From the ECDC Weekly Communicable Disease Threats Report, the US CDC, and the WHO:
- Various influenza and related:
- Japan has declared an early start of the influenza season. Elsewhere in the Northern hemisphere, namely in Europe, influenza circulation remains low. In Europe, there is widespread but decreasing circulation of SARS-CoV-2, with limited severity.
- So far in October there have been reports of one case of avian influenza A(H5N1) in Cambodia, and the second human case of avian influenza A(H5) since 2024 in Mexico City, while two new human cases of avian influenza A(H9N2) had been reported in China earlier in September. No extraordinary measures have been necessary.
- Ebola in DRC:
A total of 64 cases of Ebola virus disease haa been reported in Bulape, Kasai Province, DRC. The current risk for people travelling to the region is estimated to be low by the ECDC, due to low likelihood of exposure. Bulape is more than 1000 km by road from Kinshasa.
- Chikungunya – world:
According to a recent assessment by the WHO, given the ongoing outbreaks reported globally in 2025, including resurgence in some countries that had not reported substantial numbers in recent years, the potential for further spread remains significant. More here:
A selection of other topics and publications of interest:
Aviation Health Conference
Here are some broad-stroke highlights from this year’s Aviation Health Conference that took place in London 23-24 September. You can find details of the conference programme and speakers here https://quaynote.com/conference/aviation-health-conference-2025/ . The conference is promoted by IAMA, the International Airline Medical Association: https://iama-assn.org/
Crew, cabin, ground staff health and well-being
- More airlines are organising resource rational but impactful well-being programmes for their staff. Air Canada’s is a case in point.
- Fatigue is multifactorial. All cases need to be factored in for management and prevention: operational, regulatory, circumstantial, as well as personal, whole-of-life factors.
- Layover health has its own specificities – think (very cold or very hot) climate adaptation, food hygiene, mosquito bite prevention.
- A reminder on a fundamental concept in toxicology: chemicals are everywhere, but their presence only in itself doesn’t mean they are having toxic effects – it’s always about dose.
- When setting up a workplace drug testing programme you need to decide what you want to know: recent or very recent intake (not under the influence) or consumption, past history (e.g., pre-employment)? Then decide which biological product (saliva, urine, breath, hair) is most appropriate for the intended objective. Technological advancements and organisational innovations keep making it easier to set up drug testing programmes that comply with regulatory requirements and meet safety objectives while having minimal impact on operations and saving work hours.
- Legality of cannabis products and medicines does not change the substance – tests will give a positive result and that’s a no-go for aviation.
- Drug tests for THC (tetrahydrocannabinol, the main psychoactive ingredient) can be positive for essentially three reasons: previous recreational use within the timeframe of detection of the test, use of cannabinoid products that contain THC (product labels are not always accurate or reliable), prescribed medical cannabis/cannabinoids.
- Passive inhalation may have some minor functional impact, and tests may be positive, but evidence points to a timeframe well under 24 hrs and extreme, unventilated conditions.
- The panel discussed the fascinating and constantly evolving world of test fooling strategies and test interpretation, as well as of new products and substances with potential significant impact on safety, such as for example the recent trend with the aviation incompatible, energy booster kratom.
- Together with psychosocial and mental health factors, chronic diseases and deconditioning contribute to work-related injuries and affect recovery. Occupational health strategies to optimise care and prevent future injuries/illnesses have the potential to promote resilience and cultivate healthy workplaces and lifestyles to improve worker well-being, reduce costs, and boost productivity.
- What if you put pilots in an emergency room simulation scenario and doctors in a flight deck simulation scenario. This is what a Ross University School of Medicine research project has been doing to gain unique cross-disciplinary insights. Among the conclusions so far: pilots score high in teamwork, structured communication, and prioritization – these are core human factor competencies that should keep being reinforced in aviation; integrating empathy, questioning (seeking clarification), and briefing-debriefing skills inspired by medicine’s reflective culture may be useful for CRM; aviation training could focus more on psychological safety and emotional intelligence to strengthen crisis leadership.
Aviation medical case studies and certification
- Case studies from the Middle East and Europe illustrated how to manage and mitigate risks to make it possible to certify pilots with complex gastrointestinal, cardiac and neurological conditions.
Passenger health
- Syncope is the single most reported inflight medical event in passengers. Episodes tend to occur early in the flight and are more common in shorter than longer flights. In their vast majority, cases are not severe and have no significant implications for the passenger or the operation, though elderly males are more likely to be at risk for a serious underlying cause. Even in the rarer< cases that suggest seriousness, thorough evaluation is essential to avoid unnecessary diversions. Medical volunteers can be of help but, because of their typical training, expectations and lack of familiarity with cabin environment specificities, it is useful to predefine and communicate their role from the outset, experience suggesting that the best operational decisions result from focusing primarily on cabin crew procedures and real-time ground based medical support advice.
- A summary of a 2023 UK civil aviation authority commissioned systematic review has recently been published in the scientific literature on the evidence base for risks and best management of food-allergic individuals on commercial airlines. Main conclusions and recommendations:
- food allergic people are 10-100 times less likely to have a reaction on an aeroplane than when not flying;
- allergic reactions to aerosolised foods are very uncommon, with well-known exceptions such as fish/seafood;
- the most likely cause of reactions is either accidental ingestion of food containing the allergen or by contamination of hands due to allergen residue on surfaces;
- there is no evidence that banning food such as peanuts is an effective measure and they may give a false sense of security;
- cleaning of surfaces such as tray tables with detergent wipes is likely to be an effective mitigating measure;
- the use of ‘buffer’ zones may provide reassurance but further research is needed to determine their effectiveness;
- passengers with a known history of food allergy should carry at least one, preferably two, adrenaline autoinjectors with them in the cabin.
- Medical clearance procedures (MEDA cases) have the potential to reduce the risk of inflight medical events.
- Decisions regarding passengers who recently sustained a pneumothorax can be particularly complex; evidence is evolving and seems to be pointing towards letting passengers fly earlier than previously thought, on a case by case basis.
- With the growth of medical tourism, more and more passengers are flying after having cosmetic surgery – another aspect that poses specific challenges and waiting times.
- The main aim of aeromedically clearing pregnant passengers is to protect them. A majority of airlines are consistent with medical advice on when is safest to travel in pregnancy, and they provide their cabin crew with some training in dealing with child delivery. Diversions related to obstetrics are rare and pregnancy pre-travel certifications in their current form are unlikely to contribute to reduction of an already low incidence of inflight obstetric emergencies. Symptoms prior to flight are a major go/no-go factor for pregnant passengers.
Public health event preparedness and response
- Lessons learned from the Fukushima accident were discussed with Air New Zealand’s experience as a case in point. You can find the latest (2015) edition of the pay-walled ICAO Manual on Volcanic Ash, Radioactive Material and Toxic Chemical Clouds here: https://store.icao.int/en/manual-on-volcanic-ash-radioactive-material-and-toxic-chemical-clouds-doc-9691 plus a 2018 amendment here: https://store.icao.int/en/manual-on-volcanic-ash-radioactive-material-and-toxic-chemical-clouds-doc-9691-english-printed-1 The previous 2007 edition can be downloaded for free here: https://skybrary.aero/sites/default/files/bookshelf/2997.pdf?utm_source=chatgpt.com
- A convenient, efficient and unobtrusive methodology for collection and analysis of samples for wastewater-based epidemiology (WBE) in aviation is now well established, with Qantas a pioneer in the airline industry. WBE provides unique and specific data that augments and may direct and improve the relevance and timeliness of other public health measures. Global sentinel surveillance can be deployed to high traffic and high-risk nodes (airports/airport areas). A 2-tiered model (airport and only then aircraft) is likely to be most efficient, but needs sharing and transparency and super-national oversight and sponsorship. Any implementation needs to be cognizant of industry sensitivities and risks.
- Although it is important to prevent air transport of mosquito vectors, humans remain the most common source of dengue, Zika and other viruses introduced into new regions. The currently WHO-recommended aircraft disinsection methods are residual, pre-embarkation, pre-departure and (last resort) spray on arrival. Evidence suggests that while disinsection can be effective, the lack of standardised studies makes it difficult to assess how well it works in real-world settings. At present, aircraft disinsection can be considered good practice, but a stronger evidence base is needed including further research into cost-effectiveness. As previously reported, you can find the latest (2023) edition of the WHO Aircraft Disinsection Methods and Procedures Manual here: https://www.who.int/publications/i/item/9789240080317
IATA Emergency Response Best Practices (ERP) Handbook
The new edition of the IATA ERP handbook will be effective from next December. Family assistance guidance is included in the revised edition, namely with the following key topics:
- timely notification to families before the public release of passenger names;
- trained airline teams to respond to family inquiries and provide accurate information;
- establishment of a Family Assistance Center with essential services;
- procedures for handling personal effects of affected passengers;
- continued communication, claims support, memorial planning and employee debriefings in the days following the accident.
IATA global campaign to educate travellers on lithium battery safety
According to a poll conducted by IATA, as much as 83% of airline passengers carry mobile phones, 60% bring laptops, and 44% travel with power banks. Half of passengers wrongly believe that small lithium-powered devices can be stowed in checked baggage, while 45% think power banks should be kept in hold luggage. Such misconceptions highlight the need for clear and accurate guidance. Watch the new IATA educational video for passengers here: https://www.youtube.com/watch?v=1umWAT8f6nk
More here: https://www.iata.org/en/youandiata/travelers/batteries/