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.