- AVIAN INFLUENZA, HUMAN - EAST ASIA (25)
- A ProMED-mail post
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- International Society for Infectious Diseases
- In this update:
-  WHO update 27
-  Guidance for Airline Flight Crew and Arrivals Staff
- Date: Thu 19 Feb 2004
- From: ProMED-mail<email@example.com
- Source: World Health Organisation (WHO), CSR, Disease
Outbreak News, Thu 19
- Feb 2004 [edited]
- Avian Influenza A H5N1) Virus Infection - WHO Update
- Situation (human) in Viet Nam
- Further details are now available for Viet Nam's 22nd
case of avian influenza A (H5N1) virus infection as confirmed yesterday.
The case was a 3-year-old boy from Lam Dong Province. His death, announced
yesterday, is the country,s 15th fatality.
- Marianne Hopp
- [The total number of confirmed cases in Thailand and
Viet Nam remains at
- 31, of whom 22 have died. A 23rd suspected case in Viet
Nam has not yet
- been confirmed by WHO. - Mod.CP]
- Date: Thu 19 Feb 2004
- From: ProMED-mail <firstname.lastname@example.org
- Source: Centers for Disease Control and Prevention, Travelers'
- Guidelines and Recommendations, Wed 18 Feb 2004 [edited]
- Interim Guidance for Airline Flight Crews and Persons
- Arriving from Areas with Avian Influenza
- Since December 2003, outbreaks of highly pathogenic avian
influenza --- mostly influenza A (H5N1) virus infection --- among chickens
and ducks have been reported in several countries in Asia. Human cases
also have been reported.
- No evidence for sustained person-to-person transmission
of influenza A(H5N1) has been identified; however, influenza A viruses
can change rapidly, and therefore the situation in these countries is being
monitored carefully. The U.S. Centers for Disease Control and Prevention
(CDC), the World Health Organization (WHO), and national authorities in
Asian countries are working to assess the outbreak, provide support, and
assist with control efforts. As part of this response, CDC issues interim
recommendations for various prevention and control measures.
- This interim guidance is intended to assist airline flight
crews and personnel meeting arriving passengers in establishing appropriate
precautions in the event they must interact with a person suspected of
having avian influenza. Recommendations are based on standard infection
control practices and on available information on the disease.
- Information on the Spread of Avian Influenza
- Avian influenza viruses usually do not infect humans.
The ability of avian viruses to transmit from person to person appears
limited. Rare person-to- person infection was noted in the influenza A
(H5N1) outbreak in Hong Kong in 1997 and in the Netherlands in 2003, but
these secondary cases did not result in sustained chains of transmission
or community-wide outbreaks. These previous experiences with avian influenza
viruses suggest that limited person- to-person transmission of the current
H5N1 viruses could occur. Infected birds shed virus in saliva, nasal secretions,
- Avian influenza viruses spread among susceptible birds
when they have contact with contaminated nasal, respiratory, and fecal
material from infected birds; however, fecal-to-oral transmission is the
most common mode of spread. Humans become infected from contact with infected
poultry or contaminated surfaces. All influenza viruses can change, and
therefore it is possible that an avian influenza virus could change so
that it could infect humans and spread easily from person to person. Because
these viruses do not commonly infect humans, there is little or no immune
protection against them in the human population.
- For additional information on avian influenza, please
consult this web
- General Infection Control Precautions
- - As with all infectious illnesses, the first line of
defense to prevent transmission is careful hand hygiene. As a general rule,
wash hands frequently with soap and water or use an alcohol-based hand
rub if hands are not visibly soiled.
- - Cover your cough. Passengers who are coughing should
be encouraged to contain their coughs.
- - Avoid traveling when ill.
- Passengers with Symptoms of Possible Avian Influenza:
Management on a
- - Personnel should be aware of the symptoms of avian
influenza: http://www.cdc.gov/flu/avian/facts.htm. Although experience
with human infection is limited, persons infected with avian influenza
would likely have fever and respiratory symptoms (cough, sore throat, shortness
- - If flight crew members or other personnel are concerned
that a passenger traveling from an area in which avian influenza cases
have been reported may be ill with a fever or respiratory illness, they
should keep the sick person separated from close contact with others as
much as possible. A surgical mask can reduce the number of droplets coughed
into the air. Ask the sick person to wear a mask if one is available, provided
the person can tolerate it (that is, if the sick person does not have such
severe difficulty breathing that he or she cannot use a mask). If a surgical
mask is not available, provide tissues and ask him or her to cover the
mouth and nose when coughing. When a sick person is unable to wear a surgical
mask, personnel should wear surgical masks when working directly with that
- - Personnel should wear disposable gloves for direct
contact with blood or body fluids of any passenger. (However, gloves are
not intended to replace proper hand hygiene). Immediately after activities
involving contact with body fluids, gloves should be carefully removed
and discarded and hands should be cleaned. Gloves must never be washed
- - The captain of an airliner bound for the United States
is required by law to report the illness to the nearest U. S. Quarantine
Station prior to arrival or as soon as illness is noted (see http://www.cdc.gov/ncidod/dq/quarantine_stations.htm).
Quarantine officials will arrange for appropriate medical assistance to
be available when the airplane lands and will notify state and local health
departments and the appropriate CDC Headquarters officials. Quarantine
officials will work with the airline and local and state health departments
to assist with medical transportation of the patient upon arrival, disease
control and containment measures, passenger and crew notification and surveillance
activities, and airline disinfection procedures.
- Management on Arrival
- For Transportation Security Administration (TSA), Bureau
of Customs and Border Protection (BCBP), and other personnel interacting
with passengers arriving from areas with avian influenza, CDC does not
recommend protective measures beyond those already in use for interacting
with the general public. As with all infectious illnesses, the first line
of defense is careful hand hygiene. As a general practice, personnel should
wash hands frequently with soap and water or use an alcohol-based rub if
hands are not visibly soiled.
- Personnel who have to detain or assist a passenger who
appears to have a respiratory illness, and who may have traveled from an
area with avian influenza, should try to keep him or her separated from
the other passengers as much as possible and immediately contact the appropriate
authorities, such as the U.S. Quarantine Station with local jurisdiction
<http://www.cdc.gov/ncidod/dq/quarantine_stations.htm, and Emergency
Medical Services (EMS). In the interim, provide the ill passenger with
a surgical mask if one is available to reduce the number of droplets coughed
into the air and if the passenger can tolerate a mask. If a surgical mask
is not available, provide tissues and ask the sick person to cover his
or her mouth and nose when coughing. When an ill passenger is unable to
wear a surgical mask, personnel should wear surgical masks when working
directly with the sick person.
- Personnel should wear disposable gloves if touching blood
or body fluids. (However, gloves are not intended to replace proper hand
hygiene.) Immediately after activities involving contact with body fluids,
gloves should be carefully removed and discarded and hands should be cleaned.
Gloves must never be washed or reused.
- Management of Ill Crew
- Flight crew members and ground personnel who become ill
and who believe they have been exposed to avian influenza should take the
- - If illness onset occurs while traveling away from home,
notify employer for assistance with locating a health care provider. Let
employer know you are concerned about possible exposure to avian influenza,
and ask about your health-care options.
- - If illness onset occurs while outside the United States,
the U.S. embassy or consulate can also provide names and addresses of local
physicians. Do not travel while sick, and limit your contact with others
as much as possible to help prevent the spread of any infectious illness.
If a visit is planned to a doctor's office, clinic, or emergency room,
tell the healthcare provider in advance about your possible exposure so
that arrangements can be made, if necessary, to prevent transmission to
others in the health-care setting.
- - If illness onset occurs after return home, contact
your healthcare provider and tell him or her what your symptoms are and
the countries you have visited before going to the doctor's office or emergency
room. Precautions can then be taken, if necessary, to prevent transmission
to others in the healthcare setting.
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- Patricia A. Doyle, PhD
- Please visit my "Emerging Diseases" message
- Zhan le Devlesa tai sastimasa
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