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21–630 PDF 2005

EFFORTS TO PREVENT PANDEMICS BY

AIR TRAVEL

(109–9)

HEARING

BEFORE THE

SUBCOMMITTEE ON

AVIATION

OF THE

COMMITTEE ON

TRANSPORTATION AND

INFRASTRUCTURE

HOUSE OF REPRESENTATIVES

ONE HUNDRED NINTH CONGRESS

FIRST SESSION

APRIL 6, 2005

Printed for the use of the

Committee on Transportation and Infrastructure

(
COMMITTEE ON TRANSPORTATION AND INFRASTRUCTURE

DON YOUNG, Alaska, Chairman

THOMAS E. PETRI, Wisconsin, Vice-Chair

SHERWOOD L. BOEHLERT, New York

HOWARD COBLE, North Carolina

JOHN J. DUNCAN, JR., Tennessee

WAYNE T. GILCHREST, Maryland

JOHN L. MICA, Florida

PETER HOEKSTRA, Michigan

VERNON J. EHLERS, Michigan

SPENCER BACHUS, Alabama

STEVEN C. LATOURETTE, Ohio

SUE W. KELLY, New York

RICHARD H. BAKER, Louisiana

ROBERT W. NEY, Ohio

FRANK A. LOBIONDO, New Jersey

JERRY MORAN, Kansas

GARY G. MILLER, California

ROBIN HAYES, North Carolina

ROB SIMMONS, Connecticut

HENRY E. BROWN, JR., South Carolina

TIMOTHY V. JOHNSON, Illinois

TODD RUSSELL PLATTS, Pennsylvania

SAM GRAVES, Missouri

MARK R. KENNEDY, Minnesota

BILL SHUSTER, Pennsylvania

JOHN BOOZMAN, Arkansas

JIM GERLACH, Pennsylvania

MARIO DIAZ-BALART, Florida

JON C. PORTER, Nevada

TOM OSBORNE, Nebraska

KENNY MARCHANT, Texas

MICHAEL E. SODREL, Indiana

CHARLES W. DENT, Pennsylvania

TED POE, Texas

DAVID G. REICHERT, Washington

CONNIE MACK, Florida

JOHN R. ‘RANDY’ KUHL, JR., New York

LUIS G. FORTUN ̃ O, Puerto Rico

LYNN A. WESTMORELAND, Georgia

CHARLES W. BOUSTANY, JR., Louisiana

VACANCY

JAMES L. OBERSTAR, Minnesota

NICK J. RAHALL, II, West Virginia

PETER A. DEFAZIO, Oregon

JERRY F. COSTELLO, Illinois

ELEANOR HOLMES NORTON, District of

Columbia

JERROLD NADLER, New York

ROBERT MENENDEZ, New Jersey

CORRINE BROWN, Florida

BOB FILNER, California

EDDIE BERNICE JOHNSON, Texas

GENE TAYLOR, Mississippi

JUANITA MILLENDER-MCDONALD,

California

ELIJAH E. CUMMINGS, Maryland

EARL BLUMENAUER, Oregon

ELLEN O. TAUSCHER, California

BILL PASCRELL, JR., New Jersey

LEONARD L. BOSWELL, Iowa

TIM HOLDEN, Pennsylvania

BRIAN BAIRD, Washington

SHELLEY BERKLEY, Nevada

JIM MATHESON, Utah

MICHAEL M. HONDA, California

RICK LARSEN, Washington

MICHAEL E. CAPUANO, Massachusetts

ANTHONY D. WEINER, New York

JULIA CARSON, Indiana

TIMOTHY H. BISHOP, New York

MICHAEL H. MICHAUD, Maine

LINCOLN DAVIS, Tennessee

BEN CHANDLER, Kentucky

BRIAN HIGGINS, New York

RUSS CARNAHAN, Missouri

ALLYSON Y. SCHWARTZ, Pennsylvania

JOHN T. SALAZAR, Colorado

(II)
SUBCOMMITTEE ON AVIATION

JOHN L. MICA, Florida, Chairman

THOMAS E. PETRI, Wisconsin

HOWARD COBLE, North Carolina

JOHN J. DUNCAN, JR., Tennessee

VERNON J. EHLERS, Michigan

SPENCER BACHUS, Alabama

SUE W. KELLY, New York

RICHARD H. BAKER, Louisiana

ROBERT W. NEY, Ohio

FRANK A. LOBIONDO, New Jersey

JERRY MORAN, Kansas

ROBIN HAYES, North Carolina

HENRY E. BROWN, JR., South Carolina

TIMOTHY V. JOHNSON, Illinois

SAM GRAVES, Missouri

MARK R. KENNEDY, Minnesota

JOHN BOOZMAN, Arkansas

JIM GERLACH, Pennsylvania

MARIO DIAZ-BALART, Florida

JON C. PORTER, Nevada

CHARLES W. DENT, Pennsylvania

TED POE, Texas

JOHN R. ‘RANDY’ KUHL, JR., New York,

Vice-Chair

LYNN A. WESTMORELAND, Georgia

VACANCY

DON YOUNG, Alaska

(Ex Officio)

JERRY F. COSTELLO, Illinois

LEONARD L. BOSWELL, Iowa

PETER A. DEFAZIO, Oregon

ELEANOR HOLMES NORTON, District of

Columbia

CORRINE BROWN, Florida

EDDIE BERNICE JOHNSON, Texas

JUANITA MILLENDER-MCDONALD,

California

ELLEN O. TAUSCHER, California

BILL PASCRELL, JR., New Jersey

TIM HOLDEN, Pennsylvania

SHELLEY BERKLEY, Nevada

JIM MATHESON, Utah

MICHAEL M. HONDA, California

RICK LARSEN, Washington

MICHAEL E. CAPUANO, Massachusetts

ANTHONY D. WEINER, New York

BEN CHANDLER, Kentucky

RUSS CARNAHAN, Missouri

JOHN T. SALAZAR, Colorado

NICK J. RAHALL II, West Virginia

BOB FILNER, California

JAMES L. OBERSTAR, Minnesota

(Ex Officio)

(III)

(V)

CONTENTS

TESTIMONY

Page

Brown, Dr. Ronald., MD., Managing Partner and CEO, AeroClave, LLC .......... 24

Gendreau, Dr. Mark A., MD, Senior Attending Physician, Lahey Clinic Medical Center .............................................................................................................. 24

Jordan, Jon L., Federal Air Surgeon, Office of Aerospace Medicine, Federal

Aviation Administration ...................................................................................... 6

McCawley, Dr. Michael, PH.D., Executive Vice President and Chief Scientific

Officer, Respiratory Management Technology, Inc. .......................................... 24

Meenan, John, Executive Vice President and COO, Air Transport Association 24

Schuchat, Captain Anne, Acting Director, National Center for Infectious Diseases, Center for Disease Control and Prevention, Department of Health

and Human Services, accompanied by Ram Koppaka, Division of Global

Migration and Quarantine, Centers for Disease Control and Prevention ....... 6

PREPARED STATEMENTS SUBMITTED BY MEMBERS OF CONGRESS

Costello, Hon. Jerry F., of Illinois .......................................................................... 44

Oberstar, Hon. James L., of Minnesota ................................................................. 67

PREPARED STATEMENTS SUBMITTED BY WITNESSES

Brown, Dr. Ronald. .................................................................................................. 37

Gendreau, Dr. Mark A. ........................................................................................... 46

Jordan, Jon L ........................................................................................................... 51

McCawley, Dr. Michael, PH.D. ............................................................................... 58

Meenan, John ........................................................................................................... 62

Schuchat, Captain Anne .......................................................................................... 70

SUBMISSION FOR THE RECORD

Jordan, Jon L., Federal Air Surgeon, Office of Aerospace Medicine, Federal

Aviation Administration, response to a question from Hon. Elanor Holmes

Norton ................................................................................................................... 18

ADDITION TO THE RECORD

Albright, Penrose C., Assistant Secretary for Science and Technology, Department of Homeland Security, statement .............................................................. 85

(1)

EFFORTS TO PREVENT PANDEMICS BY AIR

TRAVEL

Wednesday, April 6, 2005

HOUSE OF REPRESENTATIVES, COMMITTEE ON TRANSPORTATION AND INFRASTRUCTURE, SUBCOMMITTEE ON

AVIATION, WASHINGTON, D.C.

The subcommittee met, pursuant to call, at 2:00 p.m., in Room

2167, Rayburn House Office Building, Hon. John L. Mica [chairman of the subcommittee] presiding.

Mr. MICA. Good afternoon. I would like to call this hearing of the

House Aviation Subcommittee to order.

Thank you for your patience while I was late today. I had some

constituents and a school group and they take precedent even over

the Subcommittee business.

The order of business today will be opening statements by members, then we have two panels of witnesses and we will introduce

them. I will begin with my opening statement and then will yield

to other members and then we will hear from our first panel.

The title of today’s hearing is our efforts to prevent pandemics

by air travel. I believe that one of the most important responsibilities of the Aviation Subcommittee is to both anticipate and also

preempt significant problems that may drastically affect our commercial aviation industry. Today’s hearing will focus on the spread

of contagious diseases by commercial aviation.

I think we all remember that the terrorist attacks of 2001 killed

some 3,000 people and its after-effects seriously damaged our economy. What we may have forgotten is that while our aviation industry was struggling to recover, it was also hurt by the Asian SARS

epidemic. SARS sent another devastating shock to passenger air

service and nearly destroyed or bankrupted a number of airlines.

Billions of dollars were lost, regional air traffic disrupted, and

economies were very seriously affected.

SARS fortunately was limited and contained. But as we may

know from some news accounts and some folks who are looking at

the bird flu epidemic, we may face an even more serious pandemic

and we must be prepared. A pandemic contagious disease spread

rapidly by air travel could do untold damage to both our aviation

industry and also to our economy.

Well before commercial air travel arrived on the scene pandemics

circled the globe in a variety of ways. In fact, the 1918 influenza

pandemic caused over 50 million deaths worldwide and over 1.5

million here in the United States. Ironically, I learned not too long

ago that my grandmother, whom I never met, died in that epidemic

of 1918.
2

Today, with over 1.6 billion passengers traveling worldwide each

year on commercial air carriers, there is a real threat that these

sometimes deadly diseases can be transmitted around the globe in

just a matter of hours. There is also concern that epidemics, or

pandemics for that matter, could be intentionally caused by terrorists or instigated by terrorists on board an aircraft or at airports

and rapidly transported around the world.

In four short years since the 9/11 attacks in 2001, the U.S. air- line industry has incurred losses of well over $32 billion. These

enormous losses are attributed to a variety of factors, including the

9/11 three-day shutdown of our national airspace system, the war

in Iraq and Afghanistan, high fuel prices, and also the SARS epidemic that we saw as the virus spread through Asia.

While there is no exact price tag associated with the outbreak of

SARS in early 2003, which in fact resulted in a sharp decline in

passenger traffic to and from Asia and Canada and the United

States, the pandemic adversely affected economies and the airline

industry worldwide lost billions of dollars, again from this one incident. With the potential of dramatic economic losses, caused either

by viruses or terrorists who use viruses, a proactive posture rather

than a reactive posture is an absolute necessity.

In June 2003, our Subcommittee took a look at the SARS situation as well as the issue of air cabin quality. According to the

World Health Organization, there were more than 8,000 probable

SARS cases worldwide between 2002 and July of 2003. Of these

cases, 774 resulted in death.

Today’s hearing will focus on questions that need to be answered

if we are confronted with a serious world pandemic or a terrorist

biological threat using commercial aviation.

With respect to aviation, the Department of Homeland Security’s

Science and Technology Biological Countermeasure activities are

focusing now on two major areas—first, protection of airports

against biological attacks, and also the development of advanced

detection technologies that have application for protection of individual aircraft.

Because of the serious health risks and potential economic consequences associated with pandemics, it is imperative that processes are in place to deal with potential problems of spreading contagious disease by air before, and I stress before this threat has a

chance to occur.

I am pleased now to recognize the acting Ranking Member, a

former Ranking Member of our Subcommittee, Mr. DeFazio.

Mr. DEFAZIO. Thank you, Mr. Chairman. Thanks for convening

a hearing on this important issue. I am looking forward to hearing

from the panel, so I will defer in the interest of time my opening

statement time to Ms. Holmes-Norton, who I believe has a statement she wishes to make.

Mr. MICA. You are recognized.

Ms. NORTON. I thank the Ranking Member and I thank you, Mr.

Chairman, for this hearing. You have focused and this Subcommittee has appropriately focused on the attacks on air travel since 9/

11. That was a mammoth challenge that I think this Subcommittee

and Committee met very well. We have not concentrated as much

on attacks within planes, as it were, by natural diseases, if I may
3

call them that, as we have on the kinds of attacks that have so

devastated us here and around the world.

We are still concerned about those attacks, if you bear in mind

chemical attacks and biological attacks, but we are far more likely

as citizens to encounter a disease from travel or from contact with

someone who has traveled than we are to be the victim of an attack

on an airplane. The avian flu, SARS, you have mentioned, Mr.

Chairman, are but perfect examples of this.

We are not, of course, just talking about those who travel. We

are certainly talking about those who go from one destination to

another, but we are also talking about the destinations to which

they come and bring with them whatever they have encountered

where they were. Those are the citizens we represent.

The only question I have, Mr. Chairman, is why have we been

so free of the transmission of such diseases thus far given the

whirlwind rate of air travel and of citizens of every variety, not just

business people, not just Members of Congress, but citizens of

every variety going all over the world all the time. Perhaps it is

that we have very good health regulations. I am not sure why.

But I am very grateful. In any case, I want to compliment you,

Mr. Chairman, for getting hold of this before it does become a matter of serious concern in our country.

Thank you very much.

Mr. MICA. I thank the gentlelady. Are there additional opening

statements? Ms. Johnson?

Ms. JOHNSON. Thank you, Mr. Chairman. With over 1.6 billion

passengers traveling worldwide each year, the risk of spreading

disease by air travel is real and warrants utmost diligence. We

hear all the time about recycling the same air. And as evidenced

by the SARS outbreak just a few years ago, for both public health

and economic reasons, it is imperative that we pay close attention

to the relationship of international air travel to public health.

We have been a very open country before many of these types of

viruses and diseases spread very rapidly. But now, with global

warming and looking at the path of disease traveling various

places, it is becoming more and more important that we give much

more attention to it. In late June of 2004, the World Health Organization reported that new lethal outbreaks of avian influenza and

infections were reported by several countries in Asia, Cambodia,

China, Indonesia, Malaysia, Thailand, and Vietnam. Fortunately,

no sustained human-to-human transmission of the virus has been

identified. Nevertheless, the outbreak in Asia poses an important

public health threat.

So as a result of this, the World Health Organization has urged

all of us to develop and update influenza pandemic preparedness

plans for responding to a swiftly moving contagious disease and to

address the widespread socioeconomic disruptions that will result

from having large numbers of people sick and dying. And while we

do not hear about this very much, very frequently in air travel the

airline attendants will bring to your attention how concerned they

are about breathing this same air over and over.

Fortunately, we have not had the kind of problem that we hope

to be ahead of. But I think it does warrant that we get busy and

try to look into it.
4

I will file the rest of my statement, Mr. Chairman, and thank

you and the witnesses for coming today.

Mr. MICA. I thank the gentlelady. Ms. Berkley?

Ms. BERKLEY. Thank you very much, Mr. Chairman, for holding

this hearing. Preventing the spread of disease is important in dealing with all air travel, but it is particularly important to international travel. After 9/11 and during the SARS outbreak, international travel to and from McCarran Airport in Las Vegas declined and declined dramatically. However, the airport passenger

count has now exceeded pre-9/11 numbers. Last year, more than

one million international travelers flew into McCarren Airport.

Given the large number of international travelers arriving in Las

Vegas each year, it is vital that airport and public health officials

have readily available information and any resources necessary to

protect the Las Vegas community and the millions of tourists who

come to visit. I know that sounds somewhat parochial, and I am

interested in the general aviation information, but given the fact

that McCarran Airport is in the center of my district, I am particularly interested in it due to the large volume of international travelers that we have coming to visit Las Vegas and enjoy our wholesome family entertainment.

So I want to thank you again, Mr. Chairman. I look forward to

the witnesses and to hearing your testimony. Thank you.

Mr. MICA. I thank the gentlelady. Are there other opening statements? Mr. Pascrell?

Mr. PASCRELL. Thank you, Mr. Chairman. Chairman Mica and

Ranking Member Costello and DeFazio, I want to thank you for

holding the hearing. This Committee has a significant role to play.

The Federal Government must pay proper attention to public

health threats such as the spread of infectious disease via aviation

before we find ourselves in a public health emergency.

In 1918, 25 million people worldwide died in six months from an

influenza pandemic dubbed the ‘‘Spanish Flu.’ While we have better medications today, we also have a level of mobility unprecedented. And that is what makes the threat of pandemics so alarming.

In a recent article in the New Yorker magazine, entitled ‘‘Nature’s Vile Terrorist,’’ it spoke directly to the threat that we now

face—public health officials in Thailand, commenting on how a

pandemic would spread, observed, ‘‘People around here fly to

Hanoi, to Phnom Penh, Paris, they visit China, they travel all over.

Well, you have to realize this and accept it. If you take a plane ride

to Paris, you may be taking an epidemic with you.’’

If there is an outbreak of pandemic influenza, our front lines in

the battle against the disease will be on our airplanes and in our

airports. Flight attendants, pilots, and aviation workers, along with

hundreds of thousands of passengers would be at immediate risk.

It is ironic that yesterday in the State of New Jersey we had a topoff dealing with a very, very serious spread of a disease in a bioattack on the counties of Union and Middlesex county. All of the

agencies responded in a most, most appropriate manner. And those

of us on Homeland Security were very pleased at the response.

This is real though. This is real.
5

So we have options available to prepare for such an occurrence.

Yesterday I joined my colleague from New Jersey, Congressman

Frelinghuysen, in sending a letter to the Secretary of Health and

Human Services, Michael Leavitt, in support of the President’s

budget request for the Strategic National Stockpile. However, we

also questioned where we stand with respect to the draft ‘‘Pandemic Influenza Preparedness and Response Plan,’’ which was released last August, as you well know.

The draft plan is supposed to be a blueprint for how the United

States would act before a pandemic hurts us and hits us and how

we would cope with the pandemic outbreak when it occurs. It has

been more than six months since the release of the draft plan and

we have not heard much regarding it. With all of the reports about

the spread of avian flu in Southeast Asia, I am extremely concerned that our planning efforts may be overtaken by events.

I would hope that the CDC would shed some light on that issue

during our hearing today, as all relevant agencies should be privy

to Federal reports and plans. We do not want anything redacted.

As we find so often, coordination and communication is key to both

effective preparedness and response. I thank you, Mr. Chairman,

for allowing me the opening statement.

Mr. MICA. I thank the gentleman. Are there additional opening

statements? Mr. Ehlers, you are recognized.

Mr. EHLERS. Thank you, Mr. Chairman. I will attempt to be brief

but I certainly want to thank you for calling this hearing. I had

read the New Yorker article that the previous speaker mentioned

and I have taken a look at some other issues surrounding

pandemics.

It is interesting that many of the pandemics were caused by

aviation long before we had airplanes, they were spread by migratory birds. So what we are talking about is not something new, it

is just a different magnitude and a different speed at which things

will happen. But it is clearly a matter of huge concern.

We spend so much time worrying about homeland security and

other security issues. I can assure you that natural causes may

well be far more serious over the next decade than the number of

deaths caused by terrorist activity. I think it is very important for

this Committee and others to be educated on the role that aviation

plays in the spread of disease.

It is particularly interesting looking at the history of bubonic

plague and how that spread. It was really one of the first cases of

a major pandemic caused by new modes of transportation, particularly by shipping. It was able to spread much more rapidly than

it had before. Of course, aviation presents a much grater problem

than ordinary shipping of several hundred years ago.

I look forward with great interest to seeing the information, but

particularly facing the issue and trying to determine what, if anything, we can do to prevent the spread of disease through aviation.

I just returned from a trip yesterday, a fairly lengthy trip, and I

was struck by the number of people starting to wear masks as they

fly and when they are walking through the terminals. They are

taking matters into their own hands. That is one answer, but not

everything is communicated through inhalants, it can also be

through touch and so forth.
6

So thank you for calling the hearing and I look forward to hearing from the witnesses.

Mr. MICA. I thank the gentleman. Are there any other that have

opening statements? If not, we will proceed to our first panel.

I would like to welcome our panelists. We have Dr. Jon L. Jordan, Federal Air Surgeon, Office of Aerospace Medicine, the Federal Aviation Administration; and then we have Captain Anne

Schuchat, Acting Director, National Center for Infectious Diseases,

Centers for Disease Control and Prevention, the Department of

Health and Human Services, and I believe Captain Schuchat is accompanied by Dr. Ram Koppaka, division of Global Migration and

Quarantine, of the Centers for Disease Control and Prevention.

I am pleased to welcome the three of you. I do not think I have

seen you before. If you have any lengthy statements or any information you would like to be made part of the record, feel free to

ask for submission of that through the Chair and we will make certain that it is included in the record of today’s hearing.

With that, I would like to welcome our three panelists. We also

have visiting in the audience today Trinity Christian Academy,

which happens to be from the Chairman’s district. So those young

people in the back are probably attending their first congressional

hearing. We would like to welcome them and the chaperons that

are with them today.

Mr. DEFAZIO. Mr. Chairman, if I could join in the welcome to the

students from your district and let them know that you are an allknowing and powerful Member of Congress as Chairman of this

Committee, and they should be duly impressed to be in your presence.

[Laughter.]

Mr. MICA. Well, we do not want to take that to a vote right now.

[Laughter.]

Mr. MICA. But I do miss Mr. DeFazio’s sense of humor as the

former Ranking Member of the Aviation Subcommittee.

So with that introduction of the young people who are attending

the hearing, and I have just introduced the three witnesses that we

have, one from the Federal Aviation Administration and two from

the Centers from Disease Control, who are going to tell us what

they are doing to deal with the possibility of spreading disease or

pandemic by air.

I would like to recognize first Dr. Jon L. Jordan of the FAA. You

are recognized, and welcome.

TESTIMONY OF JON L. JORDAN, FEDERAL AIR SURGEON, OFFICE OF AEROSPACE MEDICINE, FEDERAL AVIATION ADMINISTRATION; CAPTAIN ANNE SCHUCHAT, ACTING DIRECTOR,

NATIONAL CENTER FOR INFECTIOUS DISEASES, CENTER

FOR DISEASE CONTROL AND PREVENTION, DEPARTMENT

OF HEALTH AND HUMAN SERVICES, ACCOMPANIED BY RAM

KOPPAKA, DIVISION OF GLOBAL MIGRATION AND QUARANTINE, CENTERS FOR DISEASE CONTROL AND PREVENTION

Dr. JORDAN. Thank you very much. Chairman Mica, Congressman DeFazio, and members of the Subcommittee, good afternoon.

It is a pleasure to appear before you today to discuss the efforts
7

to prevent pandemics by air travel. I recognize that this is a priority of this Subcommittee and FAA shares your concerns. It has also

been a matter of significant concern to aviation passengers and the

crews that earn their living by working on commercial transport

aircraft. Secretary Mineta and Administrator Blakey both take

these concerns seriously. They are supportive of efforts to help protect the health, safety, and comfort of the travelling public and

cabin crews.

I wish to offer my full statement for the record and highlight just

a few points here.

Mr. MICA. Without objection, your entire statement will be made

part of the record. Please proceed.

Dr. JORDAN. This will be a short statement, Chairman Mica.

An important new initiative is underway in the Office of the Secretary of Transportation. The Office of the Secretary, in coordination with the Department of Health and Human Services, is compiling a best practices manual to provide airport operators and

local health authorities with assistance in responding to the

threats of contagious diseases in international gateway airports.

Guidelines and other important information are being assembled

from experiences at airports throughout the world and will be used

for training sessions that the Center for Disease Control and Prevention plans to begin this spring. In publishing this best practices

manual, the Department will make this information widely available to airport owners and operators and public health officials.

Considering the potential of pandemics and contagious disease

transmission on airliners in general, issues inevitably arise concerning the quality of air in airliner cabins. It is important, however, to understand that studies have indicated that many aspects

of cabin air are as good or better than that air found in offices and

home environments. For those aircraft that recirculate some part

of the cabin air, that air is typically passed through high quality

filters before it returns to the cabin. Manufacturers of new airplanes used by air carriers incorporate either high efficiency particulate air filters, similar to those used in hospital isolation areas

and surgical suites, or particulate filters that are somewhat less effective. HEPA filters are defined by EPA as those with the filtering

efficiency of 99.97 percent. The filters remove dust, vapors, bacteria, and fungi. HEPA filters also effectively capture viruses. Several airlines, in coordination with aircraft manufacturers, have

even installed HEPA filters on airplanes that did not originally incorporate them into their design.

Even though progress has been made with these efforts, we still

need to know more about what affects cabin air quality and what

further improvements can be made. In September of 2004, the Federal Aviation Administration announced the establishment of an

Air Transportation Center of Excellence for Airliner Cabin Environment Research, which I will refer to ACER. This is headed by Auburn University. ACER will research cabin air quality and conduct

an assessment of chemical and biological threats. The FAA will

provide funding for the center and matching funds will be provided

by the private sector.

ACER will conduct a comprehensive and integrated program of

research and development in cabin environment. The team brings
8

the diverse expertise necessary to conduct research on the healthfulness of cabin environment for passengers and crew, enhancement of aircraft environmental control systems, and detection and

mitigation of chemical and biological threats aboard aircraft. ACER

aims to be a unique resource for airlines, equipment manufacturers, cabin crews, and the travelling public, and places a major emphasis on partnerships with industry.

Finally, I would like to briefly comment on one area that is concern to travelers—chemical disinsection, a term used to describe

the process for ridding an aircraft of insects—has been a long time

concern. The Office of the Secretary of Transportation chairs an

interagency working group that is taking a lead in researching and

developing means of non-chemical disinsection of aircraft. OST’s efforts are currently focused on air curtain technology, which would

prevent insects from both entering and leaving aircraft, thus eliminating the need for treatment with pesticides. DOT is about to embark on a pilot program with Jamaica to demonstrate this technology.

In closing, Mr. Chairman, on behalf of Administrator Blakey, I

would like to reiterate that FAA is committed to ensuring the

safest flight possible—from the safety of the operation of the aircraft to the quality of the air that passengers and crews breathe

inside the cabin. I look forward to working with the Subcommittee

regarding any concerns you might have on the quality of airliner

cabin air and, specifically, efforts to prevent pandemics in air travel. This concludes my testimony and I would be happy to answer

any questions you might have.

Mr. MICA. Thank you. We will hear from Dr. Anne Schuchat,

Acting Director of the Center for Infectious Diseases, first and then

we will go to questions.

Welcome, Captain Schuchat, also a medical doctor, and you are

recognized.

Captain SCHUCHAT. Thank you, Mr. Chairman and members of

the Subcommittee. Good afternoon. I am pleased to be here today

to discuss this important public health topic. In this age of expanding air travel and international trade, infectious microbes are

transported across borders everyday. Because one route of introduction is air travel, and because of multiple outbreaks currently going

on in other parts of the world, today’s hearing is particularly timely.

A pandemic is broadly defined as an epidemic occurring over a

wide area, crossing international boundaries and usually affecting

a large number of people. Certain diseases such as SARS or certain

types of influenza are capable of causing a pandemic because of the

ease of their transmissibility among people, the severity of the illness they cause, the low level of immunity among the population,

and the ease and speed with which people travel. There are other

diseases, such as tuberculosis and meningococcal meningitis, that

may pose less of a threat of causing pandemics but are still of significant public health concern because of their ease of spread from

one location to another.

Because of the variety of infectious disease threats that exist in

the world and the volume of people traveling, the threat of infectious disease introduction and rapid spread is real. The best pre-
9

vention strategy is through disease surveillance, early detection,

and rapid response. Preventing the importation of an infectious disease into the U.S. must involve collaborations with many partners

and must address these critical points: pre-departure, in-transit or

upon arrival, and post-arrival.

Pre-departure prevention includes health education at home before people travel. On its web site, CDC posts travel notices and

other important travel information to inform travelers of health

events taking place globally and steps they can take to avoid infection.

Pre-departure prevention can be improved through surveillance

for infectious diseases among traveling population. One surveillance network is called GeoSentinel. It is a global network of 30

travel and tropical medicine providers established by the International Society of Travel Medicine and the CDC. These sites participate in surveillance of all travel related illnesses seen in their

clinics and share this information.

The second critical control point is in-transit or on arrival in the

U.S. The commander of an aircraft destined for a U.S. airport is

required to report the presence on board of any death or any ill

person among passengers or crew to the CDC quarantine station

at or nearest the port of arrival.

CDC currently has 11 quarantine stations and they have established protocols with State and local public health authorities for

handling ill passengers, coordinating care with local hospitals, and

handling contacts. We plan to have up to 18 stations by the end

of this year, and our goal is to have 25 stations at ports of entry

that represent over 80 percent of international arrivals.

For post-arrival prevention, mechanisms are in place to prevent

transmission of disease in the event a person was infectious while

traveling but the infection was not identified until after they arrived in the U.S. In these cases, CDC relies on a manual system

of gathering, compiling, and processing data from flight manifests,

customs declarations, and any other available sources.

Quarantine stations routinely work with State and local health

departments to contact passengers who may have been exposed

during a flight and provide guidance on what to do. In most instances, these are limited events and involve only a single aircraft.

However, during SARS the process was determined to be ineffective for an outbreak that required notification of passengers on

more than a few flights, primarily because this manual paperbased process is slow, labor-intensive, costly, and depends upon

possibly obsolete or inaccurate data. Since then, we have been

working with our Federal and private sector partners to improve

our ability to notify passengers of a possible exposure.

The experience with SARS taught us many practical lessons

about issues of infectious diseases in today’s world of frequent air

travel. As you are probably aware, there is an outbreak of Marburg

hemorrhagic fever ongoing currently in Angola. We at CDC are following this closely and we are participating in the response with

our partners at the World Health Organization and the Angolan

Ministry of Health. This situation has not progressed to the point

of having quarantine officers meet incoming flights to the U.S., but

we are prepared to do so if we need to.
10

In conclusion, both the ongoing outbreak in Angola and the current avian influenza situation in Southeast Asia reinforce the importance of global surveillance, prompt reporting, and adequate

containment measures to prevent a localized outbreak spreading to

other countries and becoming a pandemic. CDC will continue to

collaborate with State and local health departments, industry,

other Federal agencies, and other partners. A strong and flexible

public health infrastructure is the best defense against any disease

outbreak.

Thank you for your attention. Dr. Koppaka and I will be happy

to answer questions that you may have.

Mr. MICA. Thank you. So Dr. Koppaka will be available only for

questions, no statement. All right. We will go ahead and proceed

to questions. I have a few.

You mentioned, Captain Schuchat, the plans to increase the

number of quarantine stations. Could you explain further the role

of the current quarantine stations and how and why they should

be expanded.

Captain SCHUCHAT. Thank you, Mr. Chairman. I think it is helpful to realize the historical context of our current quarantine situation. By the late 1960s there were over 200 ports of entry overseas,

consular offices, and maritime vessels that had quarantine capacity

or expertise. But after the eradication of small pox and the perception that we had won the war against infectious diseases, this infrastructure was really downsized and we reached a point where

there were only six ports of entry with quarantine stations.

The SARS epidemic taught us that we really need this border

control and ability to evaluate patients on arrival and integrate

public health response into potential importation of infectious diseases. So we are in the process of rebuilding that capacity. As I

mentioned, we are at 11 stations now, with an aim to be at 18 by

the end of this year, and a goal of 25.

In addition to the number of stations increasing, we are trying

to increase the capacity at the stations with medical officers available, more senior public health experts, so that we can move from

just visual inspection into more public health evaluation of the disease risks.

Mr. MICA. On Friday, President Bush added pandemic influenza

to the list of quarantinable diseases. Why was that necessary?

Captain SCHUCHAT. The list of quarantinable diseases was developed many years ago. In 2003, SARS was added to the list, and

then Friday novel or emerging influenza strains capable of causing

a pandemic or actually causing a pandemic was added. The spirit

of what quarantine is for has always included something like pandemic influenza but it was not actually on the list.

This is not an order that we expect to need to use. The State and

local health authorities have the first line of response for quarantine issues. But in terms of preparing for a pandemic, having

this legal authority available to us sets us in better preparedness

state.

Mr. MICA. What kind of additional tools does it give?

Captain SCHUCHAT. We are able to detain a person, evaluate

them for their public health risk, arrange for care, and evaluate

contacts. So it gives us that kind of authority.
11

Mr. MICA. Now you work pretty closely with FAA on transmission of influenza or communicable diseases. Have you been

working with them on this best practices manual that they talked

about?

Captain SCHUCHAT. Yes. Most of what the CDC does is through

extremely strong partnerships, and in this area we have a close collaboration with the FAA and the Department of Transportation.

We have been carrying out a series of training exercises with our

quarantine stations, and the Department of Transportation is going

to participate in those. So for the best practices manual, we are involved as a collaborator I would say.

Mr. MICA. At what stage would you take preventative action? So

far, what you have described is if you see some signs of influenza

or sickness, the person is quarantined once they enter the United

States. At what stage of, say, the bird influenza in Asia or what

has been described in Angola, at what stage do you take preventative measures or screening measures of passengers coming into the

United States before they get on a plane?

Captain SCHUCHAT. There are a series of steps that are carried

out in these situations. It is important to individualize the circumstance and assess what is going on in the distant site. Is there

spread beyond close contacts, is it into the community, is there a

true risk for importation. I would just like to clarify that the quarantine executive order for pandemic influenza and all of the use of

quarantine is when voluntary efforts to restrict movement of a potentially contagious person have been exhausted. So you do not use

it every time you think there is a problem. It is really when you

are not able to get voluntary cooperation.

Mr. MICA. But you have all the authority you need now to proceed?

Captain SCHUCHAT. The executive order did add pandemic influenza and the wording is such that it gave us appropriate authority.

Mr. MICA. And at what point would you take measures? You

would have to have some evidence that someone could get on a

plane who was contagious and that there were not measures in

place to screen those people. Once they get to the United States

and in quarantine, it is a different situation. They have already

been on a plane potentially infecting others on the plane and the

chain sort of starts with that.

Captain SCHUCHAT. Right. This is why we emphasize the importance of controlling the outbreak at its source and why we are

working so intensively with the World Health Organization and

with countries in Southeast Asia around the avian influenza problem, or why we have people in Angola helping with the Marburg

situation. So that keeping a sick person from getting on a plane is

a better way to deal with the potential contagious threat than dealing with it after their arriving.

Mr. MICA. Finally, do we keep records now of folks coming in

from Angola or from points in Asia? Are they easily accessible, so

that if we got some report that someone had the potential or comes

down with a contagious disease after the plane has already arrived,

Are we prepared for that?

Captain SCHUCHAT. I think you raise a really central issue—how

quickly could we notify passengers who were on a flight with a po-
12

tentially infectious traveler. We have a couple methods of doing

that right now in terms of using the passenger manifest and additional information that you can get from customs records because

the passenger manifests do not include addresses. So we still, for

the most part, are dealing with a manual paper-based type of system. We have a pilot project with one of the airlines to explore electronic access to passenger manifests and whether that will speed

things up.

Do you want to add anything, Dr. Koppaka?

Dr. KOPPAKA. Thank you. I think the only thing I would add to

what the Captain stated is, since SARS we have also developed

what we call a passenger locator form that enables us to collect locator information on passengers who may have been exposed.

Again, that assumes that we know there was an ill passenger on

board the flight. But the intent behind that is to facilitate the process of identifying and locating individuals that may have been at

risk.

Mr. MICA. Thank you. I have additional questions but let me

yield to Mr. DeFazio.

Mr. DEFAZIO. Thank you, Mr. Chairman. Dr. Jordan, in your testimony talking about the aircraft cabin air being superior to that

of buildings, that assumes a certain operational aspect, does it not,

that is, that the system is being operated at its maximum capacity?

Dr. JORDAN. Yes, that is correct.

Mr. DEFAZIO. And is there an FAA standard which requires the

airlines to operate at maximum capacity or at any capacity?

Dr. JORDAN. There is no requirement for that except for acceptable air quality. We have design standards for the manufacturer of

the aircraft, however, that are generally followed by the industry.

Mr. DEFAZIO. Right. But with high fuel costs, we can expect that

the aircraft crew are getting orders to crank the system down as

much as they can.

Dr. JORDAN. Not necessarily. I think it is dependent upon the

crew’s understanding of what the air quality is for the passengers

and the—

Mr. DEFAZIO. Right. But why do we not have a standard? For instance, if we are looking at the threat of pandemic, we know that

in the circulatory system that if you crank it down it is more likely

that more people in a larger area are going to get ill on a plane

with a transmissible disease. Why do we not have a required

standard, particularly in light of this threat?

Dr. JORDAN. We have not found it necessary at this point in time.

A number of strategies—

Mr. DEFAZIO. So there has not been a pandemic yet, so it is not

necessary? It is kind of like the old tombstone mentality—the

planes have not gone down yet so we do not need to fix the problems we know about.

If I could, as I understand it, we have the vaunted group, and

I will ask both Captain Schuchat and Dr. Koppaka their opinion

here, would you think the American Society of Heating, Refrigeration, and Air Conditioning Engineers are a well-known, medically

qualified group to pass on the issues of transmission of disease in

enclosed spaces? Are they someone you consult with regularly?
13

Captain SCHUCHAT. Actually, speaking for the CDC, we do work

with ASHRAE on issues such as infectious disease issues.

Mr. DEFAZIO. Right. But do they tell you, or do you sort of consult with them when you want to achieve something and you then

talk to them about how to achieve it? Do they tell you what you

should achieve?

Captain SCHUCHAT. No.

Mr. DEFAZIO. All right. Well, the FAA has chosen them as the

body to come up with standards for aircraft. We have been waiting

for several years for ASHRA to come up with their vaunted standard. I would think that we might want to interject some of the concerns we are hearing about here into that debate and go beyond

the grand expertise of ASHRA for aviation. I would hope, Mr.

Chairman, we could facilitate some communication in perhaps the

FAA, including some expertise from CDC, in consultation with

ASHRA, since they are familiar with them on these issues.

The other issue would be, as you said, the HEPA filters and others that are not as effective. Why do we continue to allow planes

that carry over one hundred people to operate without HEPA filters?

Dr. JORDAN. Well, we have not seen at this point in time a reason to make a requirement.

Mr. DEFAZIO. Then why do we have HEPA filters at all if we do

not need them? The other 85 percent—

Dr. JORDAN. The industry is moving toward HEPA filtration toward 100 percent of the fleet.

Mr. DEFAZIO. Right. But you see no need, even though 85 percent of the planes have it and we know it is effective, that the

other 15 percent is not necessary?

Dr. JORDAN. I think eventually at some point in time we will

have 100 percent of the aircraft.

Mr. DEFAZIO. Right. After a bunch of planes are retired in 10 or

20 years. So, basically, no operating standard because there has

not been a pandemic, no requirement for HEPA filters because

there has not been a pandemic generated by aircraft, we are going

to wait until after the fact and then we will say, gee, maybe we

should have required full circulation, maybe we should have required HEPA filters, maybe we should have taken other measures,

and ASHRA has not come back with their suggestions yet on how

we might better protect the health of the traveling public.

I really am not sanguine about the FAA’s position on this. I

think just hearing the concerns expressed by the Chairman and

others here that the FAA should revisit this issue. I know there is

always pressure from the industry. But I really think that if they

just look back to what happened with SARS, they are not going to

want to be in a position to see their passenger loads cut because

they saved a little bit of money on fuel and operated the plane at

less than maximum efficiency.

I do appreciate the incremental progress on chemical

disinsection. I think it has been now 15 years since the United

States stopped doing it, since we found out it was totally ineffective

and unnecessary. And we did, with some pressure in the last Administration, negotiate away the requirement. But it is still being

done without passengers’ knowledge. I would again suggest that
14

the FAA wants to promulgate rules to inform passengers, because

then those passengers are going to say, gee, maybe I really do not

want to go to New Zealand, or they are going to say to the New

Zealand government or the Australian government, or one of the

others that is practicing this bizarre sort of totem-like protection of

their country, which has no effect but making flight attendants and

others very ill with chemical sensitivities, that we should at least

minimally inform the public.

I have been hearing about the air curtain for two years now. I

am glad we are going to try it in Jamaica. But, really, we are making people sick. I have met with flight attendants who are disabled

because of chemical disinfection. And passengers have no knowledge, even those with multiple chemical sensitivities, that they are

getting on a plane that has been disinfected because of the bizarre

requirements of these countries that are not protecting themselves

against anything by doing it. But I appreciate that you are making

progress. Thank you, Mr. Chairman.

Mr. MICA. I thank the gentleman. Mr. Ehlers?

Mr. EHLERS. Thank you, Mr. Chairman. I would like to pursue

this but along a different line. What do we know about the transmission of disease on aircraft? How much of it comes from airborne

transmission, how much through contact transmission, and how

much through ingestion, as an example? For years, we believed

that colds were transmitted by people sneezing and others inhaling

those germs. Now the general wisdom seems to be that it is primarily through contact with the hands and then you touch your

nose, your eyes, whatever, and you transmit the virus that way. I

am just curious what you have learned on this, particularly in view

of the issues of air quality. Is air really the transmission medium,

or would we be better off handing everyone some alcohol wipes or

something like that to wipe their hands with every once in a while?

Anyone wish to respond?

Dr. JORDAN. I think transmission is identified really as personto-person contact, and then the epidemiologic studies that have

been done in respect to aircraft and the carriage of passengers who

might have communicable disease indicates that, for the most part,

it is from the individual who is sitting in close proximity to you

that you are likely to get the disease from. It is not the air system

within the aircraft, the recirculation of cabin air, it seems to be

close contact with individuals that have illnesses.

Mr. EHLERS. By close contact, you mean actually touching them?

Dr. JORDAN. Well, it could be touching them, but sitting close to

them if they are coughing, sneezing, then you are more likely to

come—

Mr. EHLERS. But that does not answer my question. I said, for

example with colds, we always thought it was the coughing, sneezing, now I am being told that it is not, it is the actual physical

touching.

Dr. JORDAN. Well, it could come from a hard surface that has

bacteria or viruses on it and hand contact with that, or contact

with the individual’s mouth or respiratory system as a result of the

contact from a hard surface, also from airborne fomites that carry

bacteria and viruses. But again, it is typically being with individuals who have been in close contact with someone who is ill.
15

Mr. EHLERS. That gets to my second question of maintaining the

lists. What problems do you encounter in trying to contact people

once you find out there has been a serious communicable disease

on the plane? You mentioned you are working on trying to make

it electronic. But do you have the authority to solve that problem

now? And if so, what is impeding it?

Captain SCHUCHAT. The challenges that we face, as I mentioned

with SARS, when there are multiple flights of interest, the volume

of passengers is great and the manual system is not efficient. So

there are a couple of problems. The passenger manifest itself would

not have all of the relevant information. So you need to go to other

sources.

By the time we recognize that there is a problem, time might

have elapsed from the flight. It may be that we are meeting flights

and we know there is a problem right away, but more typically we

learn of an event some time after the flight occurred. I think you

may remember last August and September there was a U.S. citizen

who traveled from West Africa into New Jersey, who after arrival

took a train, and from the train basically went to a hospital and

some days later died and post-mortem was diagnosed as having

Lassa fever, an infection that we do not have in the U.S. that is

common in West Africa. Trying to go back and find passengers at

some remove is challenging. So, electronic access to all of the relevant information, even remote, even not just the day of arrival or

a couple days after, would help considerably.

Mr. EHLERS. But do we have the practice in country when someone comes in that they have to list where they are going to be staying initially?

Captain SCHUCHAT. The customs declaration does include your

address while you are there. So one of the airlines may not keep

that information in a database themselves, or they may have some

in their frequent traveler programs. So there are a lot of different

places where information may be. It is not all in the same place

and we usually have to go to that next step of the customs declarations records to get that. It also may not be quite as accurate as

if someone was filling information out knowing that they might

need to be contacted. So that passenger locator form that we have

developed, that Dr. Koppaka described, is an attempt to get better

quality information that then can be scanned by the quarantine

station and we would have electronic assess to. But we are not

using that routinely for every flight. That is when we have a suspicion of an ill person in transit.

Mr. EHLERS. I yield back.

Mr. MICA. I thank the gentleman. Ms. Norton?

Ms. NORTON. Thank you, Mr. Chairman. Mr. Jordan, I was interested in part of your testimony on Page 5, where you indicate that

ACER will conduct—you talk in the future—will do research about

cabin air quality and conduct an assessment of chemical and biological threats, and then you name a set of rather distinguished

looking researchers or universities, and then you say FAA will provide funding and there will be funding by the private sector. Unlike

some of the rest of your testimony which describes dates attached

to work being done, this all looks like it is in the future. Would you
16

say more about whether this work is being done? It sounds almost

as if we are beginning from scratch.

Dr. JORDAN. We are beginning from scratch with this particular

effort. This is not the only effort that the agency has engaged in

in terms of looking at cabin air quality and issues related to contamination of aircraft. But it was only last August that we established a Center of Excellence for Research in Cabin Environment,

which includes possible contamination of aircraft with biologicals

and chemicals. And in this activity, we are working with Homeland

Security, who are very interested in this particular issue, as you

might guess. The actual research has not started but we have established the Center of Excellence, we have a research plan, we

have funding dedicated to this effort, and we anticipate research on

this specific issue, decontamination of aircraft and contamination of

aircraft with biologicals and chemicals, will be begin in the very

near future.

Ms. NORTON. But you do not have a date for when it will begin?

You say the money is always available.

Dr. JORDAN. I do not have the specific date. It is part of the research plan which covers a tremendous number of issues in respect

to cabin environment.

Ms. NORTON. May I ask you, have we already done a fair amount

of research? Do you already know enough to prevent a chemical or

biological attack being transmitted through cabin air, the way in

which air is circulated in a cabin?

Dr. JORDAN. Well, we certainly know a great deal about air circulation and the cabin environment. But in terms of intentional

contamination of an aircraft with a biological or chemical, there is

not a lot that we know about that. We know about the transmission of such diseases as Small Pox and others like anthrax I

suppose that might be used as a contaminant of an aircraft. But

when it gets to the question of chemical contamination, there are

a lot of unknowns in respect to that. And so a lot of work needs

to be done in the development of sensor technology, sensors that

can actually identify that the aircraft has been contaminated, and

what must be done in respect to the decontamination with the aircraft for that specific contaminant.

Ms. NORTON. Dr. Jordan, all I can say is this one of the chief

worries, also in Homeland Security Committee, that we have focused on. Direct attacks of biological and chemical attacks are a

matter of some great concern. I do not know what can be done

about them, and that is part of the problem. I would like to suggest

that you get a date for when this will start to the Chairman of this

Committee within the next 30 days. This really sounds like real futuristic stuff, we will do this. I was very pleased to hear you say

we have the money to do it. Well, if you have the money to do it,

I do not know what we are waiting for. You have got the money,

you have got the universities, what else is needed?

Dr. JORDAN. Well, it is that we are talking about some very difficult technical issues.

Ms. NORTON. You have already got the universities, and you

spelled them out in great detail. Who is going to do the research?
17

Dr. JORDAN. The research will be done by researchers at the various academic institutions that are part of the Center for Excellence.

Ms. NORTON. Yes, and you have got their names in your testimony. Yet you say you cannot tell me when, in fact, this research

is going to even begin. And we do not know anything about this

matter now. I am very concerned if you cannot do better than that.

I am very pleased that you have gotten as far as you have gotten,

particularly when you say there is money available already. You

also say matching funds will be provided by the private sector.

Have those funds been provided as yet?

Dr. JORDAN. They are being provided by the academic institutions as well as industry.

Ms. NORTON. Well, all I can say is I cannot tell from your testimony whether this is start-up activity, if you are close to where we

can expect this very urgent and difficult research to begin. I just

really cannot tell from your testimony and it is very bothersome.

So may I ask you to get to the Chairman a date within 30 days

when you believe this research can begin. I do not say you have

to say it will begin tomorrow, and you can only say when you think

it will, but I would very much appreciate that.

Dr. JORDAN. All right.

[The information received follows:]
18
19

Ms. NORTON. Could I ask a question of Dr. Schuchat. At Page 6

of your testimony, you discuss the kind of travel from people

abroad that, of course, we and every country have direct jurisdiction over with respect to the health indicators they are required to

show when they enter the country; that is to say, refugees and immigrants. I have to ask you, in light of the amount of air travel

that takes place to our country, how likely it is that a visitor, a

business person, somebody who does not seek immigration, is not

a refugee, is not subject to the normal kinds of health screens that

these groups are subject to, would in fact be the carrier of a communicable disease, and how we handle that huge number of people

who transit everyday across the world and into our country?

Captain SCHUCHAT. I think the most important issue for the

business traveler is to be informed about the health issues in the

country you are going to. CDC runs a travel health web site with

a lot of information about—

Ms. NORTON. I am not interested in whether we are carrying disease there. We tend to be healthy people. And I am not even talking just about business people. My question is about people from

abroad who are visiting the United States.

Captain SCHUCHAT. Right. I meant a person from here going

elsewhere and bringing something back. But you are right, there

are infectious disease issues in other countries that we do not have

currently, like the Lassa fever story I told earlier. So I think our

best approach for these infectious disease problems overseas is to

have good surveillance of what is going on elsewhere and good

partnerships through the World Health Organization or travel

health networks to get information about what the risks are.

Ms. NORTON. Suppose we know that in fact there was a contagious disease in a country with which we have frequent commerce an travel, we know it is there, and here comes a visitor to

stay three or four days. Is there anything we can do when we know

that there is a contagious disease going around there that could be

brought into the country and yet this person does not seek to immigrate to this country?

Captain SCHUCHAT. Yes. This is where we have a tiered approach to health risk. So those quarantine stations that I was mentioning may do visual inspection of people coming in, they may give

out information. What we did in SARS is give out health alert notices where everybody deplaning from the affected countries was

given a yellow card with information about signs and symptoms to

look for over the next 10 days—give this card to your doctor, this

is the number to call if you have one of these things, here is what

is going on. And we translated that information into numerous languages as additional countries came on line.

So there is quite a bit we can do with education both for the arriving traveler, businessperson or otherwise, and then there are additional steps we can take if we are concerned. If we know a person

is sick enroute or if they are ill on arrival, we can evaluate them

medically with these quarantine officers, handle their care, refer

them to local hospitals that we have arrangements with, and we

can also evaluate their contacts. So we have that kind of authority

and capacity right now.
20

Ms. NORTON. I must say, you apparently, judged only by what

one picks up in the media, have been reasonably successful, and for

that I congratulate you and the steps that have been taken apparently with some considerable success. I appreciate that that is

being done and hope that level of success continues. I yield back

the balance of my time.

Mr. KUHL. [Presiding] The Chair recognizes the gentleman from

Arkansas.

Mr. BOOZMAN. I just have some general questions. What do you

feel the greatest risk is as far as the spread of stuff?

Captain SCHUCHAT. I think that—

Mr. BOOZMAN. I mean, it is one thing to get on a plane and get

a cold. It is another thing to get on and get something that can

have a severely damaging effect to the Nation.

Captain SCHUCHAT. Right. I would say that our area of greatest

concern right now is the threat of pandemic influenza. Currently,

we have quite a bit of attention around the avian influenza outbreak in poultry in Southeast Asia.

Mr. BOOZMAN. So what countries then would we be more concerned about than others?

Captain SCHUCHAT. Let me clarify about that in terms of what

countries. Influenza is a complex virus and the issue with pandemic influenza is that you need a strain of the virus that we do

not have immunity to, that is easily transmitted from person to

person, and that is very severe when you get it. Right now in

Southeast Asia there is a strain of influenza that we do not have

immunity to. It is spreading easily between poultry but it is not

spreading easily to humans or from human to human. So this particular strain has not developed the capacity to easily spread between humans.

While we have a lot of concern in the Southeast Asia region and

are increasing our surveillance efforts and laboratory support

there, I think it is important to realize that a pandemic influenza

could emerge anywhere. And so it is important that we strengthen

laboratory capacity around the world and the recognition of new influenza viruses. They could emerge here. We have, of course, had

a lot of interest in Asia because of the huge poultry problem. But

it is not the only area that we need to be attending to.

Mr. BOOZMAN. In the areas, though, where it has occurred, okay,

so you know it is there, do we do anything different there than in

an area where it has never occurred and does not have the potential to occur? I mean, if you are flying from Iceland where there

is no whatever, is that any different than flying from Thailand?

Captain SCHUCHAT. Okay. In terms of the passenger issue, there

are certain points where we would change approaches to arriving

passengers. During SARS we designated certain countries from

which we met every plane, we gave information out to people

deplaning from those aircraft, and when people were ill they were

evaluated by the quarantine staff. There are a number of issues

that get considered to reach that threshold.

At this point, because there is not widespread human-to-human

transmission, we are not at the stage where we are meeting every

plane that is coming from Southeast Asia. We certainly learned

during SARS that there is a lot of travel back from some of the af-
21

fected areas there and we were meeting hundreds and hundreds of

planes at that point. But we are not at that point with the avian

influenza concern. But much of our effort is preparing to improve

the quality of information we have about what is going on in parts

of Asia, and to improve the global and the national public health

infrastructure to respond and control problems quickly.

Mr. BOOZMAN. Okay. Thank you.

Mr. KUHL. The gentleman from New Jersey?

Mr. PASCRELL. Thank you. I want to frame my questions, if I

may, the first question I am going to ask is to Dr. Jordan, and I

want to frame the questions in this respect, that we are at war

right now. And I am reminded of Lincoln reminding the generals

during the Civil War, his own generals, hey, we have got a war

going on here, are we taking this seriously. So I want to ask you

this question and with that framework. Who is responsible in every

airplane for checking the quality of air before the plane takes off?

Who has that responsibility?

Dr. JORDAN. No one takes that responsibility at the present time.

Mr. PASCRELL. I am sorry?

Dr. JORDAN. I say no one takes that responsibility at the present

time, other than perhaps the operator of the aircraft.

Mr. PASCRELL. I am not surprised at the answer, and I thank

you for your candor. Because I think if you look back over the last

30 years in terms of responsibilities in a lot of these areas, from

security all the way up, do we have the cart being pulled, or is the

cart pulling the horse? This is serious business and I think you understand that. So what is the role of the airlines to begin with, very

basic, is pretty dubious, pretty dubious, indeed.

This report, Captain, that I referred to earlier, the Pandemic Influenza Preparedness and Response Plan, was finished last August.

I would like to know where are we in implementation? Reassure

me in some manner, shape, or form now that I know that the next

plane I get on we have no idea who is responsible for checking the

air. And we are concerned about the spread of disease? You have

got to be kidding me. In our own minds, we are not at war.

Captain SCHUCHAT. Thank you. I appreciate the analogy to war,

and I think that the Department of Health and Human Services is

taking the risk of pandemic influenza incredibly seriously. As you

mentioned, there was a draft pandemic influenza planning document released last August and we have received numerous comments on that draft.

There are several efforts going on now around pandemic planing.

We have intensified surveillance as an approach to improving the

information we have, strengthening surveillance internationally,

particularly in a couple of those Asian countries, working in close

partnership with the World Health Organization’s influenza collaborating centers. So we are really tracking the viruses that are

occurring in different places.

We have also improved surveillance in the United States and a

tremendous amount of energy has gone into improving the capacity

of our states to recognize the avian influenza, should it emerge

here.

CDC has trained 31 states, laboratory professionals in those

states, with new molecular techniques to recognize the H5N1 avian
22

strain of influenza, should one of the people here with an influenza-like illness actually have that bug. We intend to complete

training of the rest of the states this year.

In addition to surveillance, HHS has invested a lot of priority

and resources into vaccine development and supply issues, which

is a critical area to be ready for a pandemic, both in research and

development of new approaches to vaccines for influenza that will

potentially improve the reliability of the vaccine supply, encouraging expansion of manufacturing capacity in the United States.

So HHS has funded efforts for both cell-based production of influenza vaccines, and egg-based production. There is also a major effort of stockpiling anti-viral drugs to prepare for response.

In terms of the draft, it has gone through much since it was

issued in August. I would say it is at the final stages in terms of

intensifying the interactions with the state and local partners who

are going to have to use this, since one of the goals is to guide updating or developing state and local capacity. So it has been given

huge priority, and it is moving quite quickly.

Mr. PASCRELL. And you will share that as soon as it is completed?

Captain SCHUCHAT. Absolutely.

Mr. PASCRELL. You cannot give us a time when it will be finalized? You cannot give us a date?

Captain SCHUCHAT. I am not aware of a date, but we could get

you one. We could get that to the Committee.

Mr. PASCRELL. In the report from my friend from Michigan, the

magazine article, the New Yorker Magazine, I would like you to respond very quickly and I will read this quickly. It is a very small

paragraph in this report, which I found a little bit disturbing.

‘‘When the Bush Administration’s Health and Human Services

Secretary Tommy Thompson announced his resignation in December, he cited a potential epidemic of avian influenza as one of the

greatest dangers facing the United States.’’ That is what he said.

The World Health Organization has put a conservative estimate

of debts from such an event at between 2,000,000 and 7,000,000

people, and expect that as many as one billion people would fall.

Is this hyperbole? Should we not even be talking about this? Do

we scare people out of their wits, and we do not know what the

heck we are talking about, or is this real? This is not reality TV,

is it?

Captain SCHUCHAT. The influenza virus is an extraordinary virus

with the capacity to do huge damage to populations. We are in better shape now than in 1918, because we have antibiotics.

Mr. PASCRELL. That is reassuring.

Captain SCHUCHAT. Right, but our current estimates of the toll

that a pandemic would take in the United States are not of the

magnitude of what we saw in the last century. But as you know,

there were three pandemics in the last century, and people who

were very expert on influenza do not think it is a question of if,

but it is a question of when.

This is why we are giving the highest priority to the planning

around pandemic flu. It is going to improve our ability to deal with

other infectious diseases, natural or intentional, and we take it incredibly seriously.
23

Mr. PASCRELL. Thank you, and thank each of you for your service

for this country.

Mr. KUHL. Yes, the Chair would recognize the gentleman from Illinois, Mr. Costello.

Mr. COSTELLO. Mr. Chairman, thank you. Mr. Chairman, I have

no questions at this time. I simply want to thank the witnesses on

the first panel for being here.

I apologize that I came in late. We had a delegation meeting with

the Secretary of Energy concerning some major projects. I thank

my colleague, Mr. Defazio, for sitting in, and I thank the witnesses

for being here today. I look forward to hearing the testimony of

panel number two.

Mr. KUHL. Thank you, Mr. Costello. I likewise would like to

apologize for coming in late. I do have just one question, if you can

share an answer, or at least give us a brief overview. I note that

the CDC and the FAA are working together on this issue.

My question comes to, have you had any kind of a relationship

or an investigation or a development or a program with the Department of Homeland Security as it might relate to bio-terrorism in

this area, in the aviation industry?

Dr. JORDAN. Yes, we have. Our Center of Excellence, which was

created at Auburn University as the administrative lead, has been

in close contact with Homeland Security, in terms of potential contamination of an aircraft from biologicals or chemicals, and the decontamination of those aircraft. We anticipate that this will be a

major initiative at the Center of Excellence.

There are other universities that are a part of this effort, including Purdue and Harvard University and Boise State. There is a

whole list of them, as well as other universities outside the immediate circle of the universities, that are an official part of the center

of excellence. So there is coordination going on currently, and it

will go on into the future.

Mr. KUHL. Great, thank you, let me at this time thank all of you

for appearing. On behalf of Chairman Mica and the members here,

we appreciate your participation here, Dr. Jordan, Captain

Schuchat and Dr. Koppaka. Thank you very much. It has been

very, very helpful.

I would like to call the second panel now for testimony, that

panel consisting of Mr. John Meenan, Executive Vice President and

COO of the Air Transport Association; Dr. Mark Gendreau, MD,

Senior Attending Physician at the Lahey Clinic Medical Center; Dr.

Michael McCawley, Executive Vice President and Chief Scientific

Officer of Respiratory Management Technology, Incorporated; and

Dr. Ronald Brown, MD, Managing Partner and CEO of AeroClave,

LLC.

Gentlemen, welcome. Would you like to go in the order that we

have you listed with Mr. Meenan first, or have you predetermined

that you would like to go with some other batting order? All right,

Mr. Meenan?
24

TESTIMONY OF JOHN MEENAN, EXECUTIVE VICE PRESIDENT

AND COO, AIR TRANSPORT ASSOCIATION; DR. MARK A.

GENDREAU, MD, SENIOR ATTENDING PHYSICIAN, LAHEY

CLINIC MEDICAL CENTER; DR. MICHAEL MCCAWLEY, PH.D.,

EXECUTIVE VICE PRESIDENT AND CHIEF SCIENTIFIC OFFICER, RESPIRATORY MANAGEMENT TECHNOLOGY, INC.; DR.

RONALD D. BROWN, MD., MANAGING PARTNER AND CEO,

AEROCLAVE, LLC

Mr. MEENAN. Mr. Chairman, thank you very much for inviting

us to appear today. I have submitted a written statement. I would

like it made available for the record.

Efficient and affordable air transportation has helped to create a

highly international society today. That society facilitates the exchange of ideas and goods and, unfortunately, viruses. The rapid

spread of Severe Acute Respiratory Syndrome underscored that

fact. But lessons learned from that experience can help to limit the

impact of possible future disease outbreaks.

Airlines must, of course, be part of any comprehensive strategy

for controlling potential pandemics, and we continue to work to be

better prepared to respond promptly and in a coordinated way.

However, the airlines cannot do it alone. We must rely on information and guidance from the experts. ATA is proud of its record

of cooperation with both the Centers for Disease Control and the

FAA, in responding to the threats of communicable diseases.

This relationship did not start with SARS. Although through the

years, we have worked closely with Government health experts, but

SARS brought a new focus.

During the three month period that SARS played havoc with

international travel, ATA and its members were in often daily contact with CDC to receive updates and provide input on what needed to be done to respond. ATA member airlines assisted CDC in

distributing more than 2.7 million health alert notices to travelers.

Since that time, we have continued discussions with CDC, the

FAA, and others, to develop more effective mechanisms for responding to the next international health crisis.

Specifically, we have been working to expedite passenger contact

tracing, an important tool in bringing an end to an epidemic, because it allows public health authorities to take steps to isolate and

treat the affected individuals.

While airlines have cooperated with public health officials to conduct passenger contact tracking for decades, SARS taught us all

that the old methods, which relied on hand search records to reconstruct passenger lists, that simply would not work in a situation

where you had hundreds of flights and thousands of passengers.

The good news is that we have learned from the experience.

Should a SARS outbreak or a similar disease occur today, we are

better prepared to respond swiftly. Working with CDC, airlines

fully understand reporting requirements for passengers with suspected communicable diseases.

The expansion of CDC’s quarantine stations to additional airports has made reporting and response far more efficient. With

input from the airlines, CDC has developed the passenger locator

card to collect contact information from passengers in a machine-
25

readable form. Those forms have been made available to the carriers for distribution when directed.

CDC would identify the countries where exposure to disease was

of concern, and the specific flights on which locator cards and

health alert notices would be distributed. Using this targeted approach, CDC would be able to gather the information necessary to

contact the passengers on those flights very efficiently.

This is a valuable interim solution, that represents a reasonable

approach to the real world challenge we are facing in collecting and

transmitting passenger information to Government agencies.

The ultimate goal remains a seamless electronic transfer of data,

but the impediments, including concerns about data privacy, incompatible and sometimes outdated computer systems, as well as

questions of reciprocity with other nations, are very significant.

These issues are not limited to the information required by CDC

to conduct contract tracing. The same issues and much of the same

information are at the heart of debates of how to best provide advanced passenger information to the Bureau of Customs and Border Protection, data needed by TSA to screen passengers, and other

Federal requirements for passenger information.

In the interest of public health, safety, and national security,

ATA’s member airlines stand ready and willing to assist in each of

these endeavors. But we cannot do it in an ad hoc, redundant, and

uncoordinated fashion.

We have long called for the unification of these functions within

the Federal Government, and believe that containing the spread of

infectious diseases is yet another justification. We urge the various

agencies that have a need for passenger information, not only to

continue working with us, but to focus, too, on working with each

other.

Thank you for inviting us today. We would be happy to respond

to questions.

Mr. KUHL. Thank you, Mr. Meenan. You may have heard the

buzzers and the bells going off. That indicates that the members

are being called to the Chamber for a vote. We are into a 15

minute vote and there are 10 minutes left. So Dr. Gendreau, if you

would like to give your statement in three minutes, if you can do

it, or else we can just adjourn now until 4:00 and come back and

do it then.

Dr. GENDREAU. I will defer until you come back.

Mr. KUHL. We can do that. We appreciate your understanding.

So let us adjourn the Subcommittee hearing now until 4:00. There

are two votes that are going to be recorded. We are in the one now,

a 15, and then a five, and then we will be right back to continue.

Thank you very much for your patience and understanding.

[Recess]

Mr. KUHL. We will reconvene.

Dr. GENDREAU. Thank you, Mr. Chairman and members of the

Subcommittee. My name is Dr. Mark Gendreau, and I am a physician who has been involved with research regarding air travel

health issues.

Recently, a colleague and I published a comprehensive analysis

of transmission of infectious diseases aboard commercial aircraft.
26

My testimony summarizes that analysis and review, and I will submit my written testimony. I will summarize that here.

With over one billion passengers traveling by air annually, the

risk of disease transmission during commercial air travel and the

potential of commercial aircraft serving as vehicles of the

pandemics is clearly present. However, the perceived risk is actually lower than the actual risk.

Since 1946, there have been only a handful of serious infectious

disease outbreaks. Fresh in everyone’s minds, however, is the

SARS outbreak of 2002/2003. As the first severe contagious of the

21st century, SARS exemplifies the ever-present threat of newly

emerging infectious diseases and the real potential for rapid dissemination made possible by the current volume and speed of air

travel.

A total of 40 commercial air flights have been investigated for

carrying SARS-infected passengers. Five of these flights have been

associated with probable on-board transmission of SARS, infecting

a total of 37 passengers.

One particular flight, Air China Flight 12, involved 22 of the 37

infected passengers, and represents a super-spreading event.

What is the risk of contracting an infectious illness during commercial air travel? Insufficient data prohibits a proper analysis to

gain an idea of the probability of disease transmission.

However, despite these limitations, available data suggests that

the risk of transmission to symptom-free passengers within an aircraft cabin is associated to sitting within two rows of an affected

passenger, with a flight time greater than eight hours. However,

variation in this association has been reported, specifically involving an in-flight SARS transmission.

Risk of infection within the aircraft cabin also seems to be affected by ventilation within the aircraft. Ventilation dilutes the

concentration of infectious particles within any confined space,

thereby reducing the probability of infection.

Experience shows us that transmission becomes widespread

within the passenger cabin, involving all sections when the ventilation system is non-operational, as evidenced by an influenza outbreak on Air Alaska in 1979, while passengers were being kept

aboard their grounded aircraft, with an inoperative ventilation system.

HEPA filtering of re-circulated of cabin air as a means of minimizing the exposure of infectious particles is established within the

scientific literature and is strongly endorsed.

With that said, regulations requiring HEPA filtering of any aircraft that utilizes re-circulated air should seriously be considered

if we want to minimize the risk of disease spread within the aircraft cabin.

Prevention of disease outbreak is perhaps the most important

means of control and requires a proactive approach. The Government, aviation industry, and medical community should better educate the general public on health issues related to air travel and

infection control.

The only real way to eliminate any risk of cross-infection in the

aircraft cabin and the rapid world-wide spread of an infectious

agent is to prevent intending passengers who are either substan-
27

tially exposed to or are carrying a transmittable infection from flying.

This needs to come from education and promoting individual responsibility, since the systematic screening of passengers for contagious diseases is impractical.

Although thermal scanners used in airports may be useful in detecting symptomatic travelers, they are not an effective means of

control, since persons exposed to an infectious disease could travel

without any signs or symptoms, yet still be infectious. Good hand

hygiene and cough etiquette have been proven to reduce the risk

of disease transmission, and should be promoted.

In March, 2003, the World Health Organization issued specific

infection control guidelines for air travel and SARS. These guidelines include pre-flight exit screening and travel restrictions at regions with recent local transmission of SARS. These protocols

should be reviewed by appropriate agencies, and expanded to pertain to other infectious agents.

Passenger notification is an issue that is being addressed by both

the Centers of Disease Control and Prevention, and the Aerospace

Medical Association, and measures to improve the archiving of passenger manifests to facilitate the timely notification of exposed passengers should be encouraged.

In summary, commercial aircraft are a suitable environment for

the spread of pathogens carried by its occupants. The environmental control systems utilized in commercial aircraft seem to restrict the spread of infection when the system is properly functioning.

The international health regulations adopted worldwide to limit

the international spread of disease are being revised to provide a

means of immediate notification of all disease outbreaks of international importance, and it is scheduled for a final voting in the

World Health Organization General Assembly later this year in

May.

Outbreaks will be characterized by clinical syndrome, rather

than specific diagnosis, to expedite reporting. These new regulations and continued vigilance by countries, health authorities, airlines, and passengers will keep to a minimum, but will not eliminate the risk of the disease spread by the aircraft.

I would be happy to answer any questions. Thank you.

Mr. KUHL. Thank you, Dr. Gendreau. Dr. McCawley?

Dr. MCCAWLEY. Thank you, Mr. Chairman, Congressman

Costello, members of the Subcommittee, RMT would like to thank

the Committee for inviting us here today for this important topic.

I was reminded by something I had read a number of years ago

called ‘‘Rat, Lice, and History,’’ that infections and the spread of infections have altered the course of history in many cases, many

times not for the better.

So it is important, I think, that we understand that there are

both unintentional infections that a number of the members of the

panel have spoken about, and then there are, today, those intentional infections that could be brought about by groups intent upon

doing damage to the United States.

So I have submitted a written testimony, which I would like read

into the record, and let me summarize what we are talking about.
28

I could, today, go onto an airplane with a device capable of generating between five and ten billion particles per hour. The device is

readily available off the shelf, is inexpensive and, in fact, allowable

on virtually all airplanes. I am not going to go into what it is, in

public, obviously. That means a terrorist with the means of acquiring the agents could, in fact, spread them on a airplane.

The number is relatively important. I heard about the ASHRA

committee that is looking into the guidelines for air cabins. You

have to know what the contaminant source and what the contaminant levels could possibly be, before you can know what kind of dilution rate you need in that cabin.

I want to present that, at least, so you know, and so the ASHRA

can look at those kinds of numbers, because they are horrendous.

If you even take out 99.9 percent, and that is one part in 1,000,

you would still have about 10,000 particles left. So being able to

produce nine or ten billion particles per hour is pretty horrendous.

My company makes a device that is able, in fact, to pick out

those particles from the background. The reason for that is pretty

simple. The background of particles that you would find in an aircraft cabin or even in this room are very, very tiny. They are on

the order of 50 to 100 nanameters in size. That is five hundredths

of a micrometer. A human hair is 100 micrometers in size. So they

are very small particles on the number basis, if you were to count

them all.

But if you look at what comes from a generator for the kinds of

biological weapons that you would have to generate to be infectious, you would see particles that are on the order of one to ten

microns, two orders of magnitude larger.

So picking them out is like being able to pick out basketballs

from baseballs on a table. It is relatively simple and straight-forward. The means for doing that is relatively inexpensive, and we

are rolling it out of production this year. So we could, in fact, have

it on airplanes within the year, in terms of the questions that were

asked before.

We also produce, in fact, a device that is called a stage alert, because there are three stages to it. If you want the simplest measure

of that contamination, you would look at both the particle number

and the size of the particles. The first stage of the stage alert does

that.

The second stage then can take a sample, connect it on to a filter

from the air that may be contaminated, and determine whether or

not the agents that it collects are living microbial agents. That is

done with a simple dye, and it takes just a couple of seconds to do

it.

So you have a real time monitor in a couple of seconds to do an

analysis to see whether what you are getting are a lot of microbes.

We have a third stage that is a good bit more expensive in terms

of being tens of thousands of dollars, that would, in fact, readily

identify within an hour exactly what the agent is. So we have this

three stage approach that gives you a very, very low false positive

rate, in fact. As far as we can tell, it is going to be pretty much

zero and a very low false negative to go along with that.

So we think this would be of some value to the people who are

beginning to look at this. We have heard about the Auburn Univer-
29

sity Center of Excellence, and we would propose to send them information, if they want it, and it is commercially available. So I

thank you for letting me make these comments.

Mr. KUHL. Dr. Brown?

Dr. BROWN. Good afternoon, Mr. Chairman and members of the

Committee. I would like to thank you for the opportunity to speak

with you today, and would ask that my written testimony be entered into the record. Thank you.

AeroClave is a Florida limited liability corporation, which was

founded in early 2003, and is headquartered in Orlando, Florida.

Our primary objective in starting this company was to design and

build a system to decontaminate commercial aircraft, that is, rid

them of disease-causing organisms.

We had three primary objectives in designing the unit. Number

one, it had to be efficient and cost effective. Time is money in the

airline industry, and any process that required planes to be out of

service for any length of time would be unacceptable.

In addition, even though airlines could face huge potential losses

should an outbreak occur, they could hardly afford to be faced with

additional and substantial operating expenses. More simply put, we

needed to make sure that the cure was not worse than the disease.

We had to find a way to accomplish the de-contamination without using chemicals that might harm expensive avionics or other

critical aircraft components.

Lastly, and most important, at least from my personal perspective, was the need to accomplish the process without endangering

the health of the passengers and crews.

Currently recommendations for a SARS-contaminated plane call

for cleaning personnel to enter the aircraft in protective gear and

wipe down the hard surfaces. Those recommendations also advise

the employer to monitor the health of those workers in the future.

This may subject the employer to potential long-term liability,

should those workers become ill. Ideally, the process we were trying to design should be completed without putting anyone inside

the aircraft.

After two years of research and development, we believe we have

accomplished all these goals with the AeroClave unit. Number one,

the AeroClave unit is a self-contained, mobile apparatus, that manipulates the air temperature and relative humidity inside the aircraft, to create an environment that is lethal for a number of disease-causing agents, while not exceeding the aircraft manufacturer’s operational parameters.

It has its own power supply, and carries enough fuel to run for

approximately 48 hours. It meets all DOT and EPA specifications,

and can be transported over the open road, without the need for

any special equipment or permits.

It has an environmentally-controlled operator’s cab to protect the

operator for all-weather environments. It has on-board satellite

communications that allow for real time data transmission to aircraft maintenance managers, and provides a lasting record of the

details of each de-contamination cycle.

It allows us to download any new treatment parameters, without

the need for on-site reprogramming. It allows for remote
30

diagnostics of the equipment, and provides telephone communications for technical support from any location on the planet.

The entire process takes approximately two and-a-half hours, and costs approximately $100 in consumables, such as fuel and filters. Connections to the aircraft are made via quick connectors, enabling a crew of two to hook up the aircraft in approximately 15

minutes, without the need for any special tooling.

There are no modifications required of the aircraft, and regular

ground handling crew personnel can be trained to operate the

equipment in approximately two to three days.

It uses a closed loop system of hoses to prevent any leak of potential pathogens into the local environment, and multiple units

can be daisy chained together, should the need be required for larger aircraft or buildings.

After the recent hurricanes that devastated many parts of Florida last season, we realized that there might be additional uses for

our equipment. After consultation with state and Federal disaster

management officials, we have added some additional features to

increase its versatility.

After the hurricanes, a number of shelters were left without

power and communications. With the addition of our power and

communications distributions center to the unit, we are now able

to pull up to a facility and restore power, conditioned air and heat,

and communications within 30 minutes of arrival.

On a recent visit by Pentagon officials, one officer commented

how this system could be used to provide power and conditioned air

or heat to field hospitals during the day, and then decontaminate

those same facilities during the night.

They also felt that this unit had additional applications. In addition to aircraft decontamination, they felt it would be useful to help

control the spread of disease on board ships, submarines, and tactical ground vehicles.

Currently, we have two prototype units, and have carried out extensive testing on a recently de-commissioned DC-9, which we have

purchased. We have completed the design of our production unit,

and the first units will begin rolling off the assembly line in August

of 2005.

We have hosted a number of demonstrations for a variety of

state, local, and Federal officials. A number of representatives from

the United States Department of Defense, up to and including two

star generals, have witnessed demonstrations of our unit.

We have recently been invited to participate in the FAA’s Center

of Excellence for Airliner Cabin Environmental Research, or ACER,

as you have heard spoken of today, in Auburn, Alabama, where our

product will undergo efficacy and reliability testing.

We have recently begun negotiations with another company, who

is an industry leader in de-contamination and sterilization technology, about incorporating their technology into our system. By integrating these two technologies, we believe we will have a comprehensive solution, with a biological kill spectrum that ranges

from simple viruses to the most resistant spoors, including anthrax.

Should the Federal Government decide to invest in technology

such as the AeroClave unit, we would suggest that they be viewed
31

and staged as regional disaster preparedness assets, possibly under

the control of FEMA or some similar agency. From a readiness

standpoint, we believe that the first units should be stationed at

major international airports.

Whether a natural occurring pandemic, or the act of a bio-terrorist, we believe that AeroClave can help protect the country’s transportation system, and help mitigate the disastrous financial consequences of such an event.

Whether it be de-contaminating aircraft or other transportation

vehicles, or establishing and supporting field medical units and

shelters, we feel the AeroClave unit could be a valuable asset in

our Nation’s defense.

That concludes my oral presentation. Again, I would like to

thank Mr. Chairman and the other members of the Committee for

the opportunity to speak with you today. Thank you.

Mr. KUHL. Thank you, Dr. Brown.

The Chair would recognize the gentleman from Illinois, Mr.

Costello.

Mr. COSTELLO. Mr. Chairman, thank you.

Dr. McCawley, let me ask just a couple of questions. One is, you

mentioned the cost of the bio-sensor, the stage alert. How much

would it cost per aircraft?

Dr. MCCAWLEY. Well, if you handle all three stages on there, it

would cost between $25,000 and $27,000. If you had the first two

stages on, you would probably be able to do it for under $2,000.

The third stage could be located at a terminal, to then check whatever filter was sampled on the aircraft.

Mr. COSTELLO. What is involved in the maintenance of the system and the cost of maintaining stages one, two, and three?

Dr. MCCAWLEY. The primary cost is in stage three, where you

could have re-agents that would have to be replaced at the end of

the life span, which would be $100 or $200, probably every three

to six months.

Mr. COSTELLO. Explain for me again, if you will, just quickly,

how the system works.

Dr. MCCAWLEY. Okay, the first stage looks at the size and number of particles that are coming through it.

Mr. COSTELLO. How does it do that?

Dr. MCCAWLEY. It uses a light scattering photometer. Just like

in sunlight, where you can see dust particles in the air, when you

shine a laser light through and you have an aerosol coming

through, the laser light is scattered by the particles. The amount

of scattering that is there is proportional to the size of the particle.

So each time a particle passes through, you get a pulse from the

scatter, and the height of the pulse is the sign of the particle. So

you know the number that have passed through and the size.

The second stage is a dye. It is a dye that has been tested out.

It is now for sale for evaluating powders. Any living microorganism

will take up this particular dye. Once the dye is taken up, it undergoes a change that makes it florescent. So you shine a UV light on

it, and the stuff fluoresces, just like a black light.

The third stage, we actually use bacteria phages to identify specific micro-organisms. The bacteria phage, particularly for bacteria,
32

is very, very specific, when you know exactly what you want to look

for.

Mr. COSTELLO. Where are you in the production of the system?

Dr. MCCAWLEY. We have all the components in pre-production

form. We are, right now, going through our casing of those, so that

we can have the tooling for making the cases that all of the materials will fit in. Pretty much, then we will roll them off the assembly line.

Mr. COSTELLO. Is it, in your opinion, possible that the system

could be used in large buildings in an airport terminal, an airport

environment?

Dr. MCCAWLEY. Yes, absolutely. We actually had originally envisioned the system to be used in urban environments, outdoor environments, and in buildings. So both of those would be locations.

Mr. COSTELLO. Would you have a cost estimate on that?

Dr. MCCAWLEY. Again, the cost would be pretty much the same,

whether it is on an airline or whether it is in a building. In a building, depending upon the number of HVAC heating ventilation and

air conditioning systems that you have, you might want to have

one in each of those systems. So it would depend upon the number

of different HVACs.

Mr. COSTELLO. How large of an area would one cover?

Dr. MCCAWLEY. Probably a cubic foot, at most. Most of that

would be in that third stage. The first two stages are hand-held

portable kinds of devices.

Mr. COSTELLO. Very good.

Dr. Brown, if you would, could you kind of walk me through how

the AeroClave’s decontamination unit operates.

Dr. BROWN. Sure, it is hooked up. We pull the unit up to the aircraft. It is a self-contained unit, the size of a 53 foot tractor trailer.

It backs up to the aircraft. The crew will then pop the emergency

exit windows over the mid-cabin, where we enter the supply air.

We also go in through the pre-conditioned air inlet at the rear

of the plane, which is what the ground air conditioning units are

hooked up to when you are sitting on the ramp. That forces the

heated air, as well, through the internal duct system of the plane.

The returns are brought out of the baggage compartment.

Then what we do is, we place wireless sensors inside the aircraft

that transmit telemetry data back to the unit to control the process. The aircraft is then brought up to temperature.

Once all these sensors in the plane reach a predetermined temperature, then the cycle begins a countdown. Say, for example, for

SARS, it is a certain temperature for 15 minutes. What we do is,

we double that time for 100 percent redundancy.

The clock will then count backwards from 30 minutes. At the end

of that hold time, the heaters drop off, the air conditioning comes

back on, and we cool down the plane.

So within approximately an hour and-a-half to two hours after

starting the cycle, the plane would be inhabitable again. There is

no retained heat in any of the upholstery or anything, so you could

easily board passengers at that time. It takes a crew of two about

15 minutes to hook the aircraft up and to pull it back apart again.

Mr. COSTELLO. Does the aircraft have to be modified or changed

at all?
33

Dr. BROWN. No, there are absolutely no modifications required of

the aircraft.

Mr. COSTELLO. You mentioned the cost of operating the system. I think you said it was $100 an hour. Could you go ahead and

elaborate on that?

Dr. BROWN. Sure. That is the direct operating expenses of the

unit. Given the fact that each process takes about two and a half

hours to complete a cycle, that cycle would cost approximately

$100, and that is primarily in diesel fuel and filters that would be

required to be changed every 30 days. So there is very little maintenance on the unit. The direct operating costs are less than $100,

each time you would perform a cycle on an aircraft.

Mr. COSTELLO. What is the cost of one of these machines?

Dr. BROWN. Our basic unit is around $500,000.

Mr. COSTELLO. About $500,000?

Dr. BROWN. Correct.

Mr. COSTELLO. I have the same question for you that I asked Dr.

McCawley. Can this system be used in an airport terminal?

Dr. BROWN. Absolutely, absolutely. It can be used for really any

space that can be compartmentalized, either internally or externally. We have had discussions with cruise ship operators and,

again, with the military, as far as ships, submarines, things like

that, rescue vehicles, ambulances, taxis, buses, subways, trains,

anything that can be compartmentalized, either externally or internally can be treated with this system.

Mr. COSTELLO. I understand that you have tested the prototype

on a de-commissioned DC-9.

Dr. BROWN. Correct.

Mr. COSTELLO. Can you tell us about the results of that test?

Dr. BROWN. Well, those tests were primarily designed to modulate the air flow and make sure that we could keep the temperature range even throughout the aircraft, and to get the cycle time

down as low as possible.

Again, time is money in the airline industry. Our initial goal was

to complete this process within four hours, and now we are down

around two hours.

The next stage in the testing process is efficacy testing, which

through the FAA Center of Excellence. We will actually be putting

biological indicators into the system.

What we have been going off of, to date, is empirical data that

has been supplied to us by virologists and microbiologists as to, at

what temperature can you kill certain diseases. We have proved

that we can get the cabin to temperature and maintain it without

damaging the aircraft. So the next part of the testing cycle is actually using biological indicators to quantify that.

Mr. COSTELLO. When do you expect this de-contamination system

to be in production?

Dr. BROWN. Well, the first production unit will come out in early

August of 2005.

Mr. COSTELLO. Do you have customers waiting to use the product?

Dr. BROWN. Yes, sir. We are currently negotiating a contract

with an Australian firm for the purpose of 100 units. This is a

large company that has global air operations that were substan-
34

tially injured financially by the SARS crisis. So even though our

contract is pending certification and efficacy testing, they are eager

to move to the front of the production line.

Mr. COSTELLO. Dr. Gendreau, I wonder if you might want to

comment on either one of the systems, either the alert system or

the de-contamination system?

Dr. GENDREAU. I do not know much about the systems and how

they would interact with the current ventilation system on the aircraft.

Mr. COSTELLO. Is there anything else that you would like to add

before my time is up?

Dr. GENDREAU. I would say that at this point, the aircraft cabin

is safe, if there is a system that has a functional environmental

control system that includes a HEPA filter. I guess that is about

it.

Mr. COSTELLO. I have one last question, if I may. You talk about

both the Government, aviation industry and the medical community, and the need to better educate the public. I wonder if you

might want to elaborate on your suggestions as to how all three

should go about educating the public.

Dr. GENDREAU. Well, we could do it in the same fashion that the

CDC did in regards to the hand hygiene initiative that they put out

several years ago to promote proper hand hygiene in the health

care workers and the general public. That would be a good means

of doing it. Public service announcements, particularly when there

is an outbreak, would be useful, I believe.

Mr. COSTELLO. Mr. Chairman, thank you. I see my time is up,

and I thank our witnesses for being here today.

Mr. KUHL. Thank you, Mr. Ranking Member.

Mr. Meenan, I have got just a couple of questions. I am curious

as to if you have an estimate, and I know it is very difficult to

place estimates. But do you have some sort of an estimate on what

the SARS outbreak cost the airline industry?

Mr. MEENAN. We never attempted to break out the SARS impact

from the other issues that were going on at the time, particularly

the Iraq war. I know I have seen a number used publicly that said

the industry sustained a $10 billion loss. I do not know where that

number fame from.

We do have some data on traffic to and from Toronto during that

period, that indicates that it was a very substantial impact. But we

have not tried to back that up into any specific number.

Mr. KUHL. Since that time, has there been an improved communication within the industry to try to deal with this issue?

Mr. MEENAN. As my testimony alluded to, we have been working,

on a very regular basis, with CDC, the World Health Organization,

and other bodies around the world to deal with the whole array of

issues involving the possible spread of disease by aircraft. I think

dealing with things like contact tracing, dealing with the installation of filters on aircraft, the entire spectrum of activity has moved

us in a very positive direction.

Mr. KUHL. Do people in the airline industry, particularly employees, ever refuse to put sick people on airplanes?

Mr. MEENAN. The existing regulations limit very substantially

the ability of an airline to do that. The anti-discrimination regula-
35

tions of the Department of Transportation are somewhat ambiguously worded, but they are worded in such a way that it greatly

inhibits the ability of the carrier to refuse transport to anyone who

is not easily recognizable as posing an immediate threat. Obviously, most ill passengers do not fall into that category.

So we have been seeking some additional guidance in really

working again with CDC. We defer to CDC as to the best way to

address these problems.

But the airlines do obviously engage in sort of common sense approaches to dealing with passengers who appear ill. They try to encourage them to see their physicians to deal with their health

issues and so forth.

Mr. KUHL. Do you have any suggestions, or do you care to elaborate on what other types of oversight might be potentially helpful

to the industry?

Mr. MEENAN. As I said, we have specifically asked for additional

guidance as to what exactly the Department of Transportation is

referring to in this existing regulation. I think that because the diseases we are dealing with here, the symptoms may not be clear.

The communicable phase may not be understood at the time the

disease comes out.

It has to be somewhat of an ad hoc approach to the situation.

But it has to involve health care professionals at that stage. I think

expecting airline employees to fill the role of a trained medical professional is not particularly practical.

Mr. KUHL. Dr. McCawley, do you have any thoughts on that particular issue, as to ways that we could help the industry out in

avoiding contamination within the cabins?

Dr. MCCAWLEY. Well, actually, as I said, the kinds of things you

would be looking for are what we are measuring with our devices,

particularly for the terrorist attacks, which have been bothering me

for quite awhile now.

For the terrorist attacks, if you can catch somebody doing it and

there is an alarm that goes off, you can prevent a lot of contamination that you then do not have to clean up and you do not have

to worry about it. So the less that happens, the better off you are.

Prevention is the key. that is why CDC added ‘‘and Prevention’’ to

its title, I suppose.

Mr. KUHL. Lastly, Dr. Brown, I know I am not looking for you

to disclose all of your potential clients. But I am curious as to what

other countries, other industries, might potentially avail themselves of your product, that are seeking you out to try to engage

your services.

In other words, you mentioned an industry in Australia. Are

there other countries who are trying to be as preventative as we

are, who are looking to resolve these issues before they become

issues?

Dr. BROWN. Oh, very much so. We are now in discussions with

qualified customers. We have had a lot of ‘‘tire kickers’’ I guess, for

lack of a better term. But we quickly sort those out, and we are

dealing now with qualified customers from several countries in Europe, from the Middle East, and from Southeast Asia.

Besides the airline industry, we are also speaking with representatives from the shipping container industry, from the cruise
36

line industry, from the rental car industry, and mass transit authority, particularly in Europe.

Europe seems to be driven by mass transit. What seems to be

happening over there is that on an almost daily basis, the tabloids

are bringing these horrendous scare tactics stories to the press, and

it is driving people away from mass transit, which is putting them

into private vehicles, which is now clogging their system.

So they are desperately seeking a way to give the public a sense

of security that it is indeed safe to ride on the subway or the buses.

So those are the industries that we are dealing with now, and the

military has several other potential uses in mind.

Mr. KUHL. Well, thank you. Do any of you gentlemen have anything further that you would like to offer at this time, any additional comments that we did not elicit from you? Dr. Gendreau?

Dr. GENDREAU. I would like to just say something in terms of

how do you screen somebody, in terms of getting on an aircraft.

Right now, the resources that are available vary between airport

to airport. One resource that is used by some airlines right now is

private medical companies, in which someone can call a physician

and express concerns about the fitness to fly of a particular passenger.

Then that physician can get on the phone and interview that

particular passenger, and make a determination of whether or not

that person should fly or not.

Mr. KUHL. Dr. Brown, you had something you wanted to say?

Dr. BROWN. Yes. It seems like the reoccurring theme that I have

heard from a number of members of the Committee is being preemptive or being proactive, instead of reactive.

It has always been my experience that it is less expensive to prevent than to mitigate. So I would encourage members of the Committee to be supportive of the efforts, such as the FAA Center of

Excellence, that does bring together Government and private industry, with a mandate not to reinvent the wheel, but to incorporate existing technologies and bring them to market.

Because I do believe that we do face a potential threat, whether

it is imminent or in the very near future. Who knows? But I think

it will be beneficial to all if we are adequately prepared before the

event begins, rather than trying to mop up the effects after it

starts. I thank you for your leadership in bringing this issue before

us.

Mr. KUHL. Well, if there is nothing further, gentlemen, Mr.

Meenan, Dr. Gendreau, Dr. McCawley, and Dr. Brown, thank you

very much for coming. Thank you for your patience and understanding that we were called away for a short period of time, and

we thank you for your testimony. We appreciate your being here

today. With that, we will conclude the hearing.

[Whereupon, at 4:35 p.m., the subcommittee was adjourned.]
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