Emergencies preparedness, response

Procedures for prevention and management of probable cases of SARS on international cargo vessels

23 May 2003

General information and symptoms of SARS

SARS, is now a world-wide health threat. In view of this, all international travellers including crew and passengers of cargo vessels should be aware of the main symptoms and signs of SARS which include:

  • high fever (>38°C)

  • AND

  • one or more respiratory symptoms including cough, shortness of breath, difficulty breathing

  • AND one or more of the following:

  • close contact with a person who has been diagnosed with SARS

  • recent history of travel to areas reporting cases of SARS.
  • Pre-boarding

    In the event of a crew member or passenger of a vessel experiencing this combination of symptoms, he or she should immediately seek medical attention and ensure that information about symptoms, recent travel and close contacts is passed on to the health care staff and the master of the vessel. Any crew or passengers who develop these symptoms are advised not to undertake the voyage until they have recovered or have been cleared for travel by a medical officer.

    On board

    In the event of a crew member or passenger of a vessel experiencing this combination of symptoms during the voyage, the officer in charge should seek a medical opinion, ensuring that information about the symptoms, recent travel and close contacts is relayed to the medical authorities at the next port of call. Non-infected crew and passengers on-board should be informed of the person’s status as a possible case of SARS.

    As a general precaution, the suspect case should be isolated from other crew and passengers in a cabin or other closed quarters if possible. A protective face mask* should be placed on the ill person. Careful hygiene practices, including frequent hand washing with soap must be observed by the suspect SARS case. Persons taking care of the ill crew/passenger should take extra precautions, including: wearing a protective face mask* , gloves and eye protection, whilst in the vicinity of the patient's cabin, and washing hands frequently with soap.

    On arrival at the next port

    1. The health authority at the scheduled port of arrival must be informed immediately by radio of the suspect case, and asked if the necessary capacity to isolate, transport and care for the ill crew member or passenger is available at the port. Depending on the local situation, the master of the vessel may be asked to proceed to another national port that has this capacity.

    2. On arrival at the port requested by the health authority, no one may leave the vessel until a medical officer has examined the ill crew member or passenger, as well as the rest of the crew and any passengers on board.

    3. If the medical officer for the port determines that the ill crew member or passenger meets the SARS case definition, the crew member or passenger shall be removed from the vessel, using all necessary precautions, and transported to the nearest designated medical facility for treatment of SARS cases.

    4. The vessel shall be considered as being in isolation, and no one, other than health authority staff or other personnel working directly with the health authority, shall be allowed to board or leave the vessel. Security personnel should be posted to ensure compliance with this requirement.

    5. The vessel and crew will be held in port for a period of 10 days, to ensure that none of the other crew or passengers have been infected with SARS. At the end of the isolation period, prior to departure of the vessel, the cabin or quarters where the SARS patient was isolated and managed, should be cleaned and disinfected (see last paragraph) before a crew member or passenger is allowed to occupy that cabin or quarters.

    6. The vessel will be allowed to proceed to its next port of call after a medical officer has determined that none of the other crew or passengers has been infected.

    If the owners of the vessel wish to have it released from isolation, an alternate crew may be provided. Agreement with the health authorities would need to be reached to provide facilities for the isolated crew left behind. A thorough cleaning of the vessel’s quarters, including diningroom, washroom and recreation areas would also be required before the new crew boards. This cleaning should be carried out under the supervision of the port health authority.

    Disinfecting the cabin or quarters occupied by SARS patient

    The cabin or quarters occupied by a SARS patient, should be disinfected with sodium hypochlorite (bleach) and formalin 1 or chloro meta xylenol (see WHO Guide to Hygiene and Sanitation in Aviation). All surfaces that the patient may have touched should be specifically targeted for cleaning. Thoroughly rinse and clean housekeeping equipment after use in the cabin or quarters of the SARS patient.

    More information on SARS can be obtained from the WHO web site.

    * N/R/P 95/99/100 or FFP 2/3 or an equivalent national manufacturing standard (NIOSH (N,R,P 95,99,100) or European CE EN149:2001(FFP 2,3) and EN143:2000 (P2) or comparable national/regional standards applicable to the country of manufacture.

    1 Sodium hypochlorite diluted to a strength of 100 mg/l and a 5% solution of formalin, which itself is a 40% solution of formaldehyde gas in water.