Ebola Guidance For Airlines

Interim Guidance about Ebola Virus Infection for Airline Flight Crews, Cleaning Personnel, and Cargo Personnel

Overview of Ebola Virus Disease

Ebola virus disease (also known as Ebola hemorrhagic fever) is a severe, often-fatal disease caused by infection with a species of Ebola virus. Although the disease is rare, it can spread from person to person, especially among health care staff and other people who have close contact*with an infected person. Ebola is spread through direct contact with blood or body fluids (such as saliva or urine) of an infected person or animal or through contact with objects that have been contaminated with the blood or other body fluids of an infected person.

 The likelihood of contracting Ebola is extremely low unless a person has direct contact with the body fluids of a person or animal that is infected and showing symptoms. 

A fever in a person who has traveled to or lived in an area where Ebola is present is likely to be caused by a more common infectious disease, but the person would need to be evaluated by a health care provider to be sure.

The incubation period, from exposure to when signs or symptoms appear, for Ebola ranges from 2 to 21 days (most commonly 8-10 days). Early symptoms include sudden fever, chills, and muscle aches. Around the fifth day, a skin rash can occur. 

Nausea, vomiting, chest pain, sore throat, abdominal pain, and diarrhea may follow. Symptoms become increasingly severe and may include jaundice (yellow skin), severe weight loss, mental confusion, bleeding inside and outside the body, shock, and multi-organ failure.

The prevention of Ebola virus infection includes measures to avoid contact with blood and body fluids of infected individuals and with objects contaminated with these fluids (e.g., syringes).

Stopping ill travelers from boarding aircraft

People who have been exposed to Ebola virus disease should not travel on commercial airplanes until there is a period of monitoring for symptoms of illness lasting 21 days after exposure. Sick travelers should delay travel until cleared to travel by a doctor or public health authority.

Airlines should consider using their own authority (for US airlines, Federal Register[PDF - 74 pages], Department of Transportation 14 CFR Part 382) to deny boarding of sick travelers if Ebola is suspected.

Management of ill people on aircraft if Ebola virus is suspected

Crew members on a flight with a passenger or other crew member who is ill with a fever, jaundice, or bleeding and who is traveling from or has recently been in a risk area should follow these precautions:

• Keep the sick person separated from others as much as possible.
• Provide the sick person with a surgical mask (if the sick person can tolerate wearing one) to reduce the number of droplets expelled into the air by talking, sneezing, or coughing.
• Give tissues to a sick person who cannot tolerate a mask. Provide a plastic bag for disposing of used tissues.
• Wear impermeable disposable gloves for direct contact with blood or other body fluids.

Universal Precaution Kits: Airplanes traveling to countries affected with Ebola should carry Universal Precaution Kits, as recommended by the International Civil Aviation Organization[PDF - 30 pages] (ICAO), for managing ill onboard passengers.

Visit CDC's Infection Control Guidelines for Cabin Crew Members on Commercial Aircraft for more information on practical measures cabin crew members can take to protect themselves, passengers and other crew members.

Reporting Ill Travelers

The captain of an aircraft bound for the United States is required by law to report to the Centers for Disease Control and Prevention (CDC) before arrival any deaths onboard or ill travelers who meet specified criteria. This is consistent with mandatory reporting requirements of ICAO (ICAO document 4444 and Annex 9, Ch. 8, of the Chicago Convention).

CDC staff can be consulted to assist in evaluating an ill traveler, provide recommendations, and answer questions about reporting requirements; however, reporting to CDC does not replace usual company procedures for in-flight medical consultation or obtaining medical assistance.

General Infection Control Precautions

Personnel should always follow basic infection control precautions to protect against any type of infectious disease.

What to do if you think you have been exposed

Any person who thinks he or she has been exposed to Ebola virus either through travel, assisting an ill traveler, handling a contaminated object, or cleaning a contaminated aircraft should take the following precautions:

• Notify your employer immediately.
• Monitor your health for 21 days. Watch for fever (temperature of 101°F/38.3°C or higher), chills, muscle aches, severe diarrhea, vomiting, rash, and other symptoms consistent with Ebola.

When to see a health care provider

• If you develop sudden fever, chills, muscle aches, severe diarrhea, vomiting, rash, or other symptoms consistent with Ebola, you should seek immediate medical attention.
  • Before visiting a health care provider, alert the clinic or emergency room in advance about your possible exposure to Ebola virus so that arrangements can be made to prevent spreading it to others.
  • When traveling to a health care provider, limit contact with other people. Avoid all other travel.
• If you are located abroad, contact your employer for help with locating a health care provider. The U.S. embassy or consulate in the country where you are located can also provide names and addresses of local physicians.

Guidance for Airline Cleaning Personnel

Ebola virus is transmitted by close contact* with a person who has symptoms of Ebola. Treat any body fluid as though it is infectious. Blood or body fluids on interior surfaces can spread Ebola if they get into your eyes, nose, or mouth. Therefore,hand hygiene is the most important infection control measure. Wear disposable impermeable gloves when cleaning visibly contaminated surfaces.

For any ill traveler on board an aircraft, even if Ebola is not considered, the the airline's ground and cleaning crews should be notified so that preparations can be made to clean the aircraft after passengers have disembarked. When cleaning aircraft after a flight with a patient who may have had Ebola, personnel should follow these precautions:

• Wear impermeable disposable gloves while cleaning the passenger cabin and lavatories.
• Wipe down lavatory surfaces and frequently touched surfaces in the passenger cabin, such as armrests, seat backs, tray tables, light and air controls, and adjacent walls and windows with an Environmental Protection Agency (EPA) registered cleaner/disinfectant that has been tested and approved for use by the airplane manufacturers.
•  
• Special cleaning of upholstery, carpets, or storage compartments is not indicated unless they are obviously soiled with blood or body fluids.
• Special vacuuming equipment or procedures are not necessary.
• Do not use compressed air, which might spread infectious material through the air.
• If a seat cover or carpet is obviously soiled with blood or body fluids, it should be removed and discarded by the methods used for biohazardous material.
• Throw used gloves away according to the company's recommended infection control precautions when cleaning is done or if they become soiled or damaged during cleaning.
• Clean hands with soap and water (or waterless alcohol-based hand sanitizer when soap is not available) immediately after gloves are removed.

Guidance for Air Cargo Personnel

Packages should not pose a risk. Ebola virus is spread through direct contact with blood or body fluids (such as urine or saliva) from an infected person.

• Packages visibly soiled with blood or body fluids should not be handled.
• Cargo handlers should wash their hands often to prevent other infectious diseases.

* Close contact is defined as having cared for or lived with a person with Ebola or having a high likelihood of direct contact with blood or body fluids of an Ebola patient. Close contact does not include walking by a person or briefly sitting across a room from a person.

Additional Information

• CDC's Infection control on aircraft: seeInfection Control Guidelines for Cabin CrewMembers on Commercial Aircraft.
• International Civil Aviation Association[PDF - 30 pages] (ICAO): see Health-Related documents: Annex 6 — Operation of Aircraft. Part I — International Commercial Air Transport — Aeroplanes
• Ebola updates: see Ebola Hemorrhagic Fever.
• Hemorrhagic fevers and precautionary measures: see Viral Hemorrhagic Fever Disease Information.
• Situational updates about outbreaks: seeWorld Health Organization Disease Outbreak News.
• Travel recommendations and updates: seeCDC's Travelers' Health.
• How to find a doctor while abroad.