Newsletter. - EU SHIPSAN ACT Joint · PDF fileThis Newsletter arises from the EU SHIPSAN ACT Joint ... (strength, weakness, opportunities, ... is described in a National Contingency

Newsletter.

ISSN Number: 2241-5211

Editor:Dr Carmen Varela Martinez, Spain

Editorial Board:Prof Christos Hadjichristodoulou, GreeceDr Barbara Mouchtouri, GreeceMr Gary Cooper, United KingdomDr Gordon Nichols, United KingdomDr Angel Kunchev, BulgariaDr Haraldur Briem, IcelandDr Maurice Mulcahy, IrelandDr Mauro Dionisio, Italy

Section Editors:Prof Raquel Duarte Davidson, United KingdomDr Thomas von Münster, GermanyDr Martin Dirksen-Fisher, GermanyMr Martin Walker, United KingdomDr Nina Pirnat, Slovenia

Content Manager/Secretariat:Mrs Elina Kostara

Publisher:EU SHIPSAN ACT Joint Action Coordinator: University of Thessaly, Larissa Greece

Next Issue: November 2014

To subscribe or unsubscribe please contact us on: [email protected]

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,Although Ebola virus disease was already mentioned in the previous Newsletter editorial, it is inevitable to talk again about it.

According to World Health Organization (WHO), as of 3rd October 2014, the cumulative number of cases is 7470 (probable, confirmed and suspected), including 3431 deaths in Guinea, Liberia and Sierra Leone, plus 20 cases in Nigeria, 1 in Senegal and 1 in the United States. WHO Director-General said that apart from a public health crisis, this is a social, humanitarian and economic crisis. The United Nations (UN) General

Assembly and the Security Council have created the United Nations Mission for Ebola Emergency Response (UNMEER) to bring together the resources of the UN agencies, to reinforce WHO in order to contain the outbreak.

There is more Ebola information as well as other interesting topics in the Newsletter. Enjoy reading!

News from the leadership

EU SHIPSAN ACT Joint Action progress

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

The EU SHIPSAN ACT, being a European funded Joint Action, has the obligation to report the progress made at regular intervals to the Consumers, Health and Food Executive Agency (CHAFEA), which is the body that implements the EU Health Programme. At the end of September 2014, interim technical and financial reports were submitted to CHAFEA. The purpose of the reports was to describe the work carried out and to present the results obtained in the framework of the EU SHIPSAN ACT Joint Action for months 1 to 19.

At the same time, the Interim Evaluation report was also submitted. Evaluation is an ongoing process and is conducted throughout the Joint Action. Indicators are used to evaluate the progress and impact of the Joint Action and internal

and external evaluation is conducted involving interviews, questionnaire and SWOT analysis (strength, weakness, opportunities, threats). Results from the Interim Evaluation report will be presented in a future issue of the newsletter.

In parallel, the associated and collaborating partners updated the National Dissemination Plans prepared at the beginning of the Joint Action where dissemination activities implemented at national level were identified. So far, the EU SHIPSAN ACT Joint Action has been presented to more than 20 national conferences/events in EU MS, to events in Non-EU countries, to European conferences/meetings (EC, ECDC) and to International conferences (WHO, ANVISA).

The preparations for the forthcoming Interim Collaborative Group meeting and

News from the leadership

Thematic sections• Chemical and radiological

issues on ships

Environmental health and hygiene on ships• Ebola Virus Outbreak,

West Africa 2014

Inspection Practices in non-EU countriesVoice of the Industry• Cruise ships inspections in Brazil

People from the project

Recent Publications

What’s new on the website?

News and forthcoming dates

Quiz

Port in focus• Port of Koper, Slovenia

In this issue…

Issue No 10. September 2014

“Evaluation is an ongoing process and is conducted throughout the Joint Action.”

SHIPSAN NEWSLETTER Issue No 10. September 2014 2

News from the leadership continued

General Assembly meeting that will be held on 16-17 October 2014 in Luxemburg are ongoing. These meetings are of high importance since the partnership will have the opportunity to discuss the sustainability issues resulting from the outputs of this European Joint Action.

Announced inspections based on the European manual for hygiene standards and communicable diseases surveillance are conducted on passenger ships

travelling in European ports that participate voluntarily, since May 2014 and will continue until November 2014. A total of 52 inspections have been scheduled for 2014.

The SHIPSAN ACT Information System is currently being updated. Until today, the web-based Communication Network (www.shipsan.eu/comnet/) has been used by competent authorities to follow up 19 public health events on ships.

Moreover, 4990 certificates were issued using the Information System for recording/issuing IHR Ship Sanitation Certificates (http://ssc.shipsan.eu). The contact details of authorised ports of 19 EU countries for issuing Ship Sanitation Certificates under IHR (2005) are available via the European directory www.shipsan.eu/Inspections/AuthorisedportstoissueSSC.aspx.

Directory with updated guidelines for Ebola Virus Disease relevant to the maritime sector in the SHIPSAN ACT website

In response to the outbreak of the Ebola virus disease in west Africa, the international community has joined up and are working together to monitor and to provide assistance, not only economic but also in terms of information

materials, technical guides, practical recommendations and resources to all involved parties.

An International Health Regulations Emergency Committee Regarding the 2014 Ebola Outbreak in West Africa was

convened by WHO on 6th August. A list of members and advisers is available here http://www.who.int/ihr/procedures/emerg_comm_members_20140806/en/

The second meeting of the Emergency Committee convened by the WHO Director-General under the IHR 2005 regarding the 2014 Ebola virus disease (EVD, or “Ebola”) outbreak in west Africa was conducted from 16 to 21 September 2014). The WHO statement is available at http://www.who.int/mediacentre/news/statements/2014/ebola-2nd-ihr-meeting/en/

In relation to shipping, an international ad hoc Ebola Travel and Transport Task Force has been set up where the following organisations participate (www.imo.org/MediaCentre/PressBriefings/Pages/27-ebolataskforce.aspx#.VBFLnBZ7QwT):

• World Health Organization (WHO)• International Maritime

Organisation (IMO) • International Chamber of

Shipping (ICS) • Cruise Lines International

Association (CLIA) • International Civil Aviation

Organization (ICAO) • World Tourism Organization (UNWTO)• Airports Council International (ACI)• International Air Transport

Association (IATA) • World Travel and Tourism

Council (WTTC)

The Ebola virus disease outbreak which was declared by WHO on the 8th August a Public Health Emergency of International Concern (PHEIC), has affected to date five countries in West Africa (Guinea, Liberia, Nigeria, Senegal and Sierra Leone).

“In relation to shipping, an international ad hoc Ebola Travel and Transport Task Force has been set up…”


Thematic Sections

Chemical and radiological issues on shipsProviding public health advice in a maritime setting (UK Approach)Eirian Thomas, Public Health England, UK

Arrangements for dealing with maritime pollution incidents may differ between European Member States (MS). An outline of the arrangements in UK, France, Spain and Portugal was described by the EU ARCOPOL project in 20123. An illustrative example of the relationship between the maritime sector and public health is detailed below.

In the UK, the Maritime and Coastguard Agency (MCA) is the responsible authority that responds to maritime emergencies 24 hours a day4. The general coordination of the UK’s response to marine pollution is described in a National Contingency Plan (NCP). This Plan co-exists with other UK emergency response plans or contingency arrangements. It sets

out command and control procedures for incident response and has a built-in threshold to allow for flexibility of response to different categories of incidents. The legal basis for the plan is set out in legislation5, and includes for example the EU Directive 2002/59/EC7 (as amended), which requires Member States to draw up plans to accommodate ships in distress

International collaboration and cooperation is paramount to protecting public health. In 1967, the tanker Torrey Canyon was wrecked on the Seven Stones off the Isles of Scilly (south-west of England). It was carrying 117,000 tonnes of crude oil. As the pollution spread the need for international cooperation became clear. In response an alliance was formed which operates under the terms of the Bonn Agreement1. The agreement outlines how countries in the Greater North Sea work together to protect the marine environment to prevent or mitigate the effects of pollution which may pose a risk to public health. There are similar complementary arrangements in other regions of Europe, for example the Baltic and Mediterranean Seas2.

News from the leadership continued

The following guidelines from WHO, the European Centre for Disease Prevention and Control (ECDC) and IMO are relevant to the maritime sector: • WHO, Travel and transport risk assessment: Interim guidance for

public health authorities and the transport sector. September 2014 http://apps.who.int/iris/bitstream/10665/132168/1/WHO_EVD_

Guidance_TravelTransportRisk_14.1_eng.pdf?ua=1&ua=1• WHO Statement on travel and transport in relation to Ebola virus

disease (EVD) outbreak: http://www.who.int/mediacentre/news/statements/2014/

ebola-travel-trasport/en/• WHO, Ebola event management at points of entry. Interim

guidance: http://www.who.int/csr/disease/ebola/event-management-poe/en/• WHO, Ebola response roadmap: http://www.who.int/csr/resources/publications/ebola/

response-roadmap/en• WHO, Infection prevention and control (IPC) guidance summary.

Ebola guidance package: http://www.who.int/csr/disease/ebola/evd-guidance-summary/en/ • WHO, Ebola surveillance in countries with no reported cases of

Ebola virus disease: http://www.who.int/csr/disease/ebola/WHO0905_early_actions_

surveillance.pdf• ECDC, RAPID RISK ASSESSMENT, Outbreak of Ebola virus

disease in West Africa Fourth Update: 3rd September 2014. http://www.ecdc.europa.eu/en/publications/Publications/Ebola-

virus-disease-west-africa-risk-assessment-27-08-2014.pdf

• ECDC, Ebola virus disease: Information to travellers http://www.ecdc.europa.eu/en/healthtopics/ebola_marburg_

fevers/information-travellers/Pages/information-travellers.aspx • IMO, IMO joins international Ebola travel and transport task force http://www.imo.org/MediaCentre/PressBriefings/Pages/27-

ebolataskforce.aspx#.VAhugRZ7QwT • IMO, Ebola Virus Disease, Circular Letter No.3484,

2 September 2014 http://www.imo.org/MediaCentre/HotTopics/ebola/

Documents/3484%20.pdf• IMO, Full and effective implementation of maritime security

measures to assist in preventing the spread of the Ebola virus disease Circular Letter No.3485 10 September 2014

http://www.imo.org/MediaCentre/HotTopics/ebola/Documents/3485.pdf

The International Labour Organization (ILO) has also issued advice, based on existing guidance from WHO and ILO, on occupational safety and health for workers and employers http://www.ilo.org/safework/info/publications/WCMS_301830/lang--en/index.htm

ECDC has further released a case definition for Ebola virus disease accompanied by algorithms for laboratory assessment and initial assessment and management of patients as well as a Directory of guidance on EVD patient management http://www.ecdc.europa.eu/en/press/news/_layouts/forms/News_DispForm.aspx?List=8db7286c-fe2d-476c-9133- 18ff4cb1b568&ID=1062


Thematic Sections continued

in their ports or any other protected place affording the best possible conditions, in order to limit the consequences of accidents at sea. Whilst the Secretary of State’s Representative (SOSREP) for Maritime Salvage and Intervention has been designated as the UK competent authority to take independent decisions concerning the accommodation of ships in need of assistance, the MCA is the competent authority for drawing up plans and conducting risk assessments and analysis for the accommodation of ships at places of refuge which it provides to support the SOSREP in this decision making process.

There is scope within the NCP to set up an Environment Group (EG) at the very early stages of an incident, when a real threat to the marine and coastal environment is considered likely. The purpose of the Environment Group is to:• Provide public health and

environmental advice and guidance to all response units involved in response to an oil and or chemical marine pollution incident and subsequent clean-up operations.

• Advise response units so as to minimise the impact of the incident on the environment in the widest sense, taking account of risks to public health and the natural environmental, and potential impacts arising from any response operations, whether salvage or clean-up operations, at sea and on the shoreline.

• Monitor, assess and document the public health and environmental (including wildlife) impact of a maritime pollution incident with respect to oil and/or chemicals and the impact of all measures implemented in response to the incident.

• Facilitate welfare, rehabilitation or humane disposal of wildlife casualties by recognised animal welfare organisations.

Public health agencies in the UK6, such as Public Health England and others including the environmental regulator, the statutory nature conservation body, the fisheries department and MCA are core members of the Standing Environment Group and may be called

upon to provide advice when an EG is established. Extended membership may include Local Authorities, Food Standards Agency and others.

Clinical advice on the treatment of patients is provided to healthcare professionals by the National Poisons Information Service (NPIS) by assisting them in the diagnosis and care of patients, ensuring optimal treatment in cases of serious poisoning. Where toxicity is low, the NPIS offers advice to minimise unnecessary hospital admissions.

Within the UK, these arrangements will alert public health agencies to marine incidents of public health significance in order that they may be considered in the context of EU Decision 1082/2013/EU7. The decision sets provisions on notification, ad hoc monitoring and coordination of public health measures following serious cross border threats to health from biological, chemical and environmental events as well as events that have an unknown origin, as reported previously in the SHIPSAN newsletter Issue 8.

References

1. http://www.bonnagreement.org/2. http://www.rempec.org/ and http://www.helcom.fi/3. http://www.arcopol.eu/documentacion.aspx/ http://www.arcopol.eu/arcopol/archivos/documentacion/94/ContingencyPlanningReview_

ARCOPOL_final.pdf 4. https://www.gov.uk/government/organisations/maritime-and-coastguard-agency5. https://www.gov.uk/government/uploads/system/uploads/attachment_data/

file/338850/140716_NCP_LegalBasis.pdf / http://www.legislation.gov.uk/ukpga/1995/21/section/293

6. https://www.gov.uk/government/organisations/public-health-england/ http://www.hps.scot.nhs.uk/ http://www.publichealthwales.wales.nhs.uk/ http://www.publichealth.hscni.net/

7. Orford R; Crabbe H; Hague C; Schaper A; Duarte – Davidson R; Environment International: EU alerting and reporting systems for potential chemical public health threats and hazards. Volume 72, November 2014, Pages 15-25 http://www.sciencedirect.com/science/article/pii/S0160412014001494

“There is scope within the NCP to set up an Environment Group at the very early stages of an incident, when a real threat to the marine and coastal environment is considered likely.”


Environmental health and hygiene on ships Ebola Virus Outbreak, West Africa 2014Martin Walker, Port Health Officer, Suffolk Coastal Port Health Authority, Felixstowe, England

On the 8th August 2014, the International Health Regulations Emergency Committee of the World Health Organisation (WHO) declared that the 2014 Ebola virus outbreak in West Africa met the conditions for a Public Health Emergency of International Concern (PHEIC)1. As a result, shipping companies, Port Health Officers and other staff at points of entry around the world were facing a situation that has only occurred twice before (Swine Influenza, 2009 and Wild Poliovirus 2014). The Ebola virus outbreak seems to have captured more media attention however.

The Virus

The incubation period of Ebola Virus Disease (EVD) ranges from 2-21 days. People are not infectious during the incubation but become so once the symptoms appear. Typical symptoms are fever, weakness, muscle pain, headache, sore throat, vomiting, diarrhoea, rashes and bleeding. Transmission of the disease

can be by contact with blood or other bodily fluids (either of Ebola infected living persons or dead bodies), contact with wild animals (dead or alive or the raw/undercooked meat), sexual intercourse with a sick person or with a man previously infected with ebola within a period of at least 7 weeks after recovery) and contact with contaminated objects (e.g. used needles) and surfaces. During outbreaks

of Ebola, the disease can spread quickly within healthcare settings, such as clinics or hospitals. Exposure to Ebola can occur in healthcare settings where hospital staff are not wearing appropriate protective clothing including masks, gowns, gloves, and eye protection2.

WHO does not recommend travel restrictions to affected areas (currently Guinea, Liberia, Nigeria, Senegal and Sierra Leone).

“During outbreaks of Ebola the disease can spread quickly within healthcare settings.”

Key message:

Tools and guidance available to Port Health Officers and Shipping Companies in relation to the current Ebola Virus outbreak. Virus transmission is low risk if personal protection and good hygiene practices by trained personnel are followed.


Environmental health and hygiene on ships continued

Guidance for Points of Entry

As the member states of the SHIPSAN ACT joint action are states with no Ebola transmission currently, advice from WHO3 to Flag States are as follows:1 Staff should be “sensitised” to be

aware of the early and advanced symptoms of EVD

2 Establish protocols to notify your relevant public health authorities

3 Ensure basic training of staff to be aware of the principles of infection prevention and control

4 Emphasise to personnel working in the travel sector the importance of infection control and prevention measures

5 Regulatory authorities at points of entry (Port Authorities, Port Health, Customs etc.) should be kept informed and involved in decision making.

Guidance for ships and shipping companies

The same WHO document provides practical advice about the need for shipping companies to immediately notify the Port Health Authority if a person on board is suspected of having contracted EVD. This should be by the quickest possible means but also through the use of the Maritime Declaration of Health (IHR Annex 8)4. (It is worth re-iterating that this is a requirement for shipping companies

in the case of any illness onboard, irrespective of whether it is suspected EVD or not.)

Section 4.2.4 of the document3 gives specific advice to shipping companies about isolation procedures for affected persons, personal protective equipment to be worn by anyone who needs to enter the affected persons cabin or isolation room, disinfection and handwashing procedures, cleaning and disinfection procedures for contaminated surfaces and spills, handling of waste, contact tracing and monitoring of other staff for symptoms.

Avoiding overeaction

If sensible hygienic procedures and personal protection is used by trained personnel to avoid contact with sources are followed, the risk of onward transmission of EVD is low. Port Health Authorities need to ensure that over-reactions do not take place. The International Health Regulations 2005 (IHR) cannot be used as a reason for denying a ship free-pratique. There is also a requirement to ensure that any

delays of more than 24 hours have to be justified to the WHO as there should not be undue interference with travel and trade (Article 43 of the IHR 2005). By following these guidelines, flag states and Port Health Authorities should be able to achieve effective public health control and avoid undue interference with travel and trade.

Further sources of information

EU SHIPSAN ACT will continue to inform Port Health Authorities and shipping companies with the latest guidance. Readers are also encouraged to join PAGNet at https://extranet.who.int/pagnet/ to subscribe to up to date news from the WHO and also discuss relevant issues with Port Health and other public health professionals around the world.

Other WHO documents of relevance include:• WHO Travel and transport risk

assessment: Recommendations for public health authorities and transport sector: http://www.who.int/ith/updates/20140421/en/

• WHO, Ebola event management at points of entry. Interim guidance:

http://www.who.int/csr/disease/ebola/event-management-poe/en/

• WHO, Ebola response roadmap: http://www.who.int/csr/

resources/publications/ebola/response-roadmap/en

• WHO, Infection prevention and control (IPC) guidance summary. Ebola guidance package:

http://www.who.int/csr/disease/ebola/evd-guidance-summary/en/

References:

1 http://www.who.int/mediacentre/news/

statements/2014/ebola-20140808/en/

2 http://www.cdc.gov/vhf/ebola/

transmission/index.html

3 http://apps.who.int/iris/

bitstream/10665/132168/1/WHO_EVD_

Guidance_TravelTransportRisk_14.1_eng.

pdf?ua=1&ua=1%20

4 International Health Regulations 2005,

World Health Organization (Annex 8)

“Delays of more than 24 hours have to be justified to the WHO as there should not be undue interference with travel and trade.”


In this context, Anvisa adopted in 2009 a risk assessment system to improve their decision making and health risk prioritisation aboard of cruise ships. Anvisa used international standards approach (ISO 27001 and ISO 31000), providing a proven method for managing health risks based on 4 cyclic steps: Inventory (plan), Analysis (do), Evaluation (check) and Treatment (act). ANVISA inspectors use the same inspection checklist where each item presents a health risk score (probability, severity and relevance). Thus, after the survey the inspector fills out the electronic form which provides a Health Risk Index (PSR) and a Compliance Index for each vessel:• Compliance index: % of the

inspection checklist items that were complied by the vessel.

• Risk Score (PSR): sum of scores of each item of the inspection. Range from 0 (highest security) to 5000 (lowest security)

The results of inspections are posted in a hotsite (http://www.anvisa.gov.br/hotsite/cruzeiros/inspecionsresults.html) as soon as possible after the survey and the vessels are classified into four (A to D) possible standards as follows: • Standard A: PSR up to 250.

Excellent health conditions. • Standard B: PSR between 251 and

500. Good condition. • Standard C: PSR between 501 and

750. Average conditions. Several non-critical violations to comply with.

• Standard D: PSR above 750. Ship failed Anvisa’s inspection. Poor sanitation conditions with critical violations. Immediately corrective actions are necessary.

As part of their Program, annually Anvisa organises a meeting with industry representatives, specialists, tourists and international health authorities to present and discuss about public health subjects related to cruise ships. The 2014 Annual Meeting, which was held in Belem (Para State) from 26 to 29th of August, had a videoconference with participation of Prof. Christos Hadjichristodoulou, SHIPSAN ACT Joint Action Coordinator and Dr. Barbara Mouchtouri (SHIPSAN ACT Joint Action Manager) who presented

the protocols, strategies and training tools of SHIPSAN ACT and emphasised the importance of international coop-eration to strengthen the global health surveillance network. This shows how much the countries have been intensify-ing their partnership and networking to harmonise requirements and protocols.

More information:

http://www.anvisa.gov.br/hotsite/ cruzeiros/industriaingles.html

Inspection Practices in non-EU countries

Cruise ships inspections in Brazil Fabio Miranda da Rocha, Specialist in Regulation and Health Surveillance, Agência Nacional de Vigilância Sanitária – ANVISA, Brazil

All cruise ships circulating in Brazil are inspected by ANVISA – Brazilian Health Surveillance Agency. Unannounced inspections are conducted by one to four inspectors, depending on the size and complexity of the vessel. This team evaluates all areas and systems of the vessel that may pose public health risks (food and potable water safety, recreational water facilities, housekeeping, waste management, pest monitoring and control, air conditioning, among others).

“Annually Anvisa organises a meeting with industry representatives, specialists, tourists and international health authorities to present and discuss about public health subjects related to cruise ships. ”


People from the projectAllan Johnson

The pilot inspections have been very useful for the project, of course, in estab-lishing consistency of inspection against the manual but also in identifying prob-lems with some items in the manual that will enable amendments to be made.

In my experience the response to the Pilot inspections from both the cruise

I am Allan Johnson from the UK and one of the trainers for the pilot inspection programme and have taken part in several of the training courses for seafarers and Port Health Officers.

industry and regulators is mostly positive and it has been very interesting listening to different perceptions and ideas of how the project should progress.

I firmly believe that the SHIPSAN pro-ject has made a real difference to the way that the industry and inspectors work together to achieve continuous improve-

ment to systems, standards and condi-tions aboard by a greater appreciation of each other’s roles and I am looking forward to being able to contribute to making further improvements to both the manual and inspection process. We have all come a long way but there is more to be done.

Influenza B Outbreak on a Cruise Ship off the São Paulo Coast, Brazil

Fernandes EG, de Souza PB, de Oliveira ME, Lima GD, Pellini AC, Ribeiro MC, Sato HK, Ribeiro AF, Yu AL. J Travel Med. 2014 Sep; 21(5):298-303.

Abstract

BACKGROUND: In February 2012, crew and passengers of a cruise ship sailing off the coast of São Paulo, Brazil, were hospitalised for acute respiratory illness (ARI). A field investigation was performed to identify the disease involved and factors associated.

METHODS: Information on passengers and crew with ARI was obtained from the medical records of hospitalised individuals. Active case finding was performed onboard the ship. ARI was defined as the presence of one nonspecific symptom (fever, chills, myalgia, arthralgia, headache, or malaise) and one respiratory symptom (cough, nasal congestion, sore throat, or dyspnea). A case-control study was conducted among the crew. The cases were crew members with symptoms of influenza-like illness (ILI) (fever and one of the following symptoms: cough, sore throat, and dyspnea) in February 2012. The controls were asymptomatic crew members.

RESULTS: The study identified 104 ARI cases: 54 (51.9%) crew members and 50 (49.1%) passengers. Among 11 ARI hospitalised cases, 6 had influenza B virus isolated in nasopharyngeal swab. One mortality among these patients was caused by postinfluenza Staphylococcus aureus pneumonia. The crew members housed in the two lower decks and those belonging to the 18- to 32-year-old age group were more likely to develop ILI [odds ratio (OR) = 2.39, 95% confidence interval (CI) 1.09-5.25 and OR = 3.72, CI 1.25-11.16, respectively].

CONCLUSIONS: In February 2012, an influenza B outbreak occurred onboard a cruise ship. Among crew members, ILI was associated with lower cabin location and younger age group. This was the first influenza outbreak detected by Brazilian public health authorities in a vessel cruising in South American waters.

Recent publications


Recent publications continuedMolecular characterization of influenza B virus outbreak on a cruise ship in Brazil 2012

Borborema SE, Silva DB, Silva KC, Pinho MA, Curti SP, Paiva TM, Santos CL. Rev Inst Med Trop Sao Paulo. 2014 May-Jun;56(3):185-9.

Abstract

In February 2012, an outbreak of respiratory illness occurred on the cruise ship MSC Armonia in Brazil. A 31-year-old female crew member was hospitalised with respiratory failure and subsequently died. To study the etiology of the respiratory illness, tissue taken at necropsy from the deceased woman and respiratory specimens from thirteen passengers and crew members with respiratory symptoms were analysed. Influenza real-time RT-PCR assays were performed, and the full-length hemagglutinin (HA) gene of influenza-positive samples was sequenced. Influenza B virus was detected in samples from seven of the individuals, suggesting that it was the

cause of this respiratory illness outbreak. The sequence analysis of the HA gene indicated that the virus was closely related to the B/Brisbane/60/2008-like virus, Victoria lineage, a virus contained in the 2011-12 influenza vaccine for the Southern Hemisphere. Since the recommended composition of the influenza vaccine for use during the 2013 season changed, an intensive surveillance of viruses circulating worldwide is crucial. Molecular analysis is an important tool to characterise the pathogen responsible for an outbreak such as this. In addition, laboratory disease surveillance contributes to the control measures for vaccine-preventable influenza.

Measles Outbreak on a cruise ship in the western Mediterranean, Februrary 2014, Preliminary Report

S Lanini, M R Capobianchi, V Puro, A Filia, M Del Manso, T Kärki, L Nicoletti, F Magurano, T Derrough, E Severi, S Bonfigli, F N Lauria, G Ippolito, L Vellucci, M G Pompa, the Central task force for the measles outbreakEurosurveillance, Volume 19, Issue 10, 13 March 2014

Rapid communications Date of submission: 12 March 2014

A measles outbreak occurred in February 2014 on a ship cruising the western Mediterranean Sea. Overall 27 cases were reported: 21 crew members, four passengers. For two cases the status crew or passenger was unknown. Genotype B3 was identified. Because of different nationalities of cases and persons on board, the event qualified as a cross-border health threat. The Italian Ministry of Health coordinated rapid response. Alerts were posted through the Early Warning and Response System.

www.eurosurveillance.org/ViewArticle.aspx?ArticleId=20735

Comment Letters:

MEASLES ON A CRUISE SHIP: LINKS WITH THE OUTBREAK IN THE PHILIPPINES

S Mandal, M Ramsay, K Brown

Eurosurveillance, Volume 19, Issue 15, 17 April 2014

Letter to the editor: measles on the cruise ship: links with virus spreading into an emergency department in Southern Italy.

Cozza V1, Chironna M, Leo C, Prato R. Euro Surveill. 2014 May 15;19(19). pii: 20800. http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=20774

Authors reply: Euro Surveill. 2014 May 15;19(19). pii: 20803.Lanini S1, Capobianchi MR, Pompa MG, Vellucci L.

www.eurosurveillance.org/ViewArticle.aspx?ArticleId=20773

What’s new on the website?

www.shipsan.eu

In the following link you will find links to currently available guidance for Ebola virus disease and shippinghttp://www.shipsan.eu/Home/ Bibliography.aspx

https://twitter.com/shipsan_eu@shipsan_eu

https://www.facebook.com/shipsan.eu


News and forthcoming dates

SHIPSAN past events:

SHIPSAN forthcoming events:

A meeting was held in Luxembourg where representatives from DG SANCO, the Consumers, Health and Food Executive Agency (CHAFEA), the EU SHIPSAN ACT Joint Action and the Advanced National Networks for Administrations (AnNa) project participated. The objective of the meeting was to discuss the implementation of Maritime Declaration of Health in the National Single Window and the contribution of EU SHIPSAN ACT Joint Action.

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.

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

Members of the EU SHIPSAN ACT Joint Action Coordination Team met on the 22nd of September 2014 in Rome, Italy in order to prepare for the Interim Col-laborative Group meeting and General Assembly meeting which will be held in Luxembourg in October 2014.

Meeting with DG SANCO, DG MOVE, CHAFEA, SHIPSAN ACT Joint Action and the ANNA project

Interim Collaborative Group Meeting

General Assembly Meeting

Preparatory meeting for General Assembly

When: 19th September 2014

When: 16th October 2014

When: 17th October 2014

When: 22nd September 2014

Where: Luxembourg

Where: Luxembourg

Where: Luxembourg

Where: Rome, Italy


References:

WHO. 2008. International Health Regulations (IHR) http://www.who.int/ihr/publications/9789241596664/en/ WHO. 2009. Assessment tool provided to support State Parties during core capacity assessment at designated airports, ports and ground crossings http://www.who.int/ihr/publications/PoE/en/ WHO. 2013. Presentation titled “International Health Regulations – Global Overview and WHO Guidance” from Daniel Lins Menucci, WHO Technical Officer, Team Leader Ports, Airports and Ground Crossings HSE/GCR/SID/PAG – Lyon Office at the Fifth Collaborative Arrangement for the Prevention and Management of Public Health Events in Civil Aviation (CAPSCA) Americas Meeting. http://sp2010.icao.int/EURNAT/Other%20Meetings%20Seminars%20and%20Workshops/CAPSCA%20EUR/CAPSCA%20EUR%203/1-1-WHO_IHR_Menucci_CAPSCA%20_Bern_2013.pdf

News and forthcoming dates continued

Other past events:

Member States must comply with the legal requirements of International Health Regulation (IHR) and in particular the requirements for designated Points of Entry (PoE). Countries should ensure that the designated PoE have the core capacities detailed in Annex 1.B in place and these can be maintained. Further to the designation of the PoE, State Parties can also request from WHO certification of the points of entry. In accordance with Article 20 of the IHR, “WHO may, at the request of the State Party concerned, arrange to certify, after an appropriate investigation, that an airport or port in its territory meets the requirements referred to in paragraphs 1 and 3 of this Article. These certifications may be subject to periodic review by WHO, in consultation with the State Party. WHO, in collaboration with competent intergovernmental organisations and international bodies, shall develop and publish the certification guidelines for airports and ports under this Article. WHO shall also publish a list of certified airports and ports.”

WHO in order to facilitate the certifi-cation procedure has drafted a guidance document titled “WHO airport and port certification – Administrative Procedures and Technical Checklist”.

Prof. Christos Hadjichristodoulou, Joint Action coordinator, participated in the WHO Mission for the certification of the Ningbo Chuanshan Port and Meishan Port in China which was conducted from 1st till the 4th of July 2014.

If a State Party wishes to receive WHO certification for a designated airport or

port has to submit an official request for certification after a pre-consultation with WHO. The Self-Assessment conducted by using the “Assessment tool provided to support State Parties during core capacity assessment at designated airports,

ports and ground crossings” is also submitted with the official request. Upon receiving such a request, an assessment team assembles and reviews all documentation and an onsite verification visit is conducted where a verification report including recommendations is drafted and submitted to the WHO. After the evaluation of the verification report is conducted, the WHO announces the certification recommendation.

The guidelines for WHO airports and ports certification were implemented for the first time in July 2014 during the verification visit at the Ports of Ningbo Chuanshan and Meishan in China.

WHO certification of Ningbo Chuanshan Port and Meishan Port in China

“Countries should ensure that the designated PoE have the core capacities detailed in Annex 1.B in place and these can be maintained.”


News and forthcoming dates continued

2014 European Scientific Conference on Applied Infectious Disease Epidemiology (ESCAIDE)

CHAFEA and DG SANCO Conferences

The European Chemical Emergency Network (ECHEMNET) Interim Collaborative Group meeting

Dr Gordon Nichols from the Public Health England, UK will attend and represent SHIPSAN ACT Joint Action in the conference. During the conference, a stand will be set up where the SHIPSAN ACT Information System will be presented.

A poster was prepared and sent to the Consumers, Health and Food Executive Agency and Consumers Directorate General of the European Commission. CHAFEA and DG SANCO will be showcasing a number of co-financed projects at the Gastein Conference (1-3 October 2014) in Austria and at the European Public Health (EPH) conference in Glasgow (to be held in November 2014).

The EU SHIPSAN ACT Joint Action will participate in the ECHEMNET Interim Collaborative Group meeting which will be held in Sweden.

When: 5-7 November 2014

When: 11-12 November 2014

Where: Stockholm, Sweden

Where: Umeå, Sweden

Other forthcoming events:

QuizBy Allan Johnson, Senior Environmental Health Officer, Harlow Council, England

Question: Which UK port was temporarily known as HMS Badger and why? Please send your answers to: [email protected]

Answer to Issue 9 Quiz:

The “Cie Maritime Belge” started after WWII, offering regular services between Antwerp and the Belgium Congo, and later to North and South America as well.

In 1951, the fleet had 5 cruise ships and 24 cargos.

The ships could transport 248 passengers and 140 crew members. Ports of call were Antwerp, Tenerife, Lobito, to reach Matadi in 2 weeks.

In 1973, the CMB sold its last ship, the Charlesville, to be a hotel in the port of Rostock under the name of Georg Büchner. It sank in the night of May 2013 in the polish waters as it was transferred to Lithuania.

Prof. Raquel Duarte Davidson and Dr Eirian Thomas from the Centre for Radiation, Chemical and Environmental Hazards of the Public Health England and leaders of SHIPSAN ACT work package 6 titled “Dealing with chemical and radiological incidents on ships” represented SHIPSAN ACT JA at the APHA Annual Conference. The progress of the EU SHIPSAN ACT Joint Action was presented by Prof. Raquel Duarte Davidson whereas Dr Eirian Thomas delivered a presentation on the Radiological Events at Ports.

The last meeting of MediPIET 1 and Kick Off Meeting of MediPIET Implementation phase was organised in Hammamed, Tunisia. Dr Peter Otorepec and Dr Boris Kopilovic from the National Institute of Public Health in Slovenia and leaders of EU SHIPSAN ACT Joint Action work package on training attended the meeting with the aim to estab-lish collaboration with the MEDIPIET consortium.

Association of Port Health Authorities (APHA) Annual Conference 2014

Mediterranean Programme for Intervention Epidemiology Training (MediPIET) Kick OFF Meeting

When: 9-11 September 2014

When: 16-18 September 2014

Where: London, UK

Where: Hammamed (Tunisia)


Port in focus

Port of Koper, Slovenia Dr. Boris Kopilovic, National Institute of Public Health, Slovenia

The Port of Koper lies at the northern edge of the Adriatic Sea and it is the only Slovenian international cargo port. The port was established in 1957, only few years after territorial issues between Italy and the former Yugoslavia were finally and definitively solved. The port lies in the very proximity of the city of Koper and has spread its activity over the years starting from only one operational shore and now covers an area of approximately 300 hectares.

The Port of Koper is a multi-purpose port where practically any kind of cargo is being handled and stored – from general cargo, perishable goods and livestock to containers, cars, dry and liquid bulks.

The Port of Koper has 12 specialised terminals:• Container and Ro-Ro Terminal• Car Terminal• General cargo Terminal• Fruit Terminal• Timber Terminal• Terminal for minerals• Terminal for cereals and fodder• Alumina Terminal• European Energy Terminal• Liquid Cargoes Terminal• Livestock Terminal• Passenger Terminal

Port of Koper (Slovene: Luka Koper, Italian: Porto di Capodistria) is a public limited company, which provides port and logistics services in the only Slovenian port, in Koper. It is situated in the northern part of the Adriatic Sea, connecting mainly markets of Central and Southeast Europe with the Mediterranean Sea. Differently from other European ports, which are managed by port authorities, the activities of Port of Koper comprise the management of the free zone area, the management of the port area and the role of terminal operator.

The management of the area of the Port of Koper has been given through a 35-year long concession agreement by the Slovenian Ministry of Transport in year

2008 to Luka Koper, which is operating all the terminals in the port.

The Koper port community is quite a vivid one, compounded beside Luka Koper

by a great number of private entrepreneurs such as forwarders, shipping agents, control houses, ship suppliers etc, as well as state bodies (Maritime Administration of the Republic of Slovenia, Custom Administration of the Republic of Slovenia, Police, inspection offices).

The core business covers cargo handling and warehousing services for all types of goods, complemented by a range of additional services for cargo with the aim of providing a comprehensive logistics support for customers.

“The Port of Koper is a multi-purpose port where practically any kind of cargo is being handled and stored.”


The company manages the commercial zone and provides for the development and maintenance of port infrastructure.

It is estimated that about 5000 people are directly or indirectly employed by the port business, which means that the port sector is one of the most important economic activities in the Coastal-Kart region.

The Port of Koper is a transit oriented port. About 30% of the handled cargo is covering Slovenian orders, where all the rests are transits for Austria, Italy, and Hungary, Czech Republic, Slovakia and other Central and Eastern European countries.

The port traffic amounted to 17.9 million tonnes of cargo in year 2012, where about 2/3 of cargo are represented by imports, 1/3 by exports.

Luka Koper is a socially and environmentally responsible company, where monitoring and managing environ-mental impacts has become part of regular activities. In year 2000 the Port of Koper was the first Mediterranean port to establish an environment management system according to the ISO 14001 standard applying to all port activities. The certificate was upgraded in year 2010 with the company’s certification in accordance to the EMAS scheme.

Source:

http://www.greenberth.eu/portfolio/the-port-of-koper/http://en.wikipedia.org/wiki/Port_of_Koper

Port in focus continued

“The port traffic amounted to 17.9 million tonnes of cargo in year 2012, where about 2/3 of cargo are represented by imports, 1/3 by exports.”