Introduction:
The study’s aim is to describe the routine inspections that were carried out by competent Public Health Authorities (PHAs) on board passenger ships (cruise ships, inland vessels or ferries) sailing in European countries between 2018 and 2024. Eligible for inspection were all vessels from any passenger ship company sailing in EU if they fell under the following description: “Passenger ship/ship: Any seagoing or inland passenger ship (with more than 12 passengers) on an international voyage, sailing within the EU waters, providing accommodation and/or food (other than “prepacked” food items that are prepared on a licensed premises ashore) to passengers, and/or potable water from the ship water distribution system to passengers.” Inspections were conducted according to inspection protocol and the hygiene standards set out in European Manual for Hygiene Standards and Communicable Disease Surveillance on Passenger Ships (Edition 2nd, April 2016)¹ and particularly concerning medical facilities, communicable disease surveillance, food safety, potable water safety, recreational water safety, pest management, housekeeping and facilities, hazardous chemical agents, waste management and ballast water management. The General Assembly members of the EU HEALTHY GATEWAYS joint action agreed and assigned tasks required for continuation of passenger ship inspection activities and capacity-building after the joint action concluded (from 1st May 2022) to the European Scientific Association for Health and Hygiene in Maritime Transport (EU SHIPSAN Association).

Methods:
Inspections took place after a 24/48-hour notice by competent port health authorities (PHAs). Inspection reports were entered in EU Common Ship Sanitation Database (former SHIPSAN ACT Information System (SIS) https://sis.shipsan.eu/). In order for the routine inspections to be carried out in European ports University of Thessaly or EU SHIPSAN Association administration contacted the partners of European countries in order for them to arrange the inspections via official routes (ie. ministries), issue circulars in their country and develop inspection schedule for each year. According to inspection protocol, within a period of 15 days from the inspection date, inspection reports were to be finalized and notification email to be sent to company/ship including grade. Within the period of 21 days from the date of notification email, Corrective Action Statements (CAS) were to be completed and submitted by company/ship. Since June 2019, the inspection results were graded (A, B, C, D). According to the consortium agreement of the EU HEALTHY GATEWAYS joint action, the competent authorities authorized University of Thessaly and EU SHIPSAN Association to publish the list of all ships inspected in the EU HEALTHY GATEWAYS web portal² and EU SHIPSAN Association website³.

Results:
From 2018 to the end of September 2024, a total of 327 inspection reports were submitted by PHAs in SIS along with 292 Corrective Action Statements (CAS) by shipping companies or officers of ships. Out of 327 inspections that took place, 322 were routine, 4 were follow-up inspections and 1 was a focused investigation. Table 1 presents the numbers of inspection reports, deficiencies, CAS, non-compliances with requirements of the EU legislation, non-followed recommended standards of the European Manual and Notations from 2018 to 2024. Table 2 presents inspection reports and CAS in SIS per country and port. Table 3 presents the 10 most frequent inspection findings. 260 inspection reports resulted in a grade and up to now, 260 grades have been published. Out of 260 published grades, 227 were “A” grades, and 33 were “B”, “C” or “D” grades and in particular 5 D. During 2020 and 2021, due to the fact that cruise ship operations were suspended due to COVID-19 pandemic, and because priority was given to focused inspection for COVID-19, only 11 inspections were conducted. Since the beginning of 2022 cruise lines resumed sailing gradually. During 2020, the inspections were carried out on board cruise ships with no passengers and only crew on board. The average number of passengers and crew of the inspected ships was 1698 and 668 respectively. Inspections were conducted in 38 ports by 76 inspectors, five SHIPSAN experts, 16 inspectors in training and 31 observers. In total, 279 inspectors completed the e-learning from 2018 to 2024. Between 2018 and September 2024, 37 audits by five experts carried out in EU MS ports. Fifteen consultations and clarifications in written form were provided to the shipping industry, upon request, in 2019, two in 2023 and two in 2024.

Conclusions:
Aiming to improving the quality of routine inspections and bringing a consistent and proportionate approach to the inspection of all ship types, it is imperative to provide on-the-job, on-line and face-to-face training, issue yearly inspection schedules and operate information tools for recording/sharing of inspection results are significant. It is also of importance to update the European Manual and develop funding activities. Inspections represent an important chance to increase competency and knowledge all involved stakeholders.