The COVID-19 pandemic in Greenland, epidemic features and impact of early strict measures, March 2020 to June 2022.

BackgroundThe COVID-19 pandemic was of major concern in Greenland. There was a high possibility of rapid transmission in settlements, and an increased risk of morbidity and mortality because of comorbidities in the population and limited access to specialised healthcare in remote areas.AimTo describe the epidemiology of the COVID-19 pandemic in Greenland and evaluate the effects of a strict COVID-19 strategy until risk groups were immunised.MethodsWe studied the epidemiology during March 2020 to June 2022. We describe the non-pharmaceutical interventions (NPIs), PCR-confirmed COVID-19 cases and vaccination coverage with data from the registries of the Greenlandic health authority.ResultsWe found 21,419 confirmed cases per 100,000 inhabitants (54% female, 46% male), 342 per 100,000 were hospitalised and 16 per 100,000 were admitted to the intensive care unit. The COVID-19 mortality rate was 39 per 100,000, all those affected were aged above 65 years. No excess overall mortality was observed. The vaccination coverage by June 2022 was 71.67 and 41% for one, two and three doses, respectively.ConclusionSARS-CoV-2 circulation in Greenland was low, given strict restrictions until all eligible inhabitants had been offered immunisation. The main impact of the pandemic was from May 2021 onwards with increasing numbers of confirmed cases. This occurred after introduction of the vaccine programme, which may have had an influence on the severity of the associated morbidity and mortality experienced. Halting community transmission of SARS-CoV-2 with NPIs until the majority of the population had been immunised was a successful strategy in Greenland.

Health of Danish seafarers and fishermen 1970-2010: What have register-based studies found?

BACKGROUND: This study aimed to review Danish register-studies on seafarers' and fishermen's health and safety. METHODS: Register-based or register-linked studies from 1970 until 2012 were identified and reviewed. Four categories of studies were included: mortality, hospitalization, specific diagnoses and conditions and accidents. Standardized risks estimates were typically calculated by comparison with the total Danish working population. RESULTS: Elevated rates were found in all four categories. For mortality male seafarers had excess rates of accidents, cirrhosis of the liver, cancer, and suicides, and fishermen of accidents and cardiovascular disorders. Female seafarers in male-dominated occupations also had increased mortality rates. Elevated hospitalization rates for male seafarers were particularly prominent for endocrine/nutritional conditions, cervical discopathy, gastrointestinal and cardiovascular diseases, cancers, hearing impairment, and injuries, and for female seafarers cancers, circulatory and genitourinary diseases and injuries. Fishermen had increased hospitalization rates for cardiovascular diseases, bronchitis, emphysema, lung cancer, gonarthrosis, thoracolumbar discopathy, rotator cuff syndrome, carpal tunnel syndrome, injuries and hearing impairment. Specific diagnoses and conditions: There was an elevated risk of tuberculosis, hepatitis B and certain cancers for male seafarers, and of obesity and occupational accidents for both fishermen and seafarers. CONCLUSIONS: In spite of safety measures and significant structural changes in the Danish merchant and fishing fleet, the spectrum of health indicators continues to indicate considerable risk factors in the maritime environment and/or the lifestyle of seafarers and fishermen. Future monitoring of fishermen's and seafarers' health will remain essential for implementing appropriate preventive measures.

Surveillance of maritime deaths on board Danish merchant ships, 1986-2009.

BACKGROUND: A previous study demonstrated a high death rate among seafarers signed on Danish ships during the years 1986-1993. This study aimed to examine and analyse the subsequent development until 2009. MATERIAL AND METHODS: A total of 356 fatalities were identified from data supplied from the Danish Maritime Authority, an insurance company, and other sources. Maritime deaths among seafarers signed on Danish ships comprise deaths from 1) accidents, suicides and homicides; and 2) disease on board. Deaths due to 2) occurring ashore within 30 days after signing off were included. The overall and mode-specific death rates were calculated for three eight-year observation periods. The rates for work-related fatal accidents were compared with the rates for land-based trades. RESULTS: All categories of maritime deaths were significantly reduced from 1986 to 2009 - in particular during the last eight-year period (Accidents 1986-1993: 66.6 per 100,000 person years, 2002-2009: 27.0 per 100,000 person years, diseases 49.5-26.1, suicides 14.4-7.8). In spite of the remarkable improvement since 1986, seafarers remain in 2002-2009 more than six times more likely to die from occupational accidents (including shipwrecks) than do workers ashore. CONCLUSIONS: The favourable trend of maritime deaths in the Danish merchant fleet may be due to 1) preventive measures - e.g. interventions relating to vessel safety, work environment, and improved medical care on board - and to 2) technological and organizational changes - e.g. newer and larger vessels in the Danish merchant fleet, changed composition of the workforce, and reduced shore leaves. The persisting excess risk warrants further preventive actions.

Fatal occupational accidents in Danish fishing vessels 1989-2005.

The purpose of the study was to study the circumstances and incidence rates of fatal accidents in inspection obligated and non-inspection obligated Danish fishing vessels to identify areas for prevention. Information about the fatalities came from maritime authority reports, including vessel disaster reports, post mortem reports, maritime inquiries and police reports. The person- and vessel years at risk came from the Danish Directorate of Fisheries. During the period 1989-2005, 114 fatalities occurred. Sixty-one of the fatalities occurred in 36 vessel disasters mainly caused by foundering/capsizing due to stability changes in rough weather and collisions; 39 fatal occupational accidents mainly occurred on the larger inspection obligated trawlers during fishing. In the remaining 14 other fatal accidents, the main causal factors were difficult embarking/disembarking conditions by darkness in foreign ports and alcohol intoxication. In the period 1995-2005, the overall incidence rate was 10 per 10,000 fishermen per year with no down-going trend during that period. The fatal accident rates are still too high, despite the efforts to reduce the risk. Increased focus on regular and repeated safety training for all fishermen and improved safety measures are needed, especially in the underscored areas of sea disasters concerning small vessels and occupational accidents on big vessels. Better registration of time at risk for fishermen is needed to validate the effect of the safety measures.

Major differences in rates of occupational accidents between different nationalities of seafarers.

OBJECTIVES: Earlier studies and statistics have shown that merchant seafarers from the South East Asia had considerable lower accident rates when compared with seafarers from Western Europe. The purposes of the study were to investigate whether the earlier observations were sustained if further sources on occurrence of accidents were used and to identify specific causes of excess accident rates among certain nationalities. METHODS: Occupational accidents aboard Danish merchant ships during one year were identified from four different sources. These included accidents reported to the maritime authorities, accidents reported to a mutual insurance company, files on medical costs reimbursed by the government and finally, accidents in which there has been contact to the radio medical service. Time at risk aboard was obtained from a register on all employment periods aboard merchant ships. RESULTS: A total of 943 accidents causing personal injury to a seafarer directly caused by work aboard were identified. Among these accidents, 499 had taken place aboard cargo ships in international trade. Only these were used in the detailed analysis. The accident rate for all identified accidents aboard cargo ships were 84 accidents per 1,000 years aboard. The crude incidence rate ratio (IRR) for East European seafarers was 0.88 and for South East Asians 0.38 using West European seafarers as reference. In a Poisson regression analysis, the IRR for South East Asians was 0.29 (0.22-0.38). In an analysis including only more serious accidents, IRR for South East Asians rose to 0.36 (0.26-0.48). DISCUSSION: This study indicates that seafarers from South East Asia, mainly the Philippines, may have a genuine lower risk of occupational accidents in comparison with seafarers from Western and Eastern Europe. Differences in approach to safety and risk taking between South East Asian and European seafarers should be identified and positives attitudes included in accident preventing programmes. Main messages Seafarers from South East Asia, mainly the Philippines, seem to have a genuine lower risk of occupational accidents in comparison with seafarers from Western and Eastern Europe. POLICY IMPLICATIONS: Differences in approach to safety and risk taking between South East Asian and European seafarers should be identified and positives attitudes included in accident preventing programmes.

Routes of M. tuberculosis transmission among merchant seafarers.

For centuries, tuberculosis has been identified as a burden to seafarers. In this study, we assessed the magnitude of tuberculosis among merchant seafarers today. Furthermore, we identified the most likely routes of M. tuberculosis transmission by the use of DNA fingerprinting. A database containing all culture-positive tuberculosis cases in Denmark in 1992-2003 was combined with a register on all seafarers and their employment periods aboard Danish ships. All strains of M. tuberculosis were analysed using DNA-subtyping. 64 cases of culture positive tuberculosis among seafarers were identified. The risk of tuberculosis among males was 1.51 (1.10-2.01) compared with the general population. Two of the 64 cases were likely to be shipping-related, 5 were possibly shipping-related, and 10 were less likely to be shipping-related. The remaining 47 cases were very unlikely to be shipping related. Including the 2 first categories, the incidence was 0.09 cases per 1000 y at sea. The excess risk of tuberculosis among active and former Danish seafarers is most probably due to infections acquired in Denmark. Despite multi-cultural crews aboard, including many from high-incidence countries, our study indicates that only limited transmission of M. tuberculosis takes place among crew aboard modern ships or during shore leaves.

Obesity among Danish seafarers.

BACKGROUND: Danish seafarers have an excess of life style related diseases where obesity may be a factor. Obesity may in itself be a safety issue at sea. OBJECTIVES: The purpose was to study overweight among male seafarers and determine the consequences if a maximum Body Mass Index (BMI) for seafarers is decided. METHODS: As part of the mandatory pre-employment health examination, height and weight of the seafarers are recorded and BMI calculated. From a register comprising all seafarers, basic information on each individual seafarer was obtained from the last employment period before the health examination. In this study, normal weight is defined as a BMI from 20 and up to 25, moderate overweight from 25 up to 30 and obesity from 30 and above. RESULTS: The study comprised 1257 male seafarers. There were statistically significant more overweight seafarers in all age groups compared to a reference group ashore. Among those between 45 and 66 years of age 0.7% had a weight below normal, 22.7% had normal weight and 76.6% had a weight above normal, while 30.9% of this age group was obese. CONCLUSION: The method is applicable as a tool for an objective description of seafarers' health profile in a national and an international perspective. Overweight is found to be common and may influence the health of the seafarers and shipboard safety. Fixed BMI limits for seafarers on Danish ships would result in loss of license and that would have major implications even if the limit is set high.