The IHRs and airport preparedness for infectious disease pandemics

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Leonard Morrison
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1 The IHRs and airport preparedness for infectious disease pandemics Shanghai Meeting April 02, 2008 Walter Gaber, MD Vice President Human Resources Medical Director Frankfurt Airport, Germany (Fraport AG)

2 Coughs and sneezes. Tony Evans,ICAO,2006

3 IHR - Purposes and Scope The purpose and scope of these Regulations are to prevent, protect against, control and provide a public health response to the international spread of disease in ways that are commensurate with and restricted to public health risks, and which avoid unnecessary interference with international traffic and trade

4 Goal of Airports : Keep the Airport running.

5 Goal of Public Health Services : Keep the Pandemic outside

6 Medical Impact (somewhere worldwide) B A R R I E R Exit Airport Clinic Medical examinatio Exit Screening (Exit Airport) Entry Screening (Frankfurt Airport) Quarantine

7 Landings within 60 seconds!

8 Wide-body arrivals at a major airport - from one country alone : 36 x 250 Pax = 9000 Pax/day

11 Capacity at P.o.E at all times a Medical service, staff & equipment b Equipment & personnel for transport Trained staff and programme for vector control c Trained personnel for inspection of conveyances d ensure safe environment, water, catering facilities, wash rooms, disposal services & inspection programmes

12 Capacity at P.o.E during P.H.E.I.C. a Emergency resp. plan, coordinator, contact points for relevant PoE, PH & other agencies b Provide PH assessment & care for affected travellers, animals, goods by establishing arrangements with medical, veterinary facilities for isolation, treatment & other services c Provide space, separate from other travellers to interview suspect or affected persons d Provide for assessment, quarantine of suspect or affected travellers f Provide access to required equipment, personnel with protection gear for transfer of travellers with infection/ contamination e To apply entry/exist control for departing & arriving passengers e To apply recommended measures, disinsect, disinfect, decontaminate, baggage, cargo, containers, conveyances, goods, postal parcels etc

13 WHO ICAO IATA ECAC EU CDC ECDC CAPSCA RAMT FAA ACI (EAGOSH) Guidelines Airports Local German Authorities: BMG BMV RKI States Public Health S. Center of Compet E.g.

14 Entry Screening

15 Contact Patient in the aircraft (Contact/Index Patient ) 2 m Gottschalk Frankfurt 2007

16 Entry Screening (Draft) At the Apron before leaving the aircraft (inside the aircraft) Personnel will check the passengers in every aircraft coming from affected or suspicious areas (medical staff and border police) Subsequent Color Coding Subject to Coding* Pax is transmitted to designated medical services Pax obtains medical information, further advice or precepts from the medical services Pax proceeds with travel (after providing personal data) * Will be done inside the aircraft before de-boarding

17 Colour coding of Patients/Contacts Red: Index patient Yellow: close contacts, i.e. family members, passengers sitting 2 rows around the sick passenger and crew member(s) taking care of the sick passenger They might have been infected by the sick passenger but are unlikely to be infectious at that stage Green: passengers and crew members w/o close contact to the index case They would be given health information, and information for contact tracing would be obtained from them in case they need to be put under active surveillance

18 Procedure with 4 color coding in Hong Kong (SARS) Four buses for the different categories Red (Index) Orange (close contact) Yellow (social contact) Green (ok)

Possible Procedures (Entry and Exit Screening)

19 Possible Procedures (Entry and Exit Screening) Thermo scanning and manual scanning In Hong Kong and Singapore for Entry and (!) Exit Passengers: Additional 2 employees per gate (!!). Temperature scanning also daily for Employees working at the airport. (pictures taken during the SARS program)

20 Step 1 If Thermoscan is positive (over 37,5 degree Go to... Step 2 Re-testing after 15min./30 min. under super If positive (38,0 degree C) Go to... Step 3 Medical examination at the airport Inside the Terminal Close to the first control area

21 Hygiene measurements (Hong Kong Airport) At each elevator: information was shown about proper hygiene space for waste disinfectant gel provided

23 Red-coded passengers are escorted to RED restricted area (in Terminal) There will be documentation and information from a qualified medical expert about the situation and the upcoming procedures.

24 Areas are separated Medical Post and paramedics are available. In the exercise, airline employees provided support to passengers if there are any questions.

25 Passengers are informed by a medical expert a a PowerPoint presentation with information runs in the background. After filling out the public health declaration (PHD) the passengers will see the public health officer.

26 HP ok HP ok The pax will receive another patch after consulting with the Public Health Officer Paramedic service close to the different zones (red, yellow...) (pict.. below)

27 Exit Screening

* Escorted by police or security staff Exit Screening (draft) At the Terminal before check-in (before entering the Building or within the building) Medical inspection/examination Questionnaire

28 * Escorted by police or security staff Exit Screening (draft) At the Terminal before check-in (before entering the Building or within the building) Medical inspection/examination Questionnaire Temperature-Scanning. In case of negative screening results: Coding for check-in (inside the building in designated area, see Hong Kong) In case of positive* screening results: Coding for medical services (nearby)

29 HO International Health Regulations (IHR) Questions to be answered Are you aware of the IHR? (the latest revision -2005) Legal Responsibility Designated Airports Trained Staff Equipment Training/Drill Tool Box To Do List Procedures Checklists Entry Screening Exit Screening Communication (national/int.) int. Network (ICAO, ACI, IATA) Modify present Emergency Plan Take over Leadership

30 Our Service: ACI/ICAO Airport Preparedness Guidelines for Outbreaks of Communicable Diseases available at > priorities > health White Paper on pandemic procedures for airports (draft) Pandemic Plan (Catalogue of Measures for highly infectious diseases (draft) German Pandemic Plan (procedures at Frankfurt Airport Emergency Procedures (defence against infectious diseases) Flowchart for highly infectious diseases CAPSCA Steering Committee

31 ECAC

32 Acknowledgments: Public Health Service HKG Cathay Pacific Airlines Airport Authority Hong Kong Public Health Service Frankfurt/M.

34 Vielen Dank für die Aufmerksamkeit Any Questions? urther information:

Management of Public Health Events in Air Transport Training

Management of Public Health Events in Air Transport Training ICAO-WHO Sixth Meeting of the CAPSCA-EUR NAT Programme CAPSCA Workshop and Training for Technical Advisors Minsk, Belarus July 12, 2017 Emergency