EU SHIPSAN ACT Joint Action

International Workshop to Strengthen Core Capacity at Designated Points of Entry under

International Health Regulations

DG HEALTH & CONSUMERS PUBLIC HEALTH PROGRAMME 2008-2013

• Work plan 2012 for the second programme of Community action in the field of health (2008-2013) – 3.1.2.3. The Impact on Maritime Transport of health threats due to

biological, chemical and radiological agents, including communicable diseases

Acronym: SHIPSAN ACT Joint Action

Contract Number: 20122103

Duration: 39 Months (January 2013 - April 2016)

2008 - 2011

Situation analysis and needs assessment • Addressing passenger ships • State of the art: Communicable diseases & outbreaks from 1970 to 2006• EU MS categorised in 4 groups according to their capacity• Study: 32 countries and 176 authorities • Needs, gaps, legislation• Use experience of existing programmes • Manual for health and hygiene - outline

Joint Action for all types of threats in maritime transport• Cargo ships• Inland navigation vessels• Fishing vessels• Passenger ships

EU SHIPSAN ACT Joint Action - The history

Development of materials and establishment of training network • Manual for health and hygiene• Training network and pool of experts • Training material • Training modules for PHO & seafarers• EU SHIPSAN Integrated Program/pilot inspections• Web-based Communication Network

• 31 institutions from 23 countries were designated by their Ministries of Health

1. Austria2. Belgium3. Bulgaria4. Croatia 5. Cyprus6. Estonia7. France8. Germany9. Greece10.Iceland 11.Ireland

12.Italy13.Lithuania14.Malta15.Netherlands16.Norway17.Poland18.Portugal19.Romania20.Slovakia21.Slovenia22.Spain23.United Kingdom

EU SHIPSAN ACT Joint ActionThe partnership

To strengthen an integrated strategy and sustainable mechanisms at EU level for safeguarding the health of travelers and crew of passenger and

cargo ships and preventing the cross-border spread of diseases.

Facilitate the implementation of the EU legislation: • Decision No 1082/2013/EU of the European Parliament and of the council on

serious cross-border threats to health • Directive 2010/65/EU on reporting formalities for ships arriving in and/or

departing from ports of the Member States by supporting EMSA to implement MDH

• Directive 2009/13/EC based on ILO convention on occupational health by developing an outline of a risk assessment tool for occupational health on ships – OSHA-OiRa tool

Facilitate implementation of IHR:Supporting core capacities Annex 1b by training, inspections, contingency planning guidance and IHR provisions for conveyances and conveyance operators including SSC

Focus on: prevention, identification, assessment & link with existing mechanisms for response coordination to serious cross border threats to health caused by communicable diseases, chemical, biological and radiological agents.

SHIP

SAN

ACT

JAEU SHIPSAN ACT Joint Action – General objective

SHIPSAN ACT ACTIVITIES

WP1:Coordination

• Handbook• Operations plan for permanent

implementation• Interim and final technical and

financial reports

WP2:Dissemination

• Dissemination plan• Website, newsletter• Exit / Sustainability Plan

WP3:Evaluation

• Evaluation plan• Interim and final evaluation reports • Process and outcome indicators

Part A

• Literature review on infectious diseases on all types of ships.

Part B

• Literature review and survey on chemical and radiological incidents in maritime transport.

Part C

• Survey on hygiene inspection practices on fishing vessels in EU.

Part D

• Survey on training needs related to core capacities at points of entry-ports in EU.

Part E• Survey on

practices & responsibilities of port health authorities along inland waterways in EU.

Research:State of the Art report (WP4)

A five part report will be compiled, consisting of:

Draft available Draft Report

Survey results

Figure 8. Legionnaires’ diseases outbreaks by place of occurrence

Europe (Sea and rivers)

48%

Caribbean Sea 27%

Pacific Ocean10%

Trans At-lantic

5%

North America

5%

No data5%

Figure 1. Influenza outbreaks by types and subtypes. N=23

Influenza A (No subtype)

26%

Influenza A (H1N1)22%InfluenzaA (H3N2)

26%

In-fluen-zaA

(H1N1) and

(H3N2)4%

Influenza B9%

Influenza A and B

4%

Influenza virus9%

EU SHIPSAN ACT Joint Action. Draft State of the Art. Work Package 4: State of the Art ReportAuthors: R Palmera, J Pérez, F Nogareda, C Varela. INSTITUTO de SALUD CARLOS III – SPAIN. March 2014

Literature review and surveys for chemical or radiological events in all types of ships or at ports

Nuclear ships77%

Cargo ship15%

US SNN Guardfish8%

Figure 24. Radiological events by place of occurrence. N=13

Russian coast and ports54%

Atlantic Ocean15%

Mediterranean Sea8%

USA coast8%

No data15%

Figure 22. Radiological events by type of vessel. N=13

EU SHIPSAN ACT Joint Action. Draft State of the Art. Work Package 4: State of the Art ReportAuthors: R Palmera, J Pérez, F Nogareda, C Varela. INSTITUTO de SALUD CARLOS III – SPAIN. March 2014

Figure 25. Chemical events, with cases, by type of vessel. N=69

Cargo ships78%

Fishing vessels16%

No data1%

Nuclear submarine1%

Ore boat1%

Recreational boat1%

Figure 27. Chemical events, with cases, by type of chemical substances. N=69

Hydrogenades36%

Inorganics26%

Nitrosamines/Ethylen/Alcohol

14%

Mixture13%

Pesticides1%

Warfarer chemicals1%

No data7%

Training needs related to core capacities at the points of entry (ports) among the EU countries

Needs for training by level of importance for responding to events that may constitute Public Health Emergency of International Concern (PHEIC)

Knowledge of their national legislation and protocols to respond to events that may constitute a PHEIC

Establish and operate a contingency plan

Prompt assessment, care and isolation of affected travellers

Infection control on animals

Interviewing and first assessment of suspected travellers

Procedures to report to the competent authority for the point of entry

Quarantine of suspected travellers

Recognize disease symptoms

Application of recommended measures to disinsect, derat, disinfect or decontaminate

Application of entry of exit controls for arriving or departing travellers

Transport of suspected travellers

Γενικός τύπος Γενικός τύπος Γενικός τύπος

INTENSIVE MODERATE NONE

Number of countries

Train

ing I

tem

s PHE

IC -

IHR

2005

EU SHIPSAN ACT Joint Action. Draft State of the Art. Work Package 4: State of the Art ReportAuthors: R Palmera, J Pérez, F Nogareda, C Varela. INSTITUTO de SALUD CARLOS III – SPAIN. March 2014

• SHIPSAN ACT Joint Action will facilitate IHR implementation by:– Delivering European and national training courses focused on IHR (2005) and the issuance of

Ship Sanitation Certificate (SSC) by using the WHO Learning Programme– Running the web based SHIPSAN ACT information system for recording and issuing Ship

Sanitation Certificates

Inspections in all types of ships for SSCsStandards: WHO Handbook for inspection of ships and issuanceof Ship Sanitation Certificates

Tools: SHIPSAN ACT Information System for recording andissuing Ship Sanitation Certificates under theInternational Health Regulations 2005, for all types of ships sailing in EU. http://ssc.shipsan.eu

Integrated Inspection Programme

Information system for recording and issuing Ship Sanitation Certificates (SSC)

Integrated Inspection Programme

Functions Registries

• Ships• Owners• Agents• Classification Societies• Ports• Other Organizations/Authorities• Port Health Authorities• Inspectors

Overview page Inspection forms Messages Board News section Address Book Help tool Online user manual Advance Search Sitemap

Information system for recording and issuing Ship Sanitation Certificates (SSC)

Integrated Inspection Programme

Generation of an empty checklist, under the IHR 2005 Generation and print of official documents related with

the inspections Ship Sanitation Certificates (SSCC or SSCEC) Evidence Report

Functions Functions

Information system for recording and issuing Ship Sanitation Certificates (SSC)

Integrated Inspection Programme

Authorisation Different users and user groups

depending on the access level and authorization:

• System administrator• Shipsan administrators• Inspectors• International Organizations• National Authorities

Information system for recording and issuing Ship Sanitation Certificates (SSC)

Integrated Inspection Programme

A web-based system for port health officers or other public health worker conducting inspection for issuance of SSCs

To gain access visit http://ssc.shipsan.eu/ and complete an application form

Information system for recording and issuing Ship Sanitation Certificates (SSC)

Integrated Inspection Programme

•171 registered inspectors from 9 European countries •A total of 4273 Ship Sanitation Certificates have been issued and recorded in the SHIPSAN information system based on the WHO Handbook for inspection of ship and issuance of SSCs

Inspection Area Number of DeficienciesBallast water 6Cargo holds 14Child-care facilities 14Galley, pantry and service Areas

1192

Medical facilities 386Engine room 6Potable water 974Quarters 121Sewage 51Other systems and areas 44Solid and medical waste 67Stores 391Swimming pools and spas

17

Integrated Inspection Programme

Information system for recording and issuing Ship Sanitation Certificates (SSC)

European directory of authorised ports to issue Ship Sanitation Certificates under IHR 2005

• The contact details of the authorised ports of EU countries for issuing Ship Sanitation Certificates under IHR (2005) available via the EU SHIPSAN ACT Joint Action website.

• The aim is to create the first contact list for authorised ports of EU countries responsible for issuing Ship Sanitation Certificates under IHR (2005) that will:– facilitate port to port communication, – strengthen the network of port health officers in Europe and – further facilitate communication of the ship directly with the

appropriate port health authorities when desiring to ask for a Ship Sanitation Certificates renewal.

Integrated Inspection Programme

• PASSENGER SHIPS: Aims to bring a consistent and proportionate approach to ship inspections of all ship types which will improve the quality of inspections by: – providing training (e-learning, face-to-face, on the job);– issuing an annual inspection schedule;– operating information tools for recording and sharing inspection results.

Inspections of passenger shipsStandards: European legislation Tools: SHIPSAN ACT Information System & Manualwww.shipsan.eu/comnet

2013-2014: Announced inspections accompanied by a SHIPSAN ACT trainer2015: Unannounced inspections by port health officers trained by SHIPSAN ACT

Integrated Inspection Programme

SHIPSAN Manual

Introduction • Scope, structure and format, administrative issues

Part A• Medical facilities• Communicable diseases surveillance• Food safety• Potable water safety• Recreational water safety • Pest management • Housekeeping and facilities • Hazardous and/or inedible substances • Waste management • Ballast water

Part B• Guidelines for the prevention and control of influenza • Prevention and control of gastroenteritis on passenger ships• Guidelines for the prevention and control of legionellosis

• The inspection results are shared among the partners through the database, in the secured password protected area.

• Data recorded in the database regarding inspection results: – information on the type of inspection – deficiencies – recommendations for each deficiency– date of inspection – the inspection report – inspectors and employing authorities (authorisation) – name of the competent (port health) authority if different from the above – name of the port (coded)

Database for recording inspections conducted against the European standards as provided in the SHIPSAN Manual for Hygiene Standards and Communicable Diseases Surveillance on

Passenger Ships.

Pilot inspections

The SHIPSAN pool of inspectors consists of:• 31 inspectors who have attended the face-to-face training and have conducted

pilot inspections

From May until November 2013: • 48 full inspections and 2 re-inspections were conducted on board 43 cruise ships

and 5 ferries

Participants: •22 ports from 13 countries (Germany, Greece, Cyprus, Estonia, Italy, Netherlands, Spain, Malta, Iceland, Ireland, United Kingdom, Lithuania and Belgium) •9 cruise ship companies •5 ferry companies•20 SHIPSAN inspectors •7 trainers•77 “inspectors-in-training”

Pilot inspections

Chapter in the SHIPSAN Manual

Category of non-compliance

% of total*Requirements of EU

legislationRecommended

standards Notations

Frequency % of total* Frequency % of total* Frequency % of total*

Medical facilities 2/517 0.39% 19/517 3.68% 1/517 0.19% 4.26%Communicable disease surveillance 4/517 0.77% 3/517 0.58% 0/517 0% 1.35%

Food safety 58/517 11.22% 125/517 24.18% 35/517 6.77% 41.97%Potable water safety 2/517 0.39% 89/517 17.21% 3/517 0.58% 18.18%Recreational water safety 0/517 0% 51/517 9.86% 10/517 1.93% 11.90%

Pest management 1/517 0.19% 13/517 2.51% 4/517 0.77% 3.48%Housekeeping 3/517 0.58% 43/517 8.32% 15/517 2.90% 11.90%Hazardous substances 6/517 1.16% 5/517 0.97% 2/517 0.39% 2.51%Waste management 8/517 1.55% 12/517 2.32 3/517 0.58% 4.45%Ballast water management 0/517 0% 0/517 0% 0/517 0% 0%

Total 84/517 16.25% 360/517 69.63% 73/517 14.12% 100%

Evaluation of pilot inspections – positive feedback •249 questionnaires to 97 inspectors, 7 trainers, 48 Captains/ship crew and 14 shipping companies

•109 completed questionnaires:– For all 48 inspections conducted, at least one completed evaluation questionnaire was

received– 6 out of 9 participating cruise shipping companies completed the evaluation questionnaires

and none from the ferry shipping companies

•All responding shipping companies: this kind of inspections is necessary – provides a verification of companies’ standards – helps to address issues of inconsistency and weakness in inspectoral approach and of

response to communicable diseases events

•All except one of the 18 responding Captains and ship crew reported that the SHIPSAN inspection performed was useful for their ships•>90% of inspections were rated by inspectors, trainers and Captains/ship crew as excellent or satisfactory in terms of usefulness/effectiveness and conformity to objectives

Pilot inspections

Evaluation of pilot inspections – what to improveGeneral advice •Always read the “Plan for pilot inspections” before performing a SHIPSAN inspection•Familiarization of inspectors with the Manual

Inspection preparation •Any equipment used should work properly and accurately •At least two teams of trained inspectors are needed to conduct a proper inspection in a large ship

Introductory meeting •Inspectors should not demand the presence of the Captain to the introductory and closing meetings. •The roles in the inspection team (lead inspector, trainers, inspector-in-training etc.) need to be defined at the introductory meeting

Inspection •Time management

Pilot inspections

Evaluation of pilot inspections – what to improve

Inspection report •Correct description of inspection findings in the inspection report•Only inspection findings that correspond to the SHIPSAN Manual items should be included in the inspection report•A draft hard copy of the inspection findings should be given to the Captain by inspectors before leaving the ship; this is a preferable practice than the verbal reporting of inspection findings.

Other •Remarks on the Manual will be brought to the attention of the working group for the Manual revision•Inspectors attire •Outlines of inspection are a useful tool even to most experienced inspectors

Pilot inspections

Functions:–maintaining registries (ports, ships, competent authorities and inspectors)–sharing epidemiological information in a standardized and confidential way–recording information for risk assessment–exchanging information during an outbreak investigation

Communication network platform

19 events have been followed up by using the communication

network platform

Date Type of event Country 26/02/2014 Measles Spain26/9/2013 GI Spain20/9/2013 TBC Spain5/9/2013 Legionnaire's disease Greece

27/3/2013 TBC Spain21/12/2012 GI Spain12/11/2012 GI Spain16/11/2012 Dengue Spain12/11/2012 Legionnaires’ disease Spain5/11/2012 GI Spain

23/10/2012 GI Spain7/10/2012 Meningitis Italy18/6/2012 Legionnaire's disease Spain10/5/2012 GI Spain20/2/2012 GI (varicella) Spain25/1/2012 GI Spain

24/12/2011 Legionella pneumophila Germany12/10/2012 Neisseria meningitis type C Italy19/8/2011 Measles Italy

4 countries have created alerts:

Spain (14)Germany (1)Italy (3)Greece (1)

www.shipsan.eu/comnet

EU SHIPSAN ACT communication platform

Communication network platform

Disease Events Ships Numebr of casesGI 8 5 1631Varicella 1 1 3Legionellosis 4 4 4Measles 2 2 32Dengue 1 1 1Meningitis 1 1 4TBC 2 2 2TOTAL 19 16 1677

Public health events

Communication network platform

Facilitates the electronic

transmission of the

Maritime Declaration of Health

On the job training

Face to face training courses

e-learning

Training activities

Courses focused on IHR (2005) and the issuance of Ship Sanitation Certificate (SSC) by using the WHO Learning Programme

• 1 training course for lead inspectors (EU level) • 2 training courses on IHR and issuance of Ship Sanitation Certificates

(National level) (http://extranet.who.int/ihr/training)

Courses focused on the SHIPSAN Manual and the SHIPSAN ACT Information System

• 1 introductory course on the SHIPSAN Manual (EU level) • 2 advanced courses focused on water safety (EU level)• 4 introductory courses on the SHIPSAN Manual (National level)

Training activities

83 trainers from 20 countries • 70 from 17 EU countries• 13 from 3 Non EU countries

No Countries Number of applications EU countries

1 Belgium 1

2 Croatia 13 Cyprus 24 Estonia 15 France 16 Germany 57 Greece 138 Iceland 19 Ireland 6

10 Italy 111 Netherlands 212 Norway 213 Poland 114 Slovenia 215 Spain 1416 Sweden 117 UK 16

NON EU countries

18 Australia 1

19 Canada 1

20 USA 11

Pool of trainers

Pool of trainers

• For port health officers – Case studies – Exercises – Debates– Practical training on board ships – Issuance of IHR-SSCs following WHO guidelines

• For seafarers – Case studies – Problem solving exercises – Simulation exercises – Debates– Inspection findings

Training material

Total number of registered users: 325

E-learning

97 port health officersCountry Port Inspectors

SpainBarcelona 9

Málaga 8

Palma de Mallorca 6

ItalyPalermo 1Civitavecchia 3

Malta Valetta 5

Cyprus Limassol 3

Ireland Cork, Rosslare 4

Greece

Thessaloniki 5

Pireaus 3

Heraklion 1

Rhodes 4

Volos 2

Katakolon 8

GermanyKiel 2Hamburg 2

United Kingdom Harwich 5

Netherlands Amsterdam 5

Iceland Reykjavík 5

Lithuania Klaipeda 4

Estonia Tallinn 6

Belgium Bruges 6

On the job training

“Hygiene & Health Practices on Passenger Ships”Location: Italy Duration: 3 days Date: October 2013

Trainees: A total of 29 trainees: • 16 seafarers

• 6 cruise companies, • 1 ferry company • 1 ship management

company • 13 port health officers

Evaluation• 100% of the responding trainees: course met

their expectations and would recommend the training course to others.

• 91.7% of trainees found the usefulness of e-learning for “face to face training course” good or excellent.

Some comments from participants:

• “Great training, I learned a lot and felt very comfortable. The atmosphere and choosing training methods created a very beneficial learning experience”

• “ I would not tell others about the course cause I want to come again and participate”

1st training course

Location: Piraeus Duration: 4 days Date: 5-7 March 2014

Trainees:113 trainees• 52 seafarers from the industry (cruise

ship and ferry companies, and consultancy companies)

• 61 port health officers: 55 trainees from 19 EU MS and 6 trainees from 4 Non EU countries (Brazil, Israel, Montenegro and Turkey)

2nd training course

Pre and post assessment scores of knowledge showed an increase of 65% for the professional seafarers and 52% for the port health officers.

Location: Athens, GreeceDuration: 3 days Date: 17-19 June 2014

3rd training course

Advanced training course for water safety on ships

A training course for: • seafarers, • shipping industry professionals and • port health officers (working in authorities

responsible for public health issues related to hygiene inspections and communicable disease prevention in a port environment)

Training course Location MonthEuropean training coursesTC1: European introductory training course for the SHIPSAN manual for seafarers

Tivoli Terme, Rome, Italy 8-10 October 2013

TC2: European introductory training course for the SHIPSAN manual for port health officers (PHO) Piraeus, Greece 5-7 March 2014

TC3: Advanced focused training course for water safety (1) Piraeus 17-19 June 2014

TC4: Advanced focused training course for water safety (2) Piraeus October 2014

TC5: European training course for lead inspectors on IHR SSCs (+ training for chemical and radiological, + training for inland) Slovenia June 2015

National training courses TC6: National training courses for IHR SSCs (with support of SHIPSAN ACT) -1 Ireland June 2015

TC7: National training courses for IHR SSCs (with support of SHIPSAN ACT) -2 Bulgaria September 2015

TC8: National introductory training course for the manual and SIS for PHO (with support of SHIPSAN ACT) -1 Greece October 2015

TC9: National introductory training course for the manual and SIS for PHO (with support of SHIPSAN ACT) -2 Italy November 2015

TC10: National introductory training course for the manual and SIS for PHO (with support of SHIPSAN ACT) -3 Spain December 2015

TC11: National introductory training course for the manual and SIS for PHO (with support of SHIPSAN ACT) -4 Croatia September 2015

Timetable of training courses

•Guidelines for competent authorities on risk assessment and response to chemical/radiological events (accidental/deliberate release)

– in support to their risk assessment and response to chemical and radiological incidents on ships while the ship is at port.

•Training material will be developed on dealing with chemical and radiological incidents.

•Table top exercises will be used to pilot test the guidelines.

Chemical and radiological incidents on ships

Guidelines will strengthen current

approaches to safeguard the health of travellers and crew on passenger ships and cargo vessels

• Risk assessment tool for occupational and public health risks per cargo ship type

– The risk assessment tool will be developed using the Online Interactive Risk Assessment (OiRA) tool

developed by the European Agency for Safety and Health at Work (EU-OSHA)

– Opportunities for collaboration will be identified between port health and occupational health

authorities.

– Public health risks of international concern will be identified according to the type of cargo ship.• Survey on the current status of implementation of ILO Maritime Labour

Convention, 2006.

• Model for a Memorandum of Understanding between port health and port state control authorities on issues related to occupational health and ship inspections

– to be implemented by the EU MS in their own context and according to national and local rules.

Occupational health and hygiene in maritime transport

Synergies

• Collaborating partner in the European Chemical Emergency Network.

• Memorandum of Understanding between EU SHIPSAN ACT and EU OSHA – for the risk assessment tool for occupational and public health risks per

cargo ship type

• Advanced National Networks for Administrators (ANNA)– a EUMS driven project - in close co-operation with the European

Commission– supporting the effective implementation of reporting formalities for

ships arriving in/departing from EU ports

Dissemination of Results

EU SHIPSAN ACT Joint Action was presented in: • 10 national conferences related to:

• hygiene inspections, • occupational health, • travel medicine • communicable disease surveillance

• WHO global meetings • Chief Medical Officers’ Meeting in the framework of the Greek

Presidency• By 2016 to be presented in >20 national conferences

Conclusions…

SHIPSAN ACT aims to:

•Enhance core capacities of port health authorities and facilitates IHR implementation through:

Establishing an integrated inspection system and conducting inspections on passenger ships by using the SHIPSAN Manual (http://www.shipsan.eu/KeyResources.aspx)

Delivering training courses (on the job / e-learning / face to face)– Training courses focused on the SHIPSAN Manual at European and National level– Training courses focusing on the SHIPSAN Manual and SHIPSAN information

system

…Conclusions

Developing guidelines for dealing with chemical and radiological incidents

Updating scientific evidence

SHIPSAN ACT Information tools(SIS) will allow:

risk assessment standard response rapid information sharing follow up of events related to

maritime transport

For further information:www.shipsan.eu

7298 visits (August 2013 - May 2014)

www.shipsan.eu/comnet

• Communication Network Platform• Database for recording inspections conduced using the SHIPSAN

Manual http://ssc.shipsan.eu• SHIPSAN ACT Information System for recording and issuing Ship

Sanitation Certificates www.shipsan.

eu• Occupational health risk assessment tool for cargo ships

http://elearning.ship

san.eu/• SHIPSAN ACT e-learning platform

What else is available in the www.shipsan.eu

• European Manual • Advice to international

travellers for a healthy voyage• Updates on News and Events • Publications• Links to European and

international Institutions

Leaflet

Subscribe to the SHIPSAN ACT bimonthly e-newsletter

through the website

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