The maritime industry has long been a significant mode of transportation. It is essential since it contributes to 80% of the global trade. Nevertheless, the COVID-19 pandemic has affected the maritime sector and its workforce. Many countries implemented strict prevention measures like the No Sail Order, the closing of ports and movement restrictions. The study explored the potential effects of the COVID-19 restrictions on the health and well-being of seafarers with an aim to offer insight for policy recommendations. The study was cross-sectional. It took place during the period January–April 2021. The questionnaire developed by Stella Maris was used with permission. It was distributed to shipping companies and work unions and, through them, to seafarers. The sample was 106 individuals. The study features the findings of the questionnaire which were analyzed by descriptive and inferential statistics. SPSS was used for the analysis. Chi-square test and Fisher’s exact test were performed. Logistic regression was used to assess the impact of COVID-19 on physical, mental and financial aspects of seafarers’ lives. Multivariate logistic regression analysis was performed using the forward (conditional) stepwise regression method with probability for stepwise entry set at 10%. Statistical significance was considered at p < 0.05. Seafarers were affected physically (38%), mentally (53%), and financially (40%) by the pandemic. The country of origin, the time onboard and the number of supportive family members had an influence on those effects. Among the participants, those who worked on tankers and officers with more than three family members were more likely to face mental, physical or financial problems. In addition, the study showed that only 24.5% of the respondents were on regular contracts, 16% had their contracts extended, 14.2% were about to be deployed but were grounded due to the pandemic, while about half of the sample 41.5% was waiting for a new contract. The results of this study may be used as a starting point by International Organisations including IMO and ILO, flag states, ports and the industry to increase emergency preparedness and to inform outbreak response plans in the event of future infectious disease outbreaks in the shipping domain. Full article

Background: Being highly contagious through person-to-person transmission, COVID-19 can easily spread within multinational populations of ships and to land communities. The purpose of this study is to report on the prevalence of COVID-19 infections in the Commerce fleet over a two year period and to discuss measures to prevent and overcome the outbreak of COVID-19 on ships. Materials and methods: All possible cases of COVID-19 among crew on six merchant vessels were registered during 2021 by onboard medical facilities. The patients remained isolated for up to 6 days after taking a PCR test. Vulnerable contacts were identified and offered post-exposure measures. The nationality of the crew, the number of contacts vaccinated, and the cost of direct treatment were noted. Results: Across the year of 2021, there were six ships with registered COVID-19 cases (132 crew), and one out of the six ships had COVID-19 cases appearing less frequently than 1 per day, consisting of a total of 12 patients. This ship sails under the flag of the Indonesian state. Of the other five ships, among the crew, 111 caught COVID-19 (85.1% of crew cases were from Indonesia, and 21 (15.9%) of were from subtropical/tropical countries, namely India). Conclusions: All ships have to deal with cases of COVID-19 or outbreaks on board every few years. Any case of COVID-19 could start an outbreak, and thus trigger time-consuming and expensive containment measures, including isolation and mass vaccination of susceptible contacts. Mandatory pre-contract proof of COVID-19 immunity from all seafarers or from subgroups, noting their position or nationality may be worth considering. In order for sailors to be immune to COVID-19, they must be able to get COVID-19 vaccinations and valid documentation when sailing. Full article

Communicable diseases pose a significant threat for passenger vessels, as norovirus, influenza, food, waterborne diseases, and lately COVID-19 have caused several public health events. To manage the risks deriving from communicable diseases, this work focuses on ship design by developing a framework for health risk assessment. This framework is based on the risk-based design, an emerging design process for which safety is considered as a design criterion, by also integrating infection and spreading aspects. The framework shall allow the assessment of various design solutions, as risk control options, aiming at minimizing the spread of diseases and, thus, its consequences. Full article

Man-made vitreous fibers (MMVFs) are widely used in shipbuilding. Some MMVFs are “suspected of causing cancer” in Annex VI of Regulation (EC) 1272/2008 and can be easily found in ships (asbestos free or not ones). This study is an overview of the conditions/confinement of MMVFs onboard ships, focusing on the measures taken to reduce the risk of exposure and on the perception of risks, in analyzed ships. We suggest to improve on-board MMVFs safety plans (as for asbestos risk-management) and to strengthen National and European Authorities’ supervision/network on this theme also by the EU SHIPSAN ACT Joint Action’s tools. Full article

Soft power is a geopolitics concept that implies achieving what one wants through non-coercitive measures. In the context of ship sanitation, port health authorities can provide “hard” and coercitive mandates, and also non-coercitive recommendations. Herein we examine the presence of soft power in ship sanitation literature, the advantages and limitations of hard power, and the importance of the legal framework. Soft power often requires investing time in dialogue and mutual understanding and maintaining a good image; but in any case in the context of ship sanitation awareness and collaboration of all involved parts is necessary for long-term success. To conclude we recommend a careful combination of hard power and soft power. Full article

Spain is a country with an important flow of cruises in Europe. Since the restarting of cruise activity, 1,106 events with 12,134 confirmed cases of COVID-19 were reported from 21 ports. 72.3% of cases and 73.7% of events were registered in the Balearic Islands, Barcelona, Tenerife and Las Palmas, ports with the highest number of layovers and passengers. The events reported increased from October 2021, with a peak in January and April 2022. The cases raised later, in December 2021 with two peaks in January and April and a substantial increase in June 2022. The peak of January coincides with the peak of COVID-19 cases registered in Spain and Europe. The increases in April and June 2022 coincides with the Easter period and the beginning of summer holidays. Full article

This study evaluated the usefulness and validity of wastewater SARS-CοV-2 monitoring in passenger ships. Wastewater grab samples (n = 54) were collected from seven cruise ships arriving at the port of Piraeus from June to November 2021. Samples were analyzed for the presence of SARS-CoV-2 RNA with an RT-PCR based method. Results were compared against the number of cases detected on the ships before arrival. It was demonstrated that sewage monitoring can detect the presence of SARS-CoV-2, even with few cases on board. Future efforts should focus on the collection of more representative samples to increase the consistency and validity of the investigated practice. Full article

The medical assistance to seafarers was not always improved in parallel with advances in medicine and telecommunications. Today technology offers systems including digital devices helping in collecting symptoms to be referred correctly to remote physicians. CIRM SERVIZI, the spin-off of Centro Internazionale Radio Medico (C.I.R.M.), and the Italian TMAS center, have developed an advanced system called CIRM PREMIUM. This aimed at offering extensive telemedicine solutions for the treatment of illnesses or injuries on-board ships. The objective of this paper is to present the results of offered service with CIRM PREMIUM and the standard basic TMAS service given by C.I.R.M. to ships not equipped with advanced technologies. We have considered 400 seafarers assisted on-board ships from 1 January 2020 to 31 December 2021 including 200 on-board ships equipped with CIRM PREMIUM (Test Group, TG) and 200 were on-board ships requiring the C.I.R.M. standard free telemedical assistance (Control Group, CG). The five most frequent different disorders assisted by C.I.R.M in the given period were considered. Diseases of the circulatory and respiratory systems were also considered to be the most frequent cause of medical emergencies on board. Data were analyzed comparatively by analysis of variance (ANOVA) and by the Chi-squared test. The average time for a patient’s complete recovery was 115.1 ± 12.8 h (4 to 5 days) in the TG group and 132.8 ± 14.4 h (5 to 6 days) in the CG group. From a temporal point of view, PREMIUM patients showed an improvement in 12–24 h from the first request for medical advice, versus 36–48 h for those using the standard medical service. The patients who fully recovered on board were 48.8% for the TG group and 27.46% for the CG. Telemedical assistance resulted in avoiding diversions in 73.7% of cases in the PREMIUM service and in 43.7% in the standard service. The results of our analysis revealed that the CIRM PREMIUM services provide a better and quicker outcome for patient conditions and cause significantly less ship diversions for medical reasons. This indicates that technological progress can offer relevant advantages for treating diseases or accidents on-board ships. The presence of telemedical devices on board, their larger and constant use and a closer collaboration from the ship will offer seafarers adequate health protection and will reduce the present disadvantage of being ill while at sea. Full article

In January 2019, complaints of an intermittent salty taste in drinking water were received from locations in close proximity to an international seaport. Preliminary testing indicated the presence of seawater within the potable water system. A multi-disciplinary incident management team was immediately convened and a “Do Not Consume notice” was issued. Subsequent investigations revealed contamination was likely due to a mis-connection to the seawater firefighting system during freight ferry bunkering of potable water at the port. Following this incident, new procedures were introduced at the port to prevent reoccurrence of this issue. No associated cases of illness were reported. Full article

Within the framework of the interdisciplinary research project ARMIHN (Adaptive Resilience Management in the Port) a two-day large-scale exercise took place in the Port of Hamburg in October 2021. Due to the COVID-19 pandemic, the exercise could not be realized as a full-scale exercise with a large number of participants and actors as originally planned. Therefore, a hybrid exercise concept with virtual and live parts was developed. The project ARMIHN has shown that the planning, organization, and implementation of a hybrid large-scale exercise is demanding, resource- and time-intensive. On the other hand, the project showed the possibility for exercises to be conducted even when underlying conditions like the COVID-19 pandemic do not support a full-scale exercise in presence. Full article

The coordination of public health events related to ships presents a challenge to the port health authorities, and communication means and routes are not well established. The EU Common Ship Sanitation Database provides a platform for port-to-port communication of public health events on board ships. The last seven years of operation, 64 public health events were communicated through the system by port health authorities from seven EU countries. Although the usage of the platform has been appreciated, promoted, and legislated in several EU MSs, actions at the national and EU levels are needed to promote the use of the platform by all EU MS are necessary. Full article

In response to the COVID-19 pandemic, the European Union Joint Action HEALTHY GATEWAYS developed guidelines for cruise operators and authorities to restart operations and provide common COVID-19 public health preparedness and response standards. In February 2022 under the Joint Action framework, a COVID-19 outbreak onboard a cruise ship was analysed, applying the Intra-Action Review (IAR) methodology at a European level. Participants included national public health authorities and local port health authorities involved in the event response, as well as cruise line representatives. Good practices and challenges observed during the COVID-19 event are presented. Moreover, we documented the lessons learned which provided the basis for proposed revisions to future versions of HEALTHY GATEWAYS guidelines. Full article

The association of cases of Legionnaires’ disease and ships has been well documented. Results from potable water samples collected for microbiological analysis during SSC inspections conducted from 2010 to 2018 at Belgian ports were analyzed in order to evaluate the level of colonization on non-passenger ships. Results indicate a high degree of colonization (77.2% of the ships were found to be colonized with Legionella spp. at least once) and further analysis is recommended to examine possible factors associated with colonization. Inspections for issuance of SSC should focus on water safety and prevention of Legionnaires’ disease. Full article

Waterborne disease due to the microbial contamination of potable water onboard ships is a potential threat for seafarers. The results from the samples collected at Belgian ports from 2010 to 2018 during inspections of non-passenger ships are used to evaluate the microbiological and chemical quality of potable water. A small proportion of the samples was found positive for indicator organisms (7.5%), indicating the lack of proper disinfection and possible contamination. Further analyses and risk assessments are recommended for examining possible contributing factors. Inspections for the issuance of SSC should focus on water safety and the prevention of waterborne diseases. Full article

The joint action EU HEALTHY GATEWAYS (EUHG) aimed to support cooperation and coordinated action of MS to improve their preparedness and response capacities at PoE, for preventing and combating cross-border health threats from the transport sector. The aim of this study is to present how EUHG supported strengthening of core public health capacities at ports during routine operations and the COVID-19 pandemic. Methods used included surveys, literature reviews, in(tra)-action reviews, focus and expert working groups, site visits, exercises, inspection grading system methodology. In addition, the EU Common Ship Sanitation Database (EUSIS) was used as a tool to collect information on health conditions on board and to share information about public health events. EUHG network established the EUPOENET and implemented the European passenger ship inspections programme implementation where 558 inspectors in the EU SIS recorded 33,184 Ship Sanitation Certificates, followed up >80 public health events via the port communication form out of which 22 were COVID-19 related, and recorded > 4600 hygienic deficiencies. EUHG developed a web-based, searchable catalogue of best practices, SOPs for mosquito surveillance and control, a model MoU describing cooperation among authorities at ports, a tool was produced for development/assessment of contingency plans (ports), a tool serving group-based discussions about what defines risk at port level. EUHG conducted training courses and European level multi-sectorial TTE. The EUHG network of experts supported EU’s COVID-19 response by developing 16 technical guidance documents, provided >40 expert consultations and conducted three site visits and short seminars, two national level IAR and a European level meeting using IAR methodology and produced over five scientific publications. The JA’s network contribution to the pandemic has been globally acknowledged, recognized and demonstrated, with the network immediately activated to support EC and MS requests, and transport restart operations in 2020–2021. Full article

The aim of the study is to describe the routine inspections conducted by competent Public Health Authorities (PHAs) on board passenger ships (cruise ships, inland vessels or ferries) sailing in European countries during the EU HEALTHY GATEWAYS joint action and according to the hygiene standards set out in the European Manual for Hygiene Standards and Communicable Disease Surveillance on Passenger Ships (Edition 2nd, April 2016). From 2018 to the end of April 2022, 138 inspection reports were submitted by PHAs in 38 ports in SIS by 76 inspectors, three SHIPSAN experts, 16 inspectors in training and 31 observers, along with 130 Corrective Action Statements by shipping companies or officers of ships. Full article

We analysed all proven cases of SARS-CoV-2 on sea-going vessels entering or present in the Port of Rotterdam to illustrate the burden of the corona pandemic on commercial shipping. We calculated the notification rate (NR) per arrival and attack rate per vessel and correlated outbreak sizes by vessel type over time during the pandemic using routinely gathered data from the port and public health (PH) authorities. Full article

Contingency planning is a vital component of robust national emergency preparedness. In Ireland, the Health Service Executive Port Health Network engaged with Dublin Port from July 2021 to develop Ireland’s first interoperable port health contingency plan, with a view to rolling it out to other designated ports. The EU Healthy Gateways tool for public health emergency contingency plan development (2021) was utilized to support this project, ensuring public health emergency contingency planning across varied public health threats. The principles of this multi-agency approach to port contingency planning, as described, are applicable to other designated ports within Ireland and other jurisdictions. Full article

Legionella is a public health concern on passenger ships and the the need to implement a Legionellosis prevention plan is even more important in on-board hospitals that are frequented by higher risk people who are more susceptible to infection. In this paper we proposed a prevention plan specific for shipboard medical facilities derived by the Italian National guidelines for Legionellosis prevention. We presented also data of efficacy and performance specifications (field evaluation), on a Legionella point-of-use filter. The point-of-use filters when they are used in synergy with the others prevention methods can play an important role, cost–benefits ratio positive, to minimize the risk of growth and spread of Legionella and other waterborne pathogens on passenger ships in case of specific conditions. Full article

The French and Italian Riviera are one of the most important areas in the world for yachting and cruise activity. Even though ports and airports of this area make up a single network, they insist on the territory of two different EU countries (Italy and France), and of one non-EU (Principality of Monaco), that have different health systems and legislations. In this context, a collaboration between maritime port health authorities became essential to perform an effective public health action in order to prevent the spread of infectious diseases. In this paper are illustrated the best practices in the domain of maritime public health collaboration between Italy and Monaco during the Covid-19 pandemic, and programs for future developments that should be a benchmark for other cooperation programs between eropean health port authorities. Full article

The COVID-19 pandemic exacerbated many underlying issues regarding seafarers in the maritime industry, known as the “human element” at the International Maritime Organization. The challenges were a result of a global crew change crisis and issues with repatriation as a result of travel lockdowns, pay insecurity, mental health challenges, lack of digital access, and flaws within the Maritime Labour Convention (MLC) that resulted in serious questions of liability and rights and responsibilities for seafarers. The Center for Ocean Policy & Economics (COPE), hosted by the Northeast Maritime Institute’s College of Maritime Science, observed and participated in several initiatives to promote human rights at sea to improve the livelihood of seafarers. The initiatives underscore pathways and methods of improvement for maritime and ocean related issues. Full article

The adverse impacts caused by the COVID-19 pandemic reinforced and magnified issues of sexual assault and harassment (SASH) with consequences on seafarers’ mental health and wellbeing which in turn negatively affects recruitment and attrition rates of seafarers. The Center for Ocean Policy & Economics (COPE) hosted by the Northeast Maritime Institute’s College of Maritime Science, which was established to tackle wicked problems in the maritime and ocean related fields, established a working group to aid the International Maritime Organization (IMO) to amend and develop training for SASH in IMO Model Course 1.21 Personnel Safety and Social Responsibilities. The working group facilitates global participation through digital accessibility to ensure diverse viewpoints on SASH in the maritime sector. Full article

In March 2020, a ferry (Splendid G.N.V. Company, Italy) moored in the port of Genova (Northwest of Italy) was transformed into a medical care facility for COVID-19. The project intended to help infected patients that required low-intensity care, were discharged from hospitals in the Liguria Region and were not yet able to return home. The aim was to share some of the treatment burden of the completely overcrowded local ashore hospitals and to free up bed spaces for patients in the acute phase of the disease. In this work we highlighted under the health port authority perspective the safety issues that the crew faced resulting from the exceptional and very unusual allocation of ashore medical facilities on a passenger ship. Full article

Adequate medical facilities on passenger ships are essential to ensuring the quality of medical care and public health actions. Their design and construction is complex, as they have to comply with several regulations and recommendations from different authorities (IMO, ILO, EU, WHO), national flag legislation and advices from scientific societies. Therefore, proper authorization procedures become very important. The working guideline, developed in the light of our experience gained in new Italian cruise ships/ferries’ medical facilities’ authorization processes is presented. Innovative points are the participative continuous approach “from the board to the sea” and the Dynamic-Planning Method based on “what if” scenario model. A careful balance of the required features and standards against costs without compromising the quality of care is possible. The guidelines are open to be continually reviewed, updated, and expanded with the contribution of stakeholder’s. Readers are encouraged to provide feedback and to contribute material for further updates. Full article

The public health surveillance of yachts and pleasure boats is relevant to avoid and prevent the spread of infectious diseases. With the entry into force of the International Health Regulations 2005, the Ship Sanitation Exemption Certificate (SSEC) become an important tool to prevent the risk of the international spread of disease through international maritime travel. The WHOs existing international guidelines mainly refer to large ships, so the aim of this work was to create a concise checklist applicable to the yachting world. In order to facilitate and standardise the inspection procedures on board yachts, a summary checklist was therefore drawn up. A summary of mainly non compliance founded in the 2021 is also provided. Full article