Dear readers,
It is my pleasure to welcome you to this newsletter. In proud continuation with the former project SHIPSAN and also the AIRSAN project, this newsletter will try to keep you informed about the progress achieved within the field.
In a time when some question the idea of cooperation between nations and their people, the EU HEALTHY GATEWAYS Joint Action is the right answer. Many EU countries will continue the work. And it is with much joy that I am again in the position to welcome the experts from Taiwan’s TCDC in the project.
Due to the tireless work of my dear colleagues, Prof. Christos Hadjichristodoulou, Dr. Barbara Mouchtouri and their team, it is possible to continue the work being done in the field of maritime and air transporthealth. There are many new aspects and innovative ideas included in the new EU Joint Action.
The new HEALTHY GATEWAYS Joint Action, just as one example will include also the often-neglected field of the problems concerning ground crossings. By that we mean travelling with buses, trains and cars. (Just look out for the new logo, well done). You might imagine what troubles a person with a diagnosis of the infectious form of tuberculosis might cause when using a long distance bus.
I especially appreciate the holistic approach of looking closely into the interactions of the fields.
This newsletter continues with news from the consortium. Let Prof. Hadjichristodoulou inform you on the latest developments. And do not miss our new webpage: www.healthygateways.eu
All the best from Hamburg,
Martin Dirksen-Fischer
Prof. Christos Hadjichristodoulou
EU HEALTHY GATEWAYS Joint Action Coordinator, Professor of Hygiene and Epidemiology,
Department of Hygiene and Epidemiology, Medical Faculty, University of Thessaly, Greece
The EU HEALTHY GATEWAYS joint action started in May 2018 and will run until April 2021. The EU HEALTHY joint action consortium consists to date of 35 authorities from 27 EU MS (+Taiwan) and aims to support cooperation and coordinated action of Member States (MS) to improve their preparedness and response capacities at points of entry (PoE). This includes ports, airports and ground crossings, in preventing and combating cross-border health threats from the transport sector. In future public health emergencies of international concern (PHEIC), the joint action will move from inter-epidemic mode to emergency mode, supporting coherent response as per Decision No 1082/2013/EU, International Health Regulations (2005) and WHO temporary recommendations.
We are already counting 6 months of implementation, and 
during this 6 months a lot of progress was made by the consortium. Below are some key activities completed to date:
- The kick off meeting was held in June 2018 where the partners had the opportunity to discuss the work plan (see the Events section for further details).
- The consortium agreement was signed between the coordinator and beneficiaries.
- Management, Dissemination, Evaluation and Sustainability plans have been developed.
- Working groups for all technical and supporting work packages have been established with nominated experts from all participating EUMS.
- Dissemination tools were developed (leaflet, banner, website, social media)
- Stakeholder analysis questionnaires were completed by national level authorities and local level authorities at Points of Entry with the objective to define what the needs of the stakeholders are, and how would they like to be involved in the joint action. The report is under preparation.
- Questionnaires have been disseminated to partners for assessing training needs at Points of Entry (and for identification of best practices applied at airports and ports.
- The subject matter work packages (ground, air and maritime) have started working on the tool for contingency plan development and assessment.
- State of the Art report for ground crossings has started.
- To ensure the longterm success of EU HEALTHY GATEWAYS and the uptake of its outputs by EU Member States, each EU country is in the process of appointing national policy advisors to support sustainability activities.
- Partners and collaborating stakeholders have prepared national dissemination plans and submitted their first dissemination monitoring reports.
- The EU HEALTHY GATEWAYS Joint Action was presented in many meetings and conferences (see the events sections for further information).
The web portal of the EU HEALTHY GATEWAYS Joint Action was launched on 15/11/2018.
The web portal will be continuously updated and expanded. The web portal will include updated information on the progress made and access to reports and deliverables.
The web portal will also include a network of professionals named EU POENET to be hosted in the private area of the web portal. This web based network will include specific discussion forums and will be used by professionals for knowledge exchange and for facilitating competent authorities with information sharing that can be used to the risk assessment of public health events.
Visit the web portal by clicking on the link below: www.healthygateways.eu
Follow us on Social Media of the joint action
Thematic Sections:
“Report from the ECAC Workshop-Health Matters in Civil Aviation”
On the 23 of October the ECAC with kind support from the Department of Transport, Tourism and Sport invited experts from the field for a workshop in the wonderful environment of the Dublin castle in Ireland. The EU Healthy Gateways Joint action was presented by Dr. Martin Dirksen-Fischer from Germany, together with the also present John Angrén from Sweden a coleader of work package 6. The ECAC, see https://www.ecac-ceac.org/about-ecac for further information, states its mission as following:
“Founded in 1955 as an intergovernmental organisation, the European Civil Aviation Conference (ECAC) seeks to harmonise civil aviation policies and practices amongst its Member States and, at the same time, promote understanding on policy matters between its Member States and other parts of the world.”
To put things short: ECAC is based in France and one of the most important intergovernmental organisations in the field concerning civil aviation in Europe. So for sure it was no wonder to meet experts from ICAO and CAPSCA and other leading organisations as well at the meeting.
Without being able to point out all presentations it is worthwhile to focus on the excellent presentation of Sarantis Poulimenakos and Ceyrine Pellikaan from the ICAO. Mr. Poulinmenakos reported for instance on the tremendous effects that SARS and Ebola presented on civil aviation and public health at the same time. We all have to remember that outbreaks like this can occur any time again. One of the big issues being the thread of an pandemic influenza and its impact . In 2019 there will be an exercise on this, mentioned by several speakers on this meeting. EU Healthy Gateways will observe the exercise and cooperate with the partners in the field, further reports will follow. Dr. Walter Gaber from Fraport Airport as Rapporteur for ACI EUROPE Task Force on bio-risk reported on how to handle “Emerging health threats at airports”, based on his long experience at Frankfurt airport. He also stressed the facts that the concepts of preparedness have to be tested in regular exercises. All other presentations, for instance from Iceland and from Portugal, Maria Joao Martins, well known to the EU Healthy Gateways Joint action community, were based on a very high level of expertise. The presentation of the WP 6 of the Joint action was met with high interest. Our project will work very closely with all the organisations and others mentioned above to meet the never ending challenges in this field. “
Dr.med Martin Dirksen-Fischer
Hamburg Port Health Center, Germany
Recent Publications
European Web-Based Platform for Recording International Health Regulations Ship Sanitation Certificates: Results and Perspectives.
Mouchtouri, V.A.; Van Reusel, D.; Bitsolas, N.; Katsioulis, A.; Van den Bogaert, R.; Helewaut, B.; Steenhout, I.; Damman, D.; Dávila Cornejo, M.; Hadjichristodoulou, C.; the EU SHIPSAN ACT Joint Action Partnership.
Int. J. Environ. Res. Public Health 2018, 15, 1833.
Abstract
The purpose of this study was to report the data analysis results from the International Health Regulations (2005) Ship Sanitation Certificates (SSCs), recorded in the European Information System (EIS). International sea trade and population movements by ships can contribute to the global spread of diseases. SSCs are issued to ensure the implementation of control measures if a public health risk exists on board. EIS designed according to the World Health Organization (WHO) "Handbook for Inspection of Ships and Issuance of SSC". Inspection data were recorded and SSCs issued by inspectors working at European ports were analysed. From July 2011⁻February 2017, 107 inspectors working at 54 ports in 11 countries inspected 5579 ships. Of these, there were 29 types under 85 flags (including 19 EU Member States flags). As per IHR (2005) 10,281 Ship Sanitation Control Exception Certificates (SSCECs) and 296 Ship Sanitation Control Certificates (SSCCs) were issued, 74 extensions to existing SSCs were given, 7565 inspection findings were recorded, and 47 inspections were recorded without issuing an SSC. The most frequent inspection findings were the lack of potable water quality monitoring reports (23%). Ships aged ≥12 years (odds ratio, OR = 1.77, 95% confidence intervals, CI = 1.37⁻2.29) with an absence of cargo at time of inspection (OR = 3.36, 95% CI = 2.51⁻4.50) had a higher probability of receiving an SSCC, while ships under the EU MS flag had a lower probability of having inspection findings (OR = 0.72, 95% CI = 0.66⁻0.79). Risk factors to prioritise the inspections according to IHR were identified by using the EIS. A global information system, or connection of national or regional information systems and data exchange, could help to better implement SSCs using common standards and procedures.
Gastroenteritis outbreaks on cruise ships: contributing factors and thresholds for early outbreak detection.
Mouchtouri Varvara A, Verykouki Eleni, Zamfir Dumitru, Hadjipetris Christos, Lewis Hannah C, Hadjichristodoulou Christos, the EU SHIPSAN ACT partnership.
Euro Surveill. 2017;22(45):pii=16-00576.
Abstract
When an increased number of acute gastroenteritis (AG) cases is detected among tourists staying at the same accommodation, outbreak management plans must be activated in a timely manner to prevent large outbreaks. Syndromic surveillance data collected between 1 January 2010 and 31 December 2013 by five seagoing cruise ships were analysed to identify attack rate thresholds for early outbreak detection. The overall incidence rate of AG was 2.81 cases per 10,000 traveller-days (95% confidence interval (CI): 0.00-17.60), while the attack rate was 19.37 cases per 10,000 travellers (95% CI: 0.00-127.69). The probability of an outbreak occurring was 11% if 4 per 1,000 passengers reported symptoms within the first 2 days of the voyage, and this increased to 23 % if 5 per 1,000 passengers reported such within the first 3 days. The risk ratio (RR) for outbreak occurrence was 2.35, 5.66 and 8.63 for 1, 2 and 3 days' delay of symptoms reporting respectively, suggesting a dose-response relationship. Shipping companies' policies and health authorities' efforts may consider these thresholds for initiating outbreak response measures based on the number of cases according to day of cruise. Efforts should focus on ensuring travellers report symptoms immediately and comply with isolation measures.
Full text available here.
Events
Past Events of the joint action
Kick off meeting
When: 12-13 June 2018 Where: Varna, Bulgaria
The joint action Kick-off meeting took place during month 2 (12-13 June 2018) of the action in Varna, Bulgaria where 58 participants from 22 EUMS and representatives from DG SANTE, CHAFEA, ECDC, EASA, FRONTEX and the maritime industry had the opportunity to present and discuss the work plan.
Webinar for Port Health Officers on Inspection Grading System
When: 12 September 2018
A webinar was organised on the 12th of September 2018 for port health officers working in the EU MS competent authorities and conducting passenger ship inspections according to the European Manual for Hygiene Standards and Communicable Diseases Control on passenger ships.
Mr Jaret Ames (Senior technical expert) presented the methodology for developing the Grading System as well as information regarding the pilot testing of the system.
Forthcoming events of the joint action
Training of the trainers’s face-to-face training course on Preparedness and Response to public health events at ports
When: 12-14 March 2019 Where: Piraeus, Greece
The 3-day face-to-face training of the trainers training course titled “Preparedness and response to public health events at ports’’ will take place on the 12-14 March 2019 on board the cruise ship Celestyal Olympia docked at the port of Piraeus, Greece.
The training programme is being organised within the framework of the EU HEALTHY GATEWAYS joint action by the University of Thessaly (UTH), Greece in collaboration with the National Institute of Public Health and the Environment (RIMV), Netherlands.
The purpose of the training of the trainers’ programme is to increase competence and capacity for managing public health events at ports and on ships including risk assessment, decision-making and crisis communication. The training course will address issues of decision making for implementing evidence based health measures proportionate to the health risks.
After completing this course, participants will act as trainers to the face-to-face training course at national level to be organised within the framework of the EU HEALTHY GATEWAYS Joint Action at their country.
The EU Health Gateways joint action consortium will be asked within the next month to nominate participants to this training event according to their countries needs and priorities.
1st General Assembly meeting, 13-14 June 2019, Hamburg, Germany
Further information to be announced in due course.
Other Past Events
TAIEX Workshop on the implementation of the Third EU Action Programme in the field of health
When: 5 June 2018 Where: Moldova
The workshop was organised in co-operation with the Ministry of Health, Labour and Social Protection. Dr Barbara Mouchtouri, leader of work package 7 on maritime transport from the University of Thessaly, Laboratory of Hygiene and Epidemiology, Larissa, Greece, presented the EU HEALTHY GATEWAYS Joint Action (Preparedness and action at points of entry).
Best practices in the implementation of International Health Regulations Conference
When: 7-8 June 2018 Where: Athens, Greece
The Hellenic Centre for Disease Control and Prevention in collaboration with the European Commission and the Consumers, Health, Agriculture and Food Executive Agency (CHAFEA) organised under the auspices of the Greek Ministry of Health the two-day meeing on “Best practices in the implementation of International Health Regulations” in Athens, Greece on 7-8 June 2018.
Dr Miguel Dávila Cornejo, collaborating stakeholder of SHIPSAN and HEALTHY GATEWAYS joint actions from the Ministerio de Sanidad, Servicios Sociales e Igualdad, Spain, presented SHIPSAN ACT (the impact on maritime transport of health threats due to biological, chemical & radiological agents, including communicable diseases).
Dr Barbara Mouchtouri, leader of work package 7 on maritime transport from the University of Thessaly, Laboratory of Hygiene and Epidemiology, Larissa, Greece, presented the EU HEALTHY GATEWAYS Joint Action (Preparedness and action at points of entry).
The report, presentations and other information are available here: http://www.keelpno.gr/el-gr/%CE%B1%CF%81%CF%87%CE%B9%CE%BA%CE%B7/dyk_2018/ihr_2018.aspx
CLIA Port and Destination 2018 Summit
When: 17-18 September 2018 Where: Lisbon, Portugal
Prof. Christos Hadjichristodoulou, Coordinator of the EU HEALTHY GATEWAYS Joint Action from the University of Thessaly, Laboratory of Hygiene and Epidemiology, Larissa, Greece, presented the EU HEALTHY GATEWAYS Joint Action at the CLIA Port and Destination 2018 Summit. This event was organised within the framework of the SEATRADE CRUISE MED.
Prior to presenting at the CLIA Port and Destination 2018 Summit, Prof. Hadjichristodoulou held a bilateral meeting with the Secretary General of MedCruise Association on 18 September in Lisbon, Portugal. The purpose of this meeting was to inform MedCruise Association about EU HEALTHY GATEWAYS and explore how MedCruise could collaborate on the Joint Action, particularly under the framework of Work Package 7. Moreover, public health issues related to ports and simulation exercises were discussed during the meeting.
Joint Meeting for National Focal Points for Preparedness &
Response and National Focal Points for Threat Detection, EWRS & IHR
When: 26-28 September 2018 Where: Stockholm, Sweden
The aim of this meeting was to foster further cooperation between the European Centre for Disease Prevention and Control (ECDC), EU and EEA Member States, the European Commission (EC), World HealthOrganization (WHO) and EU Enlargement countries by encouraging discussion on ongoing developments within and between the areas of preparedness & response and threat detection the Early Warning and Response System (EWRS) & the International Health regulations (IHR).
Prof. Christos Hadjichristodoulou, Coordinator of the EU HEALTHY GATEWAYS Joint Action, and Dr Barbara Mouchtouri leader of work package 7 on maritime transport from the University of Thessaly, Laboratory of Hygiene and Epidemiology, Larissa, Greece, presented the EU HEALTHY GATEWAYS Joint Action.
ECAC Workshop on Health Matters in Civil Aviation
Dublin, 23 October 2018
When: 23 October 2018 Where: Dublin, Ireland
The objective of the workshop is to review current health-related recommendations related to civil aviation, discuss the most recent topics in this field (e.g. preparedness for highly infectious disease outbreaks) and share best practice and experience between national authorities and stakeholders to better implement measures in the event of a public health crisis. Dr Martin Dirksen-Fischer, Co-Leader of WP5-Air transport and Leader of WP4-Sustainability, from Hamburg Port Health Center participated to the workshop and presented the EU HEALTHY GATEAYS joint action.
Other Forthcoming Events
Final Conference of the Joint Action EMERGE - Efficient response to highly dangerous and emerging pathogens at EU level
When: 27 – 28 November 2018 Where: Brussels, Belgium
Dr Peter Otorepec, Leader of WP2 of the EU HEALTHY GATEWAYS Joint Action from the National Institute of Public Health in Slovenia will participate to this event and present the Joint Action. In this conference, the continuation of the EMERGE network and linkages towards other initiatives and networks will be discussed.
HIGH LEVEL CONFERENCE on Preparedness for public health emergencies - Challenges and Opportunities in Urban Areas
When: 3-4 December 2018 Where: Lyon, France
WHO will hold a High Level Meeting on Preparedness to Public Health Emergencies “Challenges and Opportunities in Urban Areas” on 3-4 December 2018 in Lyon, France. The objectives of the conference are to foster multi-sectorial and multi-disciplinary collaboration beyond health sector involving all relevant stakeholders, to prepare for public health emergenceis in a more predictable and coordinated way.
Public Health Agency of Sweden
The Public Health Agency of Sweden (PHAS) is the national agency for public health in Sweden and is responsible for surveillance of communicable diseases. The Agency has both epidemiological and laboratory expertise, including the only biosafety level 4 laboratory amongst the Nordic countries. Furthermore, the agency is the national focal point for IHR and for EWRS. The role of Sweden through the PHAS within the Joint Action Healthy Gateways is a co-leaders of Working Package 6, focusing on increased capacity at designated airports. One of the activities within this WP is to develop a survey with the purpose to identify best practices for implementation of core capacities at designated airports. In addition, a toolkit for the development and evaluation of contingency plans will be established and tested in different member states. Exercises and training materials as well as SOPs for surveillance and control of vectors will also be developed within this work package and in collaboration with other work packages.
Mr Angrén is an analyst at PHAS, focusing on epidemiological intelligence gathering and IHR (PoE) preparedness. His previous research was on preparedness activities for mass casualty events in Sweden, with a focus upon the geographical periphery, confined spaces and long-distance transport. Recent experiences includes preparedness activities against MERS-Coronavirus, measles and polio within Europe, in collaboration with the European Centre for Disease Prevention and Control (ECDC). Mr Angrén coordinates the Swedish participation in the Healthy Gateways Joint Action.
Dr Ribacke is a molecular biologist with a PhD in medical science. In her current position as analyst at the unit for preparedness and crisis management, her portfolio includes IHR-related work and international collaboration, as well as the development of a Swedish rapid response capacity within public health.
Anette Richardson is currently Head of Unit for Preparedness and Crisis Management, Department of Communicable Disease Control and Health Protection at PHAS. Before the position she has experience from several different positions at PHAS and also the National Board of Health and Welfare. She has long experience with national and international work dealing with knowledge management, developing guidelines and recommendations within the fields of public health, social services, health and medical services. Anette is a pharmacist and RN, with a Master of Science in Pharmacy and Master degree in medicine. Above that she has a Bachelor degree in leadership and organizational development. Beyond work experience from three different agencies she has background as manager in clinical medicine.
John Angrén 
Kim Brolin Ribacke 
Anette Richardson
Arlanda airport, Sweden
Arlanda airport was inaugurated in 1954. To date, it has three landing strips, five terminals and over 26 million passengers whom travelled to or from Arlanda in 2017. The airport is the largest in Sweden and one of Sweden’s five designated airports. Arlanda serves 81 airline companies which travels to 181 destinations and has approximately 17 500 employees. Arlanda is a fast growing airport and aims to be the main hub for air transport in Scandinavia by 2040, accommodating 40 million passengers. The airport is at the forefront of environmental work and has during the last seven years more than halved their emissions of fossil carbon dioxide at the airport. Airport buildings are heated with district heating from biofuels and all electricity purchased is produced from renewable sources, such as biofuels, solar, wind and water. In addition, the airport's vehicles are gradually replaced by environmental vehicles.
The Airport Duty Manager is a round the clock function that is responsible for coordinating the airport’s quick response measures in the event of a major incident. In addition, a press officer is on call 24/7. The airport rescue services is divided into two fire stations and consists of one airport rescue officer, two rescue officers, 11 firefighters and one nurse, all on alternating 24/7 duty. Stockholm county council is responsible for health care in the county (including Arlanda) and also for coordinating work with communicable disease control and prevention at the airport. Since Arlanda is a designated PoE, there are specific plans to prevent the spread of infectious substances that may constitute a global threat to human health. The crisis manager is in charge of the preparedness planning. In addition, an Emergency Training Group that includes several different actors perform exercises at specific intervals.
Snow clearance at Arlanda Airport. Photograph by Daniel Asplund.