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## H1N1 Flu

### H1N1 Flu

            - CDC Response: A Year In Review                - Overview of a Pandemic                  - Background on Influenza
                - Tracking Influenza
                - Preparing for a Pandemic
                - Detection of the 2009 H1N1 Virus
                - Impact of 2009 H1N1
                - Accomplishments (1)
                - Accomplishments (2)
                - Accomplishments (3)
                - Conclusion 
            - General Info                - H1N1 Flu & You
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#### Other Flu Sites

              - Seasonal Flu
              - Avian Flu
              - Canine Flu
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Content on this page was developed during the 2009-2010 H1N1 pandemic and *has not been updated*.
              - The H1N1 virus that caused that pandemic is now a regular human flu virus and continues to circulate seasonally worldwide.
              - The English language content on this website is being archived for  historic and reference purposes only .
              - For current, updated information on seasonal flu, including information about H1N1, see the  CDC Seasonal Flu website .

# Interim Guidance for Management of Influenza-Like Illness aboard Commercial Aircraft during the 2009-10 Influenza Season

November 30, 2009 5:30 PM ET

#### On this Page

                      - Background
                      - Management of Passengers and Crew Members with ILI
                      - Personal Protective Measures
                      - Post-Flight Management of Crew Exposure

This  document provides interim guidance for the commercial airline industry  regarding flights arriving in or departing from U.S. airports during the 2009-10  influenza season. This guidance will be updated as needed.

### Background

Commercial air travel is often characterized by the movement of large  numbers of people in closed and semi-closed settings. As with other close  contact environments, these settings can facilitate the transmission of  influenza from person to person or through contact with contaminated  environmental surfaces. The Centers for Disease Control and Prevention (CDC)  recommends that efforts to reduce the spread of influenza on commercial  aircraft focus on encouraging air carrier employees and passengers who have an  influenza-like illness (ILI) not to travel. This document provides guidance for  the management of ILI during and after a flight, including personal protective  measures for the crew, and is meant to supplement CDC’s recent guidance for  employers on ways to decrease the spread of seasonal and 2009 H1N1 influenza in  the workplace. See CDC’s **Guidance for Businesses and Employers to Plan and Respond to the  2009-10 Influenza Season**. 

### Management of Passengers and Crew Members with ILI

#### Influenza-Like  Illness (ILI) 

Symptoms of  influenza can include some or all of these symptoms: fever, cough, sore throat,  runny or stuffy nose, body aches, headache, chills, tiredness, diarrhea, or  vomiting. Not everyone with influenza will have a fever (a temperature of 100° F [37.8° C] or greater).  Flight crew should consider someone  to have a fever if the ill person feels warm to the touch, gives a history of  feeling feverish, or has an actual measured temperature of 100°F (37.8°C) or  greater. Because the symptoms of influenza are not  specific and most persons who have a respiratory illness are not tested for  influenza, an ILI has been defined as an  illness with fever or feverishness plus either cough or sore throat.  Passengers or Crew with ILI before a Flight    If a  cabin or flight deck crew member or a passenger has an ILI prior to a flight,  CDC recommends that he or she not board the aircraft until at least 24  hours after fever has resolved without the use of fever-reducing medications. Airline crew should also follow individual company policy if ILI develops prior to a flight. More information  for travelers is available.    Development of ILI in Passengers or Crew during  a Flight         Crew members should take the following actions if a person develops ILI during a flight: 
                - Minimize the number of persons directly exposed  to the ill person and if possible separate the ill person from others by 6 feet  without compromising flight safety
                - Keep interactions with the ill person as brief  as possible 
                - Ask the ill traveler to wear a face mask if it  can be tolerated and one is available 
                If a face mask cannot be  tolerated, provide tissues and ask the ill person to cover his or her mouth and  nose when coughing or sneezing
Provide a plastic bag for  proper disposal of used tissues

                - Practice good hand hygiene and encourage others, including the ill person,  to do the same
                Hands should be washed with  soap and water especially after  coughing or sneezing, after using the restroom, or after touching potentially  contaminated surfaces or items. If soap and water are not available, an alcohol-based hand rub can be used

                - Dispose of soiled material, such as items contaminated with body fluids and  used personal protective equipment, in a sturdy plastic bag that is tied shut  and not reopened, according to state solid waste regulations
                - Report to CDC, on a voluntary basis, persons with ILI on international  flights bound for the United    States who require medical assistance. The  need for medical assistance can be based on consultation with the airline  in-flight medical consultant or per the ill person's  request
                Notify the 
CDC Quarantine  Station
  at or closest to the airport where you are arriving of the ill person prior to  arrival or as soon as illness is noted. If unable to reach the Quarantine  Station, call 866-694-4867 to speak with the Quarantine Duty Officer covering  that airport

                - If possible, continue operating the aircraft  air conditioning or ventilation system until all passengers and crew have  disembarked to maximize air circulation in the cabin and thus the filtering of  virus particles. Safety concerns may preclude this step on some aircrafts.

If the ill person  is a crew member, CDC recommends, in addition to the actions listed above, that  the ill crew member 
                - Follow individual company policy for onset of illness or incapacitation  during flight operations
                - Discontinue work as soon as possible without impacting flight safety, and 
                - Return to work after fever has resolved for at least 24 hours  without the use of fever-reducing medications. 

Quarantine  officials will work with the airline and airport partners to assist with  arrangements for medical transportation of the ill person, if indicated, and  will implement any necessary infection control measures and surveillance  activities.     Personal Protective MeasuresHand Hygiene         Routine hand  hygiene is an important line of defense against the influenza virus, as well as  other viruses and bacteria. Wash hands with soap and water for 15-20 seconds.  If soap and water are not available, use an alcohol-based hand rub. Hands should  always be washed before donning and after removing gloves and other personal  protective items.Gloves      Crew members  should wear impermeable, disposable gloves if they are physically tending to  the ill passenger or have contact with potentially contaminated surfaces or  lavatories. Crew members should avoid touching their faces with gloved or  unwashed hands. Hands should be washed with soap and water or with a hand rub  after removing gloves. Improper use or disposal of gloves may actually increase  transmission.   Face Masks and  Respirators       Routine  use of face masks and N95 respirators is not recommended for airline  crew members (see CDC’s Interim  Recommendations for Face Mask and Respirator Use to Reduce 2009 Influenza A  (H1N1) Virus Transmission). Crew members should consult  company policies for the voluntary use of a face mask or N95 respirator.

Employers that allow workers to voluntarily use an N95  respirator should review the Occupational Safety and Health Administration’s  (OSHA) Respiratory Protection Standard (29 CFR 1910.134). Information for the  voluntary use of respirators in the workplace may be found in Appendix D, Information for Employees Using Respirators  When Not Required Under the Standard.

#### Post-Flight Management of Crew Exposure

Flight  deck and cabin crew members and ground personnel who may have been exposed to a  passenger or worker with ILI should monitor  their health for 7 days after the exposure. Any of the following signs or symptoms should be reported per employer guidance: fever, cough, sore throat, runny or stuffy  nose, body aches, tiredness, nausea, vomiting, or diarrhea. CDC recommends that flight  deck and cabin crew members who develop ILI should remain isolated at home or in a hotel and should not travel  until at least 24 hours after they are free of fever (a temperature of 100° F  [37.8° C] or greater) without the use of fever-reducing medications. Flight deck and cabin crew  members who develop symptoms while outside the United States should follow their  airline’s policy to obtain medical care overseas, if required. 

 Personnel at increased risk for severe  complications of influenza, such as persons who are pregnant or have chronic  health conditions like asthma or heart disease, should consult their  primary-care or occupational health providers. Guidance for people at high risk of developing flu-related complications  is available.

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        - Page last reviewed November 30, 2009 5:30 PM ET
        - Page last updated November 30, 2009 5:30 PM ET
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