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Interim Guidance for Decontamination and Waste Disposal in a Commercial Passenger Aircraft Carrying a Traveler with Ebola Disease or Other Viral Hemorrhagic Fever (VHF)										Related Pages
										This guidance addresses the event of a commercial passenger aircraft traveler exhibiting symptoms consistent with Ebola disease or another viral hemorrhagic fever (VHF, e.g., Marburg virus disease, Lassa fever, Rift Valley fever, Crimean-Congo hemorrhagic fever). The guidance only applies to travelers with identified exposures or laboratory-confirmed infection. To date, there is no documented evidence of hemorrhagic fever viruses being transmitted on an aircraft1.
**What aircraft this applies to**: This guidance applies to commercial passenger aircraft located in the United States.
**Who this is for**: Airlines and contract companies whose staff may clean, disinfect, or remove contaminated waste from an aircraft.
**How to use**: Use these recommendations 1) to guide personnel in cleaning, disinfection, and waste disposal procedures after a flight, 2) to select effective disinfectants, and 3) as a reference for relevant federal regulations.
**Disclaimer:**This guidance does not relieve any person of the obligation to comply with all applicable Federal Aviation Administration (FAA) regulations for issues related to the aircraft and Occupational Safety and Health Administration (OSHA) regulations for those workers conducting the decontamination of the aircraft or handling and disposing waste.
**Related guidance**:
CDC’s Preventing Spread of Disease on Commercial Aircraft: Guidance for Cabin Crew details general infection control precautions and management of a sick traveler in-flight. This guidance also provides guidance on cleaning, disinfection, and waste disposal procedures during flight.
Per federal regulations, reporting death or illness is required for domestic flights between U.S. states and territories, and on international flights arriving in the United States. Reporting tools for airlines, cabin crew, and pilots are available in the Airline Guidance for Reporting Death/Illness.Routine practices regardless of the presence of a sick traveler
Airlines should direct the airline personnel and/or designated cleaning crew to clean the passenger aircraft using airline-specified detergents and disinfectants and/or refer to the Guide to Hygiene and Sanitation in Aviation [PDF – 71 pages] developed by the World Health Organization (WHO).  As certain detergents or disinfectants may be incompatible with aircraft components, any detergent or disinfectant used on board an aircraft should be approved by the aircraft manufacturer.
Recommendations for cleaning and disinfection of the aircraft when a traveler exhibits symptoms consistent with a VHF
The approach for cleaning and disinfecting the aircraft depends on the symptoms of the ill traveler at the time they were on the passenger aircraft. The following are approaches for an ill traveler who was symptomatic during a flight and is suspected of having a VHF but does not yet have a laboratory-confirmed diagnosis.
If the ill traveler had **NO** **gastrointestinal (vomiting or diarrhea) or hemorrhagic (bleeding) symptoms while on the aircraft**, the person should not have contaminated their environment. Routine cleaning and laundering can be conducted by airline personnel or designated cleaning crew/environmental services employees. These recommendations apply even if a VHF is confirmed by laboratory testing after the flight.
If the ill traveler **had gastrointestinal (vomiting or diarrhea) or hemorrhagic (bleeding) symptoms while on the aircraft**, the aircraft should be taken out of service immediately. The aircraft can be held until the laboratory-confirmed diagnosis has been obtained. If a VHF is confirmed, follow the cleaning and disinfection process outlined below. The airline may also choose to assume the ill traveler is infected and proceed to the cleaning and disinfecting process outlined below without waiting for laboratory confirmation. If a VHF has been ruled out, the aircraft can be cleaned using conventional protocols.Recommendations for cleaning and disinfection of the aircraft when a VHF is confirmed and traveler had gastrointestinal or hemorrhagic symptoms at the time they were on the aircraft
Follow OSHA’s Fact Sheet 3756 on Cleaning and Decontamination of Ebola on Surfaces – Guidance for Workers and Employers in Non-Healthcare/ Non-Laboratory Settings [PDF – 4 pages].
Select and provide personal protective equipment (PPE) to protect cleaning workers from exposure to hemorrhagic fever viruses and to chemical hazards from the cleaning and disinfectant agents. Refer to the OSHA PPE Selection Matrix [PDF – 3 pages] for assistance in determining the appropriate PPE. Employers must comply with OSHA’s standards on Bloodborne Pathogens (29 CFR 1910.1030), PPE (29 CFR 1910.132), Respiratory Protection (29 CFR 1910.134), Hazard Communication (29 CFR 1910.1200), and other requirements, including those established by state plans, whenever such requirements apply.
For non-porous surfaces (e.g., door handles, arm rests, tray tables) contaminated by the ill traveler, use a disinfectant included in the Environmental Protection Agency (EPA) List L: Disinfectants for Use Against the Ebola Virusor List Q: Disinfectants for Emerging Viral Pathogens (EVPs). Always use disinfectants according to manufacturer’s instructions. As certain disinfectants may be incompatible with aircraft components, any disinfectant used on board an aircraft should be approved by the aircraft manufacturer.
Contaminated porous materials (e.g., linens, carpet, pillows, seat cushion) and waste generated in the care of the ill traveler should be properly contained, packaged, and disposed of as a category A infectious substance according to State, EPA, and Department of Transportation (DOT) regulations, including DOT Hazardous Materials Regulations (HMR, 49 CFR, Parts 171-180). Store the properly contained contaminated material in a secure area or room that is not being used until it can be picked up by a company with a permit for transporting Category A infectious substances (DOT Special Permit 16279). Additional guidance for managing contaminated waste include DOT Safety Advisory: Packaging and Handling Ebola Virus Contaminated Infectious Waste for Transportation to Disposal Sites and Managing Solid Waste Contaminated with a Category A Infectious Substance [PDF – 114 pages] published by a Federal interagency working group.Additional Considerations
If a traveler is confirmed to have a VHF and had gastrointestinal or hemorrhagic symptoms at the time they were on the aircraft, the airline may choose to arrange for a contract company to decontaminate the aircraft and manage contaminated waste. If contracted support is required, companies that may have experience performing this kind of cleaning and decontamination include those certified through associations such as the National Institute of Decontamination Specialists (NIDS), Institute of Inspection, Cleaning and Restoration Certification (IIRC), or American Bio Recovery Association (ABRA), or who have completed training as outlined in the OSHA Hazardous Waste Operations and Emergency Response Standard (HAZWOPER). The contract company must comply with OSHA’s standards on Bloodborne Pathogens (29 CFR 1910.1030), PPE (29 CFR 1910.132), Respiratory Protection (29 CFR 1910.134), Hazard Communication (29 CFR 1910.1200), and other requirements, including those established by state plans, whenever such requirements apply.Airlines should share CDC’s Interim Guidance for Managers and Workers Handling Untreated Sewage from Individuals with Ebola in the United States and Frequently Asked Questions (FAQs) on Interim Guidance for Managers and Workers Handling Untreated Sewage from Suspected or Confirmed Individuals with Ebola in the U.S. with relevant personnel and/or contractors responsible for cleaning lavatories and emptying waste storage tanks. Personnel should routinely handle lavatory wastes using proper PPE and hygiene practices for all flights2. There has been no evidence to date that ebolaviruses or other hemorrhagic fever viruses can be transmitted via exposure to sewage3.  However, there may be local requirements for pre-treating (adding disinfectant) this waste prior to discharge and airlines should check with the local wastewater treatment plant.
The FAA has investigated vaporized hydrogen peroxide technology as a potential biocide; this may be considered as an option for disinfection of a passenger aircraft4-8. Investigators have also been evaluating other potential fumigants that may be of use, including methyl bromide and methyl iodide9. The use of these fumigants may require a Federal Insecticide, Fungicide, and Rodenticide Act (FIFRA) Section 18 Exemption from the EPA.Definitions
*Contract company*: A company hired to complete a needed task. Regarding cleaning and disinfecting aircraft of ebolaviruses or other hemorrhagic fever viruses, the contract company should be specialized in disinfecting, handling, and discarding of toxic chemicals, infectious agents, and other hazardous materials with experience in cleaning biohazard and aircraft interiors.
*Decontamination:* Making an item safe to handle or an area safe to occupy.  The process may include cleaning and disinfection to remove and kill pathogens.
*Detergent*: A surfactant or a mixture of surfactants with cleaning properties in dilute solutions to assist in removing soil and dirt from surfaces or items.
*Disinfectants*:  Chemical products that will make certain biological agents inactive. Specific to ebolaviruses and other hemorrhagic fever viruses, use a disinfectant included in EPA List L: Disinfectants for Use Against the Ebola Virus or List Q: Disinfectants for Emerging Viral Pathogens (EVPs). Always use disinfectants according to manufacturer’s instructions. Any disinfectant used on board an aircraft should be approved by the aircraft manufacturer.
*Personal protective equipment (PPE)*: Equipment worn to prevent exposure to hazardous substances (e.g., chemicals, infectious agents, particles).References
Regan JJ, Jungerman R, Montiel SH, Newsome K, Objio T, Washburn F, Roland E, Petersen E, Twentyman E, Olaiya O, Naughton M, Alvarado-Ramy F, Lippold SA, Tabony L, McCarty CL, Kinsey CB, Barnes M, Black S, Azzam I, Stanek D, Sweitzer J, Valiani A, Kohl KS, Brown C, Pesik N; Centers for Disease Control and Prevention (CDC).  Public health response to commercial airline travel of a person with Ebola virus infection – United States, 2014.  *MMWR Morb Mortal Wkly Rep.* 2015;64(3):63-6.
CDC (2002). Guidance for controlling potential risks to workers exposed to class B biosolids. [PDF – 9 pages] NISOH Publication Number 2002-149
Weber, D.J. and W.A. Rutala (2001). Risks and Prevention of Nosocomial Transmission of Rare Zoonotic Diseases. [PDF – 11 pages] Healthcare Epidemiology. 32:446-456
Chou, S.F., M.H. Sk, N.I. Sofyan, R.A. Overfelt, W.F. Gale, H.S. Gale, C.G. Shannon, J.W. Fergus, and J. Watson, “Evaluation of the Effects of Hydrogen Peroxide on Common Aviation Structural Materials,” FAA Technical Report DOT/FAA/AM-09/23, 2009, Washington, DC: Office of Aerospace Medicine.Chou SF, Gale WF, Gale HS, Shannon CG, Buschle-Diller G, Sofyan NI. Evaluation of airliner cabin textile materials after vapour phase hydrogen peroxide decontamination. Materials Science and Technology. 2010;26(1):66-80.
Gale, W.F., H.S. Gale, and J. Watson, “Field Evaluation of Whole Airliner Decontamination Technologies for a Narrow-Body Aircraft,” FAA Technical Report DOT/FAA/AM-08, 2008, Washington, DC: Office of Aerospace Medicine.
Gale, W.F., H.S. Gale, and J. Watson, “Field Evaluation of Whole Airliner Decontamination Technologies—Wide-Body Aircraft With Dual-Use Application for Railcars,” FAA Technical Report DOT/FAA/AM-08/4, 2008, Washington, DC:Office of Aerospace Medicine.
Shaftstall, R.M., R.P. Garner, J. Bishop, L. Cameron-Landis, D.L. Eddington, G. Hau, S. Spera, T.Mielnik, and J.A. Thomas, “Vaporized Hydrogen Peroxide (VHP®) Decontamination of a Section of a Boeing 747 Cabin,” FAA Technical Report DOT/FAA/AM-06/10, 2006, Washington, DC: Office of Aerospace Medicine.
Adrion AC, Scheffrahn RH, Serre S, Lee SD. Impact of sporicidal fumigation with methyl bromide or methyl iodide on electronic equipment. *J Environ Man* 2019;231:1021-7.Additional Resources
CDC Ebola (Ebola Virus Disease), Signs and SymptomsCDC Quarantine and Isolation Airline GuidanceFAA Occupational Safety and Health Standards for Aircraft Cabin Crewmembers [PDF – 3 pages]
OSHA NIOSH Infosheet: Protecting workers who use cleaning chemicals [PDF – 4 pages]
Smither S, Phelps A, Eastaugh L, Ngugi S, O’Brien L, Dutch A, Lever M. Effectiveness of four disinfectants against Ebola virus on different materials. Viruses 2016;8(7):185.
The U.S. Code of Federal Regulations—Interstate Quarantine [42 CFR 70.4]
The U.S. Code of Federal Regulations—Foreign Quarantine [71.21(b)]
U.S. EPA Selected EPA Registered Disinfectants
U.S. EPA Where You Live – State Medical Waste Programs and Regulations
							
					
							Last Reviewed:  January 11, 2023						Source: 	Centers for Disease Control and Prevention, National Center for Emerging and Zoonotic Infectious Diseases (NCEZID), Division of Global Migration and Quarantine (DGMQ)
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