OBJECTIVES

The impact on maritime transport of health threats due to biological,

chemical and radiological agents, including communicable diseases

Carmen Varela, Miguel Dávila, Francisco Nogareda, Rocío Palmera, Jesús Perez, Nick Bitsolas, Elina Kostara, Martin Dirksen-Fischer, Thomas von Münster, Barbara Mouchtouri, for the SHIPSAN ACT partnership

Work Package Leader: Instituto de Salud Carlos III, Spain and Universitätsklinikum Hamburg-Eppendorf

Joint Action financed: EU Public Health Programme 2008-2013 Years: 2013-2016 (45 months) Total cost: 2.571.346€ Subsidy from EC: 1.799.942€ Leader Organisation: University of Thessaly (UTH), Greece

To describe:

A. Evidence for chemical, biological and radiological events on ships or at ports.

B. Characteristics of authorities responsible for responding to radiological and

chemical events.

B. Practices & legal framework related to radiological and chemical events.

C. Hygiene standards & inspection practices related to fishing vessels.

D. Training needs related to core capacities under IHR* 2005 at ports.

E. Practices & responsibilities of port health authorities along inland waterways.

* International Health Regulations. World Health Organization 2005

METHODOLOGY

Part A

• Literature review on infectious diseases on all types of ships.

Part B

• Literature review and survey on chemical and radiological incidents in maritime transport.

Part C

• Survey on hygiene inspection practices on fishing vessels in EU.

Part D

• Survey on training needs related to core capacities at points of entry-ports in EU.

Part E

• Survey on practices & responsibilities of port health authorities along inland waterways in EU.

Communicable diseases outbreaks

0

5000

10000

15000

20000

25000

0

20

40

60

80

100

120

140

Food-Waterborne Respiratory Vaccinepreventable

Emerging Other

No

. of

case

s

No

. of

ou

tbre

aks

Communicable diseases

Outbreaks

Cases

Food and Waterborne diseases outbreaks

0

1000

2000

3000

4000

5000

6000

7000

8000

9000

10000

0

5

10

15

20

25

30

35

40

Norovirus Legionella ET E. Coli Ciguatera Salmonella Shigella

No

. of

case

s

No

. of

ou

tbre

aks

Food and Waterborne diseases

Outbreaks

Cases

Respiratory diseases outbreaks

0

500

1000

1500

2000

2500

3000

3500

0

5

10

15

20

25

Influenza Tuberculosis Other

No

. of

case

s

No

. of

ou

tbre

aks

Respiratory diseases

Outbreaks

Cases

0

50

100

150

200

250

300

0

5

10

15

20

25

30

Varicella Rubella Measles Mumps N. meningitidis Measl+Rube+Varic

No

. of

case

s

No

. of

ou

tbre

aks

Vaccine preventable diseases

Outbreaks

Cases

Vaccine preventable diseases outbreaks

State of the Art report

Results of surveys and literature review for:

A. infectious diseases

B. chemical and radiological events C. fishing vessels

D. core capacities training needs E. inland navigation

RESULTS

Part A. Infectious diseases

Chemical events according to the type of ship. N=94

Cargo ships66%

Fishing vessels

12%

Others4%

No data18%

Russian coastline and

nearby54%

Atlantic Ocean15%

Mediterranean Sea8%

USA coastline8%

No data15%

Radiological events according to the place of occurrence. N=13

0

2

4

6

196

0 -

19

69

197

0 -

19

79

198

0 -

19

89

199

0 -

19

99

200

0 -

20

12

No

. o

f e

ve

nts

Years

Radiological events. N=13

Nuclear ships85%

Cargo ship15%

Radiological events according to the type of ship. N=13

Part B. Radiological and chemical events

Acknowledgments: To the EU Commission for co-financing the Joint Action and to all participants from the EU and International institutions, the EU MS and the shipping industry.

Partners: 32 partners from 24 EUMS, European and international Institutions, shipping Industry. Advisory Board: DG SANTE, CHAFEA, ECDC, WHO, CDC-VSP. Associated partners: Regional Health Inspection-Varna, Bulgaria/Regional Health Inspection-Burgas, Bulgaria/Hamburg Port Health Center, Germany/Robert Koch-Institute, Germany/National School of Public Health, Greece/Directorate of Health, Centre for Health Security and Communication Diseases, Iceland/Health Service Executive, Ireland/Ministry of Health, Italy/Klaipeda Public Health Center, Lithuania/National Institute of Public Health, Slovenia/Instituto De Salud Carlos III, Spain/Public Health England, Centre for Radiation Chemical and Environmental Hazards, United Kingdom/Association of Port Health Authorities, United Kingdom. Collaborating partners: Ministry of Health, Austria/Federal Public Service of Health, Belgium/Ministry of Health and Social Welfare, Croatia/Ministry of Health, Cyprus/Centre of Maritime Health and Society, University of Southern Denmark/Health Board, Estonia/Ministry of Labour, Employment and Health, France/Minister for Health, the Elderly and Community Care, Malta/Municipal Health Services Rotterdam, Netherlands/National Institute for Health and the Environment, Netherlands/Norwegian Directorate of Health, Norway/Ministry of Health, Portugal/Medical University of Gdansk, Poland/Ministry of Health, Romania/Ministry of Health, social services and equality, Spain/Ministry of Transport, Construction and Regional Development of the Slovak Republic

This poster arises from the EU SHIPSAN ACT Joint Action. Sole responsibility lies with the author and the Consumers, Health, Agriculture and Food Executive Agency (CHAFEA) is not responsible for any use that may be made of the information contained therein.

0

5

10

15

20

25

30

35

40

Legislation Planning Detection and Recording

Impactassessment

Response Communication Training

Nu

mb

er o

f au

tho

riti

es

Health authorities Radiological Authorities Other authorities*

Authorities for radiological events on ships or at ports

The impact on maritime transport of health threats due to biological,

chemical and radiological agents, including communicable diseases

Carmen Varela, Miguel Dávila, Francisco Nogareda, Rocío Palmera, Jesús Perez, Nick Bitsolas, Elina Kostara, Martin Dirksen-Fischer, Thomas von Münster, Barbara Mouchtouri, for the SHIPSAN ACT partnership

Work Package Leader: Instituto de Salud Carlos III, Spain and Universitätsklinikum Hamburg-Eppendorf

Joint Action financed: EU Public Health Programme 2008-2013 Years: 2013-2016 (45 months) Total cost: 2.571.346€ Subsidy from EC: 1.799.942€ Leader Organisation: University of Thessaly (UTH), Greece

State of the Art report

Results of surveys and literature review for:

A. infectious diseases

B. chemical and radiological events C. fishing vessels

D. core capacities training needs E. inland navigation

RESULTS

Part B. Management of radiological and chemical events

Part C. Fishing vessels

0

5

10

15

20

25

30

35

40

Legislation Planning Detection and Recording

Risk assessment Response Communication Training

Nu

mb

er

of

auth

ori

ties

Health authorities Chemical Centers Other authorities*

Authorities for chemical events on ships or at ports

02468

101214161820

Respondents Legislation Detectionsystem

Lab capacity Contingencyplan

Specificpersonnel

No

. of

Co

un

trie

s

Events management

Radiological Events Chemical Events

Management of radiological or chemical events on ships or at ports

0

2

4

6

8

10

12

14

16

Legislation Planning Detection and Recording

Impactassessment

Response Communication Training

Nu

mb

er

of

EU c

ou

ntr

ies

Chemical events management

1 Authority 2 - 3 Authorities ≥ 4 Authorities

Number of authorities for management of chemical events on ships or at ports

0

2

4

6

8

10

12

14

16

Legislation Planning Detection and Recording

Impactassessment

Response Communication Training

Nu

mb

er o

f EU

co

un

trie

s

1 Authority 2 - 3 Authorities ≥ 4 Authorities

Number of authorities for management of radiological events on ships or at ports

Part D. Core capacities

Respondent countries = 16

Training needs at all times Training needs for public health emergencies of international concern

Part E. Inland waterways

Response rates: 13 of 27 countries, 21 authorities.

90% (n=19) reported that core capacities are fully or partially

established.

The provision of Maritime Declaration of Health and issuing of

Ship Sanitation Certificates was heterogeneous.

Port to port communication is not well established.

Part A. Infectious diseases

Most frequently published outbreaks on

ships were due to food and waterborne

diseases, mainly norovirus transmitted

from person to person.

Highest lethality was due to Legionella.

Norovirus and Legionnaires’ disease

reported more often on cruise ships

than in other type of ships.

Tuberculosis was not reported on

cruise ships or ferries.

Vaccine preventable diseases mainly

on crew from cruise ships.

Part B. Radiological and chemical events on

ships or at ports.

No published radiological public health events

affecting people on ships or at ports in recent

years.

Chemical events published occurred in cargo and

fishing vessels.

Part B. Authorities for radiological or

chemical events on ships or at ports at the

EU.

Radiological authorities were easier to

identify than chemical.

Competent authorities are usually not

health authorities.

Legislation and contingency plans are not

specific for ships or ports.

There is lack of training.

Part C. Fishing vessels

Most of the countries do not perform

regular inspections.

Almost 60% of the respondents report

any health event to the competent

authority.

Part D. Core capacities

Personnel working at ports mentioned specific

training needs. Mainly training needs on:

Public health risks on microbiological, radiological

and chemical agents.

Proceedings to report to competent authority at

port.

Proceedings to communicate with other

authorities.

Quarantine of suspected travellers.

Part E. Inland waterways

Development of international hygiene and

sanitation guidelines for inland navigation

vessels.

Need for standardized training of

European port health inspectors.

Need for an improved exchange of

information between port health

authorities.

Acknowledgments: To the EU Commission for co-financing the Joint Action and to all participants from the EU and International institutions, the EU MS and the shipping industry.

Partners: 32 partners from 24 EUMS, European and international Institutions, shipping Industry. Advisory Board: DG SANTE, CHAFEA, ECDC, WHO, CDC-VSP. Associated partners: Regional Health Inspection-Varna, Bulgaria/Regional Health Inspection-Burgas, Bulgaria/Hamburg Port Health Center, Germany/Robert Koch-Institute, Germany/National School of Public Health, Greece/Directorate of Health, Centre for Health Security and Communication Diseases, Iceland/Health Service Executive, Ireland/Ministry of Health, Italy/Klaipeda Public Health Center, Lithuania/National Institute of Public Health, Slovenia/Instituto De Salud Carlos III, Spain/Public Health England, Centre for Radiation Chemical and Environmental Hazards, United Kingdom/Association of Port Health Authorities, United Kingdom. Collaborating partners: Ministry of Health, Austria/Federal Public Service of Health, Belgium/Ministry of Health and Social Welfare, Croatia/Ministry of Health, Cyprus/Centre of Maritime Health and Society, University of Southern Denmark/Health Board, Estonia/Ministry of Labour, Employment and Health, France/Minister for Health, the Elderly and Community Care, Malta/Municipal Health Services Rotterdam, Netherlands/National Institute for Health and the Environment, Netherlands/Norwegian Directorate of Health, Norway/Ministry of Health, Portugal/Medical University of Gdansk, Poland/Ministry of Health, Romania/Ministry of Health, social services and equality, Spain/Ministry of Transport, Construction and Regional Development of the Slovak Republic

This poster arises from the EU SHIPSAN ACT Joint Action. Sole responsibility lies with the author and the Consumers, Health, Agriculture and Food Executive Agency (CHAFEA) is not responsible for any use that may be made of the information contained therein.

SUMMARY