Commercial fishing is one of the most dangerous occupations in the United States. During 1992-2008, an annual average of 58 reported deaths occurred (128 deaths per 100,000 workers), compared with an average of 5,894 deaths (four per 100,000 workers) among all U.S. workers. During the 1990s, safety interventions addressing specific hazards identified in Alaska resulted in a significant decline in the state's commercial fishing fatality rate. During 2007-2010, CDC expanded surveillance of commercial fishing fatalities to the rest of the country's fishing areas. To review the hazards and risk factors for occupational mortality in the U.S. commercial fishing industry, and to explore how hazards and risk factors differ among fisheries and locations, CDC collected and analyzed data on each fatality reported during 2000-2009. This report summarizes the results, which showed that, among the 504 U.S. commercial fishing deaths, the majority occurred after a vessel disaster (261 deaths, 52%) or a fall overboard (155 deaths, 31%). By region, 133 (26%) deaths occurred off the coast of Alaska, 124 (25%) in the Northeast, 116 (23%) in the Gulf of Mexico, 83 (16%) off the West Coast, and 41 (8%) in the Mid- and South Atlantic. Type of fishing was known in 478 deaths; shellfish (226, 47%) was the most common, followed by groundfish (144, 30%) and pelagic fish (97, 20%). To reduce fatalities in this industry, additional prevention measures tailored to specific high-risk fisheries and focusing on prevention of vessel disasters and falls overboard are needed.
This article describes co-operation between three psychiatric hospitals in different parts of the world. Twin- and friendship-hospital work is a way to increase the status of psychiatric hospitals and psychiatric patients in society. Direct contacts between hospital workers of these hospitals is now part of everyday life. It has been an innovative addition to 'normal' psychiatric work.
Influenza outbreaks can occur among passengers and crews during the Alaska summertime cruise season. Ill travellers represent a potential source for introduction of novel or antigenically drifted influenza virus strains to the United States. From May to September 2013-2015, the Alaska Division of Public Health, the Centers for Disease Control and Prevention (CDC), and two cruise lines implemented a laboratory-based public health surveillance project to detect influenza and other respiratory viruses among ill crew members and passengers on select cruise ships in Alaska.
Cruise ship medical staff collected 2-3 nasopharyngeal swab specimens per week from passengers and crew members presenting to the ship infirmary with acute respiratory illness (ARI). Specimens were tested for respiratory viruses at the Alaska State Virology Laboratory (ASVL); a subset of specimens positive for influenza virus were sent to CDC for further antigenic characterization.
Of 410 nasopharyngeal specimens, 83% tested positive for at least one respiratory virus; 71% tested positive for influenza A or B virus. Antigenic characterization of pilot project specimens identified strains matching predominant circulating seasonal influenza virus strains, which were included in the northern or southern hemisphere influenza vaccines during those years. Results were relatively consistent across age groups, recent travel history, and influenza vaccination status. Onset dates of illness relative to date of boarding differed between northbound (occurring later in the voyage) and southbound (occurring within the first days of the voyage) cruises.
The high yield of positive results indicated that influenza was common among passengers and crews sampled with ARI. This finding reinforces the need to bolster influenza prevention and control activities on cruise ships. Laboratory-based influenza surveillance on cruise ships may augment inland influenza surveillance and inform control activities. However, these benefits should be weighed against the costs and operational limitations of instituting laboratory-based surveillance programs on ships.
Cites: Clin Infect Dis. 2003 May 1;36(9):1095-102 PMID 12715302
Expedition ships to Antarctica travel to remote areas with limited medical support.
This study determines the rate and patterns of passenger illness and injuries among those traveling on expedition ships to Antarctica. We hypothesize that severe medical conditions are encountered that require physicians serving on these ships to be skilled enough to care for critically ill or injured patients.
We performed a retrospective analysis of the medical records of all passengers who were provided medical care on 26 Antarctica voyages from October 2010 to March 2011 (four different expedition ships). A structured system was used to categorize the diagnoses from each patient encounter. The pattern of traumatic injuries was noted, including location of occurrence. Treatments rendered including patient evacuations were documented. The population is described with incidence rates.
A total of 2,366 passengers traveled on 26 trips, for a total of 34,501 person-days. In all, 680 physician visits were done, including 150 consultations for motion sickness preventive care, leaving 530 visits (15.4 visits per 1,000 person-days) for active medical care. Median age was 50 (range 10-90) years and 51% were females. Incidence rates per 1,000 person-days for the most common processes include motion sickness (4.2), infections (3.5), and injury (2.0). Injuries were more likely to occur on the ship (66%, 95% CI: 54-77%) compared to off the ship (34%, 95% CI: 23-46%). Four subjects (0.12/1,000 person-days) were evacuated (three due to traumatic conditions and one due to medical complications) and one person died (medical complication).
Passengers on expedition ships to Antarctica may experience significant illness and injury. Ship physicians should be aware of the patterns of injuries and illnesses that occur on expedition ships and should have appropriate training to treat various medical and traumatic conditions including life-threatening illnesses.
For centuries, tuberculosis has been identified as a burden to seafarers. In this study, we assessed the magnitude of tuberculosis among merchant seafarers today. Furthermore, we identified the most likely routes of M. tuberculosis transmission by the use of DNA fingerprinting. A database containing all culture-positive tuberculosis cases in Denmark in 1992-2003 was combined with a register on all seafarers and their employment periods aboard Danish ships. All strains of M. tuberculosis were analysed using DNA-subtyping. 64 cases of culture positive tuberculosis among seafarers were identified. The risk of tuberculosis among males was 1.51 (1.10-2.01) compared with the general population. Two of the 64 cases were likely to be shipping-related, 5 were possibly shipping-related, and 10 were less likely to be shipping-related. The remaining 47 cases were very unlikely to be shipping related. Including the 2 first categories, the incidence was 0.09 cases per 1000 y at sea. The excess risk of tuberculosis among active and former Danish seafarers is most probably due to infections acquired in Denmark. Despite multi-cultural crews aboard, including many from high-incidence countries, our study indicates that only limited transmission of M. tuberculosis takes place among crew aboard modern ships or during shore leaves.
With 158 victims, the fire on board the "Scandinavian Star" was one of the world's worst ferry disasters. A team of identification experts, including dentists, were employed to secure evidence for identification and to remove the victims from the ferry. Four parallel teams, each with 2 dentists, examined and autopsied the victims at the Institute of Forensic Medicine, University of Oslo. Using the INTERPOL Disaster Victim Identification forms and aided by computers, all victims were identified within 17 days. Dental identity could be established in 107 cases (68%).
BACKGROUND: Radio medical (RM) advice for seafarers and traveling passengers is important and can be crucial for the optimal medical treatment on board ships. The aim of this study was to analyze the data from consultations with passenger ferries to identify areas for possible improvements. METHODS: Data from the journals for 1 year from Radio Medical Denmark consultations with the medical officers on passenger ferries were analyzed retrospectively. RESULTS: Two hundred fourteen RM records, 73% pertaining to passengers and 27% for crew members, were analyzed. Passenger patients were generally older and more seriously ill than patients among the crew. A high number of potential and life-threatening medical conditions such as angina pectoris was seen among the passengers, and nine of these patients were evacuated by helicopter. Sixty-three percent (n = 135) of the calls related to pain complaints, and more than half of these involved severe or considerable pain. Only acetaminophen (paracetamol) and opioids were in the ferry medicine chest. At least 77 patients would have benefited from use of nonsteroidal anti-inflammatory drugs. CONCLUSIONS: The paramedical assistance and the medicine chest contents were considered insufficient in several cases. Passengers and crew members with chronic illnesses should be thoroughly prepared and advised before their travels.