Advice to travellers
The most important message for international travellers concerning SARS is to be aware of the main symptoms of SARS: high fever (>38 °C, >100.4° F), dry cough, shortness of breath or breathing difficulties. Persons who experience these symptoms and who have been in an area where there has been recent local transmission of SARS in the last 10 days (See archives of Affected Areas/Areas with recent local transmission) are advised to contact a doctor.
WHO is now recommending, as a measure of precaution, that people planning to travel to the following areas of China: Beijing, Hebei, Inner Mongolia, Shanxi, Tianjin and Taiwan province, consider postponing all but essential travel. This temporary recommendation is being reassessed daily as the outbreak evolves (see previous travel related updates 17, 37, 42, 50, 58, 61, 63), and does not apply to passengers simply transiting through international airports in these areas. WHO does not recommend the restriction of travel to any other areas.
WHO recommended measures to limit the international spread of SARS
In the absence of effective drugs or a vaccine for SARS, control of this disease relies on the rapid identification of cases and their appropriate management, including the isolation of suspect and probable cases and the management of their close contacts (see Management of Severe Acute Respiratory Syndrome). In the great majority of countries, these measures have prevented imported cases from spreading the disease to others.
To further reduce the risk that travellers may carry the SARS virus to new areas, international travellers departing from areas with local transmission in the B or C categories (see Areas with recent local transmission) should be screened for possible SARS at the point of departure. Such screening involves answering two or three questions and may include a temperature check. Travellers with one or more symptoms of SARS and who have a history of exposure or who have fever or who appear acutely ill should be assessed by a health care worker and may be advised to postpone their trip until they have recovered.
WHO does not at present conclude that any goods, products or animals arriving from areas with SARS outbreaks pose a risk to public health. No restrictions in this regard are recommended. (see Information to Member States regarding goods and animals arriving from SARS-affected areas.)
WHO further recommends that persons arriving from areas with recent local transmission should be aware of the main symptoms of SARS described above and should seek medical advice, initially by telephone, if they develop symptoms in the 10 days after leaving the outbreak area. Well persons who are not contacts of probable cases require no special measures and should be free to carry out normal activities. Contacts of probable cases should not undertake travel until 10 days after the last contact assuming they themselves remain well. Should, despite the advice above, a contact of a probable case travel to another country, the person should be placed in voluntary isolation and kept under active surveillance by the health authorities in the country of arrival. (see management of contacts.)
Travellers are advised to contact their doctors or national health authorities for supplementary information as individual countries may adapt WHO recommendations to take into account national considerations. Many national health authorities have established web sites with excellent information.
All available WHO information is posted on the WHO SARS web site which is regularly updated.
www.who.int/csr/sars/travelupdate/en/
The Centers for Disease Control and Prevention (CDC) is tracking reports of outbreaks of a respiratory illness called severe acute respiratory syndrome (SARS). The symptoms of SARS can be found at basic information about SARS. The primary way that SARS appears to spread is by close person-to-person contact. Most cases of SARS have involved people who cared for or lived with someone with SARS, or had direct contact with infectious material (for example, respiratory secretions) from a person who has SARS. Potential ways in which SARS can be spread include touching the skin of other persons or objects that are contaminated with infectious droplets and then touching the eye, nose, or mouth. This can happen when people who are sick with SARS cough or sneeze droplets onto themselves, other persons, or nearby surfaces. It is also possible that SARS can be spread more broadly through the air or by other ways that are currently not known.
CDC has issued two types of notices to travelers: advisories and alerts. A travel advisory recommends that nonessential travel be deferred; a travel alert does not advise against travel, but informs travelers of a health concern and provides advice about specific precautions. CDC updates information on its website on the travel status of areas with SARS as the situation evolves.
If you decide to go ahead with your travel to an area with SARS, please keep the following guidelines in mind.
Before you leave:
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Assemble a travel health kit containing basic first aid and medical supplies. Be sure to include a thermometer, household disinfectant, a supply of surgical masks and disposable gloves (for use if you or someone you are traveling with becomes ill with SARS), and alcohol-based hand rubs for hand hygiene.
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Inform yourself and others who may be traveling with you about SARS. For information about this illness, see CDC's SARS Web site.
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Be sure you are up to date with all your shots, and see your health-care provider at least 4 to 6 weeks before travel to get any additional shots or information you may need. For information on CDC health recommendations for international travel, see CDC's Travelers’ Health site.
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You may wish to check your health insurance plan or get additional insurance that covers medical evacuation in the event of illness. Information about medical evacuation services can be found at this US Department of State page.
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Identify in-country health-care resources in advance of your trip.
While you are in an area with SARS:
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To protect against SARS infection, wash your hands frequently.
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To minimize the possibility of infection, observe precautions to safeguard your health. This includes avoidance of settings where SARS is most likely to be transmitted, such as health-care facilities caring for SARS patients. CDC does not recommend the routine use of masks or other personal protective equipment while in public areas.
If you think you have SARS or symptoms compatible with SARS:
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If you become ill with fever or respiratory symptoms (for example, cough or shortness of breath), a visit to a health-care provider is strongly recommended. Tell the provider about your symptoms prior to going to the office or emergency room so arrangements can be made, if necessary, to prevent transmission to others in the health-care setting. The nearest US Embassy or Consular Office can help you find a provider in the area. Again, you are encouraged to identify these resources in advance. Do not travel while sick and limit your contact with others as much as possible to help prevent the spread of any infectious illness you may have.
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The person who is ill should cover their mouth and nose with a facial tissue when coughing or sneezing. If possible, a surgical mask should be worn during close contact with healthy people to prevent spread of infectious droplets. If the sick person is unable to wear a surgical mask, other persons should wear surgical masks when in close contact with the person who is ill.
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Use of disposable gloves should be considered for any direct contact with body fluids of a person with SARS. However, gloves are not intended to replace proper hand hygiene. Immediately after activities involving contact with body fluids, gloves should be removed and discarded and hands should be cleaned. Gloves must never be washed or reused.
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All close contacts staying with a person with SARS should carefully follow recommendations for hand hygiene (e.g. frequent hand washing or use of alcohol-based hand rubs), particularly after contact with body substances (e.g. respiratory secretions, urine, or feces).
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People with SARS should avoid sharing eating utensils, towels, and bedding with others, although these items can be used by others after routine cleaning, such as washing or laundering with soap and hot water.
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Environmental surfaces (e.g. toilets, sinks) soiled by body fluids should be cleaned with a household disinfectant according to manufacturer's instructions; gloves should be worn during this activity. Wash hands afterwards and throw the gloves away.
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Other close contacts staying with a person with SARS do not need to restrict their outside activities unless they develop symptoms of SARS, such as a fever or respiratory illness.
After your return:
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Persons returning from one of the affected areas should monitor their health for 10 days. Any family member who becomes ill with fever or respiratory symptoms during this period should consult a healthcare provider and tell him or her about their recent travel. Tell the provider about your symptoms prior to going to the office or emergency room so arrangements can be made, if necessary, to prevent transmission to others in the health-care setting.
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Close contacts of person with SARS who develop fever or respiratory symptoms should be evaluated by a health-care provider. Before the evaluation, health-care providers should be informed that the individual is a close contact of a person with SARS. These persons with symptoms of SARS should follow the same precautions recommended for people with SARS.
www.cdc.gov/ncidod/sars/travel_advice.htm
This document addresses the main concerns of the public at large with regard to the risk of SARS (Severe Acute Respiratory Syndrome) transmission to passengers and/or crew embarking on an international voyage particularly from an area of recent local transmission. A more detailed account of the specific measures the World Health Organization (WHO) is recommending is available in the Weekly Epidemiological Record dated 4 April 2003. WHO has been working closely with international air transport organizations, including ICAO (International Civil Aviation Organization) and IATA (International Air Transport Association), to provide accurate information in a timely manner to all persons involved in international air travel in order to further reduce the risk of spreading the disease by this means.
Risk of SARS transmission in flight
The risk of transmission in aircraft is very low. To date, symptomatic probable SARS cases on four flights have been associated with possible transmission onboard. Two of these flights preceded WHO's 15 March 2003 emergency travel advisory, and since 23 March 2003 and the introduction of WHO-recommended screening measures by public health authorities no further cases of SARS in flight have been documented. A key factor in reducing the risk is for passengers and crew to be aware of the main symptoms of SARS which include high fever (>38 °C, 100.4 °F), cough, shortness of breath or breathing difficulties.
Measure for persons with symptoms compatible with SARS prior to departure
WHO has recommended that passengers or crew who develop symptoms compatible with SARS postpone their travel until fully recovered. WHO further recommends that public health authorities ensure that areas with recent local transmission introduce exit screening measures, which may include temperature checks for all passengers and crew. Preventing symptomatic passengers from travelling minimizes what risk there is. Finally, contacts of probable SARS cases should not undertake travel (national or international) for a 10-day period following exposure.
In-flight precautions and measures
Personal hygiene All passengers and crews should observe good personal hygiene. Wash hands frequently, particularly before eating. If passengers or crew cough or sneeze while onboard, they should cover their mouth and nose, and wash their hands afterwards.
Face masks Current evidence indicates that a person infected with SARS is not infectious to others unless s/he has symptoms. Therefore, WHO does not recommend the use of masks by asymptomatic passengers or crew. However, WHO recommends that passengers or crew presenting with symptoms compatible with SARS during a flight from an area with recent local transmission:
1) wear a protective face mask∗; 2) be isolated, as far as possible, from other passengers; and 3) be given access to a toilet cordoned off for their exclusive use.
WHO also recommends that the designated crew member(s) caring for a person with symptoms compatible with SARS wear a protective face mask∗, gloves and eye protection (e.g. tight-fitting goggles or face shield).
Measures on arrival of a flight with a suspected case of SARS
The Captain of an aircraft with a person presenting symptoms compatible with SARS onboard should radio the airport of destination so that appropriate arrangements may be made for reception and management by public health authorities. Passenger disembarkation may be delayed upon arrival while the medical officer at the airport of destination examines the patient. Following an assessment by public health authorities, passengers and crew may be required to provide their contact details for the next 14 days. All passengers and crew who are otherwise healthy should be allowed to continue their onward journey. If the ill passenger or crew member is confirmed as a probable case of SARS, public health authorities should notify contacts using the contact details provided.
Risk of infection from handling baggage or goods belonging to a SARS case
There is no evidence to date to suggest that a person can be infected with SARS from handling baggage or goods, as the major route of transmission is close face-to-face contact with a SARS probable case.
Aircraft ventilation
The configurations of the air circulation system for commercial aircraft are designed to the specifications of international aviation regulations, as well as guidelines of aircraft manufacturers:
Circulation:In flight, fresh air is introduced into the cabin continuously. The entire cabin air volume is exchanged every three minutes.
Airflow: The airflow movement is designed to minimize the potential for spreading of bacteria and viruses through the cabin.
Filter: Most major airlines install HEPA (High Efficiency Particulate Air) filters which are highly efficient in removing dust and airborne contaminants such as droplets, bacteria and large microbes.
This means that the spread of all microbes is minimized inside the cabin.
Disinfection of aircraft
Following a flight with a suspected SARS case, it is recommended that the aircraft be thoroughly cleaned following procedures established by local public health authorities which must involve the strict cleansing and disinfecting of the zone of risk in the cabin area (i.e. seats, headrests, tabletops, handsets, and other materials coming in contact with the suspected case) where the case was seated, as well as all shared facilities. The virus that causes SARS loses infectivity after exposure to commonly used disinfectants.
∗N/R/P 95/99/100 or FFP 2/3 or an equivalent national manufacturing standard (NIOSH (N,R,P 95,99,100) or European CE EN149:2001(FFP 2,3) and EN143:2000 (P2) or comparable national/regional standards applicable to the country of manufacture.