Targeting Public Health Events on Ships

Abstract

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 ship's 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