CDC - Interim Guidance for Cargo Ships: Monitoring Exposed Crew and Managing Suspected Cases of Ebola Onboard

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Interim Guidance for Cargo Ships: Monitoring Exposed Crew and Managing Suspected Cases of Ebola Onboard

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• Key Points
• Assessing Potential Exposures to Ebola
• Port Visits in Countries with Widespread Ebola Transmission
• Monitoring Health of Travelers and Crew Members Who Have Been in Countries with Widespread Ebola Transmission
• Managing Ill People Onboard if Ebola is Suspected

• Reporting Ill Travelers
• Guidance for Cleaning Personnel
• Selecting a Disinfecting Product
• Guidance for Handling Cargo or Other Items
• Additional Information

CDC requests that the master of a ship or designated ship administrators monitor crew members or others onboard who have been in a country with widespread Ebola virus disease (Ebola) transmission or a country with cases in urban areas with uncertain control measures within the previous 21 days.

• Immediately report ill travelers who have been in these countries to CDC if the ship is bound for the United States or to the public health authority of the country at the next port of call.
• Crew who stayed on board or in the immediate vicinity of the ship while at port in a country with widespread Ebola transmission or a country with cases in urban areas with uncertain control measures and had no direct contact with the local community are considered to have no identifiable risk of exposure.

Purpose: To provide guidance to the master of a cargo ship or designated ship administrators for monitoring potentially exposed travelers and crew, managing and reporting onboard ill travelers and crew, protecting travelers and crew onboard from infection, and cleaning potentially contaminated areas onboard.
Key Points

• Ebola virus is spread through direct contact with the blood or bodily fluids of a person who is ill with Ebola. Ebola is not spread through the air like flu.
• CDC provides up-to-date country-specific travel information, such as travel notices and warnings for Ebola-affected countries, on the CDC Traveler’s Health website.
• Travelers or crew who have been in a country with widespread Ebola transmission or a country with cases in urban areas with uncertain control measures within the previous 21 days should be asked about other risk factors for potential Ebola exposure and monitored for illness.
• Travelers or crew who stayed onboard or in the immediate vicinity of the ship while in a port in a country with widespread Ebola transmission or a country with cases in urban areas with uncertain control measures and had no direct contact with the local community are considered to have no identifiable risk of exposure under CDC Guidance.
• If ill travelers or crew have any risk factors for Ebola and are bound for the United States, the master of a ship or designated ship administrator should contact the CDC Quarantine Station at or nearest the next U.S. port of arrival or the CDC Emergency Operations Center (EOC) at 770-488-7100 for guidance.
• If ill travelers and crew fall into the category of no identifiable risk of exposure, continue usual reporting, as required by federal regulations, of certain illnesses and all deaths to the CDC Quarantine Station with jurisdiction for the next US port of entry.
• Follow hand hygiene and other routine infection control measures, and treat all body fluids as though they are infectious.

Assessing Potential Exposures to Ebola

Assess the risk of Ebola exposure by obtaining more information. Ask travelers and crew who have been in a country with widespread Ebola transmission or a country with cases in urban areas with uncertain control measures about possible risk factors for Ebola exposure.
Port Visits in Countries with Widespread Ebola Transmission

CDC recommends the following for ships making port visits in in a country with widespread Ebola transmission or a country with cases in urban areas with uncertain control measures

• Restrict shore leave for crew members.
• Limit disembarkation of crew members to that which is necessary to perform maintenance, inspections, and obtain essential supplies within the immediate vicinity of the ship.
• Limit embarkation of port staff or other essential staff for required maintenance, or inspections, or emergency response personnel.
  • If port staff do embark, limit their contact with crew on board and avoid close contact (coming within 3 feet).Consider screening any embarking port staff, even those temporarily boarding, just as you would for newly embarking travelers or crew (see below).
• Follow guidance issued by local port authorities for public health measures for people embarking or disembarking, such as handwashing procedures or temperature checks.
• Avoid taking on unnecessary new travelers to prevent the introduction of someone who may be exposed to Ebola, but is not yet symptomatic. If new persons are allowed to board during port visits in these countries, they should be separated from crew and passengers and monitored for illness for 21 days in accordance with CDC Guidance.
• Screen any newly embarking travelers or crew for symptoms or possible exposure to Ebola by checking temperature and by asking about possible risk factors for exposure.
  • CDC recommends that anyone who has had a high risk exposure to Ebola not travel by commercial conveyances, including airplanes or ships, until 21 days after the last potential exposure.

Monitoring Health of Travelers and Crew members Who Have Been in Countries with Widespread Ebola Transmission

• The master of a ship or designated ship administrator should take and record the temperatures of crew members and travelers who have been in acountry with widespread Ebola transmission or a country with cases in urban areas with uncertain control measures twice each day until 21 days after the last potential exposure.
• Crew members on public conveyances, such as commercial ships, who are not subject to controlled movement are also not subject to occupational restriction and may continue to work on the public conveyance while under active monitoring.
  • Crew members who did not leave the ship or immediate vicinity while docked in a country with widespread Ebola transmission or a country with cases in urban areas with uncertain control measures and had no direct contact with community members are considered to have no identifiable risk of exposure.
• Crew members with potential exposure should also watch for other symptoms of Ebola—severe headache, fatigue, muscle pain, vomiting, diarrhea, stomach pain, or unexplained bruising or bleeding—and report immediately to the master of a ship or designated ship administrator if fever (subjective fever or fever ≥100.4?F / 38?C) or other symptoms develop.

Managing Ill People Onboard if Ebola Is Suspected

If a crew member or traveler who has been in a country with widespread Ebola transmission or a country with cases in urban areas with uncertain control measures becomes ill with signs and symptoms of Ebola during the voyage

• Use personal protective equipment (PPE) in any initial assessment, including waterproof gloves, a surgical mask (to protect from splashes or sprays), face shield or goggles, and waterproof protective apron or gown to prevent direct contact with the ill traveler or his or her body fluids.
• Keep the ill crew member or traveler separated from others as much as possible, maintaining a distance of at least 3 feet. Separate the sick person in a private cabin, with a private bathroom if available.
• Ask if the ill crew member or traveler has had any of the following: fever (measured temperature of 100.4?F/38?C or higher, or a subjective feeling of being feverish or having chills), severe headache, fatigue, muscle pain, vomiting, diarrhea, stomach pain, or unexplained bleeding or bruising. Immediately report any of these symptoms to public health authorities.
• Inquire again about possible exposures to Ebola. If exposures are reported, immediately report to public health authorities.
• Even if the person has been in a country with widespread Ebola transmission or a country with cases in urban areas with uncertain control measures, the master of a ship or designated ship administrators will not know for certain what type of illness an ill crew member or traveler has, and routine infection control precautions should be followed. However, extra precautions should be taken if a traveler with risk factors for exposure to Ebola becomes ill, including use of PPE as detailed above.
• Information regarding the traveler’s symptoms and risk factors for exposure to Ebola should be included in any medical consultation or arrangements for medical care.
• If the ship is in or bound for the U.S., administrators for cargo ships should contact the CDC Quarantine Station at or nearest to the U.S. port of arrival or the CDC (EOC): 770-488-7100 for further instructions. If the ship is en route to a country other than the United States, contact the public health authority responsible for that port.

Follow these precautions to protect crew members and other travelers

• Minimize the number of crew members who enter the ill crew or traveler’s room (if the person is displaying signs and symptoms of Ebola) or take care of the sick person.
  • Always wear waterproof disposable gloves before directly touching any sick person, blood, or other body fluids[PDF - 2 pages]. Also wear surgical mask (to protect mouth and nose from splashes or sprays), face shield or goggles to protect the eyes, and a waterproof coverall, gown or apron to protect clothes when providing direct care to an ill crew member or traveler who was in a country with widespread Ebola transmission or a country with cases in urban areas with uncertain control measures in the last 21 days. A link to donning and doffing procedures for PPE can be accessed here.
  • Crew members taking care of the sick person should minimize direct contact and remain at least 3 feet from the ill crew member or traveler if possible.
• Give a surgical mask to an ill crew member or traveler who is coughing or sneezing whenever the person is not in the private room. If a mask cannot be tolerated, provide tissues and ask the person to cover his or her mouth and nose when coughing or sneezing.
  • Do NOT give a surgical mask to someone who is nauseated or vomiting. Wearing a mask could harm a person who is vomiting. Provide a motion sickness bag or other suitable container if the crew member or traveler is vomiting or reports feeling nauseated.
• Dispose of soiled items, such as a motion sickness bags, face masks, linen, cloths, pillows, blankets, or other items contaminated with sick traveler’s body fluids in a biohazard bag or other leak-proof container. These containers should be labeled and kept separate from other waste. Disposal of soiled items at port will be determined by the protocols in the country at the port of call. If bound for a U.S. port, see Ebola Associated Waste Management procedures.
• Ebola spreads by direct contact with infected body fluids. Ebola does NOT spread through the air like flu[PDF - 1 page]. Many other diseases are also spread through contact with body fluids. Treat all body fluids as though they are infectious.

Reporting Ill Travelers

U.S. regulations (42 CFR 71.21(a)) require the master of a ship destined for a U.S. port of entry to immediately report any death or illness among the ship’s passengers or crew. This includes people who have disembarked or have been removed from the ship because of illness or death. For more information on required and requested reporting, please visit: CDC’s website.
Reports must immediately be made to the CDC Quarantine Station at or nearest to the U.S. port of arrival or by calling the CDC EOC: 770-488-7100. For ships arriving in the United States, this includes all deaths or illnesses that occurred within 15 days before arrival. For ships that have left the United States and will be returning to a U.S. port during the same voyage, this includes all deaths or illnesses that occurred within 15 days of departure.
CDC staff can assist in evaluating an ill traveler, providing recommendations, and answering questions about reporting requirements. If CDC determines that there is concern for Ebola or another serious contagious disease, CDC will work with federal partners such as U.S. Coast Guard and Customs and Border Protection, as well as state and local health departments to ensure that appropriate public health actions are taken.
When indicated, CDC routinely conducts contact investigations to alert passengers and crew of their potential exposure to ill travelers with certain diseases who were possibly contagious during their voyage.
Guidance for Cleaning Personnel

Ship administrators should ensure that crew members take precautions to protect themselves when cleaning areas contaminated with blood or body fluids of a sick traveler.
Cleaning crew should have PPE available for use when cleaning areas contaminated with blood or body fluids. A list of necessary PPE for those handling bodily fluids such as untreated sewage is available here.
Selecting a Disinfecting Product

For recommendations on cleaning and decontaminating Ebola on surfaces, please visit: https://www.osha.gov/Publications/OSHA_FS-3756.pdf[PDF - 4 pages].
Use a U.S. Environmental Protection Agency (EPA)-registered or other nationally registered hospital disinfectant with a label claim for a non-enveloped virus (e.g., norovirus, rotavirus, adenovirus, poliovirus) to disinfect environmental surfaces when Ebola is suspected or confirmed. Although there are no products with specific label claims against Ebola, enveloped viruses such as Ebola are susceptible to a broad range of hospital disinfectants used to disinfect hard, non-porous surfaces. A list of EPA-registered disinfectants that meets CDC’s criteria for use against Ebola on hard, non-porous surfaces is available at: http://www.epa.gov/oppad001/list-l-ebola-virus.html.
The manufacturer of the product should also be consulted to determine if the product is suitable for use on certain materials so that it will cause corrosion or be ineffective. For example, does the product work on both hard and soft (porous) surfaces, etc.
If a contaminated area cannot be cleaned and disinfected safely, use signage to cordon and isolate the area until proper disinfection procedures can be followed.
Guidance for Handling Cargo or Other Items

Cargo, packages, or luggage should not pose a risk. Ebola is spread through direct contact with blood or body fluids (like feces, saliva, urine, vomit, and semen) from an infected person.

• Do not handle or touch cargo or other items visibly dirty from blood or body fluids.
• Wash your hands often to prevent other infectious diseases.

Additional Information

• This guidance is based on current knowledge about Ebola; more information on Ebola can be accessed at http://www.cdc.gov/vhf/ebola/. Check this website often for the most up to date information on the Ebola outbreak.

From CDC

• CDC Ebola disease information
• CDC Travelers' Health recommendations and updates
• List of CDC Quarantine Stations, Contact Information, and Areas of Jurisdiction
• CDC Guidance for Cargo Ships
• CDC Ebola-Associated Waste Management
• Interim U.S. Guidance for Monitoring and Movement of Persons with Potential Ebola Virus Exposure
• Monitoring Symptoms and Controlling Movement to Stop Spread of Ebola Fact Sheet
• Ebola Updates from the CDC National Institute for Occupational Safety and Health (NIOSH)

From other sources

• Occupational Safety and Health Administration: Cleaning and Decontamination of Ebola on Surfaces Fact Sheet[PDF - 4 pages] and Bloodborne Pathogens Standard Fact Sheet[PDF - 2 pages]
• World Health Organization: Global Alert and Response and Frequently Asked Questions
• International Chamber of Shipping: Ebola Information
• International Maritime Organization: Ebola Information
• How to find a doctor while abroad

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• Page last reviewed: January 9, 2015
• Page last updated: January 9, 2015

http://www.cdc.gov/vhf/ebola/maritime/cargo.html