Avian Flu Outbreak 
Issues for the Airline and Cruise Industry 

Thursday, July 24, 2008

The CDC has issues guidelines for persons in the aviation industry, and highlights are listed below:

If airline personnel are ill, the following steps should be taken:

  • Avoid traveling
  • Cover mouths and noses with a tissue or hands when coughing or sneezing
  • Put used tissue in a waste basket
  • Clean hands with soap and water or an alcohol-based hand gel immediately after coughing or sneezing

 

Management of Ill Passengers
Personnel should be aware of the symptoms of avian influenza (see http://www.cdc.gov/flu/avian/facts.htm.)
If the flight crew is concerned that a passenger with symptoms of avian influenza traveling from an area with avian influenza may be infected, they should try to keep the ill passenger separated from the other passengers (3-6 feet).
If the ill passenger can tolerate a mask, provide a paper or gauze surgical mask to reduce the number of droplets coughed into the air.
If a surgical mask is not available, provide tissues and ask the ill person to cover his or her mouth and nose when coughing and to put the used tissues into a wastebasket or bag.
If an ill passenger is unable to wear a surgical mask, personnel may wear surgical masks when working with the ill person.
Personnel should wear disposable gloves for direct contact with blood or body fluids of any passenger. However, gloves are not intended to replace proper hand hygiene. Immediately after activities involving contact with body fluids, gloves should be carefully removed and discarded and hands should be cleaned. Gloves should not be washed or reused.
The captain of an airliner bound for the United States is required by law to report the illness to the nearest U. S. Quarantine Station prior to arrival or as soon as illness is noted (see http://www.cdc.gov/ncidod/dq/quarantine_stations.htm). Quarantine officials will arrange for appropriate medical assistance to be available when the airplane lands and will notify state and local health departments and the appropriate CDC officials.

Management of Ill Crew

Flight crew members and ground personnel who become ill and who believe they have been exposed to avian influenza should take the following precautions:
Do not travel while ill. Limiting contact with others as much as possible can help prevent the spread of an infectious illness. If crew members and ground personnel must travel (e.g., to seek medical care), they should wear a paper or gauze surgical mask to decrease the possibility of transmitting the illness to others.
If crew members and ground personnel become ill while traveling away from home, their employer should be notified and assistance should be requested in locating a healthcare provider. Employees should let their employer know if they are concerned about possible exposure to avian influenza, and ask about all available healthcare options.
If illness onset occurs while outside the United States, the U. S. embassy or consulate can provide names and addresses of local physicians.
Before crew and personnel visit a doctor’s office, clinic, or emergency room, the healthcare provider should be warned in advance about possible exposure.
If illness onset occurs after return home, employees should contact a healthcare provider. Before going to the doctor’s office or emergency room, the medical staff should be told about the employee’s symptoms, the countries visited, and whether the employee had contact with poultry.

For the details of the full document regarding recommendations for airline and cruise industry, please refer to this CDC webpage: http://www.cdc.gov/travel/other/avian_flu_ig_airlines_021804.htm

Recent legal developments
On November 22, 2005 the CDC proposed rules to update regulations for control of communicable diseases. Improved and streamlined contact tracing, and expanded reporting of ill passengers on interstate flights and ships and airline flights arriving from foreign countries are key elements of the proposed plan. In addition, provisions for administrative due process for individuals subjected to quarantine are outlined. The authority to offer vaccination, prophylaxis, and other medical interventions on a voluntary basis would be provided to individuals in quarantine.

The CDC is taking comments for 60 days prior to formalizing the rules. 

These proposed rules have broad implications for the travel industry. For example, airline pilots and ship captains would need to report passengers with certain signs of illness directly to the CDC. Airlines or ships would also need to keep lists of passengers for at least 60 days after arrival. Airlines would need to ask passengers to provide post-arrival contact information for potential use by public health officials on a voluntary basis.

The U.S. Department of Health and Human Services has authority to use isolation and quarantine to keep people with certain infectious diseases out of the U.S., and pandemic influenza was added to that list and signed by the president earlier this year. The current CDC proposal includes regulations that empower authorities to hold a person for 3 days, after which a decision must be made whether to quarantine or not. There will be an opportunity for a hearing before an independent arbiter.

The proposed rules are published in the Federal Register, and the CDC will take comments on them for 60 days, after which final rules are published.

CONCLUSION
Frequent changes in the circumstances of avian influenza worldwide call for a proactive approach to preparedness planning on the part of governments and corporations alike. Drafts of recommendations and plans will require periodic review and updates to ensure that the assumptions on which plans are made are correct and that appropriate actions correspond to the conditions at the moment. Using the framework of WHO pandemic phases allows for rational decisions for deploying key personnel and supplies, and judicious use of scarce medical resources. Communication is a most valuable tool to ensure that all interested parties are well prepared in the event the outbreaks evolve into a wider epidemic. MedAire is in an ongoing process of refining its response through its Pandemic Preparedness Task Force, and we are committed to meeting the needs of our internal and external customers.

 

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