lunes, 22 de diciembre de 2014

Ahead of Print -Evaluation of Border Entry Screening for Infectious Diseases in Humans - Volume 21, Number 2—February 2015 - Emerging Infectious Disease journal - CDC


Ahead of Print -Evaluation of Border Entry Screening for Infectious Diseases in Humans - Volume 21, Number 2—February 2015 - Emerging Infectious Disease journal - CDC

Volume 21, Number 2—February 2015


Evaluation of Border Entry Screening for Infectious Diseases in Humans

Linda A. SelveyComments to Author , Catarina Antão, and Robert Hall
Author affiliations: Curtin University, Perth, Western Australia, Australia (L.A. Selvey, C. Antão)Monash University, Melbourne, Victoria, Australia (R. Hall)


In response to the severe acute respiratory syndrome (SARS) pandemic of 2003 and the influenza pandemic of 2009, many countries instituted border measures as a means of stopping or slowing the spread of disease. The measures, usually consisting of a combination of border entry/exit screening, quarantine, isolation, and communications, were resource intensive, and modeling and observational studies indicate that border screening is not effective at detecting infectious persons. Moreover, border screening has high opportunity costs, financially and in terms of the use of scarce public health staff resources during a time of high need. We discuss the border-screening experiences with SARS and influenza and propose an approach to decision-making for future pandemics. We conclude that outbreak-associated communications for travelers at border entry points, together with effective communication with clinicians and more effective disease control measures in the community, may be a more effective approach to the international control of communicable diseases.
Many countries instituted border screening in response to the severe acute respiratory syndrome (SARS) pandemic of 2003 and the influenza A(H1N1)pdm09 virus pandemic of 2009, and although not formally evaluated, the experiences of several countries have been documented (111). Given the recent emergence of the influenza A(H7N9) virus in many parts of China (12), Middle East respiratory syndrome coronavirus in Saudi Arabia (13), and the current, most widespread Ebola outbreak in Africa (14), it seems timely to consider the costs and the effectiveness of border screening, as shown by recent experiences. Herein, we discuss the use of border-screening measures instituted during the 2003 SARS pandemic and the 2009 influenza pandemic.
Border screening, together with isolation of persons identified with suspected cases of disease and quarantine of their contacts, is implemented to delay or prevent the entry of infected persons to a country/geographic area or to prevent the global spread of a disease from a source country. The intent of border screening is to detect possibly infectious persons at the border, either on entry to or exit from a country, so that they can be placed in isolation or prevented from traveling and spreading the disease elsewhere; however, this strategy is useful only if the intended goal is successfully achieved. Other potential benefits of border screening relate to increasing public awareness about and confidence in protection from the disease in question, but the scope of this article does not allow for a discussion of these benefits.
During the 2009 influenza A(H1N1)pdm09 virus pandemic, the World Health Organization advised persons who were ill with influenza to delay travel (15). Early during the SARS pandemic and in August 2014 during the Ebola virus epidemic, the World Health Organization recommended border exit screening of travelers from affected countries (16,17). Border screening can be undertaken through self-identification by means of health declaration cards, airline/transit agency notification to health authorities of sick passengers, visual inspection of travelers, and/or fever screening of travelers implemented through the use of infrared thermal image scanners (ITISs). Three key questions are the following: How effective have these measures been at detecting ill travelers? Are there situations in which border screening is likely to be effective? If border screening is not effective, are there any other measures that could be implemented to prevent the spread of disease beyond the source country? To explore these questions, we examined border-screening experiences during the influenza A(H1N1)pdm09 virus pandemic and the SARS pandemic. Questions relating to the effectiveness of border screening are relevant regardless of the situation in which they are applied, including limited screening from one part of the world or screening on isolated island countries, because the experiences relate to the effectiveness of the measure itself in detecting cases at the border.

This work was funded by the Australian Government Department of Health
Dr Selvey is Director of Epidemiology and Biostatistics at the Curtin University School of Public Health. Her research interests include the epidemiology and control of communicable diseases.


This work was funded by the Australian Government Department of Health.
The views expressed in this paper are not necessarily shared by the Australian Government Department of Health.


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Suggested citation for this article: Selvey LA, Antão C, Hall R. Evaluation of border entry screening for infectious diseases in humans. Emerg Infect Dis. 2015 Feb [date cited].
DOI: 10.3201/eid2102.131610

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