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CDC Guidance for Commercial Aircraft Operators: Seasonal Influenza

Introduction

Commercial air travel involves the movement of large numbers of people in closed and semiclosed settings. As with other close contact environments, these settings may facilitate the transmission of influenza viruses from person to person or through contact with contaminated environmental surfaces. The Centers for Disease Control and Prevention (CDC) recommends that efforts to reduce the spread of influenza virus on commercial aircraft focus on encouraging airline employees and passengers to:

  • Get vaccinated
  • Postpone  travel  when sick
  • Take everyday steps to protect themselves and others while traveling

This document contains information to help limit the spread of seasonal influenza viruses during air travel and also provides guidance for the management of travelers with influenza-like illness (ILI) during a flight. It will be updated as needed. More information on influenza is available at:

http://www.cdc.gov/flu/symptoms.htm.

Get Vaccinated: Influenza Vaccine Recommendations

The primary and most effective to way to protect oneself and limit the spread of influenza is to be vaccinated each year. CDC recommends that everyone 6 months of age and older be vaccinated against influenza every year, including crew members and passengers. Because the antibody response after influenza vaccination takes about 2 weeks, travelers should be vaccinated at least 2 weeks before travel for optimal protection against influenza, if influenza vaccine is available and the person has not been vaccinated with the current year’s vaccine.

Access CDC’s website for general influenza vaccination information at:

http://www.cdc.gov/flu/protect/vaccine/

Postpone travel when sick

  • Symptoms of influenza can include some or all of the following: fever, cough, sore throat, runny or stuffy nose, body aches, headache, chills, tiredness, and less commonly diarrhea, or vomiting. An ILI is often defined as an illness with fever or feverishness plus either a cough or sore throat. However, not everyone with an influenza illness will have all of these symptoms, including fever, and not everyone with these symptoms will have influenza.
  • CDC recommends that persons with ILI postpone travel by public conveyance (including commercial airlines) until at least 24 hours after fever has resolved without the use of fever-reducing medications (e.g., acetaminophen, ibuprofen, paracetamol). Airline crew members should also follow individual company policy if they become ill with ILI before a flight.
  • The use of fever-reducing medications can help to lessen fever associated with influenza; however, it is important that aspirin not be used to treat influenza in children younger than 19 years because of the risk of Reye’s syndrome.
  • More information for travelers is available at: http://www.flu.gov/individualfamily/travelers/index.html

Protect yourself and others

  • In addition to annual influenza vaccination, take simple steps to protect yourself from influenza viruses and other germs that cause illness.
  • Avoid sick persons (stay more than 2 meters away, or about 6 feet)
  • Cover your coughs and sneezes
  • Wash your hands often with an alcohol-based hand rub or soap and water
  • Join CDC’s public awareness campaign to reduce disease transmission among travelers. Access CDC posters and other campaign material at the following link:

“Cover Your Cough” available at:

http://www.cdc.gov/flu/protect/covercough.htm

Management of Passengers and Crew Members with ILI

Influenza-Like Illness (ILI)

Flight crew should consider someone to have a fever if the ill person feels warm to the touch, gives a history of feeling feverish, or has an actual measured temperature of 100° F (37.8° C) or higher. ILI has been defined as an illness with fever or feverishness, plus either cough or sore throat; however, not all ILI is influenza, and not all influenza illnesses fit the definition of ILI. Anyone with a respiratory illness should exercise good hand and respiratory hygiene, as noted above, to reduce the chance of spreading respiratory illnesses to others.

Steps to take on board

Crew members should take the following actions if a person has ILI during a flight:

  • Keep interactions with the ill person as brief as possible.
  • Ask the ill person to wear a face mask, if it can be tolerated and one is available.
  • If a face mask cannot be tolerated, provide tissues and ask the ill person to cover his or her mouth and nose when coughing or sneezing.
  • If the ill person is a passenger, move her or him to a seat that is separated from other passengers, if possible (≥6 feet of separation is ideal).
  • Provide a plastic bag for proper disposal of used masks and tissues.
  • Practice good hand hygiene and encourage others, including the ill person, to do the same:
    • Hands should be washed with soap and water or an alcohol-based hand rub especially after coughing or sneezing, after using the restroom, or after touching potentially contaminated surfaces or items (e.g., faucets, door handles, or someone’s mobile phone).
  • Persons who are experiencing more severe illness (e.g., high fever, shortness of breath, difficulty breathing, rapid breathing, chest pain, altered mental status, dehydration, or worsening of chronic underlying medical conditions) should be reported to the airline in-flight medical consultant, according to airline protocols.
  • If possible, continue operating the aircraft air-conditioning or ventilation system until all passengers and crew have disembarked to maximize air circulation in the cabin and thus the filtering of virus particles. Safety concerns may preclude this step on some aircrafts.

If the ill person is a crew member, CDC recommends, in addition to the actions listed above, that the ill crew member:

  • Follow individual company policy for onset of illness or incapacitation during flight operations.
  • Discontinue work as soon as possible without affecting flight safety.
  • See his or her health care provider, or a company-recommended health care provider if away from home base, and take antiviral medication for treatment of influenza if prescribed by the health care provider.
  • Return to work only after fever has resolved for at least 24 hours without the use of fever-reducing medications.

Personal Protective Measures

Hand Hygiene

Routine hand hygiene is an important line of defense against infection with influenza viruses, as well as other viruses and bacteria. Wash hands with soap and water for 15-20 seconds or use an alcohol-based hand rub. Hands should always be washed before donning and after removing gloves and other personal protective items.

Gloves

Crew members should wear impermeable, disposable gloves if they are assisting an ill passenger or have contact with potentially contaminated surfaces or lavatories. Crew members should avoid touching their faces with gloved or unwashed hands. Hands should be washed with soap and water or with an alcohol-based hand rub after removing gloves. Improper use or disposal of gloves may actually increase transmission of infectious pathogens.

Face Masks and Respirators

Routine use of face masks and N95 respirators is NOT recommended for airline crew members. Crew members who wish to voluntarily wear face masks or N95 respirators while tending to an ill person should follow their airline’s policy on the use of personal protective equipment during flight. To best ensure maximum protection from an N95 respirator, fit testing and training on proper technique is required.

Cleaning and Disinfection

Environmental management of influenza and other respiratory viral diseases should include routine cleaning and disinfection strategies, as well as more frequent cleaning of commonly touched hard surfaces, such as food trays, lavatory surfaces, and door handles. Commonly used environmental cleaners certified for use in the aircraft cabin are sufficient. 

Reporting

Based on the current prevalence and level of severity of influenza-related illness in the United States, CDC does not recommend that commercial air carriers traveling to or within the United States routinely report individual cases of suspected or confirmed influenza. However, if a traveler has fever and difficulty breathing or multiple travelers with ILI are identified, the airline should report these events to CDC. For interstate domestic flights the airline may notify the local public health authority with jurisdiction for the arrival airport in lieu of notifying CDC.

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