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“SHIPSAN ACT, un progetto europeo a tutela della salute
dei viaggiatori marittimi”Dr. Mauro Dionisio
‘Elementi di Sanità Marittima ed Aeroportuale e Attività di Polizia Sanitaria’
Cecina (LI) 28 maggio 2015
SHIPSAN TRAINET
DURATA: 35 Mesi
Inizio: Novembre 2008
Fine : Ottobre 2011
(15 EUMS)
SHIPSAN
DURATA: 24 Mesi
Inizio: Dicembre 2006
Fine : Dicembre 2008
(6 EUMS)
Hello and welcome to all of you: those who were readers of this newsletter already in the previous SHIPSAN project as well as those who areapproaching SHIPSAN for the first time. After a years break, due to the end of SHIPSAN TRAINET, we are here to resume the publication of thenewsletter with the new name of “EU SHIPSAN ACT Newsletter”. I am glad and honored to have been indicated as the new Editor, for this year, fromthe SHIPSAN ACT Coordination Team during the kick-off meeting. A few words about me: after graduating as medical doctor in Naples - Italy, Iattended the post-graduated school in internal medicine and, then, in hygiene and preventive medicine. During the past 2 decades I have worked asport and airport doctor in 2 different Italian regions: Puglia and Sicily. I have also dealt with implementation of new International Health Regulations(IHR 2005). At the moment I work at the Ministry of Health in Rome – General Directorate for prevention - with the objective, among others, to followthe development of SHIPSAN ACT Joint Action. As most of you know, on 1st February the new SHIPSAN ACT - EU Joint Action (JA) - started followingthe successful and fruitful activities of SHIPSAN and SHIPSAN TRAINET projects (2006-2011) implemented with the support of EU Commission in theprevious SHIPSAN project. Our aim has not changed and, as the acronym suggests, we will continue to focus on ships and sanitation, but our field ofinterests has been enlarged: in this and in the next newsletters you will discover how! Also the number of partners, either ‘associated’ or‘collaborating’ has incremented: SHIPSAN ACT involves today 14 Organizations from 10 countries (Greece, Germany, Ireland, Lithuania, Slovenia,Spain, UK, Bulgaria, Iceland and Italy) as ‘associated partners’ and 16 Organizations from 15 countries (Belgium, Cyprus, Estonia, Netherlands,Portugal, Switzerland, USA, Poland, Austria, France, Malta, Norway, Romania, Slovakia and Croatia) as collaborating partners. The development of thewhole Joint Action has been divided in 9 different work packages (WP), each leaded by an Organization as follow:
• WP1 (Coordination)-Laboratory of Hygiene and Epidemiology, University of Thessaly, Larissa, Greece;
• WP2 (Dissemination)-Laboratory of Hygiene and Epidemiology, University of Thessaly, Larissa, Greece;
• WP3 (Evaluation)-General Directorate for Prevention, Ministry of Health, Italy;
• WP4 (State of the art)-Health Service Executive, Naas, Ireland;
The aim of this newsletter, as well the next ones, is to disseminate the SHIPSAN ACT JA activities. We hope to rouse yours and all stakeholders’interest and we expect to receive your active feedback. We also wait for your contribution toward the ‘port of the month’ section, and for any newsof common interest. Arduous challenges are awaiting for us, I know. All the wishes for the success of SHIPSAN ACT, for a wide dissemination of theoutcomesand for the sustainability of the EU SHIPSAN ACT JA also in the future!
Mauro Dionisio
Ministry of Health, Italy
Programma integrato
EU SHIPSAN
Manuale per la
Sorveglianza e le Ispezioni
Commmunication
Web - BasedPort to Port
Materiale di formazione e Formazione
Modulare per operatori
sanitari di Porto e marinai
Training network con
scienziati esperti
SHIPSAN ACT
SHIPSAN Manual References- Risultati progetti Shipsan
- Risultati della recensione della letteratura
- Legislazione EU esistente
- Regolamento Sanitario Internazionale 2005 (IHR)
- EUMS Guida alla sicurezza alimentare (UK, Irlanda,
Grecia, Olanda, etc …)
- Linee guida WHO vigilanza sanitaria delle navi
- Manuale WHO per il rilascio SSCS
- CDC – VSP
- Analisi descrittiva dei dati relativi a pratiche
attuate dagli Stati membri EU
Manuale
Il Manuale è diviso in 2 parti
La parte A include i seguenti punti:
punto 1: Strutture mediche
punto 2: Sorveglianza delle malattie trasmissibili a bordo
delle navi
punto 3: Sicurezza del cibo
punto 4: Sicurezza dell’acqua potabile
punto 5: Sicurezza dell’acqua per attività ricreative
punto 6: Pest control
punto 7: Sicurezza Housekeeping
punto 8: Sostanze pericolose
punto 9: Rifiuti
punto 10: Acque di zavorra
Manuale
La parte B include le seguenti linee guida:
Prevenzione e controllo delle ILI (influenza-like illness)
Prevenzione e controllo delle gastroenteriti
Prevenzione e controllo della legionellosi
EU SHIPSAN ACT Joint Action
Integrated inspection Programme
EU SHIPSAN ACT Joint Action
(2011) & 2013-2014 2015
Announced inspections by trained port health officers accompanied by a SHIPSAN ACT trainer
Short notice inspections by trained port health officers
Voluntary participation of passenger shipping companies
Non voluntary participation of passenger shipping companies
Pilot Inspections
EU SHIPSAN ACT Joint Action
May – November 2013 May – November 2014*
Inspections 48 full inspections and 2 re-inspections
50 inspections
Ports 22 32
Countries
13(Germany, Greece, Cyprus, Estonia, Italy, Netherlands, Spain, Malta, Iceland, Ireland, United Kingdom, Lithuania and Belgium)
17 (16 EUMS and 1 non – EUMS)(Belgium, Croatia, Cyprus, Estonia, Germany, Greece, Iceland, Ireland, Italy, Lithuania, Malta, Romania, Slovakia, Spain, The Netherlands, Turkey, United Kingdom)
Cruise lines (sea-going) 9 13
Ferry companies 5 5
Cruise lines (inland) 0 1
SHIPSAN inspectors 20 49 (The pool of SHIPSAN inspectors
consists of 57 inspectors)
Trainers 7 3
“inspectors-in-training” 77 68 (Inspectors in training for both
years 110)
Pilot Inspections
• In 2013: 50 inspections conducted on 48 passenger ships in 22 ports from 13 EUMS based on EU standards by trained inspectors.
• In 2014: 50 inspections conducted on 50 passenger ships in 32 ports from 16 EUMS and 1 non – EUMS based on EU standards by trained inspectors.
2011 2013 2014
Inspection Reports 42 48 50
Corrective Action Statements 20 31 out of 46 requiring Corrective
Action
35
Number of Deficiencies 393 517 689
� Non compliances with requirements of the EU legislation
41 84 106
� Non compliances with recommended standards of the Manual
282 360 524
� Notations 70 73 59
From May until November 2013
Pilot Inspections
Chapter in the
SHIPSAN Manual
Category of non-compliance
% of total*Requirements of EU
legislation
Recommended
standardsNotations
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 surveillance4/517 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
management0/517 0% 0/517 0% 0/517 0% 0%
Total 84/517 16.25% 360/517 69.63% 73/517 14.12% 100%
Pilot Inspections
Evaluation of pilot inspections 2013 – 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
EU SHIPSAN ACT Joint Action
Ship Sanitation Certificate (SSC-IHR)
This subsystem http://ssc.shipsan.eu/ aims at:
• holding and sharing information on ship sanitation inspections
• issuing the Ship Sanitation Certificates under the IHR:
- Ship Sanitation Control Exemption Certificate (SSCEC)
- Ship Sanitation Control Certificate (SSCC)
It addresses all types of ships.
It is used by the MS authorized Port Health / Competent Authorities and predictably by more authorities all over Europe.
EU SHIPSAN ACT Joint Action
Integrated Inspection Programme
�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
EU SHIPSAN ACT Joint Action
Integrated Inspection Programme
EU SHIPSAN ACT Information system for recording and issuing SSC
•190 registered inspectors from 12 European
countries
• A total of 6364 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
EU SHIPSAN ACT Joint Action
*until 06/05/2015
Training activities
e-learning Webinars
Face to face training courses On the job
training
EU SHIPSAN ACT Joint Action
Training Platform
EU SHIPSAN ACT Joint Action
Training Platform
EU SHIPSAN ACT Joint Action
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)
Pool of trainers
EU SHIPSAN ACT Joint Action
No Countries Number of applications
EU countries
1 Belgium 1
2 Croatia 1
3 Cyprus 2
4 Estonia 1
5 France 1
6 Germany 6
7 Greece 13
8 Iceland 1
9 Ireland 6
10 Italy 3
11 Netherlands 3
12 Norway 2
13 Poland 1
14 Slovenia 2
15 Spain 14
16 Sweden 1
17 UK 16
NON EU countries
18 Australia 1
19 Canada 1
20 USA 12
Training material
EU SHIPSAN ACT Joint Action
• 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
On the job training
EU SHIPSAN ACT Joint Action
1st Training course
EU SHIPSAN ACT Joint Action
“Hygiene & Health Practices on Passenger Ships”Location: Italy Duration: 3 days Date: October 2013
Trainees: A total of• 16 seafarers
• 6 cruise companies, • 1 ferry company • 1 ship management
company • 13 port health officers
Evaluationof the responding trainees: course
met their expectations and would recommend the training course to others.
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”
2nd Training course
EU SHIPSAN ACT Joint Action
Location: Piraeus – cruise ship
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)
Pre and post assessment scores of knowledge showed an increase of 65% for the professional seafarers and 52% for the port health officers.
3 Training course
EU SHIPSAN ACT Joint Action
Advanced training course for water safety on shipsA training course for seafarers and shipping industry professionals
Location: Athens Duration: 3 days Date: 17-19 June 2014
• 65 trainees participated in the training course:
• 38 seafarers from the industry (cruise ship and ferry companies, and consultancy companies)
• 7 port health officers from 11 EU Member States
Timetable of trainig courses
EU SHIPSAN ACT Joint Action
Training course Location MonthEuropean training courses
TC1: European introductory training course for the
SHIPSAN manual for seafarers
Tivoli Terme,
Rome, Italy8-10 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 coursesTC6: 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) -2Bulgaria September 2015
TC8: National introductory training course for the manual
and SIS for PHO (with support of SHIPSAN ACT) -1Greece October 2015
TC9: National introductory training course for the manual
and SIS for PHO (with support of SHIPSAN ACT) -2Italy November 2015
TC10: National introductory training course for the manual
and SIS for PHO (with support of SHIPSAN ACT) -3Spain December 2015
TC11: National introductory training course for the manual
and SIS for PHO (with support of SHIPSAN ACT) -4Croatia September 2015
Webinars
EU SHIPSAN ACT Joint Action
• The webinar on “Ebola Virus Disease and maritime transport sector” was broadcasted on 22nd April 2015.
• A total of 109 participants from 20 countries registered to view the webinar.
Occupational Health and hygiene in maritime transport
EU SHIPSAN ACT Joint Action
• 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 LabourConvention, 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.
Chemical and radiological incidents on ships
EU SHIPSAN ACT Joint Action
�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.
Guidelines will strengthen current
approaches to safeguard the health of travellers and crew on
passenger ships and cargo vessels
Dissemination of result
EU SHIPSAN ACT Joint Action
EU SHIPSAN ACT Joint Action was presented in:
• 20 national conferences within EU MS related to: � hygiene inspections,
� occupational health,
� travel medicine
� communicable disease surveillance
• Events at non EU countries
• European Events and Conferences (EC, ECDC)
• International meetings (WHO global meetings, ANVISA)
• Chief Medical Officers’ Meeting in the framework of the Greek Presidency
• By 2016 to be presented in >20 national conferences
1. Communication Networkhttp://www.shipsan.eu/comnetaims at:
� surveillance on board passenger ships
� sharing epidemiological information among competent authorities at ports in a standardized and confidential way
� sharing inspection results
� Inspection report
2. Ship Sanitation Certificate (SSC - IHR)http://ssc.shipsan.eu
EU SHIPSAN ACT Joint Action
SHIPSAN ACT INFORMATION System (SIS)
Communication Network
Communication Network forms
1. Communicable Diseases Surveillance
Routine Recording Form
2. Case/ Outbreak Recording Form
3. Maritime Declaration of Health
4. Corrective Action Statement
5. Passenger Ship Registry Form
6. Port Registry
7. Port Health Officers (Inspectors)
Registry
8. Other Competent Authority Registry
9. Competent Authority Communication
Alert Form
10. Network Communication Form
11. Inspection Report
Completed by the ship
Completed by Port Health Authorities
EU SHIPSAN ACT Joint Action
Comunication Network Platform
EU SHIPSAN ACT Joint Action
Functions:
maintaining registries (ports, ships, competent authorities and inspectors)sharing epidemiological information in a standardized and confidential wayrecording information for risk assessmentexchanging information during an outbreak investigation
Comunication Network Platform
EU SHIPSAN ACT Joint Action
Date Type of event Country
16/1/2015 Varicella Spain
14/10/2014 Legionella disease Spain
29/9/2014 Chickenpox Malta
26/2/2014 Measles Spain
26/9/2013 GI Spain
20/9/2013 TBC Spain
5/9/2013 Legionnaire's disease Greece
27/3/2013 TBC Spain
21/12/2012 GI Spain
16/11/2012 Dengue Spain
12/11/2012 GI Spain
12/11/2012 Legionnaires’ disease Spain
5/11/2012 GI Spain
23/10/2012 GI Spain
7/10/2012 Meningitis Italy
18/6/2012 Legionnaire's disease Spain
10/5/2012 GI Spain
20/2/2012 GI (varicella) Spain
25/1/2012 GI Spain
24/12/2011 Legionella pneumophila Germany
12/10/2012Neisseria meningitis type
C Italy
19/8/2011 Measles Italy
EU SHIPSAN ACT communication platform
events have been followed
up by using the communication network platform
5 countries have created alerts:
Spain (16)Germany (1)Italy (3)Greece (1)Malta (1)
www.shipsan.eu/comnet
Communication network platform
Public health events
Disease Events Ships Number of casesGI 8 5 1631Varicella 2 2 8Legionellosis 5 5 5Measles 2 2 32Dengue 1 1 1Meningitis 1 1 4TBC 2 2 2Chickenpox 1 1 1TOTAL 22 19 1684
EU SHIPSAN ACT Joint Action
European directory of authorised ports to issue Ship Sanitation Certificates under IHR 2005
EU SHIPSAN ACT Joint Action
• 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.
Contact details
EU SHIPSAN ACT Joint Action
http://www.shipsan.eu/Inspections/AuthorisedportstoissueSSC.aspx
EU SHIPSAN ACT Joint Action
19,553 visits(August 2013 –
April 2015)
For further infomation: www.shipsan.eu
Also available on the website:
• Q&A section about Ebola on Maritime
Transport
• European Manual
• Leaflet
• Advice to international travellers for a
healthy voyage
• Updates on News and Events
• Publications & Bibliography
• Links to European and international
Institutions
• Webinars
• Subscribe to the bimonthly e-newsletter
EU SHIPSAN ACT Joint Action
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• Web portal of the EU SHIPSAN ACT Joint Action
http://elearning.shipsan.eu/• SHIPSAN ACT e-learning platform
SIS web service related MDH
EU SHIPSAN ACT Joint Action
• MDH historical data for every ship will be stored on the SIS.
• MDH data archive on SIS after a specific time period (3 or 6
months).
• Online standardized analysis web services will be provided on SIS.
• Extraction data web tools will be provided to authorised users (e.g.
Port Health Authorities).
• Advanced online search facilities e.g by IMO, Ship name,
Embarkation-Dissembarkation date.
• Port Health Authorities (Local and National) will be authorised to
access SIS and view the MDH records.
SHIPSAN Information System (SIS)
EU SHIPSAN ACT Joint Action
SHIPSAN Information System (SIS)
EU SHIPSAN ACT Joint Action
Ship OVERVIEW Information
SHIPSAN Information System (SIS)
EU SHIPSAN ACT Joint Action
SSC Inspection
SHIPSAN Information System (SIS)
EU SHIPSAN ACT Joint Action
SSC
SHIPSAN Information System (SIS)
EU SHIPSAN ACT Joint Action
SSC Inspection Areas
SHIPSAN Information System (SIS)
EU SHIPSAN ACT Joint Action
Inspections based on the European Manual
SHIPSAN Information System (SIS)
EU SHIPSAN ACT Joint Action
Inspections based on the European Manual
SHIPSAN Information System (SIS)
EU SHIPSAN ACT Joint Action
Port Communication Form
SHIPSAN Information System (SIS)
EU SHIPSAN ACT Joint Action
Ship Communicable Diseases Surveillance Routine Recording Form
SHIPSAN Information System (SIS)
EU SHIPSAN ACT Joint Action
Ship Communication Form
SHIPSAN Information System (SIS)
EU SHIPSAN ACT Joint Action
MDH
Conclusions – EU SHIPSAN ACT JA Impact on Health policy
EU SHIPSAN ACT Joint Action
• Contribute to protect the EU population against health threats and improve citizens' health security.
• Help countries to preparedness planning, response to events in a coordinated manner by developing contingency plans and to develop IHR core capacities.
• Protects health of ship travelling passengers in EU by:
• strengthening compliance of ships with MS/and EU legislation, standards and guidelines related to hygiene, CBRN events management and ;
• implementing an integrated strategy for epidemiological investigation;
• Protects health of crew working on ships, by providing training on ILO MLC health related issues.
• Strengthens EU’s capacity to monitor and respond to health threats by:
• developing EUMS cooperation
• facilitating rapid ship-to-port and port-to-port information exchange using web-based tools.
• Provides risk assessment data and implementation of response measures at the port level to existing monitoring and early warning mechanisms at local, national and EU levels.