Definitions of Symptoms for Reportable Illnesses

The 42 Code of Federal Regulations parts 70/71 Final Rule defines an ill person as someone who:

1. Has a fever (has a measured temperature of 100.4 °F [38 °C]† or greater, or feels warm to the touch, or gives a history of feeling feverish) accompanied by one or more of the following:
   • skin rash
   • difficulty breathing
   • persistent cough
   • decreased consciousness or confusion of recent onset
   • new unexplained bruising or bleeding (without previous injury)
   • persistent diarrhea
   • persistent vomiting (other than air sickness)
   • headache with stiff neck, or
   • appears obviously unwell

   OR

2. Has a  fever that has persisted for more than 48 hours

   OR

3. Has symptoms or other indications of communicable disease, as the CDC may announce through posting of a notice in the Federal Register

To assist flight crews in identifying people with potential cases of a reportable illness, CDC provides the following explanations and examples of signs and symptoms that might indicate contagious diseases:

Fever

• CDC considers a person to have a fever when he or she has a measured temperature of 100.4° F (38° C) or greater, or feels warm to the touch, or gives a history of feeling feverish.Note: Even though measured temperature is the preferred and most accurate method to determine fever, it is not always possible to take a person’s temperature. In certain situations, other methods of detecting a possible fever should be considered:
  • self-reported history of feeling feverish when a thermometer is not available or the ill person has taken medication that would lower the measured temperature.
  • the person feels warm to the touch
  • appearance of a flushed face, glassy eyes, or chills if it is not feasible to touch the person or if the person does not report feeling feverish.

The presence of fever suggests an infectious cause, but fever is not always present with an infection.

Skin rash means abnormal areas on the skin that may appear as discolored bumps or flat spots or areas, or blisters or bumps containing fluid or pus that are intact or crusted over. “Rash” includes insect bites or parasite lesions.

• Color: ranges from light-colored to red or pink, purple, or black, but can also be the same color as the person’s skin tone.
• Texture: can be flat, raised, blister-like, or crusted. In some diseases, such as chickenpox, areas with more than one of these characteristics can be found at the same time.
  Select the most appropriate description of the rash’s appearance:
  • Maculopapular: A red rash with both flat red areas (macules) and small bumps (papules) that may run together.
  • Vesicular/Pustular: Small bumps filled with fluid that can be clear or cloudy (vesicles) or filled with a thick, opaque fluid (pustules).
  • Purpuric/Petechial: Red or purple discolorations caused by bleeding under the skin or mucous membranes; they do not blanch or fade with pressure. Petechial lesions appear as small, reddish freckles, while purpuric lesions cover larger areas.
  • Scabbed: Lesions that are crusted over.
  • Other: Enter a short description of the rash appearance if the other options do not apply.
• Pattern: can be disconnected (discrete) or run together (confluent).
• Location: may include one area of the body, such as the face, or more than one area.

Fever plus rash may indicate communicable diseases such as chickenpox, measles, or rubella (German measles).

Difficulty breathing or shortness of breath means the person is

• unable to move enough air into or out of the lungs, or can do so only with an unusually great effort
• gasping for air
• feeling “short of breath,” or unable to “catch” his/her breath
• breathing too fast or shallowly, or using muscles of stomach, chest or neck to breathe (especially for children).

Difficulty breathing—especially with fever—may indicate a traveler has a respiratory infection, such as pneumonia, diphtheria, or influenza.

Persistent cough means that the cough is frequent and severe enough to catch the attention of the crew or another passenger.

Persistent cough may indicate diseases of public health concern, such as pertussis, tuberculosis, legionellosis, and influenza.

Decreased consciousness or confusion of recent onset means the person

• is not fully aware of the surroundings and may be confused about who he or she is, where he or she is going, or the time of day/week,
• does not respond normally to questions or painful sensations, or
• may appear to be sleepy, groggy, unresponsive, or difficult to awaken.

Decreased consciousness, especially in the presence of fever or rash, may indicate the traveler has a serious neurological infection, such as meningococcal meningitis, or a serious infection in another body system.

New unexplained bruising or bleeding (without previous injury) means the person has noticeable and unusual bruising or bleeding from gums, ears, nose, or areas on the skin with no obvious explanation (such as injury), is vomiting blood, or has bloody stool or urine.

Bruising or bleeding, especially in the presence of fever, may indicate that the person has a hemorrhagic fever, such as Ebola.

Persistent diarrhea means that the person has loose, watery stools that occur more frequently than usual (at least 3 episodes within a 24-hour period) and the diarrhea is frequent and severe enough that

• other people notice, for example, the person going to the restroom numerous times, or the
• ill person or another passenger voices concern about it.

Persistent diarrhea may indicate the person has a gastrointestinal illness, such as norovirus, salmonellosis, or cholera.

Persistent vomiting means that the person

• has vomited two or more times (not due to motion sickness) and
• either expresses concern to the crew or it comes to the attention of others onboard (crew or passengers).

Persistent vomiting may indicate the person has a gastrointestinal infection, such as salmonellosis or norovirus infection.

Headache means the person has head pain of unusual severity.

Neck stiffness means the person has difficulty moving the neck or severe pain during neck movement.