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 Trametinib manufacturer 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 (VSP). During the 30 years of its existence the VSP demonstrated that reliable disease surveillance, prevention, Ivacaftor in vivo and control on ships can be achieved. However, VSP focuses on gastroenteritis and cruise ships only and is run by one single national service. Globally, no international surveillance specifically committed to communicable diseases on ships exists. Thus, the magnitude of disease transmission on international ships still remains unknown

on a global level. A port health authority must undertake a comprehensive risk assessment before responding to a health threat. Risks may differ according to the number of persons on board, the type of cargo, medical facilities, itinerary, and other factors. The decision-making process often is performed under time pressure due to the short turnover time of ships in ports. Clinical information by the time of action frequently is incomplete; laboratory results will be available only after the ship’s departure. Cytidine deaminase Given the complexity of the decision-making process it is well understandable that the public health response is not uniform from one port health authority to the other, but it surely inhibits the willingness of the ship’s crew to cooperate if contradictory public health advice is received while sailing through international waters as observed during the influenza pandemic (H1N1) 2009.[2, 3] The World Health Organization has now started an important consultation process to develop a more generic guidance to competent health authorities. The IHR 2005 creates a legal and technical framework for Member States to secure preparedness at points of entry.