The confined environment of a ship promotes the transmission of the severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) due to close contact among the population on board. The study aims to provide an overview of outbreaks of SARS-CoV-2 on board of cruise, navy or cargo ships, to identify relevant outbreak management techniques, related problems and to derive recommendations for prevention. Four databases were searched. The study selection included reports about seroprevalences or clinically/laboratory confirmed infections of SARS-CoV-2 on board ships between the first of January, 2020 and the end of July, 2020. A total of 37 studies were included of whom 33 reported outbreaks of SARS-CoV-2 on cruise ships (27 studies referred to the Diamond Princess). Two studies considered outbreaks on the Grand Princess, three studies informed about Nile River cruises and one study about the MS Westerdam (mention of multiple outbreaks possible in one study). Additionally, three studies reported outbreaks of SARS-CoV-2 on navy vessels and one study referred to a cargo ship. Problems in handling outbreaks resulted from a high number of asymptomatic infections, transportation issues, challenges in communication or limited access to health care. Responsible operators need to implement infection control measures which should be described in outbreak management plans for ships to prevent transmission risks, including, e.g., education, testing strategies, communication lines, social distancing and hygiene regulations.

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Background Food choices on board merchant ships are limited and seafarers repeatedly described as being at high risk of developing overweight compared to the general population. Up to date, research has not distinguished whether seafarers gain weight on board or at home and whether eating habits differ in both settings. Methods As part of the e-healthy ship project, cross-sectional data were collected in two different measurements. In the first investigation on board of three merchant ships of German shipping companies, differences in eating behaviour at home compared to on board ships were assessed for 18 Burmese, 26 Filipino and 20 European seafarers. In a second study, BMI, weight development and location of body weight change of 543 Filipino and 277 European seafarers were examined using an online questionnaire on 68 ships. Results According to the board examinations, foods and beverages consumed on merchant ships varied widely from seafarers’ diets in their home country. Burmese, Filipino and European seafarers equally reported to consume more fruit (z = 4.95, p < .001, r = .62) and vegetables (z = 6.21, p < .001, r = .79), but less coke (z = −5.00, p < .001, r = .76) when at home. Furthermore, culturally different changes were found across all other foods and beverages. The online questionnaire revealed that 45.8% of seafarers were overweight (55.4% Europeans vs. 40.8% Filipinos, p < .001) and 9.8% obese. Moreover, a higher percentage of Europeans compared to Filipinos reported weight gain over the course of their professional career (50.2% vs. 40.7%, p = .007). A sub-analysis of seafarers with weight gain found that more Europeans than Filipinos gained weight at home (43.9% vs. 23.1%, p < .001). Conclusions Both, home and working on board merchant ships, represent very different living environments which may affect seafarers’ lifestyle and eating habits in various ways and thus could favour or inhibit weight gain. From our results, it appears that the body weight and eating habits of Asian seafarers in particular are adversely affected by the working and living conditions on board. Further prospective studies are required to prove this hypothesis.

ZusammenfassungCOVID-19 stellt unsere Gesellschaft seit Januar 2020 vor große Herausforderungen. Durch den globalen Reiseverkehr konnte sich das neue Coronavirus rasch weltweit ausbreiten. In diesem Artikel sollen übersichtsartig die Herausforderungen bei der Implementierung von Maßnahmen im Flug- und Schiffsverkehr aus Sicht des Öffentlichen Gesundheitsdienstes (ÖGD) dargestellt werden. Dies erfolgt anhand einer Auswahl von Ereignissen und Maßnahmen zwischen Januar und August 2020. Die gewonnenen Erkenntnisse werden diskutiert.Während der COVID-19-Pandemie bewegt sich der ÖGD in einem Spannungsfeld, das sich aus der Dynamik wissenschaftlicher Erkenntnisse, politischer Entscheidungen und der Akzeptanz und Zustimmung in der Gesellschaft ergibt. An Grenzübergangsstellen wie Flug- und Seehäfen gibt es besondere Herausforderungen. Dazu gehören insbesondere Personalengpässe und die Notwendigkeit, Maßnahmen mit hohem organisatorischen Aufwand sehr kurzfristig umzusetzen, wie etwa gesundheitsbehördliche Passagierkontrollen direkt an Luftfahrzeugen, die Einrichtung von Testzentren an Grenzübergangsstellen sowie die Überprüfung der Einhaltung von Quarantänevorgaben. Erschwerend kommt hinzu, dass Passagierlisten, die zur effektiven Kontaktpersonennachverfolgung notwendig sind, oft fehlen oder unvollständig sind. Ebenso fehlen digitale Tools für das Kontaktpersonenmanagement, aber z. B. auch für den Austausch personenbezogener Daten innerhalb des ÖGD. Weitere Schwierigkeiten beim Ausbruchsmanagement ergeben sich durch die engen Verhältnisse an Bord von Schiffen und durch die mögliche psychische Belastung von Besatzung und Passagieren, die in den Maßnahmen noch nicht ausreichend berücksichtigt werden.Angesichts all dieser Herausforderungen ist es notwendig, den ÖGD langfristig zu stärken – allgemein und an den Grenzübergangsstellen – und den Bund-Länder-Austausch im Flug- und Schiffsverkehr zu intensivieren.