In 1975, because of several major disease outbreaks on cruise vessels, the Centers for Disease Control and Prevention (CDC) established the Vessel Sanitation Program (VSP) as a cooperative activity with the cruise ship industry. This joint program strives to achieve and maintain a level of sanitation on passenger vessels that will lower the risk of gastrointestinal disease outbreaks and provide a healthful environment for ships’ passengers and crew. The program goals are addressed through encouraging industry to establish and maintain a comprehensive sanitation program and oversight of its success through an inspections process. Every vessel with a foreign itinerary that carries 13 or more passengers is subject to twice yearly inspections and when necessary reinspection. Inspections are only conducted at those ports under U.S. control and cover such environmental aspects as:

1. Water supply, storage, distribution, backflow protection and disinfection.
2. Food preparation during storage, preparation, and service and product tempera-ture control.
3. Potential contamination of food, water, and ice.
4. Employee practices and personal hygiene.
5. General cleanliness, facility repair, and vector control.
6. The ship’s training programs in general environmental and public health practices.

A score of 86 or higher at the time of the inspection indicates that the ship is providing an accepted standard of sanitation. In general, the lower the score the lower the level of sanitation; however, a low score does not necessarily imply an imminent risk of an outbreak of gastrointestinal disease or other illness related to environmental sanitation. Each ship is required to document a plan for corrective action following each inspection.

Inspectors will recommend a ship not sail if they detect an imminent health hazard aboard ship (e.g., inadequate facilities for maintaining safe food temperatures or a contaminated drinking-water system.) Full information on inspection criteria can be obtained by writing to the VSP office at the address listed at the end of this section. At any time, the Director of CDC may determine that failure to implement corrective actions presents a threat of communicable disease being introduced into the United States and may take additional action including detention of the ship in port.

The scores for each ship are published every 2 weeks in the Summary of Sanitation Inspections of International Cruise Ships, commonly referred to as the green sheet. This sheet is widely distributed to travel-related services around the world and is a way to communicate a ship's compliance with VSP recommendations to both the cruise ship industry and the consumer. The green sheet is available to the public via INTERNET, FTP.CDC.GOV//PUB/SHIP_INSPECTIONS/SHIPSCORE.TXT; or by the CDC fax-back service by dialing (404) 332-4565 and requesting Document Number 510051. Interested parties can also obtain the green sheet or a copy of the complete inspection for a specific ship by writing to the Vessel Sanitation Program, National Center for Environmental Health, Centers for Disease Control and Prevention, 1015 North America Way, Room 107, Miami, Florida 33132.