Influenza A/H1N1- Swine flu
Introduction
The A/H1N1 influenza virus, described as ‘swine’ flu, reportedly having originated in Mexico has spread to nearly all parts of the globe. The spread has been rapid and most countries are now affected. The spread and numbers of reported infections in any specific country can be seen on the World Health Organisation (WHO) web site.
The influenza A(H1N1) is a new virus and one to which most people have no or little immunity and, therefore, this virus could cause more infections than are seen with seasonal flu. The WHO is working closely with pharmaceutical companies to provide a safe and effective vaccine; some countries have advised that they will introduce a vaccination programme for their citizens. (Vaccination should only be carried out with professional medical advice).
The new influenza A(H1N1) appears to be as contagious as seasonal influenza, and is spreading fast, particularly among younger people (from ages 10 to 45). The severity of the disease ranges from very mild symptoms to severe illnesses that can result in death. The majority of people who contract the virus experience the milder disease and recover without antiviral treatment or medical care. Of the more serious cases, more than half of hospitalized people had underlying health conditions or weak immune systems.
Members should consider the implications of crewmembers falling ill at sea. An outbreak could possibly, in an extreme situation, endanger the operation and safety of the ship and therefore an understanding of the disease and the measures necessary for its containment and management are important.
How do people become infected with the virus?
The virus is spread from person-to-person. It is transmitted as easily as the normal seasonal flu and can be passed to other people by exposure to infected droplets expelled by coughing or sneezing that can be inhaled, or that can contaminate hands or surfaces. To prevent the spread, people who are ill should cover their mouth and nose when coughing or sneezing, stay home or within their cabin when they are unwell, clean their hands regularly, and keep some distance from healthy people, as much as possible.
There are no known instances of people getting infected by exposure to pigs or other animals or from the eating of pork or pork products.
What are the symptoms?
Swine flu is common in pigs in many countries including the Americas, Europe, Kenya, China, Japan, Taiwan, and other parts of Asia. It is rare in humans. The current flu outbreak in humans is due to a new strain of influenza caused by a virus subtype that derives from combined strains of human, avian and swine influenza.
The symptoms of swine flu are similar to those of regular influenza, namely:
- a fever or chill
- a cough or sore throat
- muscle and joint aches
- headache
- runny nose
- weakness
- general discomfort, and sometimes vomiting and diarrhoea
It passes with apparent ease from human to human, mainly by people exposed to infected droplets by coughing or sneezing that are inhaled, or that can contaminate hands or surfaces.
In most cases, only mild symptoms are experienced and the infected person makes a full recovery without requiring medical attention and without the use of antiviral medicines.
What members should do
Influenza pandemics must be taken seriously precisely because of their capacity to spread rapidly to every country in the world.
Members should keep their masters informed and advise their crews of:
- symptoms
- basic precautions - keeping the ship’s public spaces clean
- what to do in the event of illness on board
- possible port restrictions
- amend crew travel policies
- inform joining and departing crews
Crew changes. Is it safe to travel?
Yes.
The WHO is not recommending travel restrictions because of the outbreak of the influenza A(H1N1) virus. Limiting travel and imposing travel restrictions would have very little effect on stopping the virus from spreading, but would be highly disruptive to the global community.
Influenza A(H1N1) has already been confirmed in many parts of the world. The global response now focuses on minimizing the impact of the virus through the rapid identification of cases, and providing patients with appropriate medical care, rather than on stopping its spread internationally.
Although identifying signs and symptoms of influenza in travellers can help track the path of the outbreak, it will not reduce the spread of influenza, as the virus can be transmitted from person to person before the onset of symptoms.
Research shows that restricting travel would be of limited or no benefit in stopping the spread of disease.
Crew travelling to and from ships should be directed to maintain the utmost of cleanliness standards whilst travelling, particularly through airports, cleaning their hands thoroughly with soap and water on a regular basis.
How can the crew member be protected from influenza A(H1N1) when travelling?
Crew who are ill should delay travel plans. They should be advised when given their joining instructions that if they show the influenza symptoms they should not travel. There is a risk that within the confines of a ship the virus could be spread. Returning travellers who become ill should contact their health care provider.
Port Entry
The WHO does not believe entry and exit screenings would work to reduce the spread of this disease. However country-level measures to respond to a public health risk are the decision of national authorities and many countries have some screening procedures in place before arrival. This can include a temperature screening and or a health declaration.
There are some reported restrictions imposed by some countries on disembarking crew members, but these are not common place. Members and masters should check with their agents before hand to confirm if there is any additional quarantine or other restrictions on crew movements.
Precautions ashore
Crewmembers expecting to join a ship should be requested to confirm that they are not suffering from the symptoms of flu.
Masters must seek their local agents advice on complying with Maritime Declaration of Health protocols required prior to arrival and liase with local Port Health Officers.
If the ship calls at a country where there are confirmed cases of swine flu, members should seek to limit any exposure to their crew.
- gangway watches as required by the ISPS code should be maintained but all crew members interacting with the shore staff should be provided with face masks
- watchmen should look for symptoms in anyone attempting to board the ship for any purpose. Any visitor appearing weak or suffering flu-like symptoms should not be allowed on board
- members should consider restricting crew shore leave in ports affected by the influenza virus
- crew allowed to go ashore should be aware of the influenza situation. Heavy populated areas are more prone to rapid passing of the influenza virus. Physical contact also increases the risk of contacting the virus
Precautions onboard – general advice
- ensure that proper hand washing facilities are available
- masters should ensure that those responsible for keeping the common spaces in the
- accommodation clean have an important task; door handles, table tops, objects routinely touched by crew members should be properly cleaned with soap and water.
- good ventilation and a free flow of air to the crew accommodation and food stores are important for the health of all on board ship. This is often arranged by means of a re-circulating air-conditioning system. It is desirable that the air from a room occupied by an infectious person should not be re-circulated
- crew should not share food, cups or utensils
restrict access to the accommodation in ports where the influenza virus has appeared
- restrict sharing of accommodation and eating resources with stevedores and shore personnel in ports/countries where the influenza virus has appeared.
- crew members with existing illnesses and those travelling from high-risk geographical areas should be closely monitored as they may be at higher risk
Crew that are well should maintain a distance of at least one metre from any crew member with influenza like symptoms and:
- refrain from touching nose or mouth
- frequently washing of hands with soap and water
- ensure that the cabin spaces are kept in a clean and sanitary condition
Dealing with illness on board
What should the master do if a crew member falls ill with flu-like symptoms?
- alert the company Designated Person Ashore (DPA)
- immediately seek medical advice and refer to the Ship Captains’ Medical Guide or the International Medical Guide for Ships
- isolate - the strict isolation of an ill patient will prevent the spread of disease to other persons on board
- the patient should be seen only by the person who nurses him
- confine the patient to the ship’s hospital or to a cabin set aside for his sole use and which has been stripped of all unnecessary furnishings and carpets to facilitate cleaning and disinfection
- eating and drinking utensils used by the patient should be washed and sterilised after use and kept in the hospital or cabin. They should never be washed up with utensils used by other crew members
- all used bed linen and towels should be sterilised, by boiling or disinfectant, or incinerated
- all possible steps should be taken to prevent contaminated air from his cabin re-circulating within the accommodation block. For example, a porthole or external door not subject to an inflow of air should if possible be opened
- all crew should wash their hands
- those infected should wear a mask to prevent the spread of infection through coughing and sneezing. Specific advice is available on the WHO web site in about the proper wearing of masks
- when tending a patient, the crew should use a medical or surgical mask, a gown and clean gloves
P&I club cover – how we can help
Club cover can include medical expenses at a port where an ill crewmember is landed and in his home country under the terms of the relevant contract of employment or Collective Bargaining Agreement. Club cover can also pay for the cost of repatriation of ill crew members and the additional costs and expenses incurred in sending replacement crew.
If a crewmember falls ill and needs medical treatment the master should contact the local correspondent and the local agent so that they can make the necessary arrangements and advise on any local port health control requirements. The master should also contact the designated person ashore who can then notify the club.
In the event of an emergency, the master should contact the club via our emergency telephone : + 44 7932 113573.
Further information
The WHO should be your first source of information. It regularly updates the global situation and provides specific advice. Members should familiarise themselves with information provided by their State authorities. Further information can be obtained from the following websites:
United States Coast Guard Office of Health & Safety - http://uscg.mil/h1n1/
World health Organization - www.who.int
USA Centers for Disease Control and Prevention - www.cdc.gov/h1n1flu
Ministry of Health of Mexico - http://portal.salud.gob.mx
UK Foreign & Commonwealth Office - www.fco.gov.uk
UK Dept of Health – www.doh.gov.uk
Japanese Ministry of Health – www.mhlw.go.jp/english
Some port states already give information which is relevant to joining crews, eg;
The Maritime and Port Authority of Singapore website provides details of restrictions imposed at the port. Members can expect many other ports worldwide to impose similar restrictions: www.mpa.gov.sg