Guidance for Airlines, Pilots, and Crew on Reporting Onboard Deaths or Illnesses to CDC

U.S. Federal Regulations

The U.S. Code of Federal Regulations [42 CFR 70.11 and 71.21] requires reporting to CDC deaths and illnesses that occur on domestic flights between U.S. states and territories, and on international flights arriving in the United States.

Pilots

42 CFR 70.11(a)

• An airline pilot operating a commercial passenger flight in interstate traffic must report to CDC as soon as practicable any deaths or ill persons (as defined in the regulations) among passengers or crew.
• The airline pilot must also take such measures as CDC may direct to prevent the potential spread of the communicable disease, as long as these measures do not affect the airworthiness of the aircraft or the safety of flight operations.
• Pilots who report deaths or illnesses to CDC are not required to report to the local health authority at destination as required by 42 CFR 70.4.

42 CFR 71.21 requires the pilot of international flights to the United States to report before arrival any deaths or illnesses (as defined in the regulations) among passengers or crew to CDC's Port Health Station at or nearest to the airport of arrival.

Cabin Crew

Follow your company's procedures for getting medical assistance and informing your pilot in command about any death or ill traveler (passenger or crew member) on board as soon as possible. Early reporting ensures prompt ground response to maximize timely care, reduce the risk for spreading disease, and minimize travel disruption.

Cabin Crew Reminders:

• Obtain information about the ill traveler or death and provide it to the pilot in command.
• Notify your pilot in command right away— before arrival—so the ground response is ready upon your arrival.
• Consult with CDC Port Health Station staff after landing and before passengers disembark for evaluation of the ill traveler and to receive instructions regarding next steps.
• Follow your airline's own procedures for ill travelers with symptoms not included in the list below, e.g., heart or neurological problems.

Please note: Contact CDC Port Health Station staff to help evaluate ill travelers or deaths if a contagious disease is suspected, provide recommendations, and answer questions about reporting requirements. Reporting to CDC does not replace usual company procedures for in-flight medical consultation or obtaining medical assistance.

Required by U.S. Regulations

Report to CDC all deaths on board and all ill persons with

1. Fever (has a measured temperature of 100.4 °F [38 °C]^† or greater, or feels warm to the touch, or gives a history of feeling feverish) accompanied by one or more of the following:
   1. skin rash
   2. difficulty breathing
   3. persistent cough
   4. decreased consciousness or confusion of recent onset
   5. new unexplained bruising or bleeding (without previous injury)
   6. persistent diarrhea
   7. persistent vomiting (other than air sickness)
   8. headache with stiff neck, or
   9. appears obviously unwell; OR
2. Fever that has persisted for more than 48 hours OR
3. Symptoms or other indications of communicable disease, as the CDC may announce through posting of a notice in the Federal Register.

See "Definitions of symptoms for reportable illnesses" for information about how to recognize signs and symptoms of contagious diseases.

NOTE: For arrivals outside the United States, the list of signs and symptoms used to identify a possible contagious disease is somewhat different from those required to be notified to CDC on U.S. arrivals. Refer to ICAO Annex 9–Facilitation, Ch. 8, 8.15 for details).

^†Fever temperatures are rounded off as 100°F/38°C in international guidance.

What to Report to CDC and Reporting Mechanisms (international or interstate flights)

[Same as International Civil Aviation Organization (ICAO) document 4444, Procedures for Air Navigation Services – Air Traffic Management, Ch.16, 16.6]

The pilot in command should report the following:

• Aircraft identification
• Departure airport
• Destination airport
• Estimated time of arrival
• Number of persons on board
• Number of suspected cases(s) on board
• Nature of the public health risk, if known

The following options are available to report to CDC:

1. Air Traffic Control (ATC)

[This reporting option complies with CAO reporting requirement, ICAO document 4444 and Annex 9, Ch. 8, 8.15.]

For Airline, Pilots, and Crew reporting to ATC:

• Inform ATC your flight has an onboard death or suspected contagious illness that needs to be reported to CDC. If not under U.S. ATC, international Air Traffic Services will immediately forward the message to the ATC serving the destination airport in the United States.
• ATC will notify the Federal Aviation Administration's Domestic Events Network (DEN) of the report, using the code "...requests a CDC consult."
• The DEN will send the report to CDC's EOC and the EOC will notify the CDC Port Health Station and local health department with jurisdiction for the arrival airport.
• The CDC Port Health Station will contact a designated airline point of contact (POC) to obtain necessary details of the death or illness. Also, the port health station will provide an update to the DEN via EOC about the response.

OR

2. Airline's point of contact (e.g., Operations Center, Flight Control, Airline Station Manager)

[Meets U.S. federal regulations for reporting to CDC]

Instruct the airline's point of contact to notify CDC by contacting the:

• CDC Port Health Station at or closest to the airport where the flight is arriving OR
• CDC EOC (770.488.7100), who will then notify the appropriate CDC Port Health Station.

Additional Resources

• Definitions of Symptoms for Reportable Illnesses
• Preventing Spread of Disease on Commercial Aircraft: Guidance for Cabin Crew