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| Severe Acute
Respiratory Syndrome (SARS) |
This guidance is intended to assist commercial passenger airlines
and the Transportation Security Administration (TSA), Bureau of Customs
and Border Protection (BCBP), and other relevant agencies in establishing
appropriate SARS-related precautions. Recommendations are based on
standard infection control practices and on available epidemiologic
information about the virus that causes SARS.
To supplement the general information provided here, the following
sections provide information related to specific job functions:
Guidance for Airline Flight Crews about Management of
Passengers with Possible SARS
Guidance about SARS for Airline Cleaning Personnel
Guidance about SARS for Airline Cargo Personnel
Guidance about SARS for Personnel Who Interact with Passengers Arriving
from Areas with SARS
Overview of SARS
Severe acute respiratory syndrome (SARS) is a respiratory disease
caused by a virus called SARS-associated coronavirus (SARS-CoV). SARS
was recognized as a global threat in March 2003, after first appearing
in Southern China in November 2002. Over the next few months, the
illness spread to more than two dozen countries in North America ,
South America , Europe , and Asia before the outbreak was contained.
Most of the cases of SARS that occurred in the 2003 outbreak involved
persons who cared for or lived with someone with SARS or who had direct
contact with infectious material (for example, respiratory secretions)
from a person who ha d SARS. The primary way that SARS appears to
spread is by close person-to-person contact. SARS-CoV is thought to
be transmitted most readily by respiratory droplets (droplet spread)
produced when an infected person coughs or sneezes. Droplet spread
can happen when droplets from the cough or sneeze of an infected person
are propelled a short distance (generally up to 3 feet) through the
air and deposited on the mucous membranes of the mouth, nose, or eyes
of persons who are nearby. The virus can also spread when a person
touches a surface or object contaminated with infectious droplets
and then touches his or her mouth, nose, or eye(s). It is also possible
that SARS can be spread more broadly through the air or by other ways
that are not known.
General Infection Control Precautions
Airline personnel should always follow basic infection control precautions
to protect against all types of infectious diseases:
- The first line of defense against infectious diseases is careful
hand hygiene. As a general rule, it is good practice to wash hands
frequently with soap and water or an alcohol-based hand rub.
- In a healthcare-related emergency, personnel should wear disposable
gloves for direct contact with blood or body fluids of any passenger
or crew member. 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.
CDC does not recommend the routine use of personal protective equipment
(PPE) such as respirators, gloves, or surgical masks for protection
against SARS exposure, except in healthcare-related situations.
Management of Possible Exposures to SARS
- All airline personnel, especially those who have been exposed
to a person who might have SARS, should be aware of the symptoms
of the disease http://www.cdc.gov/ncidod/sars/factsheetcc.htm.
- Personnel who think they have been exposed to SARS and who develop
SARS-like symptoms during travel should take the following precautions:
- Notify your employer for help in locating a healthcare provider.
Inform the employer about the possible exposure to SARS,
and ask about healthcare options. If you become ill 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. Limit contact with others as much
as possible to help prevent the spread of any infectious
illness.
- Before visiting a doctor’s office, clinic, or emergency
room, alert the healthcare provider in advance about the
possible exposure to SARS so that arrangements can be made
to prevent transmission to others in the healthcare setting.
- Personnel who think they have been exposed to SARS and who develop
SARS-like symptoms after returning home should take the following
precautions:
- Contact your healthcare provider. Before visiting a doctor’s
office, clinic, or emergency room, tell the healthcare provider
about the possible exposure to SARS and the history of recent
travel so that precautions can be taken to prevent transmission
to others in the healthcare setting.
- Do not travel while sick. Limit contact with others as much
as possible to help prevent the spread of any infectious
illness.
- Persons who develop symptoms of SARS www.cdc.gov/ncidod/sars/factsheet.htm within
10 days of being in close contact with someone with known
or possible, or within 10 days of arriving from an area where
SARS cases have been reported, should follow the precautions
described in www.cdc.gov/ncidod/sars/exposuremanagement.htm.
- Persons who have been exposed to SARS and who have SARS-like
symptoms should not go to work, school, church, or other
public areas. Ill persons should seek healthcare evaluation
promptly.
Guidance for Airline Flight Crews about Management of Passengers
with Possible SARS
Crew members on a flight with a passenger who is ill with a fever
or respiratory symptoms and who is traveling from an area in which
SARS cases have been reported should follow these additional precautions:
- Keep the ill 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 the person can tolerate
it (that is, if the sick person does not have such severe difficulty
breathing that s/he cannot use a mask). When a sick person is unable
to wear a surgical mask, personnel should wear surgical masks when
working directly with that person. If a surgical mask is not available,
provide tissues, and ask the sick person to cover the mouth and
nose when coughing.
- Personnel should wear disposable gloves for direct contact with
the ill person’s 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.
- The captain of an airliner bound for the United States is required
by law to report to the nearest U.
S. Quarantine Station any
ill passengers who meet
specified criteria.
The ill passenger should be reported before arrival or as soon
as the illness is noted. Quarantine officials will help arrange
for appropriate medical assistance to be available when the airplane
lands and will notify state and local health departments and appropriate
CDC headquarters officials. Quarantine officials will work with
the airline and health department officials 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.
- Persons who develop symptoms of SARS within
10 days of being in close contact with someone with known or possible
SARS should follow the precautions described in www.cdc.gov/ncidod/sars/exposuremanagement.htm.
- Persons who have been exposed to SARS and who have SARS-like
symptoms should not go to work, school, church, or other public
areas. Ill persons should seek healthcare evaluation promptly.
Before going to a doctor’s office, clinic, or emergency room,
the ill person should inform the healthcare provider about the
possible exposure to SARS so that precautions can be taken to prevent
the spread of infection in the healthcare setting.
Guidance about SARS for Airline Cleaning Personnel
Hand Hygiene
SARS is transmit ted by close contact with a person who has SARS
and who is experiencing fever or respiratory symptoms. Once passengers
have left an aircraft, the main source of infection will have been
removed. However, infection may occur if infectious particles, such
as droplets from coughing, remain on surfaces of the aircraft interior
and if those particles come into direct contact with a person’s
eyes, nose, or mouth (e.g., by touching a contaminated surface and
not washing hands). Therefore, hand hygiene is of primary importance for all personnel working on commercial passenger
aircraft.
Notification of Ground and Cleaning Crew
The captain of an airliner bound for the United States is required
by law to report any ill passengers who meet specified criteria to
the nearest U.S.
Quarantine Station before
arrival or as soon as the illness is noted. Quarantine officials will
help 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.
The airline’s ground and cleaning crews should be notified
at the same time so that preparations can be made for appropriate
cleaning of the aircraft after passengers have disembarked.
Cleaning and Disinfection
Personnel performing routine post-flight cleaning of passenger aircraft
should practice appropriate hand hygiene to minimize risks of disease
transmission. Cleaning of aircraft used for air medical (air-ambulance)
transport of active SARS patients requires higher level cleaning,
as described in the air medical transport guidance.
When cleaning commercial passenger aircraft after a flight with a
possible SARS patient:
- Do not use compressed air, which might re-aerosolize infectious
material.
- Wear non-sterile disposable gloves while cleaning the passenger
cabin and lavatories.
- Remove and discard gloves if they become soiled or damaged and
after cleaning activities are concluded.
- Clean hands with soap and water or an alcohol-based hand rub
immediately after gloves are removed.
- Wipe down passenger lavatory surfaces and frequently touched
surfaces in the passenger cabin such as armrests, seat backs, tray
tables, light and air controls, and adjacent walls and windows
with an EPA-registered low- or intermediate-level chemical household
germicide.1 Allow surfaces to air dry in accordance with manufacturers’ instructions.
- Special cleaning of upholstery, carpets, or storage compartments
is not indicated. There currently is no evidence to suggest that
special vacuuming equipment or procedures are necessary.
1 No disinfectant products are currently
registered by the U .S. Environmental Protection Agency (EPA) specifically
for the inactivation of SARS-CoV. However, related viruses with
physical and biochemical properties similar to SARS-CoV are known
to be readily inactivated by EPA-registered chemical germicides
that provide low- or intermediate-level disinfection during general
use.
Management of Possible Occupational Exposures
Cleaning crew managers should be aware of the symptoms of SARS.
Cleaning personnel who develop symptoms within 10 days of cleaning
an aircraft after a flight with a possible SARS patient on board should
report the illness to their occupational health service.
Guidance about SARS for Airline Cargo Personnel
There is no evidence that SARS is spread through contact with objects
or packages, including those arriving from areas where SARS cases
have been reported.
Special handling of objects or packages, including those arriving
from areas where SARS cases have been reported, is therefore not indicated.
- Cargo handlers should practice frequent hand hygiene for
prevention of all infectious diseases.
- CDC does not recommend the routine use of personal protective
equipment such as respirators, gloves, or surgical masks for protection
against SARS except for healthcare workers providing medical care
to known or possible SARS patients.
Guidance about SARS for Personnel Who Interact with Passengers
Arriving from Areas with SARS
Transportation Security Administration (TSA), Bureau of Customs and
Border Protection (BCBP), and other personnel who interact with passengers
arriving from areas with a SARS do not require 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 an alcohol-based hand rub.
- Personnel who have to detain or assist a passenger who appears
to have a respiratory illness and who might have traveled from
an area where SARS cases have been reported should try to keep
the ill passenger separated from the other passengers as much as
possible. Personnel should immediately contact the appropriate
authorities, such as the U.S. Quarantine Station with local jurisdiction and
Emergency Medical Services (EMS). In the interim, provide the ill
passenger with a surgical mask to reduce the number of droplets
coughed into the air, if the passenger can tolerate a mask. When
an ill passenger is unable to wear a surgical mask, personnel should
wear surgical masks when working directly with the sick person.
If a surgical mask is not available, provide tissues, and ask the
sick person to cover the mouth and nose when coughing.
- Personnel should wear disposable gloves for direct contact with
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.
- Persons who develop symptoms of SARS within
10 days of being in close contact with someone with known or possible
SARS should follow the precautions described in www.cdc.gov/ncidod/sars/exposuremanagement.htm.
- Persons who have been exposed to SARS and who have SARS-like
symptoms should not go to work, school, church, or other public
areas. Ill persons should seek healthcare evaluation promptly.
Before going to a doctor’s office, clinic, or emergency room,
the ill person should inform the healthcare provider about the
possible exposure to SARS so that precautions can be taken to prevent
the spread of infection in the healthcare setting.
* Close contact
is defined as having cared for or lived with a person known to have
SARS or having a high likelihood of direct contact with respiratory
secretions and/or body fluids of a patient known to have SARS. Examples
of close contact include kissing or embracing, sharing eating or drinking
utensils, close conversation (<3 feet), physical examination, and
any other direct physical contact between persons. Close contact does
not include activities such as walking by a person or briefly sitting
across a waiting room or office.
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