GUIDELINE FOR COMMUNICABLE DISEASE CONTROL AT

POINTS OF ENTRYBORDER HEALTH AND MOBILITY

MANAGEMENT

Addis Ababa, Guideline for Ethiopia-20251

 GUIDELINE FOR COMMUNICABLE DISEASE
CONTROL AT POINTS OF ENTRY

Guideline for Ethiopia-20251

APRIL
2025DECEMBER 2021
ADDIS ABABA, ETHIOPIA
TABLE OF CONTENTS

TABLE OF CONTENTS......................................................................................................................I
EXECUTIVE SUMMARY..................................................................................................................IV
ACRONYMS.......................................................................................................................................V
FOREWORD......................................................................................................................................VI
DEFINITION OF TERMS................................................................................................................VII
ACKNOWLEDGMENTS.................................................................................................................VIII
LIST OF CONTRIBUTORS...............................................................................................................1
1. CHAPTER ONE: INTRODUCTION.............................................................................................2
1.1. Background..............................................................................................................................2
1.2. Purpose of the guideline........................................................................................................4
1.3. Scope and Applicability of the Guideline.............................................................................4
2. CHAPTER TWO: COORDINATION AND COLLABORATION................................................5
2.1. Coordination with in-country stakeholders and partners...................................................5
2.2. Cross Border Collaboration...................................................................................................7
2.3. Communication and Reporting Mechanism........................................................................8
2.2.1. Information Flow from the PoEs to EPHI.......................................................................8
2.2.2. Information Flow for Handling of PHEs Detected Onboard Conveyances...............9
3. CHAPTER THREE: INFRASTRUCTURE AND PUBLIC HEALTH CAPACITY AT POINTS
OF ENTRY...............................................................................................................................................11
3.1. The Recommended IHR Core Capacities at the PoE......................................................11
3.2. Arrangement for Specimen, collection, transportation, packaging and confirmation.11
3.3. Arrangement for Case Management and Referral Linkage............................................11
4. CHAPTER FOUR: INFECTION PREVENTION AND CONTROL.........................................14
5. CHAPTER FIVE: HEALTH CARE WASTE MANAGEMENT AT POINTS OF ENTRY.......18
6. CHAPTER SIX : HUMAN REMAIN/ASH MANAGEMENT.....................................................19
6.1. Precautions during the Management of Human Remain.................................................19
6.2. Document Requirements for transport of Human Remain/Ash......................................22
6.3. Releasing Human Remain/Ash at PoE..............................................................................24
7. CHAPTER SEVEN: PREPAREDNESS AT POINTS OF ENTRY.........................................25
7.1. Public Health Emergency Response Contingency Plan..................................................25
8. CHAPTER EIGHT: EVENT DETECTION, RISK ASSESSMENT AND RESPONSE.........26
8.1. Event Detection, Notification and Communications.........................................................26
8.2. Preliminary Assessment and Information Sharing............................................................31
8.3. Public Health Event Risk Assessment at PoE..................................................................32

I
 8.4. Public Health Response/Containment Strategies.............................................................33
9. CHAPTER NINE: PUBLIC HEALTH RESPONSE MEASURES AT POINTS OF ENTRY.34
9.1. Public Health Measure with Respect to Person................................................................34
9.1.1. Travel advisories/health alert notices..........................................................................34
9.1.2. General Aircraft Health Declaration ..........................................................................34
9.1.3. Travelers Health Declaration Form.............................................................................34
9.1.4. Review Travel History in Affected Area.....................................................................35
9.1.5. Passenger Health Screening.......................................................................................35
9.1.6. Review proof of medical examination and any laboratory analysis........................37
9.1.7. Medical Examination.....................................................................................................38
9.1.8. Review of proof of vaccination or other prophylaxis.................................................38
9.1.9. General Health Advice and Alerts to Passengers during an ongoing Emergency
...........................................................................................................................................................39
9.1.10. Syndromic Surveillance..............................................................................................40
9.1.11. Social mobilization.......................................................................................................41
9.1.12. Social distancing..........................................................................................................41
9.1.13. Contact Tracing/Investigation....................................................................................41
9.1.14. Placement of Person Suspected of Exposure Under Public Health Observation
...........................................................................................................................................................42
9.1.15. Quarantine, Isolation and Treatment........................................................................42
9.2. Pubic Health Measures with Respect to the Conveyances and Cargo.........................43
9.2.1. Sanitation........................................................................................................................43
9.2.2. Disinfection.....................................................................................................................44
9.2.3. Decontamination............................................................................................................44
9.2.4. Vector control.................................................................................................................44
9.2.5. Disinsection....................................................................................................................44
9.2.6. Onboard Infection Control............................................................................................45
9.2.7. Review of Proof of Measures Taken on Departure or in Transit .............................45
9.2.8. Isolation and Quarantine for Cconveyance................................................................45
9.2.9. Seizure , Supervised Destruction /Removal of Infected or Contaminated Oobjects
...........................................................................................................................................................46
9.3. Public Health Measures with Respect to Animals............................................................47
10. CHAPTER TEN: REFERENCES.............................................................................................48
11. CHAPTER ELEVEN: LIST OF ANNEXES.............................................................................51
Annex 1: Platforms for Joint Meetings of In-country Stakeholders and Partners................51
Annex 2: Role and Responsibilities of Stakeholders ..............................................................52
Annex 3: The IHR Recommended Capacities at Points of Entry...........................................58
Annex 4: Basic Set of Variables to be Collected on Preliminary Risk Assessment.............60

II
 Annex 5: Recommendations for Cleaning and Disinfection of Aircraft..................................62
Annex 6: Steps of the Basis of the Risk Assessment Process at Points of Entry level......65
Annex 7: WHO recommended Methods for Aircraft Disinsection..........................................66
Annex 8: Travelers Health Declaration Form (THDF) used during COVID-19 pandemic...67
Annex 9: Health Part of Aircraft General Declaration Form...................................................68
Annex 10: Standard Operating Procedure for Aircraft Disinsection Using Pre-flight
Method..................................................................................................................................................69
Annex 11: Standard Operating Procedures for the Handling of Human Remain/Ash at
Points of Entry.....................................................................................................................................73
Annex 12: Standard Operating Procedure for the Management of Passenger Suspected
of Public Health Emergency/Event Onboard flight........................................................................82
Annex 13: Standard Operating Procedure for Public Health Screening of Passenger at
Airport...................................................................................................................................................85
Annex 14: Standard Operating Procedure for Public Health Screening of Passengers at
Ground Crossing.................................................................................................................................90
Annex 15: Standard Operating Procedure for the Management of Passenger Suspected
of Public Health Emergency/Event in Temporary Isolation Facility at Point of Entry.................96

III
EXECUTIVE SUMMARY

The increasing human mobility, globalization, global warming/persistent change in

weather condition etc in recent years pose significant risk of spreading communicable
diseases to different countries. The 2014-2016 Ebola virus outbreaks in West Africa,
the 2016-2017 Zika virus pandemic, the SARS/MERS-CoV epidemics and the current
COVID-19 pandemics have shown clear evidence that these health events spread to
various countries primarily due to human mobility.

Ethiopia shared a large border size with Eritrea, South Sudan, Kenya, Sudan, Djibouti,
Somalia and Somali land where most parts are very porous and significant number of
people crossed these borders daily. Besides, Bole international airport, the hub for
more than 127 destinations, is the passage for millions of passengers and cargo a year.
In the presence of such intense and complex traffic of passengers and cargo across
PoEs, the task of safeguarding the public health safety become undoubtedly
demanding, requiring coordinated efforts of various sectors present at the PoEs.

The purpose of this document is to provide the technical guidance of the implementation
of public health interventions at the PoEs as outlined in the proclamation No.1112/2019
and IHR-2005. It has been produced as a general guide to assist all public health
officers, stakeholders, and partners participate uniformly in public health interventions at
PoEs (an international airport, ports and ground crossings: designated/ non-designated)
throughout the country. Several stakeholders and partners from with in the country and
abroad participate in the development of this document aiming to make it very
invaluable. This document consists several contents including other supportive
documents, a step by step procedures, standard operative procedures (SOPs),
international and national regulation/proclamations etc.

IV
ACRONYMS

AaBET Addis Ababa Burn, Emergency and Trauma Hospital

ARRA Authority for Refugee and Returnee Affairs
CDC Center for Disease Prevention and Control
EFDA Ethiopian Food and Drug Authority
EPHI Ethiopian Public Health Institute
EVD Ebola Virus Disease
IHR International Health Regulation
HCW Health Care Waste
HoA Horn of Africa
IHR-NFP International Health Regulation-National Focal Point
INVEA Immigration Nationality and Vital Events Agency
IOM International Organization for Migration
IPC Infection Prevention and Control
JEE Joint External Evaluation
MoH Ministry of Health
MSF Médecins Sans Frontières
NAPHS National Action Plan for Health Security
NISS National Intelligence Security Service
PHE Public Health Emergency
OHSC One Health Steering Committee
PHEM Public Health Emergency Management
PHEIC Public Health Emergency of International Concern
PoE Point of Entry
PPE Personal Protective Equipment
RCCE Risk Communication and Community Engagement
SARS Severe Acute Respiratory Syndrome
SOP Standard Operating Procedures
SP Standard Precautions
SPAR State Parties Self-Assessment and Report
SPHMMC St Paul’s Hospital and Millennium Medical College
TBP Transmission Based Precaution
UNICEF United Nations International Children and Educational Fund
VDFACA Veterinary Drug and Animal Feed Administration and Authority
WHO World Health Organization

V
FOREWORD

Globalization and technology has made the world more connected than ever. Human
mobility is a complex and dynamic phenomenon that has been attributed to amplify the
spread of infectious diseases. Now days infectious diseases travel faster and farther-
public health threat can distribute from a remote corner of the country to major cities on
all continents in less than 36 hours. Threat anywhere is a threat every-for the globe to
be safe each and every individual country/state should be safe.

Ethiopia shares a large border size with Eritrea, South Sudan, Kenya, and Sudan,
Djibouti and, Somalia and Somali land. Besides, Bole International Airport, the hub for
more than 127 destinations, is the passage for millions of passengers and cargo a year.
In the presence of such intense and complex traffic of passengers and cargo across
points of entry, the task of safeguarding the public health safety become undoubtedly
demanding, requiring coordinated efforts of various sectors present at the points of
entry.

Ethiopia has recognized the demand for strengthened public health emergency
response capacities and has been striving for promoting global health security and to
meet obligations under IHR-2005. The proclamation No 1112/2019 declares that
Ethiopian Public Health Institute is mandated to implement regulatory activities related
to communicable disease control at points of entry.

The Travel and Border Health Service Directorate at EPHI ensures the existences of the
recommended IHR-2005 core capacities at points of entry to prevent, detect and
respond to the international spread of diseases. So far, there has not been a guideline
at national level that clearly spell out the implementation of set of activities that
catalyze the development of core capacity requirements at points of entry.

Hence, this technical guideline is prepared in collaboration with stakeholders to provide

guidance on the technical implementation of public health measures at points of entry
and to develop the required core capacities that are commensurate with IHR-2005.

VI
DEFINITION OF TERMS

Terms Definition
Communicable
A disease that can cause epidemics by spreading rapidly
Disease
The presence of an infectious or toxic agent or matter on a human or
animal body surface, in or on a product prepared for consumption or
Contamination
on other inanimate objects, including conveyances, that may
constitute a public health risk
The procedure whereby health measures are taken to control or kill
infectious agents on a human or animal body surface or in or on
Disinfection
baggage, cargo, containers, conveyances, goods and postal parcels
by direct exposure to chemical or physical agents
The procedure whereby health measures are taken to control or kill
Disinsection the insect vectors of human diseases present in baggage, cargo,
containers, conveyances, goods and postal parcels
Airplane/aircraft, ship, train, road vehicle or any other means of
Conveyance
transport on an international voyage
Separation of ill or contaminated persons or affected baggage,
Isolation containers, conveyances, goods or postal parcels from others in
such a manner as to prevent the spread of infection or contamination
A passage for international entry or exit of travelers, baggage, cargo,
Point of entry containers, conveyances, goods and postal parcels, as well as
agencies and areas providing services to them on entry or exit
The restriction of activities and/or separation from others of suspect
persons who are not ill or of suspect baggage, containers,
Quarantine
conveyances or goods in such a manner as to prevent the possible
spread of infection or contamination
An occurrence or imminent threat of an illness or health condition,
caused by bio-terrorism, epidemic or pandemic disease, or a novel
Public health
and highly fatal infectious agent or biological toxin, that poses a
emergency
substantial risk of a significant number of human fatalities or
incidents or permanent or long-term disability
Public health
emergency of Extraordinary event which is determined to constitute a public health
international risk to other States through the international spread of disease to
concern(PHEI potentially require a coordinated international response
C)
A sudden increase in occurrences of a disease in a particular time
Outbreak
and place which may affect a small and localized group
Persons, baggage, cargo, containers, conveyances, goods or postal
parcels considered as having been exposed, or possibly exposed, to
Suspect
public health risk and that could be a possible source of spread of
disease

VII
ACKNOWLEDGMENTS

The EPHI would like to acknowledge and express its appreciation to the World Health
Organization (WHO), Center for Disease Control and prevention (US-CDC) and
International Organization for Migration (IOM) for their financial and technical support.

Likewise, the institute would like to thank Ethiopian Airline Groups (EAG), Ethiopian
Civil Aviation Authority, Ethiopian Food and Drug Administration Authority (EFDA),
Immigration, Nationality and Vital Events Agency (INVEA) and Ministry of Agriculture
for their technical support during the preparation of this guideline.

Moreover, the Institute would also like to acknowledge travel and border health and
bacteriological, zoonotic diseases research directorate’s staffs and Ethiopia’s National
Focal Point for International Health Regulation (IHR-NFP).

VIII
LIST OF CONTRIBUTORS
Full name Organization /affiliation
Mr.Yohannes Dugasa EPHI/Travel and Border Health Service
Mr.Tamiru Tadesse EPHI/Travel and Border Health Service
Dr.Wondimu Tsegaye EPHI/Travel and Border Health Service
Dr.Fentaw Yemam EPHI/Travel and Border Health Service
Dr.Worku Fitessa EPHI/Travel and Border Health Service
Mrs.Luna Habtamu EPHI/Travel and Border Health Service
Mrs.Rahel Atakiltie EPHI/Travel and Border Health Service
Mr.Akalu Demeke EPHI/Travel and Border Health Service
Mr.Wasihun Endale EPHI/Travel and Border Health Service
Sr.Genet Tafesse EPHI/Travel and Border Health Service
Dr.Bawek Fetene EPHI/Travel and Border Health Service
Dr.Berihun Anagaw EPHI/Travel and Border Health Service
Dr.Ahmed Mohamed EPHI/Travel and Border Health Service
Dr.Feyesa Regasa EPHI/IHR National Focal Point
Dr. Baye Ashenafi EPHI/Bacterial, Zoonotic and Parasitological Disease
Research
Mr.Mengistu Temesgen EPHI/Travel and Border Health Service
Mr.Abdulwahid Hassen Ethiopian Airline Groups
Mr.Debebe Girma Ethiopian Civil Aviation Authority
Mr.Dagim Alemayew Ethiopian Food and Drug Administration
Mr.Alemseged Kabtyiemer Ethiopian Food and Drug Administration
Mr.Ashenafi Shibiru Immigration Nationality and Vital Event Agency
Dr.Berhanu Amare US CDC
Mrs. Hannan Kubinson US CDC
Mr.Raphael John Marfo WHO
Dr.Fekadu Adugna WHO
Mr.Tesfaye Tilaye WHO
Mr.Gashaw Zewdie IOM

1
1. CHAPTER ONE: INTRODUCTION
1.1. Background

Globalization and resultant human mobility has increased in recent years. Human mobility is a
complex and dynamic phenomenon that has been attributed to amplify the spread of communicable
diseases and the impact of public health events. The 2014-2016 Ebola Virus Disease (EVD) outbreak
in West Africa, the 2016-2017 Zika Virus and the current COVID-19 pandemics have demonstrated
the contribution of human mobility in increased public health risk and in turn intensified the need
for enhancing the global health security.

The International Health Regulations 2005 (IHR-2005) aimed to prevent, protect against, control and
provide a public health response to the international spread of disease in away that are
commensurate with and restricted to public health risks, and avoid unnecessary interference with
international trade and traffic, provides a framework for countries to build capacities to prevent,
detect, and respond to public health emergencies.

The IHR-2005 defines a point of entry (PoE) as "a passage for international entry or exit of travelers,
baggage, cargo, containers, conveyances, goods, postal parcels, and human remains/ash as well
as agencies and areas providing services to them on entry or exit." There are three types of PoEs:
an international airport, ports, and ground crossings, which are further classified as designated 1
and non-designated.

Ethiopia shares a large border size with Eritrea, South Sudan, Kenya, Sudan, Djibouti and, Somalia
and Somali land. Besides, Bole international airport, the hub for more than 127 141 destinations, is
the passage for millions of passengers and cargo a year. In the presence of such intense and
complex traffic of passengers and cargo across PoEs, the task of safeguarding the public health
safety become undoubtedly demanding, requiring coordinated efforts of various sectors 2 present at
the PoEs.

During the annual state parties self-assessment and report (SPAR 2024) and joint external
evaluation2023 (JEE), Ethiopia has been scoring sub optimal on the IHR recommended capacity for
public health emergency response at PoEs. Recently Ethiopia has recognized the demand for

1
A designated PoE is defined as a PoE with developed core capacities (adequate trained health screening staff, isolation centers for
health risk traveler, ambulated service to evacuate health risk persons, and designated health facility for all emergencies) to address all
emergencies of public health concerns
2
Ethiopian Public Health Institute (EPHI), Ethiopian food and drug administration (EFDA), border control (immigration, aviation), custom
commission, transportation (airports, airlines, train authority, shipping and logistic service agency), security agencies, communication and etc

2
strengthened Public health emergency response capacities and has made clear it's strong political
will both to promote global health security and meet obligations under IHR. For instance, the
ministry of health (MoH) has launched a multi-sectoral five-year costed national action plan for
health security (NAPHS, 2019-2023) & (2024/25-2028/29) and enacted proclamation Regulation
No.1112/2019529/2023 to undertake the regulatory functions/ activities related to communicable
disease control at PoEs.

Hence,this guideline had been revised to provide guidance on the technical implementation of the public
health interventions at PoEs in a way that are commensurate with IHR-2005 and Regulation
No.529/2023Hence, this guideline is prepared to provide guidance on the technical implementation of the
public health interventions at PoEs in a way that are commensurate with IHR-2005 and proclamation
No.1112/2019.

1.2. Rationale for Revision

After the endorsement of the previously prepared PoE CDC Guideline in 2021, it was distributed to the
implementing areas. A points of entry core capacity assessment conducted by the EPHI(TBHD) in
collaboration with IOM in 2025, revealed a number of challenges and gaps to fully implement IHR 2005 at
points of entry’s of Ethiopia.Additionally, However, there were it was an observed that there are gaps and
challenges raised during JEE 2023,complaint from users and at operational implementing areas especially
at airport and ground crossing PoEs on; Issues related with one health approach,dead body
Management,Vector surveillance and control at PoEs,and Conveyance regulation related
chllenges,especially aircraft disinsection.
Hence,this guideline had been decided to be revised to provide guidance on the technical
implementation of the public health interventions at PoEs in a way that are commensurate with IHR-
2005 and Regulation No.529/20233 and other related legislation
.

3
EPHI Regulation No 529/2023

3
1.3. Purpose of the guideline

The main purpose of this guideline is to provide the technical guidance of the implementation of
public health interventions at the PoEs as outlined in the proclamation No.1112/2019 Regulation
No.529/2023 and IHR-2005. It has been produced as a general guide to assist all public health
officers, stakeholders, and partners participate uniformly in public health interventions at PoEs
throughout the country.

[1.4.] Scope and Applicability of the Guideline

The guideline applies to all international passengers, conveyances, cargo, goods or postal
parcels,Animal,Environment/ecosystem and human remains/ash passing through the PoEs. The
guideline also addresses all types of health intervention related to cross border public health
emergencies (PHEs).

1.4.[1.5.] Legal framework and Institutional Arrangement

1.4.1. Institutional Arrangement

o Points of entry communicable disease control devission in Ethiopia are coordinated by Ethiopian
Public Health Institute responsible for Travel and border health in collaboration with other key
stakeholders. In the Ethiopian Public Health institute, points of entry communivcable disease
control division fall under the Travel and Border Health Directorate.The organogram (Figure1)
describes in detail how points of entry communicable disease control divission is coordinated from
national level to the point of entry level.
Legal and other Framework
Implementation of points of entry communicable disease control in Ethiopia is guided by the following
legislations and regulations;
International Health Regulations,IHR (2005): addresses risks of international disease spread and legal
binding on states parties throughout the world including all WHO member states. The IHR (2005) contain
rights and obligations for state parties (and functions for WHO) concerning prevention, surveillance and
response; health measures applied by states to international travellers, aircraft, train, ground vehicles and
goods; and public health at international ports, airports and ground crossings. In addition, the IHR highlights
the protection for the human rights of persons and travellers, setting out as principles that “the
implementation of these Regulations shall be with full respect for the dignity, human rights and fundamental
freedoms of persons” (Article 3).

4
EPHI Regulation No.529/2023: Ethiopia’s council of Minster enacted regulation No 529/2023 that
mandate the institute to undertake the regulatory functions related to communicable disease control at
PoEs.
NAPHS: Ethiopia Gov’t made clear strong political will both to promote Global Health Security and in
order to meet obligations under IHR 2005 and launched multisectorial national action plan for health
security (NAPHS, 2019-2023) and (2025 – 2029).
Others legislations includes; EFDA Proclamation No.1112/2019, Immigration and Citizenship Services
proclamation No. 354/2003, Ethiopian Civil Aviation Authority (ECAA) proclamation No.
616/2008 ,Ethiopian Airlines Groups Regulation No. 406/2017,Aviation Security proclamation No.
432/2004, Ethiopian Custom proclamation No. 859/2014 and Custom amendment Proclamation No.
1160/2019 , Federal Police Commission proclamation No. 720/2011 article 6(13),Ministry of Foreign
Affairs ,Ethiopian National Air transport Facilitation Program, 2019, and Chicago convention on
International Civil Aviation: Article 14, prevention of spread of disease

5
 1.5. Required Resources for Border Health and Mobility Management

Health Professionals

Points of Entry (PoEs) shall be managed by trained health professionals with expertise in Public Health
Emergency Management (PHEM) and emergency response.All staff shall receive training in Infection
Prevention and Control (IPC) and emergency medical response and other relevant trainings. Below is the
summary of minimum, but not limited to, human resources requirements.
Table 1: Minimum Human Resource Neded for PoEs
S/N Type of PoE Professional category Quantity
1. Addis Ababa Bole Environmental Health Officer 6
International Airport Public Health Officer (HO & MPH) 18
General practitioner (GP) 6
Nurse 6
Laboratory Technician 4
Pharmaceutical technician 4
Ambulance Driver 3
Data Encoder 3
Office Secretary 3
IPC Personnel (Spray Men) 9
2. Other International Environmental Health Officer 3
Airports Public Health Officer (HO & MPH) 6
General practitioner (GP) 3
Nurse 3
Laboratory Technician 3
Pharmaceutical technician 3
Ambulance Driver 3
Data Encoder 3
Office Secretary 3
IPC Personnel (Spray Men) 3
3 Designated Land-crossings Environmental Health Officer 3
found on major corridors Public Health Officer (HO & MPH) 3
General practitioner (GP) 1
Nurse 3
Ambulance Driver 1
Office Secretary (Data encoder) 1
IPC Personnel (cleaner and Spray Men) 3
4 Other undesignated Land- Environmental Health Officer 1
crossings???? Public Health Officer (Nurse and PHO) 2
Ambulance Driver 1
Office Secretary (Data encoder) 1

6
 IPC Personnel (cleaner and Spray Men) 2
Basic Premises

Basic Facilities
To effectively respond to the public health emergency and meet obligation stated under IHR 2005 at PoE
the following minimun infrastructures and spaces would be needed at PoEs;

Table 2: Type of health infrastructure neeed at each PoEs

Type of health infrstructure Quantity Remark

PoE screening office/counter per PoE 01 Constructed /rent
Isolation center per PoE 01 Constructed or linked through referral mechanism
Qurantine center Per PoE 01 Constructed or linked through referral mechanism
Table 3: Minimum premises required at the PoEs screening site

Room Type Number of Rooms Space (Sq. Meter)

Waiting Area 1 15
Triage/screening Room 1 12
Temporary Isolation Unit with separate
Shower and Toilet 1 30
Mini Store 1 10
Staff Office 1 12
Janitor's Room 1 4
Common Latrines and shower (Male,
Female, Disabled) 3 25
Incinerator 1
Septic tank 1
Male and Female duty station 2
Products

Essential Equipment and Material Resource Required at PoEs

The PoE shall maintain an adequate stock of essential medicines, medical supplies, and diagnostic /Lab
reagents as outlined in the national PHEM guidelines to ensure preparedness for emergency situations.
The essential equipment and supplies include, but are not limited to:
Table 4: Minimum Equipements and Materials required at PoEs

Sr.N Type of PoE Type of eqquipements & Facility Materials

o
Office eqquipemnts and furnitures :
o Chairs & tables
o File cabinet
o Examination bed
o Rapid testing kits and Sampling kits Regulation No 259/2023,
o Medical supplies IHR2005,PoE CDC
o PPEs guideline,formats /checklist,SOPs
o Laptop/desktop Computers
1 International airport
o Tablet computers

7
 o Infrded thermomethers
o Mass thermoscanning machine
o Refregrators
o Printers
o Photocopy machine
o Office stationaries
o Mobile phone
o Radio call and fax machine
o Wheel chair
o Strechair
o Oxgen cylinder
o Uniform and reflecors jackets
o Gown
o UV light torch
o Digital Camera
o Screening sheet
o Ambulance
Office eqquipemnts and furnitures :
o Chairs & tables
2 Groung Crosssing o File cabinet Regulation No 259/2023, IHR2005,
PoEs o Examination bed PoE CDC guideline,
o Rapid testing kits and Sampling kits formats /checklist,SOPs
o Medical supplies
o PPEs
o Laptop/desktop Computers
o Tablet computers
o Infrded thermomethers
o Refregrators
o Printers
o Photocopy machine
o Office stationaries
o Mobile phone
o Fax machine
o Wheel chair
o Strechair
o Oxgen cylinder (portable)
o Uniform and reflecors jackets
o Gown
o UV light torch
o Digital Camera
o Screening sheet
o Motorcycle
o Ambulance

Practices
Health Screening and inspection
o Conduct regular health screenings for incoming and outgoing travelers using mass
thermoscanners and symptom-based assessments.

8
 o Assess risk factors related to recent travel history and exposure to public health hazards
through Health Declaration Forms (digital or paper).
o Perform routine inspection and certification of conveyances, including measures such as
disinsection, disinfection, and rodent control to mitigate public health threats.
o Apply necessary health measures (e.g., quarantine, isolation, decontamination, deratting,
disinfection, disinsection, health alerts, and notices) for travelers and conveyances as
required.
o Provide Mental Health and Psychosocial Support (MHPSS) for individuals affected by
emergencies, including migrant returnees and refugees.
o Respond promptly to health emergencies within and around Points of Entry (PoEs),
coordinating with stakeholders to implement public health measures, issue travel health
alerts, and provide emergency medical and first aid services.
Quarantine and Isolation:
o Establish a Rapid Response Team (RRT) for immediate action during health emergencies,
ensuring adherence to WHO IHR core capacities.
o Implement early detection and management protocols for suspected or confirmed cases of
infectious diseases, following Standard Operating Procedures (SOPs) for Public Health
Emergency management.
Vaccination Services
o Provide on-site vaccination services for diseases requiring International Certificates of
Vaccination or Prophylaxis (ICVP) at PoEs.
Referral linkage and Follow-up
o Establish strong referral linkages with nearby health facilities and diagnostic centers for
managing cases requiring further evaluation or treatment.
Training
o Conduct regular and risk-specific orientations/training for health personnel and
stakeholders on national entry/exit requirements, disease surveillance, emergency
response, and infection prevention at PoEs.
Coordination and collaboration
o Foster coordination and collaboration with local health authorities and stakeholders to
ensure a One Health approach to address human, animal and ecosystem health concerns.
Risk Communication and Community Engagement (RCCE)
o Facilitate health education activities to promote hygiene, sanitation, and disease
prevention among travelers, local communities and PoE stakeholders.

9
1.6. Recommended IHR Core Capacities at the PoE

A. The Recommended Capacities at all Times

 An appropriate medical service, including diagnostic facilities and adequate staff, equipment and
premises so as to allow the prompt assessment and care of ill travelers.
 Access to equipment and personnel for the transport of ill travelers to an appropriate medical facility;
 Trained personnel for the inspection of baggage, cargo, containers, conveyances, goods or postal
parcels, and Human remains.
 Safe environment including appropriate ventilation system for travelers using point of entry facilities
(potable water supplies, eating establishments, flight catering facilities, public washrooms, appropriate
solid and liquid waste disposal services)
 Trained personnel for the control of vectors and reservoirs in and near PoE.
B. Recommended Capacities for Responding to Events that Constitute a Public Health Emergency
of International Concern (PHEIC):
 Appropriate public health emergency response by establishing and maintaining a public health
emergency contingency plan, including the nomination of a coordinator and contact points for relevant
point of entry, public health, and other agencies and services;
 Assessment of and care for affected travelers or animals by establishing arrangements with local/on-
site medical and veterinary facilities for their isolation, treatment, and other support services that may
be required;
 Appropriate space, separate from other travelers, to interview the suspect case or affected persons
 Quarantine of suspected travelers, preferably in facilities away from the PoE
 Disinsection, deratting, disinfection, decontamination, or otherwise treating baggage, cargo, containers,
conveyances, goods, or postal parcels when appropriate, at locations specially designated and
equipped for this purpose
 Entry or exit controls for arriving and departing travelers
 Access to specially designated equipment, and trained personnel with appropriate personal protection,
for the transfer of travelers who may carry infection or contamination.

10
11
[2.] CHAPTER TWO: COORDINATION AND COLLABORATION

1.7.[2.1.] Coordination with in-country stakeholders and partners

Collaboration and partnership are critical components in strengthening the public health
emergency response capacities at PoEs. Collaboration and partnership among
stakeholders should be well defined and encompasses joint planning, establishing and
updating relevant technical regulations, communication, training, simulation exercises to
a minimum.

The agencies/organizations primarily considered as stakeholders/partners at PoEs are:-

● Local Health Authorities (regional health bureau and/or institutes, zonal/town and
woreda health offices)
● Ethiopian Airline Groups (EAG)
● Ethiopian Civil Aviation Authority
● National Intelligence Security Service (NISS)
● Ethiopian Custom Commission
● Immigration Nationality and Vital Events Agency (INVEA)
● Federal Police Commission
● Ethiopian Food and Drug Authority (EFDA)
● Ethiopian Railway Corporation
● Ministry of Transport
● Ethiopian Shipping and Logistic Service
● Ministry of Agriculture
● Authority for Refugee and Returnee Affairs (ARRA)
● Ministry of foreign affairs (MoFA)
● National Disaster Risk Management Commission (NDRMC)
● Ministry of Peace (MoP)
● Ministry of Women and Child Affairs
● Private Business Sectors (distributors, hotel/restaurant, etc.)

12
Partners:

● IOM
● WHO
● CDC
● United Nation International Children and Education Fund (UNICEF)
● Ethiopian Red cross Society (ERCS)
● Médecins Sans Frontières (MSF)

The platform and frequency for stakeholder’s joint meeting during ongoing PHE and
non-emergency time is included under annex 1.

13
1.8.[2.2.] Cross Border Collaboration

For many years the Horn of Africa (HoA) has been challenged by weak institutions and
infrastructure at border areas. Strengthening border health systems, infrastructure, and
collaboration at designated and prioritized PoEs to better detect, respond, and control
communicable diseases must be the priority strategy.

Cross-border collaboration reinforces and augments existing capacities at PoE by

harmonizing resources, strengthening coordination and communication, and
supplementing joint operations. For effective response to the cross border PHEs, in-
country national health surveillance and information exchange should be coupled with
communication and coordination with neighboring countries.

Hence, EPHI will collaborate with MoH, national/sub-national public health institute,
agencies, partners, ,laboratory centers and health facilities in neighboring countries for
putting in-place an arrangement for;

● Timely identification of cases/suspects at PoEs and neighboring communities

and timely information sharing
● Timely identification of cases associated with travel
● Coordinating available resources to maximize the efficiency of the response
○ Referral system for patients/suspects-referring sick travelers to a health-
care facility on the other side of the border if that will facilitate more timely
medical evaluation and treatment
○ specimen referral and confirmation-shipping the specimen to the other
side of the border if that will facilitate more timely confirmation or capacity
on the other side is limited
○ Joint surge capacity if the impact of a PHE affecting a border region is
likely to be greater on one side of the border than the other, or if one
country has more resources available in the region than the other.

14
1.9.[2.3.] Communication and Reporting Mechanism

2.2.1. Information Flow from the PoEs to EPHI

The capability to share information in a timely fashion is required for effective

management of cross border PHEs. Arrangements for communication is necessary to
ensure the flow of information from the PoEs up to the EPHI and vice versa, among the
PoEs and to and from stakeholders. The ease for information exchange starts with
nomination of contact points for respective PoEs and sharing his/her contact address
with stakeholders and others with whom he/she shall communicate.

Procedures and means of communication for receiving health information, documents,

and reports from conveyance regarding public health events or cases of illness on
board, and to provide advice and advance notice of the application of control measures
are essential that should be available at all times. All active PoEs regardless of
designation status and infrastructure should be incorporated into existing integrated
disease surveillance and response (IDSR) system as additional peripheral reporting
unit. Surveillance data flow from PoEs up to the EPHI must be in compliance with the
public health emergency management (PHEM) guideline.

15
Figure 1: Information flow from/to the PoE to the EPHI and vice versa

2.2.2. Information Flow for Handling of PHEs Detected Onboard Conveyances

The PHEs can be detected onboard in conveyances.Once passengers or cargo has

departed and the travel is in progress, event detection will rely on the conveyance
crew's awareness. In any type of the conveyances the crew or the conveyance
operator/assistance must have the capacity to identify the PHEs and the need to have
awareness on to whom and how to report. Please refer to the section, in- flight: Public
Health Procedures for Cabin Crew or operators and SOP for handling suspects
detected onboard flight annexed on this guideline.

16
Figure 2: Information flow chart for handling PHEs suspect detected onboard flight in air
transport

17
2.[3.] CHAPTER THREE: INFRASTRUCTURE AND PUBLIC HEALTH
CAPACITY AT POINTS OF ENTRY
2.1.[3.1.] The Recommended IHR Core Capacities at the PoE

The recommended capacity at PoE for non emergency time and for responding to the
PHEIC is included under annex 3.

2.2.[3.2.] Arrangement for Specimen, collection, transportation, packaging

and confirmation

The laboratory's requirements may vary for different disease conditions at the PoE,
which shall be decided by EPHI. Every individual PoE must be linked to a laboratory
with a minimum capacity to conduct lab tests for outbreak-prone diseases. Such
laboratories can be government or private laboratories. The laboratory standards
should be subject to national legal, policy, and lab quality-assurance requirements.
Based on the need and feasibility, simple and random testing can be initiated on spot at
PoEs. But as all tests cannot be expected to be done onsite, for sustainable lab testing,
the referral linkage between the PoEs and the referral labs should be established. Tests
that require sophisticated laboratory and special conditions for specimen storage should
be conducted at laboratories with proven capacity. However the capacity building
activities needs to be provided to PoE health team to ensure that specimen are
collected, packed and transported per the standard.

2.3.[3.3.] Arrangement for Case Management and Referral Linkage

Different disease outbreaks will follow different courses of action. However, all cases
need to be managed and treated according to the identified standard of care. There
shall be designated treatment facilities for disease conditions identified at the PoE.
These facilities need to have a standard set up to treat the cases according to the
national guidelines. Treatment facilities designated for such purposes may be existing
or newly established health facilities. Transport arrangements to transfer cases to the
treatment centers should be put in place. Infection prevention and control (IPC)

18
measures should be strictly observed to prevent transmission at the PoE and during the
transfer. These may includes:

A. Isolating the suspect/case: there should be a designated space /isolation facility/ to

isolate suspect/case onsite at the PoE or nearby health facilities. A PoE may provide a
separate space for short-term isolation while suspect/case is awaiting transport to the
designated medical facility. Besides, isolation shall take place on board, in a cabin or
ashore in a healthcare facility or other institution including at home as appropriate.
Case/suspect may not be held for more than 3-hours at the PoE’s isolation facilities.

The basic requirements of an isolation space include:

 A clean room/s separate from other with good natural light, ventilation, and bathroom
facilities;
 A negative pressure room/s with closed-door;
 A good ventilation:
o Turned off air conditioning;
o Windows opened facing away from the public
o Independent air supply, if feasible
 Personal protective equipment (PPE- if applicable) for the case and attending staff:
o PPE should be provided to all people who come into contact with the
suspect /case at the PoE and during the transfer.
 Hand hygiene for all PoE health team, conveyance staff and passengers who come
into contact with the suspect/ case or its belongings.
 Disinfection (if applicable) - spaces used by the case at the PoE and transfer vehicle
should be disinfected immediately after use.
 A suspected case/rumor investigation form
o should be filled by PoE staff and sent to the treatment facility during the
transfer.

B. Quarantine of exposed passengers : If any passenger is suspected of exposure to

the pathogen or chemical, a passenger should be quarantined for the period of time
required to ensure that there is no risk of spreading infection or contamination. For
short-time quarantine can be on-site at PoEs. Likewise, a long-term quarantine requires

19
fulfilling complex needs, including security, accommodation, food, hygiene, and so they
should be located away from PoEs. If the PoE health team decides to put the
passengers in a quarantine facility, the following needs to be considered:

 Infrastructure: there is no universal guidance regarding the infrastructure for a

quarantine facility, but adequate space should be respected not to further enhance
potential transmission and the living placement of those quarantined should be
recorded for potential follow up in case of illness.
 Accommodation and supplies: passengers should be provided with adequate
food and water, appropriate accommodation including sleeping arrangements and
clothing, protection for baggage and other possessions, appropriate medical
treatment, means of necessary communication, in a language that they can
understand and other appropriate assistance.
 Communication: establish appropriate communication channels to avoid panic and
to provide appropriate health messaging so those quarantined can timely seek
appropriate care when developing symptoms.
 Respect and Dignity: quarantined passengers should be treated, with respect for
their dignity, human rights and fundamental freedoms and minimize any discomfort
or distress associated with such measures; taking into consideration the gender,
sociocultural, ethnic or religious concerns of passengers.
 Duration: For infectious diseases, the length of quarantine is usually equal to the
period of incubation and communicability of the disease. For other agents (e.g.
chemical) it shall be for a period as determined by the PoE health team.
 Medical care service: there should be a medical care service for other than
disease of interest 24/7.

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3.[4.] CHAPTER FOUR: INFECTION PREVENTION AND CONTROL

Infection prevention and control (IPC) refers to scientifically sound practices aimed at
preventing harm caused by infection to passengers, patients, health workers, and the
community. It is a systematic effort or process of placing barriers between a susceptible
host (person lacking effective natural or acquired protection) and infectious agents.

IPC measures should be implemented at PoEs, isolation centers, quarantine, and

treatment facilities. The necessary resources (facilities, equipment, human resources,
and technical capacity) should be provided to ensure that IPC practices are conducted
appropriately. IPC practices include standard and transmission-based precautions.

A. Standard Precautions (SP)

SP are designed for use in caring for all people. These apply when handling blood,
bodily fluids, secretions, excretions (except sweat), non-intact skin, and mucous
membranes. SP includes:

 Hand hygiene: critical measure to prevent the spread of infections. Education and
training programs should thoroughly address indications and techniques for hand
hygiene practices before performing routine procedures at PoE, isolation and
quarantine facilities .
 Use of personal protective equipment (PPE): wearable equipment designed to
protect from exposure to or contact with infectious agents. PPE that effectively
covers the skin and clothing that is likely to be soiled with bodily fluids or
contaminants should be available. These include gloves, face masks, protective
eyewear, face shields, and protective clothing.
 Respiratory hygiene/cough etiquette: infection prevention measures are designed
to limit the transmission of respiratory pathogens spread by droplet or airborne
routes. The strategies target primarily patients and individuals accompanying
patients who might have undiagnosed transmissible respiratory infections, but also
apply to anyone with signs of illness, including cough, congestion, runny nose, or
increased production of respiratory secretions.

21
 Sharps safety (engineering and work practice controls): Most percutaneous
injuries (e.g., needle stick, cut with a sharp object) among health workers involve
burs, needles, and other sharp instruments. Most exposures are preventable;
therefore, each PoEs should practice procedures that address sharps safety. When
using or working around sharp devices, people should take precautions while using
sharps, during cleanup, and during disposal.
 Safe injection practices (i.e., aseptic technique for parenteral medications): are
intended to prevent transmission of infectious diseases between one patient and
another or between a patient and health care workers during preparation and
administration of parenteral (e.g., intravenous or intramuscular injection)
medications. Safe injection practices are a set of measures public health officers and
health care workers should follow to perform injections in the safest possible manner
to protect people.
 Sterile instruments and devices: require multiple steps using specialized
equipment. Each practice at PoEs should have guidelines and procedures in place
for containing, transporting, and handling instruments and equipment that may be
contaminated with blood or body fluids. Most single-use devices are labeled by the
manufacturer for only a single-use and do not have reprocessing instructions. Use
single-use devices for one patient only and dispose of them appropriately.
 Clean and disinfected environmental surfaces: guidelines and procedures for
routine cleaning and disinfection of environmental surfaces should be included as
part of the infection prevention plan. Cleaning removes large numbers of
microorganisms from surfaces and should always precede disinfection. Disinfection
is generally a less-lethal process of microbial inactivation (compared with
sterilization) that eliminates virtually all recognized pathogenic microorganisms but
not necessarily all microbial forms (e.g., bacterial spores). The emphasis for
cleaning and disinfection should be placed on surfaces that are most likely to
become contaminated with pathogens, including clinical contact surfaces (e.g.,
frequently touched surfaces such as light handles, bracket trays, switches on dental
units, computer equipment) in the patient-care area.

22
B. Transmission-based Precautions (TBP)

Transmission-based precautions are used in addition to standard precautions; it is the

second level precaution intended for use in suspects/ cases infected or colonized with
infectious pathogens. If there is any impending development of an infectious process in
a person without a known diagnosis, implementing transmission-based precautions
should be based on signs and symptoms (empirical basis) until a definitive diagnosis is
made.

Contact Precautions- Contact precaution is used for patients with suspected or known
infections at an increased risk of contact transmission.
 Ensure appropriate patient placement in a single patient space or room if available
in acute care areas. In ambulatory settings, place patients requiring contact
precautions in an exam room or cubicle as soon as possible.
 Use personal protective equipment (PPE) appropriately, including gloves and
gowns. Wear a gown and gloves for all interactions that may involve contact with
the patient or the patient's environment. Donning PPE upon room entry and properly
discarding before exiting the patient room is done to contain pathogens.
 Limit transport and movement of patients outside of the room for medically-
necessary purposes. When transport or movement is necessary, cover or contain
the infected or colonized areas of the patient's body. Remove and dispose of
contaminated PPE and perform hand hygiene prior to transporting patients on
Contact Precautions. Don clean PPE to handle the patient at the transport location.
 Use disposable or dedicated patient-care equipment (e.g., blood pressure cuffs). If
common use of equipment for multiple patients is unavoidable, clean, and disinfect
such equipment before use on another patient.
 Prioritize cleaning and disinfection of the rooms of patients on contact precautions,
ensuring rooms are frequently cleaned and disinfected (e.g., at least daily or prior to
use by another patient if outpatient setting). Focus on frequently touched surfaces
and equipment near the patient.

Droplet Precautions- use droplet precautions for patients suspected or known to be

infected with pathogens transmitted by respiratory droplets generated by a patient who
is coughing, sneezing, or talking.
23
Airborne Precautions- use Airborne Precautions for patients known or suspected to be
infected with pathogens transmitted by the airborne route (e.g., tuberculosis, measles,
chickenpox, disseminated herpes zoster, etc).
 Source control: put a mask on the patient.
 Ensure appropriate patient placement in an airborne infection isolation room
constructed according to the Guideline for Isolation Precautions. In settings where
Airborne Precautions cannot be implemented due to limited engineering resources,
masking the patient and placing the patient in a private room with the door closed
will reduce the likelihood of airborne transmission until the patient is either
transferred to a facility with an appropriate infrastructure or returned home.
 Restrict susceptible healthcare personnel from entering the room of patients known
or suspected to have tuberculosis, measles, chickenpox, disseminated zoster, or
smallpox if other immune healthcare personnel are available.
 Use personal protective equipment (PPE) appropriately, including a fit-tested
approved N95 or higher-level respirator for healthcare personnel.
 Limit transport and movement of patients outside of the room to medically-
necessary purposes. If transport or movement outside, instruct patients to wear a
surgical mask, if possible, and observe Respiratory Hygiene/Cough Etiquette.

24
4.[5.] CHAPTER FIVE: HEALTH CARE WASTE MANAGEMENT AT
POINTS OF ENTRY

Health care waste (HCW) is defined as all waste generated by health care activities,
including infectious and non-infectious waste, i.e., sharps, non-sharps, blood, body
parts, chemicals, pharmaceuticals, medical devices, and radioactive materials. Improper
healthcare waste management at PoEs results in infectious diseases. A documented,
tested, and updated solid and liquid waste management program, including medical
waste, should be in place.

The scope of the waste management should include actions for both routine operations
and emergencies, with SOPs for safe transport and destination of the solid and liquid
waste generated and/or treated at the PoEs. The most appropriate way of identifying
the categories of health-care waste is by sorting the waste into color-coded solid waste
containers with plastic bags and safety box. It is recommended to use:

 Yellow color for healthcare infectious waste and

 Black color for non-infectious general waste.

It is also recommended to use the international biohazard symbol on the packing to

identify medical waste. The issues of waste management should be strictly
implemented by the PoE health team and other stakeholders responsible for waste
management at PoE premises.

25
5.[6.] CHAPTER SIX : HUMAN REMAIN/ASH MANAGEMENT

All human remains are potentially infectious, and "STANDARD PRECAUTIONS" should
be implemented for every case. Although most organisms in the human remains are
unlikely to infect healthy persons, some infectious agents may be transmitted when
persons come into contact with blood, body fluids, or tissues of the human remain of
persons with infectious diseases. Human remain should be handled in a way that limits
PoE health team and other stakeholder staffs and community exposure to blood, body
fluids, and tissues to minimize the risks of transmission of known and unsuspected
infectious diseases. A rational approach should include staff training and education, a
safe working environment, appropriate safe work practices, the use of recommended
safety devices.

There is a need to maintain the confidentiality of a information. At the same time, there
is an obligation to inform personnel who may be at risk of infection through contact with
human remain so that appropriate measures are taken to guard against infection. The
discrete use of labels such as "Danger of infection" on the human remain is considered
appropriate.

5.1.[6.1.] Precautions during the Management of Human Remain

Based on the mode of transmission and the risk of infection, the following categories of
precautions for handling of human remain are advised:

 Cat. 1 ： Signified by a BLUE label: Standard precautions are recommended for all
human remains other than those with infectious diseases.
 Cat. 2：Signified by a YELLOW label: In addition to standard precautions, additional
precautions are recommended for human remains with known: Human
Immunodeficiency Virus infection (HIV), Hepatitis C, Severe Acute Respiratory
Syndrome (SARS), avian influenza, Middle East Respiratory Syndrome (MERS),
COVID-19, and Other infectious diseases as advised by health professionals.
 Cat. 3 ： Signified by a RED label: In addition to standard precautions, stringent
precautions are recommended for human remains known: Anthrax, Plague, Rabies,
26
 Viral hemorrhagic fevers (VHF), and other infectious diseases as advised by health
professionals.

Recommendations for People (all personnel who are likely to come into contact with
human remain, such as health care workers, mortuary staff, funeral workers, etc.)
involved in handling and managing human remains:

 All staff should be trained in IPC. A high standard of personal hygiene should be
adopted.
 When handling human remains, avoid direct contact with blood or body fluids from
the human remain.
 Anyone coming in contact with the human remains must ensure the standard
preventive measures, including hand washing and disinfection pre and post-
interaction with the human remain.
 Keep minimum movement of the body/ coffin and safe handling during the transfer.
 Put on PPE, including:
o Category 1: Gloves, water repellent gown, and a surgical mask. Use goggles
or face shields to protect eyes in case of splashes.
o Category 2: Gloves, water-resistant gown/ plastic apron over water repellent
gown, and a surgical mask. Use goggles or face shield to protect eyes if there
may be splashes.
o Category 3: Water-resistant gown, surgical mask, eye protection (goggles or
face shield), double gloves, shoe covers/boots.
 Make sure any wounds, cuts, and abrasions are covered with waterproof bandages
or dressings.
 Do NOT smoke, drink or eat.
 Do NOT touch the eyes, mouth, or nose.
 Observe strict personal hygiene. Hand hygiene could be achieved by washing hands
with liquid soap and water or proper use of alcohol-based hand rub.
 Avoid sharp injury, both in examining the human remain and afterward, when
dealing with waste disposal and decontamination.
 Remove PPE after handling the human remain. Then, wash hands with soap and
water immediately.

27
 After the transfer, disinfect the PPEs and carefully remove them, ensuring no
contamination or touching of soiled masks or clothing surfaces.
 In case of percutaneous injury or mucocutaneous exposure to the human remain's
blood or body fluids, the injured or exposed areas should be washed with copious
amounts of water.
 Items classified as clinical waste must be handled and disposed of properly
according to the guideline requirements.
 All surfaces which may be contaminated should be decontaminated with 0.5%
chlorine solution, and Metal surfaces could with 70% alcohol.
 Used equipment should be autoclaved or decontaminated with disinfectant solutions
in accordance with established disinfectant guidelines.
 The mortuary must always be kept clean and properly ventilated with adequate
lighting. Surfaces and instruments should be made of materials that could be quickly
disinfected and maintained.
 Storage compartments for human remains should be easily accessible for both
regular cleaning and maintenance.
 All used linen should be handled with standard precautions. Used linen should be
handled as little as possible with minimum agitation to prevent possible
contamination of the person handling the linen and prevent the generation of
potentially contaminated lint aerosols in the areas. The laundry bag should be
securely tied up. Staff should follow the national IPC guidelines.

28
5.2.[6.2.] Document Requirements for transport of Human Remain/Ash

Transportation of human remains should comply with the international and national
legislation of the hazardous/ infectious substance transportation management protocol.
If it does not comply with standards, the courier/freight forwarder must not accept and
load the human remains or human remains. After required documents have been
evaluated, the freight forwarder should communicate information about the human
remains transportation at least 48 hours before departing to the destination. PoE health
team and consignee should be informed of transportation details, and copies of
documents should be sent through any means of communication (e-mail, telegram, and
others). After the transportation, the conveyances used for transportation must be
thoroughly disinfected with internationally recommended disinfectants and cleaning
procedures.

A. Document Requirements for the Incoming Human Remain/Ash

The document required for the release of human remains or ash at PoE must comply
with the departure and destination countries legislation. In Ethiopia, the incoming human
remains or human remains shall be accompanied at least with the following documents
written in English or officially translated and authenticated with the English language.

Mandatory documents

 Death certificate of deceased with full name, age, sex, cause of death, date of death,
issue organization address and seal
 Embalming certificate with full name, age, sex, cause of death, date of embalming,
issue organization with full address and seal
 Certificate of non-infectious free /free from contagious diseases of public health
importance.

Supporting documents

 Passport/ lese-passé, ID card of the deceased person

 Airway bill/bill of loading document

29
B. Documentary Requirements for Outgoing Human Remain/Ash

Only authorized health facilities (Addis Ababa Burn Emergency and Trauma Hospital
(AaBET), Minilik II hospital, Saint Paul's Hospital and Millennium Medical College
(SPHMMC)) in Ethiopia will undertake forensic investigation and provide death
certificates for the deceased. Anyone transporting human remains from Ethiopia to
abroad must provide the required documents to the PoE health team. The consignor
should transport the human remain at the PoE, accompanied with the following
documents.

30
Mandatory documents

 Death certificate issued by a authorized facilities (full name, age, sex, cause of
death, date of death should be included to a minimum)
 Certificate of non-infectious/free from contagious diseases of public health
importance.
 Passport or lese-pass or ID card of deceased

Supporting documents

 Letter from embassy or foreign affairs of the deceased, to repatriate to specified

country
 Police letter/report if a case is related to crime.
 Airway bill or bill of loading document

5.3.[6.3.] Releasing Human Remain/Ash at PoE

Releasing human remains at PoEs must comply with both the departure countries and
destination countries' legislation. The PoE health team should receive all required
documents either from the courier or consignor for both incoming and outgoing human
remains. The received document should be evaluated and cross-checked with the
physical inspection of human remains at the PoEs. If the document evaluation and
physical inspection fit the requirements, PoE health team should release the human
remains. If it does not comply with standards and requirements and is suspected of
infectious disease, the PoE health team will utilize the needed IPC measures and take
action per the legislation (proclamation No. 1112/2019 and related directive).

31
6.[7.] CHAPTER SEVEN: PREPAREDNESS AT POINTS OF ENTRY

PoEs emergency preparedness and response plan should fully consider interaction and
cooperation with stakeholders listed under CHAPTER TWO. At PoE, public health
emergency preparedness and response can be strengthened through:

 Formulation, testing, and evaluation of a public health emergency contingency plan;

 Establishment of effective mechanisms for multi-agency communication,
coordination, and information-sharing, including operational links between PoE
health team, relevant stakeholders, and IHR-NFP;
 Establishment of a clear decision-making mechanism to facilitate the incorporation of
best-available evidence and information to achieve balanced public health
responses at PoE;
 Documentation (e.g. standard operating procedures (SOP), guideline,
memorandums of understanding (MoU) of arrangements made with stakeholders for
response measures
 Undertaking bilateral and multilateral cooperation and information sharing.

6.1.[7.1.] Public Health Emergency Response Contingency Plan

A Public Health Emergency Response Contingency Plan (PHERCP) is a multi-agency

coordination plan to prevent the introduction, transmission, or spread of communicable
disease. Effective use of a PHERCP facilitate a coordinated and timely response to a
PHE at a PoE, lessening the threat of global disease spread by international travelers.
All the relevant stakeholders mentioned under CHAPTER TWO, should be part and
parcel of the PHERCP development as both PoE health team and stakeholders play
critical roles in implementing the PHERCP when a PHE occurs.

World Health Organization's (WHO’s) guide for PHERCP at designated PoE can be
used to standardize the plan as references.

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7.[8.] CHAPTER EIGHT: EVENT DETECTION, RISK ASSESSMENT AND
RESPONSE

7.1.[8.1.] Event Detection, Notification and Communications

Early detection of events allows for timely implementation of public health measures,
response, containment, and prevention of further potential exposure. Enhanced
surveillance, the capacity and arrangement to receive notifications sent by conveyance
operators, and communication and information exchange among PoEs and different
level health system, between PoEs, between stakeholder and PoE health team are
essential elements of event detection. A potential public health event may be detected
at various points.

A. Detection at the Point of Origin

If a country or region to which the passengers are going is experiencing an increase in

infectious disease or ongoing PHE, the PoE health team shall issue a health travel alert.
Depending on the risk assessment and/or level of risk to the passengers, a health travel
alert or restriction may be implemented as a national response.

B. During the boarding process

A PoE health team or stakeholders in the PoE premises should detect an illness or a
potential PHE at the time of boarding among the passengers, airline passenger agents,
security, passport control inspectors, conveyance crew or cargo staffs. The following
signal (recommended signs and symptoms to look for as outlined in the IHR) should
alarm the PoE teams for further intervention.

 Fever (380C/100F)
 Persistent cough
 Impaired breathing
 Persistent diarrhea
 Persistent vomiting
 Skin rash
 Bruising/bleeding without previous injury
 Confusion of recent onset
33
 Appearing obviously unwell.

In such situation passengers/airline passenger agents, security, passport control

inspectors, conveyance crew or cargo staffs must be interviewed or subjected to a
health assessment before being allowed to board, and subsequent decisions should be
guided by the assessment results (Refer to entry and exit screening in section for
detail).

C. In- flight: Public Health Procedures for Cabin Crew or operators

Once passengers or cargo has departed and the travel is in progress, event detection
will rely on the crew's/ conveyance operators’ awareness. The crew/ conveyance
operators are responsible for passengers' safety during a travel but have limited
capacity to detect and respond to medical or potential public health events. If a public
health events occurs during travel, the cabin crew should seek advice from a ground-
based PoE health team by the communication algorithm outlined in the separate SOPs
for handling of the suspect detected onboard flight or section 2.2.2 of this
guideline. Besides, the crew should look for the assistance of a medically trained
passenger on board. In severe cases, the pilot in command may consider diversion for
the unwell passenger to receive the necessary treatment. In case of land crossing the
communication should be initiated with the nearby PoE health team. In all cases,
communication between the cabin crew/conveyance operator, ground operations, and
the PoE health team is necessary to ensure all parties are aware of the situation.

The following steps should be applied for efficient case detection in-flight.

 Crew/conveyance operator must be accustomed to observe passengers for visible

signs of illness and distribute traveler's health declaration form to passengers one
(1) hour before scheduled landing/arrival at PoE.
 If crew/conveyance operator identifies ill passenger/s exhibiting signs and
symptoms, after observing and reviewing the traveler's health declaration form, in
collaboration with their on-ground medical crew, onboard medical volunteer, or with
PoE health team provide and instruct suspect passenger/s to adhere to basic
infection control measures to protect other travelers and crews.

34
 Crew/conveyance operator will also isolate or relocate the passenger to a less
populated section of the conveyance.
 The crew/conveyance operator will alert the commander pilot/captain of the
situation, relaying critical information.
 In case of the land crossing, the conveyance operator will implement the measures
as advised by the PoE health team. This may include the transfer of the suspect to
the nearby health facilities, implementation of the IPC and isolation on board in the
conveyances.
 In case of air transport, commander pilot/captain will alert the Flight Information
Center (FIC) while in-flight, relaying critical information about suspect passenger/s
 FIC will alert the Ethiopian airport call center of the situation in-flight.
 The airport call center will inform the PoE health team of suspected passenger/s on
the flight, relaying critical passenger information.
 Once alerted, the airport PoE health team will consult with medical and public health
experts and relay further instruction (i.e., parking and deplaning details) to the
incoming flight. They will also assemble a team in appropriate Personal Protective
Equipment (PPE) to handle the case.
For steep by steep procedures on how to handle the situation refer to the SOPs in this
guideline or section 2.2.2 of this guideline.

The practice of infection control during travel is an essential means of preventing or

reducing the transmission of communicable diseases. For air transportation, an
International air transport association (IATA) has produced a series of infection control
guidance documents for cabin crew, cargo and baggage handlers, aircraft maintenance
and cleaning staff, passenger agents, and other essential staff. The guidelines include
basic infection prevention and control procedures in the event of a potential
communicable disease case.

Based on the preliminary assessment, if an illness has the potential to be

communicable, regardless of the infectious agent, the following immediate steps must
be advised to be implemented by the crews or conveyance operator on board.

 Designate one crew/ onboard medical volunteer to look after the ill passenger,
preferably the one that has already been dealing with this passenger;

35
 Practice hand hygiene (hand washing or hand rub);
 Use appropriate personal protective equipment (PPE) when handling blood, body
substances, excretions, and secretions;
 Handle any blankets, trays, or other personal products used by the traveler carefully;
 Practice environmental cleaning and spills-management (use universal precaution
kit when spills occur).
 Handle all waste following regulatory requirements or guidelines.
 In addition to standard precautions, specific measures for disease syndromes or
communicable diseases should be applied. All potential illnesses must be
documented in writing.

Gastrointestinal Illness:

 Ill passenger should be moved to a seat near a washroom if several empty seats are
available to make access to the washroom easier without increasing the risk of
contamination. (i.e.,
 if the ill passenger has already soiled the seat or area, other passengers should not
use that seat]; that lavatory should be restricted to their use, if possible, or if not
possible, the lavatory should be cleaned following use by the ill travelers.
 If a public vomiting or fecal incident occurs use of appropriate tools/procedures to
limit the contamination.
 If the conveyance is not full, move the surrounding passengers away from the ill
passenger.

36
Respiratory illness:

 An appropriate (surgical or procedure) mask should be provided to the passenger, if

available and tolerated by him/her. If the ill traveler cannot tolerate a mask, healthy
travelers adjacent to the ill traveler may be offered masks.
 In all cases, the adjacent seat(s) should be left unoccupied, if feasible.
 In case of air transport ensure the flight crew maintains continuous operation of the
aircraft's air recirculation system (HEPA filters are fitted to most large aircraft and will
remove some airborne pathogens, depending on the size of the particulate
microorganism).

Illness Transmitted By Direct Contact with Body Fluids (Blood, Vomit, Diarrhea)

 Isolate the ill passenger by relocating travelers in the adjacent seats is advisable, if
feasible.
 Crew/conveyance operator must wear masks when assisting the ill travelers.
 The crew/conveyance operator should implement universal precaution measures if
they could be exposed to body fluids when assisting the ill passenger or when
cleaning up spilled body fluids.

37
D. Detection upon Arrival at PoE and in country

If evidence of infection is not detected during the travel, it should be detected upon
arrival at at PoE. At this stage detection can be done by PoE health team or other
stakeholder’s staff. An example of this measure is the public health' entry screening' of
conveyances originating from affected country (refer entry and exit screening section of
this guideline). Once entered into the country, the travel related PHE can be detected
through the national surveillance system. These events require follow-up measures at
PoE and must be communicated to the PoE health team by the local public health
emergency management (PHEM) staffs. Risk assessment should be performed once
the PHEs are notified that the suspect has traveled abroad within the previous
days/weeks, and appropriate measures should be taken.

7.2.[8.2.] Preliminary Assessment and Information Sharing

Once public health event was detected verification of the event by collecting accurate
information is important and part of the standard preliminary response of the PoE health
team and other stakeholders. Once a potential public health event has been detected,
and the PoE health team has been notified, there must be an attempt to verify the
event's facts to the fullest extent possible. The information must be collected from
multiple sources, including the passengers, the conveyance operator, ground-based
medical services for aircraft in flight or the agent responsible for the baggage or cargo.

The information collected must be used to ascertain what level, if any, of intervention is
required. A preliminary assessment must be conducted to determine the type of event,
level of severity, trend, and hazard level concerning the public health event; whether or
not to trigger the PHERCP.

Even if the causative agent/source is unknown, a preliminary report at least including

the variables collected under the preliminary assessment should be reported from the
PoE health team to the EPHI. Please refer the algorithm for information flow from
the PoE health team to EPHI included under section 2.2.1 of this guideline.

38
Besides, the PoE health team must collaborate with the stakeholders to ensure that
relevant information regarding a potential public health event is relayed and shared
among all. Once the event was detected the PoE health team should share the
preliminary report with the stakeholders listed under CHAPTER TWO of this guideline.
Even before the full risk assessment is initiated and the containment strategy defined
the following measures should be implemented in collaboration with stakeholders.

 Decision whether to divert the conveyance to PoE with sufficient capacity to respond
 Define the best conveyance parking position for disembarkation and subsequent
interventions
 The PoE health team must assess potential contamination of the conveyance
related to the onboard public health event.
 Allocate space separate from other travelers or the general public to interview
travelers suspected of being ill or affected persons;
 Ensure adequate parking is provided for emergency response vehicles and
personnel, including ambulances, hazardous or spill response vehicles;
 Implement security measures in case the entry or exit screenings;
 Arrange for the PoE health team to provide information within the terminal to inform
relatives and friends who may be at the arrivals area while minimizing the risk of
anxiety.

Note: Maintain a log of activities for use in risk assessment and as a permanent record
of the event;

7.3.[8.3.] Public Health Event Risk Assessment at PoE

Risk assessment is the process of evaluating the probability and consequences of injury
or illness arising from exposure to identified hazards. It is an iterative process that
continues from the time the event is first detected to the time the event is closed. The
estimate of potential risk from the public health event is a critical phase to determine
which, if any, public health measures may be required to manage the event. The steps
that form the basis of the risk assessment process at the at PoE is included under
annex six (6) of this guideline.

39
7.4.[8.4.] Public Health Response/Containment Strategies

When considering the containment of EVD, SARS or pandemic influenza, COVID-19

and other infectious diseases there are two principal strategies. Broadly the
containment strategies can be categorized into a) pharmacological- antibacterial,
antiviral medications, etc. and b) non-pharmacological public health interventions -IPC,
social distancing, isolation, quarantine, etc. Besides, those measures can be broadly
classified into those targeting a) human, b)animal and c) cargo/inanimate
objectives/conveyances. For the details of the public health response measures and/or
routine regulatory measures at PoE please refer to the section under the CHAPTER
NINE of this guideline. In general, the following public health measures can be applied
alone or in a combination.

40
8.[9.] CHAPTER NINE: PUBLIC HEALTH RESPONSE MEASURES AT
POINTS OF ENTRY

8.1.[9.1.] Public Health Measure with Respect to Person

8.1.1.[9.1.1.] Travel advisories/health alert notices

Travel advisories are an essential component of risk communications during a public

health event. The PoE health team in collaboration with the stakeholders needs to
communicate relevant and timely information to travelers, the public, the international
community, and stakeholders.

8.1.2.[9.1.2.] General Aircraft Health Declaration

This form is intended to be used in the aircraft as the health declaration for the general
disease specially during non-emergency situations which the IHR 2005 put on the
annex 9. This form is filled by the cabin crew and submitted to the PoE health team
upon arrival. The health part of the aircraft declaration form is attached (Annex 9)

8.1.3.[9.1.3.] Travelers Health Declaration Form

Traveler’s Health Declaration Form/THDF is a form that passengers must complete

about their possible exposure to cases, sign and symptoms and travel history within the
incubation period of the specific disease of interest. The form should include relevant
contact details of passengers who may need to be reached after travel when, for
instance, they are identified as a possible contact of a case. It is recommended that
such a form be filled in the conveyance before disembarkation at PoEs as advance
distribution in hard copy or online is to be considered by airlines or ministry of transport/
train in collaboration with the PoE health team.
 Priority should be given for onboard filling of the form by the travelers. THDF filling
after departure should be the least preference.
 The crew/operator should be well oriented so that they can facilitate and support the
onboard filling of the THDF by the travelers.

41
 The THDF should be prepared in languages that the majority of the travelers may
understand or the government of Ethiopia use as a working language.

Generally, the THDF used at point of entry will be adapted /revised according to the
specific public health treat or disease of interest.

8.1.4.[9.1.4.] Review Travel History in Affected Area

Travel history of the passengers to the PHE affected areas must be checked by
reviewing the THDF. For passengers moving along the land borders, information on the
travel history shall be extracted by oral queries taking into consideration incubation
period of the disease/s of interest. If there was any travel history to an affected areas
depending on the event, further information about passengers and crew who visited the
affected area must be collected. Additional information will be collected by checking the
passenger and crew list, the conveyance log, the medical log, information about
onboard activities and contacts, any patient notes available and or other health
documents such as certificates of vaccination.

8.1.5.[9.1.5.] Passenger Health Screening

The purpose of passenger health screening is to reduce the international spread of

diseases. Besides, it can also be used to educate passengers about the signs and
symptoms of disease of interest; ensure passengers know what to do if they get sick
and inform travelers whom to call if they get sick. Screening must include measures like
checking for compatible signs and symptoms and interviewing passengers about and
travel history or history of signs and symptoms via oral queries and document
review/profiling which can contribute to active case finding among sick travelers.
Symptomatic travelers and identified contacts should be guided to seek or channeled to
further medical examination, followed by further testing.

42
 Types of Passenger Screening

A. Based on the scope of passengers evaluation/assessment

 Primary screening-Observing passengers for obvious signs of illness, measuring

temperature, and collecting information on travel and exposure history by using the
passenger’s health declaration form. Primary screening can be undertaken by non-
health professionals.
 Secondary screening-Having a healthcare or public health professional conduct an
additional public health assessment of ill or potentially exposed travelers identified
through the primary screening process. The suspect/ case investigation form to
be used on the passenger screening should include at least:

o Section I: Traveler information: name, age, birth date, gender, passport

country and number, country of residence, location where the traveler
became ill or had exposure and date of exposure.
o Section II: Clinical signs and symptoms: list of symptoms, onset of
symptoms, underlying or chronic illnesses of the traveler.
o Section III: Exposure and risk factors: list of risk factors or instances of
exposure.
o Section IV: Triage and response

B. Based on the targeted passengers for screening (arriving vs. outgoing)

 Exit screening- a public health intervention to identify outgoing passengers with

possible symptoms of, or risk of exposure to, and to prevent them from further travel.
Exit screening can be paired with travel restrictions to prevent the exportation of the
diseases to other countries, protect travelers and crew, and comply with public health
recommendations for exposed or symptomatic persons.
 Entry screening: it is screening of in going passengers immediately after
disembarkation from the conveyance or in the case of ground crossings, people
crossing on foot, via moto, or in their personal vehicles.

43
For maximum effectiveness, screening should be accompanied with:

 Health messages: Dissemination of health messages and travel notices informing

persons on signs, symptoms and where to seek medical support if needed.

o THDF: Development and use of forms to collect information on symptoms,

history of exposure and contact information.
o Data collection and analysis: Establishment of proper mechanisms for
collection and analysis of data generated from the screening for rapid
evaluation and response.

Where resources are limited, entry screening is advisable and should be prioritized for
passengers arriving from affected areas with community transmission.

Please refer to the SOP for passengers Public Health screening at PoEs

Data management

As part of the exit and entry screening at the PoEs; the storing and recording of data
during screening is important for evaluation purposes and for estimating performance
indicators. Collected data should be timely analyzed for public health action. Therefore,
it is advised that the following information be systematically recorded:

 Number of travelers screened (primary screening)

 Number of passengers having been referred to a secondary screening
 Number of passengers characterized as suspected cases via a secondary screening
 Number of passengers identified as suspected cases via a secondary screening on
whom type of health measure has been implemented (e.g. public health
observation, isolation, decontamination, referral to medical facility, quarantine, and
vaccination)
 Number of travelers identified as confirmed cases.
 Number of travelers transferred to the designated HF/Isolation/quarantine center

8.1.6.[9.1.6.] Review proof of medical examination and any laboratory analysis

44
The review of the proof of medical certificate of passengers may be done for all
passengers on the conveyance or those arriving from affected areas, as decided. This
information can be collected through interviews or by using questionnaires or other
types of forms. Based on the situation patient notes, rapid diagnostic testing results, or
Laboratory results, X-rays and other medical examination results may be reviewed by
the the PoE health teams.

8.1.7.[9.1.7.] Medical Examination

Medical examinations are measures implemented by the PoE health team to determine
a traveler’s health status and the potential public health risk to others. Medical
examinations can take place on board; on arrival or departure. The passengers can
undergo either invasive4 or non-invasive5 medical examination. Based on the existing
capacity the passenger can be examined onsite at PoEs or refereed to another health
facility.

8.1.8.[9.1.8.] Review of proof of vaccination or other prophylaxis

Yellow fever proof of vaccination is required for passengers as a condition of entry into
Ethiopia. Other requirement of vaccination/prophylaxis for others may be implemented
on the basis of evidence of public health risk.

4
medical examination of the ear, nose and mouth, temperature assessment using an ear,
oral or cutaneous thermometer, or thermal imaging; medical inspection; auscultation;
external palpation; retinoscopy; external collection of urine, faeces or saliva samples;
external measurement of blood pressure; and electrocardiography. These can be
required of travelers as a condition of entry or exit to a country.
5
the puncture or incision of the skin or insertion of an instrument or foreign material into
the body or the examination of a body cavity. Notes: Invasive medical examination
shouldn’t be required as a precondition of entry of any traveler to a country, but there
are exceptions such as: on the basis of evidence of public

45
8.1.9.[9.1.9.] General Health Advice and Alerts to Passengers
during an ongoing Emergency

Key information to be shared with passengers

 Brief description of the disease

 Symptoms, cause, mode of
transmission, prevention methods, risk
factors, etc
 What to do if symptoms develops
/travelers suspects his/herself
 How to self-monitor for illness
 Public health measures in place
at departure and destination PoEs
 Measures to stay healthy and
reduce the risk of infection during travel.
 EPHI website to be referred:
www.ephi.gov.et

Methods of Communication for Travel Related Messaging

Health messages should be delivered by methods effective enough to address the large
portion of the passengers and can be used singly or in a combination. The messages
should be delivered preferably in multiple languages.

 Distributing Travel Health Alert Notices (T-HAN) – a paper handout given to

arriving or departing travelers containing information about the disease of interest.
 Displaying health messages where most international travelers enter or leave the
POE.
 Creating audio/ video messages for airlines to broadcast during flights with
information about the disease of interest and public health measures that have been
employed at destination PoE.
 Disseminating messages, e.g., through media

46
8.1.10.[9.1.10.] Syndromic Surveillance

A method of surveillance that uses health-related data based on clinical observations

rather than laboratory confirmation of diagnosis. Syndromic surveillance is used to
detect PHEs earlier than would otherwise be possible with laboratory diagnosis-based
methods. Case definitions used for syndromic surveillance are based on clinical signs
and symptoms rather than specific laboratory confirmation of the causative agent.
Syndromic surveillance by the PoE health team may support the identification of
potentially infectious illnesses such as respiratory illness (e.g., influenza), febrile rash
illness (e.g., measles), or gastrointestinal illnesses (e.g., foodborne illness, norovirus).
Usually the below listed signs and symptoms are observed but more specific guidance
can be applied during an ongoing PHE.

o Fever (380C/100F)
o Persistent cough
o Impaired breathing
o Persistent diarrhea
o Persistent vomiting
o Skin rash
o Bruising/bleeding without previous injury
o Confusion of recent onset
o Appearing obviously unwell.

47
8.1.11.[9.1.11.] Social mobilization

In addition to the travel health information, social mobilization approaches, including

health education campaigns, can be a relatively economical and effective public health
measure during a public health event; these should be used to inform the public and
passengers about other measures that may be in effect (i.e. introduction of voluntary
isolation, location of treatment centers that are open for ill individuals, safe burial, etc.)

8.1.12.[9.1.12.] Social distancing

Social distancing may be introduced as a formal public health measure. Risk

communication encourage informal social distancing (avoidance of crowded spaces,
delay of travel) through clear communication on the potential for disease transmission.
People may be more receptive to social distancing measures during a public health
event where the risk has been clearly communicated, and daily living requirements are
considered.

8.1.13.[9.1.13.] Contact Tracing/Investigation

Contact varies based on the nature of the disease. So refer to the disease specific
working documents for defining the contacts of the case of specific disease. The contact
tracings are undertaken with the intention of identifying those passengers or person who
have had contact with the case/suspect passengers.

The source of information for contact tracing for air transport:

 Passenger, crews/conveyance operators

 Aircraft general declaration form:
 Passenger manifesto: Contact identification is generally possible only where there is
allocated seating. Airlines/transport authorities should be contacted to obtain details
of passengers and flight manifests.
 Media: For public or shared transport where passenger lists or allocated seating is
not available, a media release may be required to request passengers to self-
identify. Media release may specify the date, time, pick-up location and

48
 arrival/destination, and stops along the way, requesting people self-identify as a
potential contact
 Flight itinerary/route: indicate the aircraft movement route from one country/city to
the other
 Information from Immigration Nationality and Vital Events Agency (INVEA):
 Travelers Health declaration.

Source of information for contact tracing at ground crossing

 Passenger list: from drivers/ assistants(seat #)

 Passengers, conveyance operator
 IHR focal person
 Media
 Information from Immigration Nationality and Vital Events Agency (INVEA):

For the contacts that were listed but allowed to continue travel to their next destination
flight, the full information of the passengers and flight should be given to the country's
authority by Ethiopia’s IHR-NFP.

8.1.14.[9.1.14.] Placement of Person Suspected of Exposure Under Public Health

Observation

The PoE health team must monitor the health status of a passengers that has been
exposed, or possibly exposed, to a public health risk that could be a possible source of
spreading disease at the PoE. The connecting passenger can continue an international
voyage as long as the passenger is not posing an imminent public health risk and
Ethiopia through its IHR-NFP informs authority of the destination PoE, if known, of the
passenger’s expected arrival.

8.1.15.[9.1.15.] Quarantine, Isolation and Treatment

Refer to the Case management and its referral linkage under section 3.3.

49
8.2.[9.2.] Pubic Health Measures with Respect to the Conveyances and
Cargo

According to the Proclamation No. 1112/2019 article 72, conveyances considered to

have a public health risk/ had travel history to the affected areas shall be inspected on
arrival or departure by PoE health team.

During inspection, trained PoE health staff should examine areas, baggage, containers,
conveyances, facilities and goods or postal parcels, including relevant data and
documentation, to determine if a public health risk really exists. Based on evidence of
inspection findings, the team can decide on implementation of further public health
measures such as disinfection, decontamination or disinsection, as per the developed
SOPs.

Depending on the purpose of inspection and the nature of the event (e.g. outbreak
investigation, chemical spill, presence of vectors) a focused inspection might be
necessary. In this case, the team may seek support from experts and other relevant
authorities to better assess public health risks and decide on the appropriate measures.

In case objects/conveyance suspicious for public health risks are encountered/reported

or has travel history to the affected areas, in collaboration with other relevant
stakeholders, collect detailed information and implement/suggest appropriate measures
based on the types of an event or situation.

8.2.1.[9.2.1.] Sanitation

PoE should have the capacity to ensure a safe environment for passengers at all times,
including safe food, drinking water, and sanitation that includes a vector control program
in and around the PoE. Maintaining a clean and safe environment for passengers will
reduce the potential for the transmission of infectious diseases and exposure to toxic
substances. It is crucial that PoE follow a regular cleaning and disinfection schedule.

 All areas of the PoE but mainly those open to the public should be included in a
sanitation program.

50
 All water used for drinking, personal hygiene, and food services should be from a
potable water system, which includes a safe source, water treatment as required, a
water distribution system, and routine monitoring and oversight of the system.

8.2.2.[9.2.2.] Disinfection

Disinfection is used to kill infectious agents. There are several instances where
disinfection must be applied, such as: on surfaces of a room where a patient stays; on
articles that have been contaminated by infectious discharges, including linens,
baggage, eating utensils; on environmental surfaces as a measure to control an
unsanitary condition; in water and water distribution systems. Different disinfection
methods (physical or chemical) and products can be used.

8.2.3.[9.2.3.] Decontamination

Decontamination is the process where health measures are taken “to eliminate an
infectious or toxic agent on a human or animal body surface, in or on a product
prepared for consumption or on other inanimate objects, including conveyances that
may constitute a public health risk”. Decontamination can take place, for example, by
destroying chemical agents through chemical modification, by physically removing
agents by washing, absorption, or evaporation or by physically scraping off the agents
so that they cause no damage.

8.2.4.[9.2.4.] Vector control

Controlling vectors that may transmit diseases at the PoE or be imported and become
established at another destination is an important public health measure. Arthropods,
insects, and rodents have been identified onboard aircraft, gaining access from the
environment via baggage or cargo; they can also be found on humans or animals as
ectoparasites. Vectors onboard aircraft can transmit illness on board, introduce
diseases and species in new areas, contaminate food products. Response measures to
vector infestation of aircraft include disinsection, derating, cleaning, and disinfection of
the aircraft environment or other objects such as containers, cargo, goods, baggage,
and postal parcels.

8.2.5.[9.2.5.] Disinsection

51
A public health measure routinely applied to incoming and outgoing conveyance at PoE
that have been identified as a potential source of infectious insects. That can introduce
diseases that affect the human population. This routine preventative measure reduces
the potential of transmitting diseases like yellow fever, malaria etc., into non-endemic
areas. The routine disinsection procedure at the PoE for the conveyance must be
regulated by PoE health team and certificate of proof of disinsection should be. Please
refer to the separate SOP for disinsection of aircraft and WHO recommended methods
for aircraft disinsection attached under Annex 8 of this guideline.

8.2.6.[9.2.6.] Onboard Infection Control

Refer to section in- flight event detection: Public Health Procedures for Cabin Crew or
operators, sub section C

8.2.7.[9.2.7.] Review of Proof of Measures Taken on Departure or in Transit

The PoE health team must review the proof of measures taken on departure from a
previous PoE/departure site or while the conveyance or its loads were in transit. In case
of air transport , certificate of disinfection /disinsection/derating records
must be sought for.
Besides, rreview of proof of measures taken might also involve examination of
conveyances maintenance documents – e.g. cleaning program, water safety records,
pest management plans, food safety programme, waste management records, health
records and decontamination/cleansing activities.

8.2.8.[9.2.8.] Isolation and Quarantine for Cconveyance

Isolation and quarantine are the two potential containment measures used to reduce the
potential spread of an infectious agent and/or potential exposure of either an infectious
agent or other hazard to other travelers or individuals.

If clinical signs or symptoms and information based on fact or evidence of a public

health risk, including sources of infection and contamination, are found on board a
conveyance, the conveyance may be considered as affected and the PoE health team in
collaboration with the stakeholders may consider isolation of the conveyances, as
necessary, to prevent the spread of disease.

52
Quarantine of a conveyance can be decided by the PoE health team on an affected
conveyance when there is a public health risk on board that can affect the environment,
other conveyances or the population. In such a case, the affected conveyance can be
quarantined in a designated location where the health measures can be implemented.
When exposure is suspected, the conveyance will be placed initially in quarantine until
further assessment can identify if the conveyance is indeed affected. When there is
proof that the conveyance is affected then may be placed in isolation until health
measures can be satisfactorily implemented.

8.2.9.[9.2.9.] Seizure , Supervised Destruction /Removal of Infected or

Contaminated Oobjects

Special arrangements might be needed for removal and safe disposal of any contaminated water or food, human

Additionally, PoE health team must not refuse departure of an affected conveyance if it is not able to carry out th

Affected conveyances must be permitted to take on fuel, water, food and supplies under
the supervision of the PoE health team.

If there is no available treatment of infected or contaminated baggage, cargo, containers, conveyances,

goods or postal parcels, these objects can be seized and destroyed under controlled conditions. For
some public risks that cannot be eliminated with feasible health measures, incineration is a good choice.

53
8.3.[9.3.] Public Health Measures with Respect to Animals

More than Seventy five percent of emerging diseases originate in animals (particularly
wildlife) like SARS CoV-1, MERS CoV, Ebola, Rift Valley Fever and Avian Influenza
because of land use changes, Agricultural intensification, Food industry changes and
Wild meat consumption. Live animals, including dogs, cats, ferrets, reptiles, rodents,
non-human primates, horses, poultry, captive birds, bovines, porcine, ovine and
caprines, can be transferred by conveyance.

Consequently, infected animals can travel from country to country and continent to
continent in a few hours, with increased public health threats, creating increased global
health insecurity. Some of these animals also may be inadvertent stowaways and arrive
dead trapped in containers or elsewhere on the conveyance. Anthropozoonosis may be
transmitted to passengers and crew members from animals carried aboard conveyance.
These events can be prevented or mitigated if countries are better prepared for
response to these threats. Special measures during transportation are required to
ensure the welfare of animals in transit and to prevent the transmission of diseases
among animals and between animals and humans. Animal movement regulation
provides a framework for countries to build capacities: to prevent the spread of diseases
from animal to humans as well as from country to country. WHO and OIE has stated
regulations and criteria which mostly implemented at a point of entry (international
airports, ports and ground crossings as "a passage for international entry or exit of
animals to prevent the transmission and spread of the diseases from animal to humans
as well as from country to countries.

In case of cross border zoonotic diseases, the public health measures with respect to
animal will be implemented per the advice provided by the group of experts to be
assembled from the Ministry of Agriculture (MoA) and human health under the umbrella
of one health steering committee (OHSC).

54
9.[10.] CHAPTER TEN: REFERENCES

1. International travel and health. Geneva: World Health Organization; 2012.

2. Handbook for inspection of ships and issuance of Ship Sanitation Certificates.

Geneva: World Health Organization; 2011.

3. Human health risk assessment toolkit: chemical hazards. Geneva: World Health
Organization; 2010
(http://www.who.int/ipcs/methods/harmonization/areas/ra_toolkit/ en/index.html,
accessed 13 October 2015).

4. WHO manual: the public health management of chemical incidents. Geneva: World
Health Organization; 2009 (http://www.who.int/environmental_health_emergencies/
publications/Manual_Chemical_Incidents/en/, accessed 13 October 2015).

5. Practical guidelines for infection control in health care facilities. Geneva: World
Health Organization; 2004
(http://www.who.int/water_sanitation_health/emergencies/infcontrol/en/, accessed 3
October 2015).

6. International Labour Organization. Maritime Labour Convention 2006. Geneva:

2006.

7. WHO. WHO interim guidance for Ebola virus disease: exit screening at airports,
ports and land crossings. Geneva: World Health Organization; 2014.

8. US National Academy of Sciences. 2004. News & terrorism communicating in a

Crisis. A fact sheet from the National Academies and the U.S. Department of
Homeland Security. Chemical Attack warfare agents, Industrial Chemicals, and
Toxins.

9. ICAO Guidelines for States Concerning the Management of Communicable

Disease posing a serious Public Health Risk accessed online 20150224 at
http://www.capsca.org/Documentation/ICAOHealthRelatedSARPsandguidelines.p

10. International Health Regulations (2005): a guide for public health emergency
contingency planning at designated points of entry. Manila: World Health
Organization Regional Office for the Western Pacific; 2012

11. International Health Regulations (2005). 2nd ed. Geneva: World Health
Organization; 2008.

12. Hyer RN, Covello VT. Effective media communication during public health
emergencies. A WHO handbook. Geneva: World Health Organization; 2005.

55
13. International Health Regulations (2016). Vector Surveillance and Control at Ports,
Airports, and Ground Crossings; WHO Hand Book. International Health Regulations
(2016) pp. 1-92

14. EFDA proclamation 661/200

15. WHO resolution 48.7 or world health assembly (WHA

16. Veterinary decontamination procedures Wayne E. Wingfield, MS, DVM Diplomat,

ACVS, ACVECC Emeritus Professor, Colorado State University Veterinary Medical
Officer and Squad Leader, National Medical Response Team - Central US,

17. Interim Guidance for Dog or Cat Quarantine after Exposure to a Human with
Confirmed Ebola Virus Disease; Released November 10, 2014, American
Veterinary Medical Association (AVMA) Ebola Companion Animal Response Plan
Working Group

18. OSHA's Personal Protective Equipment (PPE) standards (in general industry, 29
CFR 1910 Subpart I), which require using gloves, eye and face protection, and
respiratory protection.

19. When respirators are necessary to protect workers, employers must implement a
comprehensive respiratory protection program in accordance with the Respiratory
Protection standard (29 CFR 1910.134)

20. The General Duty Clause, Section 5(a)(1) of the Occupational Safety and Health
(OSH) Act of 1970, 29 USC654(a)(1), which requires employers to furnish to each
worker “employment and a place of employment, which are free from recognized
hazards that are causing or are likely to cause death or serious physical harm.

21. OSHA’s Blood borne Pathogens standard (29 CFR 1910.1030) applies to
occupational exposure to human blood and other potentially infectious materials
that typically do not include respiratory secretions that may transmit COVID-19.
However, the provisions of the standard offer a framework that may help control
some sources of the virus, including exposures to body fluids not covered by the
standard.

22. https://www.who.int/emergencies/diseases/novel-coronavirus-2019/question-and-
answers-hub/q-a-detail/q-a-coronaviruses?
gclid=Cj0KCQjwz4z3BRCgARIsAES_OVcTx8aDFJpRoCOEjxRraCkQTY1uCgI7Wi
m5otgDheYF3IyoMJdCVwwaAgOoEALw_wcB#:~:text=pet

23. https://www.oie.int/en/scientific-expertise/specific-information-and-
recommendations/questions-and-answers-on-2019novel-coronavirus/?
fbclid=IwAR3vDv3QuED6muxolZWnnWAMWVAbaNcz528jXkj6dq4kVqh8nFmX0uw
yDiw

24. https://www.agriculture.gov.au/coronavirus/animals?
fbclid=IwAR0z804JzklguoKfZkXTV8CHU12NM3JayRoQ0pBaR-
KQCnosSxk8mNYP3W0 (Note: “The current spread of the virus is due to
transmission between people, not through contact with domestic animals. Testing
56
 animals is currently not a priority in accordance with the latest scientific
information”)

25. https://www.gov.uk/guidance/coronavirus-covid-19-advice-for-people-with-animals

26. https://www.cdc.gov/coronavirus/2019-ncov/daily-life-coping/animals.html (Note: “If

your pet is tested for COVID-19 and is confirmed to be infected… Depending on
how sick your pet is, your veterinarian may recommend that your pet be isolated at
home, instead of staying in the hospital. ” – notably no mention of quarantine nor
euthanasia)

27. https://www.ecdc.europa.eu/en/covid-19/questions-answers (No specific guidance

just “As a general precaution, it is always wise to observe basic principles of
hygiene when in contact with animals.”

57
10.[11.] CHAPTER ELEVEN: LIST OF ANNEXES

Annex 1: Platforms for Joint Meetings of In-country Stakeholders and

Partners

During non-emergency times:

At international airports: the facilitation committee consisting of members from

Ethiopian Airlines, Ethiopian Airports Enterprise, Civil Aviation Authority, National
Intelligence Center, Custom commission, Immigration Nationality and Vital Events
Agency (INVEA), Federal Police Commission should meet monthly. The Ethiopian
Public Health Institute (EPHI) co-chair for the facilitation committee. The meeting's
membership and frequency can be revised based on the emergency and suggestions
from the stakeholders.

Land crossing: The border health unit, EPHI, INVEA, Federal Police Commission,
EFDA, Ministry of Agriculture (Animal and plant quarantine) should meet monthly. EPHI
will be the secretary, while INVEA/custom commission will chair the joint meeting.

During an Ongoing Public health Emergency:

The airport's facilitation committee and the ground crossing's border unit must meet at
least once per week. The frequency of meetings and membership can be revised as
needed.

58
Annex 2: Role and Responsibilities of Stakeholders

A. Ethiopian Public Health Institute

 Conduct rapid risk assessment based on WHO recommendations

 Define the action package for the operational period for each level based on the risk
assessment, country needs, expertise, and resources available
 Decide the scope and identify appropriate public health intervention for the PHE.
 Coordinate or execute the public health intervention/action packages for specific
PHE .
 Designate site for the screening at the PoEs as needed.
 Coordinate capacity building( training, PHERCP development, etc.) for PoE officials
(for the regulatory and other public health interventions.
 Train PoE staffs resources for surge capacity during the PHE/s.
 Coordinate response activities including active case search, contact tracing, follow-
up, risk communication and community engagement (RCCE) etc.
 Design and oversee referral linkages for the cases and suspects.
 Establish a system for specimen collection, transport, and testing
 Develop and or review existing emergency contingency plan to address PHE
 Develop, review, and update pertinent documents (Guidelines, SOPs, Manuals,
Directives, etc.).
 Conduct a logistic gap assessment
 Coordinate the regulatory and other public health interventions at the PoEs
 Communicate and/or facilitate information exchange with the Emergency Operation
Centers (EOC).
 Provide situational updates to all stakeholders.
 Monitor and evaluate the public health intervention at PoEs.
 Convene and/or participate in the stakeholder meetings.
 Establish a database to effectively collect, manage, and share response data when
appropriate.

B. Regional Health Bureau6

6
activities mentioned for regional health bureau applies to zone, woreda and local health facilities

59
 Mobilize the other health professionals /surge team in case the demand goes
beyond the PoE capacity.
 Work closely with the EPHI on the agreed action packages.
 Communicate with the PoE team to manage response activities.
 Facilitate the transportation services for ill passenger/specimen transfer
 Designate and equip the isolation/treatment/quarantine centers for referral purposes

C. Immigration Nationality and Vital Events Agency (INVEA)

 Identify any public health events and notifies the PoE health team
 Permits or deny passengers entry into Ethiopia based on the passenger's
compliance with Ethiopia's public health entry requirement.
 Collaborate with the PoE health team to implement and reinforce regulatory and
public health measures at PoEs.
 Convene and/or participate in the stakeholder meetings.
 Inform the passengers the Ethiopia's public health requirements during travel
processing.
 Provide the necessary information about the passengers as and when the request is
needed.

D. Custom Commission

 Alert the PoE health team of any suspicious cargo that may contain pose to the
public
 Participate in the stakeholder meetings with the border unit.
 Cooperate in implementing action packages for the PHE.
 Oversee the compliance status of human remains transportation (exit and entry) per
SOP for handling of human remains/ash at PoEs.

E. National Intelligence Security Services (NISS)

 Convene and /or participate in stakeholders meetings

 Provide passenger information when requested.
 Cooperate in implementing action packages for PHE
 Provide quick access to airports by providing the to the PoE health staffs and surge
team

60
F. Federal Police commission

 Provide the legal enforcement for those passengers/cases/suspects reluctant to

cooperate for the implementation of defined action packages.
 Safeguard the PoEs health team in the areas with non-reassuring security situation
 Convene and/or participate in the stakeholder meetings.

G. All Airlines Operators

 Facilitate and ensure health declaration forms are completed by all passengers
onboard incoming flights.
 Ensure that all passengers are implementing the needed IPC measures as
suggested per PoE health team
 Facilitate aircraft inspection
 Ensure aircrafts are appropriately disinfected before departure and landing
 Ensure aircrafts are appropriately disinsected according to international vector
control requirements.
 Facilitate disinsection of outgoing aircraft and seek certification from the PoE health
team
 Present the disinsection certificate for all aircraft arriving from the yellow fever belt
regions
 Facilitate the communication and handling of suspects detected on board.
 Convene and/or participate in the stakeholder meetings.
 Provide the required passenger and cargo information (manifesto) to the PoE health
team.
 Ensure that the human remains transported by the aircraft are in compliance with the
per SOP for handling of human remains/ash at PoEs. .
 Ensure proper handling and disposal of the waste generated from the aircraft,
 Cooperate in implementing action packages for the PHE
 Disseminate public health communication materials to passengers.

H. Ethiopian Airline Groups (EAG)

 Provide office/s station for the PoE health team

 Facilitate the screening of passengers.

61
 Convene and/or participate in the stakeholder meetings.
 Cooperate in establishing designated isolation and/or quarantine centers in the
airports
 Prepare the waste disposal sites in consultation with EPHI.
 Cooperate in parking aircrafts on areas agreed upon by the public health emergency
team during handling of the suspects detected onboard flight.
 Disseminate public health communication materials to passengers.
 Provide passengers information as needed.
 Cooperate in implementing the recommended action packages and preventive
measures for PHE of interest.

I. Ethiopian Civil Aviation Authority

 Liaise with the airport authority, flight crew, and PoE health team on the
cases/suspects detected onboard for smooth handling and transfer.
 Cooperate on regulation, enforcement, awareness creation on the PHE of interest
for all aviation sectors
 Provide direction to the airlines to implement onboard filling of the THDF
 Ensure that all the action packages for PHE of interest, preventive measures, and
traveler's advice are implemented as per the protocol.
 Convene and/or participate in stakeholder meetings.
 Provide passengers information as needed.

J. Ethiopian Railway Corporation

 Provide office/station for PoE health team.

 Implement and reinforce the recommended action packages and preventive
measures for PHE of interest.
 Facilitate public health screening for the passengers travelling by the train.
 Convene and/or participate in the stakeholder meetings.
 Cooperate in establishing designated isolation and /or quarantine centers in the train
station.
 Prepare the waste disposal sites in consultation with EPHI.
 Cooperate in parking train at designated areas identified by PoE health team during
handling of the suspects detected on board.

62
 Disseminate public health communication materials to passengers.
 Cooperate in provision of passengers information as needed.

K. Ethiopian Food and Drug Administration Authority (EFDA)

 Handle passengers and baggage coming from countries affected by PHEIC as per
the recommended IPC
 Give priority for emergency logistic purchase during pre-import permit process and
arrival product inspection
 Assign focal person for communication and coordination in emergency task force
 Facilitate orientation/training for their staffs on the health related emergency
 Ensure medical wastes and expired foods generated at BIA are properly disposed.
 Ensure the availability of sufficient PPE for their staff
 Implement the recommended public health preventive measures packages

L. Ministry of Foreign Affairs (MoFA)

 Notify the national health requirements and necessary measures to diplomatic

communities ,Ethiopian embassies, consular affairs abroad.
 Work in collaboration with MoH/EPHI to collect relevant heath certificate issued for
diplomats from their departure country
 Facilitate for the health screening of diplomatic community at Bole International
Airport
 Notify to MoH/EPHI the arrival schedule of diplomatic officials in to the country
 Work actively in collaboration with other stakeholders
 Ensure the availability of sufficient persona protective equipment for their staff
 Implement the recommended public health preventive measures packages
 Assign focal person for communication and coordination in emergency task force
meeting

M. National Disaster Risk Management Commission (NDRMC)

 Coordinate the provision of the food and non-food items (clothes, utensils….) for
those who were in isolation/treatment/quarantine centers
 Coordinate multi-sectoral response activity.
 Any other emerging tasks that are applicable to the NDRMC

63
N. Ministry of Labor and Social Affairs (MoLSA)

 In collaboration with all concerned ensure the protection for the women, children and
disabled
 Facilitate the transportation services/transportation fees for returnees on their way to
their destination.
 Facilitate family integration for returnees
 Any other emerging tasks that are applicable to the MoLSA

64
Annex 3: The IHR Recommended Capacities at Points of Entry

C.[A.] The Recommended Capacities at all Times

 An appropriate medical service, including diagnostic facilities and adequate staff,

equipment and premises so as to allow the prompt assessment and care of ill
travelers.
 Access to equipment and personnel for the transport of ill travelers to an appropriate
medical facility;
 Trained personnel for the inspection of baggage, cargo, containers, conveyances,
goods or postal parcels, and Human remains.
 Safe environment including appropriate ventilation system for travelers using point of
entry facilities (potable water supplies, eating establishments, flight catering facilities,
public washrooms, appropriate solid and liquid waste disposal services)
 Trained personnel for the control of vectors and reservoirs in and near PoE.

D.[B.] Recommended Capacities for Responding to Events that Constitute a

Public Health Emergency of International Concern (PHEIC):

 Appropriate public health emergency response by establishing and maintaining a

public health emergency contingency plan, including the nomination of a coordinator
and contact points for relevant point of entry, public health, and other agencies and
services;
 Assessment of and care for affected travelers or animals by establishing
arrangements with local/on-site medical and veterinary facilities for their isolation,
treatment, and other support services that may be required;
 Appropriate space, separate from other travelers, to interview the suspect case or
affected persons
 Quarantine of suspected travelers, preferably in facilities away from the PoE
 Disinsection, deratting, disinfection, decontamination, or otherwise treating baggage,
cargo, containers, conveyances, goods, or postal parcels when appropriate, at
locations specially designated and equipped for this purpose
 Entry or exit controls for arriving and departing travelers

65
 Access to specially designated equipment, and trained personnel with appropriate
personal protection, for the transfer of travelers who may carry infection or
contamination.

66
Annex 4: Basic Set of Variables to be Collected on Preliminary Risk
Assessment

Background information
Country of origin

PoE at origin

Flight number(s)

Intermediary PoE (during transit)

Country and PoE at destination

Final destination

Type of exposure (infectious agent, chemical or radiological)

Estimated time of exposure

Number of persons exposed/cargo exposed

Care and/or treatment provided

Signs/symptoms if illness has occurred

Current status of persons exposed, including medical assessment, release,

hospitalization or death
Nationality of passengers

Conveyance type

Number of travelers

Number of crew,

Number of passengers

Voyage number

Itinerary,

Basic information about the event

Any indication about the causative agent,

Time of occurrence & whether it is still ongoing,

Name and contact details of reporter

Persons involved

67
Main symptoms

Any deaths,

 Measures taken,

Additional information, if available, will inform the preliminary risk assessment:

Where did the ill passenger sit during the flight (seat
number, cabin area)?

Who were close contacts (crew, medical personnel

onboard, families, and traveling companions)?

Was there any contamination? If yes, where (e.g., seats,

toilets) and what materials (e.g., blood, vomit)

Were there any travel delays? If yes, how long? If an aircraft

has an air recirculation system, was it on or off?

68
Annex 5: Recommendations for Cleaning and Disinfection of Aircraft

1. Wear appropriate PPE recommended by IATA or PoE health team.

2. Remove and discard gloves if they become soiled or damaged and after cleaning.
3. Use only cleaning agents and disinfectants that have been approved by aircraft
manufacturers at recommended concentrations and contact times.
4. Begin the cleaning at the top (light and air controls) and proceed downward,
progressively working from clean to dirty areas.
5. Surfaces to be cleaned are:
a. Affected seat
b. Adjacent seats same row,
c. Back of the seats in the row in front,

Post-event disinfection procedures for aircraft

 Put on protective gloves.

 Wear eye protection if there is a chance of splashing.
 Open a biohazard bag, and place it near the site of contamination.
 If a biohazard bag is not available, label a regular waste bag as “biohazard.”
 The following surfaces should be cleaned and then disinfected at the seat of the
suspected case(s), adjacent seat(s) in the same row, adjacent row(s), and other
areas, as noted below:
o Seat area
o Armrests
o Seatbacks (the plastic and/or metal part)
o Tray tables
o Seat Belt latches
o Light and air controls,
o Cabin crew call button and
o Overhead compartment handles
o Adjacent walls and windows -
o Individual video monitor Lavatories

69
 o Lavatory or lavatories used by the sick traveler: door handle, locking device,
toilet seat, faucet (tap), washbasin, adjacent walls, and counter.
 Clean the area of soil (remove solids and soak up liquid waste).
 Apply the disinfectant according to procedures approved by the original equipment
manufacturer and as instructed on the disinfectant manufacturer’s label. Once the
area is wet, use paper towels to clean the area, and discard paper towels into the
biohazard bag.
 Use a suitable disinfectant. Studies of hydrogen peroxide-based disinfectants
containing additives such as surfactants and chelators have shown promising results
in scientific studies. Some industries already using these products are reporting
excellent results. Ethanol has also been found to be an effective and suitable
disinfectant for aircraft. However, other materials could be considered if they are
approved or registered for surface disinfection and sanitization on aircraft by an
appropriate government or independent organization.
 Ensure adequate contact time between the disinfectant and contaminated surface
for the destruction of microorganisms. Adhere to any safety precautions as directed
(e.g., ensure adequate ventilation in confined areas such as lavatories, and avoid
splashing or generating unintended aerosols).
 Change gloves that become visibly soiled.
 Remove any affected portion of the carpet.
 Rinse the surface with water and dry. Put all paper towels into the biohazard bag.
 Remove gloves, and place them into the biohazard bag.
 Seal the used biohazard bag, and ensure its proper transport and final disposal.
 When cleaning and disinfecting are complete, and gloves have been removed,
immediately clean hands with soap and water or an alcohol-based hand rub. Avoid
touching the face with gloved or unwashed hands.
 Do not use compressed air and/or water under pressure for cleaning or any other
methods that can cause splashing or might re-aerosolized infectious material.
Vacuum cleaners should be used only after proper disinfection has taken place.
 Operation of the aircraft’s environmental control system at least until the suspect
traveler and passengers have disembarked or may also contribute to interrupting
transmission of infectious material and should be performed if consistent with safety
factors. Otherwise, ventilation should be provided from a ground source.

70
Disinfection equipment and supplies

 Biohazard bags; if a biohazard bag is not available, label the regular waste bag as
“biohazard”;
 Disposable gloves (non-latex materials to avoid the risk of an allergic reaction can
be considered);
 Eye protection;
 Paper towels;
 Detergent solution;
 Water;
 Disinfectant;
 Signs as necessary to isolate the area

71
 Annex 6: Steps of the Basis of the Risk Assessment Process at Points of
Entry level

1. Event description,
2. Primary overview of the event,
3. Assessment of the impact of the event,
4. Potential for spread,
5. Preventability of the event.
6. Is there any recommendation issued by WHO regarding the specific event?
7. Is the event among the diseases that must be notified under Annex 2 of IHR
(smallpox, poliomyelitis due to wild type poliovirus, human influenza caused
by a new subtype, SARS)
8. Is the event among the diseases included in Annex 2 of IHR where the algorithm should al
ways be used (cholera, pneumonic plague, yellow fever, VHFs (EVD, Lassa fever,
Marburg virus disease), West Nile fever, other diseases that are of special national or
regional concern, e.g., dengue fever, Rift valley fever , and meningococcal disease)
9. Are there any immediate response actions that can be taken by the conveyance master an
d crew on the conveyance?
10. Does the PoE health team have the capacity to treat the event, especially in severe
diseases or serious conditions?
11. What will happen if the authority will not take action
12. Can the event be characterized as serious?
13. Does the public health hazard have the potential to affect a large number of susceptible
or vulnerable people (e.g., outbreaks) during their journey or at their final destination?
14. Is there a risk for introducing the agent (e.g., disease, vector) in the country (if it is not
already endemic or present)?
15. Is there evidence that the hazard and/or disease has spread internationally?
16. Does the event have the potential to interfere with international traffic and trade?
17. Is there evidence that this event has had adverse consequences in public health in the
past?
18. Are evidence-based prevention and control measures available, and can they be
implemented?
19. What is the likelihood of spread?

72
20. Is my PoE able to deal with the situation?

Annex 7: WHO recommended Methods for Aircraft Disinsection

Pre-flight: A pre-flight aerosol containing an insecticide with rapid action and limited
residual action is applied by ground staff to the flight deck, passenger cabin, including
toilet areas, overhead compartments, lockers, and crew rest areas. The spray is applied
before passengers board the aircraft but not more than 1 hour before the doors are
closed. A 2% permethrin cistrans (25:75) formulation is currently recommended for this
application, at a target dose of 0.7 g a.i./100 m3. Preflight spraying is followed by a
further in-flight spray, i.e., top-of-descent as the aircraft starts its descent to the arrival
airport.

Blocks away: Spraying is carried out by crew members when the passengers are on
board after the cabin door closes and before the flight takes off. An aerosol containing
2% D-phenothrin is currently recommended by WHO and should be applied at a rate of
35 g of formulation per 100 m3 (i.e., 0.7 g a.i./100 m3).

Top-of-descent: Top-of-descent spraying is carried out as the aircraft starts its descent
to the arrival airport. An aerosol containing 2% D-phenothrin is currently recommended
by WHO for this purpose and is applied with the air recirculation system set at high to
normal flow.

Residual: The internal surfaces of the passenger cabin and cargo hold, excluding food
preparation areas, are sprayed with a compression sprayer that has a constant flow
valve and flat fan nozzle according to WHO specifications. Permethrin 25:75 (cis:trans)
emulsifiable concentrate is currently recommended by WHO at a target dose of 0.2
g/m2 applied at intervals not exceeding 2 months.

73
Annex 8: Travelers Health Declaration Form (THDF) used during COVID-19
pandemic

74
Annex 9: Health Part of Aircraft General Declaration Form

Name and seat number or function of persons on board with illnesses other than
air sickness
or the effects of accidents, who may be suffering from a communicable
disease (a fever - temperature 38°C/100 °F or greater - associated with one or more of
the following signs or symptoms, e.g. appearing obviously unwell; persistent coughing;
impaired breathing; persistent diarrhoea; persistent vomiting; skin rash; bruising or
bleeding without previous injury; or confusion of recent onset, increases the likelihood
that the person is suffering a communicable disease) as well as such cases of illness
disembarked during a previous
stop__________________________________________________________________
_____________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________ Details of
each disinsecting or sanitary treatment (place, date, time, method) during the flight. If no
disinsecting has been carried out during the flight, give details of most recent
disinsecting____________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
_______________________________

Signature, if required, with time and date

_____________________________________________________

Crew member
concerned_____________________________________________________________
___________

75
Annex 10: Standard Operating Procedure for Aircraft Disinsection Using
Pre-flight Method

1. Introduction

Disinsection is defined as “the procedure whereby health measures are taken to control
or kill the insect vectors of human disease present in baggage, cargo, containers,
conveyances, goods and postal parcels” it should “be carried out so as to avoid injury
and, as far as possible, discomfort to persons. Disinsection is permitted under
international law in order to protect public health, agriculture and the environment.

Disinsection of the aircraft is to be carried out in such a manner that passengers do not
undergo any discomfort or suffer any injury to health that no damage is done to the
structure or operating equipment of the aircraft. As far as possible, the aircraft should be
disinfected using methods approved by world health organization. As Ethiopia is malaria
and other mosquito borne disease prone area disinsection to be done as per
International Health Regulations when the aircraft leave our international airports for an
area where these vectors have been eradicated. The same requirement applies to
aircraft leaving an airport in an area where the transmission of malaria or other
mosquito borne diseases is occurring. Disinsection is also permitted at the airport of
arrival if it is not carried out satisfactorily. Hence, this is the standard operating
procedures (SOP) prepared to describes the purposes, responsibilities and procedures
to be followed during aircraft disinsection using pre-flight method.

2. Purposes

 To describes technical procedure to be followed during aircraft disinsection

using pre-flight method as health measures to control or destroy the insect
vectors of human disease present in passenger cabins and cargo holds.

3. Scope

 This SOP is concerned with pre-flight method of insecticide spraying in which

first sprayed on the aircraft while on the ground with an aerosol containing a
residual insecticide before passengers and crew board the aircraft. This pre-

76
 flight spray is applied with containing 2% permethrine in passenger cabins and
cargo holds.

4. Responsibilities

A. Spray man: perform the disinsection of aircrafts at both passenger cabins and
cargo holds.
B. Supervisor: performs the supervision for controlling of the proper disinsection of
aircrafts and issue General Declaration/Disinsection Certificate.
C. Appearance control personnel: provide the aerosol insecticides and follow-up
on the aircraft disinsecion works performed.
D. Cabin crew: receive the General Declaration/Disinsection Certificate from the
Supervisor with empty spray cans.

5. Prerequisite

The following resources are required to perform aircraft disinsection using the pre-flight
method:
 Manpower
 Aerosol sprays 2% permethrine of 60 gram
 General Declaration/Disinsection Certificate
 Logbooks
 Computer
 Stationery

6. Procedures

1) This procedure is applied when the aircraft is first sprayed on the ground with an
aerosol containing a residual insecticide before passengers and crew board the
aircraft.
2) The aircraft is treated by spray man of Point of Entry (PoE) health team walking
through the cabins and discharging approved aerosol containing a residual
insecticide based on 2% permethrine.
3) Spraying is to be carried out at a rate of 35 g of the formulation per 100 m3 (10 g
per 1000 ft3).

77
 4) The aerosol insecticide is sprayed into the passenger cabin walking along each
aisle holding 2 cans of 60 g cans with arm’s length at a slow walking pace of one
row per second starting at the rear of the aircraft.
5) Prior to disinsection the procedure should be announced to all ground personnel
to make the aircraft empty so as to undertake pre-flight disinsection procedure by
EPHI-Point of Entry (PoE) health team.
6) For disinsection to be effective, the aircraft air conditioning system must be
turned off whilst spraying is carried out. This to be requested to responsible
maintenance personnel to turn off the air-conditioning of the aircraft, if it is on.
7) The Point of Entry (PoE) spray man must treat all possible insect harbourages
including flight deck, all toilet areas, lockers, wardrobes and crew rest areas.
Foodstuffs and galley utensils should be protected from contamination.
8) Cargo holds, wheel wells and all other parts of the aircraft accessible from the
outside only, in which insects can find shelter are to be disinsected by Point of
Entry (PoE) spray man or ground staff as near as possible to the time the aircraft
leaves the apron.
9) Depending on the type and size of the aircraft, the number of aerosol cans
required will be determined based char based on 60 gram per can.
10)The dispensers are marked with a serial number. Only the numbers of the used
dispensers are entered on the Health Part of the Aircraft General Declaration or
entered on the Point of Entry (PoE) disinsection certificate.
11)The empty aerosol dispensers must be retained and upon the aircraft’s arrival at
its destination, must be produced along with the General Declaration/Disinsection
Certificate to the Destination Port Health Authority as evidence of disinsecting.
12)The Supervisor will control and ensore the proper performance of the air craft
disinsection performed by spray man.
13)The Point of Entry (PoE) health staff will record all the necessary aircraft
disinsection data and make database system.
14)Prepare and issue the General Declaration/Disinsection Certificate for aircraft
disinsection performed.
15)Prepare daily, weekly and monthly reports of the aircraft disinsection activities.

7. References:

78
1. Aviation public health manual, first edition, civil aviation authority of Bangladesh,
Nov.2015.
2. IATA medical manual, 11th edition, international air transport association,
Montreal, Geneva, 2018.

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Annex 11: Standard Operating Procedures for the Handling of Human
Remain/Ash at Points of Entry

1. Introduction

Handling and transportation of dead body/human remain may pose threat to human
health as it may have been infected by a wide range of pathogens, those presenting
particular risks to the individuals and community including, tuberculosis, streptococcal
infection, gastro-intestinal pathogens, the agents causing transmissible spongiform
encephalopathy, hepatitis B and C, HIV infection, Middle East respiratory syndrome
(MERS), hemorrhagic fever viruses such as Ebola, and possibly meningitis and
septicaemia (especially meningococcal). The health risks to the public can be
exacerbated by the improper preparation and disposal of human remains.

Repatriation of human remains is the process whereby human remains are transported
from the country where death occurred to another for burial at the request of the next-of-
kin. Repatriating human remains is a complicated process involving the cooperation and
coordination of various stakeholders on several levels to ensure that it is conducted
properly and in compliance with relevant international and national regulations.

To ensure that the human remains are transported with dignity in a way that does not
pose a health threat to the public or individuals, an International arrangement
concerning the Conveyance of Corpses (Berlin Agreement), signed at Berlin on 10th
February 1937.

The initial condition, as laid out in article one of the agreement was that, for the
conveyance of any corpse by any means and under any conditions, a special laissez-
passer/ death certificate be issued for a corpse which would state the surname, first
name and age of the deceased person, and the place, date and cause of decease.
The competent authority for the place of decease or the place of burial in the case of
corpses exhumed had to issue the laissez-passer/death certificate and it was
recommended that the laissez-passer should be made out, not only in the language of
the country issuing it, but also in at least one of the languages most frequently used in
international relations.

80
Hence, this SOP is developed as a part of the working documents prepared in
compliance with IHR and other national and international documents. It was meant for
guiding the handling of the human remains being transported along the point of entries
throughout the country in a way that respected the dignity for the deceased and
families/importer while not compromising the precaution taken to hinder threat to the
public.

2. Definition of terms

Human remains: a deceased human body or any portion of a deceased human body,
except:
● Clean, dry bones or bone fragments; human hair; teeth; fingernails or toenails; or
● A deceased human body and portions thereof that have already been fully
cremated before import; or
● Human cells, tissues, or cellular or tissue-based products intended for
implantation, transplantation, infusion, or transfer into a human recipient.
Cremated remains (ashes): the residual matter after human remains is completely
reduced to ash by intense heat.
Death certificate: an official document that certifies that a death has occurred and
provides identifying information about the deceased, including (at a minimum) name,
age, and sex. The document must also certify the time, place, and cause of death.
Importer: any person importing or attempting to import an item referred in the SOP.
Leak-proof container: a container that is puncture-resistant and sealed in such a
manner as to contain all contents and prevent leakage of fluids during handling,
storage, transport, or shipping, such as:
● A double-layered plastic, puncture-resistant body bag (i.e., two sealed body
bags, one inside the other);
● A casket with an interior lining certified by the manufacturer to be leak-proof and
puncture-resistant; or
● A sealed metal body-transfer case.
Embalming: the process of preserving human remains by treating them with chemicals
to forestall decomposition.

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Acceptance: prior permissions obtained from PoE health team for importation of
human remains meant for advance arrangement to be made for the carriage of all
human remains.

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3. Purpose and Scope

The document is developed to provide technical guidance on the step by step

procedures of handling human remains at points of entries in Ethiopia. This SOP is
thus for use by the point of entry health team to ensure standard working approaches
are carried out to the incoming and outgoing human remains in a consistent manner.

4. Acceptance process

In many cases prior permissions shall be obtained for importation and diplomatic and
public health formalities may be involved. It is therefore necessary for advance
arrangement to be made for the carriage of all shipment of human remains. Before
acceptance, a confirmation shall be obtained from the airport of destination confirming
that the shipment is accepted for carriage and permission for importation has been
granted by the PoE health team.

A. Handling of Incoming Human Remains

Required Documents

Except for cremated human remains (ash), that are considered to be noninfectious
and can be allowed to enter into Ethiopia without a death certificate or other
documentation regardless of the cause of death, all incoming human remains need to
be presented with the following documents.

1) Death Certificate: should be;

● Official document; must contain at least identifying information of the deceased

(name, age, and sex) and time, place, and cause of death.
● Written in English; otherwise it must include an English language translation of
the official government document.
● Specify the attributed cause of death and a vague word must not be used.
● Accompanied by other supporting documents, if any.

If a death certificate is not available, the dead body will not be granted entry to the
country.

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2) Embalming Certificate:

● Official certificate issued from designated authority

● Should clearly indicate that the dead body has been embalmed, sanitized and
sealed and no risk of infection.

3) Certificate Indicating the dead body’s status of contagiousness; should be

presented separately unless indicated on the embalming certificate.

5. Examination of Packaging of Incoming Human Remains

Every incoming dead body should be sealed with leak-proof container; puncture-
resistant and sealed in such a manner as to contain all contents and prevent leakage of
fluids during handling, storage, transport, or shipping, such as a double-layered plastic,
puncture-resistant body bag (i.e., two sealed body bags, one inside the other); a casket
with an interior lining certified by the manufacturer to be leak-proof and puncture-
resistant; or A sealed metal body-transfer case. The transporting airline must ensure
that the external packing of human remains (coffin) is undamaged. The PoE health
team should verify the documents and inspect the packing upon arrival.
● If there are any obvious signs of damage to the external packing (coffin), the
PoE-inspector shall use full PPE, cover the coffin in plastic sheets to avoid any
contact with the body/ body fluids before hand-over of the human remains to the
concerned authority for final burial/incineration.
● The personnel handling the human remains should follow the laid down
procedures for donning and doffing of Personal Protective Equipment and follow
other protective measures like, hand-washing with soap and water, etc. to ensure
that they remain protected during the procedure.
● The inspector should inform receiving families or responsible authorities as the
packaging (coffin) must be buried /incinerated following the norms for burial/
incineration for Human Remains with high risk pathogens. The inspector and
others who had contact with the fluid/leakage would be monitored for a number
of days appropriate for the disease and the conveyance shall be disinfected as
per the norms.
● In all such cases, the PoE health team shall direct the concerned airline (carrying
the damaged packing containing human remains) to carry out the disinfection of

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 the aircraft as per the norms. In addition, the staff handling the cargo (Human
remains in question) shall be quarantined for a number of days appropriate for
the disease.

6. Detail procedures for incoming human remain/ashes:

1. Receive all necessary/ required documents to release the dead body:

a. Death certificate of deceased with full name, age, sex, cause of death,
date of death, issue organization address and seal
b. Embalming certificate with full name, age, sex, cause of death, date of
embalming, issue organization with full address and seal
c. Certificate of non-infectious free /free from contagious diseases of public
health importance.
d. Passport/lese-passé, ID card of deceased person
e. Airway bill/bill of loading document

2. Evaluate the received documents for its correctness;

3. Wear appropriate/ proper personal protective equipment/s(PPE) for the physical
inspection;
4. Crosscheck whether the document and arrived human remains/ashes is similar
or not or as per the legislation
5. Receive service payment fee;
6. Issue the release permit;
7. If the physical inspection and document evaluation is not as per the legislation,
decide as per the legislation;
8. Register data on the provided registration/log book;
9. Prepare report as per the schedule (daily and /or weekly);

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B. Handling of outgoing Human Remain
Required Documents

The required documents and remarks stated for in-going human remains under section
5 also apply to human remains going out of Ethiopia. However those documents need
to be presented from recognized and designated facilities. The embalmed human
remains should be inspected thoroughly at the point of entry before embalming
certificate is issued. Any human remains found to have leaks or gaps in embalming
should be sent back to the embalming facilities.

Detail procedures for outgoing human remains/ashes:

1. Receive all necessary/ required documents to produce embalming certificate from

the consignor;

● Receive death certificate issued by competent authority with full name, age, sex,
cause of death, date of death
● Receive certificate of non-infectious/free from contagious diseases of public
health importance
● Receive passport or lese-pass or ID card of deceased
● Receive support letter written by Embassy or foreign affairs of the deceased, to
repatriate to specified country
● Receive support letter written by police /report if a case is related to any criminal.
● Receive Airway bill or bill of loading document prepared by airlines/custom

2. Evaluate the received documents for its correctness;

3. Wear appropriate/ proper personal protective equipment/s(PPE) for the physical

inspection;

4. Ensure that the human remains/ashes were properly enclosed in a hermetically

sealed coffin using lid with heat at designated morgue room;

5. Receive service payment fee;

6. Issue embalming certificate for the deceased if all documents and physical
inspection is as per the legislation;

86
7. If the physical inspection and document evaluation is not as per the legislation,
decide as per the legislation;

8. Register data on the provided registration/log book;

9. Prepare report as per the schedule (daily and /or weekly);

C. Death onboard Flight

In case death has occurred onboard flight:-

● The pilot in command of the Aircraft has to inform the PoE health team about the
death onboard via ATS/FIC for taking appropriate measures.
● The crew must cover the dead body with sheets / blankets and move the
passengers from nearby seats to other seats.
● If the remaining flight time is more than 8 hours, the pilot would seek permission
to land at the nearest airport.

The following procedures must be applied:

● The pilot in command of the Aircraft has to mention in the General Declaration,
the details of any illness/symptoms reported/experienced by the deceased prior
to death and submit it to the PoE health team.
● All passengers must disembark before the dead body is handled inside the
Aircraft.
● The PoE health team, using full PPE, moved the deceased from the aircraft seat
to a wheelchair. The wheelchair shall be taken out onto the tarmac.
● Thereafter, the body shall be placed in an air-borne pathogen resistant body bag
and hermetically sealed.
● The personnel handling the dead body shall follow the laid down procedure for
donning and doffing of Personal Protective Equipment and follow other protective
measures to ensure that they remain protected during the procedure.
● The law enforcement agencies to be informed as per the provisions of the rules.
● The relatives of the deceased, if not co-passenger(s), will be informed
immediately

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● If a delay in arrival of relatives of the deceased is expected the dead body shall
be kept in the mortuary of the designated hospital/airport (temperature, with full
sanitization process. Further, the body would be transported in a designated
vehicle to the burial ground / crematorium.
● The PoE health team should properly counsel the family members/ surveillance
officer) & local Police officer, for careful handling and not to
damage/temper/change the packaging of the human remains.
● Autopsy may be considered.
● The disinfection & decontamination of the Aircraft is to be done as per the
approved procedures. Also, the vehicle used for carrying the dead body needs to
be disinfected.
● Airlines will provide the detailed list of passengers and crew to the PoE health
team for further surveillance activities.

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Annex 12: Standard Operating Procedure for the Management of Passenger
Suspected of Public Health Emergency/Event Onboard flight

1. Introduction

Once passengers or cargo has departed and the flight is in progress, event detection
will rely on the cabin crew's awareness. The cabin crew are responsible for passengers'
safety during a flight but have limited capacity to detect and respond to medical or
potential public health events. If a medical emergency occurs in-flight, the cabin crew
should seek advice from a ground-based medical service provider or the assistance of a
medically trained passenger on board. In severe cases, the pilot in command may
consider diversion for the unwell passenger to receive the necessary treatment. In all
cases, communication between the cabin crew, ground operations, and the PoE health
team is necessary to ensure all parties are aware of the situation. The detection of a
suspect/case onboard a flight is generally dependant on the cabin crew's capacity to
identify ill passengers. The following steps should be applied for efficient case detection
in-flight.

2. Purpose

The purpose of this SOP is to used as guidance during handling of passengers

suspected for public health events onboard flight. It outlines the role of the pilot in-chief
and cabin crew, the inflection prevention and control measures that needs to be
practiced and set of information that needs to be conveyed to the ground team in the
airport.

3. Scope

This SOP applies to international passenger(s) on board flight.

4. Procedures

1. Cabin crew must be accustomed to observe passengers for visible signs of illness
and distribute traveler's health declaration form to passengers one (1) hour before
scheduled landing.

89
2. If cabin crew identifies ill passenger/s, a cabin crew member will interview suspect
passenger/s, complete and review the responses on traveler's health declaration
form
3. If the ill passenger/s exhibits signs and symptoms consistent with the disease of
interest after observing and reviewing the traveler's health declaration form, cabin
crew members will provide and instruct suspect passenger/s to adhere to basic
infection control measures to protect other travelers and cabin crews.
4. Cabin crew will also isolate or relocate the passenger to a less populated section of
the cabin
5. The cabin crew member will alert the commander pilot/ captain of the situation,
relaying critical information.
6. Commander pilot/captain will alert the Flight Information Center (FIC) while in-flight,
relaying critical information about suspect passenger/s.
7. The FIC will alert the Ethiopian airport call center of the situation in-flight.
8. The airport call center will inform the screening shift coordinator/team of suspected
passenger/s on the flight, relaying critical passenger information.
9. Once alerted, the airport PoE health team will consult with medical and public health
experts and relay further instruction (i.e., parking and deplaning details) to the
incoming flight. They will also assemble a team in appropriate Personal Protective
Equipment (PPE) to handle the case.
10. When the flight arrives at EA, the PoE health team will immediately proceed to the
designated gate or aircraft standing area dressed appropriately.
11. After landing, the Commander pilot/captain will await instructions from the PoE
health team before deplaning passengers
12. When the doors of the aircraft are unlocked, appropriately dressed health care
worker/s among the health screening team will enter the plane and observe the
situation of the suspected passenger/s.
13. All other passengers, except suspected passenger/s, will deplane following
deplaning procedures via the exit far away from the suspect.
14. All deplaning passengers will be checked for temperature as they disembark from
the plane and proceed to a designated screening area.
15. The PoE health team will take the suspect to a temporary isolation unit by
Ambulance, and further evaluation and triage will continue.

90
Figure 1: Information flow chart for handling PHE suspect detected onboard flight

91
Annex 13: Standard Operating Procedure for Public Health Screening of
Passenger at Airport

1. Introduction

Human mobility is a complex and dynamic phenomenon which amplifies the spread of
the communicable disease and the impact of the public health events. The statement
“when people move pathogen moves” highlight the public health risk inflicted by the
movement along the international borders. i.e an infected individual travels from country
to country and continent to continent in a few hours, with increased public health
threats, creating increased global health insecurity. The 2014-2016 West Africa Ebola
and 2016-2017 Zika outbreaks and the recent 2019/2020 COVID-19 Pandemics are the
evidence of this fact.

Health screening is one of the border health control strategies intended to reduce the
international spread of diseases by detecting departing and/or arriving travelers who are
infected or have been exposed. It is a flexible and scalable intervention that can be
rapidly deployed or shifted based on the needs and resources of the PoE.

Entry and exit screenings are required as core capacities for designated airports for
responding to events that may constitute a public health emergency of international
concern (PHEIC) . In this way, international airports must be prepared to manage
pandemics and other infectious disease emergencies.

Full scale health screening has been implemented in Ethiopia since the outbreak of
Ebola Viral Disease in West Africa in 2014, which paved the way towards enhancing
communicable disease control activities at point of entries. Screening at PoE continued
during the Ebola outbreak in DRC in 2016 which finally led to the realization of the
importance of instituting strong border control for PHEIC and establishment of a
dedicated department in Ethiopian Public health institute immediately before the era of
COVID 19 pandemic.

This standard operating procedure is meant to be implemented by the health team at all
international airports throughout the country in a uniform manner with maximum
effectiveness. According to the International Health Regulations, these measures
should be reasonable, so as to avoid unduly inconveniencing or even harming

92
passengers, and should not disrupt the smooth handling of passenger traffic more than
is necessary.
2. Purpose and Scope

The document is developed to provide technical guidance on the step by step

procedures of passenger health screening at international airports. This SOP is thus for
use by the point of entry health team at all International Airports in Ethiopia to guide an
effective operation is carried out in a consistent manner.

3. Detail procedures

During non-emergency, collecting and reviewing of the aircraft general declaration form
filled by the cabin crew onboard flight, visual observation of passengers for any visible
sign of illness and temperature check using mass thermal scanners mounted on the
main passage may suffice and others . But during an ongoing public health emergency,
in addition to the aforementioned measures; onboard filling of the event specific THDF,
screening by using additional non-contact thermometer (NCT) check and additional
measures applicable to the PHE of interest will be implemented.

Arrangement and needed equipment for the health screening

 Whenever temperature check is appropriate, non-contact infrared thermo-meters

(NCTs) must be used to reduce cross-contamination and the risk of spreading of
a disease.
 Health screening points for incoming passengers should be set up in a
convenient place selected by the PoE health team in a way that halts mixing up
of the passengers, preferably prior to arrival to immigration and custom clearance
desk while for outgoing passengers, it should set up before the airline's check in
desk.
 Make sure that the health screening checkpoint also addresses the transfer and
transit passengers too.
 In order to avoid the sunlight effect on the equipment’s’ reading, health screening
check points should be shaded from sunlight.
 If hand washing or disinfection is applicable /recommended for the disease of
interest, it should precede the health screening points.

93
 Avail space that allows adequate physical distancing between the health
screener and the passenger.
 Arrange a separate waiting area near the health screening point where persons
with signs and symptoms of disease stay.
 Assigned screeners should receive adequate orientation or training on the
screening procedures and the operation of the equipment.
 Health screening check points should be properly labeled for easy recognition;
health screening announcements/notices should be posted at the screening point
either in written, video or audio form.
 Regular calibration must be done for the equipment’s and the correction factors
for temperature, if any, should be posted visibly for the reference by the
screener.
 The screener should strictly follow the manufacturer’s guidelines and instructions
for use for the specific equipment being used.
 Dust bin for waste disposal should be in place.
 Make sure that appropriate personal protective equipment, formats, working
documents, supplies and medical equipment are in place.
 In case electronic data collections are implemented make sure that internet
connectivity is available and working properly.
 Orientation for the cabin crew and script to be used
 Use multiple languages on the THDF

Routine7 Passengers Public Health Screening

 For early preparation, collect the schedule of expected arrival time of each
aircraft from the interline desk/Integrated Operations Center (IOC).
 Health workers/ screeners should wear appropriate PPE during screening.
 Immediately after parking and before the passengers leave an aircraft, collect the
general aircraft declaration form8 from the cabin crew and review.
 If the cabin crew declares that he/she has not encountered any ill passengers
onboard, inform him/her to let the passengers to the gate.

7
The health screening when there are no ongoing emergency/ PHEIC
8
The general health declaration form can be submitted to the PoE team in hardcopy or electronically

94
  If the general declaration form is not completed, make sure that it is filled on
arrival by cabin crew.
 Make sure that the mounted thermal scanners are ready; all the passengers are
checked within the acceptable range and orientation of the thermal scanners. It is
advisable to use the lane while the passengers are heading toward the health
screening points.
 While visually observing for any sign of illness, let the passengers proceed to the
next immediate desk.
 If passengers with signs of illness encountered onboard or after arrival, handle
and investigate further as per the prevailing protocols.

Passengers Health Screening during an Ongoing Public Health Emergency/PHEIC

In addition to the above listed screening procedures under section II, the following step
by step activities should be implemented during ongoing public health
emergency/PHEIC.

 Make sure that all arriving passengers including the transit/connecting, diplomats
and cabin crews (passengers and cargo aircraft) pass through any designated
thermal scanner fixed on a gate/ terminal of an airport.
 If the screening targets only passengers arriving from affected areas make sure
that they are passing through a separate gate.
 Make sure that at least two health screeners are assigned on the gate/terminal
fixed with thermal scanner so that one will monitor the temperature on the
computer screen and other will facilitate the movement of passengers and
separate the suspect/alert detected by the thermo-scanner, if any from other
passengers
 Work closely with the other stakeholders’ staff to make sure that the passengers
are guided to the appropriate health desk maintaining their distances.
 Once they arrive at the health desk, collect the THDF and other requested
documents, if any, review for its completeness/reliability, and fill additional
information that is meant for the PoE health team, if applicable.
 For those passengers who didn’t fill the THDF on board, provide necessary
support to fill at the health desk.

95
  In addition to the mass thermal scanner, If additional temperature checking by
using the NTC is required9, the following need to be implemented/checked:-
○ The test area of the head/forehead is clean, dry and not blocked during
measurement.i.e cap, scurph and others are removed during screening.
○ Hold the NCT sensing area perpendicular to the head/forehead and
instruct the person to remain stationary during measurement.
○ The distance, angel and duration of holding is specific to each NCT (Refer
the manufacturer’s instructions for correct measurement distances).
○ Do not touch the sensing area of the NCT and keep the sensor clean and
dry.
○ If the person's body temperature is above the cutoff point for the disease,
take the person to the arranged waiting area, register the temperature and
handle as per the prevailing protocols. Upon investigation, if the
passenger is found to have another medical problem, link the person to
the airports’ emergency clinic for further assessment and medical
intervention.
 Otherwise, if body temperature of the passengers was below the cutoff point, no
sign of illness:-
○ Make sure that THDF are complete and temperature is checked and
registered on the THDF.
○ Collect the THDF and direct the passengers towards the next health desk
for other health measures under implementation, if any (specimen
collection, vaccination, etc). Otherwise provide the health messages AND
OTHERS and let passengers proceed to exit.
 Establish cross checking/tracking mechanisms with INVEA and security
personnel to track passengers bypassing the screening procedures.
 Every step should be undertaken under the supervision of the coordinators
 Data exchange, including delivery of the THDF can be done in hard copy or
electronically.

9
Additional temperature measurement by using NTC is needed if individual passengers’ temperature reading
needs to be registered on the THDF or the mass thermal scanner is suspected to miss febrile passengers

96
Annex 14: Standard Operating Procedure for Public Health Screening of
Passengers at Ground Crossing

1. Introduction

This standard operating procedure (SOP) describes the purposes, responsibilities and
procedures to be followed during public health screening of passengers at ground
crossing in jurisdiction of the Ethiopia.

2. Definition of Terms

“Ground Crossing Point of Entry” means a point of land entry in a State Party,
including one utilized by road vehicles and trains.
“Point of entry” means a passage for international entry or exit of travellers, baggage,
cargo, containers, conveyances, goods and postal parcels, as well as agencies and
areas providing services to them on entry or exit.
“Passenger” means a natural person undertaking an international voyage.
“Point of Entry Health Team“ staff assigned by Ethiopian public health institutes at
point of entry to execute public health interventions.
“Vehicles” means train, road vehicles or other means of transport on an international
voyage but did not include aircraft and ship.
“Events” means a manifestation of disease or an occurrence that creates a potential for
disease.
“Passengers”: means international passengers who pass in and out through the point
of entry.

3. Purposes

 To provide a coordinated screening from importation of communicable diseases and

steps to be followed while public health screening at Ground crossing point of entry.

4. Scope

 This standard operating procedure applies for all land crossing at point of entry
located in Ethiopian territory and all international passengers arrived via
conveyances such as vehicles, trains, back of animals and on foot excluding aircraft.

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5. Responsibilities

Point of Entry (PoE) heath team

 Conduct public health screening of international travelers at land crossing point

of entry arriving via conveyances such as vehicles, trains, back of animals, and
other means of transportation.
● Approach the passengers and staffs at the working place with discipline and
courtesy
○ Gently greet, introduce yourself, explain why you are here for, when
approaching to passengers
○ Provide reliable information and health advice for the passengers
continuing their journey
● Avoid providing information to media, regarding the traveler and the event you
are screening unless you are delegated to do so by higher body usually EPHI
 Avoid using computer, cell phone, tablets etc. at screening site unless it is really
necessary

Vehicle drivers

 Park the vehicles at designated parking area.

 Provide passenger list, if available.
 Identify and notify to Point of Entry (PoE) health team if there are death or ill
travellers with communicable disease of PHE interest in the vehicles.
 Cooperate with Point of Entry (PoE) health staff for all necessary
accomplishments of public health screening of travellers such as parking of
vehicles, disembarkation of travelers, disinfection, disinsection and other vector
control interventions of vehicles or other objects.
 Provide fumigation or disinfection certificate upon arrival as requested if
necessary.

Passengers

 Cooperate with Point of Entry (PoE) health staff for all necessary
accomplishments of public health screening such as:

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 - Present him/her to screening site for public health screening.
- Show documentations required, including identification cards, passports,
vaccination cards, medical reports (with laboratory results if available).
- In case of isolation or quarantine needed, obey Point of Entry (PoE) health
staff order/advice.
Sprayers

 Conduct all required disinfection, disinsection and other vector control

interventions of vehicles or other objects when requested.
Cleaners

 Conduct all required cleaning activities of Point of Entry (PoE) offices, TIU,
quarantine facilities, screening sites, and all contaminates areas or objects
including vehicles.

6. Prerequisites

To apply this SOP the following prerequisite must be fulfilled.

- Health screening post, Isolation and quarantine facility
- Manpower
- Health declaration form
- Protocols, guideline and manuals
- Medical equipment (e.g. Infrared thermometer) and supplies (PPE…)
- Disinfectants and others

7. Procedures

1. The security will stop the travellers in vehicles or other means of terrestrial
transportation for border control checkpoints.
2. The point of entry health staffs approaches to the vehicles driver or passengers
from other means of transportation and greet him/her courteously.
3. Orient the passengers about the screening purposes and procedures.
4. Inform the passengers to remove hat, eye glass, cap and anything that can cover
the head of the passengers.

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5. Let the passenger go through the screening post and come one by one
6. If there are travellers with visible signs and symptoms of PHE interest, the
travellers will be immediately directed to the secondary screening.
7. Request the following primary information of each passenger for PHE of interest:

a. Country of departure
b. Receive and check passports/ identification card and other relevant
documents

8. The Point of entry health staff carry out public health screening activities with due
consideration to the following points:
a. Public health screening using signs and symptoms
b. Hold the infrared thermometer as per the manufacturer guide to measure
body temperature
c. Request and check yellow fever vaccination card.
d. Ensure the filling of the Travellers Health Declaration Form
e. Point of entry health staff fills the relevant information of travellers on the
registration logbook

9. The Point of entry health staff make decision on passenger/s suspected of PHE
interest based on existing protocols and case definitions for as follows:

a. If the temperature is normal and no travel history to the affected country

for the specified range of days, register the passengers information and let
him/her pass to immigration counter
b. If the passenger has travel history to affected countries with normal body
temperature and no other specific disease based consistent sign and
symptoms, take action as per the existing protocols.
c. If the body temperature is above the threshold isolate at the waiting areas
and recheck.
d. If the body temperature is above the threshold and did not subside and/or
have consistence signs and symptom related to the specified public health
disease;
i. inform and aware the passengers about the situation and what
is/are expected

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 ii. take detail history including his/her travel history
iii. isolate immediately in the isolation facility until further decision is
made,
iv. if no isolation facility at Point of entry, refer to the nearest
designated facility

e. For example when the following conditions occur at point of entry,

immediate interventions needs to be taken:

I. Gastrointestinal Illness:

1. In the event of a GI illness, ill travellers should be advised to move to isolated

facility and can use toilet at isolation facility.
2. If a public vomiting or faecal incident occurs, the point of entry health staff advice
to limit the contamination and make the performance of disinfection of
contaminated areas.

II. Respiratory illness:

In the event of a respiratory illness:-

a. An appropriate mask should be provided to the traveller.

III. For illness transmitted by direct contact with Body Fluids (Blood, Vomit,
Diarrheal):

In the event of illness in travellers from an affected country who exhibits signs or
symptoms related to that illness:

a. Isolating the ill traveller in temporary isolation facility.

b. Point of Entry (PoE) health staffs wear masks when assisting the ill travellers.
c. Universal precaution measures should be implemented by the point of entry
health staff if they could be exposed to body fluids when assisting the ill
traveller or when cleaning up spilled body fluids.

3. For the suspected passenger, immediately notify to the nearest local health
authority and point of entry unit at EPHI.

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 4. Prepare report as per schedules.

8. References:

1. Vector Surveillance and Control at Ports, Airports, and Ground Crossings,

WHO, 2016.
2. Handbook for public health capacity-building at ground crossings and cross-
border collaboration, WHO, 2020.

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Annex 15: Standard Operating Procedure for the Management of Passenger
Suspected of Public Health Emergency/Event in Temporary Isolation
Facility at Point of Entry

1. Introduction

Temporary Isolation Facility (TIF) is a temporary facility at the point of entry (PoE) used
for managing suspected passenger(s) for public health emergency/events arrived from
affected country. At this facility a decision is be made to transfer the traveler to a
treatment center or to continue his/her journey. Emergency medications including O 2, IV
fluids should be available and the required emergency treatment will also be provided
during the travelers stay at this particular facility.

This Standard Operating Procedure (SOP) describes the purpose, scope, responsibility,
prerequisite and procedure for managing suspected passengers at TIF of the point of
entry.
2. Purpose
The purpose of this SOP is to use as guidance during isolation and management of the
suspected travelers for public health emergency/events in isolation facility until they will
be transferred to treatment center or discharged/allowed to continue his/her journey.
3. Scope
This SOP applies to international passenger(s) in the temporary isolation facility
established at both ground crossing point of entries and airports.
4. Responsibility
 Point of Entries Public Health team: screen and manage the suspected
passenger(s) for public health emergency/events referred from screening site of
PoE. They also carryout documentation and reporting regarding the passengers
information.
 Cleaners: clean premises of TIF
 Sprayers: disinfect and disinsect the premises of TIF

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5. Pre-requisite
 Temporary isolation facility/room with other necessary materials like table, chair,
wheelchair, stretcher, bed etc.
 Manpower-health professionals and other staffs
 Medical equipment and supplies
 Protocols, Guidelines, SOPs
6. Procedure
 Identification/detection of suspected case started usually at screening site of the
POE based on case definition i.e. clinical and epidemiologic criteria (e.g., travel
history or exposure to someone with confirmed or suspected disease of interest)
 Once the suspected case identified at screening site, he/she should be
transferred immediately to the TIF prepared for that purpose.
 Give face mask to the suspect if he/she don’t have one, especially if the
suspected person had respiratory symptoms or come from affected country.
 Keep at least 1m distance (may vary based on the event) from the suspect
during accompanying or managing the suspect at TIF
 If there is no face mask, provide paper tissues or request the patient to cover
their nose and mouth with a scarf, bandana, or T-shirt during the entire care at
TIF.
 Take further detailed history related to the PHE of interest at the triage of TIF.
 Isolate the suspected person if he/she required isolation based on case definition
during detailed history taking.
o During isolation at TIF, if symptom subsided consider discharging of the
passenger based on discharging protocol and clinician judgment
 Explain to the suspected case about the nature of disease, about the subsequent
procedures to be done.
 In managing the suspected travelers, treat them with courtesy and respect- for
their dignity, human rights, and fundamental freedom and minimize any
discomfort or distress associated with such measures
 Clinician should adhere to standard precautions which include hand hygiene and
wear appropriate PPE (gown, gloves, goggle/face shield, boots) based on risk
assessment, before evaluating the suspect at TIF

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 o For eg. If the patient is critically ill with respiratory distress, the clinician
should wear gown, gloves, goggle, boots
o If the patient is stable with mild symptoms, clinician may use gloves,
gown, facemask with face shield, keeping the 1m distance from the patient
 Selection of PPE for other staffs also depend on what their duty at TIF
Example:
o Cleaners, should wear gowns, boots, heavy duty gloves, face shield
o Spray man should wear gowns, gloves, goggle, and boots
 Follow appropriate donning and doffing of PPE procedures at TIF.
 Perform frequent hand hygiene with an alcohol-based hand rub/ with soap and
water.
 Avoid repeated hand shaking, unnecessary touching, frequent repositioning TIF.
 During evaluation:
o Take history: about the symptoms (fever, cough, headache, malaise,
nausea, vomiting, sore throat ,diarrhea, muscle pain, difficulty breathing,
SOB), about pre-existing conditions such as DM, HTN, CVD, COPD,HIV,
TB, CKD etc.
o Travel information: history of travel to country/ies especially in the
incubation period of a specific epidemic/ pandemic existing currently
o Conduct physical examination including vital signs: BP, RR, HR,
Temperature, oxygen saturation, chest auscultation, signs of dehydration (
sunken eyes, dry lips & buccal mucosa, skin turgor return slowly,
lethargic), signs of severe respiratory distress such as fast breathing,
grunting, chest in drawing, inability to breast feed (usually for children)
 If the suspect has mild symptoms fever, cough, sore throat, nasal congestion,
malaise, headache, muscle pain or malaise with no severity sign:
o Give PO conservative fluid supplementation if available i.e juce, ORS,
highland water if available
o Paracetamol 1gm PO stat for pain and fever, can be repeated as per need
o Dose will be adjusted for pediatric age group
 If the suspect has severe symptoms: high grade fever, RR>30beats/min, PSO2<
90% and other severity signs

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 o Give supplemental oxygen, initiate with lower amount usualy2-3L/min and
titrate flow rates to reach target SpO2 ≥90% (target for pregnant mothers
and children SpO2 ≥92-95 %)
o Secure IV line and start giving conservative IV fluid (1bag of RL/NS)
especially if the suspect has signs of dehydration. (be cautious during
resuscitation for patients with SARI)
o Paracetamol 1gm stat for pain and fever, may be repeated as per need
before the transferring the suspect
o dose for pediatric age must be adjusted
o Other symptomatic management may take place based on clinician
judgment during the suspects stay at TIF
 The clinician or PoE staff should communicate with PoE unit at EPHI, side by
side about the suspect so that RRT will be deployed to the TIF and transfer the
case to the treatment unit
 Suspected case/rumor investigation form and clinician note at TIF should be sent
to the treatment facility during the transfer.
 The PoE health team should document the traveler’s information and report to
EPHI timely.
 A thorough disinfection should be applied with 0.1% (1000ppm/1:50) chlorine
bleach solution for contaminated surfaces or 70% alcohol for surfaces that do not
tolerate chlorine after the suspect transferred to the treatment center. For large
blood and body fluid spills 0.5% (5000ppm/1:10) chlorine bleach solution is
usually recommended.
 Infectious waste generated i.e., sharps, non-sharps, blood, body parts,
chemicals, pharmaceuticals, medical devices and radioactive materials should be
placed in color coded waste container and disposed properly after transferring
the suspected travelers to treatment center. A waste bin with lid and plastic bag
inside should also be available at the bed side in the TIF where patient can
discard used paper tissues.

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