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Important advice to all seafarers

Revision of Carnival Corporation Standard – MED 2107 – Annex 1 Crew Vaccination

requirements.

This is to inform You that as of the 1st of May 2018 all embarking seafarers employed by:
• Costa Crociere, CSCS International NV,
• Starboard Holding Ltd.
• Sto Italy (Steiner) and
• Selection srl
will be required to comply with Carnival Corporation Standard – MED 2107 Annex 1 Rev. 2 on crew vaccination.

The new standard includes following vaccination requirements:

- measles, mumps and rubella (MMR) checks or vaccinations extended to all seafarers (unchanged
respective to previous version);
- tuberculosis checks are required only for seafarers coming from or residing in following countries
or having resided there in the previous two years:
- Angola, Algeria, Afghanistan, Armenia, Azerbaijan, Bangladesh, Belarus, Benin, Botswana, Burkina,
Bangladesh, Burundi, Bolivia, Brunei, Bhutan, Cambodia, Cameroon, China, Congo, Central African
Republic, Cabo Verde, Chad, Dominican Republic, DPR Korea, DR Congo, Ecuador, Ethiopia, Eritrea,
Fiji, Gabon, Gambia, Ghana, Gibuti, Guinea, Georgia, Groenlandia, Guyana, Guam, Honduras, Honk
Kong, Haiti, India, Indonesia, Islands Marianne, Islands Solomon, Ivory Coast, Kenya, Kiribati,
Kazakhstan, Kyrgyzstan, Lithuania, Laos, Lesotho, Liberia, Madagascar, Maldives, Mozambique,
Myanmar, Malawi, Mali, Morocco, Mauritania, Macao, Malaysia, Moldova Republic, Mongolia, Marshall
Islands, Micronesia, Namibia, Nauru, Nepal, Nicaragua, Nigeria, Pakistan, Palau, Papua New Guinea,
Peru, Philippines, Romania, Ruanda, Russian Federation, Senegal, Sierra Leone, Somalia, South Korea,
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South Africa, Sri Lanka, Sudan, Swaziland, Thailand, Tanzania, Tajikistan, Timor, Togo, Turkmenistan,
Tuvalu, Ukraine, Uzbekistan, Uganda, Vanuatu, Vietnam, Zambia and Zimbabwe
- Hepatitis A vaccination is required for all foodhandlers.
- Yellow fever vaccination extended, as a company requirement, to all those onboard during the
Brazilian season for 2018/2019 onwards.

Reimbursement for these expenses is done onboard vessels through payslip as per procedure in force.
A threshold is defined for each expense, variable in accordance with the cost of vaccination in different sourcing
countries. Relevant form P 5.05.04 IO 03 MO01 has been updated to revision 1 (updated amounts in some
countries).

In addition following changes are implemented

- Revision of Covis form ( Annex 3 MED 2107 now available with versions in English / Italian / German).
The previous Covis form shall be considered expired only if some of the exams therein reported are
expired. In this case the new form shall be filled in. If exams / vaccinations reported on the Covis are
not expired the old form is still acceptable to embark.
- Revision of P 5.02 IO 01 SMS MO04 Medical Checklist Rev. 2. It has been added the informed consent
on alcohol and drug testing.

MEASLES, MUMPS AND RUBELLA (MMR) VACCINATION (only point d has been changed)
MMR vaccination shall be registered in the Covis form. Same rule applies for evidence of previous series of
vaccinations (2 shots, i.e. those done in the childhood) or blood test to verify immunity. Seafarers comply with
this requirement by:
a) Providing evidence of 2 doses of MMR vaccine being received prior to s/on, the 2nd one to be
inoculated at least 1 month after the 1st one and both prior to s/on; or
b) Providing lab evidence of immunity (by previous dosage or disease through a blood test to verify
antibodies IgG levels against measles, mumps and rubella);
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c) Providing evidence of previous vaccinations (2 MMR shots) registered in a public / private medical
archive. Copy of this archive shall be provided to the doctor who signs the Covis form.
d) The 2nd dose of MMR vaccine is mandatory only if required by the legislation of the origin country of
the seafarer. If the legislation of the origin country doesn’t specify how many doses are necessary for
MMR vaccine on adults, the seafarer is accepted with the minimum requested, which means a single
dose.
MMR vaccination covers immunization against measles, mumps and rubella. The vaccine is
administered subcutaneously. The usual side effect of the vaccine is low-grade fever on the first 24-48
hours after vaccine administration and/or a red rash on the injection site and is considered not
infectious.

Important note: Pls. consult with the doctor administering MMR vaccination if You are a
female in childbearing age in order to be duly informed about caution to be taken with

the vaccination.

Pls. visit https://www.cdc.gov/measles/lab-tools/who-lab-manual.html for more information on these

risks. A negative pregnancy test is already a mandatory check for pre-embarkation. As the MMR

vaccination shall be performed in advance respective to the pre-embarkation medical check (10 days
prior to s/on), the same test done before MMR vaccination will be accepted for pre-embarkation
purposes.
Once the Covis form is filled in, a copy shall be handed to the Manning Agent to have it checked and
uploaded into Company’s software (mistral). Seafarers employed by a Concessionaire’s company will
address same copy to their Employer. Direct hired seafarers from Costa / CSCS will address a copy to:
- Deck & Engine Personnel: pls. send to the relevant Hr Manager or Hr Operator
- Hotel and CSCS Personnel: HR_Compliance@costa.it
- Seafarers from Concessionaire’s companies will use usual addresses to send covis form to their
Employer.
Original Covis form and original receipts of payments shall be brought onboard. Each seafarer will
receive the reimbursement form and provide it, duly filled in with original copy of the receipts of
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expenses to the onboard Hr Director. Once authorized, the reimbursement will be brought forward by
the Crew Cashier with Shipboard Hr Payroll Dept. Thresholds apply to reimbursement by type of
expense and by country. Threshold are detailed in the reimbursement form. Expenses missing original
invoices will not be reimbursed. Reimbursement will be applied in the currency of the contract. Expenses
shall be handed for reimbursement up to six months after issuance date.
Should a vaccination not be available in Your country of residence, pls verify with the Manning agent
(contacts specified above in case of direct hired) how to comply with this requirement. Seafarers who
might refuse vaccination for medical reasons shall report this information to the Manning agent
(contacts specified above in case of direct hired) and provide evidence of the reasons behind this refusal.

TUBERCULOSIS CHECK.
Tuberculosis check will be performed only by seafarers coming from the list of countries specified
above (1st page). Seafarers supposed to make the tuberculosis check shall produce a negative
result through:
- Mantoux test/PPD test or
- QuantiFERON test or
- Pulmonary x-Ray with Medical Certificate from Pneumologist Doctor (only for country where
Mantoux test or/and QuantiFERON test are not available).
Tuberculin intradermal reaction (Mantoux test/PPD test) should be considered positive in
subjects with a negative history of TB if the diameter of the skin infiltrate is equal to or greater
than:
-5 mm in HIV+ subjects,
-10 mm in subjects from high endemic countries ,
-15 mm in subjects without risk factor for tuberculosis disease.
In case of a positive Test, the C.M. can only embark if provided of a Medical Certificate issued
by a Pulmonologist or by an Infectious Disease Specialist who declares that the seafarer doesn’t
have an active TB disease.
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A crewmember who is under an ongoing tuberculosis treatment, for any reason, shall be denied
embarkation.
HEPATITIS A VACCINATION.
Foodhandler seafarers (all staff in Galley, Bar, Restaurant, F&B Stores, Room service. In addition,
following positions: F&B Director, Asst. F&B Director, Sanitation Officer, Butler, Night Steward, Master’s
Valet) are required to be vaccinated against Hepatitis A . Also this vaccination shall be registered in
Covis form. The same applies to evidence of previous series of vaccinations (2 shots, i.e.) or blood test
to verify immunity. Foodhandlers comply with this requirement by:
a) Providing evidence of 2 doses of Hepatitis A vaccine being received prior to s/on, the 2nd one to
be inoculated at least 6 months after the 1st one and both prior to s/on (consecutive contracts);
or
b) Providing lab evidence of immunity (by previous dosage or disease through a blood test to
verify antibodies IgG levels against Hepatitis A);
c) Providing evidence of previous vaccinations (2 Hepatitis A shots) registered in a public / private
medical archive. Done in the last 10 years. Copy of this archive shall be provided to the doctor
who signs the Covis form.
Foodhandler seafarers shall be accepted onboard with one dose of Hepatitis A vaccination if it
was not possible to apply the second shot prior to the embarkation. The second dose shall be
administered at the seafarer’s initiative after s/off.
Covis form shall be updated at each change in vaccination status. A copy of the updated covis form
shall be sent to the manning agent (contacts specified above in case of direct hired) and its original
copy shall be brought onboard.

YELLOW FEVER VACCINATION

Yellow fever vaccination is a mandatory requirement in some specific areas where vessels are operating
or from some sourcing countries from which seafarers are coming from. Yellow fever vaccination has
been extended, as a company requirement, to all those onboard during the Brazilian season for
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2018/2019 onwards. Under this circumstance, vaccination against yellow fever is reimbursed by the
company.
Following countries are considered with risk of yellow fever transmission, according to the WHO (1):
Africa: Angola, Benin, Burkina Faso, Burundi, Cameroon, Central African Republic, Chad, Congo, Congo
(Dem. Rep.), Ivory Coast, Equatorial Guinea, Ethiopia, Gabon, Gambia, Ghana, Guinea-Bissau, Guinea,
Kenya, Liberia, Mali, Mauritania, Niger, Nigeria, Rwanda, Senegal , Sierra Leone, South Sudan, Sudan,
Togo, Uganda;
Central and South America: Argentina, Bolivia, Brazil, Colombia, Ecuador, French Guyana, Guyana,
Panama, Paraguay, Peru, Suriname, Trinidad and Tobago, Venezuela.
This means that:
- vaccination against yellow fever is required if arriving within 10 days after leaving or transiting from
above countries (1) towards following countries (2):
Bahamas, Ecuador, El Salvador, Fiji, Guyana, Mauritius, Panama, Thailand;
- vaccination against yellow fever is required if arriving within 6 days after leaving or transiting from
above countries towards following countries (3):
Aruba, Australia, Bahrain, Brunei, Cabo Verde, China, Costarica, Cuba, Djibuti, Dominica, Egypt, French
Polinesia, French West Indies, Grenada, Honduras, India, Indonesia, Jamaica, Jordan, Kiribati,
Madagascar, Malaysia, Maldives, Malta, Mayotte, Mozambique, Myanmar, New Caledonia, Nicaragua,
Panama, Philippines, Reunion, Sri Lanka, St. Helena, St. Kitts, St. Lucia, St. Vincent & Grenadines,
Seychelles, Singapore, Solomon Islands, South Africa, Trinidad &Tobago, Tunisia, Venezuela, Vietnam.
This list includes also other countries where Costa vessels don't make any call.

Actions:
- Seafarers embarking in countries listed under (1) shall always bring international certificate of
vaccination against yellow fever;
- Seafarers coming from countries listed under (1) shall always bring international certificate of
vaccination if entering or transiting in a country listed under (2) or (3).
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- Seafarers embarked on vessels in area under (1) shall always bring international certificate of
vaccination if transferring to a vessel calling countries listed under (2) or (3) within the time limits listed.
If international certificate of vaccination is not in the hands of the seafarer, change vessel is
questionable.

For further details, pls. visit WHO website at following link:

http://www.who.int/ith/2015-ith-annex1.pdf?ua=1&ua=1

TYPHOID FEVER VACCINATION

Typhoid fever vaccination is a mandatory vaccination for food-handlers as per Flag requirement. As a
mandatory vaccination, its cost shall not be refundable. Typhoid fever vaccination data shall be reported
in the covis form. Seafarers coming from countries where this vaccination is not available shall report
it to the manning agent (contacts specified above in case of direct hired), who will instruct them how
to do it. On each Costa vessel a small stock of typhoid-fever vaccination is available to manage
vaccination for seafarers coming from countries where this vaccination is not available. In such a case,
involved seafarers shall be charged the relevant cost.

REIMBURSEMENT PROCESS.
Direct costs (vaccinations and exams only) related to MMR, Hepatitis A vaccination and tuberculosis
check and yellow fever shall be refunded, subject to a threshold amount for each expense, variable by
country, provided the original copy is attached to the reimbursement form and that the reimbursement
is asked within six months since the incurred expense. Seafarers shall bring onboard all relevant direct
expenses and ask for reimbursement to the Crew Purser. Each seafarer will fill in the reimbursement
form (to be received onboard the vessel). The Hr Director will verify it, have it signed by the seafarer,
and approve it with the total amount to be reimbursed. A copy of this form is handed to the seafarer.
Therefore, the seafarer will verify his/her payslip to see the amount refunded on the first available
month.
This process applies to all seafarers, including those employed by Concessionaire companies.
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Just to remind that FOODHANDLER EXAMS’ validity has been extended to one year (and no longer
15 days). They consist of :
- Throat culture (to verify absence of Group A streptococcus, staphylococcus, candida albicans, neisseira
meningitides, other bacteria or fungi);
- Stool culture (to verify absence of pathogenic bacteria). To be checked against: salmonella, shigella,
campylobacter, E-coli, clostridium);
- Ova and parasite test (to verify absence of Giardia, Cryptosporidium, Entamoeba hystolitica).
Exams shall be valid for the whole length of the contract. In case they expire during the contract, they
shall be renewed prior to embarkation. As a general rule, they shall be valid for six months since the
s/on date for an EU seafarer and for nine months for a Non-Eu seafarer. Foodhandler exams are
mandatory exams by Flag requirement and therefore shall not be refunded.
Your manning agent (Your hr manager in case of direct hired seafarer or Concessionaire company’s
employees) are available for further information You may need.

Your sincerely,

Genoa, on February 13, 2019

Costa Crociere Spa