title: Infection burden among medical events onboard cargo ships: a four-year study.
abstract: . Cargo ships are medically isolated, yet neglected environments. We aimed to know about medical events onboard cargo ships.
  
  
  
  We reviewed all the medical events onboard a large commercial 471-cargo ship company for 4 years. Medical events were recorded within 20 categories as routinely used by Medical Maritime Consulting Centers, using a 4-level medical gravity score. The χ 2 test and logistic regression and correspondence analyses were used for the analysis of qualitative variables.
  
  
  
  Excluding wounds and burns, a total of 322 illness events were notified by onboard health officers for 471 ships totalizing 46 navigation/months. 250 non-infectious events and 72 cases of infection yielded an incidence of 7.75 medical events for 1000 person-years. Infections comprised 25 digestive tract infections, 17 skin infections, 8 urinary tract infections, 5 dental infections, 4 isolated fevers, 3 Ear-Nose-Throat and respiratory tract infections, 2 ocular infections, myalgia and orchitis and 1 case of mediastinal infection. The mean age for sailors diagnosed with infection (37.7 ± 10.5 years) was significantly younger than the mean age of sailors diagnosed with non-infectious disease (40.8 ± 11.2 years) ( P  = 0.04). In affected sailors, the proportion of death and hospitalization among infectious disease cases (26/69, 37.7%) was significantly higher than the proportion of death and hospitalization for non-infectious disease cases (48/242, 19.8%) ( P   =  0.02). The correspondence analysis showed that the routes may be classified according to two main independent risks, digestive infections and skin infections. We observed a statistically significant correlation between the severity of medical events and the maritime route "North Europe-OI-Australia-India-North Europe".
  
  
  
  These data illustrate a previously underreported variability of the medical risks in various maritime routes; and help promoting targeted medical interventions including the implementation of onboard point-of-care laboratories, to further increase the rapidity of the diagnosis and the medical management onboard cargo ships.
authors.affiliation: Aix Marseille Univ, URMITE, UMR CNRS 7278, IRD 198, INSERM 1095, IHU Méditerranée Infection, 19-21 Bd Jean Moulin 13005 Marseille, France.
authors.forename: Cyril
authors.initials: C
authors.lastname: Marimoutou
authors.affiliation: Aix Marseille Univ, URMITE, UMR CNRS 7278, IRD 198, INSERM 1095, IHU Méditerranée Infection, 19-21 Bd Jean Moulin 13005 Marseille, France.
authors.forename: Davide
authors.initials: D
authors.lastname: Tufo
authors.affiliation: Aix Marseille Univ, URMITE, UMR CNRS 7278, IRD 198, INSERM 1095, IHU Méditerranée Infection, 19-21 Bd Jean Moulin 13005 Marseille, France.
authors.forename: Hervé
authors.initials: H
authors.lastname: Chaudet
authors.affiliation: CMA-CGM, Tour CMA CGM, 4 Quai d'Arenc, 13002 Marseille, France.
authors.forename: Marc
authors.initials: M
authors.lastname: Abdul Samad
authors.affiliation: Faculté de Médecine, Département Universitaire de Médecine Générale, Aix-Marseille Université, 27, Boulevard Jean-Moulin, 13385 Marseille Cedex 05, Marseille, France.
authors.forename: Gaëtan
authors.initials: G
authors.lastname: Gentile
authors.affiliation: Aix Marseille Univ, URMITE, UMR CNRS 7278, IRD 198, INSERM 1095, IHU Méditerranée Infection, 19-21 Bd Jean Moulin 13005 Marseille, France.
authors.forename: Michel
authors.initials: M
authors.lastname: Drancourt
mesh_terms: D000328:Adult; D003140:Communicable Disease Control; D003141:Communicable Diseases / Q000453:epidemiology*; D004196:Disease Outbreaks; D006801:Humans; D008297:Male; D009784:Occupational Diseases / Q000453:epidemiology* / Q000517:prevention & control; D009786:Occupational Health Services; D012767:Ships; D014195:Travel
keywords: Seafarer; infectious disease; point of care; telemedicine