Periodic Reporting for period 1 - HEALTHY SAILING (Prevention, mitigation, management of infectious diseases on cruise ships and passenger ferries)
Reporting period: 2022-09-01 to 2024-02-29
Passenger ships are crowded environments where infections may spread rapidly without effective detection and control measures. Even with rigorous hygiene standards, infectious diseases impact the health of travelers and communities, with potential economic consequences. COVID-19 demonstrated preparedness plans’ inability to rapidly detect emerging diseases and respond effectively. HEALTHY SAILING (HS) provides an innovative approach to address known, expected or emerging infectious diseases, facilitate preparedness for potential future public health emergencies and makes passenger shipping safer, more resilient, competitive and efficient. Current preparedness and response protocols are underpinned by limited scientific evidence. HS applies a multi-method approach to establish an evidence base to understand risk factors, infection spread, and measures’ effectiveness. Results will inform guidance development, and implementation of measures differentiated by passenger ship type. With no holistic approach for surveillance onboard, infections can be undetected leading to outbreaks. HS is developing a prototype software to integrate real-time syndromic, laboratory and environmental health surveillance onboard for early threat detection. To standardize responses, a prototype with artificial intelligence (AI) will provide health threat alerts, support health measure decision making and monitor measure implementation. To enhance hygiene standards, a toolkit for monitoring surface disinfection onboard and an AI water safety plan tool are being developed. A blended learning toolkit with hands-on training for crew and passengers is being produced to increase knowledge and compliance. Mixed methods are identifying social, behavioral and cultural factors to measure compliance, considering gender issues. To assess impact, specific measures will undergo cost-benefit analysis.
HS produced a Foundation Report with 5 overarching components. A systematic review for passenger ships described infection frequency, outbreak dynamics, risk factors and measure effectiveness by pathogen type. Additional systematic reviews described impact on seaports, and behavioral determinants of infection spread among cruise crew and passengers. Epidemiological studies were conducted assessing: a cruise line’s medical logs for communicable diseases, COVID-19 incidence on EU cruises and Greek ferries, non-pharmaceutical measure effectiveness to prevent COVID-19, and a cruise ship gastroenteritis outbreak. Focus groups among cruise crew provided insight to facilitators and barriers travelers face in health measure compliance. Surveys of cruise crew and passengers focused on infectious disease knowledge, attitudes for measure compliance and symptom reporting. A review of standards and regulations identified interoperability requirements of HS outputs with existing ship design and operations. An inventory of digital features/technologies on passenger ships for infection prevention/control was produced. HS produced an interim version of evidence-based guidelines for COVID-19 prevention and management on passenger ships to guide authorities/industry on appropriate measures and public health emergency preparedness. Infection chain analyses for respiratory viruses (COVID-19 and influenza) and Norovirus were conducted considering the entire traveller journey.
An experimental trial was conducted onboard a 12-day cruise, providing a validation data set of measurements of accumulation/dispersion of CO2 and particulate aerosol release in two ship spaces, under several ventilation conditions. A syndromic surveillance system was developed to identify trends in space/time for early detection of passenger ship outbreaks, assess communicable disease burdens and monitor measures’ effectiveness. Data models were created for two software prototypes: 1) E-Surveillance System (E-SS) - integrated system collecting data from various onboard sources for early health threat detection; 2) AI Intelligence Immune System (IIS) to produce outbreak alerts and recommend control measures based on threat level. To improve water quality and prevent waterborne diseases onboard, the first version of a Water Safety Plan tool was developed. The electronic prototype will simplify plan development (AI for decision support), suggest control measures and operational monitoring of onboard water systems. A four-arm intervention study was conducted onboard a cruise ship to improve hand hygiene practices, assessing surface disinfection, hand hygiene techniques via electronic device, and crew hand hygiene training. Five intervention study protocols were developed to assess the impact of evidence-based measures introduced by HS. The first version of a blended learning training toolkit was produced, combining e-learning courses for selected crew groups with hands-on training for crew/passengers using Augmented Reality scenarios. A short video communicates good COVID-19 prevention practices to cruise passengers.
An experimental trial was conducted onboard a 12-day cruise, providing a validation data set of measurements of accumulation/dispersion of CO2 and particulate aerosol release in two ship spaces, under several ventilation conditions. A syndromic surveillance system was developed to identify trends in space/time for early detection of passenger ship outbreaks, assess communicable disease burdens and monitor measures’ effectiveness. Data models were created for two software prototypes: 1) E-Surveillance System (E-SS) - integrated system collecting data from various onboard sources for early health threat detection; 2) AI Intelligence Immune System (IIS) to produce outbreak alerts and recommend control measures based on threat level. To improve water quality and prevent waterborne diseases onboard, the first version of a Water Safety Plan tool was developed. The electronic prototype will simplify plan development (AI for decision support), suggest control measures and operational monitoring of onboard water systems. A four-arm intervention study was conducted onboard a cruise ship to improve hand hygiene practices, assessing surface disinfection, hand hygiene techniques via electronic device, and crew hand hygiene training. Five intervention study protocols were developed to assess the impact of evidence-based measures introduced by HS. The first version of a blended learning training toolkit was produced, combining e-learning courses for selected crew groups with hands-on training for crew/passengers using Augmented Reality scenarios. A short video communicates good COVID-19 prevention practices to cruise passengers.
Production of a Foundation Report to understand mechanisms of onboard infection spread and effectiveness of mitigation methods creates a scientific impact, providing evidence to inform real-word protocols and policies differentiated by passenger ship type. HS measures will produce positive societal impacts on traveler and community health. Prototype software tested onboard will improve quality of infection surveillance, facilitate early health threat detection and support health measure decision-making, while enhancing hygiene standards. Seaport capacities for disease prevention and control will be strengthened via a prediction toolkit. User-centric training technologies will improve traveler awareness and behavioural change. Passengers will feel increased security onboard, leading to positive economic impacts. Operations will resume with increased growth of the passenger ship industry, employment and expenditures in ports of call. Developers of HS outputs are defining requirements to ensure uptake of results, technological integration, compatibility and interoperability with maritime operations.