The Airliner Cabin Environment and the Health of Passengers and Crew (2002) / Chapter Skim
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6 Health Surveillance
6 Health Surveillance
Pages 223-253
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From page 223... ...
The column "Health Outcomes" identifies outcomes related to chronic exposure, to cabin air, or to physiological responses in groups of people who may be at particular risk in the cabin of a commercial airliner, such as passengers with underlying cardiac or pulmonary disease. Most of the symptoms listed in the first three categories have been reported primarily by cabin crews.
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From page 224... ...
224 ˘ · _ 5 Cal ˘ o Ct o o ;^ ~ ~ no .m ~ U
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From page 225... ...
Finally, the current health-related data collection systems are reviewed. STUDIES OF AIRCRAFT CABIN AIR QUALITY Relatively few formal studies have evaluated the effects on passengers and cabin crew of exposure to aircraft cabin air during routine flights or during flight-related air-quality incidents.
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From page 226... ...
Weak statistical analysis. Questionnaire Survey to Evaluate the Health and Comfort of Cabin Crew, Lee et al.
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From page 227... ...
In-Cabin Trace Chemicals and Crew Health Issues, Balouet (1998~; Airborne Chemicals in Aircraft Cabins, Balouet and Winder (2000a) —Data based on 350 selected reports of symptoms supposedly related to documented leak events.
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From page 228... ...
- Alternative explanations could be found for all cases with positive skin tests. Tuberculosis Transmission among Flight Crew, Driver et al.
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From page 229... ...
8 subjects reported symptoms. Oxygen Saturation in Cabin Crew, Ross (2001)
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From page 230... ...
The Occupational Health Clinic of San Francisco General Hospital was commissioned by the AFA and American Airlines to conduct a study of the cause of symptoms reporter! by flight crews on flights between San Francisco and Honolulu in association with an odor described as that of"dirty socks" (Cone and Cameron ~ 984~.
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From page 231... ...
Cabin crews were "encouraged" to record symptoms reported by passengers, but no systematic surveillance was conducted. Background information on smoking and upper respiratory symptoms was obtained.
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From page 232... ...
Of the ~ 6 symptoms included in the questionnaire, four were considered to be O3-related (coughing, tightness of the chest, shortness of breath, and "breathing hurts". Symptoms were reported equally by cabin crew ofthe two airlines before flight (68%)
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From page 233... ...
. A regression analysis showed that onlyTABI,E 6-4 Frequency of Symptoms Reported by Cabin Crew 26 36 41 43 57 66 67 68 71 73 Symptoms Dry, stuffy nose Irritation, dryness, itchiness in eyes Dry, sore throat Dry, irritated skin Stomach discomfort (indigestion, gas)
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From page 234... ...
five factors (health before trip; eye irritation and dryness; back, muscle, and joins pain; headache; and skin dryness and irntation) were related to "overall health," most of the variance being associated with health status before the trip.
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From page 235... ...
Although this report provides data that are complete with respect to frequency of occurrence of incidents, no information is provided on the extent to which the reports of symptoms were obtained by standardized methods or on the duration ofthe exposures; nor were objective exposure measures mentioned. Percentages are not given because it is not clear whether the denominator refers to events or persons.
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From page 236... ...
The "Aerotoxic Syndrome" Balouet and Winder have argued in a series of documents for the exisfence of a stereotypical symptom complex, "aerotoxic syndrome," which attends exposure of cabin crew to hydraulic fluids, engine oil, and their pyrolysis products (Balouet 1998; Balouet and Winder 1999, 2000a,b; Winder and Balouet2000b)
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From page 237... ...
The symptoms reported by flight attendants were headache, sore throat, skin rash, nausea, runny nose, eye buming, difficultyin breathing, cough, dizziness, shortness of bream, and sinus problems. The total pool of at-nsk flight attendants who could have made a report was not provided.
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From page 238... ...
Although the report acknowledged that disinsection was not a desirable practice, no data were provided on the risks Dosed by various types and frequencies of exposure. Transmission of Infectious Agents There is evidence that the environment of an aircraft cabin does not contain higher concentrations of microorganisms than do comparable public environments (see Chapter 4, Table 4-2~.
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From page 239... ...
Those two studies do not constitute an adequate database from which to determine whether the risk oftransmission of influenza virus is heightened in the aircraft cabin environment relative to other closed environmental spaces under conditions of normal or abnormal operation ofthe environmental control systems (ECSs)
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From page 240... ...
of the 246 noncitizens. The authors could find alternative explanations for all the persons reported to have positive skin tests for M
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From page 241... ...
, had skin-test conversions—two were attributed to the booster phenomenon. Two ofthe four subjects with true conversions sat within two seats ofthe woman with tuberculosis, and all the passengers who had positive skin tests but no other risk factors or conversion sat within two rows of the woman or visited with friends who were sitting near the woman.
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From page 242... ...
Although it is reasonable to assume that infectious agents are transmitted during commercial airline flights, it has not been possible to determine conclusively whether transmission is related to close personal contact or environmental conditions specific to passenger cabins (see Chapters 2 and 4 for more details)
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From page 243... ...
Cabin pressure was measured hourly dunng flights, and primely readings in cabin crews were "instantaneous spot measurements." On each of 16 flights, 10-15 crew members were studied. Cabin altitudes were ~ ,585-2,286 m (5,200-7,500 ft)
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From page 244... ...
OTHER SOURCES OF HEALTH EFFECTS INFORMATION A considerable amount of material was submitted to the committee in support of health effects related to incidents of smoke, fumes, and unusual odors in the cabins of commercial aircraft both in association with and independent of known or suspected episodes of leaks of hydraulic fluid, engine oil, or other sources of contaminants in the cabin. Those materials consisted primarily oftestimony and summaries of unpublished date.
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From page 245... ...
However, the Australian Senate went on to recommend that "aerotoxic syndrome" be included "in appropriate codes as a matter of reference for future Workers Compensation and other insurance cases," although this appeared to contradict its summary of the evidence. Two sets of unpublished data illustrate the difficulty with the data used to link specific symptoms to putative incident exposures in aircraft cabin air.
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From page 246... ...
Moreover, no data are provided on similar symptoms reported on flights during which no odors were detected and no observable conditions occurred or on the health status ofthose affected. it is not possible to distinguish symptoms reported by passengers and those reported by flight attendants.
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From page 247... ...
, 17.6% of incidents identified as hydraulic fluid or oil Symptom Reports (based on 925 flight attendants involved in 760 incidents) C 97.2% of incidents involved reports of disorientation, confusion, "spacey," euphoria for incidents with smoke or haze Landing: difficulty in breathing, coughing, imtation of eyes, throat, and lungs Mid-flight: headaches, disorientation, giddiness, difficulty in concentrating, nausea, vomiting Ground and takeoff same as for mid-flight a See text for definition of"incident." b Number of fight attendants and/or passengers involved not given.
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From page 248... ...
AFA has distributed a standard event reporting form to its members as part of its Safety and Health Database Initiative (AFA 2001~. The form is intended to be completed primarily by cabin crew, but may also be completed by passengers, pilots, or mechanics in response to a perceived air-quaTity incident, including required pesticide spraying on international flights.
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From page 249... ...
or hydraulic fluids, the committee recommends that the term aerotoxic syndrome not be used for symptoms associated with incidents of cabin air contamination. · Currentregulationsforcabinpressureshouldbereviewedtodetermine whether they are adequate for protecting people who might be unusually susceptible to changes in air pressure, such as the elderly, infants, children, and people with cardiovascular or pulmonary disease.
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From page 250... ...
A program for the systematic collection, analysis, and reporting of health data in relation to cabin air quality needs to be implemented to resolve many of the issues raised in this report. REFERENCES AFA (Association of Flight Attendants)
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From page 251... ...
1991. Air travel in patients with chronic obstructive pulmonary disease.
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From page 252... ...
1983. Respiratory symptoms of flight attendants dunng high-altitude flight: possible relation to cabin ozone exposure.
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From page 253... ...
Pp. 196-199 in Towards a Safe and Civil Society, Proceedings of International Congress on Occupational Health Conference, Brisbane, Australia, Sept.
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