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ANYURYSM

EBOLA QUARANTINE AT THE AIRPORT

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SEQUENCE OF FLOW• INTRODUCTION • QUARANTINE LAW • QUARANTINE PHASES • PLANNING CONSIDERATIONS• IMPACT OF QUARANTINE IN AIRPORT• QUARANTINE FACILITY IN INDIA • CONCLUSION

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Introduction

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• Research undertaken by Tri Data and Centre for

disease control and prevention

• ------------------------------------------------------------------------------------------------------------------National Aviation Resource Manual for Quarantinable Diseases, U.S. Department of Transportation, December 2006

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Quarantine

• According to the Centers for Disease Control and Prevention (CDC), quarantine is the “separation and restriction of movement of persons, who, while not yet ill, have been exposed to an infectious agent and therefore may become infectious.”

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How does it differ from isolation ?• Isolation, as defined by the CDC, applies to people who have a specific infectious illness.

• Their movements are restricted and they are separated from individuals who are healthy (or at least not symptomatic yet).

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Laws Related to Quarantine

• Public Health Service Act, authorizes the Surgeon General to make and enforce such regulations as in his judgment necessary to prevent the introduction, transmission, or spread of communicable diseases from foreign countries

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• In November 2005, CDC proposed new regulations that would allow CDC to order a “provisional quarantine,” lasting up to 3 business days.

• The proposed regulations would give CDC time to determine if the suspected disease was present.

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Phases of Quarantine

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Phase 1. Decision to Quarantine

• Assessment of travelers • Public health officials and airline medical consultants

• The aircraft might be directed to a more remote area of the airport or to a gate closer to the Quarantine Station.

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Phase 2. Establishment of Quarantine

• Accommodations for a quarantined persons

• May need to be detained for hours, days, or even

weeks until a diagnosis is confirmed

• Incubation period and risk of spread is determined

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• A procedure for transport to the quarantine

facility is designated

• Vehicles, like buses or airport shuttles

• Later, the vehicles should be decontaminated

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Phase 3. Quarantine Operations• Supplies and staffing for food preparation• Medical care• Security• Cleaning• Counselling

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• Important to maintain good records • Personnel from many different agencies• CDC officials• State and local public health employees• Hospitals

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Phase 4. Demobilization• Finalizing all records• Financial records• Documentation of medical conditions • The records management planning

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A demobilization plan should cover the following items in depth1. Final medical checkout by medical staff2. Planned release times for travelers and crew3. Coordination with air carrier for travelers 4. Shutdown of service items such as food delivery,

trash pickup

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Phase 5. Recovery

• Restoration of services and the environment• The aircraft should be decontaminated and disinfected

• Specific cleaning and clearance procedures• Trained personnel and equipment

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Psychological effects

• Reassurance to the staff

• An important part of demobilization

• To prepare the staff to return to routine duties

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Planning Considerations for Airport Quarantine

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Planning consideration 1/13

1.LocationThere are several possible locations

An unused hangar Trailers, tents a portion of a terminal building

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Planning consideration 2/13Space requirement• Sustain quarantine for as many as 200 people for up to 14 days

• FMEA guidance indicates more 10 square feet per person.

• Standards for longer stays are double or triple that number.

• Thus, at least 4,000 Sq ft. of space would be needed

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Planning consideration 3/13Transportation

• Jet bridge to the terminal

• Mobile stairs

• Motor vehicles such as buses

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Planning consideration 4/13

Security• People being held in quarantine must be protected from harm

• Security for their personal belongings• Unauthorized people should not enter the facility

• Curious people, the press, politicians should be avoided

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Planning consideration 5/13

2. AccomodationPower Source

If the building does not have adequate primary and backup power, generators and fuel supplies have to be available to keep the facility operational for the duration of the quarantine

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Planning consideration 6/13Heating, Ventilation, and Air Conditioning

• Portable HVAC units may have to be brought to the quarantine site

• Ventilation will have to be evaluated by an HVAC expert.

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Planning consideration 7/13. Lighting

• Adequate lighting for daytime and night time use

. Sanitation• Four to five (in-place or portable) toilets are recommended per 100 occupants.

• For 200 people then, a minimum of 8 and preferably 10 toilets would be needed

• One ADA-approved handicapped toilet also would be required.

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Planning consideration 8/13Communication

• Telephone lines• Internet• Television• Public address system

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Planning consideration 10/13

3. SuppliesFood and Water

• Include provisions to store a supply of basic foods for the first 24–48 hours of the quarantine

• Special food for diabetics and children• Between a half to 1 gallon of water per day per person may be necessary

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Planning consideration 11/13b. Clothing and Personal Items

• Passengers and crew may not have access to their baggage and belongings for they may be taken away for disinfection.

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Planning consideration 12/13

4. Special needsa. Language and Cultural Needs

• Quarantined individuals or airport or airline employees with multi-lingual skills may be of assistance in providing interpretation

• Embassy contact information for foreign nationals

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Planning consideration 13/13b. Media Management

• handling media inquiries • requests for interviews• managing (or restricting) access for media on site

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Planning consideration 12/13

•5. clean up and disinfection• It must be cleaned sufficiently to ensure that there is no risk of further contagion from the items or materials left behind

• Returned to other service • Left in a stand-by mode for future use as a quarantine facility

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Ebola in INDIA

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• There are nearly 45,000 Indian nationals living and working in Guinea, Liberia, Sierra Leone and Nigeria

• There is also a large population of West Africans, mainly students, in India

WHO

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Precautions taken by the Government of INDIA

•  The measures including infection control practices

taken by the States are being communicated

• Protocols have been put in place

• All inbound passengers are being screened.

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• A health facility to quarantine passengers has been set up at the Indira Gandhi International Airport (IGIA) in New Delhi.

• Ram Manohar Lohia (RML) Hospital in the city• Quarantined, till their blood tests come back. 

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Airline Crew

• Immigration officers have been trained and crew members of flights have also been sensitized on the measures

• Standard operating procedures for passenger screening at the airports by Airport Health Organisation

• Inflight announcements regarding the virus and its symptoms

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• A health screening card and advisory for passengers has also been prepared

• State Governments have been asked to maintain coordination with all ports so that ship crew are also screened properly

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Health screening cards

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Crew members of flights arriving at• Delhi• Mumbai• Hyderabad• Bengaluru• Kochi and Trivandrum (covering 11 airlines)

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Delhi Government Sets Up Helpline For Information on Ebola

The control room can be contacted at 011-22307145

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• According to statistics placed 22,150 passengers have been screened, of which 7 were identified to be at medium risk and 56 at high risk

• While the low risk passengers are given general advice• A tracking system has been put in place under the Integrated Disease Surveillance Programme

http://www.livemint.com/Politics/zatgMfscvM4uotqe4b SZI/India-reviews-Ebolapreparedness.htm

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• Passengers arriving at 18 international airports and 9 major ports from the affected countries are being screened for Ebola.

•  IDSP is even keeping a track of passengers• A Control Room has been set up at the Ministry of Health & Family Welfare. The numbers are 23063205, 23061469 and

23061302.

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Committee The Indian health ministry confirmed 3 member committee 1. Ministries of health2. Civil aviation3. Immigration

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• Health Ministry has stopped entry of people having been discharged after being treated for Ebola who do not have the medical certificate

• They have been advised not to travel to India for a period of 90 days from their discharge, Health Minister JP Nadda

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Challenges •Cost and resources•Health and its spread•Training of the personnel

•Lapses during incubation period

•Psychological issues and dignity

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Conclusion • The current outbreak of Ebola is the worst on record. It has killed at least 5,177 people, mostly in Sierra Leone, Liberia and Guinea, according to the latest figures from the WHO. 

• Airport and international borders play a huge role in movement of infected personnel across the countries which can lead to outbreak of these infectious diseases

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Quarantine achieves 2 goals• First, it stops the chain of transmission • Second, it allows the individuals under surveillance to be identified

Hence effective quarantine programme is an important part for prevention of migration of infected across the borders

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