Public health significance of chickenpox on ships - conclusions drawn from a case series in the port of Hamburg

Background: Despite international notification requirements, the magnitude of disease transmission on board ships remains undetermined. This case series aims to exemplify that varicella aboard ships is a topic of interest for maritime medicine and of public health significance. Material and methods: Systematic presentation of cases of chickenpox reported to the Hamburg Port Health Authority between November 2007 and April 2008. A systematic literature search on 'ships and chickenpox' was performed. Results: Five crew cases of chickenpox were reported from two passenger ships and two cargo ships. The cases originated from Indonesia (2), the Philippines (1), and Sri Lanka (2). Three cases were notified by the shipmaster, one by a general practitioner, and one by the immigration service. Sources of infection were other crewmembers, passengers, and persons in the home countries. Conclusions: This description of five varicella cases aboard ships points to the significance of the disease among seafarers. Many seafarers originate from tropical countries where seroconversion to varicella zoster virus generally occurs in late adolescents and adults. Thus, a substantial portion of the crew may be non-immune and have the potential to introduce the disease from their home country to the ship, or are at risk for infection on the ship. Port health authorities, shipmasters, and doctors need to be well informed about the relevance of chickenpox on ships and the recommended control measures. Travellers should be advised to report to the ship doctor with any signs of infectious disease. Int Marit Health 2010; 61, 1: 28-3

Infection control measures on ships and in ports during the early stage of pandemic influenza A (H1N1) 2009

Shipping companies were surveyed to evaluate the effect of public health measures during the influenza A (H1N1) pandemic of 2009 on ship and port operations. Of 31 companies that operated 960 cruise, cargo, and other ships, 32% experienced health-screening measures by port health authorities. Approximately a quarter of ports (26%) performed screening at embarkation and 77% of shipping companies changed procedures during the early stage of the pandemic. Four companies reported outbreaks of pandemic influenza A (H1N1) 2009 on ships, which were ultimately stopped through infection control practices. Public health measures did not interfere substantially with port and ship operations with the exception of some port authorities that delayed embarking and disembarking procedures in a few ships. However, in the shipping companies’ experience, measures were inconsistent between port health authorities. Access to antiviral drugs and pandemic vaccine was not provided in all ports. Current guidelines on medical care, hygiene, and emergency procedures on ships need to address pandemic influenza preparedness in future revisions

Occupational health legislation and practices related to seafarers on passenger ships focused on communicable diseases: results from a European cross-sectional study (EU SHIPSAN PROJECT)

<p>Abstract</p> <p>Background</p> <p>Seafarers play an important role in the transmission of communicable diseases. The aim of the present study is to draw information and identify possible gaps on occupational health practices related to seafarers sailing on ships within the European Union Member States (EU MS) with focus on communicable diseases.</p> <p>Methods</p> <p>A structured questionnaire was sent to competent authorities from 21 EU MS. The questionnaire included questions about occupational health policies, medical certification of seafarers, communicable diseases reporting and relevant legislation. Descriptive analysis of the data was conducted by the use of Epi Info software: EU MS were categorized in four priority groups (A, B, C, D) based on: number of passenger ships visits, volume of passengers, and number of ports in each country. Moreover, EU MS were categorized to old and new, based on the date of entry in the EU.</p> <p>Results</p> <p>All 21 countries with relevant competent authorities responded to the questionnaire. The existence of specific national legislation/regulation/guidelines related to vaccination of seafarers was reported by three out of the 21 (14%) responding authorities. Surveillance data of communicable diseases related to seafarers are collected and analyzed by 4 (19%) authorities. Five out of 21 of the responding countries (24%) reported that tuberculin test result is required for the issuance of seafarer's medical certificate while a great variety of medical examination is required for the issuance of this certificate among countries.</p> <p>Gaps on occupational health services focused on communicable diseases related to maritime occupation have been reported by 33% of the responding countries.</p> <p>Responding authorities from Group A and B had the highest percentage of reported gaps followed by groups C and D. Old MS reported a higher frequency regarding gaps on occupational health services in comparison to new MS.</p> <p>Conclusion</p> <p>Our results revealed heterogeneity regarding occupational health of maritime employees in EU MS. This work provides some evidence that further work at international and European level could be considered, in order to explore the potential for harmonized initiatives regarding occupational health of seafarers.</p

Surveillance and control of communicable diseases related to passenger ships in Europe

This study was conducted within the European SHIPSAN (ship sanitation) project and aims at exploring the legislative framework and current practices related to surveillance of communicable diseases and response aboard passenger ships in Europe. A detailed questionnaire was disseminated and completed by 59 competent authorities in 27 European countries. The majority of competent authorities used national legislation without special provisions for passenger ships. Only 20% had specific provisions for ships regarding quarantine, while a smaller proportion of new Member States (MS) have specific legislation in comparison with old MS (p = 0.01). The Maritime Declaration of Health (MDH) was the main reporting tool used. About 30.5% of the competent authorities declared that they require submission of MDH by all arriving ships, but 28.8% only from affected areas, and 11.9% never require MDH. A total of 45 outbreaks or incidents (36 gastrointestinal, 1 incident of legionellosis, 3 respiratory, and 1 influenza-like illness outbreak, occupational tuberculosis, varicella, scabies, and meningitis) were reported to EU competent authorities during 2006. About 75% of the responders stated that there are gaps in the surveillance and control of communicable diseases. A diversity of approaches in EU countries, and gaps regarding surveillance and response and training needs of personnel were identified. (Int Marit Health 2011; 62, 2: 138&#8211;147

Cardiovascular diseases in modern maritime industry

Acute cardiovascular diseases (CVD) are the main natural causes of death in industrialized countries - both at sea and on land. Seafarers face very specific job-related cardiac risk factors, such as time pressure, long working hours, or high stress factors onboard [1, 2]. Taking into consideration the healthy worker effect of seafarers, cardiac risk factors are shown to occur slightly more frequently in seafarers than in the general population. Owing to the lack of health professionals onboard and the limited treatment options of events at sea, effective cardiopulmonary resuscitation is often delayed and the outcome of cardiac events may be worse compared to that in other occupations ashore. Seafarers&#8217; medical surveillance examinations should be used more intensively as an opportunity for education of crews in CVD risks and the possibilities to reduce them. Further, enhancement of treatment options (e.g. by implementation of advanced therapy and diagnostics such as telemedicine or AED onboard) may contribute to improved CVD prognosis at sea

Procedural aspects of COVID-19 vaccinations for seafarers on ocean-going vessels

The increasing availability of safe and authorised coronavirus disease 2019 (COVID-19) vaccines for the first time provides the opportunity to vaccinate seafarers on board their ships while in port. Speedy vaccination of seafarers secures their health and serves to avoid the international propagation of COVID-19 virus variants via maritime traffic. As a port medical clinic, we will share our practical vaccination experience on board of merchant vessels in German/European ports with our esteemed coastal colleagues to stimulate their participation in this endeavour. You will have to adapt the procedure to your national particularities, otherwise please freely share the information with interested parties. Detailed guidance on COVID-19 vaccination in shipping and accompanying legal issues was published by the International Chamber of Shipping (www.ics-shipping.org)

Design and characterization of an antiproton deceleration beamline for the PUMA experiment

We report on the design and characterization of an antiproton deceleration beamline, based on a pulsed drift tube, for the PUMA experiment at the Antimatter Factory at CERN. The design has been tailored to high-voltage (100kV) and ultra-high vacuum (below 10−10mbar) conditions. A first operation achieved decelerating antiprotons from an initial energy of 100keV down to (3898±3)eV, marking the initial stage in trapping antiprotons for the PUMA experiment. Employing a high-voltage ramping scheme, the pressure remains below 2×10−10mbar upstream of the pulsed drift tube for 75% of the cycle time. The beamline reached a transmission of (55±3)% for antiprotons decelerated to 4keV. The beam is focused on a position sensitive detector to a spot with horizontal and vertical standard deviations of σhoriz=(3.0±0.1)mm and σvert=(3.8±0.2)mm, respectively. This spot size is within the acceptance of the PUMA Penning trap.We report on the design and characterization of an antiproton deceleration beamline, based on a pulsed drift tube, for the PUMA experiment at the Antimatter Factory at CERN. The design has been tailored to high-voltage (100 kV) and ultra-high vacuum (below $10^{-10}$ mbar) conditions. A first operation achieved decelerating antiprotons from an initial energy of 100 keV down to ($3898\pm 3$) eV, marking the initial stage in trapping antiprotons for the PUMA experiment. Employing a high-voltage ramping scheme, the pressure remains below $2\cdot 10^{-10}$ mbar upstream of the pulsed drift tube for 75% of the cycle time. The beamline reached a transmission of ($55 \pm 3$)% for antiprotons decelerated to 4 keV. The beam is focused on a position sensitive detector to a spot with horizontal and vertical standard deviations of ${\sigma}_\mathrm{horiz}$ = ($3.0 \pm 0.1$) mm and ${\sigma}_\mathrm{vert}$ = ($3.8 \pm 0.2$) mm, respectively. This spot size is within the acceptance of the PUMA Penning trap

Actions for prevention and control of health threats related to maritime transport in European Union

Background: Actions at European Union level for International Health Regulations (IHR) 2005 implementation and maritime transport were focused on two European projects implemented between 2006 and 2011. Method: Situation analysis and needs assessment were conducted, a Manual including European standards and best practice and training material was developed and training courses were delivered. Ship-to-port and port-to-port communication web-based network and database for recording IHR Ship Sanitation Certificates (SSC) were established. Results: Fifty pilot inspections based on the Manual were conducted on passenger ships. A total of 393 corrective actions were implemented according to recommendations given to Captains during pilot inspections. The web-based communication network of competent authorities at ports in EU Member States was used to manage 13 events/outbreaks (dengue fever, Legionnaires’ disease, gastroenteritis, meningitis, varicella and measles). The European information database system was used for producing and recording 1018 IHR SSC by 156 inspectors in 6 countries in accordance with the WHO Handbook for inspection of ships and issuance of SSC. Conclusions: Implementation of corrective actions after pilot inspections increased the level of compliance with the hygiene standards in passenger ships sailing within the EU waters and improved hygiene conditions. The communication tool contributed to improvement of outbreak identification and better management through rapid sharing of public health information, allowing a more timely and coordinated response. After the implementation of actions on passenger ships, the European Commission co-funded a Joint action that will expand the activities to all types of ships and chemical, biological and radio-nuclear threats (deliberate acts/accidental). (C) 2013 Elsevier Ltd. All rights reserved