Academic journal article Bulletin of the World Health Organization

Entry and Exit Screening of Airline Travellers during the A(H1N1) 2009 Pandemic: A Retrospective Evaluation/ Depistage D'entree et De Sortie Des Passagers Aeriens Au Cours De la Pandemie De Grippe A(H1N1) En 2009: Une Evaluation retrospective/Deteccion Sistematica En Las Entradas Y Salidas De Pasajeros De Avion Durante la Pandemia De la Gripe A (H1N1) En 2009: Evaluacion Retrospectiva

Academic journal article Bulletin of the World Health Organization

Entry and Exit Screening of Airline Travellers during the A(H1N1) 2009 Pandemic: A Retrospective Evaluation/ Depistage D'entree et De Sortie Des Passagers Aeriens Au Cours De la Pandemie De Grippe A(H1N1) En 2009: Une Evaluation retrospective/Deteccion Sistematica En Las Entradas Y Salidas De Pasajeros De Avion Durante la Pandemia De la Gripe A (H1N1) En 2009: Evaluacion Retrospectiva

Article excerpt

Introduction

New infectious diseases appear to be emerging faster now than ever before, and many diseases that were once controlled are re-emerging. (1) These trends are probably driven by the convergence of various global forces, including growth in the human population, urbanization, changes in the interactions between human and animal populations, climate change, and increases in international travel and trade. (2-6) Each year, more than 700 airlines transport over 2.5 billion (i.e. 2500 million) travellers between 4000 airports. While growth in air travel confers tremendous benefits to humankind, it also expands the opportunities for local infectious disease outbreaks to transform swiftly into international epidemics that can threaten global health, security and prosperity. (7,8) In 2005, in response to the changing patterns observed in the global spread of several infectious diseases, the World Health Assembly ratified changes to the 1969 International Health Regulations. (9) The stated aims of the revised regulations were "to prevent, protect against, control and provide a public health response to the international spread of disease in ways that are commensurate with and restricted to public health risks, and which avoid unnecessary interference with international traffic and trade". (9) These aims can be achieved by addressing the local conditions that contribute to the emergence of epidemics of infectious disease and--if such prevention fails--by tackling local infectious disease outbreaks before they evolve into international events. Since public health capacity can be easily overwhelmed, particularly in resource-limited countries, some infectious disease epidemics will inevitably spread across international borders. (10) In these instances, national authorities worldwide will face difficult, time-sensitive decisions about whether the entry screening of international travellers is warranted. These decisions require not only a clear, a priori articulation of the goals of traveller screening--specifically, whether the objective is to prevent the importation of a pathogen or just to delay such importation and so "buy" a little time to enhance preparedness --but also rigorous assessments of the expected costs and benefits of screening and of the probability of its success (with estimates of uncertainty), as well as predictions of the morbidity and/or mortality that could be averted by screening.

While outright travel restrictions are generally regarded as excessively disruptive, current opinions on the health screening of travellers--and the best strategies to adopt--are mixed. (11-18) In attempts to model the public health impact of traveller screening, little attention has been paid to the location of the cities that are contemplating screening in relation to the location of the epidemic or pandemic of interest within the global air transportation network. Decisions about traveller screening are frequently made on the basis of suboptimal evidence and, inconsequence, may be unduly influenced by public or political perception of the risks to health posed by a particular pathogen. Recently, a panel of international experts in the field evaluated the performance of the 2005 International Health Regulations during the influenza A (H1N1) 2009 pandemic and highlighted the need for stronger evidence to justify any public health measures that could substantially disrupt international travel and trade. (19) The panel recommended that the World Health Organization review and assess the effectiveness and impact of the border measures that were implemented during the A(H1N1) 2009 pandemic, to provide evidence-based guidance for managing future infectious disease events of international concern. (20) Responding to this recommendation, we studied worldwide patterns of air travel to and from Mexico, the country where the A(H1N1) 2009 pandemic presumably began, (19) both before and during the pandemic. A central aim of this study was to define and distinguish screening measures that are "commensurate with and restricted to public health risks" from those that cause "unnecessary interference with international traffic". …

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