Proceedings Summer 2014
The USCG assists when the CDC director issues a no-sail
order to a ship that represents an imminent health hazard
to passengers and crew members.
Surveillance and Outbreak Response
CDC's Vessel Sanitation Program also focuses on acute gas-
troenteritis syndromic (based on symptoms) surveillance
and outbreak response. Cruise ships use VSP's electronic
surveillance system to report the total number of cases
(including zero cases) the medical staff has evaluated, before
the ship arrives in a U.S. port from a foreign port.
Personnel also use the surveillance system to send auto-
matic, real-time electronic notifications to stakeholders
and partners when the illness count exceeds 2 percent of
the total number of passengers or crew when the vessel is
within 15 days of arrival at a U.S. port. Ship crew, cruise
line representatives, and VSP staffers use this early alert
to communicate and consult with one another, so they can
reduce the further spread of illness. Ship personnel also
send separate outbreak notifcations when 3 percent or more
of passengers or crew report acute gastroenteritis symptoms
to the ship's medical staff and for other outbreaks of public
A team of environmental health offcers and a program epi-
demiologist are dispatched to the ship to investigate the
outbreak, recommend mitigation measures to minimize fur-
ther spread during the voyage, prevent carry-over to future
voyages, and develop program guidance to assist ships in
avoiding similar occurrences. Outbreak updates are also
made public online.
CDC's Vessel Sanitation Program is unique in that it is
entirely self-supporting. All program expenses — including
personnel, travel, outbreak investigations, and direct train-
ing expenses — are covered by a fee cruise ship owners pay,
based on the ship's size. This fee also covers operational
inspections, re-inspections, and on-site and fnal construc-
tion inspections. There is no fee for plan reviews or outbreak
The VSP staff assists the cruise ship industry in providing
a healthy cruising environment through construction con-
sultation, training, operations inspections, surveillance, and
About the author:
CDR Luis O. Rodriguez is an environmental health offcer and the assistant
VSP training coordinator. Previous assignments include serving as a con-
sumer safety offcer with the Food and Drug Administration in San Juan,
P.R., and Rockville, Md.
The Public Health Service Act, Part G, Quarantine and Inspection (Public Health
Service Act: Quarantine and Inspection Regulations, 42 U.S.C.§264) provides the
program's inspection and surveillance authority. U.S. foreign quarantine regula-
tions (42 CFR Part 71) also require ships to immediately report onboard deaths and
certain communicable illnesses to CDC, but not to VSP. Those reports are sent to
CDC's Division of Global Migration and Quarantine.
Program staffers post all fnal reports for public view on VSP's searchable inspec-
tion database [wwwn.cdc.gov/InspectionQueryTool/InspectionSearch.aspx]. The
Corrective Action Statement submitted by the cruise line for each of the inspection
fndings is also posted on the inspection results website.
The fee schedule is published each year in the Federal Register and is also posted on
the VSP website, www.cdc.gov/nceh/vsp/desc/about_inspections.htm.
For More Information:
Planning a Cruise?
If you're planning to cruise, check out VSP's
website at w w w.cdc.gov/nceh / vsp/ for
inspection scores and reports for cruise ships
you're considering and to fnd tips on how to
stay healthy while aboard.
Additionally, VSP holds an annual public
meeting for all stakeholders, including
the cruising public, to have a public forum
discussing all aspects of the program. See
program details at www.cdc.gov/nceh/vsp/.
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