CDC's
Vessel Sanitation Program (VSP) and Quarantine Stations
In 1975, in response to several large gastrointestinal disease outbreaks
on cruise ships, CDC established the VSP, a joint cooperative program
with the cruise industry, to achieve a high level of sanitation and
minimize the risk of gastrointestinal (GI) disease on cruise ships.
The VSP encourages the cruise industry to establish and maintain a
comprehensive sanitation program, including surveillance for acute
gastroenteritis (AGE). The VSP staff conducts biannual, unannounced
sanitation inspections on U.S.-bound cruise ships with international
itineraries carrying 13 or more passengers. The VSP also engages in
the design and construction of new ships, as well as retrofitting
older ones to enhance facilities and provisions that promote shipboard
sanitation and public health.
The VSP shipboard sanitation inspections cover the following areas
of public health interest:
1) water supply storage, distribution, disinfection and protection;
2) spas and pools disinfection and filtration;
3) food handling, including storage, preparation, and service;
4) potential for contamination of food, water and ice;
5) personal hygiene and sanitation practices of crew;
6) general cleanliness and condition of the ship, and
7) ship training programs in environmental and public health practices.
An inspection score of 86 or higher (out of 100) indicates an acceptable
level of sanitation. In general, the higher the score, the higher
the level of sanitation, but this score does not reflect the risk
of acquiring gastrointestinal disease. The VSP could recommend or
require that a cruise ship not sail if sanitation deficiencies could
pose a public health threat.
U.S. Federal Quarantine Regulations require that, 24 hours before
arrival at a U.S port, vessels notify public health authorities of
onboard incidents of death, diarrhea (defined as at least 3 stools
in a 24-hour period), and certain febrile syndromes of public health
significance. The VSP receives reports of AGE and may respond with
an epidemiologic and environmental investigation if at least 3% of
passengers and/or crew members seek medical attention for AGE, or
if an unusual GI illness occurs. Surveillance and response for reports
of onboard deaths and febrile syndromes of public health concern are
conducted by CDC Quarantine Stations, located at major U.S. ports
of entry and land border crossings and administered by the Division
of Global Migration and Quarantine in Atlanta.
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