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During the COVID-19 pandemic, international shipping activity was disrupted as movement of people and goods was restricted. The Port of Rotterdam, the largest port in Europe, remained operational throughout.


We describe the burden of COVID-19 among crew on sea-going vessels at the port and recommend improvements in future infectious disease event notification and response at commercial ports.


Suspected COVID-19 cases on sea-going vessels were notified to port authorities and public health (PH) authorities pre-arrival via the Maritime Declaration of Health. We linked data from port and PH information systems between 1 January 2020 and 31 July 2021, derived a notification rate (NR) of COVID-19 events per arrival, and an attack rate (AR) per vessel (confirmed cases). We compared AR by vessel type (workship/tanker/cargo/passenger), during wildtype-, alpha- and delta-dominant calendar periods.


Eighty-four COVID-19 events were notified on ships, involving 622 cases. The NR among 45,030 new arrivals was 173 per 100,000 impacting 1% of vessels. Events per week peaked in April 2021 and again in July 2021, when the AR was also highest. Half of all cases were notified on workships, events occurring earlier and more frequently than on other vessels.


Notification of COVID-19 events on ships occurred infrequently, although case under-ascertainment was likely. Pre-agreed protocols for data-sharing between stakeholders locally and across Europe would facilitate more efficient pandemic response. Public health access to specimens for sequencing and environmental sampling would give greater insight into viral spread on ships.


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  1. World Health Organization (WHO). WHO Coronavirus (COVID-19) Dashboard. Geneva: WHO. [Accessed: 22 Apr 2022]. Available from: https://covid19.who.int/
  2. Millefiori LM, Braca P, Zissis D, Spiliopoulos G, Marano S, Willett PK, et al. COVID-19 impact on global maritime mobility. Sci Rep. 2021;11(1):18039.  https://doi.org/10.1038/s41598-021-97461-7  PMID: 34508144 
  3. World Trade Organization (WTO). World trade primed for strong but uneven recovery after COVID-19 pandemic shock. Geneva: WTO; 31 Mar 2021. Available from: https://www.wto.org/english/news_e/pres21_e/pr876_e.htm
  4. International Chamber of Shipping (ICS). Shipping and world trade: driving prosperity. London: ICS; 2022. Available from: https://www.ics-shipping.org/shipping-fact/shipping-and-world-trade-driving-prosperity/
  5. Lloyd’s List Intelligence. One hundred ports 2020. The definitive ranking of the world's largest container ports. [Accessed: 22 Apr 2022]. Available from: https://lloydslist.maritimeintelligence.informa.com/one-hundred-container-ports-2020
  6. Port of Rotterdam Authority. Staying on course in exceptional times. Make it happen. Highlights of 2020 Annual Report. Port of Rotterdam Authority; 2020. Available from: https://www.portofrotterdam.com/sites/default/files/2021-06/Annual-report-highlights-Port-of-Rotterdam-2020.pdf
  7. Port of Rotterdam Authority. Continuously working on the future. Make it happen. Annual Report 2019. Port of Rotterdam Authority; 2019. Available from: https://www.portofrotterdam.com/sites/default/files/2021-06/annual-report-highlights-port-of-rotterdam-2019_0.pdf
  8. Guagliardo SAJ, Prasad PV, Rodriguez A, Fukunaga R, Novak RT, Ahart L, et al. Cruise Ship Travel in the Era of Coronavirus Disease 2019 (COVID-19): A Summary of Outbreaks and a Model of Public Health Interventions. Clin Infect Dis. 2022;74(3):490-7.  https://doi.org/10.1093/cid/ciab433  PMID: 33978720 
  9. Fanoy E, Ummels AE, Schokkenbroek V, van Dijk B, Wiegmans S, Veenstra T, et al. Outbreak of COVID-19 on an industrial ship. Int Marit Health. 2021;72(2):87-92.  https://doi.org/10.5603/IMH.2021.0016  PMID: 34212347 
  10. Fernandes EG, Santos JDS, Sato HK. Outbreak investigation in cargo ship in times of COVID-19 crisis, Port of Santos, Brazil. Rev Saude Publica. 2020;54:34.  https://doi.org/10.11606/s1518-8787.2020054002461  PMID: 32236385 
  11. Hatzianastasiou S, Mouchtouri VA, Pavli A, Tseroni M, Sapounas S, Vasileiou C, et al. COVID-19 Outbreak on a Passenger Ship and Assessment of Response Measures, Greece, 2020. Emerg Infect Dis. 2021;27(7):1927-30.  https://doi.org/10.3201/eid2707.210398  PMID: 33979565 
  12. Bylicki O, Paleiron N, Janvier F. An Outbreak of Covid-19 on an Aircraft Carrier. N Engl J Med. 2021;384(10):976-7.  https://doi.org/10.1056/NEJMc2034424  PMID: 33567182 
  13. Miller JM, Tam TWS, Maloney S, Fukuda K, Cox N, Hockin J, et al. Cruise ships: high-risk passengers and the global spread of new influenza viruses. Clin Infect Dis. 2000;31(2):433-8.  https://doi.org/10.1086/313974  PMID: 10987701 
  14. Jenkins KA, Vaughan GH Jr, Rodriguez LO, Freeland A. Acute Gastroenteritis on Cruise Ships - Maritime Illness Database and Reporting System, United States, 2006-2019. MMWR Surveill Summ. 2021;70(6):1-19.  https://doi.org/10.15585/mmwr.ss7006a1  PMID: 34555008 
  15. Overheid.nl. Wet publieke gezondheid [Public Health Act]. Dutch Government: The Hague. [Accessed: 17 Apr 2023]. Dutch. Available from: https://wetten.overheid.nl/BWBR0024705/2022-10-10
  16. National Institute for Public Health and the Environment (RIVM). COVID-19. Bilthoven: RIVM. [Accessed: 2 May 2022]. Available from: https://www.rivm.nl/en/coronavirus-covid-19#:~:text=This%20is%20called%20the%20incubation,take%20more%20than%2010%20days
  17. GGD Amsterdam, GGD Rotterdam-Rijnmond, GGD Kennemerland, National Institute for Public Health and the Environment (RIVM). Common infectious diseases/Hygiene & Inspections. Port of Amsterdam; 2020. Available from: https://www.portofamsterdam.com/sites/default/files/2020-08/Additional%20measures%20cruise%20july%202020.pdf
  18. National Institute for Public Health and the Environment (RIVM) and Ministry of Health Welfare and Sport (VWS). COVID-19. Bilthoven: RIVM. [Accessed: 22 Apr 2022]. Dutch. Available from: https://lci.rivm.nl/richtlijnen/covid-19
  19. National Institute for Public Health and the Environment (RIVM) and Ministry of Health Welfare and Sport (VWS). COVID-19 op schepen en in havens. [COVID on ships and in port]. Bilthoven: RIVM. [Accessed: 22 Apr 2022]. Dutch. Available from: https://lci.rivm.nl/verdenking-covid-19-op-vrachtschepen-b-havens
  20. National Institute for Public Health and the Environment (RIVM) and Ministry of Health Welfare and Sport (VWS). COVID-19 aan boord van zeecruiseschepen. [COVID-19 on board cruise ships]. [Accessed: 22 Apr 2022]. Dutch. Available from: https://lci.rivm.nl/verdenking-covid-19-zeecruiseschepen
  21. International Maritime Organization (IMO). IMO identification number schemes. London: IMO. [Accessed: 31 May 2022]. Available from: https://www.imo.org/en/OurWork/MSAS/Pages/IMO-identification-number-scheme.aspx
  22. Sekizuka T, Itokawa K, Kageyama T, Saito S, Takayama I, Asanuma H, et al. Haplotype networks of SARS-CoV-2 infections in the Diamond Princess cruise ship outbreak. Proc Natl Acad Sci USA. 2020;117(33):20198-201.  https://doi.org/10.1073/pnas.2006824117  PMID: 32723824 
  23. Plucinski MM, Wallace M, Uehara A, Kurbatova EV, Tobolowsky FA, Schneider ZD, et al. Coronavirus disease 2019 (COVID-19) in Americans aboard the Diamond Princess cruise ship. Clin Infect Dis. 2021;72(10):e448-57.  https://doi.org/10.1093/cid/ciaa1180  PMID: 32785683 
  24. National Institute for Public Health and the Environment (RIVM) and Ministry of Health Welfare and Sport (VWS). Noodzakelijk zittend Vervoer van personen met COVID-19. [Transport of persons with COVID-19]. Bilthoven: RIVM; 2021. [Accessed: 22 April 2022]. Dutch. Available from: https://lci.rivm.nl/noodzakelijk-zittend-vervoer
  25. International Chamber of Shipping. Coronavirus (COVID-19). Guidance for Ship Operators for the Protection of the Health of Seafarers; London: International Chamber of Shipping; Nov 2020. Available from: https://www.ics-shipping.org/publication/coronavirus-covid-19-guidance-for-ship-operators-for-the-protection-of-the-health-of-seafarers-v3/
  26. Wilhelmsen. COVID-19 Global Port Restrictions Map. [Accessed: 4 May 2022]. Available from: https://www.wilhelmsen.com/ships-agency/campaigns/coronavirus/coronavirus-map/
  27. Institute for Human Rights and Business (IHRB). What is the Crew Change Crisis? Eastbourne: IHRB. [Accessed: 4 May 2022]. Available from: https://www.ihrb.org/explainers/what-is-the-crew-change-crisis
  28. Centers for Disease Control and Prevention (CDC). COVID-19 Orders for Cruise Ships: March 14, 2020 Update. Atlanta: CDC; 2020. Available from: https://www.cdc.gov/quarantine/cruise/covid19-cruiseships.html
  29. Cruise Port Rotterdam. #Wewillbeback. Rotterdam: Cruise Port Rotterdam. [Accessed: 2 May 2022]. Dutch. Available from: https://www.cruiseportrotterdam.nl/2020/03/19/we-will-be-back/
  30. Willebrand KS, Pischel L, Malik AA, Jenness SM, Omer SB. A review of COVID-19 transmission dynamics and clinical outcomes on cruise ships worldwide, January to October 2020. Euro Surveill. 2022;27(1):2002113.  https://doi.org/10.2807/1560-7917.ES.2022.27.1.2002113  PMID: 34991781 
  31. Gravningen K, Henriksen S, Hungnes O, Svendsen K, MacDonald E, Schirmer H, et al. Risk factors, immune response and whole-genome sequencing of SARS-CoV-2 in a cruise ship outbreak in Norway. Int J Infect Dis. 2022;118:10-20.  https://doi.org/10.1016/j.ijid.2022.02.025  PMID: 35189341 
  32. Convergence. Opening of the Pandemic & Disaster Preparedness Center (PDPC). Convergence. [Accessed: 10 Jan 2023]. Available from: https://convergence.nl/opening-of-the-pandemic-disaster-preparedness-center/
  33. Rocklöv J, Sjödin H, Wilder-Smith A. COVID-19 outbreak on the Diamond Princess cruise ship: estimating the epidemic potential and effectiveness of public health countermeasures. J Travel Med. 2020;27(3):taaa030.  https://doi.org/10.1093/jtm/taaa030  PMID: 32109273 
  34. Walker LJ, Codreanu TA, Armstrong PK, Goodwin S, Trewin A, Spencer E, et al. SARS-CoV-2 infections among Australian passengers on the Diamond Princess cruise ship: A retrospective cohort study. PLoS One. 2021;16(9):e0255401.  https://doi.org/10.1371/journal.pone.0255401  PMID: 34492022 
  35. Mouchtouri VA, Koureas M, Kyritsi M, Vontas A, Kourentis L, Sapounas S, et al. Environmental contamination of SARS-CoV-2 on surfaces, air-conditioner and ventilation systems. Int J Hyg Environ Health. 2020;230:113599.  https://doi.org/10.1016/j.ijheh.2020.113599  PMID: 32823069 
  36. van Waasdijk L. Maritime Declaration of Health (MDoH). Rotterdam: Portbase. [Accessed: 9 May 2022]. Dutch. Available from: https://www.portbase.com/wp-content/uploads/2021/07/Declaration-of-Health-nu-digitaal.pdf?utm_medium=email
  37. SHIPSAN ACT Information System (SIS). EU Common Ship Sanitation Database. Larissa: SIS. [Accessed: 31 May 2022]. Available from: https://sis.shipsan.eu/

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