Operations in foreign countries

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5.1 Spread of Communicable Diseases (local, regional, international) by carriers/vectors

Role of air transportation in the dissemination of communicable diseases

Preventive measures

Disinsection of aircraft (impact on the occupants)

Management of communicable disease incidents in aviation
Communicable diseases have spread by different modes of transportation throughout history. In the Fourteenth Century, bubonic plague, the Black Death, crossed Europe in 5 years, the speed of an ox cart. In the Nineteenth Century, Cholera circled the world in sailing ships. In 1918 and 1919, the Influenza Pandemic girded the world in six months and killed more people than died in World War I, spread by steamships and railroads. In 1958, two missionaries infected with influenza B flew from Hong Kong to Iowa to attend a convention. Within two weeks the great Hong Kong flu pandemic was worldwide. The West Nile virus that struck North America in 2001-2 probably originated when an infected carrier emigrated from the Middle East to the United States in 2001. Aviation has the ability to disseminate diseases worldwide. Today we can transport an incubating Ebola patient from Africa to anyplace on the planet in 24 hours. We require special knowledge and action to control and prevent diseases from entering new ecosystems and becoming new epidemics.
Airports designated as International must meet mandatory World Health Organization requirements. These include quarantine zones, health and customs inspections, and at least a quarter mile zone around the airport free from breeding grounds for mosquitoes.

Flight crews operating to and through international airports demand additional medical support in terms of planning and prevention. These may include preventive vaccinations, medications, and protocols for occupational illness and injuries. In addition, flight crews should be aware of local customs, environmental issues, and potential threats of violence or terrorism. Passengers should be aware of international travel requirements and the potential for acquiring local infectious diseases. Transfers to and from other forms of transportation, notably cruise ships, occur at many ports. Health assessment of cruise ships is available at the Centers for Disease Control and Prevention web site: http://www.cdc.gov.

Passengers can transfer to and from cruise ships, bringing illnesses along.

Crewmembers and travelers must first consider personal medical requirements. If a traveler needs personal medications, they must carry them on their person along with a reserve supply. It is often difficult to obtain medications in foreign countries. In some countries, the medications must be carried in original prescription bottles. Others do not permit mailing drugs into the country.

Obtaining minor over-the-counter medications can be difficult. For example, treating a headache might be limited to aspirin or acetaminophen (Tylenol) and the latter may be labeled as panadol. Other drugs which are over-the-counter in the U.S., such as the H2 blockers cimetidine (Tagamet) and ranitidine (Zantac), may only be available by prescription. In some countries, notably Canada, opiates like codeine are available without a prescription and must not be brought back into the U.S. Likewise in South America, teas containing cocaine (Mate de Coca and Inca Tea) may not be imported into the U.S. Use of these teas can cause flight crews to fail a drug test on return to the U.S. or a traveler to have a long conversation with the Drug Enforcement Agency.

Dental care should be completed to the point where dentition is stable prior to a long trip. Considering the distress that even a minor dental emergency can raise when one is away from home, it is advisable for all travelers to take preventive measures to reduce the likelihood of such an occurrence. Following dentist's recommendations for regular preventive maintenance care, and obtaining necessary treatment on a timely basis would go a long way toward traveling with healthy, secure, and comfortable dentition. Obtaining emergency dental care overseas can be difficult, and the local administration should keep a listing of available dentists.
If you are the primary or occupational provider for flight crew and travelers, in the event of a mishap, you should have a plan to assist the local coroner or medical examiner in acquiring antemortem materials necessary for identification of fatally injured crew members. Rapid provision of the names and contact information of treating dentists and physicians to local authorities can allow them to locate and obtain these materials, thus facilitating the identification process. Useful materials include dental and medical records and diagnostic images, biopsy specimens (for DNA comparisons), as well as recorded or latent friction ridge patterns of fingers, palms and soles. Personal items may provide a source of antemortem references in the form of latent print patterns and/or trace materials containing DNA.

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