title: The decision making process on public health measures related to passenger ships: the example of influenza pandemic 2009.
abstract: BACKGROUND
  Public health measures at sea ports have posed a challenge for public health competent authorities, especially in the context of the influenza pandemic of 2009. This paper discusses the response of authorities to notifications of infectious diseases on passenger ships and the importance of assessing the risks related to cases of influenza. It further provides options for health measures and considerations for decision making during a pandemic such as the influenza pandemic of 2009.
  
  
  CONCLUSIONS
  Prevention and control of influenza have included action taken by both competent port authorities and ships' crews. Assessing the public health risk of each event reported from ships to competent authorities at ports is important before advice is given on implementation of control measures. Public health risk assessment involves appraisal of threats to passengers and crew on board the ship as well as to the population in the community.
  
  
  CONCLUSIONS
  Any public health measures taken should be necessary and proportional to the threat. Measures at ports cannot alone be effective in the prevention of the spread of a disease to the community since other means of transport play a major role. Measures taken on board ships can be effective in containing the disease. Consistent policy based on common protocols and carried out by competent authorities at local, national, European, or international levels are essential.
authors.affiliation: Department of Hygiene and Epidemiology, Faculty of Medicine, University of Thessaly, Larissa, Greece.
authors.forename: V A
authors.initials: VA
authors.lastname: Mouchtouri
authors.forename: C L R
authors.initials: CL
authors.lastname: Bartlett
authors.forename: Bogdan
authors.initials: B
authors.lastname: Jaremin
authors.forename: G
authors.initials: G
authors.lastname: Nichols
authors.forename: T
authors.initials: T
authors.lastname: Paux
authors.forename: T
authors.initials: T
authors.lastname: Riemer
authors.forename: N
authors.initials: N
authors.lastname: Black
authors.forename: C
authors.initials: C
authors.lastname: Varela-Martinez
authors.forename: C M
authors.initials: CM
authors.lastname: Swaan
authors.forename: C
authors.initials: C
authors.lastname: Schlaich
authors.forename: G
authors.initials: G
authors.lastname: Rachiotis
authors.forename: J
authors.initials: J
authors.lastname: Kremastinou
authors.forename: C
authors.initials: C
authors.lastname: Hadjichristodoulou
mesh_terms: D003140:Communicable Disease Control / Q000379:methods*; D003657:Decision Making; D014943:Global Health; D006291:Health Policy; D006801:Humans; D053118:Influenza A Virus, H1N1 Subtype; D007251:Influenza, Human / Q000453:epidemiology / Q000517:prevention & control* / Q000635:transmission*; D058873:Pandemics; D018570:Risk Assessment; D012767:Ships; D014195:Travel