Responding to Ebola Virus Disease on Commercial Airlines

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Responding to Ebola Virus Disease on Commercial Airlines The CDC Experience Joanna Regan, MD, MPH, FAAP Conveyance Investigation Lead Global Migration

1 Responding to Ebola Virus Disease on Commercial Airlines The CDC Experience Joanna Regan, MD, MPH, FAAP Conveyance Investigation Lead Global Migration Task Force Centers for Disease Control and Prevention National Center for Emerging and Zoonotic Infectious Diseases Division of Global Migration and Quarantine

2 Objectives Describe the public health risk assessment used by CDC when a person with suspected Ebola is on a flight CDC process for use of passenger locator forms Messaging to passengers and partners Conducting an Ebola contact investigation involving exposure on a commercial flight

3 Ebola Public Health Risk Assessment Exposure Questions Don personal protective equipment right before interacting with ill passenger First, confirm travel history to a country with Ebola in past 21 days If yes, remove ill traveler from aircraft for further assessment

4 PASSENGER LOCATOR FORM (PLF) AND TRAVEL HEALTH ALERT NOTICE (T-HAN) If Ebola is suspected during an onboard response, distribute PLFs and T-HANs to all passengers and crew on board. Ask flight attendant to read onboard script for SCENARIO 2: POSSIBLE PUBLIC HEALTH RISK and PLF instructions. Collect PLFs before passengers disembark. Organize the PLFs according to exposure and proximity to ill passenger. Mark with a check those passengers and crew considered contacts and place these PLFs on top of pile. 4

5 Messaging to passengers and partners Website link on T-HAN for updates: Three template entries for the different scenarios. Cities listed here are just examples. Month DD, 2014 XXXX Airlines flight #XXX from Brussels, Belgium to Newark, New Jersey: The sick passenger is under observation. Suspicion of Ebola is very low. Month DD, 2014 Follow up/action requested: As we learn more about this sick passenger s status, we will update this site. Revisit this page at a later date for updated information. XXXX Airlines flight XXXX from Brussels, Belgium to Newark, New Jersey: The sick passenger does not have Ebola. You were not exposed to Ebola or any other illness of public health concern. Month DD, 2014 Follow up/action requested: No action is needed. XXXX Airlines flight XXX from Brussels, Belgium to Newark, New Jersey: The sick passenger has been confirmed to have Ebola. Follow up/action requested: If you were on this flight, please call this number for further information: XXX-XXX-XXXX.

6 Messaging to passengers and partners Rapid contact with airline partners also a priority Guidance for cleaning and managing plane can be found here:

Conducting an Ebola air contact investigation http://www.cdc.

7 Conducting an Ebola air contact investigation

8 Gilsdorf A, Morgan D, Leitmeyer K. Guidance for contact tracing of cases of Lassa fever, Ebola or Marburg haemorrhagic fever on an airplane: results of a European expert consultation. BMC public health. 2012;12:1014.

9 Conducting an Ebola air contact investigation

10 Conducting an Ebola air contact investigation

11 Conducting an Ebola air contact investigation

12 Conducting an Ebola air contact investigation

13 Conducting an Ebola air contact investigation Considerations Recommendations vary from different organizations about contact radius Symptoms of the ill traveler play a role in multiple decision points If the incident takes place at an airport without CDC staff onsite, Emergency Medical Services can perform the assessment with telephone input from CDC

14 CDC s Monitoring and Movement Guidance 14

15 Selected CDC Resources jsapi=1&playerapiid=491822&modestbranding=1&rel=0&origin=http: //

16 Conclusions Ebola public health assessment is very similar to all DGMQ responses to illnesses on commercial flights and a general set of principles can be used. The initial assessment is not a physical exam and can be conducted by non-medical staff. There are various approaches, risks and benefits of all approaches should be considered.

17 References Gilsdorf A, Morgan D, Leitmeyer K. Guidance for contact tracing of cases of Lassa fever, Ebola or Marburg haemorrhagic fever on an airplane: results of a European expert consultation. BMC public health. 2012;12:1014. Leitmeyer K. European risk assessment guidance for infectious diseases transmitted on aircraft--the RAGIDA project. Euro surveillance : bulletin Europeen sur les maladies transmissibles = European communicable disease bulletin. 2011;16(16). Regan JJ, Jungerman R, Montiel SH, Newsome K, Objio T, Washburn F, et al. Public health response to commercial airline travel of a person with ebola virus infection - United States, MMWR Morbidity and mortality weekly report Jan 30;64(3):63-6. Shuaib F, Gunnala R, Musa EO, Mahoney FJ, Oguntimehin O, Nguku PM, et al. Ebola virus disease outbreak - Nigeria, July-September MMWR Morbidity and mortality weekly report Oct 3;63(39): Fasina F, Shittu A, Lazarus D, Tomori O, Simonsen L, Viboud C, et al. Transmission dynamics and control of Ebola virus disease outbreak in Nigeria, July to September Euro surveillance : bulletin Europeen sur les maladies transmissibles = European communicable disease bulletin. 2014;19(40).

18 Acknowledgements CDC, Global Migration Task Force DGMQ Air Activities: Faith Washburn, MPH; Efrosini Roland, Tina Objio, MSN

19 Questions? Joanna Regan, MD, MPH, FAAP

20 LEGAL AUTHORITIES To prevent the introduction, transmission, and spread of communicable disease from foreign countries into the States or possessions of the United States CFR Title 42 Part 71 Subpart C 71.21(b) Subpart D Public Health Foreign Quarantine Notice of Communicable Disease Prior to Arrival (radio report of death or illness) Health Measures at U.S. Ports: Communicable Diseases (persons, carriers, things) 20

IHR AND AIRPORT SCREENING DURING A PUBLIC HEALTH EMERGENCY OF INTERNATIONAL CONCERN (PHEIC)

IHR AND AIRPORT SCREENING DURING A PUBLIC HEALTH EMERGENCY OF INTERNATIONAL CONCERN (PHEIC) AIRPORT SCREENING Kimberly Rogers Quarantine and Border Health Services Branch Division of Global Migration and Quarantine U.S. Centers for Disease Control and Prevention October 13, 2015 OBJECTIVES Understand