May 7, 2009. CDC Gives Advice for Cruise Ships
| SOURCE: | Centers for Disease Control and Prevention |
The novel influenza A (H1N1) virus that has infected humans in the United States and other countries, including Mexico, is a new H1N1 virus that has not previously been identified in North America or anywhere in the world. CDC and HHS are working to provide information to assist the transportation industry, public health officials, and the public in addressing the challenges posed by this newly identified influenza A (H1N1) virus.
The symptoms of novel influenza A (H1N1) virus in people are similar to the symptoms of regular human flu and include fever, cough, sore throat, body aches, headache, chills and fatigue. Some people have reported diarrhea and/or vomiting associated with novel influenza A (H1N1) virus . Investigations of these cases suggest that ongoing human-to-human transmission of the novel influenza A (H1N1) virus is occurring.
As the guidelines for the prevention and control of novel influenza A (H1N1) are being developed and new information is gained, more detailed updated guidelines will be published on the CDC H1N1 Flu web page (http://www.cdc.gov/h1n1flu/).
Transmission of Influenza Viruses
Novel influenza A (H1N1) virus is likely to spread from person-to-person in the same way as seasonal flu. The main way that influenza is thought to spread is through the coughing or sneezing of people infected with the influenza virus. People may also become infected by touching something with flu viruses on it and then touching their mouth or nose.
INTERIM RECOMMENDATIONS
Recommendations in this guidance document are based on standard infection control and industrial hygiene practices. They should be implemented immediately in order to protect passengers and crew members from infection and prevent the spread of this virus via cruise ship travel. All cruise ship personnel and passengers should follow the practices and instructions described below to prevent spreading infectious disease and becoming ill.
Stay Home If You Are Sick
If you get sick, stay home and limit contact with others to keep from infecting them. If you are sick you should not board the ship.
Hand Washing
Wash your hands often with soap and warm water for at least 20 seconds, especially after you cough or sneeze. Alcohol-based hand cleaners are also effective. Avoid touching your eyes, nose or mouth because germs spread that way.
Cough Etiquette
Cover your nose and mouth with a tissue when you cough or sneeze. Throw the tissue in the trash after you use it. If you don't have a tissue, cough or sneeze into your upper sleeve, not your hands.
Social Distancing
Whenever possible, crew members and passengers should maintain a distance of at least 6 feet between themselves and others. When possible, minimize time spent in the common public gathering areas of the ship.
Gloves
Crew members should wear impermeable, disposable gloves if they need to have direct contact with ill passengers or potentially contaminated surfaces, rooms, or lavatories used by ill passengers. They should avoid touching their face with gloved or unwashed hands. Improper use of gloves may actually increase transmission.
Surgical Masks and Respirators
People with symptoms of influenza-like illness should not leave home or travel. Crew members or passengers who develop symptoms of influenza-like illness should wear a surgical mask to reduce the number of droplets coughed or sneezed into the air. Personnel assisting an ill person with symptoms of influenza ideally should wear a NIOSH-certified disposable particulate respirator, rated N-95 or better for which they have been fit-tested in the context of a respiratory protection program. Surgical masks provide barrier protection against droplet and contact transmission of the virus, but they do not protect against inhalation of airborne particles. Droplets are still considered to be the primary route of influenza virus transmission, but airborne transmission can not be ruled out at this time. Disposable surgical masks and respirators should not be reused; once removed they should be discarded.
Ill Crew Members and Passengers
If a crew member or passenger is displaying signs and symptoms of an influenza-like illness prior to the cruise, they should not board the ship. If a passenger or crew member develops influenza-like symptoms en route, they should be medically evaluated and confined to their cabin quarters for the duration of the illness. Ill people should cover their nose and mouth when coughing or sneezing, use tissues to contain respiratory secretions and dispose of used tissues in the nearest waste receptacle after use. If tolerated they should wear a surgical mask to reduce the number of droplets coughed or sneezed into the air. Hands should be washed after contact with respiratory secretions or contaminated objects or materials.
The interim U.S. case definition of novel influenza A (H1N1) virus infection is available at the following Web site: (http://www.cdc.gov/h1n1flu/casedef.htm)
Healthcare personnel aboard the ship should follow the recommendations for healthcare personnel described at the following Web site: (http://www.cdc.gov/h1n1flu/guidelines_infection_control.htm")
MANAGEMENT OF PASSENGERS OR CREW MEMBERS WITH SYMPTOMS OF INFLUENZA
Cruise ship personnel should be aware of the possible symptoms of novel influenza A (H1N1) virus including fever, cough, sore throat, body aches, headache, chills, fatigue, and in some cases, diarrhea and vomiting. Visit CDC's novel H1N1 flu website:(http://www.cdc.gov/h1n1flu/)
Minimize the number of personnel directly exposed to the ill person.
Separate the ill person from others as much as possible (at least 6 feet).
Move the sick person to an isolated area such as their cabin quarters. They should remain in their cabins for the duration of their illness.
Consider isolating the sick person with a family member or companion if necessary for control, comfort, or compliance. The companion should take appropriate precautions to protect themselves.
Have the ill person wear a surgical mask in common areas, if it can be tolerated, to reduce the number of droplets coughed or sneezed into the air. Surgical masks should not be reused.
If a surgical mask can not be tolerated, provide tissues and ask the ill person to cover his or her mouth and nose when coughing or sneezing.
Wash hands for 20 seconds with soap and warm water before tending to the sick person and after handling garbage, touching commonly touched surfaces, contacting respiratory secretions or tending to the sick person.
Wash hands before removing a respirator and after removing gloves and a respirator.
Use waterless, alcohol-based hand gels when soap is not available and hands are not visibly soiled.
Personnel tending to the ill person or contacting potentially infectious materials should use impermeable, disposable gloves. Gloves are not intended to replace proper hand hygiene. Gloves should be carefully removed and discarded and hands should be cleaned immediately after activities involving contact with body fluids. Gloves should not be washed or reused.
Personnel having close contact with an ill person ideally should wear a NIOSH-certified particulate respirator, rated N-95 or better, as described previously. Respirators should not be reused.
Dispose of soiled material, gloves, items contaminated with body fluids, and disposable respirators in a sturdy plastic bag that should be tied shut and not reopened, and disposed of according to state solid waste regulations. Ensure that the cruise ship is adequately cleaned and disinfected by personnel wearing appropriate PPE.
If a suspect H1N1 influenza case is identified aboard a ship the captain is required by law to report the illness to the CDC Quarantine Station in the jurisdiction of the U.S. port where the ship is expected to arrive.
If the ship will not be arriving imminently at a U.S. port, Quarantine health authorities will assist ship officials with the management and isolation of the suspect case and the recommendations for other passengers and crew members.
When the ship arrives in a U.S. port, Quarantine officials will work with the cruise ship industry and local and state health departments to assist with medical transportation of the patient upon arrival, disease control and containment measures, passenger and crew notification and surveillance activities, communicating with local public health authorities, and cruise ship disinfection procedures.
MANAGEMENT OF CREW FOLLOWING EXPOSURE
Crew members who may have been exposed to a passenger or coworker suspected of having influenza should monitor their health for 7 days after the exposure. If they become ill with influenza-like symptoms, including fever, body aches, runny nose, sore throat, nausea, or vomiting or diarrhea they should immediately take the following steps:
Notify their supervisor
Report to the shipboard dispensary
Follow the current recommendations for the use of antiviral medications
If the crew member is taken to a health care facility off the ship, inform the facility before visiting about the possible exposure to influenza.
Limit contact with others as much as possible. When not alone or in a public place, wear a surgical mask to reduce the number of droplets coughed or sneezed into the air.
Copyright © 2009, Centers for Disease Control and Prevention