The decision making process on public health measures related to passenger ships: the example of influenza pandemic 2009

Background. Public health measures at sea ports have posed a challenge for public health competent authorities, especially in the context of the influenza pandemic of 2009. This paper discusses the response of authorities to notifications of infectious diseases on passenger ships and the importance of assessing the risks related to cases of influenza. It further provides options for health measures and considerations for decision making during a pandemic such as the influenza pandemic of 2009. Discussion. Prevention and control of influenza have included action taken by both competent port authorities and ships’ crews. Assessing the public health risk of each event reported from ships to competent authorities at ports is important before advice is given on implementation of control measures. Public health risk assessment involves appraisal of threats to passengers and crew on board the ship as well as to the population in the community. Summary. Any public health measures taken should be necessary and proportional to the threat. Measures at ports cannot alone be effective in the prevention of the spread of a disease to the community since other means of transport play a major role. Measures taken on board ships can be effective in containing the disease. Consistent policy based on common protocols and carried out by competent authorities at local, national, European, or international levels are essential. (Int Marit Health 2010; 61; 4: 241-245

European web-based platform for recording international health regulations ship sanitation certificates: results and perspectives

The purpose of this study was to report the data analysis results from the International Health Regulations (2005) Ship Sanitation Certificates (SSCs), recorded in the European Information System (EIS). International sea trade and population movements by ships can contribute to the global spread of diseases. SSCs are issued to ensure the implementation of control measures if a public health risk exists on board. EIS designed according to the World Health Organization (WHO) Handbook for Inspection of Ships and Issuance of SSC. Inspection data were recorded and SSCs issued by inspectors working at European ports were analysed. From July 2011-February 2017, 107 inspectors working at 54 ports in 11 countries inspected 5579 ships. Of these, there were 29 types under 85 flags (including 19 EU Member States flags). As per IHR (2005) 10,281 Ship Sanitation Control Exception Certificates (SSCECs) and 296 Ship Sanitation Control Certificates (SSCCs) were issued, 74 extensions to existing SSCs were given, 7565 inspection findings were recorded, and 47 inspections were recorded without issuing an SSC. The most frequent inspection findings were the lack of potable water quality monitoring reports (23%). Ships aged 12 years (odds ratio, OR = 1.77, 95% confidence intervals, CI = 1.37-2.29) with an absence of cargo at time of inspection (OR = 3.36, 95% CI = 2.51-4.50) had a higher probability of receiving an SSCC, while ships under the EU MS flag had a lower probability of having inspection findings (OR = 0.72, 95% CI = 0.66-0.79). Risk factors to prioritise the inspections according to IHR were identified by using the EIS. A global information system, or connection of national or regional information systems and data exchange, could help to better implement SSCs using common standards and procedures

European union SHIPSAN ACT Joint action publishes interim guidance on maritime transport and Zika virus disease

[No abstract available

Health measures to travellers and cruise ships in response to COVID-19

[No abstract available

Re-Starting the Cruise Sector during the COVID-19 Pandemic in Greece: Assessing Effectiveness of Port Contingency Planning

Coronavirus disease (COVID-19) outbreaks on board cruise ships early in the pandemic highlighted gaps worldwide in public health emergency contingency plans (PHECPs) for responding to unknown threats. To restart cruise operations in 2021 and respond to potential COVID-19 outbreaks, a major tourist-based Greek island port (Port A) developed a COVID-19 PHECP. We assessed plan effectiveness by reviewing epidemiological data and monitoring outcomes, followed by an intra-action review (IAR) analyzing three event responses. From May to December 2021, 118 calls from 23 cruise ships with 119,930 passengers were recorded, with 29 COVID-19 cases in 11 cruises on board 7 ships. No outbreak was recorded during the study period. Strengths of the introduced PHECP included commitment of senior management; a core multi-disciplinary team of local authorities/ship agents involved in design and execution; interoperability agreements for port and ships’ PHECPs; cruise industry commitment to compliance; and pre-existing scenarios considering capacity needs. Central government coordination for preparedness planning at local ports is essential for successful responses. Monitoring local and country level response capacities is critical to inform planning, risk assessment, and decision-making. Immediately recording ports’ response actions provides the basis to capture lessons and improve contingency plans. To facilitate communication and common response protocols between European and non-European ports, IARs should be conducted between countries. © 2022 by the authors

First reported isolation of an emerging opportunistic pathogen (Elizabethkingia anophelis) from hospital water systems in Greece

After the Elizabethkingia anophelis outbreak in Wisconsin, USA, an active search for the detection of the microorganism in hospital water systems from Central and Northern Greece was performed from June to December 2016. In total, 457 water samples from 11 hospitals were analyzed. Elizabethkingia spp. was detected in three samples collected from two hospitals, both of which are located in Northern Greece. Two of the three isolated strains were identified as Elizabethkingia anophelis. No cases of Elizabethkingia infection were reported in either hospital during 2016. This is the first reported isolation of the pathogen in water supply systems in Greece. © IWA Publishing 201

Effects of selection to diflubenzuron and bacillus thuringiensis var. Israelensis on the overwintering successes of aedes albopictus (diptera: Culicidae)

Aedes albopictus is an invasive mosquito species responsible for local transmission of chikungunya and dengue viruses in Europe. In the absence of available treatments, insecticides-based control remains one of the most important viable strategies to prevent emerging problems. Diflubenzuron (DFB) and Bacillus thuringiensis var. israelensis (Bti) are among the most commonly used larvicides for Ae. albopictus control with consequent concerns for the potential development of resistance. Studies on the resistance emergence in Ae. albopictus and its persistence in the wild to both DFB and Bti are essential for the efficient and sustainable planning of the control programmes. In this context, larvae from a recently laboratory established population were subjected to increas-ing selective pressure for nine successive generations using both DFB and Bti. The resistance levels and the overwintering success of the selected populations relative to control (colonies that received no selection) were determined. Results revealed an 8.5-and 1.6-fold increase on the resistance levels following selection with DFB and Bti, respectively. The selection process to both larvicides had no apparent impacts on the overwintering capability relative to control, suggesting the successful persistence of the selected individuals in the wild on an annual base. © 2021 by the authors. Licensee MDPI, Basel, Switzerland

Detection of imported COVID-19 cases worldwide: Early assessment of airport entry screening, 24 January until 17 February 2020

The purpose of this study was to provide an overview of entry screening measures applied at airports in response to the COVID-19 epidemic worldwide. Between 24 January and 17 February 2020, 5.2% (95% CI 3.1-8.5) of the 271 total imported COVID-19 cases worldwide (excluding imported cases arriving in China, Macao, and Hong Kong) with known detection location were captured through airport entry screening. The majority of imported COVID-19 cases (210) were identified by the health care system (77.5%). Efforts should focus on health care system preparedness for early case detection, since according to our and previous studies health care facilities are the actual point of entry of imported cases. © 2020 The Author(s)

Detection of imported COVID-19 cases worldwide: Early assessment of airport entry screening, 24 January until 17 February 2020

The purpose of this study was to provide an overview of entry screening measures applied at airports in response to the COVID-19 epidemic worldwide. Between 24 January and 17 February 2020, 5.2% (95% CI 3.1-8.5) of the 271 total imported COVID-19 cases worldwide (excluding imported cases arriving in China, Macao, and Hong Kong) with known detection location were captured through airport entry screening. The majority of imported COVID-19 cases (210) were identified by the health care system (77.5%). Efforts should focus on health care system preparedness for early case detection, since according to our and previous studies health care facilities are the actual point of entry of imported cases. © 2020 The Author(s)

Prevalence and determinants of smoking and secondhand smoke exposure in a rural population of central Greece: A cross-sectional study

Introduction: Smoking is one of the most important risk factors for heart and lung disease and is responsible for many forms of cancer. The resulting morbidity and mortality weigh heavily upon countries with high prevalence, such as Greece. According to the Global Adult Tobacco Survey (GATS) Greece, 38.2% of Greeks aged ≥15 years, namely 51.2% of men and 25.7% of women, are smokers. Smoking is also common among the young and people of high education. Despite laws prohibiting smoking at indoor places, exposure to environmental tobacco is very high both in private and public places. The study goal was to estimate the prevalence and characteristics of smoking, the level of tobacco exposure and the factors that affect both in a rural population. Methods: A cross-sectional household study was conducted using the GATS questionnaire in a rural borough of Thessaly, Greece. Eligible participants were permanent residents of the selected villages, aged ≥18 years and they were selected by a combination of stratified sampling with probability proportional to size, random sampling and convenience sampling. Population demographics, current smoking status and tobacco use patterns, exposure to secondhand smoke, attitudes and knowledge on smoking were recorded. Analyses were performed according to the GATS manuals using the SPSS complex samples module. Results: A total of 330 adults participated in the study (168 men, 162 women). The mean age of the sample was 54.2±17.75 years (range 18.5-86.1 years). Smoking prevalence was 32.4%; 46.4% (95% confidence interval (CI) 37.8-55.3%) of men and 17.9% (95%CI 12.0-25.9%) of women were smokers. Smoking was also common among the young, people with secondary education and high school graduates. The manufactured cigarette was the most preferred tobacco product. Daily smokers consumed on average 20.6 (95%CI 17.67-23.52) cigarettes per day. Men smoked more cigarettes and started at an earlier age than women. Overall exposure to environmental tobacco smoke was high among the population. Men, individuals aged 18-24 years and 40-54 years were more exposed than their counterparts. Places where high exposure was recorded included restaurants (80.0%, 95%CI 76.0-83.5%), bars (87.8%, 95%CI 75.7-94.3%) and coffee shops (82.6%, 95%CI 68.4-91.3%). Six out of ten (62.1%, 95%CI 51.7-71.5%) workers were exposed at their workplace and nearly half were exposed on a daily basis. Prevalence of home exposure was 40.4% (95%CI 32.0-49.5%). The multivariate analysis showed that sex and age were independent predictors of current smoking status, while only sex was independently associated with exposure to secondhand smoke. Conclusions: There are very few studies studying the characteristics of smoking and tobacco exposure exclusively in rural populations in Greece, such as the present study. Both the high prevalence of smoking and the high levels of exposure to tobacco show a population at increased risk for tobacco-related disease. These call for immediate action to reduce smoking prevalence, help smokers quit and protect the health of non-smokers. The present study's conclusions provide the basis for designing local prevention programs and the baseline for monitoring of future trends in the area. © 2018 Stafylis C, Rachiotis G, Katsioulis A, Mouchtouri VA, Hadjichristodoulou C