Introduction:
The COVID-19 pandemic significantly impacted the cruise shipping industry with operations ceasing by mandate in Ireland from 24 March 2020. As shipping return was under consideration in late 2021, we developed comprehensive multi-stakeholder health protection guidance to manage maritime public health emergencies effectively, ensuring compliance with International Health Regulations¹ and emphasising the role of Port Health in safeguarding the health of passengers, crew members, and the broader community.

Methods:
Guidance development evolved through a series of consultations and collaborations. Ongoing international intelligence gathering and collaboration by the HSE Port Health Network including with Public Health Agency, Northern Ireland, UK Port Health Association and EU Healthy Gateways² were integral to the process. Development of the guidance document involved considerable input from the Department of Transport (document host), Health Service Executive (HSE) Port Health Network, the port authorities, Cruise Ireland, and other relevant stakeholders. Meetings with representatives from the Harbourmaster Association, cruise line representatives, Department of Health and other key stakeholders were essential.

Results:
The first version of the cruise protocol was published in March 2022, with subsequent updates in April 2023³ which widened the guidance to be non-COVID specific. The guidelines emphasise tailored disease mitigation plans, adherence to Flag State requirements, and compliance with international conventions. They highlight the necessity for coordinated outbreak management plans between ship and port authorities, and interoperability with the HSE seaport guidance⁴. Key components include comprehensive risk assessment, sanitation measures, and detailed contingency plans for health emergencies.

Conclusions:
Since the WHO declared the COVID-19 pandemic over in May 2023, the document revision ensures it remains a valuable tool for general infectious disease prevention and control, providing agreed interoperable guidance for health protection and preparedness for future public health emergencies in Irish waters.