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PREPARING AIRPORTS FOR COMMUNICABLE DISEASES ON ARRIVING FLIGHTS (2017)


CHAPTER: APPENDIX A - DISEASES OF PUBLIC HEALTH SIGNIFICANCE

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Suggested Citation:"Appendix A - Diseases of Public Health Significance."
National Academies of Sciences, Engineering, and Medicine. 2017. Preparing
Airports for Communicable Diseases on Arriving Flights. Washington, DC: The
National Academies Press. doi: 10.17226/24880.
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Suggested Citation:"Appendix A - Diseases of Public Health Significance."
National Academies of Sciences, Engineering, and Medicine. 2017. Preparing
Airports for Communicable Diseases on Arriving Flights. Washington, DC: The
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69 Appendix A diseases of public Health Significance Canada For Canada, the
Quarantine Act (2005, c. 20, Sch.; 2007, c. 27, s. 4) includes a Schedule of
diseases of concern. Canada currently has 25 diseases of concern: • Active
pulmonary tuberculosis • Anthrax • Argentine hemorrhagic fever • Bolivian
hemorrhagic fever • Botulism • Brazilian hemorrhagic fever • Cholera •
Crimean-Congo hemorrhagic fever • Diphtheria • Ebola hemorrhagic fever •
Lassa fever • Marburg hemorrhagic fever • Measles • Meningococcal
meningitis • Meningococcemia • Pandemic influenza type A • Plague •
Poliomyelitis • Rift Valley fever • Severe acute respiratory syndrome •
Smallpox • Tularemia • Typhoid fever • Venezuelan hemorrhagic fever •
Yellow fever. If PHAC processes someone with another disease such as dengue and
norovirus, PHAC would help facili- tate the response and care through its
partners (S. Jain, personal communication, Dec. 21, 2016). United States For the
U.S., the list of quarantinable diseases is contained in Presidential Executive
Order 13295 (Revised List of Quarantinable Communicable Diseases, July 31,
2014). The quarantinable diseases for the U.S. are • Cholera • Diphtheria
• Infectious tuberculosis • Plague • Smallpox • Yellow fever • Viral
hemorrhagic fevers (such as Marburg, Ebola, and Congo–Crimean) • Severe
acute respiratory syndromes. Many other illnesses of public health significance,
such as measles, mumps, rubella, and chicken pox, are not contained in the list
of quarantinable illnesses, but continue to pose a health risk to the public.
Quarantine Station personnel respond to reports of ill travelers aboard
airplanes, ships, and at land border crossings to make an assessment of the
public health risk and initiate an appropriate response. International—The
World Health Organization (WHO) International guidance is contained in the
International Health Regulations (2005) (IHR 2005; WHO 2005). Compared with
previous international health regulations, IHR 2005 moved to a process whereby
the scope was not limited to any specific disease or manner of transmission, but
instead outlined processes for reporting to WHO events that could constitute
public health emergencies of international concern (PHEIC). By not limiting the
application of the IHR to specific diseases, it then would remain relevant over

70 the years and be applicable for example to emerging or novel diseases (WHO
2005, p. 1). IHR 2005 calls for reporting as a potential PHEIC, three groups of
conditions. i. Any event of potential international public health concern,
including those of unknown causes or sources ii. Essentially one case of the
following diseases because a case would be unusual or unexpected: a. Wildtype
poliovirus Poliomyelitis b. Human influenza caused by a new subtype c. Severe
acute respiratory syndrome (SARS). iii. Diseases that have demonstrated the
ability to cause serious public health impact and spread rap- idly
internationally: a. Cholera b. Pneumonic plague c. Yellow fever d. Viral
hemorrhagic fevers (Ebola, Lassa, Marburg) e. West Nile fever f. Other diseases
that are of special national or regional concern; e.g., dengue fever, Rift
Valley fever, and meningococcal disease. Note: The Canadian and U.S. lists show
how IHR 2005 affects national regulations. In addition, the fol- lowing
observations illustrate how IHR 2005 is applied (CDC, personal communication,
Jan. 27, 2017): I. Each country may face different threats related to volume of
travel from specific regions of the world to that country, etc.; therefore, they
may have diseases on their list related to those threats. II. Countries may also
set their own disease elimination goals, in addition to goals set by WHO. TB is
a goal for the U.S., but not for many other countries; that’s why many of our
air investigations involve TB. III. In the U.S., we don’t expect airlines, or
our partners in the airports to identify disease. In fact, except for a few
obvious cases of rash illnesses, even an infectious disease specialist would be
hard pressed to make a diagnosis in an air travel related reported illness. So,
we provide our partners with a list of symptoms that we ask them to report. IV.
The issue for this report is travel related to airports, therefore the diseases
of interest should be communicable either during air travel or in an airport
setting. Rabies, though a serious and deadly disease is not likely communicable
in that environment. That said, we have been involved with at least one
potential PHEIC involving air travel and a few air contact investigations. But
those were highly unusual circumstances, one being a bat on a plane. The PHEIC
process allows us to do that without having to list every specific disease. V.
Although WHO has listed some diseases as outlined in 2, each country has to
respond based on its own regulatory authority, not WHO’s. We have learned that
it is better to be a bit more general than specific, that’s why the WHO moved
to the PHEIC process. If you look closely, you will notice that the U.S. list
says Severe acute respiratory syndromes and not Severe acute respiratory
syndrome. In July 2014, Executive Order 13295 was amended and replaced with
Severe acute respiratory syn- dromes, because when MERS arose it was clearly
different from SARS. In anticipation that there could be other novel coronavirus
infections, it did not make sense to list specific diseases, but rather to
define a term that could encompass a range of similar diseases so we would not
need either a rule change or a new executive order for each new occurrence.
That’s the same thinking WHO and the world public health community had for not
listing specific novel influenza virus strains.

Next: Appendix B - ICAO Document 4444, Paragraph 16.6 »
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TRB's Airport Cooperative Research Program (ACRP) Synthesis 83: Preparing
Airports for Communicable Diseases on Arriving Flights examines current disease
preparedness and response practices at U.S. and Canadian airports in
coordination with public health officers and partners. While larger airports
that receive international flights are most likely to experience the challenges
associated with these events, the preparedness and response lessons are
transferable to the aviation sector more widely. Smaller airports may be final
destinations of those traveling with communicable diseases, so report findings
are useful to all airport operators and local public health officers.

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CONTENTS

 * 
 * Front Matter i–viii
 * Summary 1–2
 * Chapter One - Introduction 3
 * Chapter Two - Air Travel and Communicable Diseases 4–12
 * Chapter Three - Survey Results 13–21
 * Chapter Four - Where the Rubber Hits the Tarmac: Six Case Examples 22–54
 * Chapter Five - Findings, Conclusions, and Further Research 55–59
 * Glossary 60–63
 * Acronyms 64
 * References 65–68
 * Appendix A - Diseases of Public Health Significance 69–70
 * Appendix B - ICAO Document 4444, Paragraph 16.6 71
 * Appendix C - Study Participants 72–75
 * Appendix D - Survey Questions and Responses 76–81
 * Appendix E - Lessons Learned as Stated by Airports and Local Health
   Departments 82–86
 * Appendix F - Ebola Time Line for DFW Cases 87–89
 * Appendix G - Checklist for Airport Communicable Disease Response Planning
   90–94

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