Guidance for airline cabin crews, cleaning personnel and cargo personnel: How to protect yourself and others from Ebola virus disease

Prepared by: Public Health Agency of Canada

The following guidance provides precautions to be taken by airline cabin crews (flight attendants) and cleaning and cargo personnel when someone on a commercial aircraft is ill and Ebola virus disease (EVD) is suspected. This guidance is based on currently available information and is subject to change as new information becomes available. It should be read in conjunction with employer-specific operating procedures.

EVD is a rare and severe viral disease that can infect both humans and non-human primates (monkeys, gorillas, etc.).

When infected, people can become very ill, with sudden onset of fever, intense weakness, muscle pain, headache and sore throat. This is followed by vomiting, diarrhea, rash, and in some cases, internal and external bleeding. The time from exposure to the onset of symptoms can range from 2 to 21 days. There is currently no specific licensed treatment or vaccine for EVD.

EVD does not spread easily from person to person. It is spread through direct contact with infected blood and other body fluids of ill persons, not through casual contact. Persons with EVD can only spread the disease to others once symptoms begin.

According to the World Health Organization (WHO), the risk of transmission of EVD during air travel is low. On the small chance that someone on the plane is sick with symptoms of EVD, the likelihood of other passengers and crew having contact with their body fluids is even smaller. Usually when someone is sick with EVD, they are so unwell that they cannot travel.

For further information about EVD, visit the Ebola virus disease page.

Management of an ill person

If a passenger or other cabin crew member becomes ill with symptoms that are consistent with EVD (as noted above) and they have recently (within the last 21 days) been a resident in or travelled to an affected country:

  • Provide the ill person with a surgical mask to cover their nose and mouth, if tolerated. If not tolerated, ask the person to cover their nose and mouth with a tissue.
  • If the ill person is vomiting, provide them with an air sickness bag.
  • Provide the ill person with a plastic bag for disposing soiled tissues and used air sickness bags.
  • Encourage the ill person to clean their hands by washing with soap and water or, if soap and water are not available, to use an alcohol-based hand rub.
  • If possible, keep the ill person separate from others. Ideally, the ill person should be close to a washroom for their exclusive use.
  • Keep direct contact with the ill passenger to a minimum. Assign one cabin crew member (two if the person needs more assistance) to take care of the ill person, preferably those who have already been in contact with the ill person.

Those in contact with the ill person should:

  • Clean hands after every contact with the ill person/their belongings or immediate environment. Clean hands by washing with soap and water or, if soap and water are not available use alcohol-based hand rub. 
  • In addition to cleaning hands, cabin crew members who are assisting the ill person should use appropriate personal protective equipment (PPE), as per employer’s occupational health and safety protocol and as recommended in the International Civil Aviation Organization (ICAO) Universal Precaution Kit such as impermeable, disposable gloves and masks.
  • Treat all body fluids (such as phlegm, diarrhoea, vomit, or blood) as potentially infectious. Airline personnel and cleaning personnel should not directly handle contaminated materials or touch any body fluids or soiled surfaces and materials.
  • Restrict access, where possible, to the affected area until disinfection activities are completed.

Communication and reporting

As per usual protocol, notify airport authorities at the destination airport of the ill traveller as soon as possible. Ensure aircraft cleaning personnel are aware of the situation and the potential for contamination of surfaces.

If there is reason to believe that others onboard the aircraft have potentially been exposed to someone suspected of having EVD, information from the cabin crew and other passengers may be collected at the time.  Cabin crew may be requested to assist in this process, if needed, by asking passengers to complete ICAO Public Health Passenger Locator forms and by making onboard announcements.

If contact tracing is required, the flight crew and other passengers may be contacted.

When to see a health care provider after exposure to someone suspected of having EVD (applicable to all cabin crew, cleaning and cargo personnel)

If you become ill within 21 days following exposure to someone with suspected EVD, you should:

  • Immediately self-isolate (maintain a 2-metre distance and no physical contact) if not already isolated from others.
  • Wash hands, especially after vomiting or toileting.
  • Ensure that others do not come into contact with your blood or body fluids (including urine, feces, vomit, saliva, sweat, and semen) or anything that may have come in contact with your blood or body fluid (e.g. linens, clothing, toilet, toiletries). Refer to Measures for the management of Ebola virus disease-associated waste and linen in home settings
  • Follow instructions provided by your local public health authority. If you have not been in contact with your local public health authority (due to no known exposure), you should call your local public health authority to receive instructions. If your symptoms require immediate medical intervention you should follow the recommendations below to ensure that all paramedic/emergency medical services and health care professionals you will see are prepared to take appropriate infection prevention and control precautions.

The local public health authorities will:

  • Arrange for the individual to have a medical assessment at an acute care facility (an EVD-designated facility, if located in close proximity to the individual) to confirm or rule out EVD.
  • Recommend that the individual not take public conveyances (bus, train, taxi) to that facility. The individual should be transported to hospital via ambulance unless the local public health authority permits travel to the medical facility by private vehicle.
  • Ensure the paramedic/emergency medical services (if involved) and the receiving acute care facility are informed of status of the traveller with the EVD-compatible symptoms in advance to help ensure that appropriate infection prevention and control measures are in place during transport and before their arrival at the acute care facility.

Environmental cleaning

If a passenger or cabin crew member has been ill on board the aircraft with symptoms compatible with EVD and a risk of exposure to EVD:

Cargo personnel

Packages and baggage should not pose a risk to those handling them, as EVD is spread through direct contact with blood or body fluids from an infected person. Baggage and cargo workers normally do not have direct contact with travellers.

Regardless of the presence of a passenger with symptoms consistent with EVD, it is recommended that:

  • packages visibly soiled with blood or body fluids not be handled; and
  • workers be trained on proper hand hygiene and wash their hands often.

Employers should have a response plan in the event that potentially infectious materials are found, which should include at a minimum:

  • procedures for reporting suspect packages and baggage;
  • steps to prevent access to packages and baggage that are visibly soiled with blood or body fluids; and
  • training on personal protective equipment for anyone handling infectious material.

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