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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)., (Copyright © 2013 Elsevier Ltd. All rights reserved.)

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

Passenger ships carry a large number of people in confined spaces. A case of the new influenza A (H1N1) virus aboard a passenger ship is an expected event and would lead to rapid spread of the virus, if preventive measures are not in place. However, many cruise lines have detailed policies and procedures to deal with cases of influenza like illness (ILI). The EU SHIPSAN and SHIPSAN TRAINET projects include in their objectives guidelines for the prevention and control of communicable diseases aboard passenger ships. A literature review showed that from 1997 to 2005, nine confirmed outbreaks of influenza were linked to passenger ships, with attack rates up to 37%. It is important to establish and maintain a surveillance system for ILI aboard passenger ships, in order to systematically collect data that can help to determine the baseline illness levels. Monitoring these will enable early identification of outbreaks and allow timely implementation of control measures.