icao and management of communicable disease · emergency committee health information un un wto...
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ICAO and management of communicable disease
Dr Anthony EvansChief, Aviation Medicine SectionChief, Aviation Medicine Section
International Civil Aviation Organization
Mexico, June 2009
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PlanPlan
• Pandemic planning in aviationPandemic planning in aviation– Chicago Convention
• Central role of WHOCentral role of WHO• Communication
– UN– Pilot/Air Traffic
• ICAO provisionsp• Airport screening• (ICAO declaration)( )
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Article 14, Convention on International Civil Aviation(Chi C ti 1944)(Chicago Convention – 1944)
• ‘Each contracting State gagrees to take effective measures to prevent the spread by means of airspread by means of air navigation of cholera, typhus (epidemic),
fsmallpox, yellow fever, plague, and such other communicable diseases as the contracting States shall from time to time decide to designate ’decide to designate….
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2005 – Avian influenza2005 Avian influenza
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2009
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Central role of WHOCentral role of WHO
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Wednesday 24 JuneWednesday 24 June
• 55,867 laboratory confirmed cases, 238 deaths
• 6-9 months for virus to spread p• Only 2 months into the initial phase• May become more severe• May become more severe
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Pandemic alert phase 5( h i ifi d f di t it )(phase - signifies spread of disease, not severity)
• Phase 5Phase 5– The same identified virus has caused
sustained community level outbreaks in atsustained community level outbreaks in at least two countries in one WHO region
• Phase 6it l l tb k i t l t....community level outbreaks in at least one
other country in another region
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World Health OrganizationWorld Health Organization
• No travel restrictions advisedNo travel restrictions advised– Disease has already spread – Screening unlikely to have any significant effectScreening unlikely to have any significant effect
• At present, illness is mild in most casesbut about half of deaths occur in otherwise– but about half of deaths occur in otherwise healthy young individuals
• Can be treated by oseltamivir (Tamiflu)• Can be treated by oseltamivir (Tamiflu)
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World Health OrganizationWorld Health Organization
• Simple practical measures:• Simple, practical measures:– Frequent handwashing (sanitizer if
h d hi t ibl )handwashing not possible) – Social distancing/illness distancing
• Do not travel/go to work with flu-like symptoms• Returning travellers who fall ill – seek medical
care– Cough etiquette (use a tissue, dispose of g q ( p
tissue, wash hands)
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CommunicationCommunication
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DAILY UPDATE OF CASES DAILY PRESS BRIEF
WHOEMERGENCY COMMITTEE
HEALTH INFORMATION
UN WTOUN
Inter agency WTOTERNTWGInter-agency
Technical Working Group
TourismEmergency Response Network
UN AGENCIES TRAVEL & TOURISM INDUSTRY
Network
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DAILY UPDATE OF CASES DAILY PRESS BRIEF
WHO
EMERGENCY COMMITTEE
HEALTH INFORMATION
UN WTO
UN AHI
TWG WTOTWG
UN AGENCIES TRAVEL & TOURISM INDUSTRY
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Main role of ICAOMain role of ICAO
• Implementation of appropriate, harmonized preparedness plans by stakeholders in the aviation sector
• Support WHO in implementation of health measures in aviation
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Aviation related actionsAviation related actions
WHO l b lGuide to hygiene and Sanitation in aviation WHO global
PreparednessIHR 2005
Sanitation in aviation
Case managementof Influenza A(H1N1)
ICAO State
of Influenza A(H1N1) in air transport
Guidelinespreparedness planning
Airports Council International
International Air Transport Association
airport guidelines airline guidelines
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Changes to ICAO provisions2007• States to have a pandemic preparedness plan forStates to have a pandemic preparedness plan for
aviation - integrated into national plan• Cabin crew advice on how to identify a suspected case
( h t i ft l d l ti )(changes to aircraft general declaration) • Passenger locator card for contact tracing agreed by
WHO (collaboration with IATA)WHO (collaboration with IATA) 2009• ‘Universal precaution kit’ for managing on board
communicable disease (Annex 6)• Pilot in command to notify air traffic control of a
suspected case (PANS ATM)suspected case (PANS-ATM)• Public health emergencies included in air traffic (Annex
11) and aerodrome (Annex 14) contingency plans
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Identification of case of communicable disease by cabin crew
Fever (38°C/100°F or greater) plusFever (38 C/100 F or greater) plus one or more of the following signs or symptoms:
•Appearing obviously unwell •Persistent coughing •Impaired breathing •Persistent diarrhoeaPersistent diarrhoea •Persistent vomiting •Skin rash •Bruising or bleeding without
i i jprevious injury •Confusion of recent onset
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On board medical suppliesOn board medical supplies
– Inclusion of a ‘universal precaution kit’• Managing on board communicable disease event• Managing on board communicable disease event• Personal protective equipment• Absorbent powderp• Germicidal disinfectant• Biohazard disposal bag etc.
– Inclusion of thermometer in first aid kit
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Procedures for Air Navigation S i Ai T ffiServices – Air Traffic
Management (PANS-ATM)Management (PANS ATM)
• procedure for utilising Air Traffic Control for notifying destination of communicablefor notifying destination of communicable disease
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CURRENT SITUATION:AIRLINE NOTIFICATION OF EVENTAIRLINE NOTIFICATION OF EVENT
PHA
?
AIRLINE OPERATING AGENCY
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ATC NOTIFICATION OF EVENTATC NOTIFICATION OF EVENT
PHA
AIRPORTOPERATOR OTHER
AGENCY
AIRLINE OPERATING AGENCY
En route ATCAerodrome tower
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Public Health Passenger Locator Card
For contact tracing of travellers who havetravellers who have been in contact with a suspected or known cases of H1N1 – on WHO/ICAO/IATA bitWHO/ICAO/IATA wesbite
Use in conjunction with jhealth declaration card(IATA website)
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Airport screeningAirport screening
• Health declaration cardHealth declaration card• Temperature
– Infra-red imagingInfra red imaging– Temperature probe
• Screening not recommended by WHO for H1N1g y– But could be regarded as disease surveillance tool– Advice not clear: left to national decision
• Over 100 States have implemented some form of screening
• Not likely to be too disruptive– Significant disruption under IHR = delay of >24 hours
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Health declaration cardHealth declaration card
• Developed by IATA – to assist harmonization • Specifically for use in H1N1
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Temperature screeningTemperature screening
• Identifies travellers with fever
• Possible to be infectious without fever• Not all H1N1 cases have a feverNot all H1N1 cases have a fever•? Deterrent effect to travellers
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Screening - summaryScreening summary• May identify some travellers at risk• Not likely to have any significant effect on
preventing spread of H1N1p g p• May have a reassuring effect – the
government is ‘doing something’government is doing something• May deter unwell potential travellers from
travellingtravelling• For consideration by governments - but
t tl d d b WHOnot currently recommended by WHO• Implemented in a non-standardised way
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Key messages• Simple preventative measures are effective – handwashing,
cough etiquette, illness distancing• Risk of developing a serious illness is low:
– and can be treated with oseltamivir (Tamiflu)
International communication between main players is good• International communication between main players is good-lessons have been learned from SARS
• Communication between public health and aviation sector at pnational level is vital – could be improved
• ICAO in collaboration with its partners has developed id t i l f i ti d id l il blguidance material for aviation preparedness-widely available
• Evolution of H1N1 cannot be predicted – likely to last 1-2 years yea s
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FutureFuture
• Screening – research as to why StatesScreening research as to why States have adopted (WHO/CDC collaborative project)project)– How efficient has it been?
CASPCA developed as a joint ICAO/WHO• CASPCA developed as a joint ICAO/WHO project
C O/ O f• Major ICAO/WHO conference on preparedness planning - 2010
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“Plan for the worst“Plan for the worst, hope for the best”hope for the best
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Useful websitesUseful websites• ICAO
http://www.icao.int/icao/en/med/guidelines.htm• WHO• WHO
http://www.who.int/ihr/travel/A(H1N1)_air_transport_guidance.pdfhttp://www.who.int/water_sanitation_health/hygiene/ships/guide_hygien
e_sanitation_aviation_3_edition.pdf• United Nations
http://www.un-influenza.org/• UN World Tourism Organization
http // sos tra el/http://www.sos.travel/• US Centers for Disease Control and Prevention
http://www.cdc.gov/• International Air Transport Association• International Air Transport Association
http://www.iata.org/index.htm• Airports Council International
http://www.airports.org/cda/aci_common/display/main/aci_content07.jsp?zn=aci&cp=1_665_2__
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ICAO and management of communicable disease
Dr Anthony EvansChief, Aviation Medicine SectionChief, Aviation Medicine Section
International Civil Aviation Organization
Mexico, June 2009