The Vessel Sanitation Program: government partnering with the cruise ship industry to improve public health.Editor's note Editor's Note (foaled in 1993 in Kentucky) is an American thoroughbred Stallion racehorse. He was sired by 1992 U.S. Champion 2 YO Colt Forty Niner, who in turn was a son of Champion sire Mr. Prospector and out of the mare, Beware Of The Cat. Trained by D. : NEHA NEHA National Environmental Health Association NEHA National Executive Housekeepers Association NEHA Northern Estates Homeowners Association (Indianapolis, Indiana) strives to provide up-to-date and relevant information on environmental health and to build partnerships in the profession. In pursuit of these goals, we will feature a column from the Environmental Health Services health services Managed care The benefits covered under a health contract Branch (EHSB) of the Centers for Disease Control and Prevention Centers for Disease Control and Prevention (CDC), agency of the U.S. Public Health Service since 1973, with headquarters in Atlanta; it was established in 1946 as the Communicable Disease Center. (CDC See Control Data, century date change and Back Orifice. CDC - Control Data Corporation ) in every issue of the Journal. [ILLUSTRATION OMITTED] EHSB's objective is to strengthen the role of state, local, and national environmental health programs and professionals to anticipate, identify, and respond to adverse environmental exposures and the consequences of these exposures for human health. The services being developed through EHSB include access to topical topical /top·i·cal/ (top´i-k'l) pertaining to a particular area, as a topical antiinfective applied to a certain area of the skin and affecting only the area to which it is applied. top·i·cal adj. , relevant, and scientific information; consultation; and assistance to environmental health specialists, sanitarians, and environmental health professionals and practitioners. EHSB appreciates NEHA's invitation to provide monthly columns for the Journal. EHSB staff will be highlighting a variety of concerns, opportunities, challenges, and successes that we all share in environmental public health. In the early 1970s, outbreaks on cruise ships This is a list of cruise ships, both those in service and those that have since ceased to operate. Both cruise ships and cruiseferries are included in this list. (Ocean liners are not included on this list, see List of ocean liners. of diarrheal di·ar·rhe·a also di·ar·rhoe·a n. Excessive and frequent evacuation of watery feces, usually indicating gastrointestinal distress or disorder. disease associated with foodborne foodborne infection or other damaging agent transmitted via the animal's (or human's) food chain. foodborne adjective Referring to that which is carried by food, either by pathogens: viruses–HAV, bacteria–eg salmonellosis, and waterborne transmission led to the creation of the Centers for Disease Control and Prevention's (CDC's) unique environmental health program: the Vessel Sanitation Program Vessel Sanitation Program See Sanitation score. (VSP VSP - Very Simple Prolog+. ) (Merson, Hughes, Wood, Yashuk, & Wells, 1975). Today, although diar-rheal-disease outbreaks on cruise ships are often associated with person-to-person contact, VSP's mission remains to assist the cruise ship industry with the prevention and control of gastrointestinal gastrointestinal /gas·tro·in·tes·ti·nal/ (-in-tes´ti-n'l) pertaining to or communicating with the stomach and intestine. gas·tro·in·tes·ti·nal adj. Abbr. (GI) illnesses and to promote public health and environmental sanitation sanitation: see plumbing; sanitary science. programs. Ships from foreign ports carrying 13 or more passengers that arrive at U.S. ports of call participate in the VSP. The VSP includes sanitation and construction inspections, GI illness surveillance and outbreak support, training for cruise ship personnel, and provision of public information. It operates on a fee-for-service basis; 100 percent of the program costs are recovered from user fees during inspections (Table 1). Resources for the Public VSP publishes a variety of information for travelers, media specialists, environmental health professionals, and the cruise industry. The following resources are available on its Web site, www.cdc.gov/nceh/vsp: * Inspection and corrective-action reports describe deficiencies in environmental health standards aboard cruise ships as defined in the VSP Operations Manual. The inspection reports include a score determined by the number of critical and noncritical deficiencies found during inspections. A 100 is a perfect score, and any score below an 86 is considered failing. Cruise ships are asked to respond to the deficiencies and to submit a corrective-action report to VSP For inspection scores, visit wwwn.cdc.gov/vsp/InspectionQueryTool/Forms/InspectionSearch.aspx. * Peer-reviewed publications are listed, with links (at www.cdc.gov/nceh/vsp/pub/biblio/biblio.htm and www.cdc.gov/nceh/vsp/pub/mmwr/mmwr.htm). * The Green Sheet is a complete list of ships in the program and their latest inspection scores (at wwwn.cdc.gov/vsp/Inspec-tionQueryTool/Forms/InspectionGreen-SheetRpt.aspx). * Advisories include handwashing instructions and tips, norovirus facts, tips for avoiding illness during your cruise, and frequently asked questions (at www.cdc.gov/nceh/vsp/pub/pub.htm). * Announcements are made on the site, including announcements of public meetings. * Cruise ship outbreak updates describe the number of sick passengers and crew, actions taken by the cruise line A cruise line is a company that operates cruise ships. Cruise lines have a dual character; they are partly in the transportation business, and partly in the leisure entertainment business, a duality that carries down into the ships themselves, which have both a crew headed by the , VSP response activities, and pathogens associated with outbreaks (at www.cdc.gov/nceh/vsp/surv/GIlist.htm). * The Outbreak Prevention and Response Protocol (to be posted soon) will outline how to manage an outbreak and prevent further spread of illness. * Guidelines guidelines, n.pl a set of standards, criteria, or specifications to be used or followed in the performance of certain tasks. for shipping of specimens are given (www.cdc.gov/nceh/vsp/cruiselines/shipping_info.htm). Partnership with the Cruise Ship Industry VSP is unique because it's a partnership with the cruise ship industry. Public meetings of VSP staff and industry officials are held annually to review the accomplishments and future direction of the program. This arrangement allows the industry to comment on items such as revisions to the VSP Operations Manual (www.cdc.gov/nceh/vsp/operationsmanual/OPSManua12005.pdf) and the VSP Construction Guidelines (www.cdc.gov/nceh/vsp/ConstructionGuidelines/ConstructionGuidelines2005.pdf). Since 1980, at the request of cruise lines
Name Headquarters A'rosa Europe NCL America America AIDA Cruises Europe American Cruise Lines America , VSP has been visiting shipyards and reviewing blueprint blueprint, white-on-blue photographic print, commonly of a working drawing used during building or manufacturing. The plan is first drawn to scale on a special paper or tracing cloth through which light can penetrate. plans to analyze cruise ship designs with the intent of eliminating or controlling as many environmental health risks as possible before the ship ever goes into service. Such inspections are based on the VSP Construction Guidelines. Achieving Standards Some cruise lines are implementing standards that vary from those in the VSP Operations Manual. Industry officials can request variances by submitting a set of protocols to follow to maintain safe standards aboard their ships. If these are approved by VSP, they can be implemented. Because of such variances, some cruise ships allow children to enter pools with diapers, passengers eat recreation-ally caught fish, and some ships have potable potable /pot·a·ble/ (po´tah-b'l) fit to drink. po·ta·ble adj. Fit to drink; drinkable. potable fit to drink. water tanks that share a wall with the hull of the vessel. Many cruise ships switched from maintaining buffet A buffet is a meal serving system where patrons serve themselves. It is a popular method of feeding large numbers of people with minimal staff. The term is also used to describe a sideboard, an antique form of furniture which was sometimes used to offer the dishes of a buffet meal operations under time rather than temperature control for potentially hazardous foods Potentially Hazardous Food is a term used by food safety organizations to classify foods that require time-temperature control to keep them safe for human consumption. A PHF is a food that:
PHF Paired Helical Filaments PHF Pakistan Hockey Federation PHF Paul Harris Fellow PHF Potentially Hazardous Food PHF Peak Hour Factor (highway capacity, civil engineering) PHF Psychiatric Health Facility ). Management is responsible for developing and monitoring each ship's time control plan. Because continuous temperature monitoring and recording is not needed, use of time as a public health control requires less labor from food workers and has been widely embraced by the industry. (For general time control plans, see the following: cold: www.cdc.gov/nceh/vsp/manual/cold%20phf%20flowchart.pdf; hot: www.cdc.gov/nceh/vsp/manual/hot%20phf%20flowchart.pdf.) VSP looks to a future of changing technologies and trends while continuing its unique service to the public, media, and the cruise ship industry For resources, see Table 2. An upcoming issue of the Journal of Environmental Health will feature more information about inspections and their recent trends in an article titled "Ship Shape: Sanitation Inspections on Cruise Ships, 1990-2005, Vessel Sanitation Program, Centers for Disease Control and Prevention." Corresponding Author: Lisa Beaumier, Public Health Analyst, Centers for Disease Control and Prevention, Vessel Sanitation Program, 4770 Buford Highway, MS F-23, Atlanta, GA 30341. E-mail: aoy5@CDC.gov. Reference Merson, M.H., Hughes, J.M., Wood, B.T., Yashuk, J.C., & Wells, J.G. (1975). Gastrointestinal illnesses on passenger cruise ships. Journal of the American Medical Association JAMA: The Journal of the American Medical Association is an international peer-reviewed general medical journal, published 48 times per year by the American Medical Association. JAMA is the most widely circulated medical journal in the world. , 231(7), 723-727. RELATED ARTICLE: Norovirus Facts * Recent research has uncovered Uncovered may refer to:
* Most recent outbreaks on cruise ships have been caused by norovirus. * Although norovirus is frequently thought of as the cruise ship virus, it is found on campuses, in nursing homes, and other areas with high volumes of people.
TABLE 1 2007 Vessel Sanitation Program Inspection Fees
Vessel Size Gross Registered Tonnage Fee (U.S. dollars) per Inspection
Extra small <3,000 $1,300
Small 3,001-15,000 $2,600
Medium 15,001-30,000 $5,200
Large 30,001-60,000 $7,800
Extra large 60,001-120,000 $10,400
Mega >120,000 $15,600
TABLE 2 Resources
Government Agency, Program,
or Document Where to Look
CDC Home: www.cdc.gov
VSP: www.cdc.gov/nceh/vsp
Food and Drug Administration (FDA) Home: www.fda.gov/
U.S. Department of Agriculture Home: www.usda.gov/wps/portal/
(USDA) usdahome
Food Safety and Inspection
Service: www.fsis.usda.gov
Ship Operational Guidelines
CDC, VSP Operations Manual www.cdc.gov/nceh/vsp/
operationsmanual/OPSManual2005.pdf
CDC, VSP Construction Guidelines www.cdc.gov/nceh/vsp/
ConstructionGuidelines/
ConstructionGuidelines2005.pdf
FDA, Interstate Travel Program, www.cfsan.fda.gov/~acrobat/
Compliance Program Guidance cp18029.pdf
Manual
U.S. Navy, prevention medicine www.nepmu5.med.navy.mil/html/
manuals preventive_medicine_manuals.html
Scientific Publications at CDC
CDC, VSP cruise ship publications www.cdc.gov/nceh/vsp/pub/biblio/
biblio.htm
CDC, Morbidity and Mortality www.cdc.gov/mmwr
Weekly Report
Handwashing Tips and Techniques
CDC, Keeping Your Hands Clean on www.cdc.gov/nceh/vsp/pub/
a Cruise Handwashing/HandwashingTips.htm
Clean Hands Coalition www.cleanhandscoalition.org
Noroviruses
CDC, Facts About Noroviruses on www.cdc.gov/nceh/vsp/pub/Norovirus/
Cruise Ships Norovirus.htm
CDC, general norovirus information www.cdc.gov/ncidod/diseases/
submenus/sub_norwalk.htm
Food Safety
FDA, Food Code www.cfsan.fda.gov/~dms/foodcode.html
FDA, time as a public health www.cfsan.fda.gov/~acrobat/
control fc05-3.pdf
FDA, Bad Bug Book www.cfsan.fda.gov/~mow/intro.html
For more references and resources, please visit
www.cdc.gov/nceh/vsp/manual/ops_manual_resouces.htm.
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