The Centers for Disease Control and Prevention (CDC) established the Vessel Sanitation Program (VSP) in the early 1970s as a cooperative activity with the cruise industry. The program assists the cruise industry in fulfilling its responsibility for developing and implementing comprehensive sanitation programs in order to minimize the risk for gastrointestinal diseases. CLIA cruise lines maintain frequent communication with the CDC and proactively report any communicable illness.
Cruise lines and the CDC work closely together during the entire life of a ship. The CDC provides guidelines, reviews plans and conducts on-site inspections on all new ship builds or renovations. Cruise lines continue to work with the CDC to maintain the ship through regular inspections, crew training and passenger education.
Routine Inspections
Every vessel that has a foreign itinerary, carries 13 or more passengers and calls on a U.S. port is subject to unannounced, twice-yearly inspections and, when necessary, to re-inspection by VSP staff. The vessel owner pays a fee, based on tonnage, for all inspections.
The ships must meet the criteria established by VSP in the "Vessel Sanitation Program Operations Manual." The ship is given a score based on a 100 point scale. To pass the inspection, a ship must score 86 or above. If the ship fails an inspection, it will be re-inspected, usually within 30 to 45 days.
The inspections are conducted by Environmental Health Officers (EHO) of the VSP, and take place only in U.S. ports. Depending on the size of the ship, an inspection may take from one to four EHOs, but typically two are assigned to conduct the inspection. The inspection may take from five to eight hours to complete, depending on the size and complexity of the vessel.
- The ship's water supply—to determine how water is stored, distributed, protected and disinfected.
- The ship's spas and pools—to ensure adequate filtration and disinfection.
- The ship's food—to determine how it is protected during storage, preparation and service.
- The potential for contamination of food and water—to determine what interventions are needed for protection.
- The practices and personal hygiene of employees—to ensure cleanliness and the use of appropriate hygienic practices.
- The general cleanliness and physical condition of the ship—to ensure cleanliness and the absence of insects and rodents.
- The ship's training programs in general environmental and public health practices—to determine the scope and effectiveness of such training.
Inspection scores and reports are published on the VSP Web site. In addition, scores are published every month in the "Summary of Sanitation Inspections of International Cruise Ships," commonly referred to as the "green sheet." This sheet is distributed to more than 3,000 travel-related services around the world.
In general, the lower the score, the lower the level of sanitation; however, a low score does not necessarily imply an imminent risk for gastrointestinal disease. Since the program began, the number of disease outbreaks on ships has declined despite significant growth in the number of ships sailing and the number of passengers carried.
CDC Requirements Under the authority of the Public Health Service Act to take measures necessary to prevent the introduction, transmission or spread of communicable diseases in the United States from a foreign country [42 United States Code Section 264(a)], a surveillance system for gastrointestinal illnesses on board passenger ships carrying 13 or more passengers has been maintained by the VSP. This reporting system, along with a rigorous VSP sanitation inspection program and the industry's commitment to provide safe and healthy cruises, has been instrumental in significantly reducing the number of incidents of gastrointestinal illness aboard cruise ships.
However, with a rapidly growing cruise industry that now serves more travelers in a more extensive itinerary than ever before, we face new patterns of old diseases or newly recognized causes of diseases as we attempt to ensure a safe passage for the traveling public. Cruise ships are required to maintain a standardized gastrointestinal illness incidence report for each cruise. It contains information on the total numbers of passengers and crew members and on the passengers and crew members who reported gastrointestinal illness, including the number of cases of gastrointestinal illness by dates of onset.
If increased incidents of gastrointestinal illness such as norovirus occur, cruise lines take every precaution to contain the spread of this illness through aggressive measures and open communications with their guests before they board and while onboard the ship. CLIA cruise lines identify the safety and health of their passengers and crew as their highest priority and proactively report any communicable illness on board to the CDC immediately as participants in the VSP program.
