All airports across the country have been put on high alert after the Ministry of National Health Services Regulations and Coordination confirmed that the country has reported its first cases of monkeypox (Mpox), reported 24NewsHD TV channel on Wednesday.
The confirmation of the first cases has prompted the authorities to issue guidelines for rare viral zoonotic disease.
The airport authorities have been directed to provide information about passengers with Mpox symptoms.
The Director General of Sindh Health Services also issued a high alert to several hospitals in the province, including Jinnah Post Graduate Medical Center, National Institute of Child Health, Dr Ruth Fao Civil Hospital and Sindh Government Lyari General Hospital Karachi, Hyderabad, Shaheed Benazirabad, Sukkur, Sehwan, Jacobabad, Larkana, and Khairpur hospitals and directed them to take steps to deal with Mpox cases.
Additionally, he has asked authorities to keep a close watch on inbound passengers.
Hospitals have been ordered to manage suspected or confirmed cases by taking appropriate measures.
In order to provide affected patients safe and effective care, the authorities are beefing up the preventive measures at airports by establishing isolation wards.
The Directorate General Health Services has asked health facilities to designate separate five to ten rooms for isolating monkeypox patients with appropriate infection control measures, including negative pressure, hand hygiene facilities and personal protective equipment within 24 hours.
On Tuesday, Pakistani authorities had identified two confirmed cases of monkeypox infection. The persons infected were said to have travelled from Saudi Arabia and landed in Pakistan on April 17, with symptoms of monkeypox.
The identity of the victims had been kept confidential, and samples were sent to the National Institute of Health (NIH) in Islamabad, which confirmed the presence of the virus.
The federal health ministry had begun tracing contacts of the infected persons.
Following the detection of the virus, hospitals in Sindh have been advised to take proactive steps for the management of suspected or confirmed cases.
The World Health Organization (WHO) had recently declared the spread of Monkeypox a ‘global health emergency’ amid the rising infection rates worldwide. Fortunately, Pakistan remained safe from the fatal virus until now.
Monkeypox symptoms
Monkeypox has an incubation period of seven to 14 days. The initial symptoms of monkeypox are similar to influenza with fever, chills, exhaustion, headache, muscle weakness and swelling in lymph nodes.
The widespread of rashes all over the infected bodies include the inside of the mouth, palms of the hands, and feet. Moreover, it has been reported that the rashes are mostly in the genital area for the early stages of the illness.
The most distinguished ways of transmission of the Monkeypox infection from one person to another are typically through contact with body fluids and respiratory droplets, contact with skin lesions of an infected person and contact with contaminated surfaces.
Public Health Emergency of International Concern
In view of the emergence of cases of mpox in non-endemic countries and in line with the International Health Regulations, multi-country outbreak of mpox has been declared as Public Health Emergency of International Concern (PHEIC) by the World Health Organization (WHO).
The Border Health Services — Pakistan being the focal point for implementation of National “The Pakistan Aircraft” (Public Health) Rules, 1970 and International Health Regulations IHR-2005, has formulated following guidelines/ instructions for sister organizations i.e. Civil Aviation Authority (CAA), Federal Investigation Agency (FIA Immigration), Pakistan Customs, Antinarcotics Force (ANF) and Airport Security Force (ASF) working at Points of Entry (POEs) especially at all International Airports which envisaged as under:
GUIDELINES FOR THE FUNCTIONARIES
FOR PREVENTION AND CONTROL AT ARRIVAL
On Arrival
1. Air traffic control tower shall informBHS-P for safe disembarkation of the diseases suspected passenger.
2. To prevent the exposure from the suspected diseases passenger the aircraft will be allowed by the air traffic control tower to let disembark the said passenger at apron and not through routine channel of bridge area. The passenger will be accompanied with
BHS-P staff and Airline staff in the ambulance of CAA and moved further for isolation after immigration.
3. Civil aviation is directed to coordinate, cooperate and facilitate in above situation as and when required.
4. Immigration of the Suspect to be done by Airline staff from FIA under proper preventive measures. Handle the documents wearing mask and gloves and keep them in a zip lock.
5. The practice of protocols shall be stopped at once to prevent any chance of exposure from suspected disease passenger and further outbreak of diseases of international concern. In this regard all functionaries including CAA, FIA, ASF, ANF, Custom and Airlines
staff are hereby directed not to allow their staff /officials to do protocol and not let them to stand at and around the health counters to protect them self and to prevent further outbreak of the diseases. ASE and CAA in this matter are directed to make the necessary compliance of the above directives of BHS-P,
Wheel Chair Handlers (Airlines)
6. Staff carrying wheel chairs must observe protective measures. Ground handling agencies should provide them with masks and gloves.
7. Any sick passenger to be reported to the BHS-P staff at Airport.
Baggage handling
8. All baggage handlers must wear masks and gloves while handling baggage. BHS-P fumigators to carry out disinfection of all the baggage as soon as it is disembarked from the aircraft. BHS-P fumigator after such flight having diseases suspected passenger will
disinfect the luggage, luggage area, FIA counter Area, Health inspection Area, corridors, high touch surfaces ofescalator, toilets and as well as arrival lounge if any transit passengers stay there for next flight for deport where required in this connection the concerned airline Operators is held responsible to carry out all process under required Public Health Preventive measures
Guidelines for Health staff:
9. Wear proper PPE’s. Tyvek Suit, gloves and masks.
10. Do not come in close contact with passengers.
11. Observe each and every passenger vigilantly, one by one specially Umra pilgrims. Anyone observed with any skin lesion on exposed parts to be isolated immediately from the rest and inform team lead for further management and transfer for isolation.
12. Strict disinfection measures of the premises to be followed including toilets.
13. Proper disposal of used PPE’s.
CAA and ASF
14.CAA and ASF are hereby directed to manage the overcrowding of passengers smoothly and facilitate BHS
passes for protocol hence not to create the chances for the outbreak of such lethal diseases by such act.
15. Civil Aviation is directed to provide suitable place to BHS-P Airport Health Department at all International airports at cargo area as soon as possible so that the required screening of cargo goods/parcel/livestock could be done and no contaminated good with Mpox virus could reach in the country which may cause outbreak in the country from the infected region.
Porters (Airline)
16.CAA Porters handling baggage to wear masks and gloves while handling baggage.
17. Sanitize Trolley handles for Washing hands with soap and water thoroughly and frequently
FIA/Immigration
18. To observe public health preventivemeasures while handling the passengers.
19. Wear masks and gloves when handling passports and other documents of the passengers.
20. Wash hands thoroughly with soap and water and sanitize counter front and desk area after each flight.
Customs Staff
21. Customs officers / officials are hereby directed to follow Public health preventive measures properly by Wearing, masks, gloves and using sanitizer while handling and screening baggageand guiding the passengers at arrival
22. Frequent Hand hygiene and sanitization should be practiced.
23. Custom Authority is directed to submit the detail of consignment / detail of cargo (Goods or any livestock or Plants) being imported in the country as mentioned below.
24. Custom Authority is directed to get cleared the cargo / consignment / Goods etc. at arrival after Health clearance at airport and necessary Health clearance certificate will be issued by BHS-P through Airport Health Department.
ANF Officials
25. The officers / officials of ANF are directed to follow Public Health Preventive Measure including wearing PPE’s, mask, and gloves and using sanitizer while performing their duty for checking of baggage of the diseases suspected passenger
26. Wash hands thoroughly with soap and water after handling baggage.
27. Sanitization and disinfection of counters.
Janitors Cleaning Staff
78. Janitors and cleaning staff deputed to clean premises and toilets to wear masks and gloves for self-protection.
29.Use appropriate sanitation material to clean the toilets preferably household bleach (diluted)
30. Thorough washing of the toilets with detergent and bleach.
31. Disinfection of urinals.
32. Proper and safe waste disposal of toilets waste bins.
33. Frequent monitoring and supervision of hygienic and sanitary conditions of the Airport and its premises area.
Safe Disposal of Air Craft Waste
34.The concerned CAA agency engaged in proper safe disposal of aircraft waste should be directed to perform their task according to advised SOPs with the mechanism of monitoring and supervision of higher officers of CAA should be continued.
Lifts, Hand Rails and Baggage Trollies
35.As they come in frequent contact with passengers. These should be disinfected after each flight by BHS-P Staff and CAA.
IMPLEMENTATION OF GUIDELINES FOR MPOX
AT INTERNATIONAL SEAPORTS
The border Health Services Pakistan (BHS-P) being the focal point for implementation of National” The Port Health Rules-1974 and International Health Regulation-2005, has formulated the following guidelines/Instructions for sister organization working at Seaports of Pakistan.
1. No personnel from any agency should be allowed to get on board of the ships/Conveyance before the Port Health Department visit and inspection of the ship and Health Clearance irrespective of the origin of the ship Voyage.
2. No Personnel from any Agency/Department should be allowed to get on board without proper PPE’s (personal protective equipment) irrespective of non-endemic Mpox reporting countries bound/voyaged ships or other.
3. All the Pax/Crew on the board is advised to use PPE’s including mask and gloves.
4. For all Pakistani crew arriving, there is no obligation to sign off if the personnel did not visit any effected shores/ Port of country within last 21 days or has a history of contact. In case of a crew coming from a Mpox endemic country should be strictly advised for Home Quarantine for 21 days.
5. All the second-hand goods/ containers must be Disinfected/Fumigated under the supervision of Port Health Department and certified by the Port Health Officer.
6. The Pakistan Customs is advised to include the Fumigation Certificate of Port Health Department in their system Web Based One Custom (WeBOC) and give access to BHS-P and Port Health Department for submission and verification of Health Documents. It is necessary that WeBOC is required so that we could trace out the origin of contamination of the goods from the infected region.
7. All health-related data must be shared with the Port Health Authorities on daily/regular basis.
8. All Port authorities are hereby directed to take routine preventive health measures like fumigation disinfection or disinsection etc within the territory of the port of berth area under the supervision of Port Health Officers.
9. All International Health documents required routinely as per International Agreement (IHR-2005 etc.) remain intact.
10. In case of a suspected crew on board the master of the ship is advised to stay on the outer anchorage of the port and immediately inform the BHS-P about the case.
11.In case of a suspected case on board the ship Master/Ship Surgeon immediately isolate the suspected crew in his room or a specified area for this purpose. The Ship Master without any delay must inform the Port Health Authority about the case for further necessary Health
measures.
12. In case of a confirmed Mpox case on board, all the Crew must be quarantine for 21 days and should not be allowed any shore leave.
13. In case of a confirmed case on board the ship should undergo proper disinfection/Fumigation procedures under the supervision of Port Health Department.
14. Strict personal hygiene including frequent hand washing practices should be encouraged.
15. The Animal Quarantine Department is directed to take necessary preventive measures while handling the animals as Mpox is zoonotic disease spread from animal to human being.
IMPLEMENTATION OF GUIDELINES FOR MPOX AT
LAND CROSSING FUNCTIONARIES/SISTER AGENCIES
1. All functionaries are hereby directed to take Public Health preventive measures while performing their duties and if found anyone suspected to have communicable disease then report to BHS-P staff posted at that area.
2. Ensure monitoring/screening of passenger and disinfection of baggage cargo arriving from affected areas in the containers (I trucks) or carried in hand by person without vehicle so that they are maintained in such a condition that they are free of contamination.
3. Custom is directed to submit the detail of the containers (loaded with goods / livestock and coming from which region whether infected or non-infected with Mpox).
4. BHS-P Staff is directed to screen the passenger coming in the vehicle or pedestrian through thermal scanner and by observation being properly dressed with PPE.
5. Incase if any passenger is suspected to have communicable disease and coming from the infected region of Mpox then he/she will be deported or quarantined in isolation center (if foreigner) and allowed to come for home quarantine for 21 days if National.
6. Proper Screening of container truck drivers and assistance through thermal guns and obtaining health declaration form.
7. Fumigation/Disinfection of containers when required under the supervision of BHS-P staff,
Provision of Security:
8. The Ministry of Interior will issue advisory to the IGP, Islamabad for provision of Police Mobile Van with Officers at arm who will ensure safely transfer of suspected or confirmed cases from Airport premises to Quarantine Facility in collaboration with Border Health Services- Pakistan. The Police Mobile will remain present outside the Airport Premises 24/7 till the end of ongoing pandemic (PHEIC-Monkeypox). They will ensure the safety of Ambulance or the transport vehicle having suspected/ confirmed passengers.
9. The Chief Secretary of the Province (KPK, Gilgit, Punjab, Sindh, Baluchistan) will issue advisory to the Inspector General of Police (IGP) (concerned) for provision of Police Mobile Van with Officers at arm who will ensure safely transfer of suspected or confirmed cases
from Airport premises/ Land Crossing border to Quarantine Facility in collaboration with Border Health Services-Pakistan. The Police Mobile will remain present outside the Airport Premises/ Land Crossing Border 24/7 till the end of ongoing pandemic (PHEIC- Monkeypox). They will ensure the safety of Ambulance or the transport vehicle having suspected/confirmed passengers.
Disposal of Biomedical Waste/Aircraft Waste
10. Keeping in view the ongoing Pandemic, the Secretary Ministry of Aviation will direct the Civil Aviation Authority (CAA) to ensure the safe discarding of Bio Medical Waste of the premises and the waste of Aircraft of any type.
11. The Chief Secretary of the Province (KPK, Gilgit, Punjab, Sindh, Baluchistan) will issue directions to Local Waste Management Authority who will ensure the safe discarding of Bio Medical Waste of the premises of any type.
Shifting of Passengers/Timely intimation to BHS-P
12.The Airline concerned will be responsible for shifting of confirmed/suspected cases if come in bulk to be shifted from Airport Premises to Quarantine Facility on their own transport with the collaboration of Border Health Services-Pakistan.
13. The Airline concerned will be held responsible for timely intimation of deportees to border health services Pakistan through their country representative minimum 03 hours before the arrival of the aircraft in country.