ENFORCEMENT OF MINIMUM HEALTH STANDARDS BY THE U.S.
CENTER FOR DISEASE CONTROL
(Published August 1993)
Contagious diseases that are virtually non-existent in the United States are frequently encountered abroad. In recognition of this scientific fact, the United States Congress has enacted a series of regulations designed to prevent the importation of such diseases into the United States. Moreover, recognizing that the closed environment of a vessel presents an ideal environment for the spread of such diseases, the Public Health Service has enacted a series of special regulations aimed at preventing ships from carrying contagious diseases into the United States. The following is an overview of some of the most commonly encountered regulations affecting the cruise industry.
Vessel Operator Requirements
Of particular importance to cruise operators is 21 C.F.R. § 1240.50 which prohibits the operator of a vessel engaged in interstate traffic from knowingly accepting for transportation any person with a communicable disease who fails to present a travel permit issued by the Surgeon General us required by 21 C.F.R. § 1240.50. When a suspected case of a communicable disease develops aboard a ship the master is required, as soon as practicable, to notify the local health authority at the next port of call. The vessel operator is required to take precautionary measures to prevent the spread of the disease, including placing the person suspected of carrying the communicable disease in isolation for surveillance and/or quarantine. After the ill person is disembarked, the vessel may be required to submit to an inspection and, if deemed necessary by the local public health agency, disinfection.
The regulations under 21 C.F.R. § 1240 are only applicable to individuals suspected of having or carrying the following diseases: anthrax, chancroid, cholera, dengue, diphtheria, granolema inguinale, infectious encephalitis, favus, gonorrhea, leprosy, Iymphogranoloma venereum, meningococcus meningitis, plague, poliomyelitis, psittacosis, relapsing fever, ringworm of the scalp, scarlet fever, streptococcal sore throat, small pox, syphilis, trachoma, tuberculosis, typhoid fever, typhus, and yellow fever.
Foreign Quarantine
42 C.F.R. § 71.21 is specifically intended to prevent the introduction, transmission, and spread of communicable diseases from foreign countries into the United States or its possessions. The master of any vessel destined for a United States port is required to report to the nearest quarantine station the occurrence on board of any death or illness among passengers or crew (including those who have disembarked or have been removed) during the 15-day period preceding the date of expected arrival, or during the period since departure from a US port, whichever period of time is shorter. In addition, the master of any ship carrying 13 or more passengers mast report by radio 24 hours before arrival the number of cases (including zero) of diarrhea in passengers and crew recorded in the ship's medical log during the current cruise. Any case of diarrhea that occurs after the 24-hour report must be reported not less than four hours before arrival. Based on these reports, the Director for the Center for Disease Control ("CDC") determines whether an inspection of the ship is necessary to prevent the introduction of communicable diseases into the United States.
Under the applicable law, the threat of communicable diseases introduction into the United States exists whenever a vessel has an individual aboard who is diseased or ill. 42 C.F.R. § 71.31. However, the law allows for vessel inspections even when there are no reported cases of illness aboard. Since contagious illnesses can be carried ashore by a ship's non-human residents, 42 C.F.R. § 71.41 provides that ships arriving at a US port from a foreign area "shall be subject to a sanitary inspection to determine whether there exists rodent, insect, or other vermin infestation, contaminated food or water, or other unsanitary conditions requiring measures for the prevention of the introduction, transmission, or spread of communicable diseases." The Director of CDC may require detention of a vessel until the completion of necessary measures to prevent the introduction or spread of such diseases. The Director may also detain, isolate or place under surveillance any arriving person he has reason to believe is infected with, or has been exposed to, cholera, diphtheria, infectious tuberculosis, plague, small pox, yellow fever, or viral hemorrhagic fevers (Lasso, Marbarg, Ebola, or CongoCrimean). Disinfection, disinfestation or fumigation may also be ordered if necessary to prevent the introduction, transmission, or spread of disease.
The remains of any person who died of a communicable disease may not be brought into a United States port unless the body is properly embalmed and placed in a hermetically sealed casket, cremated, or accompanied by a permit issued by the CDC.
Any person who violates any provisions of these regulations is subjected to a fine of not more than $1,000, or imprisonment for not more than one year, or both.
Control of Communicable Diseases within the United States
The United States Code of Federal Regulations restricts a person with a communicable disease (an illness due to infectious agents or their toxic products, which may be transmitted either directly or indirectly) in the communicable period (period during which the etiologic agent may be transferred from the infected person to another) from traveling without a permit from one state or possession of the United States (including Puerto Rico and the US Virgin Islands) to another. 21 C.F.R. § 1240.40.
Under these rules any parson traveling from one state or possession to another who is in the communicable period of cholera, plague, smallpox, typhus or yellow fever, or who has been exposed to these diseases and is in the disease incubation period, must obtain a written permit from the Surgeon General or his authorized representative prior to traveling. An application for a permit may be made directly to the Surgeon General or to his representative authorized to issue permits. A person to whom a permit has been issued must retain it in his possession throughout the course of his authorized travel.
Sanitation Inspections of Cruise Ships
All passenger cruise ships carrying 13 or more passengers arriving at United States ports are subject to unannounced inspections under the Voluntary Cooperative Inspection Program administered by the United States Public Health Service Vessel Sanitation Program. The purpose of these inspections is to achieve levels of sanitation that will minimize the potential for gastrointestinal disease outbreaks and to reduce the risk that contagious diseases will be spread among the passengers or crew. Vessels are generally inspected twice yearly and a demerit system based on a 100 point scale is used to rate the vessel's sanitation standards. Vessel inspectors routinely examine the vessels potable water supplies and onboard holding tanks, food preparation and holding areas, as well as the general cleanliness of the vessel. A score of 86 or higher indicates the vessel is providing an acceptable standard of sanitation. In general, the lower the score, the lower the level of sanitation. However, according to materials provided by Randall Peterson, Chief of the Vessel Inspection Program in Miami, a low score does not necessarily imply an imminent risk of an outbreak of gastrointestinal disease. A vessel unable to achieve a score of at least 86 on a routine periodic inspection will be re-inspected within a reasonable time frame (usually within 40 days), depending on vessel schedules. Any ship which fails the inspection must submit a "statement of corrective action" detailing the measures taken by the vessel to rectify areas which the inspector found to be substandard.
The vessel inspectors also have the authority to recommend a vessel not sail when circumstances so dictate. This could occur when the vessel's potable water supply is contaminated or there is an inadequate treatment of the potable water supply.
Shipowners pay for these vessel inspections. Fees vary according to gross tonnage as indicated in the following chart:
| Vessel Gross Weight: | Cost of Inspection: |
| under 3000 tons | $794 |
| 3,000-14,999 tons | $1.584 |
| 15,000 -29,000 tons | $3,178 |
| 30,000-59,999 tons | $4,767 |
| Over 60,000 tons | $6,356 |
The Public Health Service publishes a list of all ship inspection results in the hope ship operators will make recommended improvements in order to avoid adverse publicity. According to a summary of scores through July 16, 1993, 123 ships had been inspected under the program and nine ships had received scores below 86. Of the 85 ships Inspected which regularly sail out of U. S. ports, only four had failed the test. According to Chief Peterson, no ship had received a perfect score of 100, although two vessels, VIKING PRINCESS and ROYAL MAJESTY, had received near perfect scores of 97. The lowest reported score was 48 for a Soviet cruise ship which rarely visits U. S. ports.
