UPDATES ON EBOLA HAEMORRHAGIC FEVER

UPDATES ON EBOLA HAEMORRHAGIC FEVER
Ebola virus is causing the worst outbreak ever seen in three West African countries ‐ Liberia,
Sierra Leone and Equatorial Guinea. It’s infected at least 1,711 people and killed more than 932
of them.

The disease has been reported in Nigeria and currently there is a suspected case each in Saudi
Arabia and Uganda.

FAQs on EBOLA
1. How is the disease contracted/spread?
Infection is by contact with blood or body fluids of an infected ailing patient /person or animal,
and also by contact with contaminated objects. It is spread by contact, it is not air borne.
2. What is the incubation period?
The incubation period is 1 ‐ 21days, and at this stage someone is well enough to travel but
cannot transmit infection. On board spread has therefore been estimated to be minimal.
3. Can someone infect others during the incubation period?
NO. During the incubation period, someone does not shed the virus.
4. When is an infected person able to transmit the disease?
Ebola is transmitted by someone only when they are already ill and have developed symptoms.
At this point, they are usually too ill to travel by air.
5. What are the symptoms of Ebola?
Symptoms include fever, weakness, muscle pain, headache and sore throat. This is followed by
vomiting, diarrhea, rash, and in some cases, bleeding.
Fever is usually the first symptom and someone deteriorates rapidly after this and may not be
fit to fly.
6. Is there a vaccine for Ebola?
There is no licensed vaccine.
7. Is there treatment for Ebola?
No specific drug has been shown to help people infected with Ebola.
However, patients are given:
   Saline to replace fluids lost to vomiting and diarrhea;
   Painkillers to reduce fever and to help fight the general misery the virus causes; and
   Antibiotics to prevent what doctors call secondary infections.

Early treatment has greatly improved survival of the patients.
Patients need to be isolated so as not to infect other people.
8. Does everyone who gets the disease die?
NO. Without any intervention, 90% of patients die. With basic support for fever, diarrhea and
vomiting, the death rate is reduced to 61%.
9. Is Ebola a risk to travelers to the affected area?
WHO notes that the risk to travelers to affected regions is low: “The risk of a tourist or
businessman/woman becoming infected with Ebola virus during a visit to the affected areas
and developing disease after returning is extremely low, even if the visit included travel to the
local areas from which primary cases have been reported.
10. Transmission requires direct contact with blood, secretions, organs or other body fluids of
    infected living or dead persons or animal, all unlikely exposures for the average traveler.
    Tourists are in any event advised to avoid all such contacts”.
11. What is the risk of being infected in the aircraft cabin?
WHO notes that Ebola is only contagious when the infected person is displaying symptoms of
the disease. Symptoms include fever, weakness, muscle pain, headache and sore throat. This is
followed by vomiting, diarrhea, rash, and in some cases, bleeding. It is unlikely that someone
who is symptomatic will feel well enough to travel. And even that unlikely event “the risk to
fellow travelers is very low.”
12. How can one prevent themselves from being infected?
  i.    Frequent proper hand washing with soap and water.
  ii.   Avoid touching body parts like the eyes, nose, mouth, face, etc. unnecessarily.
 iii.   Avoid touching contaminated surfaces.
 iv.    Avoid all contact with blood and body fluids of infected people or animals.
  v.    Do not handle items that may have come in contact with an infected person’s blood or
        body fluids.
 vi.    Avoid intimate relations with someone that has recovered from the disease for at least
        7 weeks.
If you stayed in the areas where Ebola cases have been recently reported seek medical
attention if you develop any of these symptoms (fever, headache, achiness, sore throat,
diarrhea, vomiting, stomach pain, rash, or red eyes).

13. How can airline staff protect themselves as they handle passengers and aircrafts that have
    travelled to and from West Africa?
Airline staff will include cabin crew, cleaning crew, maintenance crew and passenger services
agents. All the have guidelines to facilitate prevention of infection as they conduct their duties.
Medical staff have separate guidelines from the Ministry of Health. Please look at the guidelines
attached.
14. What must we as KQ staff do to prevent Ebola coming into Kenya through our aircrafts?
All staff must be on high alert.
    i.    Cabin crew:
Ensure 100% profiling of all boarding passengers and any guest requesting for assistance has
undergone PMC Procedures and holds a clearance from KQ Medical.
 ii.      CSAs:
100% physical and face‐to‐face profiling of all passengers during check‐in. Please do not allow
buddy check‐ins.
This profiling should be extended to the Transfer desk and the gates.
Stay alert on all sick passengers and ensure proper PMC procedures are followed.
 iii.     Cabin Groomers:
Make sure aircrafts are thoroughly cleaned according to procedures especially the areas that
passengers tend to touch often.
Report any suspicious body fluids e.g vomit, urine, blood etc; that they come across in the
aircraft to the KQ Supervisor.
 iv.      Out‐Station Managers:
Ensure surveillance and screening is being done by the Airport or Port Health Authorities from
their stations.
Provide periodic updates to KQ Medical Division in Nairobi.
15. What are we doing at JKIA?
The following measures are currently in place at JKIA:

        Surveillance and contact tracing is being carried out at JKIA on all flights from West Africa

        Screening by observation and temperature checks

        All flights from West Africa, EBB and Addis have been allocated different gates to be
         rescreened, including all transit passengers

       Completion of a KQ Surveillance form on board for all flights originating from West Africa.

16. What are we doing in affected out‐stations?

        All passengers will undergo surveillance and temperatures will be taken on boarding

        Our ground staff at the stations have been sensitized on prevention and provided with
         necessary PPEs

        Advised against attending any gatherings and funerals

        Clinicians from the Medical Division have been dispatched to FNA, ROB and ACC to
         support the teams.
The chain of preparedness extends to Public Health Departments in the counties.

Close 24 hour monitoring of the situation with daily updates ongoing at KQ.

October 2011

                       SUSPECTED COMMUNICABLE DISEASE

General Guidelines for Passenger Agents

The following are general guidelines for passenger agents who may be faced with a
suspected case of communicable disease at the airport.
During an outbreak of a specific communicable disease, the World Health
Organization (WHO) or member states may modify or add further procedures to
these general guidelines.
However, these general guidelines provide a basic framework of response to
reassure passenger agents and help them manage such an event.

A communicable disease is suspected when a traveller:

       -    Has a visible skin rash or,
       -    Has a severe cough or,
       -    Is obviously unwell and/or,
       -    Complains of any of the following:

                •   Severe cough
                •   Fever
                •   Bruising or bleeding without previous injury
                •   Persistent diarrhea
                •   Skin rash (non visible)
                •   Persistent vomiting

Most of these signs and/or symptoms may not be obvious at the counter. However,
when in doubt regarding the health of a traveller, especially during an outbreak, refer
to the airline procedures.

       1.       Call your supervisor.

       2.       If the supervisor agrees with your concerns and if medical support is
                available (own medical department or outside designated physician or
                group) contact that support immediately.

       3.      If the supervisor agrees with your concerns but medical support is not
               immediately available, deny boarding and ask the traveller to obtain
               medical clearance in accordance with your airline’s policy. For some

countries you may also have to involve the company's Customer
     Complaint Resolution Official (CCRO).

4.   If assistance is required to escort a sick traveller, and if the sick
     traveller is coughing, ask him/her to wear a face mask. If no mask is
     available or the sick traveller cannot tolerate the mask, e.g. because of
     breathing difficulties, provide tissues and ask him/her to cover the
     mouth and nose when coughing, sneezing or talking.

     If masks are available but the sick traveller cannot tolerate a mask and
     the airline recommends that designated passenger agents should do
     so under those circumstances, the airline should ensure that their
     passenger agents have adequate training in its use to ensure they do
     not increase the risk (for example by more frequent hand-face contact
     or adjusting and removing the mask).

October 2011

                     SUSPECTED COMMUNICABLE DISEASE

General Guidelines for Cabin Crew

The following are general guidelines for cabin crew when facing a suspected case of
communicable disease on board.
During an outbreak of a specific communicable disease, the World Health
Organization (WHO) or member states may modify or add further procedures to
these general guidelines.
However, these general guidelines provide a basic framework of response to
reassure cabin crew and help them manage such an event.

A communicable disease is suspected when a traveller (passenger or a
crewmember) has a fever (temperature 38°C/100°F or greater) associated with one
or more of the following signs or symptoms:

          -    Appearing obviously unwell
          -    Persistent coughing
          -    Impaired breathing
          -    Persistent diarrhea
          -    Persistent vomiting
          -    Skin rash
          -    Bruising or bleeding without previous injury
          -    Confusion of recent onset

Note 1: This list of signs and symptoms is identical to that listed in the Health part of
the ICAO Aircraft General Declaration and in the World Health Organization
International Health Regulations (2005) 2nd Edition.

Note 2: If food poisoning from in-flight catering is suspected, proceed as per
company-established protocol. The captain still has to follow the ICAO procedure of
section 13 below.

Note 3: If temperature of the affected person is normal but several travellers have
similar symptoms, think of other possible public health issues such as chemical
exposure.

1.   If medical support from the ground is available, contact that ground support
     immediately and/or page for medical assistance on board (as per company
     policy).

2.   If medical ground support and/or on board health professional is available,
     crew should follow their medical advice accordingly.

3.   If no medical support is available, relocate the ill traveller to a more isolated
     area but only if two rows can be cleared immediately in front of a solid
     bulkhead. If the ill traveller is relocated, do not reuse the vacated seat and
     make sure that the cleaning crew at destination is advised to clean and
     disinfect both locations.

4    Designate one cabin crew member to look after the ill traveller, preferably the
     crew member that has already been dealing with this traveller. More than one
     cabin crew member may be necessary if more care is required.

5    When possible, designate a specific lavatory for the exclusive use of the ill
     traveller. If not possible, clean and disinfect the commonly touched surfaces
     of the lavatories (faucet, door handles, waste bin cover, counter top) after
     each use by the ill traveller.

6.   If the ill traveller is coughing, ask him/her to follow respiratory etiquette:
               i.          Provide tissues and the advice to use the tissues to cover the
                           mouth and nose when speaking, sneezing or coughing.
               ii.         Advise the ill traveller to practice proper hand hygiene∗. If
                           the hands become visibly soiled, they must be washed with
                           soap and water.
               iii.        Provide an airsickness bag to be used for the safe disposal
                           of the tissues.

7.   If a face mask is available, the ill traveller should be asked to wear it. As soon
     as it becomes damp/humid, it should be replaced by a new one. These masks
     should not be reused and must be disposed safely after use. After touching
     the used mask (e.g., for disposal), proper hand hygiene∗ must be practiced
     immediately.

8.   If the ill traveller cannot tolerate a mask or refuses it, the designated cabin
     crew member(s) or any person in close contact (less then 1 metre) with the ill
     person should wear a mask. The airline should ensure that their cabin
     crewmembers have adequate training in its use to ensure they do not
     increase the risk (for example by more frequent hand-face contact or by mask
     adjustment, or by repeatedly putting it on and off.)

9.   If there is a risk of direct contact with body fluids, the designated cabin crew
     member should wear disposable gloves. Gloves are not intended to replace
     proper hand hygiene.∗ Gloves should be carefully removed as per training
     syllabus and discarded as per paragraph (10) and hands should be washed
     with soap and water. An alcohol-based hand rub can be used if the hands are
     not visibly soiled.

10.    Store soiled items (used tissues, face masks, oxygen mask and tubing, linen,
       pillows, blankets, seat pocket items, etc.) in a biohazard bag if one is
       available. If not, use a sealed plastic bag and label it “biohazard”.

11.    Ask accompanying traveller(s) (spouse, children, friends, etc.) if they have
       any similar symptoms.

12.    Ensure hand carried cabin baggage follows the ill traveller and comply with
       public health authority requests.

13.    As soon as possible, advise the captain of the situation because he/she is
       required by the International Civil Aviation Organization regulations (ICAO
       Annex 9, Chapter 8, and paragraph 8.15) and the World Health Organization
       International Health Regulations (WHO IHR 2005, Article 28(4)) to report the
       suspected case(s) to air traffic control. Also remind the captain to advise the
       destination station that cleaning and disinfection will be required.

14.    Unless stated otherwise by ground medical support or public health officials,
       ask all travellers seated in the same row, 2 rows in front and 2 rows behind
       the sick traveller to complete a passenger locator card if such cards are
       available on the aircraft or at the arrival station.

∗ A general term referring to any action of hand cleansing, performed by means of
applying an antiseptic hand rub (i.e., alcohol-based hand rub) if hands are not visibly
soiled, or washing one’s hands with soap and water for at least 15 seconds.
Touching the face with hands should be avoided. Hands should be washed
frequently.

March 2014

                    SUSPECTED COMMUNICABLE DISEASE

General Guidelines for Cleaning Crew

The following are general guidelines for cleaning crew who have to clean an arriving
aircraft with a suspected case of communicable disease.
During an outbreak of a specific communicable disease, the World Health
Organization (WHO) or member states may modify or add further procedures to
these general guidelines.
However, these general guidelines provide a basic framework of response to
reassure the cleaning crew and help them manage such an event.

       1.     Wear impermeable disposable gloves.
       2.     Remove and discard gloves if they become soiled or damaged, and
             after cleaning.
       3.    Use only cleaning agents and disinfectants that have been approved
              by aircraft manufacturers at recommended concentrations and contact
              times.
       4.     Begin the cleaning at the top (light and air controls) and proceed
              downward progressively working from clean to dirty areas.

       5      Surfaces to be cleaned

              Affected seat, adjacent seats same row, back of the seats in the row in
              front),
               - Light and air controls
               - Adjacent walls and windows
               - Seatbacks (the plastic and/or metal part)
               - Individual video monitor
               - Tray tables
               - Armrests
               - Remove seat pocket contents and replace. Safety Briefing Card
                   can be cleaned with the approved disinfectant

               In the lavatory(ies) used by the sick traveller:
               - door handle, locking device, faucet, wash basin, adjacent walls
                    and counter and toilet seat

               * In exceptional circumstances public health authorities may require
               additional cleaning.

6.   Disinfection of upholstery, carpets, or storage compartments is only
     indicated when they have been soiled by body fluids. In such cases,
     use absorption agent first if required, clean any visible soil and
     disinfect before vacuuming to eliminate the risk of re-aerosolization.

7.   Wash hands with soap and water immediately after gloves are
     removed. An alcohol based hand sanitizer can be used if the hands
     are not visibly soiled.
8.   Dispose of soiled material and gloves in a biohazard bag if one is
     available. If not, use a sealed plastic bag and label it as biohazard.
9.   Do not use compressed air. It might re-aerosolize infectious material.

October 2011

                    SUSPECTED COMMUNICABLE DISEASE

General Guidelines for Maintenance Crew

The following are general guidelines for maintenance crew who carry out
maintenance on an arriving aircraft with a suspected case of communicable disease.
During an outbreak of a specific communicable disease, the World Health
Organization (WHO) or member states may modify or add further procedures to
these general guidelines.
However, these general guidelines provide a basic framework of response to
reassure the maintenance crew and help them manage such an event.

High Efficiency Particulate Air (HEPA) filters

About 50% of the air in most modern aircraft is re-circulated. However, air is only
reused after having gone through HEPA filters. Microorganisms suspended in air,
including bacteria and viruses, are captured by HEPA filters applied to aircraft air
circulation systems. Just like HEPA filters used in containment laboratories, the best
HEPA cabin air filters have a microbial removal efficiency of >99.999% for bacteria
and viruses. As used filters may contain microorganisms trapped in their meshes
after hours of filtering activity, it is good routine practice to apply reasonable
precautions when handling them, e.g. during their exchange.

There is no need to change HEPA filters on an arriving aircraft that has carried a
suspected case of communicable disease. HEPA filters should rather be changed at
the intervals recommended by the filter manufacturer.

When replacing HEPA filters:

       1.   Wear disposable gloves.
       2.   Avoid hitting, dropping or shaking the filter. If that cannot be achieved,
            wear a face mask and eye protection.
       3.   Do not use compressed air to try and clean a filter (it may create an
            aerosol).
       4.   The used HEPA filter should be disposed of in a sealed plastic bag. A
            specific biohazard bag is not required. Put the used disposable gloves in
            the same plastic bag.
       5.   Wash hands with soap and water when the task is finished.

Vacuum waste tank

Since the external venting system of vacuum waste tanks is not equipped with
filtering devices capable of preventing the spread of viral or bacterial contamination, it
is not recommended to vent the vacuum waste tanks inside a hangar. If venting of
the vacuum waste tanks has to be done inside a hangar, it is recommended to use a
technique that exhausts the air outside the hangar.

Bird Strike*

The issue of a potential health risk to personnel involved in maintenance tasks
following a bird strike has been discussed with bio-safety specialists at the World
Health Organization and, while the risk is remote, the following general measures are
recommended:

- Wear disposable gloves
- If body contact is unavoidable while cleaning the engine, wear a disposable
  coverall, and a face mask and eye protection.
- Do not use air or water under pressure to clean the part of the aircraft that was hit
  by the bird.
- Remove the bird remains and put them in a plastic bag.
- Do not touch face, eyes, nose, etc. with your gloves.
- Remove the gloves, the disposable coverall and mask (if used) and put them in the
  same plastic bag as the remains and seal the bag.
- Dispose of the bag as for normal garbage.
- Wash hands thoroughly with soap and water.
The US Centers for Disease Control and Prevention (CDC) provides detailed
guidelines for bird strike in “affected areas”. These guidelines can be reviewed on
the following CDC website:
 http://wwwnc.cdc.gov/travel/page/avian-flu-bird-collisions.htm

   *There is also a direct electronic link for this specific guideline:

   http://www.iata.org/SiteCollectionDocuments/Documents/Guidelines_bird_strike_
   042008.pdf