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2005 – Avian influenza ............................................................................................................. 3
2006 to 2009 – Development of ICAO SARPs and guidance material ..................................... 4
Guidance material ............................................................................................................... 4
Standards and Recommended Practices (SARPs) .............................................................. 4
Notification of public health authority at destination ...................................................................... 6
Cooperative Arrangement for the Prevention of
Spread of Communicable disease
through Air travel (CAPSCA) ................................................................................................... 7
Conclusion ............................................................................................................................... 7
References ............................................................................................................................... 7
Appendix – Extract from the PANS-ATM (Doc 4444) ................................................................... 9
ICAO Preliminary Unedited Version — March 2010 III-18-1
INTRODUCTION
With the possible exception of airline medical advisors, the primary role of civilian doctors
specializing in aviation medicine has been to undertake medical selection of applicants and to ensure
the medical fitness of licence holders for the duration of the period of validity of their Medical
Assessment. The importance of these two fields of activity is demonstrated by the fact that, apart from
this chapter, almost the entire Manual of Civil Aviation Medicine is dedicated to help achieve this goal.
In recent years, however, interest has focused on another topic of relevance to aviation medicine, that
of the role of air travel in the spread of communicable disease.
Article 14 of the Convention on International Civil Aviation1 deals with the spread of communicable
disease by air:
Each contracting State agrees to take effective measures to prevent
the spread by means of air navigation of cholera, typhus (epidemic),
smallpox, yellow fever, plague, and such other communicable
diseases as the contracting States shall from time to time decide to
designate, and to that end contracting States will keep in close
consultation with the agencies concerned with international
regulations relating to sanitary measures applicable to aircraft. Such
consultation shall be without prejudice to the application of any
existing international convention on this subject to which the
contracting States may be parties.
Written in 1944 (the year the Convention was developed), it shows its age by referring to smallpox, a
disease eradicated in 1979. Nevertheless, it remains relevant as demonstrated by events related to
communicable disease outbreaks during the first decade of the 21st Century and it places a formal
onus on States to play their part in public health initiatives to reduce the risk of disseminating such
disease by air transport.
Air transport plays an important role with respect to the spread of communicable disease as it is one
of the main means by which such diseases can spread in modern society. An infected air traveler can
be virtually anywhere on earth within a day or two, often within the incubation period of many
important communicable diseases such as the various sub-types of influenza. The remainder of this
chapter considers the issues raised by this observation and how they may be managed.
AVIATION MEDICINE AND MANAGEMENT OF COMMUNICABLE DISEASE
Public health is the specialty most involved in prevention of spread of communicable disease. Public
health specialists (supported by infectious disease specialists) are experts in aspects of communicable
disease such as incubation periods, virulence, disinfection, diagnosis and protective measures, etc.,
and they are likely to play the lead role in any national pandemic preparedness plan. Aviation
medicine specialists clearly need the advice of such experts when developing a preparedness plan
specific to aviation. On the other hand, the aviation environment differs in several important respects
from most others that are encountered by public health officers. In particular, the aircraft cabin
environment varies from other modes of transport with respect to aspects such as reduced air pressure,
reduced humidity and specialized environmental control systems. Further, by its very nature, aviation
is an international business, unlike most other aspects related to public health, and is affected to
varying degrees by public health policies and procedures at each airport into which there are
　
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