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Injuries involving chemicals occur aboard merchant ships, since such agents are carried commonly on board either as cargo or as needed for running the ship. In case of events involving chemicals, the crew may seek advice from the Medical First Aid Guide for Use in Accidents Involving Dangerous Goods published by the International Maritime Organization. The Guide is currently under revision. To improve knowledge of what is relevant in such a guide, a study was undertaken to identify all intoxications and corrosive incidents occurring aboard Danish merchant ships.A retrospective study of all intoxications and corrosive incidents reported to the Danish Maritime authorities between 1988 and 1996.A total of 177 injuries were identified, of which 66 were systemic poisonings and 111 were due to corrosive damage to the eyes and skin. Thirteen of 66 systemic poisonings were fatal and almost three out of four corrosive injuries involved the eyes.This study and others show that the majority of injuries aboard merchant ships involving dangerous goods are amenable to first aid and symptomatic measures. Specific antidotes seem to have a limited role aboard merchant ships.

The purpose of the study was to assess the incidence and relative risk of hepatitis A and B and tuberculosis among Danish merchant seamen. We also assessed the occurrence of malaria. The study was based on record linkage of a research database containing data on 24,132 Danish male seamen and the Registry for Notifiable Infectious Diseases in Denmark, supplemented by data from other sources. The standardized incidence ratio (SIR) for hepatitis A for male seamen was 1.77 (0.91-3.10) as compared with the incidence in the general population. The incidence was 0.9 notified cases/10,000 years. The SIR for hepatitis B for male seamen was 3.02 (1.79-4.78), the main risk factors being intravenous drug use and casual sex abroad. Tuberculosis was not more common among seamen than in non-seamen. The results have implications for vaccination strategies in this occupational group. Malaria occurred frequently in the seamen, especially among those involved in West African trade. Irregular use of malaria prophylaxis and probably chloroquine resistance were of importance in some cases. To detect further cases of hepatitis A and B and malaria, other sources were reviewed. Only a few extra cases were identified. The registry of notifiable infectious diseases was thus found to be rather complete.

Seamen constitute a special group of international travellers who may run an increased risk of contracting hepatitis, because of visits to foreign ports and the particular environment on board ship. The purpose of the survey was to assess the prevalence of serological markers for hepatitis A, B and C virus infection among seamen and to identify present and previous risk factors for infection. 515 seamen were studied. The prevalence of antibodies against hepatitis A was 0.3% in subjects below 40 years of age, increasing with age above 40 years, and highest among those who had sailed in international trade. The prevalence of antibodies against hepatitis B was 2.7% in subjects below 40 years of age, increasing to 35.7% in the group above 60 years of age. Hepatitis C antibodies occurred in 1.2%. Vaccination of sailors against hepatitis A should follow the same recommendations as to other travellers. The prevalence of hepatitis B was higher than in reference groups of non-seamen but, because hepatitis B is only one of many blood-borne diseases, prevention should be directed towards changes in behaviour rather than vaccination, except for special groups. Young seamen in international trade were found to be most at risk of contracting sexually transmitted diseases.

For centuries, tuberculosis has been identified as a burden to seafarers. In this study, we assessed the magnitude of tuberculosis among merchant seafarers today. Furthermore, we identified the most likely routes of M. tuberculosis transmission by the use of DNA fingerprinting. A database containing all culture-positive tuberculosis cases in Denmark in 1992-2003 was combined with a register on all seafarers and their employment periods aboard Danish ships. All strains of M. tuberculosis were analysed using DNA-subtyping. 64 cases of culture positive tuberculosis among seafarers were identified. The risk of tuberculosis among males was 1.51 (1.10-2.01) compared with the general population. Two of the 64 cases were likely to be shipping-related, 5 were possibly shipping-related, and 10 were less likely to be shipping-related. The remaining 47 cases were very unlikely to be shipping related. Including the 2 first categories, the incidence was 0.09 cases per 1000 y at sea. The excess risk of tuberculosis among active and former Danish seafarers is most probably due to infections acquired in Denmark. Despite multi-cultural crews aboard, including many from high-incidence countries, our study indicates that only limited transmission of M. tuberculosis takes place among crew aboard modern ships or during shore leaves.

Danish seafarers have an excess of life style related diseases where obesity may be a factor. Obesity may in itself be a safety issue at sea.The purpose was to study overweight among male seafarers and determine the consequences if a maximum Body Mass Index (BMI) for seafarers is decided.As part of the mandatory pre-employment health examination, height and weight of the seafarers are recorded and BMI calculated. From a register comprising all seafarers, basic information on each individual seafarer was obtained from the last employment period before the health examination. In this study, normal weight is defined as a BMI from 20 and up to 25, moderate overweight from 25 up to 30 and obesity from 30 and above.The study comprised 1257 male seafarers. There were statistically significant more overweight seafarers in all age groups compared to a reference group ashore. Among those between 45 and 66 years of age 0.7% had a weight below normal, 22.7% had normal weight and 76.6% had a weight above normal, while 30.9% of this age group was obese.The method is applicable as a tool for an objective description of seafarers' health profile in a national and an international perspective. Overweight is found to be common and may influence the health of the seafarers and shipboard safety. Fixed BMI limits for seafarers on Danish ships would result in loss of license and that would have major implications even if the limit is set high.

The purpose of this study was to estimate the minimal magnitude of the HIV problem among seafarers in Denmark. The material is based on case records from the 6 medical departments in Denmark that undertake treatment of HIV patients. Retrospectively, all case records of HIV infection among seafarers - and of their sexual contacts - have been identified. 33 seafarers with HIV infection or AIDS were identified; 17 had no other known risk factor than heterosexual contacts in high-endemic areas. These results show that HIV infections have entered into the heterosexual group of seafarers. HIV-infected seafarers are a risk group for carrying HIV infection into the heterosexual population in non-endemic areas. In 5 known cases, this has actually taken place in Denmark. The majority of the heterosexually infected seafarers were probably infected early in the AIDS era. We do not know if Danish seafarers are still acquiring HIV abroad.

In order to determine the prevalence of Cryptosporidium and other intestinal parasites, a household sample survey of children under 5 years old was carried out during the late dry season in 8 rural villages in southern Guinea-Bissau, West Africa. Cryptosporidium oocysts were found in 10 of 270 stool samples (3.7%), using a safranin-methylene blue staining method. Of these 10 children (age range 5-16 months), all non-Muslims, 6 had diarrhoea, giving a prevalence of 12.5% in 48 children with diarrhoea, compared with 1.8% in children without diarrhoea (P less than 0.001). The ethnic group with the highest prevalence (9.2%) also kept most domestic animals, and was the only group to keep cattle. Giardia lamblia was found in 16 children, and the overall prevalences of other enteric parasites were: hookworm, 21.7%; Strongyloides stercoralis, 7.4%; Ascaris lumbricoides, 6.9%; Trichuris trichiura, 4.4%; Entamoeba histolytica, 1.5%; and Taenia sp., 0.5%. The prevalence of cryptosporidiosis was highest in the age group 7-12 months, while for the other parasites it was highest in the oldest children. The prevalence of hookworm was highest (c. 50%) in the southernmost villages. No significant relationship was found between hookworm infection and anaemia.