Hundreds of people at major U.S. airports each year are severely ill with symptoms of potentially contagious diseases, yet few are reported to health officials as intended under U.S. regulations and international guidelines, USA TODAY reported in a review of ambulance records and federal data. To detect diseases such as pandemic flu, tuberculosis and measles, federal regulations require airlines to notify health officials of passenger illnesses involving diarrhea or fever plus rash, swollen glands or jaundice. The International Civil Aviation Organization, a United Nations agency, also includes persistent vomiting or coughing in its guidelines. Concerns about fliers spreading dangerous diseases have been fueled by the 2003 SARS outbreak, high-profile tuberculosis patients and the H1N1 flu pandemic. In 2009, the Centers for Disease Control and Prevention’s (CDC) twenty U.S. regional quarantine stations received 1,623 reports of illnesses or deaths involving airline passengers, data obtained under the Freedom of Information Act show. Yet in some CDC regions, ambulance records at a single airport show far more people receiving emergency medical treatment for illnesses than were reported from multiple states. Under-reporting is a concern because the CDC cannot assess what it does not know about, and in some cases it has learned of unreported deaths, the director said.

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