Newsletter.

ISSN Number: 2241-5211

Editor:Dr Martin Dirksen-Fischer, Germany

Editorial Board:Prof Christos Hadjichristodoulou, GreeceDr Barbara Mouchtouri, GreeceDr Gordon Nichols, United KingdomDr Angel Kunchev, BulgariaDr Thorolfur Gudnason, IcelandDr Maurice Mulcahy, IrelandDr Carmen Varela Martinez, SpainDr Rimantas Pilipavicius, Lithuania

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: September 2016

To subscribe or unsubscribe please contact us on: info@shipsan.eu

Disclaimer: 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 Consumers, Health, Agriculture and Food Executive Agency (CHAFEA) is not responsible for any use that may be made of the information contained therein.

Editorial Dr. Martin Dirksen-Fischer, Head of Hamburg Port Health Authority, Germany

Dear Readers,Once again: it is time for the newsletter. In this edition again, I am sure, you will find inspiring articles and you will meet inspiring people.

So let us start with the people: Read about my friend from Lithuania, Brigita Kairiene in the section: “People of the project”. The section “News from the leadership will inform you on the positive developments that the Joint Action is taking, also reporting on a visit to the European commission recently, concerning Zika. “Public health risks can be controlled by a variety of means”. Our colleague Martin Walker reminds us in his new article of this well known sentence. Read yourself about the solutions he discusses when meeting by-passes. Good reading like always. Also from Great Britain we find an article from Alison Jones on the regulation applying concerning radioactive goods transported by ships. It is useful to be remembered about the legislation applying.

A special section in the newsletter that I always like is on the different ports. Take the chance to visit Venice this time. There has been some turmoil about cruise liners appearing in that city for sure.

Again it is wise to make yourself aware of the new literature in the field, for instance an article from ports in Barbados, reporting about attack rates of gastrointestinal diseases and influenza.

The major event of the SHIPSAN community this year is still coming up: The final conference in September in Rhodes, Greece. We will all discuss future perspectives of the project there. See you there!

Yours M.DF

News from the leadershipProf. Christos Hadjichristodoulou, SHIPSAN ACT Joint Action Coordinator Dr Barbara Mouchtouri, SHIPSAN ACT Joint Action Manager

During the last two months, representatives of the EU SHIPSAN ACT had the opportunity to attend two meetings organised by the European Commission DG SANTE with regards to the Zika Virus outbreak:

• On 20–21 June 2016, the EC DG SANTE held a meeting with repre-sentatives from the transport sector to discuss their preparedness with regards to the Zika virus outbreak. SHIPSAN informed the EU representa-tives that the Joint Action has provided guidance for ship operators. (Further information regarding the meeting is available here: http://ec.europa.eu/health/preparedness_response/docs/zika_ev_20160620_flash_en.pdf)

• Another meeting followed titled “Zika vector control measures in the EU” organised by DG SANTE in Luxem-burg on the 8th of July 2016. In this

meeting, the Head of Unit “Crisis management and preparedness in health” gave a presentation on the EU activities in response to Zika and ECDC presented the state of the epi-demic, risk for Europe, overview of vectors and their control. An overview of the methods of mosquito control as well as the availability, efficiency and regulatory aspects of insecticides was

News from the leadership

Thematic sections• Environmental health and

hygiene on ships: Promoting Alternative Solutions

• Occupational health on ships: Results of the expert meeting on Inland-navigation in Hamburg, Germany at the 24th of June

• Chemical and radiological issues on ships: International legislation for the carriage of dangerous goods on ships

People from the project:• Brigita Kairiene

News and forthcoming dates

What’s new on the website?

Recent Publications

Port in focus• Venice, Italy

In this issue…

Issue No 21. June 2016

“the availability, efficiency and regulatory aspects of insecticides was presented.”

SHIPSAN NEWSLETTER Issue No 21. June 2016 2

Thematic Sections

News from the leadership continued

The WHO Technical Handbook1 should be well known to inspectors by now. However, experience of it’s application is likely to vary as it is relatively new and there is a huge challenge in terms of the numbers of ports and inspectors to train around the world. Although the technical aspects of the handbook are invaluable during inspection, it is easy to forget the general messages given to inspectors in Part A “Inspection System Requirements” of the handbook. Paragraph 5 “Control Measures” makes it clear that “Public health risks can be controlled by a variety of means.” In addition, “The Competent Authority should enforce reasonable and practical control measures, according to the risk assessment.” The same approach should be applied to non-compliances that could be deemed to require “corrective actions” under the handbook. I was reminded at a recent UK course that we could apply this approach in relation to bypasses of disinfection units.

Environmental health and hygiene on ships: Promoting Alternative SolutionsMartin Walker, Port Health Officer, Suffolk Coastal Port Health Authority, Felixstowe, England

presented. EUMS representatives gave an overview of the vector control methods in the field and SHIPSAN and AIRSAN gave a presentation titled “Vector control at ports of entry”. (Further information regarding the meeting is available here: http://ec.europa.eu/health/preparedness_response/docs/zika_ev_20160708_flash_en.pdf)

The activities of the EU SHIPSAN ACT Joint Action are progressing rapidly:• EU SHIPSAN ACT Information System (SIS): The upgraded

version of SIS has been released and is accessible on the following link. https://sis.shipsan.eu

• The short notice (48hrs) inspections on passenger ships sailing in EU on an international voyage are now conducted in according with the 2nd Edition of the Euro-pean Manual for Hygiene Standards and Communicable Disease Surveillance.

• All public health officers that conduct inspections in accord-ance with the pre-agreed European Schedule for Routine Inspections on passenger ships have been given access to the new e-learning course titled “Inspections of passenger ships in accordance with the European Manual for Hygiene Standards and Communicable Diseases Surveillance”.

• Evaluation: As we informed you in the previous issue, a meeting was held in June 2016 in Athens where the evaluation team had the opportunity to discuss the final evaluation questionnaires. The evaluation is an important process of the Joint Action and allows the partnership to assess the processes, outputs and outcomes of the Joint Action. Evaluation questionnaires assessing different aspects of the work completed were disseminated to the stakeholders and results will be presented at the Final conference in September 2016.

A common finding

One of the more common findings on board vessels, particularly cargo vessels is that of a “bypass” which allows water to bypass the potable water disinfection treatment. Indeed, non-conformances relating to potable water safety in general are the second most common class of findings by SHIPSAN ACT inspectors2. On the face of it, it is an inspection finding with a straightforward solution according to the WHO Technical Handbook. How-

ever, the question as to whether it is the only (and also most appropriate) remedy was raised during a recent UK training course and so are there alternative solu-tions that can and should be applied?

Hazards of Bypasses

Bypasses are most commonly found where there is a physical point of disin-fection. A typical example could be to an Ultra-Violet (UV) disinfection unit. The principle purpose is to allow for ease of

maintenance (for example when the UV tube needs to be cleaned or replaced). The difficulty of course, is that when potable water is diverted past the treat-ment unit, it may not be receiving any disinfection treatment at all. If UV is the only form of treatment (common on cargo ships), it also provides no residual treat-ment. There are also other hazards in terms of stagnant water and sedimenta-tion building up within the divert pipes.

Corrective Actions

The WHO Technical Handbook seems quite clear in it’s position as regards bypass piping. Paragraph 9.8.10 has a requirement that Bypass piping is removed. Similarly, the WHO Guide to

Key message:

The scope for alternative solutions to non-compliances when using the WHO handbook, using bypasses as an example.

SHIPSAN NEWSLETTER Issue No 21. June 2016 3

Thematic Sections continued

Ship Sanitation3 goes further to state that “bypass around UV devices is neither allowed nor useful because of the increased risk of contaminating the whole system”. Certain Flag State rules also seem to indicate that bypass pip-ing around automatic disinfection units is not permitted, for example UK Marine Guidance Notes4,5. However the word “should” appears in certain sections which implies there can be discretion in interpretation. Other registries6 do not seem to have specific mention of bypass piping, but there is an overriding requirement for safe potable water under the Maritime Labour Convention 20067. Nevertheless, bypass piping is extremely common on cargo vessels, even new build vessels. Why is this and what alter-natives may there be?

Risk Assessment and Legal Positions

Ultimately, one of the problems with trying to apply any form of prescriptive stand-ard is that there can be a large number of variables that can challenge the need for a single solution. It is therefore helpful to consider the overall aim of what you are trying to achieve. With potable water, it is to ensure that the health of crew and passengers on board the vessel is protected. There may be multiple ways of achieving this aim.

For example, as mentioned in previous newsletter articles, one of the key attrib-utes of inspectors is the need to be able to Risk Assess. Here, a bypass around a UV disinfection unit may present a lower risk if the unit is providing a secondary

means of disinfection than if it is the only form of disinfection. What would be the effects of removing that bypass when maintenance needs to be carried out and a water supply is still required to be maintained? Short shut-offs of the water supply may not be a problem during maintenance activities such as changing the UV lamp.

If removal of the divert is not possible/practical or is resisted by the Captain/Ships representatives, what alternatives may there be? Could a second treatment unit be applied to the bypass? Advan-tages could be that supplies will always be maintained during maintenance (especially if extended). However, there are additional costs, the need to ensure

that supplies through both units are changed frequently to ensure that water does not stagnate in one set of pipes (as a deadleg could inadvertently have been formed). Could alternative treatment be supplied (e.g. chlorination) during the period of maintenance? This could be an alternative during use of the bypass but assessment of the Ships Water Safety Plan, particularly what processes and procedures are in place for Public Health protection is going to form a major part of an inspectors risk assessment.

Conclusions

Ultimately, the task for inspectors is to achieve a balance between public health protection and avoiding excessive or unnecessary measures. Whilst the con-trol measures and corrective actions in the technical handbook is useful in this respect, inspectors need to bear in mind the possibility of alternative solutions that may achieve the same aim. When such decisions are taken, it is a little known fact that the Evidence Report Form (ERF) can be used to provide addi-tional justification to be recorded by an inspector as to how and why they came to particular conclusions. The greater space afforded in the ERF allows for such free text.

References:

1 Handbook for Inspection of Ships and Issuance of Ship Sanitation Certificates”; World Health Organisation, http://www.who.int/entity/ihr/publications/handbook_ships_inspection/en/index.html

2 “SHIPSAN ACT Inspection results 2013–2014” – SHIPSAN ACT Webinar presentation, “The art of inspection”, Barbara Mouchtouri, DLSHTM, MSc, PhD

3 “Guide to Ship Sanitation” (third edition); World Health Organisation, http://www.who.int/water_sanitation_health/publications/2011/ship_sanitation_guide/en/

4 “Marine Guidance Note 525 (M+F) Amendment 1 Guidelines for the Provision of Food and Fresh Water on Merchant Ships and Fishing Vessels”, Maritime and Coastguard Agency, United Kingdom https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/445615/MGN_525_Amd_1.pdf

5 “Shipping Notice 07/2014 MARITIME LABOUR CONVENTION 2006 – REQUIREMENTS AND GUIDANCE FOR THE PROVISION OF FOOD AND FRESH WATER AND TRAINING REQUIREMENTS FOR CATERING STAFF ON SHIPS”, Cayman Maritime, http://www.cishipping.com/portal/page/portal/srghome/survey/shippingnotices/2014/SN%2007-2014/2014_07_CISN_R1.pdf

6 “The Panama Registry, Merchant Marine Circulars Reference Guide”, http://www.segumar.com/circulars/

7 “Maritime Labour Convention, 2006”, International Labour Conference, http://www.ilo.org/wcmsp5/groups/public/@ed_norm/@normes/documents/normativeinstrument/wcms_090250.pdf

Bypass piping – helpfully labelled!

SHIPSAN NEWSLETTER Issue No 21. June 2016 4

Thematic Sections continued

The experts agreed that there is a rela-tively small amount of literature gathered about this industry and its problems. This is for instance also true for the problems in the field of infectious diseases that can be obtained, for instance while taking a cruise. So it was more than welcome to learn from one of the working examples in the field where different countries work together successfully. This is the case in the Rhine region, involving Switzerland, France and Germany. Dr. Pfaff, a long-time activist in this field reported on this. Also, positive results were reported from the Danube region, involving Germany, Austria, Hungary, Slovakia and Hungary (Mister Gottinger).

One has to be aware of the fact that the inland water navigation industry differs quite a bit from those companies that offer long-distance cruising on the open sea. For instance, one will find smaller companies and not all of them comply with the standards. As we found out in the SHIPSAN ACT Joint Action on inland navigation, the controls of ships and standards within Europe differ widely. Especially the experts where interested to hear that the communication in times

of outbreaks are rather difficult in some regions and in some circumstances. The experts in Hamburg agreed that it is utterly important to develop standards in this field of ship hygiene in the field of inland navigation and that it must be made sure that these standards are well controlled thereafter. For sure – there is an important part for the DGMM and its partners like the SHIPSAN ACT Joint Action to be played in this field.

The SHIPSAN ACT Joint Action can rely heavily on the knowledge gained concerning maritime cruise liners.

The experts also heard talks on the issue of occupational health and inland navigation. For instance, some of the requirements for today’s workforce seem to be outdated. A more rigorous and science-based process is needed to install new standards. This report will not try to include all aspects of the meeting. Of course – the experts also heard talks on the psycho-social stressors and how to cope with them and the dangers of accidents. One has to accept the fact

that the crews in inland navigation are rather small, consisting of 2 to 4 people. These crews will have to manage with all the aspects of their ships.

In the future the DGMM will develop a working program to tackle some of the problems mentioned above. It is good to know that this society (to which I belong) has friends like SHIPSAN and also institutional partners like the Institute for occupational and maritime health at Hamburg University. The head of this institution, Volker Harth offered his will-ingness to work together in this field. The head of the DGMM (Mister Seidenstücker) has to be thanked for their willingness to support this important initiative. For the moment we would be more than thankful for your further suggestions what seems important in this evolving field.

As mentioned in the last newsletter we had an expert workshop under the auspices of the Deutsche Geselschaft für maritime Medizin (German society of maritime medicine).

Occupational health on ships: Results of the expert meeting on inland-navigation in Hamburg, Germany at the 24th of JuneDr. med. Martin Dirksen-Fischer, Institute for Hygiene and Environment, Hamburg, Germany

“It is utterly important to develop standards in this field of ship hygiene…”

SHIPSAN NEWSLETTER Issue No 21. June 2016 5

Thematic Sections continued

The occurrence of radiological incidents on a ship (i.e. the exposure of individuals to radioactive material) which has the effect of causing a public health threat is rare. The transport of radioactive material by sea is rigorously regulated to ensure that potential risks are minimised. Any shipments of radioactive material by sea must comply with international and national regulations of the originating country and also the country of destination. The figure depicts the flow from international to national legislation that governs the transport of radioactive material and explained in the text below.

Chemical and radiological issues on ships: International legislation for the carriage of dangerous goods on shipsAlison Jones, Public Health England, Centre for Radiation, Chemical and Environmental Hazards

The transport of radioactive material by sea is rigorously regulated to ensure that potential risks are minimised. Any ship-ments of radioactive material by sea must comply with international and national regulations of the originating country and also the country of destination. The figure depicts the flow from international to national legislation that governs the transport of radioactive material and explained in the text below.

The main international regulations for the control of radioactive material dur-ing transport are the Regulations for the Safe Transport of Radioactive Materials issued by the International Atomic Energy Agency (IAEA, 2012). The IAEA regula-tions establish standards of safety for all modes of transport (air, sea, road and rail) such that hazards to people and the envi-

ronment are controlled to an acceptable level. They set out requirements for activ-ity levels and classification, requirements and controls for transport, packaging, consignors shipping documents and give guidelines on segregation and stowage. The United Nations (UN) has also issued Recommendations on the Transport of Dangerous Goods (United Nations, 2015), which give model regulations on the transport of dangerous goods aimed at providing a basic scheme for the development of national and international regulations governing the various modes of transport. For the transport of radio-active material the UN recommendations adopt the safety requirements as given in the IAEA regulations.

The International Maritime Organisa-tion (IMO) has also established codes for

the safe transport of packaged hazard-ous materials by sea. The principal code issued by IMO is the International Mari-time Dangerous Goods (IMDG) Code 2012 (IMO, 2014). This code set standards for shipping papers, marking, labelling, plac-arding, stowing, segregation and other handling requirements. The IMDG also incorporates the IAEA regulations for the safe transport of radioactive material.

National legislation is developed from these regulations. For example, in the UK the Merchant Shipping (Dangerous Goods and Marine Pollutants) Regula-tions, (UK Parliament, 1997) and The Dangerous Substances in Harbour Areas Regulations (UK Parliament, 1987) make provisions for the carriage of dangerous goods based on the IAEA and IMO codes and standards.

References:

IAEA (2012). Regulations for the safe transport of radioactive material 2012 Edition. IAEA, Vienna, SSR-6.

IMO (2014). IMDG Code: International Maritime Dangerous Goods (IMDG) Code. I. M. Organisation, IMO Publishing, London, 2014 Edition.

UK Parliament (1997). The Merchant Shipping (Dangerous Goods and Marine Pollutants) Regulations. SI 1997 No. 2367. Department for Transport

UK Parliament (1987). The Dangerous Substances in Harbour Areas Regulations 1987. No. 37. Health and Safety Executive

United Nations (2015). Recommendations on the Transport of Dangerous Goods, Model Regulations. U. Nations, New York and Geneva, ST/SG//AC. 10/1/Rev. 19.

SHIPSAN NEWSLETTER Issue No 21. June 2016 6

News and events

EU SHIPSAN ACT forthcoming events:

Other forthcoming events:

Final Conference and 2nd General Assembly Meeting

The rapid rise of New Microbiological Techniques

The EU SHIPSAN ACT Final Conference and 2nd General Assembly Meeting will be held on the 27th and 28th of September 2016, respectively in Rhodes, Greece.

The aim of the Final Conference is to present the results and the impact and added value of the EU SHIPSAN ACT Joint Action in preparedness and response to Public Health Events of International Concern (PHEIC), enhancement of capacities in regards to maritime transport and health threats. Additionally, scientific sessions will be held presenting research developments for maritime health and hygiene.

After the Final Conference, on the 28th of September, the General Assembly of the EU SHIPSAN ACT Joint Action consisting of officially assigned representatives from the Ministries of Health of 24 EUMS will come together to discuss the sustainability of the Joint Action activities.

Further information and a preliminary agenda is available here: http://www.shipsan.eu/Home/NewsandEvents/TabId/116/ArtMID/527/ArticleID/93/EU-SHIPSAN-ACT-Joint-Action---Final-Conference.aspx

When: 27th and 28th September 2016 Where: Rhodes, Greece

When: 24th November 2016 Where: London, UK

QuizAuthor: Fernando del Hierro Vega, Director, Ministerio de Hacienda y Administraciones, Spain

QUESTION:The Adventures of Tintin is a series of 24 comic albums created by Belgian cartoonist Georges Remi, who wrote under the pen name Hergé. The series was one of the most popular European comics of the 20th century.

What is the title of the album where a cargo ship named “Pachacamac” was kept in quarantine by the Callao Port Health Authority in Peru because of two cases of bubonic plague?

Please send your answers to: info@shipsan.eu

www.facebook.com/shipsan.eu

twitter.com/shipsan_eu@shipsan_eu

What’s new on the website? www.shipsan.eu

Leaflet for port health officersA new leaflet for port health officers is available for download from the EU SHIPSAN ACT website. The leaflet describes the inspection and information system tools provided by EU SHIPSAN ACT.www.shipsan.eu/Home/Newsand Events/TabId/116/ArtMID/527/ ArticleID/92/A-new-leaflet-for-port-health-officers-is-available-for-download.aspx

“The aim of the Final Conference is to present the results and the impact and added value of the EU SHIPSAN ACT Joint Action in preparedness and response to Public Health Events of International Concern (PHEIC)…”

SHIPSAN NEWSLETTER Issue No 21. June 2016 7

Persistence and Elimination of Human Norovirus in Food and on Food Contact Surfaces: A Critical Review

Cook N, Knight A, Richards GP.J Food Prot. 2016 Jul; 79(7):1273-94.

Abstract

This critical review addresses the persis-tence of human norovirus (NoV) in water, shellfish, and processed meats; on ber-ries, herbs, vegetables, fruits, and salads; and on food contact surfaces. The review focuses on studies using NoV; information from studies involving only surrogates is not included. It also addresses NoV elimi-nation or inactivation by various chemi-cal, physical, or processing treatments. In most studies, persistence or elimination was determined by detection and quan-tification of the viral genome, although improved methods for determining infec-tivity have been proposed. NoV persisted for 60 to 728 days in water, depending on water source. It also persisted on ber-ries, vegetables, and fruit, often showing <1-log reduction within 1 to 2 weeks. NoV was resilient on carpets, Formica, stain-less steel, polyvinyl chloride, and ceramic surfaces; during shellfish depuration; and to repeated freeze-thaw cycles. Copper alloy surfaces may inactivate NoV by damaging viral capsids. Disinfec-tion was achieved for some foods or food contact surfaces using chlorine, calcium or sodium hypochlorite, chlorine dioxide, high hydrostatic pressure, high tempera-tures, pH values >8.0, freeze-drying, and UV radiation. Ineffective disinfectants included hydrogen peroxide, quaternary ammonium compounds, most ethanol-based disinfectants, and antiseptics at normally used concentrations. Thorough washing of herbs and produce was effec-tive in reducing, but not eliminating, NoV in most products. Washing hands with soap generally reduced NoV by <2 log. Recommendations for future research needs are provided.

Recent publications

Development of software for handling ship’s pharmacy

Nittari G, Peretti A, Sibilio F, Ioannidis N, Amenta F.Int Marit Health. 2016;67(2):72-8.

Abstract

BACKGROUND: Ships are required to carry a given amount of medicinal products and medications depending on the flag and the type of vessel. These medicines are stored in the so called ship’s “medicine chest” or more properly – a ship pharmacy. Owing to the progress of medical sciences and to the increase in the mean age of seafarers employed on board ships, the number of pharmaceutical products and medical devices required by regulations to be carried on board ships is increasing. This may make handling of the ship’s medicine chest a problem primarily on large ships sailing on intercontinental routes due to the difficulty in identifying the correspond-ence between medicines obtained abroad with those available at the national market. To minimise these problems a tool named Pharmacy Ship (acronym: PARSI) has been developed.

MATERIALS AND METHODS: The application PARSI is based on a database contain-ing the information about medicines and medical devices required by different coun-tries regulations. In the first application the system was standardised to comply with the Italian regulations issued on the 1st October, 2015 which entered into force on the 18 January 2016.

RESULTS: Thanks to PARSI it was possible to standardise the inventory procedures, facilitate the work of maritime health authorities and make it easier for the crew, not professional in the field, to handle the ‘medicine chest’ correctly by automating the procedures for medicines management. As far as we know there are no other similar tools available at the moment. The application of the software, as well as the automa-tion of different activities, currently carried out manually, will help manage (qualitatively and quantitatively) the ship’s pharmacy.

CONCLUSIONS: The system developed in this study has proved to be an effective tool which serves to guarantee the compliance of the ship pharmacy with regulations of the flag state in terms of medicinal products and medications. Sharing the system with the Telemedical Maritime Assistance Service may result in avoiding mistakes in drug administration. Last but not least the availability of PARSI could help reduce/ avoid problems with maritime health authorities in case any of the required medicinal products are missing.

“Copper alloy surfaces may inactivate NoV by damaging viral capsids.”

SHIPSAN NEWSLETTER Issue No 21. June 2016 8

Recent publications continued

An epidemiological study of rates of illness in passengers and crew at a busy Caribbean cruise port

Marshall CA, Morris E, Unwin N. | BMC Public Health. 2016 Apr 12;16(1):314

Abstract

BACKGROUND: The Caribbean has one of the largest cruise ship industries in the world, with close to 20 million visitors per year. The potential for communicable disease outbreaks on vessels and the transmission by ship between countries is high. Barbados has one of the busiest ports in the Caribbean. Our aim was to describe and analyse the epidemiology of illnesses experienced by passengers and crew arriving at the Bridgetown Port, Barbados between 2009 and 2013.

METHODS: Data on the illnesses recorded were extracted from the passenger and crew arrival registers and passenger and crew illness logs for all ships and maritime vessels arriving at Barbados’ Ports and passing through its territorial waters between January 2009 and December 2013. Data were entered into an Epi Info database and most of the analysis undertaken using Epi Info Version 7. Rates per 100,000 visits were calculated, and confidence intervals on these were derived using the soft-ware Openepi.

RESULTS: There were 1031 cases of illness from over 3 million passenger visits and 1 million crew visits during this period. The overall event rate for communicable illnesses was 15.7 (95 % CI 14.4–17.1) per 100,000 passengers, and for crew was 24.0 (21.6–26.6) per 100, 000 crew. Gastroenteritis was the predomi-nant illness experienced by passengers and crew followed by influenza. The event rate for gastroenteritis among passengers was 13.7 (12.5–15.0) per 100,000 and 14.4 (12.6, 16.5) for crew. The event rate for non-communicable illnesses was 3.4 per 100,000 passengers with myocardial infarction being the main diagnosis. The event rate for non-communicable illnesses among crew was 2.1 per 100,000, the leading cause being injuries.

CONCLUSIONS: The predominant illnesses reported were gastroenteritis and influenza similar to previous published reports from around the world. This study is the first of its type in the Caribbean and the data provide a baseline for future sur-veillance and for comparison with other countries and regions.

People from the projectBrigita Kairienė

Klaipeda Department of National Public Health Centre under the Ministry of Health, Lithuania

International Health Regulations (2005) – Third edition

Overview

The 3rd edition of the International Health Regulations (2005) is now available. This edition includes the text of World Health Assembly resolution WHA58.3, the amended version of Annex 7 concerning period of protection of vac-cination against yellow fever, and validity of related certificates that entered into force on 11 July 2016, the Health Part of the Aircraft General Declaration that entered into force on 15 July 2007, and appendices containing an updated list of States Parties and State Party reserva-tions and other communications in con-nection with the IHR (2005).

http://www.who.int/ihr/publications/ 9789241580496/en/

I am Brigita Kairienė from Klaipeda, the only one seaport of Lithuania. I was born, grew up, studied, made a family and am bringing up two daughters here.

In 2003, I started to work in Klaipeda Public Health Centre as information analysis special-ist in Department of Public Health Program and Analysis. A year later, I became a Head of this unit and my main responsibilities were statistics and analysis of non-infectious dis-eases and preparation and implementation of public health programs and analysis. In 2007, after the reform of public health in Lithuania, these functions moved to another institution and at the same time, I left on Maternity leave for 5 years.

I came back to Klaipeda Public Health Centre in 2012 and in the beginning of 2013, I started my career in Department of Infectious Diseases Prevention and Control. In March 2016, I became a Head of this unit. From the 1st of April 2016, all public health centres in Lithuania were connected and new institution – National Public Health Centre with its ter-

ritorial departments started its activities. From that day, I am Head of Department of Infectious Dis-eases Management at Klaipeda Department of National Public Health Centre.

My first acquaintance with SHIPSAN was in 2006. After a break, from 2013 I continue my active participation in SHIPSAN ACT activi-ties. I was involved in WP 9 working group for the development of risk assessment tool for occupational risks in cargo ships and in other activities: webinar, dissemination of the project and its results and etc.

Besides, in 2010, I have finished Kaunas University of Medicine and got my Master Diploma of Public Health. In addition, I have a Master of Social Geography.

Hope that activities of SHIPSAN Act will continue even after the end of this project. And look forward to see all of You in new Joint Action.

SHIPSAN NEWSLETTER Issue No 21. June 2016 9

A fascinating city which nevertheless acted as the Mediterranean’s cultural and business capital for centuries, at the heart of all commercial traffic to and from the mainland and the ideal centre of the known world.

For centuries the sea and the port has been the biggest resource for Venice. The particular city has been for long time the queen of the seas with international magnitude: the Venetian Lagoon has always been the focal point where the Mediterranean goes deeper into the heart of Europe. Due to its strategic position Venice has been able to get advantage and profit, opening itself and its lagoon to ships and goods. In the eighteenth century the port gravitated between the basin of San Marco and the Zattere area;

At the beginning of the twenty-first century, Venice had an efficient cargo terminal on the mainland (an important European gateway for trade flows to and from Asia) and a Passenger terminal at the entrance of the Venice island.

The Port of Venice’s strengths

The Port of Venice is one of the major Euro-pean ports for project and general cargo, and one of the main ports in the Adriatic for the number of containers handled.

In addition, it ranks as the first cruise homeport in the Mediterranean hosting 2 million passengers yearly.

A leader in many traffic segments, it is the only port in Italy to benefit from a river port providing freight transport by barge along the Po river.

A constantly developing port

In the Planning Period 2008–2011 the Port expected participations to enhance existing port infrastructure, to expand its facilities, to improve connections to road

Port in focus

Port of Venice, Italy Dr. Martina Negretto, Venice Port Health Authority Inspector, ItalyDr. Emilia Mancuso, Venice Port Health Authority Medical Officer, Italy

The port between 1890 and 1900

“The Port of Venice is one of the major European ports for project and general cargo and one of the main ports in the Adriatic…”

SHIPSAN NEWSLETTER Issue No 21. June 2016 10

Port in focus continued

and railroad connections, to dredge the port’s channels and for remediation and disposal of sludge.

The following are also in the pipeline to expand the port to facilitate its future development:• a new container terminal at Marghera;• a Motorways of the Seas terminal at

Fusina;• an off-shore terminal to enable access

to ships with a draught up to 20 metres and to keep oil-tankers out of the Venice lagoon.

The Port is very sensitive to environmental issues and is committed to many projects for reducing its environmental impact. A remarkable reduction of CO2 emissions is achieved by choosing Venice rather than a north European port to transport cargo between the Far East and Central Europe.

Terminals

Seven (7) commercial terminals, 1 pas-senger terminal and 19 other terminals form the Port of Venice. They handle any kind of traffic, from containers, to liquid and solid bulk, steel products, Ro-Ro/Ro-Pax, general and project cargo. The Port

of Venice is the only one in Italy having an inland waterways terminal.

Passenger terminal

The Venezia Terminal Passeggeri S.p.A. was founded in 1997 by the Venice Port Authority in order to manage and improve cruise traffic in the Port of Venice. The VTP operates in the Marittima, S. Basilio and Riva dei Sette Martiri areas which stretch over a surface altogether of more than 260,000m2 of which the Terminals occupy 47,267m2.

Other terminals

16 other companies operate a port terminal within the Port of Venice. They work on their own account, and are oil terminals and industries.

The Venice Port Authority and the welfare of seafarers and port workers

In addition to being committed to the social and economic advancement of the port’s infrastructures, the Venice Port Authority is well aware of its ethical responsibilities. As a result it ensures the inclusion of social considerations in its decisions and plans, and is especially committed to assuring the welfare of seafarers and port workers.

“A remarkable reduction of CO2 emissions is achieved by choosing Venice rather than a north European port to transport cargo…”

https://www.port.venice.it/it/il-porto.html

SHIPSAN NEWSLETTER Issue No 21. June 2016 11

Port in focus continued

Local Committee for the Welfare of Seafarers

The Venice Port Authority is a member of the Committee, established in Venice on 18 February 2009, to help coordinate Local Authorities and private associa-tions to identify and help solve problems faced by seafarers and port workers, regardless of their nationality, race, sex, religious beliefs, political opinion and social status.

Sources

The “National Committee for the Welfare of Seafarers” was founded in Rome on 5 May 2006 to promote the implementation in Italy of the ILO’s (International Labour Organisation) Consolidated 2006 Maritime Labour Convention, the first step towards the establishment of a universal code regulating maritime labour issues and the founding of Local Committees for the Welfare of Seafarers.

The crucial role of maritime work

Maritime transport has a crucial role in the world economy: consider that it accounts for 70% of total exchanges between the European Community and the rest

of the world. Within this context, people represent the crucial element to ensure quality and efficiency.

The aims of the Local Committee

The Committee’s aim is to encourage commitment and promote collaboration between institutions and the volunteer sector, acknowledging the crucial role of associations in ports in welcoming and helping seafarers as they transit through the port.

Venice Port and Airport Health Office

The USMAFThe Port and Airport Health Office (USMAF) is a local branch of the Ministry of Health. Its main task is to check the health and hygiene of food for human consumption that does not contain animal products, materials that will be used in contact with food, pharmaceutical products, cosmetics and all other goods originating from non-EU countries that could pose a potential health risk for individuals.

USMAF also checks the health of the environment on board ships in all the ports falling under its jurisdiction. It also issues a number of documents, includ-

ing health clearance documents for all ships hailing from non-European ports, ship sanitation control for all ships, and, for Italian ships only, it certifies that the water supply on board is potable and that the ship’s medicines cabinet is suitably equipped.

USMAF also makes available its doc-tors to supply the vaccinations required based on international health protocols and conducts the medical assessments needed to be included in the Italian List of Seafarers.

USMAF offices are located on Fonda-menta delle Zattere in Venice.

The Passenger PortAs far as longer-term developments are concerned, the port areas in the Venice city centre are involved in a project for the creation of a new city Gateway. A new link between the port and the city will contrib-ute to the regeneration of a large area, where several infrastructures will be built, specifically a directional and reception centre with a large garden-plaza, many shops, a conference centre, a hotel and a large garage for the Venetians and the port. This area is already directly linked to the city centre by a fast monorail service.

References:

https://www.port.venice.it/

https://www.port.venice.it/files/page/dovelaterragiraintronoalmare_2.pdf

“The port areas in the Venice city centre are involved in a project for the creation of a new city Gateway.”