Textbook of Maritime Medicine

Due to legal requirements a competent authority responsible for issues of public health will function in most ports. These services differ substantially globally in terms of qualification, scope and services. Some Port Health Authorities offer full medical services; others do not have medical doctors in their team but mainly deal with issues of environmental health and ship sanitation. Frequently the local health department covers the responsibility for the port area beside their duties in the municipality. Sometimes, private port health practices are mandated to perform governmental duties, such as yellow fever vaccinations. Generally spoken the port medical doctor needs to familiarize him/herself with the duties and services of the local port health authority. Also he /she needs to be aware of legal obligations, such as notification requirements and foster good working relations with the port health authority.

Depending on national legal requirements and local arrangements Port Health Authorities do offer public health services such as:

13.14.1. Notification of disease by shipmasters (Maritime Declaration of Health), granting of “free practice”

The International Health Regulations 2005 apply to ships and ports, the port health authority ensures/enforces the application of the rules. Every port maritime physician should know them as well and assist the authorities in applying these important rules.

13.14.2. Sanitary inspection of Ships

Port Health Authorities have the duty to inspect the ships and port area as regards hygiene and the presence of infections or vermin and to take measures to control public health risks. If the port medical doctor suspects a disease that may be caused by unsanitary conditions on board he may contact the port health authority for follow up. This may also include conditions such as insufficient protection from vectors while sailing in malaria areas and others.

13.14.3. Assessment and control of communicable disease and outbreaks

The shipmaster legally is obliged to notify the port health authority on any non-traumatic disease and death board. The port health services will assess the occurrence of disease and command all necessary measure to prevent the spread of disease. This may include outbreak investigations, contact tracing, isolation and vaccination. The port clinic is an important partner of the port health authority. Often the port medical doctor is the first to detect an infectious disease on board, e.g. open lung tuberculosis. It is the port medical doctors’ obligation to notify the public health service on any notifiable disease so that control measures to protect the public health can be initiated.

13.14.4. Vaccinations

The port health authority also handles vaccinations and controls the vaccination cards where necessary. In some ports the vaccinations are given by port maritime physicians and therefore a close relation with the port health authorities is necessary.

13.14.5. Health counselling, diagnosis and treatment of sexually transmitted diseases

Some port health authorities do offer free and confidential services for the prevention of disease. The port medical doctor needs to work closely with these services.

13.14.6. Disaster and contingency planning

Disaters in ports may be very complicated due to the varity of goods and chemicals stored and handled I a small area. In the case of a fire or an explosion, the port health authority is at the core of the rescue planning. Also, port health authorities will have more or less developed plans to cope with disease outbreaks on board and scenarios such as an influenza pandemic.