Vessel Sanitation Program: Protecting Public Health on Cruise Ships since 1975

Thank you for watching our training video about the vessel sanitation program or VSSP. Since 1975, VSSP has been working with the cruise ship industry to protect public health on cruise ships. This training uses computerenerated voiceovers. In this presentation, you will learn the mission, scope, and history of the vessel sanitation program, VSSP, and the main components that ensure we meet our mission. The photo on the right shows three VSSP inspectors preparing for a construction inspection of a cruise ship in Europe. Above all, VSSP is an applied environmental public health program. We assist the cruise ship industry in developing and using comprehensive sanitation programs to minimize the risk of gastrointestinal illness and other public health issues. VSSP operates under the authority of the public health service act 42 USC section 264 quarantine and inspection regulations to control communicable diseases. And how do we do it with a collection of environmental health services? VSP does not get congressional appropriations. Cruise ships pay a fee for inspections to fund the program. The photo on the right shows a ship under construction in the shipyard. Traveling on cruise ships exposes people to new environments and high volumes of people including other travelers. This exposure can create the risk for illness from contaminated food or water or more commonly through person-toperson contact. As you can see from the number of people, stateaterooms, recreational water facilities, and food venues, some ships are floating cities that can be larger than many small towns on land. VSP establishes consistent standards for cruise ships calling on US ports. Ships under VSSP jurisdiction carry 13 or more passengers and have foreign ports in their itinerary. Our work transcends borders. We work collaboratively with cruise lines, shipyards, international governments, and organizations around the world. This work helps to ensure cruise ships maintain the highest public health standards. Revisions to VSSP standards are made and substantiated based on current technical advances, published scientific studies, evidence of experience, and other references. You can see on this slide the 2025 versions of the VSSP construction standards and VSSP environmental public health standards. Four core services make up VSP's applied environmental public health program. First, we provide cruise ship construction expertise to evaluate ship design during plan reviews and construction inspections. Our construction activities help eliminate public health risks and incorporate modifications to promote public health on board. Second, we monitor gastrointestinal illnesses to catch outbreaks. Our electronic surveillance system tracks cases on cruise ships under our jurisdiction. Ships submit routine 24-hour and 4-hour update reports electronically. VSSP provides support and technical assistance to cruise ships when 2% or more of the ship's passengers or crew members report they are sick with symptoms of gastrointestinal illness. We also investigate and respond to outbreaks when they occur. If the number of ill passengers or crew members reaches 3% or more of the total number of passengers or crew members, we consider it an outbreak. Third, we also train cruise ship employees on public health practices to help them learn why these practices are important and how to do them. We put classroom training into action. Our construction and operational inspections provide opportunities for inspectors to interact with, discuss, and educate ship employees on public health issues on cruise ships. And lastly, our largest service is our periodic unannounced operational public health inspections. Every ship can have up to two inspections every year. So this is our largest workload. We do operational inspections to make sure public health practices are being followed. We inspect ships of all sizes from very small passenger ships with less than 100 passengers to cruise ships with thousands of passengers. While we can inspect some ships with only one inspector, for some larger ships, we need several inspectors. VSSP reviews construction plans and conducts on-site shipyard construction inspections using our VSSP construction standards. Design is the first line of defense for public health. VSSP meets with cruise ship designers before construction begins. For example, handwashing before meals is important, and VSSP makes sure the design includes enough sinks for a restaurant's capacity. We conduct plan reviews like the blueprints in the center and we evaluate equipment and provide multiple consultations by email. All this before we see a ship being built. That is when we visit the shipyard like on the photo on the right and do a construction inspection to verify that public health standards were followed during construction of the new ship. We track gastrointestinal illness on cruise ships under our jurisdiction. Common symptoms include diarrhea, muscle aches, headache, abdominal pain, and fever. Reporting symptoms on cruise ships is important. When passengers and crew tell the medical center on board about their symptoms, it helps outbreaks get detected quickly. This allows steps to be taken to limit the spread of illness. We post outbreak updates to VSSP's website at https colonwww.cdc.gov. gov/vessel sanitation slc cruise hyphen ship hyphen outbreaks. Norovirus is often a cause of gastrointestinal illness outbreaks on cruise ships, but not always. Sometimes we don't know the cause of the outbreak. When an outbreak occurs, people whose symptoms met the case definition are asked to provide stool or vomitus samples. These samples are tested to determine the causitive agent. We provide training on public health practices. VSSP's operational and construction inspections provide informal training. Inspectors provide public health guidance to cruise ship staff on public health issues on ships. Additionally, VSSP has provided structured training seminars and workshops to cruise ship managers and designers. VSSP will continue conducting these activities in the future to promote the best maritime public health. We post all inspection scores and reports on our website www.cdc.gov/vesselhey sanitation slashabout/index.html. Anyone can find details including descriptions of violations and how the ship addressed them. Operational inspections are VSSP's primary activity. Where in the United States does VSSP conduct these inspections? VSP conducts operational public health inspections in all major US ports in the contiguous United States along with ports in Alaska and the US islands of the Caribbean and the Pacific. Each year, VSSP travels to more than 150 ports to inspect cruise ships. VSSP inspectors use the environmental public health standards to conduct operational inspections in eight major areas on cruise ships. For medical centers, we review medical information about onboard medical visits for people who said they had diarrhea or vomiting. We also review medical center supplies to make sure they have the required specimen containers and shipping containers. We interview medical staff to ensure they know about VSSP procedures for managing people who have diarrhea or are vomiting. We also interview crew members to ensure they are well trained in VSSP requirements for their job and that no crew members are working while they have diarrhea or are vomiting. For portable water systems, we review charts and logs to see that H hallogen and pH levels have been correct since the last inspection. We inspect areas of the portable water system to ensure that the drinking water system is safe. We also take water samples to make sure chlorine and pH levels are correct. Drinking water is either bunkered from a portable water supply as shown in the top photo in the middle or produced from seawater by means of evaporators or reverse osmosis plants as shown in the top right photo. In these processes, bunkered water or produced distillate or permeate water is further chlorinated and pH controlled as shown in the bottom right photo. For galleys and dining rooms, we ensure that food is being stored, prepared, and served safely. We check that dishwashers and other galley equipment are wellmaintained and in good working order. We also interview food service employees to make sure they know safe food handling practices. And we look at employees health and personal hygiene. For recreational water facilities such as swimming pools, whirlpools, and water parks, we review charts and logs to make sure the cruise ship has followed VSSP standards. We also take water samples to ensure chlorine and pH levels are correct and interview staff to ensure they know the ship's procedure for accidents involving feces or vomit. For housekeeping, we meet with the housekeeping manager to review the outbreak prevention and management procedures, including the outbreak prevention and response plan. We also ensure the housekeeping manager and staff are well informed about general disinfection of public areas, measures to prevent the spread of disease, and how to respond in case of a rise in the number of people getting sick with diarrhea or vomiting or to an outbreak. For pest and insect management, we interview the person in charge of the plan to manage pests on the ship. We also ensure that staff is well informed about how to manage pests on the ship. We make sure child activity centers are properly equipped with a place for diaper changing, toilets, and a place for handwashing. We also ensure that the toys are clean and that staff know what to do when children are sick with diarrhea or vomiting. For heating, ventilation, and air conditioning HVAC, we inspect air conditioning, heating, and ventilation rooms to ensure that water is not collecting inside the units and that the units are clean. Next, we will talk about where we've been and where we are headed. CDC established VSSP in 1975 as a cooperative activity with the cruise ship industry. VSSP operated continuously at all major US ports until 1986 when CDC terminated portions of the program because of cruise industry intentions to self-regulate. Industry and public pressures resulted in Congress directing CDC to resume the program. The National Center for Environmental Health held a series of public meetings to determine the needs and desires of the public and cruise ship industry. And on March 1st, 1987, a restructured program began. In 1988, the program was further modified by introducing user fees to reimburse the US government for costs. VSSP charges a fee based on ship size for inspections and reinspections. VSSP again operated continuously at all major US ports until 2020 when VSSP became part of the CDC maritime unit during the CDC coid9 response. In 2023, VSSP resumed its primary mission of conducting public health inspections and monitoring gastrointestinal illness on cruise ships. VSSP continues building the science related to public health issues on cruise ships. One thing that we have learned through research and experience is that gastrointestinal illness can spread quickly in closed and semi-encclosed environments such as cruise ships. However, rates on passenger cruise ships have significantly decreased over time. For a list of VSSP publications, visit https colon/www.cdc.gov/vessel sanitation/phpdatah research/cruise shipyations.html. HTML. The cruise industry is experiencing significant growth since the pandemic, highlighting the increasing need for programs like VSSP. The cruise lines and shipyards add several new ships a year. This table is from the cruise ship order book which is available online at https colon slc cruiseindustrynews.com/cruise shipyorderbook slash Thank you for your interest in VSSP. We hope you have found this training video helpful.