1 March 25th 2015
Usefulness and applicability of infectious disease control measures in air travel: a review
Corien Swaan
MD Consultant Inf Dis Control
Head department Preparedness & Control
LCI/CIb/RIVM
Literature study
Aim
●to inventory experiences and applicability of infectious disease control measures:
– Added value in limiting transmission
– Analyze constraints in implementation
Methodology
●Literature search in Pubmed, period 1990 – 2013
●Using:
– Air travel terms (Ragida guidelines:http://www.ecdc.europa.eu/en/publications/publications/0906_ter_risk_assessment_guidelines_for_infectious_diseases_transmitted_on_aircraft.pdf )
– Intervention terms (Core capacity requirements IHR)
●Scoring on outcome, resources, required preparations, passenger inconvenience, compliance
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Methodology
● Intervention terms:
– Exit and entryscreening
– Information provision to passengers
– Isolation, quarantine and health monitoring
– Contact tracing
– Hygiene measures
– Travel restrictions
– Animal care
– Vector control
– Contaminated goods
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Methodology
● scoring: Criteria for analysis of experiences and applicability of interventions
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Criteria Description Scoring ++: very positive, +: positive, +/- neutral -: negative, --: very negative
Outcome Extent to which measures are expected to prevent disease transmission
Measures able to prevent disease spread to a large extent: ++. Measures able to prevent disease spread to some extent: +. Measures hardly effective: +/- Measures ineffective: -
Resources Required funds, supplies and personnel
Measures that were considered applicable with very few additional resources: + + Measures that were considered applicable with few additional resources:+ Measures that were considered “rather resource-intensive”: - Measures that were considered “very resource-intensive”: --
Required preparation
Required preparation efforts to install the measure in a timely manner
Measures considered easy to set up and implement ad hoc: + Measures requiring extensive preparation: -
Passenger inconvenience
Burden on passengers Passengers are barely affected by a measure: ++ A few passengers are affected by the measures: – Inconvenience to a number or majority of passengers: --
Compliance Extent to which compliance by the passengers is necessary for prevention in transmission
Measures little dependent on compliance: ++ Measures require some compliance: + Measures that completely depend on passengers’ willingness to comply: -
● Pubmed
861 records
100 records
●Selection on abstract and title
●Inclusion criteria:
-Description of cases
-Description of models
-Description of experiments
-Infectious disease control in the context of commercial air travel
•Exclusion criteria:
- language other than English,
100 records
●Check reference lists for additional articls
Selection strategy
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Results
Intervention Exit and entry screening Includes entry- en exitscreening: health
declarations, medical examination, thermal screening
Effectiveness depends on: prevalence, detectability, quality of scr method, Quantative information on
Influenza and SARS
Information provision To passengers, and cabin crew, and medical authorities
Not resource intensive, compliance passengrs questionable
Isolation, quarantine and health monitoring Quarantaine of passengers can help delay spread/introduction, however very resourcefull and
inconvenient for passengers. Isolation: more effective, less resources, better compliance. HM:
little published
Contact tracing Effectiveness differs per disease. Resource intensive.
Hygiene measures Effect not well documented, standardised procedures, not resourcefull
Travel restrictions Strictly implemented to have effect. Modeling studies: only effective with few cases.Inconvenient
for passengers Animal care Literature limited
Vector control One study: malaria transmission reduced. Limited resources. Compliance passengers not needed
Contaminated goods Literature limited
Total
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Overview of experiences and applicability of control measures
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●[1
Outcome Resources Required prepara-tion
Passenger inconve-nience
Compliancerequired
Total
1. Entry and exit screening +/- -- - -- + -4
2. Providing information to travelers & self-reports
+/- ++ + ++ - 4
3a. Quarantine +/- -- - -- + -4
3b. Isolation ++ + + - + 4
3c. Health monitoring + + + - + 3
4. Contact tracing +/- - - ++ + 1
5. Hygiene measures + -- + ++ + 3
6. Travel restrictions - - + -- - -4
7. Animal care l.o.i. l.o.i. l.o.i. l.o.i. l.o.i.
8. Vector control + + - + ++ 3
9. Control of goods l.o.i. l.o.i. l.o.i. l.o.i. l.o.i.
++ very positive, + positive, +/- neutral, - negative, -- very negative. l.o.i.= lack of information
For total, the total of the other columns was taken (1).
Conclusion
● Measures best experiences and most applicable to prevent infectious disease spread:
– information to passengers (little resources, inconvenience limited)
– Isolation of patients (prevention transmission)
● Measures limitations in applicability and positive experiences:
– Exit and entry screening (resource intensive, inconvenient for passengers)
– Quarantine (idem)
– travel restrictions (inconvenient for passengers, compliance quesionable, limited effect on outcome)
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● Discussion:
– added value of measures might differ per disease
– Political reasons to implement measures
● Recommendation
● Research comparing the effectiveness of different measures for different infectious diseases, in order to:
– Determine proportionateness of measures (fe contact tracing, entry- and exit screening)
– Invest in preparedness (collect and store passenger information details, quarantaine facilities)
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12 March 25th 2015
● Acknowledgements:
● Yvonne Huizer
● Katrin Leitmeyer (ECDC)
● Aura Timen (LCI/RIVM)
● Maria an der Heiden (RKI)
● Andreas Gilsdorf (RKI)
Results
June 17th 2014 13
Search terms
# of articles found
# of articles selected
Intervention terms
Exit and entry screening Entry screening; exit screening; border screening; thermal scanning; thermal screening; health declarations; self-declarations; medical exam; medical examination; laboratory testing
76 37
Information Travel information; informing public; traveler; informing authorities 51 9
Isolation, quarantine and health monitoring
Quarantine; patient isolation 94 8
Contact tracing Contact tracing; passenger contacts; locator cards 59 14
Hygiene measures Hygiene measures; facial mask; facemask; hand washing; disinfection 50 10
Travel restrictions Travel restrictions; cancel 36 8
Animal care Animal; animal travel; animal care 7 2
Vector control Vector control; reservoir; reservoir control; disinsection; insecticide 141 12
Contaminated goods Contaminated materials; contaminated merchandises; infected materials; infected merchandises; luggage; baggage; contamination; cargo
347 0