Local Authorities (LAs) and Port Health Authorities (PHAs) are responsible for the enforcement of infectious disease controls. PHAs were constituted with the primary objective of preventing the introduction into the country of dangerous epidemic diseases through shipping activity without creating unnecessary disruptions to world trade.
As ports generally extended over the area of more than one Local Authority, legislation allowed for the constitution of port sanitary authorities with permanent jurisdiction over the port. These statutory powers are now embodied in the Public Health (Control of Disease) Act 1984.
The crew of aircraft and ships, passengers and other visitors, cargo and transported animals can spread infectious diseases. International travel is undertaken by large, and ever increasing, numbers of people. More people travel greater distances and at greater speed than ever before, and this upward trend looks set to continue. Travellers are thus exposed to a variety of health risks in unfamiliar environments.
The International Health Regulations 2005
In 2005, the World Health Organization issued revised International Health Regulations, extending the scope of previous regulations. The new International Health Regulations address the multiple and varied health risks that face the world today and cover existing, new (e.g. SARS, Ebola virus) and re-emerging diseases (e.g. tuberculosis), including emergencies caused by non-infectious agents.
The Department of Health in England and the devolved administrations in Northern Ireland, Scotland and Wales are responsible for transposing the International Health Regulation into national law, for identifying national focal points and developing state capabilities and capacities, including surveillance and responses. New reporting procedures are aimed at expediting the flow of timely and accurate information to the World Health Organization about potential public health emergencies of international concern.
The Public Health (Control of Disease) Act 1984 assigns powers for applying controls for health, disease and waste disposal to PHAs and LAs. The Act is currently in revision.
When outbreaks of infectious disease are associated with international travel, PHAs and LAs liaise with the Consultant Physician in Health Protection, formerly the Consultant in Communicable Disease employed by Public Health England in England. Similar arrangements exist for the devolved administrations in Scotland, Wales and Northern Ireland, except that in Scotland this service is provided by the local health boards.
As international health controls develop, LAs and PHAs will prepare emergency plans for dealing with incidents or outbreaks of infectious disease with associated colleagues.
National outbreak planning and response advice in the case of Norovirus has been prepared by a joint working group of which participants include members of the Association of Port Health Authorities, Public Health England (etc) and the Maritime Coastguard Agency.
Powers for applying health controls on ships in England are contained in the Public Health (Ships) Regulations 1979 (under review) and Public Health (Ships) (Amendment) (England) Regulations 2007. Parallel legislation is in place in the devolved administrations. These Regulations provide for notification by the ship’s master of health conditions on board; inspection of incoming ships by PHAs and LAs; issuing of ship sanitation certificates; examination of people; and authorizes measures to be taken for preventing danger to public health.
The applications of additional measures appropriate to specified diseases particularly dangerous to public health are subject to the International Health Regulations
Ship Sanitation Certificates
The International Health Regulations provide for the global issuance of ship sanitation control/ exemption certificates. Legislation is in place to allow all UK administrations to issue these certificates. Ship Sanitation Certificates are designed to prevent international vessels from causing a public health risk and cover all areas of ship borne public health risks including vector control, potable and ballast water and food safety controls. More information about these areas can be found later in this section.
Ship Sanitation Certificates are issued by port health or environmental health officers following an inspection of the ship and are valid for six months. Ship Sanitation Certificates can only be issued at ports which have been authorised to do so. If the ship inspection is satisfactory a Ship Sanitary Exemption Certificate will be issued. If Public Health risks are found on board ship the PHA or LA will issue a Ship Sanitation Control Certificate and require that the problems are remedied within a certain timescale. Some inspections of ships have required the issuance of control certificates despite the presence of exemption certificates on board. In these cases APHA members have dealt with problem conditions on board and have contacted the next port of call in the UK and abroad, where possible. Table 1 shows the UK ports currently authorised to issue the certificates. Contact details for the PHA or LA responsible for issuing a ship sanitation certificate can be found in Section 5.
Detailed guidance on issuing ship sanitation certificates is available on the WHO website.
Suspect Disease on Board a Ship
When arriving from a foreign port, a Master of a ship is required to report any suspected infectious disease or death on board amongst crew, passengers or animals/birds to the Port Health Authority or Local Authority. This report should be made not less than 4 hours and not more than 12 hours before arrival.
Such reportable incidents include:-
- the occurrence on board ship before arrival of
- the death of a person otherwise than as a result of an accident, or
- illness where the person who is ill has or had a temperature of 38ºC or greater which was accompanied by a rash, glandular swelling or jaundice, or where such temperature persisted for more than 48 hours, or
- illness where the person has or had diarrhoea severe enough to interfere with work or normal activities
- the presence on board of a person who is suffering from an infectious disease or tuberculosis or who has symptoms which may indicate the presence of an infectious disease or tuberculosis;
- any other circumstances on board which are likely to cause the spread of infectious disease or other danger to public health; and
- the presence of animals or captive birds, and the occurrence of mortality or sickness amongst such animals or birds.
Where a report is required The Public Health (Ships) Regulations 1979 (as amended) specify that no person other than a pilot, customs officer, immigration officer or port health officer shall board or leave a ship without consent of the Port Health Authority. The ship is required to obtain a free pratique for health clearance.
The Master may be required to complete a Maritime Declaration of Health and should also have ready for the port health officer a list of passengers and crew leaving the ship together with the addresses they are going to in the United Kingdom.
The Port Health Authority or Local Authority can be contacted through a shipping agent or alternatively the port radio should be able to provide a direct contact. An officer of the PHA or LA will investigate when there has been a notification before granting clearance.
There is a penalty for not notifying the PHA or allowing persons to board or leave the ship.
New public health regulations for conveyances for international transport and trade are anticipated.
Links to all SHIPSAN ACT Information Systems for port health officers in the European Union:
- Communication Network Platform for EU ports and database for recording inspections conducted against the European standards as provided in the SHIPSAN Manual http://www.shipsan.eu/comnet/
- Information system for recording and issuing Ship Sanitation Certificates based on WHO handbook. http://ssc.shipsan.eu
- European directory for travelers ports of EU countries for issuing Ship Sanitation Certificates under IHR (2005). http://www.shipsan.eu/Inspections/AuthorisedportstoissueSSC.aspx
- SHIPSAN ACT e-learning platform http://elearning.shipsan.eu/
- Bibliography (European legislation and scientific articles). http://www.shipsan.eu/Home/Bibliography.aspx
- Questions and answers about Ebola virus disease for maritime transport http://www.shipsan.eu/Home/AdhocForumforEbola.aspx
Powers for applying health controls on aircraft are contained in the Public Health (Aircraft) Regulations 1979 and Public Health (Aircraft) (Amendment) (England) Regulations 2007. Parallel legislation is in place in the devolved administrations. These Regulations define the responsible authorities charged with enforcing and executing the Regulations. The development of commercial flying and the speed with which people, animals and cargo can move around the world to and from infected areas is reflected in the scope of the regulations.
Provisions are made for measures to be taken for both incoming and outgoing aircraft and their passengers with a view to preventing danger to public health and the spread of infection, including detention of the aircraft, passengers, stores, equipment and cargo.