Newsletter.
Issue No 2. June 2013
In this issue…
Editorial Mauro Dionisio, Ministry of Health, Italy
News from the leadership
Thematic sections
Dear friends, dear readers,
Welcome to the second issue of the new edition of our newsletter, refreshed
with new sections and from today with a new graphic design too.
• Chemical and radiological issues
on ships
• Environmental health and hygiene
on ships – Crew accommodation
Infectious diseases on ships
• Non-infective effects of mould in
the indoor environment
Recent Publications
News and forthcoming dates
• EU SHIPSAN ACT Joint Action
3-day Working Group meeting,
Madrid, Spain, 24-26 April 2013
• EU SHIPSAN ACT Joint Action
2-day Working Group meeting,
Athens, Greece, 23-24 May 2013
• EU-OASHA site visit, Bilbao,
Spain, 26April 2013
What’s new on the website?
Quiz
Port in focus
• The port of Reykjavík – Service
centre in the North-Atlantic
ISSN Number: 2241-5211
Editor:
Dr Mauro Dionisio, Italy
Editorial Board:
Prof. Christos Hadjichristodoulou, Greece
Dr Barbara Mouchtouri, Greece
Mr Gary Cooper, United Kingdom
Dr Gordon Nichols, United Kingdom
Dr Carmen Varela Martinez, Spain
Dr. Angel Kunchev, Bulgaria
Dr Haraldur Briem, Iceland
Dr Maurice Mulcahy, Ireland
Section Editors:
Dr Raquel Duarte Davidson, United Kingdom
Dr. med. Thomas von Münster, Germany
Dr. Martin Dirksen-Fisher, Germany
Mr Martin Walker, United Kingdom
Dr Nina Pirnat, Slovenia
Content Manager/Secretariat:
Mrs Elina Kostara
Next Issue:
July 2013
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.
SHIPSAN ACT’s activities continue and
the partnership is kept busy; last month
the coordination group meeting was
held in Madrid. I have just returned from
Athens, where the working group on the
SHIPSAN information system and the
evaluation of the Joint Action have been
held in a friendly atmosphere and with
fruitful results.
The inspection program on board
ships, in my opinion the ‘core activity’ of
the Joint Action, has begun too. It was
decided during the coordination meeting
in Madrid, to perform in 2013 a total of
50-60 inspections on cruise ships and
ferries. Starting from Malta, it will continue
with scheduled inspections in Greek, Italian, Estonian, Dutch and Spanish ports
throughout the whole summer. In the next
months and till the end of the Joint Action,
the inspection program will be extended
to other European ports. For those of you
wondering about the framework in which
inspections are performed, I would like to
clarify that we are performing scheduled
announced inspections accompanied
by a trainer during the first two years for
didactic purposes. However, during the
third year, inspections will be conducted
unannounced and without the presence
of a trainer. Finally, we have started preparing the training course for seafarers in
Rome, which will be held in October 2013.
I hope you enjoy reading and I would
like to welcome you on the next issue of
the newsletter.
News from the leadership
Prof. Christos Hadjichristodoulou, SHIPSAN ACT Joint Action Coordinator
Dr Barbara Mouchtouri, SHIPSAN ACT Joint Action Manager
We are currently on the fifth month of the EU SHIPSAN ACT Joint Action. The
last four months were quite busy for the partnership, since different activities of
all nine work packages run in parallel.
Three working group meetings were held
regarding the State of the Art, the Evaluation work package and the SHIPSAN
Information System (SIS). Details on the
above meetings are presented in the
“News and forthcoming meetings” section of the Newsletter.
The Dissemination plan of the
SHIPSAN ACT Joint Action is currently
being prepared. A concrete dissemination strategy will provide the basis for
diffusing the Joint Action products and
make provisions for reaching all levels of
stakeholders (internal and external) with
a focus on strengthening the adaptation,
sustainability and transferability of the EU
SHIPSAN ACT Joint Action outcomes. As
part of the dissemination strategy, a total
of 13 countries have identified the target
groups in their country, and 12 countries
have prepared National Dissemination
Plans. Moreover, the contact details of
the ports authorised to issue Ship Sanitation Certificates under International
Health Regulations (IHR 2005) have been
collected from 9 countries.
As part of the State of the Art report,
four surveys and a literature review will
be completed. The Working Group for
the State of the Art has already prepared
the methodology and the questionnaires,
and in the forthcoming months the questionnaires will be pilot tested in five countries (Greece, Germany, Spain, Ireland,
and England).
The methodologies have been prepared for preparing the guidelines for
dealing with chemical and radiological
SHIPSAN NEWSLETTER Issue No 2. June 2013
2
News from the leadership continued
incidents on ships, and the table top
exercises for testing these guidelines.
The working group for the SHIPSAN
Information System (SIS) has recorded
partners’ comments on system functionality that have been collected during
the last 2 years. A total of 49 cases for
improvement have been recorded and
grouped by topic, and some of them have
been implemented. The working group
decided to produce a document explaining access rules, and roles and responsi-
bilities of users and administrators. The
need for training and e-learning courses
on the SIS was reported and the working
group decided to develop an e-learning
manual adjusted to user roles.
Regarding the training courses; the
call for trainers is currently under development. The first training course for the
passenger ship operators will be scheduled in October 2013 in Rome, Italy.
Within the next month’s more news about
the training activities will be published in
the newsletter and the EU SHIPSAN ACT
website.
A site visit was conducted by representatives of SHIPSAN ACT to the
European Agency for Safety and Health
at Work (EU-OSHA) in Bilbao, Spain.
Discussions were initiated to explore the
application of the OiRA project (http://
www.oiraproject.eu) tools to the development of the SHIPSAN ACT risk assessment tool for occupational health and
safety on cargo ships.
Thematic sections
Chemical and radiological
issues on ships
Key message:
SHIPSAN Joint Action will develop
guidance for competent authorities
in support of their risk assessment
and response to chemical and
radiological incidents on ships.
This development signals a desire
to take an all-hazards approach to
public health events on passenger
ships and cargo vessels.
Public Health England (PHE) is delighted to be participating in the SHIPSAN ACT
Joint Action project. Dr Gordon Nichols and colleagues from PHE (formally the
Health Protection Agency) have been engaged in previous SHIPSAN projects,
but are joined now by colleagues from PHE Centre for Radiation, Chemical and
Environmental Hazards (CRCE) who are based at the Centre’s headquarters in
Chilton, Oxfordshire.
CRCE provides advice, research and services to protect the public from hazards
resulting from exposure to chemicals
and poisons, radiation both ionising and
non-ionising and ultrasound and infrasound. The Centre also leads for PHE on
public health effects of climate change
and extreme environmental events such
as flooding. CRCE also commissions
the National Poisons Information Service (NPIS) which provide 24/7 advice on
treatments and poisonings.
As part of SHIPSAN ACT Joint Action,
Raquel Duarte-Davidson, Tiberio Cabi-
anca, Eirian Thomas, Alison Jones
and Ehi Idahosa-Taylor from CRCE will
be developing guidance for competent authorities in support of their risk
assessment and response to chemical
and radiological incidents on ships. This
development signals a desire to consider
an all-hazards approach to public health
events in order to strengthen current
approaches to safeguard the health of
travellers and crew on passenger ships
and cargo vessels.
This guidance will focus on the development of a general risk assessment
PHE CRCE team (from left to right):
Raquel Duarte-Davidson,
Alison Jones, Eirian Thomas.
At the back: Tiberio Cabianca,
Ehi Idahosa-Taylor
tool which can be applied to accidental
releases or deliberate events. A table
top exercise and training material will be
developed to accompany the document.
The project team will work in collaboration
with various national, EU and international
organisations involved in the protection
and promotion of global health as well
as stakeholders involved in the maritime
industry and port authorities. PHE will be
contributing to this section of the newsletter from time to time in order to update
you on progress, seek your input and to
share topical issues of interest.
SHIPSAN NEWSLETTER Issue No 2. June 2013
3
Thematic sections continued
Environmental health and
hygiene on ships
Crew accommodation
Martin Walker, Port Health Officer, Suffolk Coastal Port Health Authority,
Felixstowe, England
Key message:
An introduction to what inspectors
will look for when inspecting crew
accommodation on board vessels.
Public Health, Safety and Welfare
issues.
When the International Health Regulations 2005 came into force, they
incorporated many new requirements for Port Health Officers. One of these,
(and coincidentally, the first area covered by the WHO Technical Handbook)
was that of crew accommodation. As inspectors will realise, a variety of different
cabins may be encountered and need to be inspected as part of the routine
issuance of an SSC, let alone the need to look at the accommodation in the case
of the outbreak of disease.
As Public Health practitioners, our key
focus is upon the public health aspects
of the vessel. For seafarers, who may
typically spend 6-12 months or more
on board the vessel, health, safety and
indeed their welfare is critical. The International Labour Organisation (ILO) Maritime Labour Convention 2006 comes into
force on 20 August 2013, having been
ratified by at least 30 member states
and together with other conventions (The
Accommodation of Crews (Supplementary Provisions) Convention no. C133 for
example), and sets out a number of minimum standards including floor area per
person, toilet facilities, washing facilities,
minimum headroom, lighting standards
and standards for sleeping accommodation. The standards are variable (or sometimes excluded) based upon the size of
the vessel and will normally fall under the
auspices of Port State Control.
As Public Health
practitioners, our key focus
is upon the public health
aspects of the vessel.
The WHO Handbook for Ship Inspection covers crew and passenger accommodation in the first chapter. As well as
overlapping with the ILO Convention, the
handbook also covers items of Public
Health concern. (The SHIPSAN Trainet
manual also covers these areas with a
series of recommended standards that
largely align with the WHO handbook).
Although Ship Sanitation Inspections will
focus on public health issues, we will have
a role liaising with Port State Control where
our findings may interest them. There are
actually few measures that are requirements as compared to recommendations,
though these are logical. Toilet facilities
must be provided (either in cabins or a
common place outside living quarters) and
be equipped with a means for hand drying,
toilet paper and soap but unusually, the
provision of hand washing facilities is only
a recommendation. Screening or mesh
and other constructional details to prevent
vector entry is another key Public Health
measure. As these are recommendations,
a risk based approach is entirely appropriate. Vector control measures may be
different for vessels sailing to areas where,
for example, yellow fever or malaria are
prevalent, than perhaps those limiting their
voyages around Northern Europe.
As would be expected, there are
requirements for suitable cleaning and
maintenance to take place in cabins
and accommodation. There is a key
requirement to perform disinfection,
disinsection or deratting measures where
evidence of vectors or other reservoirs
are found. It is this area that I intend to
cover in the next issue; particularly insect
vectors that may cause public health
risks in accommodation areas. If you
have any good examples of cases that
you would like to share with SHIPSAN
ACT readers, please email details to me
at [email protected]
References:
World Health Organization, International
Health Regulations 2005, available
through http://whqlibdoc.who.int/
publications/2008/9789241580410_
eng.pdf
World Health Organization, 2011
Handbook for Inspection of Ships
and Issuance of Ship Sanitation
Certificates available through
http://www.who.int/ihr/publications/
handbook_ships_inspection/en
International Labour Organization,
Maritime Labour Convention 2006,
available through http://www.ilo.org/
global/standards/maritime-labourconvention/WCMS_090250/lang--en/
index.htm
International Labour Organization,
C-133 Accommodation of Crews
(Supplementary Provisions) Convention
1970, (No. 133), available through
http://www.ilo.org/dyn/normlex/
en/f?p=1000:12100:0::NO::P12100_ILO_
CODE:C133
SHIPSAN NEWSLETTER Issue No 2. June 2013
4
Infectious diseases on ships
Non-infective effects of mould in the indoor environment
Simona Perčič, Nina Pirnat, Peter Otorepec,
National Institute of Public Health, Trubarjeva 2, Ljubljana, Slovenia
Phone: + 386 1 2441 400 Fax: + 386 1 2441 447
Moulds have a worldwide distribution
and grow in a wide range of habitats
all over the world including extreme
environments, such as deserts, or
areas with high salt concentrations or
ionizing radiation, as well as in deep
sea sediments(1).
Around 100,000 species of moulds have
been formally described (2). Moulds are
fungi that grow in the form of multicellular
filaments called hyphae (3). The most frequently isolated indoor buildings moulds
in one study were Penicillium (96%), Cladosporium (89%), Uocladium (62%) Geomyces pannorum (57%), and Sistronema
brinkmanii (51%) (4). In one German study,
which examined the link between air from
air conditioning systems of sea-going
vessels and diseases of the upper respiratory tract of seafarers, the data on
the concentration of microorganisms
(fungi and bacteria) in indoor air samples
were collected (5). The numbers of moulds
indoor varied from 14 to 914 cfu/m3, what
according to American Association of
Paediatrics produced guidelines does not
mean danger to the health (5, 6). Because in
indoor air as well as in the filter layers of
air condition systems much more bacteria
than fungi were enumerated, they concluded that most of the respiratory diseases of the crew were due to bacterial
infections (5). There are no available data
as to which moulds are most frequent on
the ships. An individual can be exposed to
moulds through inhalation, ingestion, and
touching mouldy surfaces (7). Most prevalent reactions on exposure to moulds
are allergic, infectious, irritant or toxic (7).
Most moulds are metabolically active
over a broad temperature range; however,
high moisture and relative humidity are
required for optimal growth (8). The lowest
level of relative humidity for moulds to
grow is 75% (4). We assume that this could
also be applicable to large ocean-going
ships. Because typically the crew spend
quite a lot of time indoors on a big ship,
there is an increasing risk for mould exposure if the ship is contaminated.
Immune-mediated health
effects of mould exposure
Immunologically; moulds produce allergens that may lead to respiratory diseases (7). The most risky populations for
developing allergic diseases are: babies;
children; older people; persons infected
with HIV; patients on chemotherapy;
pregnant women; patients with other lung
diseases and immunocompromised persons (9). The causal relationship between
damp housing and illness is unclear, since
there are a variety of pollutants in the
indoor environment (10). The list of putative
symptoms generally consists of upper
respiratory complaints but can include:
headache; eye irritation; epistaxis; nasal
and sinus congestion; cough, cold and
flu symptoms; as well as generalised
gastrointestinal complaints (11). Other less
common immune-mediated responses
are allergic broncho-pulmonary aspergillosis, allergic fungal sinusitis, and hypersensitivity pneumonitis (7). If a person was
exposed to moulds, blood IgE levels for
specific mould should be checked to confirm the diagnosis (7). We found no specific
data about developing respiratory diseases on big ocean-going ships due to
mould exposure. Taskinen et al. reported
an increased prevalence of asthma in
moisture affected schools, although there
were no objective measurements of respiratory diseases (12). Asthma is a complex
chronic inflammatory disease of the airway, with reversible airway obstruction as
a key characteristic. Clinicians diagnose
asthma on the basis of medical history;
a physical examination including a lung
function test; a longitudinal assessment
of reversibility of airway obstruction; and
the exclusion of the diseases with similar
symptoms (13).
We found no specific
data about developing
respiratory diseases on big
ocean-going ships due to
mould exposure.
SHIPSAN NEWSLETTER Issue No 2. June 2013
Non-immune-mediated
health effects
Irritation
During growth, moulds produce secondary metabolites, so called volatile
organic compounds (VOCs). VOCs in
the environment (outdoor and indoor)
are low molecular weight alcohols, aldehydes and ketones, toluene, benzene,
alkenes, aromatic hydrocarbons, esters,
carbon dioxide and ozone, and are not
exclusively produced only by moulds (14).
VOCs originating from moulds are well
known irritants, and produce symptoms
of respiratory diseases like: eye, nose and
throat irritation; headache; and fatigue (7).
Secondary metabolites are the cause of so
called mould odours, and the human nose
is very sensitive to these odours; more
so than current analytical instruments (7).
Data including animal research indicate
that the median lethal dose of many of
these components is high (15). There are no
current data for effects of prolonged lowlevel exposure for humans (7).
Mycotoxins
Mycotoxins are diverse secondary
metabolites produced by moulds growing on a variety of foodstuffs consumed
by both animals and humans. Outbreaks
of various types of animal mycotoxicosis
due to ingestion have occurred world-
wide (16). Beside ingestion, humans and
animals can be exposed to mycotoxins through inhalation and skin contact.
Mycotoxins are lipid soluble and they
are easily absorbed via the airways or
through the skin (7). There are many mycotoxins. Mycotoxins, some in small, others
in large doses are toxic for all internal
organs, including heart, lungs, reproductive organs, liver, and kidney (17). The crew
should check the food on board regularly
for mould growth, but because mycotoxins are natural contaminants of food
sources, they cannot be totally eliminated
before consumption (18). Current scientific
evidence shows that there is not enough
evidence that human health has been
adversely affected by inhaled mycotoxins
in the indoor environment. However, to
date, no data have been collected relating to indoor ship mycointoxication (18).
The most important mycotoxins are:
5
•
•
•
•
• aflatoxins: produced by certain strains
of Aspergillus spp. These naturally
occurring mycotoxins were discovered
in barley, corn, nuts and wheat. The
limits for food and milk are 20 and 0.5
parts per billion (ppb), respectively.
Levels up to 300 ppb are allowed in
feed for livestock and poultry (7);
• cirinin: found in Penicillium spp.
It typically contaminates barley,
corn, rye and wheat. Because this
mycotoxin is destroyed by food
Beside ingestion, humans and animals can be exposed to
mycotoxins through inhalation and skin contact.
processing, there are no Food and
Drug Administration regulations (7);
fumonizins: produced by Fusarium
spp. They are commonly found in
corn and are detectable in tortilla
flour. To date, no toxic effects have
been identified in humans. FAO
and WHO recommend a maximum
tolerable intake of 2 micro g/kg of
body weight per day (7);
ocharatoxins: isolated from
Aspergillus and Penicillium spp;
found in barley, cocoa, coffee, corn,
soybeans, and wheat. The WHO/FAO
recommended a tolerable weekly
intake of 100 micro g/kg (7);
patulin: produced by Aspergillus
and Penicillium spp. and other
moulds that grow in fruits such as
apples, grapes and pears. There is
recommended limit of 50 micro g/kg
of patulin in apple juice and cider (7);
trichothecenes: metabolites,
produced by a number of fungi. There
are almost 150 natural trichothecenes,
of which at least 40 are mycotoxins.
They are found in crops and animal
feed contaminated with Fusarium
spp. In commercial food, such as
corn, flour, popcorn, potato, wheat
flour, breakfast cereals, and infant
food, trichothecene levels are in the
range of 0.03 to 0.5 mg/kg (7).
Prevention
Currently we do not know the concentration of different types of moulds in the
indoor air and certain parts of big ships,
but it is impossible to avoid growth of
SHIPSAN NEWSLETTER Issue No 2. June 2013
mould in the indoor environment. The most
effective technique for preventing mould
growth is moisture control. Moulds grow at
a relative humidity of more than 75% inside
buildings (4). Consequently we have to keep
relative humidity indoors below 50% (4).
Bathrooms often have high humidity levels, especially when showering, and this
can be controlled by use of extraction fans
or opening widows. In other indoor areas
of ships where elevated humidity levels are
consistent, dehumidifiers should be used;
ventilation should be increased by opening doors and windows, and mouldy surfaces should be cleaned and disinfected
regularly (7). Cleaning and disinfection
procedures involve the use of potentially
dangerous chemicals. Precautions should
be taken to guarantee the safety of cleaning workers and they should be made
aware of correct use of corrosive and/or
toxic chemicals. The electricity supply (air
conditioning/ventilation system?) must be
switched off during cleaning. Dust and
aerosols may be dangerous, so the workers should wear proper protective clothing
and equipment. All sensitive machinery
and equipment should be protected from
exposure to potentially corrosive and
damaging cleaning chemicals. Non porous
surfaces where moulds are growing can
be cleaned with soap and water, but for
porous surfaces (e.g. carpets, soft furnishings, wood, plywood, chipboard and MDF,)
biocides, such as chlorine bleach may be
used (19). After cleaning/fumigation, adequate ventilation is necessary.
Conclusion
At present, the data on the growth of
certain types of moulds in the indoor
environment on ships are insufficient.
Consequently, we do not know which are
the most prevalent mould species found
in large ocean-going ships. Valid concerns
exist regarding the relationship between
indoor air, mould exposure, mycotoxins
and human disease. Review of the available literature reveals certain moulds/diseases associations, especially respiratory
diseases. Because symptoms and signs
of respiratory diseases that are caused
by moulds occurring inside buildings are
almost the same all over the world, we
assume that symptoms occurring after
exposure to moulds inside big ships could
be the same. There is a need for studies
on the effects of mould on human health
in ships, using objective markers of illness
and proper epidemiologic techniques for
measuring most prevalent species and
the concentrations of these moulds in big
ships’ indoor environment.
References
1. Raghukumar C, Raghukumar S.
Barotolerance of fungi isolated
from deep-sea sediments of the
Indian Ocean. Aquatic Microbial
Ecology.1998; 15 (2): 153-63.
2. This estimation is determined
by combining the species count
for each phyla, based on values
obtained from the 10th edition of
the Dictionary of the Fungi (Kirk
et al., 2008): Ascomycota, 64163
species (p. 55); Basidiomycota,
31515 (p. 78); Blastocladiomycota,
179 (p. 94); Chytridiomycota, 706
(p. 142); Glomeromycota, 169 (p.
287); Microsporidia, >1,300 (p. 427);
Neocallimastigomycota, 20 (p. 463).
3. Moore D; Robson GD; Trinci APJ
(editors). (2011). 21st Century
Guidebook to Fungi (1st ed.).
Cambridge University Press
4. Grant C, Hunter CA, Flannigan B,
et al. The moisture requirements
of moulds isolated from domestic
buildings. Int Biodeterior. 1989; 25:
259-84.
5. Meyer G, Schepers BF. Does air
conditioning impact on hygienic
quality of indoor air on seagoing
vessels. Int Marit Health. 2007; 58(14): 71-7.
6. American Academy of Pediatrics
Commite on Environmental Health.
Toxic effects of indoor molds.
Pediatrics. 1998;101:712-14.
7. Mazur LJ, Kim J. Spectrum of
noninfectious health effects from
molds. Pediatrics. 2006; 118(6):
1909-26.
The most effective technique
for preventing mould growth
is moisture control.
6
8. Ciegler A, Burmeister HR, Vesonder
RF, Hesseltine CW. Mycotoxins.
occurrence in the environment,
p. 1-50. In R. C. Shank (ed.),
Mycotoxins and N-nitroso
compounds: environmental risk, vol.
1. CRC Press, Inc. Boca Raton, Fla.
9. Brunekreef B, Dockery DW, Speizer
FE, et al.Home dampness and
respiratory morbidity in children. Am
Rev Respir Dis. 1989; 140: 1363-67.
10.Gravesen S, Larsen L, Gyntelberg
F, Skov P. Demonstration of
microorganisms and dust in school
and offices. An observational study
of non.industrial buildings. Allergy.
1986;41: 520-25.
11.Mahmoudi M, Gershwin ME. Sick
building syndrome.III. Stachybotris
chartarum. J Asthma. 2000; 37:
191-98.
12.Taskinen T, Hyvarinen A, Meklin T.
Asthma and respiratory infections
in school children with special
reference to moisture and mold
problems in the school. Acta Pediatr
1999;88: 1373-79.
13.Eder W, Ege MJ, von Mutius E, The
asthma epidemic. N Engl J Med.
2006; 355 (21): 2226-35.
14.Kjaergaard S, Molhave L, Pedesen
F. Human reactions to a mixture
of indoor air volatile organic
compounds. Atmos Environ.
1990;25A: 1417-26.
15.Sorenson WG, Frazer DG, Jarvis BB,
et al. Trichothecene mycotoxins in
aerosolized conidia of Stachybotris
atra. Appl Environ Microbiol.
1987;53: 1,370-75.
16.Pier AC, Richard JL, Cysewski SJ.
Implications of mycotoxins in animal
disease. J Am Vet Med Assoc.1980;
176: 719-24.
17.Fung F, Clark RF. Health effects of
mycotoxins: a toxicological review. J
Txicol Clin Toxicol.2004;53: 790-93.
18.American College of occupational
and environmental Medicine. Position
statements/guidelines: adverse
human health effects associated with
molds in the indoor environment.
Accessed December 1, 2005.
19.Cancellotti FM. Aircraft and ship
disinfection. Rev Sci Tech.1995;
14(1): 177-89.
SHIPSAN NEWSLETTER Issue No 2. June 2013
7
Recent publications
Actions for prevention and
control of health threats
related to maritime transport in
European Union
Hadjichristodoulou C, Mouchtouri VA,
Guglielmetti P, Lemos CM, Nichols G,
Paux T, Schlaich C, Cornejo MD,
Martinez CV, Dionisio M, Rehmet S,
Jaremin B, Kremastinou J;
the SHIPSAN TRAINET partnership.
Travel Med Infect Dis. 2013 Mar 18. pii:
S1477-8939(13)00010-0.
Abstract
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 1,018 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).
http://dx.doi.org/10.1016/j.
tmaid.2013.02.001
Awareness of health risks at
the workplace and of risks of
contracting communicable
diseases including those
related to food hygiene, among
seafarers.
Grappasonni I, Paci P, Mazzucchi F,
De Longis S, Amenta F.
Int Marit Health. 2012;63(1):24-31.
Abstract
BACKGROUND: The awareness of
health risks on board ships in terms of
knowledge of dangers and discomfort at
the workplace, and of risks of contracting
communicable diseases including those
related to food hygiene was assessed in
a sample of workers of an Italian shipping
company. Analysis was performed on
crew members and on ashore personnel
of the same firm to assess possible differences in risk perception.
MATERIALS AND METHODS: The study
was conducted by proposing an anonymous questionnaire to the crew members
of 9 tankers and to the office staff of the
shipping company Finaval S.p.A., which
has its headquarters in Rome.
RESULTS: People living ashore have a
better knowledge of infectious risks than
seafarers. Both ashore workers and seafarers have a reasonable awareness of
blood-borne and sexually-transmitted
diseases. Seafarers are more concerned
about the risks of psychological problems
due to isolation than are office personnel.
The risk of not being adequately cared
for in case of disease or injury on board
is also perceived as a major problem by
seafarers. Ashore personnel, eating raw
fish more than their mates on board, are
at a greater risk of communicable gastrointestinal diseases.
CONCLUSIONS: Seafarers should be the
target of specific informative campaigns
about health risks, possible consequences, and how to minimise exposure
to them during travel/life at sea.
Assessment of hygiene standards
and Hazard Analysis Critical
Control Points implementation on
passenger ships
Varavara Mouchtouri , Eleni Malissiova ,
Panagiotis Zisis , Evina Paparizou &
Christos Hadjichristodoulou.
International Journal of Environmental Health
Research, (2013) 23:2, 170-179
Abstract
The level of hygiene on ferries can have
impact on travellers’ health. The aim of
this study was to assess the hygiene
standards of ferries in Greece and to
investigate whether Hazard Analysis Critical Control Points (HACCP) implementation contributes to the hygiene status
and particularly food safety aboard passenger ships. Hygiene inspections on 17
ferries in Greece were performed using a
standardised inspection form, with a 135point scale. Thirty-four water and 17 food
samples were collected and analysed.
About 65% (11/17) of ferries were scored
with >100 points. Ferries with HACCP
received higher scores during inspection
compared to those without HACCP (p
value <0.001). All 34 microbiological water
test results were found negative and, from
the 17 food samples, only one was found
positive for Salmonella spp. Implementation of management systems including
HACCP principles can help to raise the
level of hygiene aboard passenger ships.
http://dx.doi.org/10.1080/09603123.20
12.708920
SHIPSAN NEWSLETTER Issue No 2. June 2013
8
News and forthcoming dates
EU SHIPSAN ACT
Joint Action 3-day
Working Group
meeting, Madrid, Spain,
24-26 April 2013
A 3-day combined working group meeting of Work package 4: State of the Art,
Work package 6: Chemical and Radiological incidents on ships risk assessment
and management and Work package 9:
Occupational health and hygiene in maritime transport took place.
The main objectives of the meeting
were the following:
• To define the specific objectives and
methodology for the five parts of state
of the art report.
• To discuss and finalise the
methodology for Work Package 6.
• To discuss and finalise the
methodology for Work Package 9.
To prepare the draft questionnaire for the
surveys of state of the art work package.
EU SHIPSAN ACT Joint
Action 2-day Working
Group meeting, Athens,
Greece, 23-24 May 2013
A 2-day combined working group meeting of Work Package 7: SHIPSAN Information System (SIS) and Work Package
3: Evaluation took place.
The meeting objectives for day 1 were:
• To discuss the content, the update
and the long-term operation of SIS
(Work Package 7).
• To explore possible links of SIS with
existing systems in EU.
The meeting objectives for day 2 were:
• To decide the evaluation strategy for
the Joint Action (Work Package 3).
• To define the objectives and
methodology for SHIPSAN ACT
evaluation procedures.
• To discuss and finalise the Evaluation
Plan.
EU-OASHA site visit,
Bilbao, Spain, 26April 2013
SHIPSAN ACT representatives to the site
visit were Prof. Christos Hadjichristodoulou (Greece), Ass. Prof. George Rachiotis
(Greece), Dr med Thomas von Munster
(Germany)
The purpose of the site visit was to
discuss about the process for the development of a risk assessment tool and
explore opportunities for collaboration
with the OiRa project.
What’s new on
the website?
www.shipsan.eu
The new SHIPSAN website is
currently under development and
will go on air within the next month.
Quiz
http://www.shipsan.eu
What may be considered
the first international
health care expedition in
history?
What disease was it
related to and what mean
of transport did they use?
Dr Miguel Davila Cornejo
Ministry of Health, social services and
equality, General Directorate for Public
Health, Quality and Innovation
Spain
Answer to
Issue 1 Quiz:
Title of the novel:
Love in the Time of Cholera
Author’s name:
Gabriel García Márquez
http://elearning.shipsan.eu
Infectious disease, compared to
lovesickness:
Cholera
At least two infectious diseases
for which in ports sanitary hygienic
measures had been implemented:
cholera, plague, yellow fever
Congratulations to Ana Guerra
from the International Health
Service in Tenerife (Spain) for
answering correctly.
https://www.facebook.com/shipsan.eu
https://twitter.com/shipsan_eu
@shipsan_eu
SHIPSAN NEWSLETTER Issue No 2. June 2013
9
Port in focus
The port of Reykjavík – Service centre in the North-Atlantic
Asa St. Atladottir, RN, BS, Diploma PHS, Infection Control Nurse – Project Manager, Centre for Health Security
and Communicable Disease Control, Directorate of Health, Reykjavik, Iceland
Reykjavík is the capital of Iceland, an island with a population of 318,000 people. Two thirds of the population live in the
capital area. The port of Reykjavík is the principal seaport of Iceland, with facilities for handling all types of cargo and a
comprehensive range of maritime support services.
The port is divided into two main areas,
the old harbour (constructed in the years
1913-1917) and the newer part of the
harbour called Sundahöfn (constructed
in 1960-1968). In 2005, a new company,
Associated Icelandic Ports (AIP), began
its operations. The company runs the harbours and ports of Reykjavík and nearby
towns, Grundartangi, Akranes and Borgarnes, and is a partnership jointly owned
by the municipalities of Reykjavík and the
nearby towns. The purpose of merging
the ports is to create a more comprehensive and dynamic company in a new
competitive environment and to enhance
operating efficiency and ensure good and
efficient service in all our ports.
The Old Harbour, in the heart of Reykjavík, still has a maritime role. Small
cruise ships (up to 170 metre long)
can berth and the west side is used
for fish handling. However, its future is
dependent on the cultural and social life
of the city.
Figure 1: The port of Reykjavík
Large cruise ships berth and cargo is handled in the Sundahöfn harbour complex,
east of the city centre. Here, Iceland’s two
largest shipping companies, Eimskip and
Samskip, operate major container terminals and offer warehousing and logistics
support. Associated Icelandic Ports (AIP)
has developed the Sundahöfn to maximise its potential. Reclamation work has
been carried out to free up additional land
for container handling. A new 450 metre
multipurpose quay, the Skarfabakki, was
opened in 2007 and a new 25-hectare
container storage area, linking the terminals of Eimskip and Samskip, was completed in 2011.
In 2012, 82 cruise ships berthed in
Reykjavík harbour, 15 berthed in the old
harbour and 67 in Sundahöfn, and these
Figure 2: The older part of Port of Reykjavík
SHIPSAN NEWSLETTER Issue No 2. June 2013
Figure 3: Sundahöfn in Port of Reykjavík
brought a total of 90 thousand passengers. The majority of cruise ships stop
for 1-2 days and 70% of the passengers
take sightseeing tours.
In 2012 the total of 1471 ships over 100
ton stopped in the harbour:
•
•
•
•
•
685 fishing ships(100-5,000 tons)
448 cargo ships (100-15,000 tons)
93 research – and coast control ships
158 fuel-tank ships
82 cruise ships
Service
Two major shipyards operate within the
AIP ports network, providing marine services for ship owners – particularly in the
fishing sector – as well as non-marine
work for land-based customers. Ship
inspections according to the International Healthcare Regulation (WHO) are
provided upon requests. Providing bunker fuel and lubricants is a key activity for
Reykjavík in its role as a total maritime
services centre. Reykjavík is the North
Atlantic’s No 1 bunkering centre. It is
also a storage and distribution hub for
petroleum products for the home market. The port has major storage facilities
at Örfirisey, near the Old Harbour. This
allows direct bunkering of vessels calling Reykjavík and the numerous depots
in other parts of Iceland. Reykjavík has a
total storage capacity of about 115,000
cubic metres. Its facilities are used by
the three main supply companies –
Olíufélagið, Olíuverslun Íslands (Olís) and
Skeljungur – offering a wide choice of
grades for vessels of all sizes, from fishing boats to large cruise ships. A bunker
barge of 500,000 litres capacity is operated from Örfirisey by Olíudreifing, a joint
venture between Olís and Esso. Many
foreign fishing vessels use Reykjavík as
their bunker port because of its convenient location.
http://www.faxafloahafnir.is/faxafloahafnir/en
10