Public Transport and H1N1

In the era where infectious illnesses and diseases are widespread, public transportation systems need to provide a safe and healthy environment for both passengers and workers. Gershon and colleagues (2005) carried out a structured review of scientific and grey literatures on subway safety from either the mass transit or passenger perspective. These literatures were sought out from Medline, Ovid, Embase, Cochrane Database of Systematic Review, HealthStar, and CINAHL. They found that apart from general safety (e.g., injuries), violence, and noise (which are the major hazards potentially associated with subways), another major concern relates to the widespread of illnesses and diseases. Here is an excerpt of this article on this issue:

"Another potential health hazard related to subways is the transmission of infectious diseases communicable through close person-to-person spread, or indirectly, through contact with a contaminated fomite (inanimate object). Although it is not inconceivable that both respiratory and gastrointestinal pathogens could be spread this way, this has not been documented. Similarly, transmission of various diseases of the skin and hair [e.g., tinea capitis, ringworm of the scalp, and head and body lice (Pediculus humanus)] may also occur, either through direct contact with infected persons, or indirectly through contact with contaminated objects (e.g., seat backs, clothing). Again, this has been not documented to occur. Because rats may be a problem in some subway systems, it is important to consider diseases that may be spread by these rodents. In particular, Streptobacillus moniformis (rat bite fever), although uncommon in North and South America and most European nations, is a concern because it can be readily spread from infected rats to human through rat bites, which have been anecdotally reported to occur on subways.

Prevention of disease transmission includes maintenance of ventilation systems to lessen the likelihood of respiratory transmission of diseases and adequate sanitation of the system, including periodic disinfection of subway surfaces for other types of pathogens.

At the individual level, hand hygiene is important, including hand washing after leaving the subway and being careful to keep hands away from eyes and mouth during the trip. Control of rats is essential.

Source:
R. R. M. Gershon, K. A. Qureshi, M. A. Barrera, M. J. Erwin, and F. Goldsmith (2005). Health and Safety Hazards Associated with Subways: A Review. Journal of Urban Health: Bulletin of the New York Academy of Medicine, Vol. 82, No. 1: p.17.


Influenza A (H1N1): Guidelines for the public transport industry
Source: Ministry of Health Malaysia

A pandemic influenza a virus (H1N1) is a newly discovered strain of the influenza virus which has infected humans in many countries around the world. The virus is constantly spreading and it is imperative that measures are taken to control this spread among the people. The public transport industry deals with the movement of large numbers of people on a daily basis and measures have to be taken to ensure that the spread of the virus is kept in check.

On Board Measures

• Where possible announcement to be made on board (train and bus) for passengers with the symptoms of influenza A (H1N1) to identify themselves.
• Transport operators, conductors or drivers of public transport should be vigilant and take necessary precautionary measures if there are passengers displaying symptoms such as high fever, headache, coughing and difficulty in breathing.
• Passengers identified as suspects are to be given appropriate protective masks and they should be isolated at the rear section of the bus allowing two rows of seats vacant in front and at the back.
• Toilets should be cleaned regularly and adequate soap and tissues should be provided for the use of such passengers at all times.
• Suspects should be advised to seek medical treatment.
• Adequate signages should be present to inform passengers regarding precautionary measures.
  

Maintain good ventilation in vehicles

• Open the windows whenever possible to ensure good ventilation.
• For closed vehicle compartments, clean the air-conditioning system frequently to maintain a clean environment.

Keep Vehicle Compartments Clean

• Make waste bins available for passengers’ use.
• Wash/wipe vehicle compartments (surfaces, door handles, railings) with diluted sodium hypochlorite (mixing 1 part of sodium hypochlorite with 99 parts of water) regularly.
• Make tissue paper available for passengers’ use when necessary.
• Make vomit bags available for passengers' use.
• If vehicle compartments are contaminated with vomitus or other body fluids, wash or wipe with diluted sodium hypochlorite (mixing 1 part of sodium hypochlorite with 49 parts of water) immediately.
• Persons doing the disinfection of the vehicle should wear mask, disposable apron and glove.
• Hygienic practices like washing of hands with water and soap or alcohol-based hand sanitizes after removal of the gloves should be practiced.
• All protective equipment are to be disposed off with due care.
  

Advice to Passengers:

• Observe personal hygiene.
• Wash hands with soap and water
• Avoid touching eyes and nose
• Cover the nose and mouth with handkerchief or tissue paper when sneezing or coughing.
• Dispose of used tissue paper appropriately.
• Use a vomit bags to hold vomitus and dispose of it properly.
• Consult a doctor promptly if they develop symptoms of respiratory tract infection.
• Passengers with respiratory symptoms are advised to wear masks to reduce the chance of spread of the infection.

Advise to Drivers and Conductors

• To observe personal hygiene.
• Wash hands before and after work
• Don’t rub eyes or nose
• Do self temperature monitoring before and after work shift.
• Inform management if he develops fever and other symptoms of Influnza A (H1N1)