This guideline assists human biosecurity officers (HBOs) in NSW to assess and manage the risk of listed human diseases posed by aircraft and maritime vessels entering Australian territory at a first point of entry in NSW. It should be used to assist in carrying out duties under the Biosecurity Act 2015 (Commonwealth).
In addition to this Guideline, NSW public health units (PHUs) with first points of entry in their jurisdiction are required to ensure that local policies supporting the implementation of this Guideline are in place.
Human biosecurity officers (HBOs) should undertake decisions and actions that:
This Guideline is intended for use by NSW Health medical officers authorised as HBOs, including the NSW Chief Human Biosecurity Officer (CHBO).
Note, this document should be read in conjunction with the Biosecurity Act 2015 (Commonwealth) and the NSW Health Policy Directive Early Response to High Consequence Infectious Disease (PD2024_005).
Human biosecurity officers (HBOs) are required to:
The NSW CHBO is required to:
This Guideline is intended for all NSW Health medical officers designated as human biosecurity officers (HBOs) under the Commonwealth Biosecurity Act 2015 (the Biosecurity Act). This Guideline focuses on how to assess for the likelihood of a listed human disease, and subsequent case management options.
This Guideline also provides high-level advice on common public health risks that HBOs may encounter such as acute respiratory infections and acute gastroenteritis outbreaks on cruise ships.
This Guideline is applicable to aircraft and vessels. Where there is a protocol specific to a type of aircraft or vessel, it is appended to this Guideline.
Aircraft For the purposes of this Guideline, aircraft means any machine or craft that can derive support in the atmosphere from the reactions of the air, other than the reactions of the air against the earth’s surface. This includes commercial or non-commercial flights entering Australia that originated outside Australian territory for this Guideline
Cruise vessel As per the Biosecurity (Negative Pratique) Instrument 2016 (Commonwealth), a cruise vessel means a passenger vessel that is usually used to provide a service of sea transportation, being a service that:
Disease
Negative pratique As per section 49 of the Biosecurity Act 2015, negative pratique arises where the Director of Human Biosecurity (Commonwealth Chief Medical Officer) prescribes classes of aircraft or vessels that are subject to negative pratique, that is, must comply with requirements before a biosecurity officer (BO) will grant pratique.Information on the classes of aircraft/vessels subject to negative pratique and the compliance requirements is set out in the Biosecurity (Negative Pratique) Instrument 2016 (Commonwealth) made under subsection 49(1) of the Biosecurity Act.
Note, cruise vessels and non-commercial vessels will arrive in negative pratique. They require further assessment by the BO before pratique can be granted. Aircraft and other commercial vessels will generally arrive in positive pratique at the first point of entry.
Non-commercial vesselAs per the Biosecurity Regulation 2016, non-commercial vessel means a vessel that is used, or is intended to be used, wholly for recreational purposes (whether or not crew are employed on the vessel).
Positive pratique
As per section 48 of the Biosecurity Act 2015, positive pratique is when an aircraft or vessel arrives in Australian territory, pratique is granted by force of subsection 48(2) of the Biosecurity Act [positive pratique], unless the class of aircraft or vessel is one for which pratique must be granted by a BO.
Pratique
Pratique is granted under Division 4 of the Biosecurity Act for incoming aircraft and vessels. Pratique allows things to be unloaded from, and persons to disembark from, aircraft or vessels. Pratique also allows things to be loaded onto, and persons to embark on, aircraft or vessels.
Pratique can be granted by force of the Biosecurity Act (positive pratique) or by a biosecurity officer (BO) (negative pratique) where the criteria for positive pratique under the Biosecurity Act have not been met.
Pre-Arrival Report A pre-arrival report (PAR), in relation to an aircraft or vessel, means a report given by the operator of the aircraft or vessel under section 193 of the Biosecurity Act 2015.As per section 193, the PAR provides information on aircraft or vessels entering or intending to enter Australia. For a vessel, the PAR provides information about the vessel, arrival details, sanitation, human health and biosecurity.For an aircraft, a PAR is submitted if there is illness or death of a person on the aircraft.
Traveller with illness checklist The primary assessment tool used at the Australian border to screen for the presence of listed human diseases. It is administered by a biosecurity officer (BO).
Vessel For the purposes of this Guideline, a vessel:
The Biosecurity Act, among other subject matter, sets out the approach for assessing and managing human health risks posed by travellers on international aircraft and vessels entering Australia. While the Australian Government Department of Health and Aged Care is responsible for administering human health aspects of the Biosecurity Act, administrative arrangements are in place for BOs from the Australian Government Department of Agriculture, Fisheries and Forestry (DAFF) to perform these functions with support from state and territory health departments at Australia's international borders.
Under the Biosecurity Act, the following positions have a role in biosecurity clearance:
The Director of Biosecurity is a position held by the person in the role of the Secretary of DAFF. This individual authorises BOs and can provide approval for:
Biosecurity officers are DAFF employees authorised by the Director of Biosecurity. These individuals assess and manage human, animal and plant health, and environmental biosecurity risks at Australia's borders. Human health activities include gathering information, assessing passengers where indicated, imposing limited measures through a human biosecurity control order (HBCO), and granting pratique for aircraft and vessels subject to negative pratique. BOs seek advice from HBOs as required. A BO or biosecurity enforcement officer has the power to enter premises at a landing place or port in Australian territory.
The Director of Human Biosecurity is a position held by the person in the role of Commonwealth Chief Medical Officer. This individual authorises Chief Human Biosecurity Officers (CHBOs) and HBOs, can review measures imposed by a HBCO and holds legislative powers, one of which is to determine the requirements for negative pratique.
Chief Human Biosecurity Officers are state and territory officers authorised by the Director of Human Biosecurity – in NSW this position is usually held by the Director of Communicable Diseases Branch, NSW Health. This individual nominates HBOs in their jurisdiction, is a contact point for the Commonwealth and performs the functions of a HBO.
HBOs are state or territory health employees with appropriate clinical expertise and are authorised by the Director of Human Biosecurity. These individuals assess and manage human biosecurity risks, including imposing human biosecurity control orders where required and providing advice to BOs on public and human health risks that may arise on incoming aircraft and vessels that are subject to negative pratique.
The NSW Health Border Management Governance Committee (the Committee) institutes administrative arrangements to determine which HBOs take primary responsibility for each port of first entry.
Arrangements for lead HBOs are as outlined in Agreed allocation of HBO lead agency below. Depending on capacity of local health districts, lead HBO designation may change over time if approved by the Committee.
As per subsection 42(1) of the Biosecurity Act 2015 (Commonwealth), the Director of Human Biosecurity has the power to determine that a human disease is a 'listed human disease' if the Director considers that the disease may be communicable and cause significant harm to human health.
The Director of Human Biosecurity must first consult with the chief health officer for each State and Territory and the Director of Biosecurity. Listed human diseases are enacted by and added to the Biosecurity (Listed Human Diseases) Determination 2016 (Commonwealth). There are currently 8 listed human diseases2.
The Biosecurity Act 2015 (Commonwealth) provides the legislative framework for the human biosecurity powers. Relevant powers under the Biosecurity Act can only be used in relation to listed human diseases. Powers of HBOs under the Biosecurity Act 2015 (Commonwealth) are directly linked to assessing and managing listed human disease risk, with one of the most significant being the imposition of a human biosecurity control order (HBCO). A HBCO can only be imposed if a person has symptoms or signs of a listed human disease, was exposed to a listed human disease or did not comply with entry requirements relating to a listed human disease.
Most calls from a biosecurity officer (BO) from the airport or other first points of entry are likely to be requests to assess and manage illness in a traveller or manage contacts of an ill or deceased traveller. In these situations, the main task of the HBO is to assess the probability of a listed human disease and, if required:
Listed human diseases are also Category 4 notifiable conditions in NSW under the Public Health Act 2010 (NSW) [Public Health Act], except yellow fever, plague and smallpox which are Category 3 conditions. While human coronavirus with pandemic potential is still a listed human disease (LHD), the Australian Government Department of Health and Aged Care considers that COVID-19 no longer constitutes a human coronavirus with pandemic potential. Therefore, COVID-19 is no longer treated as a LHD for the purposes of the Biosecurity Act 2015. However, COVID-19 is still a notifiable condition in NSW under the Public Health Act.
If HBOs suspect a person has signs or symptoms of a listed disease and/ or other suspected diseases, a HBO should read this Guideline in conjunction with the NSW Health Policy Directive Early Response to High Consequence Infectious Diseases (PD2024_005).
Note, that the human influenza with pandemic potential listed human disease is equivalent to the Category 4 condition avian influenza in humans, in the NSW Public Health Act.
The NSW Public Health Act also has provisions for making a public health order for Category 4 and 5 conditions under certain circumstances. This is generally the preferred approach rather than using a human biosecurity control order.
A public health order may require the person subject to the order to be detained at a specified place for the duration of the order or undergo specified treatment at a specified place or to be detained at that place while undergoing the treatment.
Detailed information about each of the listed human diseases can be found in the NSW HealthControl Guidelines and the Communicable Diseases Network Australia (CDNA) Series of National Guidelines (SoNGs) for that notifiable condition.
Table 2 below provides an overview of transmission modes and potential infectious periods for listed human diseases.
Table 3 (formatted as list below) provides a guide to the key signs and symptoms, epidemiology and likely exposure risks for each listed human disease.
Human influenza with pandemic potential
Severe acute respiratory syndrome (SARS‑CoV‑1)
MERS‑CoV
VHF (including Ebola virus disease)
Smallpox
Yellow fever
Plague
Human coronavirus with pandemic potential 4
The majority of calls from a biosecurity officer (BO) to a human biosecurity officer (HBO) are triggered by:
All vessels (commercial, cruise vessel and non-commercial) arriving to a NSW port from an international location are required to provide information on any ill or deceased travellers as part of Commonwealth pre-arrival processes.
For most vessels, the timeframe for vessels to provide their PAR is 12-96 hours prior to arrival. Non- commercial vessels are required to report 12 hours – 90 days prior to arrival. A PAR which is submitted through the Maritime Arrivals Reporting System (MARS) is used to indicate illness, including signs and symptoms of listed human disease (LHD). Vessel operators must also provide additional information (generally in the form of an updated PAR) if the information, including human health information, in the previous report is no longer current.
Aircraft are also required to provide a PAR if there is death or LHD risk on board. The PAR must be provided either at the top of descent or 30 minutes before the aircraft is estimated to come to a standstill on arrival, whichever is earlier 5. However, ill travellers on flights are usually managed via TICs.
International vessels with their first Australian port of entry outside of NSW that continue to a port in NSW (or elsewhere) are required by the Department of Agriculture, Fisheries and Forestry (DAFF) protocols to update the human health report within the PAR human health report (HHR) if health conditions on the vessel change significantly. Generally, this would consist of a rapid increase in the number of cases, multiple outbreaks, or death(s) on board the vessel.
If any reports indicate a concern for the presence of a listed human disease on board, the biosecurity officer (BO) will assess the information provided, and contact the relevant HBO for the point of entry as appropriate (see agreed allocation of HBO lead agency).
The HBO will make an assessment with consideration of the PAR and any additional information provided by the vessel.
A BO will administer a TIC when reviewing an ill traveller to determine the management pathway and whether to escalate to a HBO. The Traveller with Illness Checklist is included in resource list.
It is important to remember that BOs do not have any medical training and will contact a HBO when certain symptoms are reported in the TIC as indicated by the TIC algorithm.
The TIC will be administered in one of four settings:
Any call from a biosecurity officer (BO) is potentially a call about the possibility of a listed human disease in a traveller on an aircraft or vessel prior to disembarkation of passengers. Therefore, it is essential that calls from a BO relating to TICs are actioned immediately as they may be coming from a vessel or aircraft with many passengers waiting to disembark or load or unload cargo.
For both the maritime and air pathways, the BO will begin by attempting to call the jurisdictional HBO (see agreed allocation of HBO lead agency for the responsible unit for each port) as the first point of contact. If the HBO does not answer or respond within 5 minutes the BO will call the second point of contact (CDOnCall or the relevant jurisdictional contact). If no response is received within 5 minutes the BO will then attempt to call CDOnCall again. Finally, if no response is received within 5 minutes the BO will then contact the National Incident Centre (NIC) for advice.
For the purposes of aircraft pratique, if the BO is on-board the aircraft and has not received a response from the second point of contact, the officer must orally grant pratique to the aircraft and will escort the ill traveller(s) to an area for health screening to continue the assessment process.
For the purposes of vessel pratique, the HBO must provide the following within 3 business hours:
For vessels, the National Maritime Centre (NMC) will provide the ship with an outcome of the HBO assessment as soon as it becomes available.
Use the NSW Health Human Biosecurity Officer Response Form (see resource list) to record the following incident details:
The HBO is to ask the BO, and if necessary, the ill traveller, accompanying travellers or other relevant people directly 'on speakerphone' or on a video call, about symptoms, date of onset, precise timing of travel in countries with the listed human disease, and all potential listed human disease exposures. For example, contact with camels for MERS- CoV.
In general, outside of a pandemic, the probability of listed human diseases in returning travellers is very low as the listed human diseases are uncommon (yellow fever, MERS- CoV) or exceptionally rare (others). For there to be a reasonable possibility of a listed human disease in a traveller entering Australia, there should usually be:
The assessment of probability of a listed human disease is based on best judgement. There may be situations where the above criteria are not met or the information is unknown but the clinical suspicion of a listed human disease remains high. For example, a traveller presenting with clinical features of a viral haemorrhagic fever without a known epidemiological link to an endemic or outbreak area.
Step 1: Determine and implement the most suitable patient management option, from the following:
See below What to do if you decide no further action is required.
Step 2: Provide human biosecurity advice to the BO in relation to the granting or withholding of pratique if required.
The human health assessment will inform the advice given to the BO about granting of pratique.
Undertake the following immediately:
And undertake the following on the next business day:
The Chief Human Biosecurity Officer (CHBO) will arrange for the Traveller with Illness Checklist (TIC) to be attached to the NCIMS record when the TIC is received from the Australian Government Department of Health and Aged Care.
Step 1: Provide human biosecurity advice to the BO in relation to the granting or withholding of pratique if required.
If there is reasonable belief that other passengers were exposed to a listed human disease, then advice should be given that pratique be withheld until passengers who were potentially exposed are identified and managed prior to disembarkation of the aircraft/ vessel. The BO should inform the HBO of any significant changes to the human health status of the vessel as they are reported.
Advise the BO of additional management actions for the vessel/ aircraft (written directions). The BO will inform the vessel.
Step 2: Advise course of action for contact management and environmental management. For more information on these options, see Advise on any required contact management and environmental management. DAFF should communicate directions/ plan of action from HBO immediately to key stakeholders (Australian Border Force (ABF), Port Authority of NSW, relevant port operators and Australian Maritime Safety Authority (AMSA)).
DAFF should ensure these stakeholders are updated as required and may coordinate a teleconference of relevant stakeholders to communicate the plan and coordinate logistics.
Step 3: Hospital transfer direct from the port of entry should generally be arranged if a listed human disease is suspected AND the person is potentially infectious (see Table 2) or is unwell even if not potentially infectious.
Undertake the following:
The Contact details for NSW Health and relevant agencies is included in resource list.
If you assess that the ill traveller has a suspected listed human disease and requires a hospital transfer or a human biosecurity control order (see Considerations for non-compliant travellers), you can take the following steps to allow pratique to be granted:
Step 1: Discuss via phone call the matter immediately with the NSW CHBO. If the NSW CHBO is unavailable, contact the Executive Director Health Protection NSW or NSW Chief Health Officer. See Contact details for NSW Health and relevant agencies, available in resource list.
Step 2: Advise that there is no reason to withhold pratique provided the following information about every passenger and crew member can be obtained within 2 hours of clearing immigration:
To expedite the process, for example, the BO can take the steward's copy of the passenger and airline staff manifest and take photos of the incoming passenger cards.
As per the AHPPC national approach to cruise ship reporting, cruise vessels should provide within 4 hours when requested an accurate manifest of personal contact details (such as email addresses and phone numbers) for passengers and crew to NSW Health. If disembarkation has already occurred, consider requesting the collection of contact details of ground staff who may have been exposed to the case.
For commercial vessels, the ship's agent or vessel operator could be approached for the manifest.
Step 3: If a listed human disease is suspected on a vessel, provide the local service agent of the airline or shipping agent with information on infection control measures to minimise the risk of infection (see Advise on any required contact management and environmental management).
Step 4: Manage the case as per hospitalisation/ human biosecurity control order as determined.
Step 5: Send an email summary of the situation to the NSW CHBO, NSW Chief Health Officer, Executive Director Health Protection NSW and Communicable Disease (CD) On-Call.
An HBO can consider the following options when a listed human disease is suspected AND the person is potentially infectious (see Table 2) AND non-compliant with public health recommendations. This includes refusing transfer to hospital or not complying with a request from a biosecurity official to provide information or to remain within an area at a port.
An HBO should also consult the Human Biosecurity Control Orders Policy and Human Biosecurity Control Order Frequently Asked Questions when making considerations (see resource list).
For possible human influenza with pandemic potential and human coronavirus with pandemic potential, no clear advice is possible at present on threshold for hospitalisation/ human biosecurity control order. See advice at time of pandemic.
For possible severe acute respiratory syndrome (SARS) there should be a presumption of transfer of a suspected case to hospital in airborne, contact and droplet transmission-based precautions. In the absence of confirmed SARS cases in the world at present, a human biosecurity control order is not likely to be justifiable.
For possible Middle East respiratory syndrome (MERS-CoV), the threshold for transfer to hospital is presence of pneumonia and travel to countries with active cases, but to impose a human biosecurity control order probably requires pneumonia AND at least one of either confirmed case contact / camel exposure / healthcare exposure in a country with active cases.
For possible viral haemorrhagic fevers (VHFs), refer to the Response to suspected or confirmed viral haemorrhagic fever, addendum of the NSW Health Policy Directive Early Response to High Consequence Infectious Diseases (PD2024_005).
For possible smallpox, no clear advice is possible at present, as there are no declared cases. A human biosecurity control order is unlikely to be required as patients are typically gravely ill.
For possible yellow fever, consider hospitalisation for any suspected case who is unwell. A human biosecurity control order is unlikely to be justifiable even if non- compliant given lack of infectiousness to humans, unless the traveller is indicating an intention for onward travel to an area where there are mosquito vectors competent to transmit yellow fever (such as dengue-receptive areas of North Queensland).
For possible plague, hospitalisation is highly recommended given poor prognosis without rapid antibiotics. A human biosecurity control order should be considered if non- compliant with any form of plague, especially pneumonic, however patients are usually so unwell it would not be necessary.
For yellow fever:
For plague:
An HBO can also consult the NSW Health Policy Directive Early Response to High Consequence Infectious Diseases (PD2024_005) and contact the NSW Specialist Service for High Consequence Infectious Diseases for further infection control advice as needed.
Escalate to the NSW CHBO, or Executive Director Health Protection NSW if the NSW CHBO is unavailable:
See Contact details for NSW Health and relevant agencies, available in resource list.
If an escalated public health response is identified, this is likely to require a coordinated public health response, including:
A decision to initiate an escalated public health response should be taken in discussion with the NSW CHBO, Executive Director Health Protection NSW, NSW Chief Health Officer, local health district (districts) public health unit director and district chief executive or delegate, such as the health services functional area coordinator (HSFAC) of the relevant district. If a decision is made to escalate a public health response, NSW Health Pathology (NSWHP) should be informed through either the NSWHP Public Health Pathology or the Chief Executive of NSWHP.
If state-level coordination arrangements are required, this can be facilitated with the State Preparedness and Response Unit (SPRU). The SPRU will also be key to supporting any centralised incident command structure (ICS).
For the State Health Services Functional Area Coordinator contact details see Contact details for NSW Health and relevant agencies available in resource list.
For incidents involving Sydney Kingsford Smith International Airport or the international seaports in South Eastern Sydney Local Health District (SES district) there will likely be implementation of the SES LHD Communication and Response Protocol for Border Health Incidents Related to an Infectious Disease.
Acute respiratory infections [ARI] (including COVID-19 and influenza) and acute gastroenteritis (AGE) are not listed human diseases but can still pose a public health risk and are known to cause occasional outbreaks on vessels and aircraft.
Additionally, there are differing requirements for managing these health events across jurisdictions. The public health response to ARI and AGE outbreaks will be guided by:
People identified at the airport with suspected or confirmed ARI or AGE should be advised to seek their own medical attention and refer to the following guidance for more information:
An HBO may be notified of a cruise or commercial vessel reporting an acute respiratory and/ or gastrointestinal infection outbreak. Once an assessment is undertaken and excludes the probability of a listed human disease, the HBO or relevant local health district public health unit should follow the Protocol for the management of confirmed/suspected infectious disease outbreaks or listed human disease on vessels.
Where a request is received for a crew member or passenger with respiratory symptoms requiring medical care, the relevant local health district public health unit should be notified to assist with an initial health assessment and response.
A health response may include:
This Resource list contains documents for internal use only.
* The most up-to-date version of these documents can be found on the GovTeams HBO page.