Version 2: May 8, 2003
PDF Version (6 Pages, 107 KB)
This document has been developed in response to an urgent need for recommendations regarding the follow-up of passengers upon airplanes when a Severe Acute Respiratory Syndrome (SARS) case is detected in a person who has traveled by air. As more information about the cause, communicability and transmission of this illness becomes available, the recommendations provided in this document may change.
Key Changes in this version are:
The material provided on this site has been produced through consultations among federal, provincial, territorial and local public health officials across Canada and is aimed at producing scientifically sound guidelines on SARS for health professionals. Health Canada would like to acknowledge the significant and ongoing contributions of all participating stakeholders.
Principles and Assumptions
The current recommendations were based on the following principles/assumptions:
Case Definitions
Case definitions for SARS have been developed. Case definitions are subject to revision as further epidemiological and laboratory information becomes available. For the most recent case definitions please refer to the Health Canada website at: www.sars.gc.ca
Fact Sheets
General information and educational material about SARS is available on the Health Canada website at: www.sars.gc.ca
Management of Severe Acute Respiratory Syndrome (SARS): Interim Guidelines for Health Care Providers
Clinical management recommendations have been developed for clinicians managing a case of SARS and are subject to revision as further information becomes available. For detailed Clinical Management guidelines, please refer to "Management of Severe Acute Respiratory Syndrome (SARS): Interim Guidelines for Health Care Providers" on the Health Canada website at www.sars.gc.ca
Public Health Management of SARS Cases and Contacts
Public Health management recommendations have been developed. Public Health recommendations are subject to revision as further information becomes available. For full details of Public Health management guidelines, please refer to "Public Health Management of SARS cases and Contacts" on the Health Canada website at www.sars.gc.ca
Infection Control
Infection control guidelines have been developed for institutions, airlines/airports, and the general public. Infection control practices are subject to revision as further epidemiological and laboratory information becomes available. For full details of infection control practices for SARS cases, please refer to the Health Canada website at: www.sars.gc.ca
Diagnostic Testing
Recommended laboratory investigations for SARS have been developed. Recommended laboratory investigations are subject to revision as further information becomes available. For full details of laboratory testing recommendations, please refer to the Health Canada website at: www.sars.gc.ca
Passenger Follow-Up
The following recommendations refer to the follow-up of passengers when a suspect or probable case of SARS has been identified on an airplane.
If the SARS case was asymptomatic at the time of the flight, follow-up is not required. However, if the probable or suspect case had any symptoms of the illness during their flight, follow-up is required.
When Provincial/Territorial (P/T) public health officials are notified of a suspect or probable SARS case that was symptomatic during a flight, they should request the airplane passenger manifest from Health Canada's, Centre for Emergency Preparedness and Response (CEPR). This should be done using the Flight Manifest Requisition Form on which the following information should be indicated:
The P/Ts will need to follow up passengers in their respective jurisdictions who were on a flight with a symptomatic case (according to Table 1). To facilitate this process CEPR will provide the following information to the appropriate P/Ts:
All passengers and flight crew in the plane are considered contacts of the case, however the type of contact and the appropriate public health follow-up will vary (Table 1).
Traveling companions including family members, care providers and anyone for whom there is a strong suspicion of direct contact with respiratory secretions and/or body fluids of the case would be included in the highest risk setting (Table 1). Any person (flight attendant or passenger), who provided care, including helping a case with an oxygen mask, would be considered a care provider.
Included in the table are specific recommendations for any passengers seated in close proximity to the case (i.e., who are seated in the same row as the case, two rows ahead of the case and two rows behind the case). These people, in addition to the flight attendants, are considered to be potentially at higher risk of infection than passengers seated elsewhere in the airplane with no connection to the sick passenger.
All other passengers on the flight are considered at lower risk however further public health follow-up may be indicated in certain circumstances (Table 1).
Health Canada will notify the appropriate authorities regarding any passengers who do not, or will not, be residing in Canada during the 10 days following the flight and will share the applicable Canadian public health management recommendations with these authorities.
Follow-up of flight crew
Information on the flight crew will be collected by CEPR at the same time that the manifest is requested. If a crew member resides in Canada, the P/Ts in which they reside will receive the appropriate information from CEPR (as indicated for passengers above) in order to facilitate follow-up. These individuals should be followed up according to the recommendations in Table 1. If active surveillance of a crew member is required, the public health authority must ensure that it is implemented. The public health authority may, through collaboration with the airline company, choose to delegate this activity to the occupational health representatives within airline company.
If the crew members reside outside of Canada, or will not be residing in Canada during the contact monitoring time period (i.e. 10 days following the flight), Health Canada will ensure that the appropriate authorities are notified of the persons exposure to a suspect or probable case. Health Canada will also share the applicable Canadian public health management recommendations with these authorities.
Follow-up when source of exposure is an ill flight attendant
If a flight attendant is symptomatic during a flight and is subsequently found to meet the suspect or probable case definition, the recommendations regarding the follow up of passengers will be more active. Specifically, all passengers on a flight with a symptomatic flight attendant who is identified as a SARS case should be followed in the same way as if they were seated in close proximity to a case (see second row of Table 1). The exception being that if the ill flight attendant's work activities were limited to a specific and easily identified section of the plane, for example first class, then only passengers in those sections need to be followed up using the more stringent recommendations and the rest of the passengers can be followed up according the bottom row of Table 1.
Note: See "Public Health Management of SARS Cases and Contacts: Interim Guidelines" for details about isolation in the home and active daily surveillance. Anyone on home isolation should also be on active daily surveillance.
Table 1: Passenger and Crew Follow-up
Risk Setting | Type of SARS case the passenger was exposed to: | ||
Probable Case | Suspect Case - known contact of a case* | Suspect Case - travel history only** | |
Traveling Companions, Care Provider, or Strong Suspicion of Contact with Respiratory Secretions | If contact is If contact is asymptomatic: home quarantine with active daily surveillance* for 10 days from last exposure to the probable case or until symptoms develop (then assess as "symptomatic") |
If contact is symptomatic: isolation in hospital, home or designated health care site as per management of probable or suspect cases or persons under investigations, depending on symptoms (see Public Health Management guidelines) If contact is asymptomatic: active daily surveillance* for 10 days or until symptoms develop (then assess as "symptomatic") or until source case progresses to "probable" and then should be managed as contacts of a probable case. |
If contact is symptomatic: isolation in hospital, home or designated health care site as per management of probable or suspect cases or persons under investigations, depending on symptoms (see Public Health Management guidelines) If contact is asymptomatic: active daily surveillance* for 10 days or until symptoms develop (then assess as "symptomatic") or until source case progresses to "probable" and then should be managed as contacts of a probable case. |
Passengers seated in close proximity to case and flight attendants | If contact is If contact is asymptomatic: active daily surveillance* for 10 days or until symptoms develop (then assess as "symptomatic") |
If contact is symptomatic: isolation in hospital, home or designated health care site as per management of probable or suspect cases or persons under investigations, depending on symptoms (see Public Health Management guidelines) If contact is asymptomatic: active daily surveillance* for 10 days or until symptoms develop (then assess as "symptomatic") |
No active follow-up by public health unless source case progresses to "probable", then manage these people as contacts of a probable case. Note: All passengers should have received information about SARS on the Health Alert Notice (i.e., yellow card). |
Other passengers and other crew on the flight |
If contact is If contact is asymptomatic: If passenger is asymptomatic, confirm how to reach passenger in future and provide a follow up number for them to use if they develop symptoms; passengers should be instructed to self-monitor temperature and to be alert for presence of symptoms for 10 days (or until symptoms develop then assess as symptomatic). |
No active follow-up by public health unless source case progresses to "probable", then manage these people as contacts of a probable case. Note: All passengers should have received information about SARS on the Health Alert Notice (i.e., yellow card). |
No active follow-up by public health unless source case progresses to “probable”, then manage these people as contacts of a probable case. Note: All passengers should have received information about SARS on the Health Alert Notice (i.e., yellow card). |
*Note: Person must have had or reported to have had close contact with a probable SARS case that meets the Canadian case definition in terms of "affected areas".
**Note: Refers to a person who has travelled to an affected area but who
has no known contact with a probable SARS case.