Information that has changed from the 2011 version of the VSP Operations Manual is marked with a yellow highlight and a vertical rule.# Foreword; ii

# Foreword
The Centers for Disease Control and Prevention (CDC) established the Vessel Sanitation Program (VSP) in the 1970s as a cooperative activity with the cruise ship industry. The program assists the cruise ship industry in fulfilling its responsibility for developing and implementing comprehensive sanitation programs to minimize the risk for acute gastroenteritis. Every vessel that has a foreign itinerary and carries 13 or more passengers is subject to twice-yearly unannounced inspections and, when necessary, reinspection.
VSP operated continuously at all major U.S. ports from the early 1970s through 1986, when CDC terminated portions of the program. Industry and public pressures resulted in Congress directing CDC through specific language included in CDC appropriations to resume the program. CDC's National Center for Environmental Health (NCEH) became responsible for VSP in 1986.
NCEH held a series of public meetings to determine the needs and desires of the public and cruise ship industry and on March 1, 1987, a restructured program began. In 1988, the program was further modified by introducing user fees to reimburse the U.S. government for costs. A fee based on the vessel's size is charged for inspections and reinspections. A VSP Operations Manual based on the Food and Drug Administration (FDA) 1976 model code for food service and the World Health Organization's Guide to Ship Sanitation was published in 1989 to assist the cruise ship industry in educating shipboard personnel.
In 1998, it became apparent that it was time to update the 1989 version of the VSP Operations Manual. Changes in the FDA Food Code, new science on food safety and protection, and newer technology in the cruise ship industry contributed to the need for a revised operations manual. Over the next 2 years, VSP solicited comments from and conducted public meetings with representatives of the cruise industry, the general public, FDA, and the international public health community to ensure that the 2000 manual would appropriately address current public health issues related to cruise ship sanitation. A similar process was followed to update the VSP 2000 Operations Manual in 2005 and the VSP 2005 Operations Manual in 2011.
Although the VSP 2011 Operations Manual was in use for almost 6 years, new technology, advanced food science, and emerging pathogens require updates to the manual. The VSP 2018 Operations Manual reflects comments and corrections submitted by cooperative partners in government and private industry as well as the public. We would like to thank all those who submitted comments and participated throughout this process.
As new information, technology, and input are received, we will continue to review and record that information and maintain a public process to keep the VSP Operations Manual current.
The VSP 2018 Operations Manual continues the more than 40 years of government and industry working together to achieve a successful and cooperative program that benefits millions of travelers each year.

# Aimee Treffiletti (CDR, USPHS)
Vessel Sanitation Program