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Mission
Because of several major disease outbreaks on cruise vessels,
the Centers for Disease Control and Prevention (CDC) established
the Vessel Sanitation Program (VSP) in the early 1970s as a
cooperative activity with the cruise ship industry. The program
assists the cruise ship industry in fulfilling its responsibility
for developing and implementing comprehensive sanitation programs
in order to minimize the risk for gastrointestinal diseases.
How the Program Works
ROUTINE INSPECTIONS
 Every vessel that has a foreign itinerary, carries 13 or more
passengers, and calls on a U.S. Port is subject to un-announced twice-yearly
inspections and, when necessary, to reinspect by VSP staff.
The vessel owner pays a fee, based on tonnage, for all
inspections. Currently, over 140 cruise ships participate in the
program.
The
ships must meet the criteria established by VSP in the "Vessel Sanitation
Program Operations Manual". The ship earns a score based on a 100 point
scale. To pass the inspection, a ship must score 86 or above. If
the ship fails an inspection, it will be re-inspected, usually
within 30 to 45 days.
The inspections are conducted by Environmental Health Officers
(EHO) of the Vessel Sanitation Program, and take place only in
U.S. Ports. Depending on the size of the ship, an inspection may
take from 1 to 4 EHOs, but typically 2 are assigned to conduct
the inspection. The inspection may take from 5 to 8 hours to
complete, depending on the size and complexity of the vessel.
The inspection focuses on the following:
- The ship's water supply -- to determine how
water is stored, distributed, protected, and disinfected.
- The ship's spas and pools -- to ensure adequate
filtration and disinfection.
- The ship's food -- to determine how it is
protected during storage, preparation, and service.
- The potential for contamination of food and
water -- to determine what interventions are needed for
protection.
- The practices and personal hygiene of
employees -- to ensure cleanliness and the use of
appropriate hygienic practices.
- The general cleanliness and physical
condition of the ship -- to ensure cleanliness and the
absence of insects and rodents.
- The ship's training programs in general
environmental and public health practices -- to determine
the scope and effectiveness of such training.
Inspection scores and reports are published on the VSP website
www2.cdc.gov/nceh/vsp/vspmain.asp.
In addition, scores are published every month
in the Summary of Sanitation Inspections of International
Cruise Ships, commonly referred to as the green sheet.
This sheet is distributed to more than 3,000 travel-related
services around the world.
In general, the lower the score, the lower
the level of sanitation; however, a low score does not
necessarily imply an imminent risk for gastrointestinal disease.
Since the program began, the number of disease outbreaks on ships
has declined despite significant growth in the number of ships
sailing and the number of passengers carried.
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SURVEILLANCE AND OUTBREAK INVESTIGATION
 The VSP staff continually monitors reports
of diarrheal illness on each ship. The ship is required to
maintain a standardized
gastrointestinal illness incidence report for each cruise. It
contains information on passengers and crew members who had
reported diarrhea, including the number of cases of
gastrointestinal illnesses by dates of onset and the total
numbers of passengers and crew members.
If at least 3.0% of the ship's
passengers and/or crew members have gastrointestinal illness, the
VSP, in consultation with other environmental health and
infectious diseases programs at CDC, may conduct an investigation
to determine if an outbreak of gastrointestinal illnesses
occurred. If an unusual gastrointestinal illness pattern or
characteristic is found even when the illness rate is less than
3.0% (e.g., relatively high incidences of illnesses in successive
cruises, unusual severity of illnesses or complications, a high
number of persons reporting illnesses over a brief period of
time, suspicion of an uncommon etiologic agent), an investigation
may also take place.
In the 1970s and early 1980s, 12 to 15
outbreaks of diarrheal illness occurred each year on cruise
ships. The number of outbreaks has decreased steadily since then;
in Fiscal Year 1999, there were only three outbreaks.
Outbreaks of diseases, other than gastrointestinal, such as
influenza, are investigated by CDC's National Center for
Infectious Disease, Division of Quarantine. Information on other
health risks and diseases affecting the traveling public can be
found at: http://www.cdc.gov/travel.
Consultation on New Construction and
Renovation
C ruise vessel owners or shipyards that build or renovate
cruise vessels may request plan reviews, on-site shipyard
construction and/or final construction inspections of new or
remodeled vessels before their first or next operational
inspection, as the case may be. The vessel owner or shipyard pays
a fee, based on gross registered tonnage of the vessel, for
on-site and final construction inspections.
CDC has provided construction guidelines for various
components of the vessel's facilities related to public health,
such as food storage, preparation, and service; water bunkering,
storage, disinfection, and distribution. The guidelines were
published in August 1997.
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Plan Reviews and Consultations
For new-buildings, plan reviews are normally conducted a
minimum of 18-24 months before the vessel is scheduled for
delivery. Because of the variable time lines associated with
major renovations, the plan reviews for such projects shall be
coordinated well before the work is begun, allowing time to make
any necessary changes. Persons requesting a plan review shall
submit their request in writing, such as a fax, to the Chief,
VSP. Two officers will normally be assigned to conduct the
review. Most plan reviews will take two working days and will be
conducted in Atlanta or Fort Lauderdale. The review shall be
attended by representatives from the shipyard, the vessel owner,
and the subcontractor(s) who will be doing most of the work.
These representatives shall bring all pertinent plans or drawings
and equipment specifications for the areas covered in these
guidelines, including but not limited to general arrangement
plans; all food-related storage, preparation, and service area
plans; potable and non-potable water system plans with details on
water inlets (sea chests), outlets, and backflow protection
devices; ventilation system plans; and, if applicable, swimming
pool and whirlpool spa plans. Following the plan review, the
shipyard shall provide 1) a complete set of plans or drawings and
specifications for the vessel, 2) any plans that are re-drawn and
3) a statement of corrective action outlining how each of the
items identified in the plan review will be corrected.
Additionally, the VSP shall be sent copies of any major change
orders in the areas covered by these guidelines that are made
after the plan review, before the on-site construction
inspection, or completion of the vessel. Any questions or
requests for consultative services by the VSP while the vessel is
being built shall be directed in writing, such as a fax, to the officer(s) assigned to the project and shall be coordinated with
either the owner or shipyard. The person sending the request
shall include the fax numbers of the contact person or project
manager for the vessel owner, shipyard or subcontractor so that
they may receive a copy of the VSP's response.
On-Site Construction Inspections
Most on-site or shipyard construction inspections are
conducted in shipyards outside the United States. An on-site construction
inspection normally requires the expertise of one to three
officers, depending on the size of the vessel and whether it is
the first of a hull design class or a subsequent hull in a series
of the same class of vessels. The inspection, including travel,
generally takes 5 working days. The on-site inspection
shall be conducted approximately 4 to 5 weeks before delivery,
and when the areas of the vessel to be inspected are 90%
completed. Following the inspection, and before the
ship's arrival in the U.S., the shipyard shall submit to the VSP
a statement of corrective action outlining how each item
identified in the inspection report will be addressed and
corrected.
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Final Construction Inspections
At the request of a vessel owner or shipyard, a final
construction inspection may be conducted by the VSP. A formal,
written request shall be submitted, such as a fax, to the Chief,
VSP as soon as possible after the vessel is completed, a minimum
of 10 days before its arrival in the U.S. Final construction
inspections may be conducted outside the U.S. at the request of a
vessel owner or shipyard if the vessel is not immediately
entering the U.S. market. After a final construction inspection, a statement of
corrective action shall be submitted to the VSP as soon as
possible outlining how each item identified in the inspection
report will be addressed and corrected including the projected
date of completion. Vessels that undergo a final construction
inspection are generally scheduled for an unannounced operational
inspection by the VSP within 6 weeks of the vessel's arrival in
the United States. Operational inspections are conducted in
accordance with the VSP Operations Manual. If a final construction inspection is
not requested, then an unannounced operational inspection will
generally be conducted by the VSP within 4 weeks of the vessel's
arrival in the U.S. Operational inspections are conducted in
accordance with the
VSP Operations Manual.
Training Seminars
Since December 1989, the VSP staff has
offered sanitation seminars five times each year for shipboard
management personnel. Conceived and designed by
 VSP personnel,
these seminars bridge the communication gap between government
regulators and shipboard personnel by explaining recommended
standards, emphasizing the reasons for them, and discussing how
to comply with them.
Topics covered are the storage,
distribution, protection and disinfection of a ship's water
supply; protection of food during storage, preparation, cooking,
and service; employee practices and personal hygiene; general
cleanliness, facility repair, and vector control; and potential
for contamination of food and water.
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Cruise ship companies frequently ask the VSP
staff to help them improve their on-board sanitation efforts. we
also disseminate information about new disease outbreaks and the
risk that such outbreaks create for the cruise ship industry. The
VSP distributes an advisory letter about various public health
concerns and recent changes in public health practices and
interpretations.
In addition to the many seminars and
consultative services we offer to the cruise ship industry, VSP
responds to requests for information from state and local
agencies, health professionals, international agencies and
governments, and the general public.
For more information, please
contact us at: vsp@cdc.gov
Vessel Sanitation Program
National Center for Environmental Health
Centers for Disease Control and Prevention (CDC)
Telephone: (770) 488-7070
FAX: (770) 488-4127
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