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  • Welcome to the presentation: Ebola: What Airline Crew and Staff Need to Know

  • I am Dr. Phyllis Kozarsky, a Medical Consultant with the Centers for Disease Control and

  • Prevention, Division of Global Migration and Quarantine.

  • I specialize in Infectious Diseases and Travel Medicine and have worked many years with

  • the airlines about health and travel.

  • We understand that airlines and crews are concerned about Ebola, and we want to make

  • sure we address those concerns.

  • The airline industry is an important CDC partner in protecting health security and in

  • transporting humanitarian and public health aid to countries in need.

  • CDC is aware that several airlines have begun to stop flights to and from countries

  • where Ebola outbreaks are occurring.

  • It's important that airlines and their crew feel secure when flying to countries with

  • Ebola, so we are working with international partners to address your concerns and provide

  • you with the information and resources you need to protect yourselves.

  • In this presentation, we will cover these topics:

  • Information about Ebola, how to protect yourself, what is being done to stop the spread,

  • what to do if you have an onboard ill traveler, and finally, where you can find

  • additional information.

  • Information about Ebola

  • Ebola is a severe and often fatal disease in humans that is caused by the Ebola virus.

  • The disease is highly infectious, but transmission can be prevented with proper

  • infection prevention and control procedures.

  • Once a person is infected with the Ebola virus, symptoms can appear within 2 to 21 days

  • of exposure, although from 8-10 days is most common.

  • Symptoms include:

  • Fever, severe headache, muscle pain, vomiting, diarrhea, stomach pain and unexplained

  • bruising or bleeding.

  • It is important to note the signs and symptoms of Ebola, because a person can only

  • spread Ebola when they have symptoms.

  • So, how is Ebola spread?

  • It spreads through direct contact with a sick person's body fluids, which include:

  • Blood, feces, saliva, semen, urine and vomit or direct contact with objects contaminated

  • with infected body fluids.

  • And when we say direct contact , we mean contact through either broken skin or through

  • mucous membranes, this includes your eyes, nose, or mouth.

  • However, it is important to note that Ebola doesn't spread by people who don't have

  • symptoms, even if they have been exposed to Ebola.

  • It is also not spread through the air, water, or food.

  • However, in Africa, Ebola may spread as a result of handling bushmeat (that is, wild

  • animals hunted for food, such as monkeys).

  • Traveling to West Africa: how do you protect yourself

  • Before you travel, take care of yourself.

  • Make sure your immunizations are up to date, that you've had your flu shot, that you

  • take your anti-malaria pills, and be sure to pack any medicines you usually take.

  • Check CDC's Travelers' Health website for country-related health advice.

  • If you are traveling or staying in West Africa, it is important to remember that the

  • risk for getting Ebola is highest for people who either:

  • 1) Live with an Ebola patient

  • 2) Care for a patient with Ebola or

  • 3) Participate in burial preparation of a body of a person who has died of Ebola.

  • And remember, you can't get Ebola just by walking by someone with the disease at the

  • airport or passing somebody in the hallway at the hotel.

  • While in West Africa, follow these precautions to protect yourself.

  • Avoid visiting persons, including family or friends, who are sick.

  • Avoid contact with blood and other body fluids.

  • Don't touch the body of someone who died.

  • Always practice good hygiene.

  • Hand washing is your first defense against infection.

  • Use soap and water or alcohol-based hand sanitizer with at least 60% alcohol.

  • Use only soap and water if your hands are visibly dirty.

  • Avoid hospitals where Ebola patients are being treated.

  • However, if you need medical care, contact your employer to locate medical care; if

  • unable to contact your employer, contact your embassy.

  • What is being done to stop the spread of Ebola

  • CDC, the World Health Organization, Doctors Without Borders, and other partners are

  • working with the Ministries of Health in Guinea, Liberia, Nigeria, and Sierra Leone to

  • respond to the outbreak.

  • CDC is advising and training airport authorities and ministries of health on how to

  • conduct exit screening in the affected areas to prevent the international spread of

  • Ebola.

  • What is exit screening?

  • Exit screening is a public health measure that may slow and reduce further spread of the

  • disease.

  • Exit screening procedures are being implemented in countries where the Ebola outbreak is

  • occurring.

  • The purpose of exit screening is to:

  • 1) Identify travelers who are sick or may have been exposed to Ebola and

  • 2) Delay them from traveling commercially.

  • The process includes:

  • Asking travelers must respond to a health questionnaire, where a screener reviews the

  • questionnaire to determine if the traveler has been exposed to Ebola or has had any symptoms.

  • And then the screener also looks at the traveler for any signs of illness and takes

  • their temperature, using a non-contact thermometer.

  • Travelers not requiring further evaluation may proceed with their travel.

  • Travelers who report or show any signs or symptoms of Ebola will be further evaluated.

  • People should not travel commercially until 21 days after their last known potential exposure

  • to Ebola.

  • They should receive clearance from a doctor or public health authority prior to

  • traveling.

  • If exit screening does miss a traveler and the crew suspects the traveler is ill with a

  • serious contagious disease, you can use your airline's own authority to deny boarding to

  • the traveler.

  • Airlines are permitted to deny boarding to air travelers with serious

  • contagious diseases.

  • Onboard: what you should do with an ill traveler

  • It is very unlikely a traveler infected with Ebola would spread disease to passengers or

  • crew on board an airplane.

  • The risk is extremely low, because Ebola spreads by direct contact with infected body

  • fluids.

  • Remember, Ebola does not spread through the air like flu.

  • Although the risk for Ebola is low, you should still be on alert for passengers who are

  • not feeling well.

  • Observe passengers who seem unwell or are using the restroom many times.

  • Ask them: How they are feeling?

  • If they have a fever?

  • If they were recently near a sick person with similar symptoms?

  • Including what countries have they visited during their trip?

  • While these questions may help you better assess if the passenger is at risk for having

  • Ebola, it is important to note that Ebola symptoms are similar to many other illnesses,

  • such as malaria or even severe travelers diarrhea.

  • Without further evaluation and lab tests, you will not know what a sick traveler has.

  • Therefore, be safe and treat all body fluids as infectious.

  • Remember: Hand washing is your most important defense against infection.

  • Always follow routine infection control precautions.

  • All international aircraft should carry Universal Precaution Kits as recommended by

  • ICAO.

  • Use personal protective equipment if you have to manage an onboard ill traveler.

  • And, if you have to manage an ill traveler on the plane, follow your airline's

  • procedures for medical assistance.

  • Separate the ill traveler from others as much as possible.

  • If travelers are nauseated or vomiting, don't give them a surgical mask as it could

  • cause harm to a traveler who is vomiting.

  • Give them an air sickness bag and give them a plastic bag for disposing used tissues or

  • air sickness bags.

  • To protect yourself while managing an ill patient, wear waterproof disposable gloves

  • before touching an ill person or body fluids.

  • Protect yourself from splashes or sprays by using a surgical mask, face shield, or

  • goggles, and a protective apron or gown.

  • Don't touch your eyes, nose, or mouth (even when wearing gloves).

  • And after a helping traveler, take off your gloves very carefully.

  • Throw away used gloves as per your airline's infection control recommendations

  • Even when wearing gloves, wash hands with soap and water immediately after removing or

  • changing gloves.

  • Because Ebola can be transmitted through body fluids, you will want to notify your

  • ground and cleaning crews about any ill traveler, so they can make preparations to clean

  • the aircraft after passengers have disembarked.

  • If in-flight cleaning is needed, cabin crew should follow routine airline procedures

  • using personal protective equipment available in the Universal Precautions Kit.

  • Now reviewing how to report to CDC.

  • If you have an ill traveler on board a flight to the United States, you must follow CDC's

  • reporting requirements.

  • Cabin crew give information to the pilot.

  • Then the pilot will report to ATC, who will notify CDC.

  • Early reporting ensures prompt ground response to maximize timely care, reduce the risk

  • for spreading disease, and minimize travel disruption.

  • See the CDC website for specific tools for airlines, cabin crew, and pilots on reporting

  • to CDC.

  • If you have reported an ill traveler, when you land, CDC or other public health

  • authorities will board the plane to evaluate the ill traveler.

  • The other passengers and crew will have to remain on the plane until the evaluation is

  • complete.

  • The health investigators may request your assistance with distributing forms and health

  • information, such as:

  • Giving a public health announcement to be read aloud to passengers;

  • Distributing out travel health alert notices to be given to passengers or crew explaining

  • what to do in the event of exposure to an ill traveler, and

  • Handing out passenger locator forms for passengers to fill out with their contact

  • information.

  • The public health authorities will tell you and the passengers when it is okay to

  • disembark.

  • What to do if you think you were exposed

  • If a traveler is confirmed to have had infectious Ebola on a flight, you should discuss

  • with your employer, monitor your symptoms and seek medical care if you have fever or

  • other symptoms of Ebola, such as:

  • severe headache, muscle pain, vomiting, diarrhea, stomach pain, or unexplained bleeding

  • or bruising.

  • If you are sick, realize that a fever could indicate a number of illnesses, not just

  • Ebola.

  • Malaria is a far more common illness in people coming from these countries.

  • Therefore, seek medical attention immediately and don't travel on commercial vehicles,

  • such as planes, ships, trains, or buses.

  • There are a number of additional resources.

  • If you need more information on this topic, CDC has additional resources to support

  • airline personnel in identifying and reporting ill travelers.

  • These resources include:

  • Ebola Guidance for Airlines;

  • Infection Control Guidelines for Cabin Crew;

  • and information on Reporting Death and Illness to CDC: for the airlines, the cabin crew, and

  • pilots.

  • An additional resource on CDC's website are Ring Card tools for air and ground crew

  • personnel.

  • These cards help workers determine what to do if you have an ill traveler.

  • These materials may be downloaded and printed by anyone who wishes to use them.

  • Also, check CDC's website for more information about Ebola and Travelers' Health.

  • If you have any questions about Ebola, please send your questions to airadmin@cdc.gov.

  • Your questions and concerns are important to us.

  • And thank you for listening.

Welcome to the presentation: Ebola: What Airline Crew and Staff Need to Know

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