environmental health and hygiene on ships The Galley Voice of the Industry The ship s water safety plan as a paradigm of systemic approach to on board Public Health Pullmantur Continually Improving Public Health Standards in their Fleet People from the project Recent Publications News and forthcoming dates What s new on the website? Quiz Port in focus Port of Genoa, Italy ISSN Number: 2241-5211 Editor: Dr Carmen Varela Martinez, Spain Editorial Board: Prof Christos Hadjichristodoulou, Greece Dr Barbara Mouchtouri, Greece Mr Gary Cooper, United Kingdom Dr Gordon Nichols, United Kingdom Dr Angel Kunchev, Bulgaria Dr Haraldur Briem, Iceland Dr Maurice Mulcahy, Ireland Dr Mauro Dionisio, Italy Section Editors: Prof Raquel Duarte Davidson, United Kingdom Dr Thomas von Münster, Germany Dr Martin Dirksen-Fisher, Germany Mr Martin Walker, United Kingdom Dr Nina Pirnat, Slovenia Content Manager/Secretariat: Mrs Elina Kostara Publisher: EU SHIPSAN ACT Joint Action Coordinator: University of Thessaly, Larissa Greece Next Issue: September 2014 To subscribe or unsubscribe please contact us on: info@shipsan.eu This Newsletter arises from the EU SHIPSAN ACT Joint Action which has received funding from the European Union, in the framework of the Health Programme (2008-2013). Sole responsibility lies with the author and the Executive Agency for Health and Consumers is not responsible for any use that may be made of the information contained therein. Editorial Dr Carmen Varela Martinez, Spain Dear Readers, I would like to remind you that there is currently an outbreak of Ebola virus disease (EVD) in Guinea, Liberia and Sierra Leona. EVD is one of the world s most virulent diseases. The infection is transmitted by direct contact with the blood, body fluids and tissues of infected animals or people. The infection can be controlled through the use of recommended protective measures. According to World Health Organization (WHO), as of 8 July 2014, the cumulative number of cases is 888 (664 confirmed), including 539 deaths (368 confirmed). A travel and transport risk assessment from WHO could be found at http://www. who.int/ith/updates/20140421/en/ A short summary of these recommendations for ships are: In case of a passenger presenting with symptoms compatible with EVD placed him/her in a medical isolation room or in his/her cabin and inform about EVD to persons who will take care of the patient (they should wear Personal Protection Equipment). Cleaning and disinfection should be done without creating aerosol. All waste produced in the cabin should be handled as clinical waste. Case investigation should be started immediately. Monitoring of close contacts should be implemented. A suspected diagnosis of EVD on a ship must be reported as soon as possible to the next port of call. Patient should disembark avoiding any contact with healthy travellers and wearing a surgical mask. Ship operators shall pass to Port Health Authorities (at their request) the contact details and itinerary of exposed passengers. Countries may consider requiring arriving ships to issue a Maritime Declaration of Health. The European Centre for Disease Prevention and Control has also published information to travellers related to Ebola virus disease. http://www.ecdc.europa. eu/en/publications/publications/ebolatraveller-advice-leaflet-18-apr-2014.pdf Enjoy your holidays and be healthy travellers!! News from the leadership Prof. Christos Hadjichristodoulou, SHIPSAN ACT Joint Action Coordinator Dr Barbara Mouchtouri, SHIPSAN ACT Joint Action Manager This time of the year may indeed be less busy for many; however, for the EU SHIP- SAN ACT Joint Action partnership it is an important and busy period. We are currently on the 18th month of the Joint Action implementation, almost in the middle of the SHIPSAN ACT Joint Action before its completion at the end of April 2016. At the beginning of summer, June 2014, the partnership successfully organised the SHIPSAN ACT advanced training course on water safety for port health officers and seafarers. Moreover, the EU SHIPSAN ACT Joint Action was presented in China at the International Workshop to strengthen We are currently on the 18th month of the Joint Action implementation, almost in the middle of the SHIPSAN ACT Joint Action before its completion at the end of April 2016. Erratum 25/10/2017: Page 4 - The sentence with increased risk of infections caused by so-called emerging food-borne pathogens, including the bacterial strains Listeria monocytogenes, Yersinia enterocolitica, Aeromonas spp., Plesiomonas shigelloides, Pseudomonas spp., and moulds such as Penicillium and Cladosporium spp (1),(2) was changed to with increased risk of infections caused by so-called emerging food-borne pathogens, including the bacterial strains Listeria monocytogenes, Yersinia enterocolitica, Aeromonas spp., Plesiomonas shigelloides, Pseudomonas spp., and toxigenic effects caused by mycotoxins produced by moulds such as Penicillium and Cladosporium spp (1),(2)
SHIPSAN NEWSLETTER Issue No 9. July 2014 2 News from the leadership continued the core capacities at designated points of entry under the International Health Regulations. We are also pleased to inform you that the European Manual for Hygiene Standards and Communicable Diseases Surveillance on Passenger ships has been translated in Chinese. The EU SHIPSAN ACT Joint Action progress and the SHIPSAN Information System were presented by Dr Gordon Nichols and Mr Martin Walker, respectively, to the technical meeting of the Association of Port Health Authorities. Pilot inspections are being conducted across Europe and at the same time the interim technical implementation and financial reports have to be produced outlining all the work completed within the 19 month period and the work remaining. Additionally, the interim evaluation report will be produced and delivered to the Consumers, Health and Food Executive Agency. This report will present the assessment of the Joint Action indicators (process, outcome, output) as well as the results of the internal and external evaluation questionnaires that will be completed by the partnership. Finally, preparations have begun for three meetings that will take place in October 2014: the Interim Collaborative Group meeting, the General Assembly meeting, and the Sustainability Working Group meeting. Despite the busy period, we wish partners to have a relaxing and enjoyable holiday. Thematic Sections Chemical and radiological issues on ships David Jones, Secretary, Port Health Special Interest Group. Public Health England (PHE) Centre for Radiation, Chemicals and Environmental Hazards (CRCE) hosted a meeting to discuss chemical and radiological issues on ships on Thursday 8th May 2014. This was attended by 20 officers from the Port Health Special Interest Group (SIG) and eight staff from CRCE with expertise on how to deal with chemical and radiological incidents. The Port Health SIG set up for members of the Chartered Institute of Environmental Health (CIEH) 1 who work at sea and airports throughout the UK aims to strengthen and promote its work among the profession and has proved successful in representing Environmental Health Practitioners (EHP s) working in food hygiene on ships and aircraft, infectious disease control, imported food control and pollution control and is dedicated to maintain high standards of professionalism and competency. The Port Health SIG is committed to providing practical and theoretical training for its members and to help raise the profile of the work carried out and develop and strengthen links with such national bodies such as the Association of Port Health Authorities, Food Standards Agency, PHE and colleagues working in other European ports. Since the implementation of SHIPSAN ACT Joint Action Project in early 2013, the Port Health SIG has been fortunate that some of its members have been at the forefront of leading training courses on the inspection and hygiene standards on passenger ships. The knowledge gained during these training courses has resulted in a number of seminars been run in the UK by the SIG to cascade much of this information back to the officers who carry out the inspections and promote a level of consistency. The recent Port Health SIG meeting considered opportunities for working in partnership to manage cross border health threats from chemicals, radiation and environmental hazards. PHE provided an overview of the arrangements and resources available in the UK to respond to a public health event and discussed arrangements for reporting within Europe. Port health colleagues presented an update on the SHIPSAN project and promoted the Ports, Airports and Ground Crossings Network (PAGNet) organised by the World Health Organization 2. Following the presentations, an interactive case study was used to explore the roles that both organisation would undertake when managing a public health event associated with a chemical or radiological hazard, on ships and at ports. This proved to be an extremely beneficial exercise with both parties gaining a valuable insight into the work of the other and will assist CRCE developing guidance, training material and case studies to assist competent authorities assess and respond appropriately to chemical and radiological events at designated Points of Entry. The training day was very well received by all who attended and hopefully will forge closer working relationships between colleagues from both agencies. Further reading 1. Chartered Institute of Environmental Health (http://cieh.org/) 2. PAGNet, World Health Organization (https://extranet.who.int/pagnet/ home).
SHIPSAN NEWSLETTER Issue No 9. July 2014 3 Thematic Sections continued Occupational health on ships New strategic partnership between SHIPSAN ACT Joint Action and the European Agency for Safety and Health at Work (EU-OSHA) Tanoey J, von Muenster T, Sevenich C, Dirksen-Fischer M, Oldenburg M, Harth V, Pilipavičius RJ and SHIPSAN WP9 Workgroup As in any other workplace, safe operation of a ship requires regular risk assessments. This is required by such international conventions as the Maritime Labour Convention 2006 (MLC 2006) and the ISM-Code. To facilitate risk assessments, especially for medium and small enterprises, SHIPSAN ACT has now formed a partnership with the European Agency for Safety and Health at Work. Risk assessment is the key to healthy and safe workplaces. This is emphasized in Council Directive 89/391/EEC, which introduces measures to encourage improvements in the safety and health of employees in the workplace. In the maritime sector, international conventions such as the Maritime Labour Convention (MLC 2006) and the ISM-Code, make these measures mandatory for the majority of all seagoing vessels. As it currently stands, not all vessels are obliged to carry out a risk assessment. This is due to several exemptions regarding size, purpose and the area of operation. SHIPSAN ACT Joint Action aims to facilitate risk assessment on all vessels in the maritime sector. Carrying out risk assessments can be challenging. A ship s crew may lack the resources or the knowledge about occupational health and safety to do this effectively. SHIPSAN ACT Joint Action aims to facilitate risk assessment on all vessels in the maritime sector. After assessing the needs for a risk assessment tool for cargo ships, we developed a concept for such an instrument. This tool should fulfil three main criteria: international accessibility, easy to use, and cost-free. DG SANCO, DG EMPLOYMENT and the Consumer, Health and Food Executive Agency created all the necessary links and brought together SHIPSAN ACT with the European Agency for Safety and Health at Work (EU-OSHA), initiating a fruitful collaboration. EU-OSHA has developed a platform called OiRA Online interactive Risk Assessment. It is a web platform that enables the creation of sectoral risk assessment tools in any language in an easy and standardised way. At present, 33 tools from 9 different countries have been developed. The platform is based on a Dutch Risk Assessment instrument which now exists in more than 172 sectoral variants, each tailor-made to the needs of its particular sector. Practical values of the tool: 1. Reducing the number of occupational diseases and accidents. 2. Ensuring the health and safety of workers. 3. Improving the working conditions. EU SHIPSAN ACT Joint Action has now signed a memorandum of understanding with EU-OSHA on the development of a Risk assessment tool for different cargo ship types. In a recent meeting in Klaipeda, Lithuania the working group made excellent progress in the development of the tool. Key points were clarified and we are now awaiting the first results before setting up an online version of the tool for preliminary testing. At present, 33 tools from 9 different countries have been developed.
SHIPSAN NEWSLETTER Issue No 9. July 2014 4 Thematic Sections continued Environmental health and hygiene on ships The Galley Martin Walker, Port Health Officer, Suffolk Coastal Port Health Authority, Felixstowe, England For this month s article, I am grateful to Dr. Maria Gambuzza of the Ufficio di Sanita Marittima di Messina who has submitted this very timely piece. Microorganisms able to grow or survive at cold temperatures: A hidden danger on board ships The microorganisms live in every part of the biosphere, and some of them are even capable of growing at low temperatures, including those below the freezing point. These microorganisms live in the sea or in high mountains, but unfortunately also in the refrigerators, where they may spoil or, as pathogens, contaminate foods. Therefore, although storing foods in the refrigerator is the best way to keep them safe from bacterial contamination, there are also types of bacteria that can grow in cold temperature as well as inside the refrigerators. The typical changes of the modern era leading to increased reliance on low temperature storage of food, has resulted in a change of the spectrum of foodborne diseases, with increased risk of infections caused by so-called emerging food-borne pathogens, including the bacterial strains Listeria monocytogenes, Yersinia enterocolitica, Aeromonas spp., Plesiomonas shigelloides, Pseudomonas spp., and toxigenic effects caused by mycotoxins produced by moulds such as Penicillium and Cladosporium spp (1),(2). Most of these microorganisms, are well able to grow down to 0-2 C, can enter the refrigerator through raw and improperly packaged foods (typically meats, eggs and milk) or even through an open refrigerator door during cargo by poor cleanliness refrigerator seals, or are already growing from lack of proper sanitation or warm temperature, and, if ingested, cause dangerous foodborne illnesses, including sepsis, diarrhoea, meningitis, dysentery, food poisoning, urinary tract infections, and gastrointestinal infections. In addition, the mould species Penicillium and Cladosporium, always present in the refrigerator sides, produce poisonous compounds (mycotoxin, aflatoxins) that spread throughout the refrigerated foods and are known to be potent carcinogens. Cruise ships are at increased risk of food contamination from these psychrophilic microorganisms, because large amounts of foods are consumed every day. Moreover, not all foods are consumed during the voyage, because the ships must keep a percentage in reserve to allow for delays, in refrigerated or frozen conditions. Key message: There are several types of foodborne pathogenic microorganisms able to multiply at low temperatures. On board cruise ships there is an increased risk for food contamination from these psychrophilic microorganisms, due to very large amounts of foods stored in the cold storage rooms. There are some simple rules to prevent or limit these bacteria from growing and spreading inside the cold storage rooms. Examples of pathogens able to survive in refrigerated foods In the last columns of the right the survival and optimum growth temperatures are indicated. Microorganism Common food sources Survival T ( C) Campylobacter jejuni Listeria monocytogenes Yersinia enterocolitica Aeromonas hydrophila Plesiomonas shigelloides Pseudomonas spp. Penicillum, Cladosporium Raw chicken, foods contaminated by raw chicken, unpasteurised milk, untreated water Ready-to-eat foods, including raw milk, cheeses, ice cream, raw vegetables, fermented raw sausages, raw and cooked poultry, raw meats, raw and smoked fish Raw milk, chocolate milk, water, pork, other raw meats Optimum growth T 0 45 (3) 37 42 (3) -1,5 45 (4) -1,5 45 (4) -1,5 44 (5) -1,5 44 (5) Seafood including oysters, water -2 45 (4) 5 25 (4) Raw oysters 8 44 (5) 37 38 (5) Meat, fish, shell fish and dairy products 4 43 (6) 37 38 (6) -3 35 (7) 25 26 (7)
SHIPSAN NEWSLETTER Issue No 9. July 2014 5 Thematic Sections continued How to prevent psychrophilic pathogens from growing and spreading inside the fridges, and the cold storage rooms? Where Food Goes in the Cold Storage Rooms Make sure fridges are set at 5 C (SHIPSAN Manual reference 3.4.40 and 3.4.19). Ensure that all food is packaged, covered and stored properly (SHIPSAN Manual reference 3.4.10). Avoid leaving the fridge doors or the cold storage rooms open for longer than necessary (SHIPSAN Manual Reference 3.4.17). Keep raw foods covered and separated from cooked foods (SHIPSAN Manual reference 3.4.10). Clean and sanitise regularly using antibacterial such as bleach cleaners (3.3.18). Check for discolouration or moulds in foods and immediately dispose them(shipsan Manual Reference 3.4.21). Moulds are often signs of bacterial growth. Allow frozen food to thaw in one of the following ways (SHIPSAN Manual reference 3.4.33); under refrigeration at a temperature of 5 C (41 F); by completely submerging food in cold running potable water at a temperature not above 21 C (70 F) for a period not exceeding 4 hours; as part of cooking process (but only when thawing is taken into consideration in determining cooking time and following any directions on the food packaging); by using a microwave (attention is to be given to ensure a proper thawing cycle controlled time or temperature). SHIPSAN recommends a thawing temperature of 5 C (41 F) or below as best practice however some EU countries require that frozen foods are thawed in a temperature of <8 C (46 F). References 1. Jackson V, Blair IS, McDowell DA, et al. The incidence of significant foodborne pathogens in domestic refrigerators. Food Control 2007; 18: 346-51. 2. Behravesh CB, Williams IT, Tauxe RV. Emerging foodborne pathogens and problems: expanding prevention efforts before slaughter or harvest. In: Institute of Medicine (US). Improving Food Safety Through a One Health Approach: Workshop Summary. Washington (DC): National Academies Press (US); 2012. A14. Available from: http://www.ncbi.nlm.nih.gov/books/ NBK114501/ 3. Haddad N, Burns CM, Bolla JM et al. Long-term survival of Campylobacter jejuni at low temperatures is dependent on polynucleotide phosphorilase activity. Appl Environ Microbiol 2009; 75: 7310-18. 4. Rossvoll E, Ronning HT, Granum PE et al. Toxin production and growth of pathogens subjected to temperature fluctuations simulating consumer handing of cold cuts. Int J Food Microbiol 2014; doi.: 10.1016. 5. Ingham SC. Growth of Aeromonas hydrophila and Plesiomonas shigelloides on cooked crayfish tails during cold storage under air, vacuum and a modified temperature. J Food Prot 1990; 53: 665-67. 6. De Jonghe V, Coorevits A, Van Hoorde K. Influence of storage conditions on the growth of Pseudomonas species in refrigerated raw milk. Appl Environ Microbiol 2011; 77: 460-70. 7. Sautour M, Dantigny P, et al. A temperature-type model for describing the relationship between fungal growth and water activity. 2001; 67: 63-69. 8. EU SHIPSAN TRAINET Project partnership, European manual for hygiene standards and communicable diseases surveillance on passenger ships, (2011).
SHIPSAN NEWSLETTER Issue No 9. July 2014 6 Voice of the Industry The ship s water safety plan as a paradigm of systemic approach to on board Public Health Dr. Pierfrancesco Lepore, Director of Corporate Medical Services MSC Cruises Public Health on board a cruise ship is a continuous challenge for cruise company and for shipping and seafarers in general. Nowadays we have to respect and to be in compliance with a lot of regulations and guidelines. MSC Cruises, for instance, have to follow Flag Regulations (Authority of Panama Canal), USPH, ANVISA, SHIPSAN, and for next itineraries also CANADA and AUSTRALIA rules. In the last 10 years, the company has implemented for the fleet an internal manual that comprehends guidelines, manuals and standard operative procedures in public health matters that involve more fields of application. We have to provide to Food Safety, Water Safety, Pest Management, Environmental Health, Occupational Health and most of all to guarantee to our passengers less risk as possible to contract an illness on board. But the difficulty that we often meet in ship s daily activities is the practical application of this rules and manuals on board. To resolve this conflict we think that a systemic approach can be more effective and can help us to reach our goals. Why the Water Safety Plan can be an example of good practice that can be translate in other field of Public Health? The answer is simple: because the approach to a WSP, as reported by WHO (2004) and by Mouchtouri, Bartlett, Diskin and Hadjichristodoulou (2012) is proactive, is holistic, is risk-based, is dynamic, but most of all is based on a systemic approach. What means systemic approach? Ludwing von Bertalanffy (1968) wrote: With the term systemic approach refers to the size of the general methodological Systemic, for which, considering a problem, we cannot evaluate the effectiveness of using model systems that identify the most appropriate level of description, as the components, the scaling, the interactions, the role of the observer who invents constructivist variables. In our case we face with a close system (the water plant or also the whole ship) and we are the observer that can make, after a description of the system and of the problem that Key message: The Public Health on board the cruise ships is a continuous challenge. To be in compliance with international laws and regulations in a complex system like a modern ship we need to change our traditional frames of reference basing our activity on a successful paradigm. A Water Safety Plan well done can be the paradigm that we are searching for. we have with, the new variable that can resolve the problem and improve the plan. An example was the review of WSP that MSC has to implement after a notified outbreak of legionellosis in the 2012 by ELDSnet. During the study of the problem and the implementation of a new Plan we have carried out that the systemic approach that we have used for the WSP can be transferred in the other Public Health procedures that we need to make them constantly updated. Finally, an operative approach based on a lean management joint with the Deming Cycle : Plan Do Check Act can realise a sort of on-going rechecking that, in daily activities, can lead us and our seafarers to the continuous improvement that we need to realise an healthy ship for an healthy cruise. Public Health on board a cruise ship is a continuous challenge
SHIPSAN NEWSLETTER Issue No 9. July 2014 7 Voice of the Industry continued Pullmantur Continually Improving Public Health Standards in their Fleet Jorge E. Coronado, Fleet Environmental & Public Health Manager, Pullmantur Cruises & Croisieres de France Pullmantur never takes a break when it comes to ensuring public health standards on board our vessels. As a Family member of Royal Caribbean Cruises Ltd. Pullmantur operates five vessels that includes two under the Croisières de France brand. Our ships sail across the Atlantic from Brazil and Caribbean to European waters twice per year. This means large changes in operating environment, supply chains, guest nationalities and profiles, and national and port regulations and facilities. To meet these challenges it has been necessary for Pullmantur to design a Public Health and Food Safety management system that not only meets international standards, but also specific national requirements. At the same time the system must be flexible enough to take into account differences in guest preferences and habits together with large variations in port standards and available facilities to the ship. Furthermore, the fleet in itself has differences in galley and space design that must also be taken into account. Working in this diverse environment and facing a growing interest from external parties for the Public Health compliance on our ships, we early came to realise that using SHIPSAN standards and recommendations as our main yardstick would facilitate our work and ensure our standards were based on best practices that are scientifically founded. We also share our best practices internally across all the brands of Royal Caribbean Cruises Ltd. We understand that the plans and policies can only be as good as the supervision and support that the head office is offering to the ship s crew and their training. The company has therefore taken advantage of the trainings offered by SHIPSAN to send its crew and shore side managers to attend. What the crew will learn will then be familiar and recognised from the public health and food safety management system of the company. The management systems is designed to set clear instructions on what has to be done and how. The training compliments by also giving the crew the understanding of why the standards and practices are set as they are and an understanding of the risks involved. The ship design element has been a particular challenge. Typically the ships were built under a different regulatory environment than today and also for different itineraries. The close cooperation between the public health teams and the company s technical department has been essential in developing the right and most cost-effective solutions. New technology is available on the market that often represents a win-win situation; easier operation and higher standard and reliability. There has been a lot to learn when implementing the water safety plan on board of our ships during recent years. In this task the company chose to get support from external consultants with cruise ship experience, but also with knowledge of land based systems. The development included legionella risk assessments to the entire fleet and awareness training. We think it has been essential to have this support in order to rapidly identify improvement areas and develop proactive solutions. The consultants have enabled us to better understand the risks and consequently prioritise and chose the right solutions. The development of the plans were carried out with heavy involvement from ships officers which has been a tremendous success adding to understanding of water safety, risks and most importantly; creating buy-in from those that essentially are responsible for the day to day operation.
SHIPSAN NEWSLETTER Issue No 9. July 2014 8 People from the project Dr Dominique Wagner Being born in Belgian Congo, my first vaccination booklet has a stamp form 1956 issued by Saniport the department for which I currently work for. I left Africa in 1967 and after a few year in Iran, I graduated from the Medical School of the Université Libre de Bruxelles in 1982, and from the Institute of Tropical Medicine in Antwerp in 1983. I soon left for Sudan, working for Médecins Sans Frontières in South Darfur (Ed Dain) until they expelled MSF after the Islamic coup. But I went back a few months later, to supervise a dispensary for refugees in Omdurman, outside of Khartoum (project financed by the GTZ German cooperation). I left Sudan a year after with my husband, and after giving birth to my first boy (I have two of them), I followed him to Cairo and, a year later, to Istanbul. I returned to Belgium in 2000, to attend a special degree in Environmental Sciences Management at the Université Catholique de Louvain from which I graduated in 2002. After working for the European project ARPAC for 3 years, I joined the Belgian Federal Public Health in 2007, in crisis management first, then for Saniport, implementing IHR in PoE. Recent publications Acute gastroenteritis and video camera surveillance: a cruise ship case report Diskin AL, Caro GM, Dahl E. Int Marit Health. 2014; 65 (1):20-2 Abstract Norovirus Outbreaks on Commercial Cruise Ships: A Systematic Review and New Targets for the Public Health Agenda Fabrizio Bert, Giacomo Scaioli, Maria Rosaria Gualano, Stefano Passi, Maria Lucia Specchia, Chiara Cadeddu, Cristina Viglianchino, Roberta Siliquini Food and Environmental Virology. June 2014, Volume 6, Issue 2, pp 67-74 Abstract Noroviruses are recognised as the leading cause of human acute viral gastroenteritis worldwide. The rate of outbreaks on cruise ships has grown significantly in recent years. Given the potentially harmful consequences of outbreaks for passengers and crewmembers and the subsequently high costs for cruise companies, disease outbreaks on cruise ships represent a serious public health issue. The aim of our study was to systematically review published studies related to Norovirus outbreaks on commercial cruise ships. We searched the PubMed and Scopus scientific databases. We included eligible studies published from January 1990 to July 2013 that were written in English and described infectious episodes involving at least two passengers and/or crewmembers on a commercial cruise ship. As a result, 15 studies and seven reviews met the inclusion criteria, describing a total of 127 outbreaks. The majority of the cases were reported in Europe and the USA, affecting <1 to 74 % of the embarked passengers. In the majority of the studies, stool samples and/or serum specimens from ill passengers were collected and tested for laboratory confirmation. Twelve studies reported that an ad-hoc questionnaire was administered. Fifteen studies investigated the possible source of infection which was contaminated food in the majority of cases. Our findings suggest a strong need for the monitoring and implementation of preventive measures in semi-closed communities, such as cruise ships. It would be advisable to strengthen all relevant initiatives in order to improve the detection of, response to and control of Norovirus outbreaks on cruise ships. A faecal accident was discovered in front of a passenger cabin of a cruise ship. After proper cleaning of the area the passenger was approached, but denied having any gastrointestinal symptoms. However, when confronted with surveillance camera evidence, she admitted having the accident and even bringing the towel stained with diarrhoea back to the pool towels bin. She was isolated until the next port where she was disembarked. Acute gastroenteritis (AGE) caused by Norovirus is very contagious and easily transmitted from person to person on cruise ships. The main purpose of isolation is to avoid public vomiting and faecal accidents. To quickly identify and isolate contagious passengers and crew and ensure their compliance are key elements in outbreak prevention and control, but this is difficult if ill persons deny symptoms. All passenger ships visiting US ports now have surveillance video cameras, which under certain circumstances can assist in finding potential index cases for AGE outbreaks.
SHIPSAN NEWSLETTER Issue No 9. July 2014 9 News and forthcoming dates EU SHIPSAN ACT Joint Action Past Events: Advanced training course for water safety on ships When: 18th-20th June 2014 Where: Athens, Greece The EU SHIPSAN ACT Joint Action organised an advanced training course for water safety on ships from Wednesday 18th until Friday 20th of June 2014 in Athens, Greece. A total of 65 trainees participated in the training course: 38 seafarers from the industry (cruise ship and ferry companies, and consultancy companies); 27 port health officers from 11 EU Member States; The first impression of the participants, both trainers and trainees, was that this was a useful course that was successfully conducted. A short summary of the evaluation report, which is currently being prepared, will be published in the next issue of the Newsletter. All trainees had to complete an anonymous assessment before and after the training course. As it is presented in Figure 1, a significant increase is observed in the percentage of participants that scored >50% in the assessment conducted before and after the course. In particular, for the port health officers, the percentage of participants that scored >50% increased from 11,8% before the course to 78,9% after the course. Similarly, the percentage of the seafarers that scored >50% increased from 11,5% before the course to 54,1% after the course. This is an important indicator of the knowledge improvement during the training course.
SHIPSAN NEWSLETTER Issue No 9. July 2014 10 News and forthcoming dates continued Conference on Perspectives in water safety When: 20th June 2014 A conference titled Perspectives in water safety was organised on Friday 20th June 2014 in Athens, Greece by the EU SHIPSAN ACT Joint Action partnership. Recent technological advances as well as experiences and policies of participating cruise ship companies were presented. Presentation of EU SHIPSAN ACT Joint Action at the International Workshop to strengthen the core capacities at designated points of entry under the International Health Regulations When: 5th July 2014 Where: Where: Athens, Greece China The EU SHIPSAN ACT Joint Action Coordinator, Prof. Christos Hadjichristodoulou, presented the EU SHIPSAN ACT Joint Action at a workshop titled International Workshop to strengthen the core capacities at designated points of entry under the International Health Regulations, which was held on Saturday 5th July, in Ningbo, China. Participants in this conference included representatives from WHO headquarters, the Minister of General administration of Quality Supervision, inspection and quarantine of China, representatives of IHR focal points from WHO regional offices, experts from 12 countries (Australia, Cambodia, France, Greece, Lao People s Democratic Republic, Singapore, Vietnam, Malaysia, Mongolia, Nepal, New Zealand, Russia), in country IHR related partners and the cruise industry. EU SHIPSAN ACT Joint Action Forthcoming Events: Interim Collaborative Group meeting What s new on the website? www.shipsan.eu Restricted Area of the Website: All partners with access to the restricted area of the website can download the following: Training evaluation reports by visiting the Training Courses section under Work Packages & Milestones and by clicking on the respective training course title. Reports from the working group meetings. Bimonthly Management reports. A PowerPoint presentation with the progress update of SHIPSAN ACT. Other letters and communications. Quiz By Dr Dominique Wagner, Médecin Chef Saniport/ Saniport Hoofdgeneesheer, Belgium Question: Which flag is this? https://www.facebook.com/ shipsan.eu https://twitter.com/shipsan_eu @shipsan_eu When: 16th October 2014 Where: Luxembourg The objectives of the Interim Collaborative Group meeting will be to decide on the methodology for developing deliverables, plan and discuss on activities and processes of the Joint Action. General Assembly Meeting When: 17th October 2014 Where: Luxembourg The General Assembly members have the role to decide on recommendations derived from the sustainability working group, the advisory board and the coordination team. The objectives of the General Assembly meeting will be to: Prepare a long-term vision for the Joint Action activities. Discuss the draft consensus document. Discuss and finalise the exit/sustainability strategy. Please send your answers to: info@shipsan.eu Answer to Issue 8 Quiz: Holland America Line, now owned by the Carnival Corporation Congratulations to: 1. Fernando del Hierro Vega, Director, Ministerio de Hacienda y Administraciones, Spain. 2. R K Rowlands, Principal Environmental Health Officer, Isle of Anglesey County Council, Llangefni, Anglesey, UK responsible for port health duties at Holyhead, UK.
SHIPSAN NEWSLETTER Issue No 9. July 2014 11 Port in focus Port of Genoa, Italy Dr. Domenico Avenoso, Ministry of Health, Italy Genua urbs maritima, that is Genoa city of sea reports the title of a fifteenth-century woodcutting that withdraws the city with the port basin. Liguris are not born as fishermen, but as a population which sail into the sea to overcome the mountains in order to bring commodities and goods from a valley to the other one, avoiding climbing mountains. Since its birth, Genoa has been a city of the sea, has improved itself and played an important role in the history and economy of Europe, through its port. Flanked by two cliffs, one on the east side and one on the west side - the old Dock and the Promontory and on the north by the mountains, that shelter it from winds and has protected it from hostile raids, Genoa is in a favourable position and a natural crossroads of trade: it is the door between the Mediterranean and the North, the natural outlet for the lowland Padana and it is on the route that brings you to Marseille. The circular form of the old port coincides with the natural basin and the most ancient information about it s construction comes from the first Middle Ages, and the epoch of the Commune. The institution of the figures of the Consuls of the Sea were entrusted to manage the port activities, maintenance and development of the port s infrastructure. In the 12th century, there was an expansion of Genoese trade routes and the city became the centre of traffic in luxury commodities from the Indian Ocean and from Flanders: this development produced financial and banking activity bringing the Genoese bankers as protagonists in Europe. At the start of the 14th century Genoa started the construction of the Lantern, as we know it today. Since 1128 a tower was built that allowed ships to navigate and since 1161 ships moving to Genoa were asked for pay a compulsory fee for the service of a bright signal from the lighthouse. The port structure did not change substantially in its fundamental aspects until the end of the 16th century: the greatest interventions were in the Dock (which was equipped with a smaller lighthouse), that comes to more resumptions magnified up to 1553, when reaching its 490 meters of length, it s built the Door of the Dock (or Porta Siberia) planned by Galeazzo Alessi. The six perpendicular bridges of the Ripa Maris, that is the shore, take the name from the type of commodity that the port receives or from the families that have resident in the local area. The bridges were originally built entirely of wood, but were reconstructed in stone at the beginning of the 1400 s, at the same time as the progressive expansion of the dock and the excavation of the backdrop in order to allow bigger ships to dock. Today the port of Genoa can be defined as an Urban Port with over 20km of situated benches inside the city, in which container and rinfuse are enlivened.
SHIPSAN NEWSLETTER Issue No 9. July 2014 12 Port in focus continued Today, the Port of Genoa is as one of the principal harbours in Europe in terms of shipped tons, with comparison to the harbours of Dunkerque, London and Zeebrugge. For container traffic the Genoese port is the largest in Italian and is among the largest in the Mediterranean. There has been an increase in passenger traffic (4.6% growth), mainly due to the increase of the Cruise passengers (31.7% increase). In Italy Cruise traffic increased from 10.8 to 11.2 million passengers between 2012 and 2013 with a 3,6% increase in embarkations, debarks and transits. Passengers who choose Genoa as port of embarkation/debark are around the 61,8% of the total transit putting the port at the fourth place in Italy after Venice, Trieste and Savona. At the start of the 14th century Genoa started the construction of the Lantern, as we know it today.