SHIP SANITATION TRAINING NETWORK SHIP SANITATION TRAINING NETWORK No 2007206No 2007206
Christos Hadjichristodoulou SHIPSAN TRAINET Project leader
European Commission – DG SANCO – Executive Agency for Health and Consumers
Workshop on Generic Preparedness (GP) projectsLuxemburg, 30 September – 1 October 2009
Content
• The SHIPSAN project • Objectives • Outcomes• The SHIPSAN manual • The Inspection Programme• The SHIPSAN Network• The partnership vision
The problem•• Ships vehicle of translational transmission of communicable diseShips vehicle of translational transmission of communicable diseasesases
•• Outbreaks and diseases on board Outbreaks and diseases on board –– reported mainly to countries with reported mainly to countries with specific surveillance systems: US VSP, Sydney, EUspecific surveillance systems: US VSP, Sydney, EU--EWGLI, DIVINETEWGLI, DIVINET
•• Increasing numbers of cruise ships & ferries in the EU: Increasing numbers of cruise ships & ferries in the EU: 66 cruise lines, 66 cruise lines, 192 cruise ships (192 cruise ships (119 in US)119 in US)
•• Modern cruise liners designed to carry many more passengers and Modern cruise liners designed to carry many more passengers and crew crew (some 5(some 5--10,000), 19 decks, 30 restaurants 10,000), 19 decks, 30 restaurants ……
•• Approximately 320 million ferry passengers passed through EUApproximately 320 million ferry passengers passed through EU--27 ports 27 ports in 2007 in 2007
•• Surveillance of disease associated with ships is inadequateSurveillance of disease associated with ships is inadequate
•• Quality of hygiene inspections of ships varies enormously betweeQuality of hygiene inspections of ships varies enormously between n countries in Europe, even within countries, even within the samecountries in Europe, even within countries, even within the same portport
When we first realized the problem
• In 2001, during the preparation for the 2004 Olympic games- Hellenic vessel sanitation program
2005 SHIPSAN2007 SHIPSAN TRAINET
Started: December 2006Started: December 2006Ended: December 2008Ended: December 2008
Duration: 24 monthsDuration: 24 months
ASSESSING THE USEFULNESS OF AN EU SHIP SANITATION PROGRAMME ASSESSING THE USEFULNESS OF AN EU SHIP SANITATION PROGRAMME AND COORDINATED ACTION FOR THE CONTROL OF COMMUNICABLE AND COORDINATED ACTION FOR THE CONTROL OF COMMUNICABLE
DISEASES IN CRUISE SHIPS AND FERRIESDISEASES IN CRUISE SHIPS AND FERRIES
Project Leadership:Project Leadership: National School of Public Health, Athens, Greece
Scientific Coordination :Scientific Coordination : University of Thessaly, Larissa, Greece
DG Health & ConsumersPublic Health Programme
The SHIPSAN project
Addresses • passenger ships sailing in European waters • sea-going and inland navigation ships• on international and on national voyages
Involves • communicable diseases and outbreak reporting• response and management• hygiene inspections
Target group 3
MS officersPort Health Authorities
Target group 2
IndustryPassenger shipping
companies
Target group 1
Consumers(Passengers & crew members)
The SHIPSAN partnership
•
14 EU Member States – 9 associated – 5 collaborative
•
European Centre for Diseases Prevention and Control
•
World Health Organization
•
CDC Vessel Sanitation Program
•
International Maritime Organization
•
1 passenger ship company
•
2 passenger ship associations
•
1 professional association
The SHIPSAN added value
• Integrated surveillance of communicable diseases on passenger ships across the EU by the EU Port Health Authorities
• Communication and sharing of information among port health authorities
• Comparability of data across the EU
• Standardization and coordination of hygiene inspections
• Avoiding overlapping and duplication of inspections
• Cooperate with shipping industry to deal with communicable diseases on passenger ships when they occur
• Supporting and advice to shipping industry to apply European legislation on passenger ships
Health authorities
Regular training Guidance in emergencies
Standards to work with Harmonization of practices
Scientific and technical support
Shipping companies
Harmonization of standardsRecognition of certificates in all EU countries
Provide a “gold standard” certificateSupport in emergencies
A pool of expertise for consultation
Consumers Healthier voyages
Advice for behaviour
SHIPSAN
The benefits from SHIPSAN
What the SHIPSAN has achievedWithin 24 months
• The most appropriate programme for the EU (based on best practice, experience, existing programmes etc) was explored
• Communicable diseases and outbreaks have been published from 1970 to 2006 on passenger ships were collated and included in the State of the Art report
• The European passenger ships market was examined and EU MS were categorized in four groups
• A study was conducted in the 32 countries and 176 authorities
• Identified the EU, national and international legislation applied by competent authorities in the EU
• Description of the current situation in the EU based on study findings (needs, gaps)
• Established a partnership which consists of experts scientists and intends to expand it
• Developed synergies with ECDC, authorities, the industry, key stakeholders and internationally recognized programmes
Project Leadership : University of Thessaly, Larissa, Greece Scientific Coordination : National School of Public Health, Athens, Greece
DG HEALTH & CONSUMER PROTECTIONDG HEALTH & CONSUMER PROTECTION PUBLIC HEALTH PROGRAMPUBLIC HEALTH PROGRAM
DurationDuration : 30 months30 monthsStart : : November 2008 November 2008
End: : May 2011May 2011
• Priority Area Responding to health threats rapidly and in a co-ordinated manner (HT 2007)
• ActionHealth security and strategies relevant to communicable diseases control
THE PARTNERSHIP
•
18 EU Member States (11 associated, 7 collaborative)
•
4 Euromed
countries: Jordan, Lebanon, Israel, Turkey
•
European Centre for Diseases Control and Prevention
•
World Health Organization
•
CDC Vessel Sanitation Program
•
International Maritime Organization
•
5 passenger ship companies
•
2 passenger ship associations
•
1 professional association
Health Protection Surveillance Centre,
IRELAND
Health Protection Agency, Centre for Infections, UNITED
KINGDOM
Institute of Public Health of the Republic of Slovenia,
SLOVENIA
National Centre for Epidemiology,
SPAIN
Health Protection Inspectorate,
ESTONIA
Klaipeda Public Health Centre,
LITHUANIA
Hamburg Port Health Centre,
GERMANY
Consulting Management
Training (C.M.T.) Prooptiki Athens,
GREECE
Technological Institute of Athens, Faculty of Health
and Caring Professions,
GREECE
Medical university of Gdansk, Interfaculty
of Maritime and Tropical Medicine,
POLAND
Ministry of Health, Section of Communicable Diseases
Surveillance, BULGARIA
The National Board of Health and
Welfare, Unit of Communicable
Disease Prevention and Control, SWEDEN
Associated Partners 11 EU countries
17 Collaborating Partners
National Institute for Public Health and the Environment,
THE NETHERLANDS
Ministry of Health, Department of alert,
response and preparedness,
FRANCE
Ministry of Public
Health, BELGIUM
Ministry of Health, Medical and Public
Health Services,
CYPRUS
Ministry of Health - Department of
Preventive Hygiene,
ITALY
Ministry of Health, PORTUGAL
Centre of Environment,
FINLAND
Association of Port Health Authorities,
UNITED KINGDOM
Spanish Ministry of Health, SPAIN
Ministry of Health, Department of alert,
response and preparedness,
FRANCE
Carnival Cruise Lines, UNITED
KINGDOM
Ministry of Health, PORTUGAL
Ministry of Health, Department of alert,
response and preparedness,
FRANCE
Spanish Ministry of Health, SPAIN
Ministry of Health, PORTUGAL
Ministry of Health, Department of alert,
response and preparedness,
FRANCE
Ministry of Health - Department of
Preventive Hygiene,
ITALY
Spanish Ministry of Health, SPAIN
Ministry of Health, PORTUGAL
Ministry of Health, Department of alert,
response and preparedness,
FRANCE
Ministry of Public
Health, BELGIUM
Ministry of Health - Department of
Preventive Hygiene,
ITALY
Spanish Ministry of Health, SPAIN
Ministry of Health, PORTUGAL
Ministry of Health, Department of alert,
response and preparedness,
FRANCE
National Institute for Public Health and the Environment,
THE NETHERLANDS
Ministry of Public
Health, BELGIUM
Ministry of Health - Department of
Preventive Hygiene,
ITALY
Spanish Ministry of Health, SPAIN
Ministry of Health, PORTUGAL
Ministry of Health, Department of alert,
response and preparedness,
FRANCE
National Institute for Public Health and the Environment,
THE NETHERLANDS
Ministry of Public
Health, BELGIUM
Ministry of Health - Department of
Preventive Hygiene,
ITALY
Spanish Ministry of Health, SPAIN
Ministry of Health, PORTUGAL
Ministry of Health, Department of alert,
response and preparedness,
FRANCE
Centre of Environment,
FINLAND
National Institute for Public Health and the Environment,
THE NETHERLANDS
Ministry of Public
Health, BELGIUM
Ministry of Health - Department of
Preventive Hygiene,
ITALY
Spanish Ministry of Health, SPAIN
Ministry of Health, PORTUGAL
Ministry of Health, Department of alert,
response and preparedness,
FRANCEANEK Ferries,
GREECE
Centre of Environment,
FINLAND
National Institute for Public Health and the Environment,
THE NETHERLANDS
Ministry of Public
Health, BELGIUM
Ministry of Health - Department of
Preventive Hygiene,
ITALY
Spanish Ministry of Health, SPAIN
Ministry of Health, PORTUGAL
Ministry of Health, Department of alert,
response and preparedness,
FRANCE
Hellenic Centre for Infectious Diseases Control, GREECE
Ministry of Health and Social Solidarity,
GREECE
Centre of Environment,
FINLAND
Passenger Shipping Association,
UNITED KINGDOM
National Institute for Public Health and the Environment,
THE NETHERLANDS
Ministry of Public
Health, BELGIUM
Ministry of Health - Department of
Preventive Hygiene,
ITALY
Spanish Ministry of Health, SPAIN
Ministry of Health, PORTUGAL
Ministry of Health, Department of alert,
response and preparedness,
FRANCE
Carnival Cruise Lines, UNITED
KINGDOM
MINOAN Lines,
GREECEBluestar Ferries,
Superfast Ferries, GREECE
Hellenic Association of passenger ships,
GREECE
9 country authorities, 5 associations, 5 shipping companies
European Centre for Diseases Control and Prevention World Health Organization CDC Vessel Sanitation Program International Maritime Organization
Turkey
Jordan
Israel
Lebanon
Aim
The overall aim of the project is to:
• Cover the gaps on a common European strategy and training network on:
• ship sanitation inspections• outbreak investigations• surveillance and control of communicable diseases
on board cruise ships and ferries.
• Facilitate the practical implementation of the International Health Regulations (IHR) (2005) in order to enhance the common EU policy on the prevention of communicable disease related to cruise ships and ferries.
General Objectives
22.. To To strengthen existing public strengthen existing public health structureshealth structures aiming to aiming to safeguard the public health and safeguard the public health and prevent the spread of prevent the spread of communicable diseases among communicable diseases among passengers and crew memberspassengers and crew members
1.1. To promote and establish the To promote and establish the integrated European ship integrated European ship sanitation strategysanitation strategy, based on , based on the SHIPSAN project results the SHIPSAN project results and on the requirements of and on the requirements of the IHR (2005). the IHR (2005).
3.3. To develop a To develop a European training European training networknetwork regarding ship sanitation regarding ship sanitation and control of communicable and control of communicable diseases on board cruise ships diseases on board cruise ships and ferries. and ferries.
4. 4. To produce an To produce an integrated training integrated training programmeprogramme among EU Member among EU Member States regarding ship sanitation, States regarding ship sanitation, outbreak management, surveillance outbreak management, surveillance and control of communicable and control of communicable diseases related to cruise ships and diseases related to cruise ships and ferries.ferries.
5. To provide 5. To provide training on the implementation of the IHR training on the implementation of the IHR (2005)(2005) on issues related to cruise ships and ferries.on issues related to cruise ships and ferries.
SHIPSAN TRAINET specific objectives
EU SHIPSAN
Integrated Programme
Manual for
surveillance and
inspections
Common standards Common training Communication
Training materialand
Training modulesfor
port health professionalsand
seafarers
Training network with
expert scientists
Web-based Port to port
Communication
MethodologyMethodology
State of the ArtSHIPSAN Outputs
Questionnaires
Working Group Meetings
Site Visits
CoordinationStrategy
EvaluationStrategy
DisseminationStrategy
Web Based NetworkPilot Testing
Communication Strategy
What the SHIPSAN TRAINET project will deliver
•
An integrated programme for communicable diseases control and passenger ship hygiene
•
Enhanced harmonised surveillance of disease and outbreak detection and investigation for the EU port health authorities
•
A manual for inspection
•
Training across Europe
•
A network for sharing surveillance data and inspection results
•
Technical support upon request
Timeline for main deliverablesNov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May
2008 2009 2010 2011
Manual
Training material
TM1 TM2 TM3 TM4 TM5
6 months pilot network
Project Handbook
State of the Art report
Communication plan
Dissemination & Exploitation plan
Web site
Evaluation plan
Surveillance data
Inspection data
Contact detailsport health authorities
inspectors shipping companies
Corrective action data
Outbreak detection data
Ship registry data
SHIPSAN COMMUNICATION
NETWORK
The SHIPSAN NETWORKThe SHIPSAN NETWORK
SHIPSAN communication network
Objectives
• To create a communications system that can improve consumers (passengers and crew) protection through:– implementation of the EU Port Health Authorities surveillance and
response system (using web based standardized diseases reporting forms for passenger ships)
– facilitating the exchange of information between ports during outbreak investigation
– sharing of information on hygiene inspections
– share epidemiological information among professional groups, competent authorities, and international organizations in a standardized and confidential way
– creating an alert system to ensure that outbreaks and other public health events can be investigated and controlled in a timely manner without over reaction
– facilitating communication by creating registries including contact details for ships, Port Health Authorities and inspectors
Ship
Port Health Authority
National Health
Authority
NFP
ECDC
EWRS
WHO
DG SANCO
SHIPSANWeb based tool
SHIPSAN
Secretariat
Access to SHIPSAN Web based tool
PHA will inspect /
contact ship
Port Health Authority
National Public Health
Authority
National Surveillance
System
International Surveillance
System
Alert generation by national or international surveillance
SHIPSAN
SecretariatIs there an alert?
If no
Trigger alertor
Confirm noalert
PHA alert form
SHIPSAN Web based tool
OutbreakInitial report
(when event/outbreak comes to light)
Case initial report(when a case comes to light)
OutbreakUpdate report
(not less than 4hrs before arriving to the next port of call)
OutbreakUpdate report
(before each port-of-call)
Case/Outbreak final report
Ship
1
2
3
4
5
Case / Outbreak / alert route
SHIPSAN web based tool
PHA
Notification of National or International Surveillance which
needs alert status
Is alert status necessary?
Alert notified
UpdatePHA inspects or checks
progressPHA notifies next port -of-call (if it does not have access to SHIPSAN web based tool)
UpdatePHA inspects or checks
progressPHA notifies next port -of-call (if it does not have access to SHIPSAN web based tool)
PHA Alert (final)Closing the alert
Triggers activeincident status
Yes
No
Active status closedNo further
communication to PHAs
Alert next port-of-call
Recommendations of SHIPSAN on surveillance and response
Integrated surveillance system
Specific outbreak definitions
Specific guidelines for prevention and management of GI diseases (Norovirus etc.)
General guidelines on outbreak management
SHIPSAN reporting forms
1. Case/Outbreak report form2. Routine surveillance form 3. Maritime Declaration of Health
4. Ship registry form5. Health port registry form 6. Inspector registry form7. SHIPSAN inspection 8. Port Health Authority Alert form9. Network reporting form
They are completed by the ship
They are completed by Port Health Authorities or
collected by LOYD’s
Pilot testing of the Network and the Surveillance System
The following countries have agreed to participate:
Two ferries industries in Greece, two big and one small companies from cruise industry will participate voluntary.
In the second phase two more countries, Turkey and Italy, might be added.
Greece UnitedKingdom France Netherlands
Germany Spain Poland Estonia
Recommendation for events/outbreaks management coordination
Initial event/outbreak
alert
Next port-of-call
Provide update alert report
Next port-of-call
Final event/outbreak
alert report
CoordinatingCentre
Support
SubmitCommunicable Disease Routine Surveillance
Reporting Form
SubmitCase/Event/Outbreak
Reporting Form
ViewAnalyze
Choose format of• Archives• Cases• Events• Outbreaks• Syndromes
Passenger ships web based communication tool
Viewfor ship or for port
Port Health Authorities web based communication tool
Create alert & communicate outbreak
management data
Registries
Submitinspection reports
Exchange epidemiological
information
View current events
View archives
Cases/events/outbreaks
Inspection reports
Alerts
Draft inspection report
Final inspection report
Epidemiological information
Ferries & Cruise ships
Port Health Authorities
Inspectors
Ship companies
Other contacts (European, international)
SHIPSAN TRAINET Inspection programme
components
SHIPSAN Databases
& Reports
Inspectors inCompetent authorities
Manual for inspections
Communication network
Scope
of the SHIPSAN Manual
Description of standards for passenger ships in the EU:
• Communicable diseases reporting requirements
• Hygiene standards
• Administrative issues
• Outbreak management guidelines
• Operational guidelines
Target audience for the final Manual
Scientific community/ Public
National and regional authorities of EU Member States• surveillance • inspections
Port health authorities –Network participants
Shipping industry
Hygiene inspections
SHIPSAN Manual
Food safety
Potable water safety
Swimming Pools
Pest management
Waste management
Housekeeping and facilities
Hazardous substances
AimConsumers Protection
SHIPSAN Manual references
Administrative issues Standards Specific
for ships
Food safety:EU Directives and National
Catering GuidesYes
Waste
management: EU Directive
& IMO conventions Yes
Potable water safety:EU Directive & WHO guidelines
for Water Safety PlansNo
Pest
management:
EU Directive
& IMO
recommendationNo
Hazardous
and/or
inedible
substances:EU Directive
& WHO guidelines No
Housekeeping
and
facilities: No
EU legislation ‐
Recreational
water
safety: No
EU legislation ‐
Port health authorities
The SHIPSAN TRAINET inspection network DATABASE
future development
Passenger shipping companiesSubmit an inspection report
Inspection reports history
Targeting a ship for inspection Submit corrective actions
Cruise ships and ferries
companies directory
Ferries and Cruise ships directory
Port directoryPort Health Authorities Contact detailsInspectors
Administrative issuesInspectors
working in competent authorities of MS
Continuing
professional
development
Trained and
certified in
common
standards
Using a
common EU
Manual for
inspections
Exchange data,
information,
knowledge
through a web‐
based database
Communicate
frequently
Competent authorised officers who have undertaken training should conduct the inspectionsSelection criteria for the inspectors will be defined
StandardisationStandardisationof inspectionsof inspections
Training Frequent communication Written inspection procedures Check list and scoring during inspections Statistical analysis of inspection resultsAuditing of personnel inspection activities
Administrative issuesInspectionsInspections
• Different inspections categories • Frequency of inspections •• Corrective action Corrective action •• Publication of inspection resultsPublication of inspection results•• Fees Fees •• Revision and amendmentsRevision and amendments
Pilot training modules•
2 train the trainers modules
•
2 training modules for health professionals
•
2 training modules for cruise ships crew members
•
1 training module for ferry crew members
17
trainees
for
each training module 5 days
each training module
Training networkThe partnership will initially determine:
Criteria for trainers
Conditions for membership in the training network
The criteria and the membership conditions will be validated by the steering
committee
The partnership will
seek for experts:
•
An announcement
will be published in SHIPSAN TRAINET website & Eurosurveillance
•
Experts from international and other organizations will be invited to apply
‐
WHO
‐
IMO
‐
CDC‐VSP
‐
ECDC
Working group meeting
•
To select the trainers
•
A checklist will be internally used to cross‐check the trainers’
qualifications with
the selection criteria and the membership conditions
Strategic aims
1.
Work to secure political commitment and support
2.
Implementation of a plan for improved communications with stakeholders’
and
the general public
3.
Engagement of qualified best experts for different core activities
4.
Development of trust based relations with collaborators and stakeholders
5.
Establishment of a virtual reference centre for providing training, advice and
guidance
6.
Contribution to scientific knowledge of public health on passenger ships
7.
Provision of a “State of the Art”
programme suggesting a holistic approach to the
public health problem
8.
Development of the means for long‐term funding
The SHIPSAN project partnership vision
“All travellers on passenger ships sailing in European waters
will be protected from communicable diseases through the
implementation of coordinated evidence based actions
taken by European and international authorities, competent
port health authorities of the European countries, shipping
industries and travellers”.
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