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This interim guidance is intended to assist commercial passenger airlines, cargo and charter carriers, and the Transportation Security Administration (TSA), Bureau of Customs and Border Protection (BCBP), and other relevant agencies in establishing appropriate precautions for Ebola virus infection. Recommendations are based on standard infection control practices and on available epidemiologic information about the Ebola virus. Overview of Ebola Disease Ebola hemorrhagic fever is a severe, often-fatal disease in humans and nonhuman primates (monkeys, gorillas, and chimpanzees). The disease is caused by infection with Ebola virus, named after a river in the Democratic Republic of the Congo (formerly Zaire) in Africa, where it was first recognized in 1976. The virus is one of two members of a family of RNA viruses called the Filoviridae. There are four identified subtypes of Ebola virus. Three of the four have caused disease in humans: Ebola-Zaire, Ebola-Sudan, and Ebola-Ivory Coast. The fourth, Ebola-Reston, has caused disease in nonhuman primates, but not in humans. Although the disease is rare, it has the potential for person-to-person spread, especially among health-care staff and family members or others who care for the patient. Transmission to humans may occur through direct contact with blood or body fluids (e.g., saliva, and 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. Spread of the virus between humans has occurred in settings of close contact* with infected persons, such as in hospitals. The likelihood of contracting any viral hemorrhagic fever (VHF), including Ebola, is considered extremely low unless there has been travel to the affected area and direct contact with the body fluids of symptomatic infected persons or animals or with objects that have been contaminated with body fluids. The cause of fever in persons who have traveled or live in areas where VHF is present is more likely to be a common infectious disease, but such persons would need to be evaluated by a health-care provider to be sure. The incubation period for Ebola hemorrhagic fever ranges from 2 to 21 days. Early symptoms of the disease include with sudden fever, chills, and muscle aches. Around the fifth day after onset of symptoms, a skin rash can occur. Nausea, vomiting, chest pain, a sore throat, abdominal pain, and diarrhea may follow. Symptoms become increasingly severe and may include jaundice, severe weight loss, mental confusion, 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). When to See a Health-care Provider Any personnel who think they have been exposed to Ebola virus either through travel, assisting an ill passenger, handling a contaminated package, or cleaning a contaminated aircraft should take the following precautions:
General Infection Control Precautions Personnel should always follow basic infection control precautions to protect against any type of infectious disease. For information about these precautions see IATA's Guidelines for Suspected Communicable Diseases . Guidance for Airline Crews Management of possible exposure to Ebola virus Crew members on a flight with a passenger who is ill with a fever, jaundice, and/or bleeding and who is traveling from an area in which Ebola cases have been reported should follow these precautions:
If exposure occurs abroad Airline flight crew should familiarize themselves with the symptoms of Ebola hemorrhagic fever. Personnel who think they have been exposed to Ebola virus and who develop symptoms during travel should take the following actions:
Guidance for Air Cargo Personnel Packages should not ordinarily pose a risk to package delivery employees. Ebola virus is spread via direct contact with blood or body fluids (e.g., urine, saliva) from an infected individual.
Guidance for Airline Cleaning Personnel Ebola virus is transmitted by close contact* with a person who has symptoms of Ebola infection. Once passengers have left an aircraft, the main source of infection will have been removed. However, infectious blood and/or body fluids that may remain on surfaces of the aircraft interior may pose a risk of infection if those particles come into direct contact with a person’s eyes, nose, or mouth. Therefore, frequent hand washing is of primary importance for all personnel working on commercial passenger aircraft (see IATA's Guidelines for Suspected Communicable Diseases). In addition, the captain of an airliner bound for the United States is required by law to report any ill passenger who meets specified criteria to the nearest U.S. Quarantine Station. The airline’s ground and cleaning crews should be notified at the same time so that preparations can be made for cleaning the aircraft after passengers have disembarked. When cleaning commercial passenger aircraft after a flight with a possible Ebola hemorrhagic fever patient, personnel should follow the precautions described below.
Guidance for Personnel Who Interact with Arriving Passengers TSA, BCBP, and other personnel who interact with passengers arriving from areas affected by Ebola disease should keep in mind that the cause of fever in persons who have traveled or live in areas where VHF occurs is more likely to be a common infectious disease. However, personnel who have to detain or assist a passenger ill with a fever, jaundice (yellow skin and eyes), and/or bleeding should follow these precautions:
* Close contact is defined as having cared for or lived with a person known to have Ebola disease or having a high likelihood of direct contact with blood or body fluids of a Ebola patient. Examples of close contact include kissing or embracing, sharing eating or drinking utensils, close conversation (<3 feet), physical examination, and any other direct physical contact between persons. Close contact does not include activities such as walking by a person or briefly sitting across a room. For more information about Ebola infections, see http://www.cdc.gov/ncidod/dvrd/spb/mnpages/dispages/ebola.htm. For information about hemorrhagic fevers and precautionary measures, see http://www.cdc.gov/ncidod/dvrd/spb/mnpages/disinfo.htm. For situational updates about outbreaks, see http://www.who.int/csr/don/en/. |
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