22
1385 / 5 / 15 1385 / 5 / 15 ل س رل ت ن ك امه رن ب ه لان سا ت س ش ن ل س رل ت ن ك امه رن ب ه لان سا ت س ش ن ور$ ي ر ه ش ور$ ي ر ه ش1385 1385 1 Tuberculosis Tuberculosis & & Air Travel Air Travel

1385 / 5 / 15 نشست سالانه برنامه كنترل سل شهريور 1385 1 Tuberculosis & Air Travel

Embed Size (px)

Citation preview

Page 1: 1385 / 5 / 15 نشست سالانه برنامه كنترل سل شهريور 1385 1 Tuberculosis & Air Travel

1385 / 5 / 151385 / 5 / 15 نشست ساالنه برنامه كنترل سلنشست ساالنه برنامه كنترل سل 13851385شهريور شهريور

11

Tuberculosis Tuberculosis & & Air Travel Air Travel

Page 2: 1385 / 5 / 15 نشست سالانه برنامه كنترل سل شهريور 1385 1 Tuberculosis & Air Travel

1385 / 5 / 151385 / 5 / 15 نشست ساالنه برنامه كنترل سلنشست ساالنه برنامه كنترل سل 13851385شهريور شهريور

22

TB & Air Travel

IntroductionIntroduction

Millions of people travel by air every year. Millions of people travel by air every year. it is not possible to medically assess the it is not possible to medically assess the majority before their flights.majority before their flights.

Page 3: 1385 / 5 / 15 نشست سالانه برنامه كنترل سل شهريور 1385 1 Tuberculosis & Air Travel

1385 / 5 / 151385 / 5 / 15 نشست ساالنه برنامه كنترل سلنشست ساالنه برنامه كنترل سل 13851385شهريور شهريور

33

TB & Air Travel

Tuberculosis on aircraftTuberculosis on aircraft

Most evidence indicates that:Most evidence indicates that:

airborne transmissionairborne transmission of infectious of infectious diseases on board aircraft appears to be diseases on board aircraft appears to be limited limited toto close personal contact close personal contact and / orand / or close proximityclose proximity..

Page 4: 1385 / 5 / 15 نشست سالانه برنامه كنترل سل شهريور 1385 1 Tuberculosis & Air Travel

1385 / 5 / 151385 / 5 / 15 نشست ساالنه برنامه كنترل سلنشست ساالنه برنامه كنترل سل 13851385شهريور شهريور

44

TB & Air Travel

Practical issues in Practical issues in investigations investigations concerning Exposure to M.TBconcerning Exposure to M.TB

AdequateAdequate and and timelytimely contact tracingcontact tracing after after potential exposure to M.Tuberculosis may potential exposure to M.Tuberculosis may be impeded by practical constraints, be impeded by practical constraints, particularly:particularly:• the length of the length of timetime between travel and between travel and

diagnosis and diagnosis and • the the accuracyaccuracy and and availability of airline recordsavailability of airline records..

Page 5: 1385 / 5 / 15 نشست سالانه برنامه كنترل سل شهريور 1385 1 Tuberculosis & Air Travel

1385 / 5 / 151385 / 5 / 15 نشست ساالنه برنامه كنترل سلنشست ساالنه برنامه كنترل سل 13851385شهريور شهريور

55

TB & Air Travel

Legal & regulatory issuesLegal & regulatory issues

Airline companies are expected to comply Airline companies are expected to comply with the:with the:

• International Health Regulations and International Health Regulations and • laws of the countries in which they operate.laws of the countries in which they operate.

Page 6: 1385 / 5 / 15 نشست سالانه برنامه كنترل سل شهريور 1385 1 Tuberculosis & Air Travel

1385 / 5 / 151385 / 5 / 15 نشست ساالنه برنامه كنترل سلنشست ساالنه برنامه كنترل سل 13851385شهريور شهريور

66

TB & Air Travel

Reducing the risk of exposure to Reducing the risk of exposure to M.TB on aircraftM.TB on aircraft

People known to have infectious TB must People known to have infectious TB must • not travel not travel by public air transportation by public air transportation • untiluntil at least two weeksat least two weeks of adequate treatment of adequate treatment

have been completed. have been completed.

Patients with Patients with MDR-TBMDR-TB should should

• not travelnot travel untiluntil they have been they have been proved to be proved to be non-infectiousnon-infectious (i.e. (i.e. culture-negativeculture-negative).).

Page 7: 1385 / 5 / 15 نشست سالانه برنامه كنترل سل شهريور 1385 1 Tuberculosis & Air Travel

1385 / 5 / 151385 / 5 / 15 نشست ساالنه برنامه كنترل سلنشست ساالنه برنامه كنترل سل 13851385شهريور شهريور

77

TB & Air Travel

Aircraft ventilationAircraft ventilation

In case of ground In case of ground delaysdelays of of more than 30 more than 30 minutesminutes ,adequate cabin ventilation must ,adequate cabin ventilation must be ensured.be ensured.

Page 8: 1385 / 5 / 15 نشست سالانه برنامه كنترل سل شهريور 1385 1 Tuberculosis & Air Travel

1385 / 5 / 151385 / 5 / 15 نشست ساالنه برنامه كنترل سلنشست ساالنه برنامه كنترل سل 13851385شهريور شهريور

88

TB & Air Travel

Cabin air qualityCabin air quality

There is There is no evidenceno evidence that that recirculationrecirculation of of cabin air cabin air facilitates transmissionfacilitates transmission of of infectious disease agents on board.infectious disease agents on board.

Page 9: 1385 / 5 / 15 نشست سالانه برنامه كنترل سل شهريور 1385 1 Tuberculosis & Air Travel

1385 / 5 / 151385 / 5 / 15 نشست ساالنه برنامه كنترل سلنشست ساالنه برنامه كنترل سل 13851385شهريور شهريور

99

TB & Air Travel

criteria for deciding whether to criteria for deciding whether to inform passengers & crewinform passengers & crew

Infectiousness of the person with TBInfectiousness of the person with TB Duration of exposure Duration of exposure Time elapsed between the flight(s) and the Time elapsed between the flight(s) and the

notification of the casenotification of the case Proximity of other passengers and crew to Proximity of other passengers and crew to

the index patient the index patient

Page 10: 1385 / 5 / 15 نشست سالانه برنامه كنترل سل شهريور 1385 1 Tuberculosis & Air Travel

1385 / 5 / 151385 / 5 / 15 نشست ساالنه برنامه كنترل سلنشست ساالنه برنامه كنترل سل 13851385شهريور شهريور

1010

TB & Air Travel

TB patient should be considered TB patient should be considered infectious at the time of the flightinfectious at the time of the flight

If :If :• Lab Positive:Lab Positive:

PositivePositive Sputum SmearSputum Smear for AFB &/or for AFB &/or Positive CulturePositive Culture for M.TB for M.TB

• AndAnd Clinical symptoms of TB including coughClinical symptoms of TB including cough Not receiving adequate TB treatment orNot receiving adequate TB treatment or Receiving TB treatment for less than 2 weeks orReceiving TB treatment for less than 2 weeks or Receiving adequate TB treatment for more than 2 weeks but Receiving adequate TB treatment for more than 2 weeks but

with no evidence of response (clinically or paraclinically)with no evidence of response (clinically or paraclinically)• If MDR-TB, If MDR-TB,

not receiving adequate treatment ornot receiving adequate treatment or Receiving adequate treatment for any time but with no Receiving adequate treatment for any time but with no

evidence of culture conversion evidence of culture conversion

Page 11: 1385 / 5 / 15 نشست سالانه برنامه كنترل سل شهريور 1385 1 Tuberculosis & Air Travel

1385 / 5 / 151385 / 5 / 15 نشست ساالنه برنامه كنترل سلنشست ساالنه برنامه كنترل سل 13851385شهريور شهريور

1111

TB & Air Travel

criteria for deciding whether to criteria for deciding whether to inform passengers & crewinform passengers & crew

Determination of infectiousnessDetermination of infectiousness

Informing close contacts is indicated if Informing close contacts is indicated if total flight total flight duration exceeded 8 hoursduration exceeded 8 hours

Informing passengers and crew should be limited to Informing passengers and crew should be limited to flightsflights that took place that took place during the three months before during the three months before notification of the TB casenotification of the TB case to the health authorities to the health authorities

Passenger-to-passenger transmission of M.TB has been Passenger-to-passenger transmission of M.TB has been documented documented only among close contacts seated in the only among close contacts seated in the same sectionsame section as the person with infectious TB as the person with infectious TB

Page 12: 1385 / 5 / 15 نشست سالانه برنامه كنترل سل شهريور 1385 1 Tuberculosis & Air Travel

1385 / 5 / 151385 / 5 / 15 نشست ساالنه برنامه كنترل سلنشست ساالنه برنامه كنترل سل 13851385شهريور شهريور

1212

TB & Air Travel

Airline employee healthAirline employee health

The The risk risk of TB of TB among cabin crewamong cabin crew members is members is similarsimilar to that of the general to that of the general population. population.

mandatory routinemandatory routine or or periodic screeningperiodic screening is is not indicatednot indicated for cabin crew for cabin crew

Page 13: 1385 / 5 / 15 نشست سالانه برنامه كنترل سل شهريور 1385 1 Tuberculosis & Air Travel

1385 / 5 / 151385 / 5 / 15 نشست ساالنه برنامه كنترل سلنشست ساالنه برنامه كنترل سل 13851385شهريور شهريور

1313

TB & Air Travel

Summary Summary RecommendationsRecommendations

Page 14: 1385 / 5 / 15 نشست سالانه برنامه كنترل سل شهريور 1385 1 Tuberculosis & Air Travel

1385 / 5 / 151385 / 5 / 15 نشست ساالنه برنامه كنترل سلنشست ساالنه برنامه كنترل سل 13851385شهريور شهريور

1414

TB & Air Travel

For passengers & air crewFor passengers & air crew

1.People with 1.People with infectious TBinfectious TB must must postpone postpone long-distance travellong-distance travel (total flight exceeding (total flight exceeding eight hours) eight hours) until they become non-until they become non-infectiousinfectious (completion of at least two (completion of at least two weeks of adequate treatment) and weeks of adequate treatment) and according to the recommendations of their according to the recommendations of their physicians.physicians.

Page 15: 1385 / 5 / 15 نشست سالانه برنامه كنترل سل شهريور 1385 1 Tuberculosis & Air Travel

1385 / 5 / 151385 / 5 / 15 نشست ساالنه برنامه كنترل سلنشست ساالنه برنامه كنترل سل 13851385شهريور شهريور

1515

TB & Air Travel

For passengers & air crewFor passengers & air crew

2. People with 2. People with MDR-TBMDR-TB must must postpone any postpone any air travelair travel until advised by their physicians until advised by their physicians that they are no longer infectious, i.e. that they are no longer infectious, i.e. culture-negative. culture-negative.

Page 16: 1385 / 5 / 15 نشست سالانه برنامه كنترل سل شهريور 1385 1 Tuberculosis & Air Travel

1385 / 5 / 151385 / 5 / 15 نشست ساالنه برنامه كنترل سلنشست ساالنه برنامه كنترل سل 13851385شهريور شهريور

1616

TB & Air Travel

For physiciansFor physicians

1.Physicians should 1.Physicians should inform all infectious TB inform all infectious TB patientspatients that that they must not travel by airthey must not travel by air on a on a flight flight exceeding eight hoursexceeding eight hours until they have until they have completed completed at east two weeksat east two weeks of adequate of adequate treatment.treatment.

2.Physicians should 2.Physicians should inform all MDR-TBinform all MDR-TB patients patients that that they must not travel by air-under any they must not travel by air-under any circumstancescircumstances or on a or on a flight of any durationflight of any duration until until they are proven they are proven to be culture-negativeto be culture-negative..

Page 17: 1385 / 5 / 15 نشست سالانه برنامه كنترل سل شهريور 1385 1 Tuberculosis & Air Travel

1385 / 5 / 151385 / 5 / 15 نشست ساالنه برنامه كنترل سلنشست ساالنه برنامه كنترل سل 13851385شهريور شهريور

1717

TB & Air Travel

For physiciansFor physicians3.Physicians should advise TB patients who undertake 3.Physicians should advise TB patients who undertake

unavoidable air travel of short durationunavoidable air travel of short duration (less than eight (less than eight hours) to hours) to wear a surgical maskwear a surgical mask when possible or to when possible or to cover cover the nose and mouth when speaking or coughingthe nose and mouth when speaking or coughing at all at all times during the flight. times during the flight.

4.Physicians should 4.Physicians should inform the relevant health authorityinform the relevant health authority when they are aware of an infectious TB patient’s when they are aware of an infectious TB patient’s intention to travel against medical advice.intention to travel against medical advice.

5.Physicians should 5.Physicians should immediately inform the relevant health immediately inform the relevant health authorityauthority when an infectious TB patient has when an infectious TB patient has a recent a recent history of air travel (i.e. within three months).history of air travel (i.e. within three months).

Page 18: 1385 / 5 / 15 نشست سالانه برنامه كنترل سل شهريور 1385 1 Tuberculosis & Air Travel

1385 / 5 / 151385 / 5 / 15 نشست ساالنه برنامه كنترل سلنشست ساالنه برنامه كنترل سل 13851385شهريور شهريور

1818

TB & Air Travel

For public health authoritiesFor public health authorities

1.Public health authorities who are aware that a 1.Public health authorities who are aware that a person with infectious TB is planning to travel person with infectious TB is planning to travel with a commercial carrier on a flight whose total with a commercial carrier on a flight whose total duration could potentially exceed eight hours duration could potentially exceed eight hours should inform the concerned airline.should inform the concerned airline.

2.Health authorities should promptly contact the 2.Health authorities should promptly contact the airline when an infectious TB patient is known to airline when an infectious TB patient is known to have traveled on a commercial flight of at least have traveled on a commercial flight of at least eight hours’ duration ( including ground delay eight hours’ duration ( including ground delay time) within the preceding three months.time) within the preceding three months.

Page 19: 1385 / 5 / 15 نشست سالانه برنامه كنترل سل شهريور 1385 1 Tuberculosis & Air Travel

1385 / 5 / 151385 / 5 / 15 نشست ساالنه برنامه كنترل سلنشست ساالنه برنامه كنترل سل 13851385شهريور شهريور

1919

TB & Air Travel

For public health authoritiesFor public health authorities

3.Health authorities should promptly contact 3.Health authorities should promptly contact potentially exposed passengers and crew potentially exposed passengers and crew and advise them to seek medical and advise them to seek medical evaluation.evaluation.

4.Public health authorities should establish 4.Public health authorities should establish country-specific policies and provide country-specific policies and provide guidance to airlines on the prevention of guidance to airlines on the prevention of risks due to infectious diseases.risks due to infectious diseases.

Page 20: 1385 / 5 / 15 نشست سالانه برنامه كنترل سل شهريور 1385 1 Tuberculosis & Air Travel

1385 / 5 / 151385 / 5 / 15 نشست ساالنه برنامه كنترل سلنشست ساالنه برنامه كنترل سل 13851385شهريور شهريور

2020

TB & Air Travel

For airline companiesFor airline companies

1.Airline companies should 1.Airline companies should deny boarding to deny boarding to any person who is known to have any person who is known to have infectious TBinfectious TB and is intending to travel on and is intending to travel on a flight whose a flight whose total durationtotal duration is likely to be is likely to be at least eight hoursat least eight hours..

2.Airline companies should 2.Airline companies should minimize ground minimize ground delaysdelays to less than to less than 3030 minutes minutes if the if the ventilation system is not in operationventilation system is not in operation..

Page 21: 1385 / 5 / 15 نشست سالانه برنامه كنترل سل شهريور 1385 1 Tuberculosis & Air Travel

1385 / 5 / 151385 / 5 / 15 نشست ساالنه برنامه كنترل سلنشست ساالنه برنامه كنترل سل 13851385شهريور شهريور

2121

TB & Air Travel

For airline companiesFor airline companies

3.Airline companies should ensure that 3.Airline companies should ensure that HEPA HEPA filters on all aircraft are changed regularly filters on all aircraft are changed regularly according to the recommendations of the filter according to the recommendations of the filter manufacturer.manufacturer.

4.Airline companies should ensure that cabin 4.Airline companies should ensure that cabin crews receive adequate trainingcrews receive adequate training on potential on potential exposure to infectious diseases, in first aid and exposure to infectious diseases, in first aid and in using universal precautions when there may in using universal precautions when there may be exposure to body fluids.be exposure to body fluids.

Page 22: 1385 / 5 / 15 نشست سالانه برنامه كنترل سل شهريور 1385 1 Tuberculosis & Air Travel

1385 / 5 / 151385 / 5 / 15 نشست ساالنه برنامه كنترل سلنشست ساالنه برنامه كنترل سل 13851385شهريور شهريور

2222

TB & Air Travel

For airline companiesFor airline companies

5.Airline companies should ensure that there are 5.Airline companies should ensure that there are adequate adequate emergency medical suppliesemergency medical supplies on board on board of all aircraft ( including gloves, surgical masks of all aircraft ( including gloves, surgical masks and biohazard disposal bags).and biohazard disposal bags).

6.Airline companies should cooperate with health 6.Airline companies should cooperate with health authorities in authorities in providing all contact informationproviding all contact information needed by them and facilitate contact tracing of needed by them and facilitate contact tracing of passengers and/or crew.passengers and/or crew.