Outbreak preparedness & control PPHSN Guidelines For the Preparedness, Surveillance And Response To Severe Acute Respiratory Syndrome (SARS) in Pacific Island Countries And Territories Last update REDUCING THE RISK OF IMPORTING SARS THROUGH INTERNATIONAL TRAVEL (Updated 05.05.03) Key points As on 5 May 2003 WHO recommendation that persons travelling to Beijing, Hong Kong SAR, and Guangdong and Shanxi provinces, China, consider postponing non-essential travel, remains in effect. However, the same recommendation for Toronto was lifted on 30 April. Vietnam was removed from the list of SARS affected countries on 28 April 2003. An earlier WHO recommendation suggested that countries where there had been cases of SARS enhance screening at departure points to prevent suspect cases from travelling. Countries should develop national SARS-related travel policies. Countries should develop information sheets (such as a health alert card) for international travellers. This should detail the incubation period for SARS, and explain what they should do and who they should report to if they develop a fever. Airlines should develop polices to prepare for and manage a potential case of SARS detected in-flight, and how to manage other passengers on the same flight.
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WHO recommendations to limit the spread of SARS by international travel WHO released its first SARS-related travel advice on 15 March 2003. It provided advice to travellers who developed SARS-like symptoms, and recommendations to airlines on what to do if a possible SARS case was identified in-flight. On 27 March 2003, WHO recommended new measures to prevent travel-related spread of SARS. These included a screening process to identify people with possible SARS symptoms leaving an affected area. Individual countries, as they make their own travel advice, may wish to take into account national considerations. Information updates on affected areas and the number of SARS cases, deaths and evidence of local transmission are issued daily by WHO (http://www.who.int/csr/sars). On 2 April, 2003, WHO recommended that "that persons travelling to Hong Kong and Guangdong Province of China consider postponing non-essential travel." This recommendation is based on concerns about more general community transmission of SARS in these regions. This is a temporary recommendation and it will be reassessed in the light of the evolution of the SARS outbreak in currently affected areas. Other areas of the world could become subject to recommendations if the situation demands. This recommendation applies only to travellers entering Hong Kong SAR and Guangdong province and not to passengers directly transiting through international airports within those areas. On 23 April 2003, as a result of ongoing assessments as to the nature of outbreaks of severe acute respiratory syndrome (SARS) in Beijing and Shanxi Province, China, and in Toronto, Canada, WHO recommended, as a measure of precaution, that persons planning to travel to these destinations consider postponing all but essential travel. This temporary advice was an extension of travel advice previously issued for Guangdong Province and Hong Kong Special Administrative Region, China. On 28 April 2003, Vietnam was the first country to be removed from the list of SARS affected areas. On 29 April WHO recommended that travel advisories for Beijing, Hong Kong SAR, and Guangdong and Shanxi provinces, China, remain in effect. However, the travel advisory for Toronto was lifted as from 30 April. WHO travel advice is available at www.who.int/csr/sars/en, and is updated regularly based on the changing global situation and the risk of transmission in the SARS-affected areas.
Travellers' Alert All travellers, including airline/ship crews, should be aware of the main symptoms and signs of SARS. They should seek immediate medical attention should fever occur, and ensure that information about their recent travel is passed on to health care staff. Travellers who develop these symptoms are advised not to undertake further travel until they have recovered. Many countries are now distributing SARS health alert cards (for an example see ANNEX 5). These cards briefly describe the symptoms of SARS, advise travellers to seek immediate medical care when showing these symptoms, specify the potential incubation period (14 days), and give a contact address and telephone number/hotline of a SARS referral centre. Cards may also contain advice for physicians.
PPHSN SARS Task Force advices The PPHSN SARS Task Force suggests as much caution and restriction as locally practical, both to and from the more severely SARS-affected areas, given the limitations in the Pacific in safely managing suspected SARS patients, PPHSN travel advice is provided in ANNEX 3, and may be updated on the PPHSN website (www.spc.int/phs/PPHSN). PPHSN SARS Task Force agrees with WHO recommendations. For the purpose of travel advisories, the PPHSN SARS Task Force follows WHO list of areas and countries with recent local transmission of SARS, with the three levels reflecting the risk for getting infected by SARS in these places. The current WHO travel advisory recommends, as a measure of precaution, that persons planning to travel to destinations listed as with high transmission to consider postponing all but essential travel. As the situation is unclear in China as on 05 May 2003, PPHSN SARS Task Force advises the PICTs to consider the whole mainland China as potentially with high transmission (and therefore avoid unnecessary travel to mainland China and Hong Kong SAR). Given the limited means most of the PICTs have to fight SARS (and the disastrous consequences SARS introduction would have), PPHSN SARS Task Force understands some of them might want to be more careful and restrictive, and have the same recommendation for areas or countries with medium-level transmission. As another step, PPHSN SARS Task Force understands that some of the PICTs may also wish to discourage passengers having been in the worst-affected (high-level transmission) areas or countries within 14 days before arrival from coming to their PICT until 14 days have passed since they were in high-transmission places. Some PICTs may also wish to apply the same measure for medium-level transmission countries or areas. It is clear for the Task Force that these travel-related measures shouldn't be isolated, but that the PICTs should prepare themselves for SARS importation, and introduce proper surveillance, contact tracing, and infection control measures.
Advice to airline staff and national airport health authorities See "In-flight care of suspected case of SARS". See "Contacts of suspected cases on aircraft ". In order to respond to these recommendations, airlines will have to ensure that flights with passengers from affected areas are provided with sufficient gloves, face masks and disinfectant, and they should ideally ensure that a seat in an isolated area can be made available when needed. Airlines must also make sure that flight attendants are properly trained.
Disinfection of aircraft See WHO Guide to Hygiene and Sanitation in Aviation (http://www.who.int/csr/ihr/guide.pdf). Although these recommendations are mainly directed to air travel, the same procedures are recommended for international travel from affected areas by sea, rail or road. |
