[4] The EU project ShipSan documented the high diversity of practices, administrative arrangements, qualifications, staffing, and equipment of competent port health authorities among EU countries.[5] Clearly it will need a thorough assessment of existing infrastructures and a political commitment to close the gaps and allocate resources. Hopefully, the two main evils that hamper effective public health services in many ports will not be overlooked by countries:

corruption and lack of protection of personal health data. As long as ships’ crews experience intimidation and arbitrariness in global ports, compliance and trustful cooperation of ship personnel PD0325901 with the public health services will be impaired and opportunities for interventions missed. This issue of the Journal of Travel Medicine includes two papers that pose a timely reminder to the events that must be considered when allocating

public health capacities to serve ships and ports: Elaine Cramer and colleagues[6] summarize reports to the electronic Maritime Illness and Death Reporting System of the Centers of Disease Control from 2005 to 2010. Varicella was the vaccine-preventable disease most frequently reported to CDC by cruise ships. It must be of interest to contingency planning of shipping companies and health authorities alike that 70% of reported cases were associated with outbreaks on board. The number of cases per outbreak ranged between 2 to 9 with a majority of first-generation ACP-196 cases and a substantial number of two- or more generation cases. In the opinion of Elaine Cramer and co-authors the CDC protocol for varicella outbreaks on cruise ships[7] was useful to rapidly curtail respective outbreaks. This is important information not only to cruise ships but also to cargo ships where often less than 30 seafarers, many of South East Asian origin are responsible for the ship’s safe navigation. Port health services are better being ready to assess immunity and offer post-exposure vaccination

to ships’ non-immune crew and to passengers. Mirtuka and colleagues[8] describe the enormous consequences Oxymatrine of reporting two crew patients, one from Ukraine and one from the Philippines, with rashes after signing to a cruise ship in 2006. The comprehensive investigations over 36 days revealed 1 case of rubella, 3 cases of measles and 11 cases of varicella. A stunning 30,000 passengers, traveling on this ship were notified of potential exposures to measles and rubella with no cases detected among passengers. All 1,197 crew members were considered potential contacts, assessed for immunity to measles and rubella and underwent active and passive surveillance for rash illness. The total costs were estimated at $67,000 for vaccinations, supplies, and health department staff time. Only three of the crew had sufficient immunization records to prove immunity.