CDC Guidance for Commercial Aircraft Operators - 2011 Update on Measles

Measles alert

• Measles ─ one of the most highly contagious diseases known ─ can cause serious illness, even death.
• Measles can spread in close-contact environments, including on planes and in airports. The virus can remain active and contagious for up to 2 hours in the air or on surfaces, therefore transmission can occur without face-to-face contact.
• Symptoms appear within 3 weeks of exposure and often start with fever, cough, runny nose, red watery eyes, or sore throat. A rash usually follows in 3–5 days.  

Measles overseas

• Western Europe is experiencing an unusually high number of measles cases this year—more than 10,000 cases have already occurred since January 2011.
• Measles continues to be widespread in Asia, Southeast Asia, the South Pacific, and Africa.

Measles in the United States

• In the United States, the widespread use of the highly effective and safe measles, mumps, rubella (MMR) vaccine has stopped ongoing measles transmission. Since 2001, only about 70 measles cases have been reported per year in the United States.
• The United States has had an unusually large number of cases of measles in 2011 – over 150 by mid-June – due to an increase in the number of cases arriving from Europe, Asia, and Africa.  Most of these measles cases are occurring among unvaccinated U.S. residents who traveled overseas.
• Every case of measles requires an urgent response to prevent further spread of the disease.

Measles transmission

• Measles viruses live in the mucus in the nose, mouth, and throat of the infected person and are dispersed into the air when the ill person coughs, sneezes, or talks
• A person with measles is infectious from 4 days before to 4 days after the rash appears
• People who are not immune may become infected by inhaling the virus,  having contact with droplets containing the virus, or by touching a contaminated surface and then touching the mouth or nose

You are considered to be immune from measles if you

• Have had physician or laboratory-confirmed measles or a positive antibody test for measles OR
• Were born in the United States before 1957 (when measles was still widespread) OR
• Have had 2 doses of MMR vaccine
• Otherwise you are at risk for getting measles
  • the Centers for Disease Control and Prevention (CDC) recommends that all crew members receive 2 doses of MMR vaccine

Managing ill passengers and crew members

1. Personal protective measures - see box below
2.  Recognize symptoms that suggest possible measles
   • Consider someone to possibly have measles if the person has fever and a rash
     • Fever:the ill person feels warm to the touch, gives a history of feeling feverish, or has an actual measured temperature of 100° F (37.8° C) or higher
     • Rash: the red or reddish-brown rash usually begins on a person’s face at the hairline, then spreads downward to the neck, trunk, arms, and legs
3. Take these steps onboard
   • Take the following steps if a person has fever and a rash during a flight:
     • Keep interactions as brief as possible
     • Provide a face mask to the ill person. If a face mask cannot be tolerated or is not available, offer tissues and advise to cover coughs and sneezes.
     • Separate and move ill person(s) at least 6 feet from other passengers, if possible
       • Keep track of original and changed seats (so all passengers who sat near the ill person can be identified and notified if measles is diagnosed)
     • Limit the ill person’s movement about the cabin and arrange use of lavatory so the ill person does not need to wait in an aisle
     • Provide a plastic bag for proper disposal of used masks and tissues
     • Practice good hand hygiene and encourage others, including the ill person, to do the same
   • In addition to the actions listed above, the CDC recommends that ill crew members:
     • Follow individual company policy for onset of illness or incapacitation during flight operations
     • Discontinue work as soon as possible without affecting flight safety
     • See their doctor, or a company-recommended health care provider if away from home base, and inform them ahead of time of the possibility of measles so precautions can be taken to prevent exposure to others at the health care facility
     • Return to work no sooner than 4 days after the onset of the rash, if measles is diagnosed 
4. To maximize removal of virus particles from the air, continue operating the aircraft air-conditioning or ventilation system until all passengers and crew have disembarked. Safety concerns may preclude this step on some aircrafts.

Report ill persons to

• Airline in-flight medical consultant: According to airline protocols, contact  in-flight medical consultants for any cases of severe illness in travelers
  
  CDC: As required by federal regulations, report onboard fever-and-rash illnesses in travelers to CDC before arrival to ensure a prompt ground response, to maximize timely care, reduce the risk for spreading disease, and minimize travel disruption.

See the Onboard Death and Illness Response Tool for Cabin Crew.

For more information about measles

• CDC Measles homepage
• In the News: 2011 Measles Update
• Ask your doctor or contact your local or state health department.