Claude Thibeault

Air travel and TB: an airline perspective.

The commercial airline industry in the 21st century is a global business, able to transport large numbers of people to almost any part of the world within a few hours. There has long been concern in public health circles about the potential for transmission of communicable diseases, such as TB, on board aircraft. The recent threats from novel and emerging infectious diseases including SARS and pandemic flu has facilitated unprecedented levels of cooperation between international industry representatives, regulators and public health authorities in addressing the issues of air travel and communicable disease. This paper reviews the regulatory environment, ways in which the risks are mitigated through aspects of aircraft design, opportunities for prevention by identifying individuals who may be suffering from a communicable disease prior to flight and the approach used in managing suspected cases of communicable disease on board aircraft.

AsMA Medical Guidelines for Air Travel: Stresses of Flight

INTRODUCTION Medical Guidelines for Airline Travel provide information that enables healthcare providers to properly advise patients who plan to travel by air. Modern commercial aircraft are very safe and, in most cases, reasonably comfortable. However, all flights, short or long haul, impose stresses on passengers. Preflight stresses include airport commotion on the ground such as carrying baggage, walking long distances, getting to the gate on time, and being delayed. In-flight stresses include acceleration, vibration (including turbulence), noise, lowered barometric pressure, variations of temperature and humidity, and fatigue among others. Healthy passengers normally tolerate these stresses quite well; however, there is the potential for passengers to become ill during or after the flight due to these stresses, especially for those with pre-existing medical conditions and reduced physiological reserves.

A Case of Active Tuberculosis in a Cabin Crew: The Results of Contact Tracing

INTRODUCTION Transmission of communicable diseases on board aircraft is of considerable concern for passengers and aircrew. Previously published estimates of risk of tuberculosis (TB) transmission have been highly variable. Furthermore, very few studies have been published for active TB in aircrew. METHODS The public health authorities advised the Medical Advisor of an airline that a cabin crewmember had been diagnosed with active TB. Contact tracing was done for the cabin crew who worked with the index case for more than 8 h. Cabin crewmembers were divided in two groups according to their exposure and had one tuberculin skin test (TST) more than 8 wk after the last exposure. Those with a TST > or = 5 mm have been recommended to have a QuantiFERON-TB Gold In-Tube (QFT) assay. RESULTS Among the 56 identified contacts, 32 agreed to be evaluated, of whom 6 (19%) had a TST > or = 5 mm. Of those six, four underwent a QFT with one positive result. None had active TB. The percentages of positives in the two exposure groups were similar. All the positive contacts were born in Canada in the period when the childhood Bacille Calmette-Guérin (BCG) vaccination program was in effect. DISCUSSION The same percentage of positives in the two exposure groups, the proportion of positive contacts below the expected rate in Canadians, and the high proportion of QFT negative among the TST positive contacts suggest that transmission of TB to the cabin crew is unlikely.

Prevention of spread of communicable disease by air travel.

Mathematical modeling suggests that travel restrictions are likely to have only a limited effect on minimizing the spread of disease. Nevertheless, medical screening of travelers remains an option to be considered in a risk-reduction strategy. Screening of departing and/or arriving travelers are possibilities, although the World Health Organization (WHO) favors the former as it is normally easier to geographically contain a disease prior to its transmission outside the outbreak area. Apart from airport screening, several other related issues require consideration, including: transmission of disease on board aircraft; transmission of disease in airport terminal buildings; and contact tracing. A major challenge is to ensure adequate resources are devoted to pandemic preparedness planning in the aviation sector, which may not be fully considered in a national preparedness plan. This is because the prevention of accidents occupies most of the attention of regulatory aviation authorities, and public health authorities do not always see aviation as a priority area. Chief medical officers of regulatory authorities may be in a position to facilitate collaboration between the many stakeholders involved in preparedness planning for aviation.

AsMA Medical Guidelines for Air Travel: Fitness to Fly and Medical Clearances.

INTRODUCTION Medical Guidelines for Airline Travel provide information that enables healthcare providers to properly advise patients who plan to travel by air. Not everyone is fit to travel by air and physicians should advise their patients accordingly. They should review the passengers medical condition, giving special consideration to the dosage and timing of any medications, contagiousness, and the need for special assistance during travel. In general, an individual with an unstable medical condition should not fly; cabin altitude, duration of exposure, and altitude of the destination airport are all considerations when recommending a passenger for flight.

AsMA Medical Guidelines for Air Travel: Reported In-Flight Medical Events and Death

INTRODUCTION Medical Guidelines for Airline Travel provide information that enables healthcare providers to properly advise patients who plan to travel by air. Although there are no publicly available databases providing information on the number of in-flight medical emergencies, the few studies published in the literature indicate that they are uncommon. Minor illnesses such as near-fainting, dizziness, and hyperventilation occur more frequently. However, serious illnesses, such as seizures and myocardial infarction, also occur. In-flight deaths are also rare.

AsMA Medical Guidelines for Air Travel: Airline Special Services

INTRODUCTION Medical Guidelines for Airline Travel provide information that enables healthcare providers to properly advise patients who plan to travel by air. Treating physicians should advise patients in need of special services to contact the airline well before travel to find out if the required services will be available. Ensuring the required services are available throughout a journey can be challenging, especially when different airlines and aircraft types are involved. For example, airlines carry a limited supply of oxygen for use in the event of an unexpected in-flight emergency; however, this supply is not intended for use by passengers needing supplemental oxygen. Arrangements must be made in advance with the airline. Therefore, early contact with the airline is helpful.

AsMA Medical Guidelines for Air Travel: In-Flight Medical Care

INTRODUCTION Medical Guidelines for Airline Travel provide information that enables healthcare providers to properly advise patients who plan to travel by air. All airlines are required to provide first aid training for cabin crew, and the crew are responsible for managing any in-flight medical events. There are also regulatory requirements for the carriage of first aid and medical kits. AsMA has developed recommendations for first aid kits, emergency medical kits, and universal precaution kits.