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Measles Warnings and Preventing the Spread of Disease when Flying

Numerous measles warnings have recently been issued by health authorities to travelers flying certain airlines, as persons carrying the contagious disease have been arriving in Australia.

On Friday 11 January, a man infected with measles traveled to Sydney from Manila on a Qantas flight. He had developed measles whilst travelling in the Philippines and was diagnosed with the infectious illness upon return to Sydney. Those flying Flight QF20 were alerted by NSW Health, and isolation measures were put in place.

On the same day, two unvaccinated children suffering the measles also flew into Sydney from Sri Lanka. This was on Singapore Airlines Flight SQ211, flying in from Singapore.

NSW Health noted that those who flew on those flights, and those who attended the reported areas that these people went to around Sydney, should be on alert until late January for symptoms. These include fever, sore eyes and a cough. Victims can develop a red, blotchy rash about three or four days later. These symptoms usually arise about 10-12 days after infection

NSW Health insisted that those travelling in Southeast Asia ensure that they are completely vaccinated before attending those countries.

Border screening: Detecting the spread of disease when flying?

We have seen diseases spread through passengers travelling airborne before. Aviation is not a stranger to it. Even earlier in January 2019, there was another measles alert in north Brisbane as Queensland Health issued a warning. A male passenger had arrived on China Southern Airlines flight CZ 381 from Guangzhou, and was unaware he was carrying the disease.

Many countries since the early 21st century have adopted stricter border measures to stop or slow the spread of infectious illnesses from other countries. This was especially so after the 2003 severe acute respiratory syndrome (SARS) outbreak in China and the 2009 influenza pandemic in the United States.

However, a 2015 analysis of border screening observing the SARS and influenza pandemics argued that border screening as a response to disease outbreaks is not an effective way to detect infectious travelers. Another 2015 article by a range of doctors also suggested that certain border screening methods using self-reported symptoms and temperature testing is a very limited way to prevent, for instance, pandemic influenza from entering a country. Another December 2017 article in the Clinical Microbiology and Infection journal reads:

Current technology limits our ability to control the transmission of influenza. However, because influenza is associated with substantial morbidity and mortality public health control of influenza is a worthwhile objective. Unfortunately it would seem that border entry screening and quarantine play a limited role in influenza control.

There are generally four routes for the spread of infectious micro-organisms: contact, airborne, common vehicle, and vector-borne.

One expert concluded that, indeed, commercial airlines are a very suitable environment for the spread of pathogens carried by both passengers and crew. He suggests that early recognition and control measures are critical, but systematic screening of passengers is not practical.

A better solution?

Many suggest that education is key to limiting the spread of disease when flying through commercial air travel. This can include things like videos, posters, in-flight announcements, signs, and health alert notices.

Simple things like good hand hygiene reduces the risk of diseases transmission and should really be part of regular travel routine.

Cabin crew can also take steps to prevent the spread of disease on commercial aircraft. The U.S. Centers for Disease Control and Prevention has published a useful general guide on this. It provides guidance on identifying a potentially sick and infectious passenger (or other crew member), as well as using personal protective equipment like gloves and facemasks. Crew should minimise the persons exposed and also learn the possible symptoms of infectious respiratory, gastrointestinal and bloodborne diseases

The Department of Health has a useful Travel Health Information page advising on how to protect yourself from infectious illness whilst travelling overseas.

More generally, this Vaccines Travel Guide provides a useful list of recommendations per country, advising which vaccinations to take prior to travelling to any particular location overseas.