CDC Guidance for Commercial Aircraft Operators: Measles

Measles alert

• Measles ─ one of the most highly contagious diseases known ─ can cause serious illness, even death.
• Measles can spread in close-contact environments, including on planes and in airports. The virus can remain active and contagious for up to 2 hours in the air or on surfaces, therefore transmission can occur without face-to-face contact.
• Symptoms appear within 3 weeks of exposure and often start with fever, cough, runny nose, red watery eyes, or sore throat. A rash usually follows in 3–5 days.  
• Although measles has been eliminated in the United States, measles continues to be widespread in many countries around the world, including in Europe, Asia, Southeast Asia, the South Pacific, and Africa.
• Every case of measles requires an urgent response to prevent further spread of the disease.

For the latest information on measles related to travel, check under Notices on the CDC Travelers’ Health website at: http://www.cdc.gov/travel/

Measles transmission

• Measles viruses live in the mucus in the nose, mouth, and throat of the infected person and are dispersed into the air when the ill person coughs, sneezes, or talks
• A person with measles is infectious from 4 days before to 4 days after the rash appears
• People who are not immune may become infected by inhaling the virus,  having contact with droplets containing the virus, or by touching a contaminated surface and then touching the mouth or nose

You are considered to be immune from measles if you

• Have had physician or laboratory-confirmed measles or a positive antibody test for measles OR
• Were born in the United States before 1957 (when measles was still widespread) OR
• Have had 2 doses of MMR vaccine
• Otherwise you are at risk for getting measles
  • the Centers for Disease Control and Prevention (CDC) recommends that all crew members receive 2 doses of MMR vaccine

Managing ill passengers and crew members

1. Personal protective measures - see box below
2. Recognize symptoms that suggest possible measles
   • Consider someone to possibly have measles if the person has fever and a rash
     • Fever: the ill person feels warm to the touch, gives a history of feeling feverish, or has an actual measured temperature of 100° F (37.8° C) or higher
     • Rash: the red or reddish-brown rash usually begins on a person’s face at the hairline, then spreads downward to the neck, trunk, arms, and legs
3. Take these steps onboard
   • Take the following steps if a person has fever and a rash during a flight:
     • Keep interactions as brief as possible
     • Provide a face mask to the ill person. If a face mask cannot be tolerated or is not available, offer tissues and advise to cover coughs and sneezes.
     • Separate and move ill person(s) at least 6 feet from other passengers, if possible
       • Keep track of original and changed seats (so all passengers who sat near the ill person can be identified and notified if measles is diagnosed)
     • Limit the ill person’s movement about the cabin and arrange use of lavatory so the ill person does not need to wait in an aisle
     • Provide a plastic bag for proper disposal of used masks and tissues
     • Practice good hand hygiene and encourage others, including the ill person, to do the same
   • In addition to the actions listed above, the CDC recommends that ill crew members:
     • Follow individual company policy for onset of illness or incapacitation during flight operations
     • Discontinue work as soon as possible without affecting flight safety
     • See their doctor, or a company-recommended health care provider if away from home base, and inform them ahead of time of the possibility of measles so precautions can be taken to prevent exposure to others at the health care facility
     • Return to work no sooner than 4 days after the onset of the rash, if measles is diagnosed 
4. To maximize removal of virus particles from the air, continue operating the aircraft air-conditioning or ventilation system until all passengers and crew have disembarked. Safety concerns may preclude this step on some aircrafts.

Report ill persons to

• Airline in-flight medical consultant: According to airline protocols, contact  in-flight medical consultants for any cases of severe illness in travelers
• CDC: Report onboard fever-and-rash illnesses in travelers on international and interstate domestic flights to CDC before arrival (see Guidance for Air Travel Industry on Reporting Onboard Deaths or Illnesses to CDC)
• Local public health: For interstate domestic flights airlines may report to the local public health authority with jurisdiction for the arrival airport in lieu of reporting to CDC

For more information about measles

• CDC Measles homepage
• Ask your doctor or contact your local or state health department.