Clara Schlaich

Occupational risks and challenges of seafaring.

Occupational Risks and Challenges of Seafaring: Marcus Oldenburg, et al. Department of Maritime Medicine, Institute for Occupational and Maritime Medicine, Germany—Seafarers are exposed to a high diversity of occupational health hazards onboard ships.

Estimating the Risk of Communicable Diseases aboard Cargo Ships

BACKGROUND International travel and trade are known to be associated with the risk of spreading communicable diseases across borders. No international surveillance system for infectious diseases on ships exists. Outbreak reports and systematic studies mainly focus on disease activity on cruise ships. The study aims to assess the relevance of communicable disease occurrence on cargo ships. METHODS Retrospective analysis of all documented entries to 49 medical log books from seagoing cargo ships under German flag between 2000 and 2008. Incidence rates were calculated per 100 person-years at sea. Case series of acute respiratory illness, influenza-like illness, and infectious gastrointestinal illness affecting more than two persons within 1 successive week were classified as an outbreak. Attack rates were calculated based on number of entries to the medical log book in comparison to the average shipboard population during outbreak periods. RESULTS During more than 1.5 million person-days of observation, 21% of the visits to the ships infirmary were due to presumably communicable diseases (45.8 consultations per 100 person-years). As many as 33.9 patients per 100 person-years sought medical attention for acute respiratory symptoms. Of the 68 outbreaks that met predefined criteria, 66 were caused by acute respiratory illness with a subset of 12 outbreaks caused by influenza-like illness. Attack rates ranged between 3 and 10 affected seafarers per ship (12.5&-41.6% of the crew). Two outbreaks of gastrointestinal illness were detected. DISCUSSION Respiratory illness is the most common cause of presumably communicable diseases aboard cargo ships and may cause outbreaks of considerable morbidity. Although the validity of the data is limited due to the use of nonprofessional diagnoses, missing or illegible entries, and restriction of the study population to German ships, the results provide guidance to ship owners and to Port Health Authorities to allocate resources and build capacities under International Health Regulations 2005.

Targeting Public Health Events on Ships

It is still deeply engraved in the collective memory of nautical personnel that health authorities in global ports focus on the transmission of yellow fever, plague, smallpox, and cholera. But the scope and purpose of the recently updated International Health Regulations 2005 (IHR 2005) 1 is much broader: health measures at ports now aim to prevent and control all kinds of public health threats from spreading internationally. Five years into the global implementation of the IHR 2005 we do recognize a great acceptance with the new scope and procedures, such as the Sanitary Ships Inspections. But we should not overlook that major challenges for an appropriate and effective response to health threats on ships remain. Under the legal framework of the IHR 2005, ships traveling in international waters must notify to the health authority any non‐traumatic illness aboard. Frequently, health events on ships are rather identified through informal sources or during the biannual ship sanitation inspections than by formal notification. The extent and reasons of underreporting health events on ships are not well studied. In many global ports notification of disease is neither enforced nor made technically easy (eg, publishing a contact). Shipmasters may fear retardation of their voyage, inappropriate responses or even penalties and therefore avoid notifications of disease. Probably the most detrimental reaction to the notification of disease on ships is the non‐response of competent health authorities: no ship visit, no phone call, no response at all. Surely this will not encourage the ships master to cooperate with notification requirements in the ports to follow. Even where functioning communication channels exist in ports, data collection does not result in a systematic evaluation in most countries. One well‐publicized exception to this lack of systematic surveillance on ships is the US Centers for Disease Control and Prevention Vessel Sanitation Programme … Corresponding Author: Clara Schlaich, MD, MPH, Hamburg Port Health Center, Institute for Occupational and Maritime Medicine, University Medical Center Hamburg‐Eppendorf, Seewartenstrase 10, Haus 1, Hamburg D‐20459, Germany. E‐mail: claraschlaich{at}jhu.edu