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Airport exit screenings more effective in assessing pandemic risk
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Screening airplane passengers as they leave an area during an infectious disease outbreak, such as the A(H1N1) 2009 pandemic, is significantly more efficient than screening passengers after they arrive at their final destination.
During the influenza A(H1N1)pdm09 outbreak, international experts evaluated the performance of the 2005 International Health Regulations and cited the requirement for stronger evidence to validate public health measures that could disrupt international travel and trade. In addition, the panel recommended that WHO review the effectiveness and impact of the border measures that were implemented during the pandemic, to present evidence-based guidance for managing future international outbreaks.
Kamran M. Khan
“One never waits for a fire to spread before putting it out,” Kamran M. Khan, MD, of the division of infectious diseases at St Michael’s Hospital in Toronto, said in a press release. “It only makes sense to intervene as early as possible right at the source. The same principle applies to infectious disease outbreaks. To prevent or slow the spread of infectious disease, the most efficient strategy is to control an outbreak at it source, and if this cannot be achieved, to consider screening travelers as they depart the affected area for destinations around the globe.”
To evaluate the screening measures that would have been required to evaluate airplane travelers at risk for transporting A(H1N1)pdm09 out of Mexico at the start of the 2009 pandemic, Khan and colleagues analyzed data on worldwide flight itineraries collected by the International Air Transport Association.
The researchers then compared the possible disturbance in international air traffic that would have resulted from screening passengers at their point of departure from any international airport in Mexico — “exit” screening — with that which would have resulted from screening all passengers arriving at other international airports after flying from Mexico on any direct or connecting flight — “entry” screening.
For each scenario, Khan and colleagues evaluated air traffic disruption by considering the numbers of cities and countries where screening would have been needed to screen all at-risk travelers and the number of travelers who would need to be screened for every traveler at risk.
Results from the review demonstrated that exit screening at 36 airports in Mexico, or entry screening of travelers arriving on direct flights from Mexico at 82 airports in 26 other countries, would have resulted in the assessment of all air travelers at risk for transporting A(H1N1)pdm09 out of Mexico at the start of the pandemic.
“While entry screening may offer the perception of being more closely aligned with the self-interests of a country, the reality is that it’s far more resource intensive and inefficient than exit screening in the source country,” Khan said. “Since entry-screening consumes valuable health and human resources that could be used more effectively elsewhere, it can actually be counterproductive from both a public health and an economic perspective.”
According to researchers, entry screening of 116 travelers incoming from Mexico by direct or connecting flights would have been necessary for every one traveler at risk for transmitting A(H1N1)pdm09. However, screening at only eight airports would have resulted in the evaluation of 90% of all air travelers at risk for transporting A(H1N1)pdm09 out of Mexico in the early stages of the pandemic.
“If countries adopt this tool, it would help distinguish settings where traveler screening is reasonable from those where screening is clearly not warranted,” Khan said. “Taking a highly targeted approach to screening would efficiently produce public health returns while minimizing disruption to international travel, and consequently the world’s economy.”
Disclosure: Khan reported intellectual property rights to BioDiaspora technology.
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