Introduction:
HEALTHY SAILING is a research and innovation action that aims to improve the quality of passenger shipping services, facilitate recovery from the COVID-19 pandemic and make passenger shipping safer, more resilient, competitive and efficient. Traditional detection methods of infectious diseases on cruise ships miss asymptomatic infections and unreported symptoms. This approach has significant limitations, as it lacks systematic syndromic surveillance to detect trends of known or emerging diseases, except for gastroenteritis and recently COVID-19. However, even COVID-19 surveillance faces challenges due to the high percentage of asymptomatic cases. Our integrated E-SS is a health data platform element that addresses these challenges, providing a robust solution for early health threat detection.

Methods:
A complete tool was developed, consisting of a relational database, API layer, web frontend and supporting data input and output scripts, to provide functionality for: • Secure communication with heterogeneous data sources. • Data recording through provided electronic. • A dashboard with visualizations such as epidemic curves, epidemiological indicators, and charts, capable of providing generated reports to authorities. • An API for delivering analytic outputs to complementary tools.

Results:
The E-SS was validated with synthetic data, consisting of a fictional cruise ship with 1400 crew and passengers, supplemented with anonymized historical data of an actual gastrointestinal disease outbreak. The complete dataset was inserted in distinct stages, simulating the progression of the outbreak over the 7 day cruise and the corresponding reporting actions of the fictional medical crew on the E-SS. The system was capable to provide reliable recording and real-time reporting, as well as analytic outputs to complementary tools to facilitate early detection and mitigation.

Conclusions:
The utilization of a modern, responsive and secure web-based tool to record medical cases, collect data, and perform syndromic surveillance, can improve current practices regarding on board cruise ships by providing a real-time overview of the situation, as well as prompt sharing of the information to the appropriate parties, prompting further action depending on the situation. The E-SS is a solution for medical logging, syndromic surveillance, report generation and data sharing, that can be shown to facilitate improvements in outbreak response, mitigation and ultimately outcomes. The development is ongoing, and planned tests by ship medical personnel will provide valuable feedback to improve all aspects of the tool, in anticipation of validating its effectiveness in a real environment.