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Guidance for Protecting Travelers on Commercial Aircraft Serving Haiti During the Cholera Outbreak

These guidelines provide crew members on commercial aircraft with practical measures to protect themselves, passengers, and other crew members when a traveler from Haiti has a diarrheal illness that may be cholera.

GENERAL INFORMATION

Cholera Illness

  • Cholera causes watery diarrhea that may be severe.
  • Cholera patients often have vomiting.
  • Severe diarrhea causes massive loss of fluids from the body (dehydration).
  • Without treatment, a person with cholera could die within hours.

Cholera Transmission

  • People get cholera by drinking water or eating food that has cholera germs in it.
  • Water can be contaminated with the feces of a person sick with cholera.
  • Food can be contaminated by water that has cholera germs in it or food prepared or handled by a person sick with cholera.
  • Cholera does not spread directly from person to person.
  • Cholera is not a major health threat in the United States or other countries where there are advanced water and sanitation systems. However, the disease can spread rapidly in areas without treatment of sewage and drinking water.

Cholera Treatment

  • Although cholera can be life-threatening, it can be easily treated.
  • Travelers from Haiti with watery diarrhea should get medical care immediately
  • Cholera can be treated by immediate replacement of the fluid and salts lost through diarrhea. Oral rehydration salt (ORS) solutions are recommended for this purpose.
  • Treatment with antibiotics can shorten the duration and reduce the severity of the illness.

Cholera Prevention

  • Cholera can be easily prevented by following CDC’s safe food and water advice:
    • Drink and use safe water
    • Cook food thoroughly
    • Wash your hands often with soap and safe water
    • Clean up safely
    • Use latrines or sanitation system

More detailed information regarding Cholera prevention measures is available at  http://www.cdc.gov/haiticholera/five_messages.htm.

CHOLERA AND AIR TRAVEL

What is the risk of the spread of cholera from an ill traveler on a plane?

  • The risk of transmission during usual interactions onboard an aircraft is extremely low.
  • The organism that causes cholera will not cause illness by penetrating through skin or being inhaled. However, it is always important to take precautions against disease spread when dealing with a sick passenger.

Should travelers from Haiti with diarrhea be allowed to board aircraft?

  • The Centers for Disease Control and Prevention (CDC) is not applying travel restrictions to suspected or confirmed cholera cases; however, CDC recommends that travelers from Haiti who are ill with diarrhea should not travel by commercial air transport.
  • Although the risk of transmission of cholera to others is low, a person with cholera could become severely unwell during the flight, necessitating a flight diversion or resulting in serious health consequences for the person with cholera, including death.

PERSONAL PROTECTIVE MEASURES

Hand Hygiene

Good hand hygiene is the single most important infection control measure. Wash your hands and any soiled areas of skin with soap and water for 20 seconds after assisting sick people or coming in contact with body fluids or surfaces that may be contaminated. If soap and water are not available, use an alcohol-based hand rub. Hands should always be washed before donning and after removing gloves and other personal protective items.

Gloves

Wear disposable gloves when assisting an ill passenger or having contact with potentially contaminated items, surfaces, or lavatories. Avoid touching your face with gloved or unwashed hands. Hands should be washed with soap and water or with an alcohol-based hand rub after removing gloves. Dispose of contaminated gloves and any other contaminated items in a plastic bag. Tie the bag securely and label it as ‘biohazard’ for appropriate disposal after landing.

Masks

Masks are not necessary for protection against cholera. However, if company policy indicates masks should be worn when cleaning areas or items contaminated with diarrhea or vomit, a surgical-type face mask is sufficient. Dispose of the used mask with the other contaminated items. Routine use of face masks or N95 respirators is NOT recommended for airline crew members.

MANAGEMENT OF ILL PASSENGERS WITH DIARRHEA OR VOMITING

  • Minimize the number of persons who have direct contact with the ill person.
  • Seat the ill person close to a lavatory, if possible.
  • Restrict the use of that lavatory to only the ill individual(s), if possible.
  • Provide air sickness bags.
  • Provide fluids to prevent dehydration.
    • Preferably ORS if available
    • NO alcoholic drinks
  • Provide an alcohol-based hand rub to sick person, if available.
  • Follow the instructions in “TARGETED CLEANING” below, as necessary.

MANAGEMENT OF ILL CREW MEMBERS WITH DIARRHEA OR VOMITING

  • Follow the actions listed above for ill passengers.
  • Follow individual company policy for onset of illness or incapacitation during flight operations.
  • Ill crew member should discontinue all galley work and food and beverage services immediately and only be assigned to safety tasks if and when necessary.
  • Ill crew member should NOT return to work until diarrhea resolves and he or she is cleared to return to work by the airline’s occupational health policy.

REPORTING TRAVELERS FROM HAITI WITH DIARRHEA TO CDC

  • As soon as possible, crew members should advise the captain of a traveler that has vomiting or diarrhea, so that he or she can notify CDC of the case before arrival, and also inform the airline or its handling agency, as required by company procedures.
  • To notify CDC of onboard cases of vomiting or diarrhea in travelers before arrival, see Guidance for Airlines on Reporting Onboard Deaths or Illnesses to CDC.

TARGETED CLEANING

  • Wear impermeable, disposable gloves when cleaning or handling surfaces or items contaminated with fecal material or vomit
  • Hard (non-porous) surfaces, such as tray tables, TV monitors, seat arms, windows and walls that are visibly soiled:
    • Remove visible contaminating material with your company’s accepted cleaning agents, then disinfect with a disinfectant agent approved by your airline. (In many cases, cleaning agents also contain a disinfectant agent.)
  • Soft (porous) surfaces, such as carpeted floor or seat cushions that are obviously soiled, such as with vomit or diarrhea:
    • Remove as much of the contaminant as possible, then cover the area with an absorbent substance such as dry ground coffee or a specialized material for this purpose, if available.
    • Cover the area with an impermeable material, such as plastic, to reduce the risk of spread beyond the immediate area. Secure the plastic with tape.
  • If a contaminated item can be easily removed and is small enough to fit inside a plastic bag (such as a pillow, blanket or small cushion), carefully place it inside a plastic bag. Tie the bag securely to prevent leakage and label it ‘biohazard’.

POST-FLIGHT MEASURES

  • Properly dispose of bags containing contaminated items as per your company’s procedures.
  • Notify cleaning crew of areas needing more than routine cleaning or possible removal, such as:
    • Visibly soiled soft materials (e.g., seat cushion, carpet),
    • Hard surfaces like arm rests and tray tables, and
    • Lavatories used by ill person(s).

Additional Information

CDC Traveler’s Health: Travel Health Precaution, Cholera in Haiti

CDC’s cholera website

CDC’s Haiti cholera website

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