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CDC Enhanced Ebola Screening to Start at 5 US Airports & New Tracking Program for all People Entering US from Ebola-affected Countries

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  • CDC Enhanced Ebola Screening to Start at 5 US Airports & New Tracking Program for all People Entering US from Ebola-affected Countries

    Enhanced Ebola Screening to Start at Five U.S. Airports and New Tracking Program for all People Entering U.S. from Ebola-affected Countries

    New layers of screening at airports that receive more than 94% of West African Travelers


    Joint Airport Screening Fact Sheet (English) http://www.cdc.gov/media/releases/20...gFactSheet.pdf

    Joint Airport Screening Fact Sheet (Spanish) http://www.cdc.gov/media/releases/20...et_Spanish.pdf

    Joint Airport Screening Fact Sheet (French) http://www.cdc.gov/media/releases/20...eet_French.pdf

    The Centers for Disease Control and Prevention (CDC) and the Department of Homeland Security's Customs & Border Protection (CBP) this week will begin new layers of entry screening at five U.S. airports that receive over 94 percent of travelers from the Ebola-affected nations of Guinea, Liberia, and Sierra Leone.

    New York's JFK International Airport will begin the new screening on Saturday. In the 12 months ending July 2014, JFK received nearly half of travelers from the three West African nations. The enhanced entry screening at Washington-Dulles, Newark, Chicago-O'Hare, and Atlanta international airports will be implemented next week.

    "We work to continuously increase the safety of Americans," said CDC Director Tom Frieden, M.D., M.P.H. "We believe these new measures will further protect the health of Americans, understanding that nothing we can do will get us to absolute zero risk until we end the Ebola epidemic in West Africa."

    "CBP personnel will continue to observe all travelers entering the United States for general overt signs of illnesses at all U.S. ports of entry and these expanded screening measures will provide an additional layer of protection to help ensure the risk of Ebola in the United States is minimized," said Secretary of Homeland Security Jeh Johnson. "CBP, working closely with CDC, will continue to assess the risk of the spread of Ebola into the United States, and take additional measures, as necessary, to protect the American people."

    CDC is sending additional staff to each of the five airports. After passport review:

    Travelers from Guinea, Liberia, and Sierra Leone will be escorted by CBP to an area of the airport set aside for screening.

    Trained CBP staff will observe them for signs of illness, ask them a series of health and exposure questions and provide health information for Ebola and reminders to monitor themselves for symptoms. Trained medical staff will take their temperature with a non-contact thermometer.

    If the travelers have fever, symptoms or the health questionnaire reveals possible Ebola exposure, they will be evaluated by a CDC quarantine station public health officer. The public health officer will again take a temperature reading and make a public health assessment. Travelers, who after this assessment, are determined to require further evaluation or monitoring will be referred to the appropriate public health authority.

    Travelers from these countries who have neither symptoms/fever nor a known history of exposure will receive health information for self-monitoring.

    Entry screening is part of a layered process that includes exit screening and standard public health practices such as patient isolation and contact tracing in countries with Ebola outbreaks. Successful containment of the recent Ebola outbreak in Nigeria demonstrates the effectiveness of this approach.

    These measures complement the exit screening protocols that have already been implemented in the affected West African countries, and CDC experts have worked closely with local authorities to implement these measures. Since the beginning of August, CDC has been working with airlines, airports, ministries of health, and other partners to provide technical assistance for the development of exit screening and travel restrictions in countries affected by Ebola. This includes:

    Assessing the capacity to conduct exit screening at international airports;
    Assisting countries with procuring supplies needed to conduct exit screening;
    Supporting with development of exit screening protocols;
    Developing tools such as posters, screening forms, and job-aids; and
    Training staff on exit screening protocols and appropriate personal protective equipment (PPE)

    Today, all outbound passengers are screened for Ebola symptoms in the affected countries. Such primary exit screening involves travelers responding to a travel health questionnaire, being visually assessed for potential illness, and having their body temperature measured. In the last two months since exit screening began in the three countries, of 36,000 people screened, 77 people were denied boarding a flight because of the health screening process. None of the 77 passengers were diagnosed with Ebola and many were diagnosed as ill with malaria, a disease common in West Africa, transmitted by mosquitoes and not contagious from one person to another.

    Exit screening at airports in countries affected by Ebola remains the principal means of keeping travelers from spreading Ebola to other nations. All three of these nations have asked for, and continue to receive, CDC assistance in strengthening exit screening.


  • #2
    Re: CDC Enhanced Ebola Screening to Start at 5 US Airports & New Tracking Program for all People Entering US from Ebola-affected Countries

    How many travelers need to be checked in order to prevent one case of Ebola in the United States?
    ...
    The next step is to look at how many people travel to the United States from the three affected countries. Several news outlets reported that around 150 or 160 people travel to the US from the three countries every day. If one in 10,000 people in infected, then we may expect that one infected person would travel to the US in the time that 10,000 people in total travel to the US. With 160 travelers per day, 10,000 people travel to the US in 10,000/160 = 62.5 days, or roughly two months. In other words, we should expect about one traveler with Ebola to arrive in the US every two months.

    If we split this up again in asymptomatic and symptomatic Ebola patients, we find that we should expect an asymptomatic patient (like Thomas Duncan) every 17000/160 = 106 days (3.5 months) and a symptomatic patient every 26000/160 = 161 days (5.5 months) arriving in a US airport.

    If the airports in the United States would check every traveler from West Africa for Ebola symptoms, I?d expect them to find one such patient every 5.5 months, in the time they screen 26,000 travelers. During that time it is quite likely that an asymptomatically infected person enters the US, because we should expect one every 3.5 months.
    ...
    Note (added on Oct 12th): several of my colleagues think that my analysis is too optimistic. Specifically, they think that the epidemic is currently larger than the reported numbers and they think …
    Twitter: @RonanKelly13
    The views expressed are mine alone and do not represent the views of my employer or any other person or organization.

    Comment


    • #3
      Re: CDC Enhanced Ebola Screening to Start at 5 US Airports & New Tracking Program for all People Entering US from Ebola-affected Countries

      Airport screening for Ebola
      BMJ 2014; 349 doi: http://dx.doi.org/10.1136/bmj.g6202 (Published 14 October 2014)
      Cite this as: BMJ 2014;349:g6202

      David Mabey, professor, Stefan Flasche, lecturer, W John Edmunds, professor
      Author affiliations

      Will it make a difference?

      ...

      Why was this measure so ineffective, and could it work now? During the SARS epidemic a simple model was used to assess the fraction of cases that could be detected by entrance screening.2 Assuming that people with symptoms are not allowed to board, entrance screening can only pick up those who develop symptoms while travelling. The longer the incubation period in relation to the flight duration, the lower the chance that this will happen, and the lower the yield from entrance screening. Updating the model using data on Ebola (incubation time 9.1?7.3 days3; direct flight from Freetown to London 6.42 hours), we estimate that, if everyone with symptoms was denied boarding, about 7 out of 100 people infected with Ebola travelling to the UK would have symptoms on arrival and hence be detectable by entrance screening (95% confidence interval 3 to 13). The other 93% would enter the UK unimpeded. If passengers arriving via Paris or Brussels (journey time about 13 hours) were not screened in transit, entrance screening in the UK could detect up to 13% of infected people (95% CI 7% to 21%). The majority would still enter the UK before developing symptoms. Only if patients are allowed to fly irrespective of symptoms would entrance screening be able to detect a substantial fraction of cases (43% if there is no direct flight, 95% CI 34% to 53%).
      ...
      Adopting the policy of ?enhanced screening? gives a false sense of reassurance. Our simple calculations show that an entrance screening policy will have no meaningful effect on the risk of importing Ebola into the UK. Better use of the UK?s resources would be to immediately scale-up our presence in west Africa?building new treatment centres at a rate that outstrips the epidemic, thereby averting a looming humanitarian crisis of frightening proportions. In so doing, we would not only help the people of these affected countries but also reduce the risk of importation to the UK.
      ...
      Will it make a difference? On 9 October the UK government announced that “enhanced screening” for Ebola virus disease will be implemented at Heathrow and Gatwick airports and Eurostar terminals. Details of how this will be done are not yet available, but the objectives presumably are to identify people arriving from Sierra Leone, Guinea, or Liberia who may have been exposed to Ebola, assess whether they have symptoms consistent with Ebola, test those who do, and isolate anyone with positive results. Several practical difficulties will need to be overcome to achieve these objectives. As most direct flights to the UK from Sierra Leone, Guinea, and Liberia have been discontinued because of the epidemic, passengers will be arriving from various European cities, and itineraries will need to be carefully checked to identify passengers arriving from those countries. Those who are identified will be asked to complete a questionnaire stating whether they have been in contact with sick people or have attended funerals in west Africa, and whether they have symptoms such as fever, headache, diarrhoea, or vomiting. People who answer “yes” to any of these questions will presumably …
      Twitter: @RonanKelly13
      The views expressed are mine alone and do not represent the views of my employer or any other person or organization.

      Comment


      • #4
        Re: CDC Enhanced Ebola Screening to Start at 5 US Airports & New Tracking Program for all People Entering US from Ebola-affected Countries

        Airport screenings haven't turned up any Ebola patients
        Liz Szabo, USA TODAY 5:47 p.m. EST December 9, 2014

        Airport screenings of travelers from West Africa haven't turned up anyone with Ebola, health officials announced Tuesday.

        U.S. officials screened nearly 2,000 travelers for Ebola symptoms over 31 days in October and November, according to a report Tuesday from the Centers for Disease Control and Prevention.

        Only seven travelers with symptoms were referred to the CDC for medical exams, and none had the disease, the report says.
        ...


        Airport Exit and Entry Screening for Ebola — August–November 10, 2014
        Early Release
        December 9, 2014 / 63(Early Release);1-6

        Clive M. Brown, MBBS1, Aaron E. Aranas, MPH2, Gabrielle A. Benenson, MPH1, Gary Brunette, MD1, Marty Cetron, MD1, Tai-Ho Chen, MD1, Nicole J. Cohen, MD1, Pam Diaz, MD2, Yonat Haber, MBA1, Christa R. Hale, DVM1, Kelly Holton, MA1, Katrin Kohl, MD1, Amanda W. Lee, MPH1, Gabriel J. Palumbo, MPH1, Kate Pearson, MA1, Christina R. Phares, PhD1, Francisco Alvarado-Ramy, MD1, Shah Roohi, MPH1, Lisa D. Rotz, MD1, Jordan Tappero, MD3, Faith M. Washburn, MPH1, James Watkins1, Nicki Pesik, MD1, (Author affiliations at end of text)

        In response to the largest recognized Ebola virus disease epidemic now occurring in West Africa, the governments of affected countries, CDC, the World Health Organization (WHO), and other international organizations have collaborated to implement strategies to control spread of the virus. One strategy recommended by WHO calls for countries with Ebola transmission to screen all persons exiting the country for "unexplained febrile illness consistent with potential Ebola infection." Exit screening at points of departure is intended to reduce the likelihood of international spread of the virus. To initiate this strategy, CDC, WHO, and other global partners were invited by the ministries of health of Guinea, Liberia, and Sierra Leone to assist them in developing and implementing exit screening procedures. Since the program began in August 2014, an estimated 80,000 travelers, of whom approximately 12,000 were en route to the United States, have departed by air from the three countries with Ebola transmission. Procedures were implemented to deny boarding to ill travelers and persons who reported a high risk for exposure to Ebola; no international air traveler from these countries has been reported as symptomatic with Ebola during travel since these procedures were implemented.

        On October 11, 2014, after the first imported Ebola case was identified in the United States, an enhanced U.S. entry screening program was started at five international airports as an added measure to identify travelers from the three countries with widespread Ebola transmission who might have been exposed to Ebola within 21 days before arrival or who currently had signs or symptoms of Ebola. Entry screening first began at John F. Kennedy International Airport (JFK) in New York City, then Newark Liberty International Airport (EWR), Washington-Dulles International Airport (IAD), Chicago O'Hare International Airport (ORD), and Hartsfield-Jackson Atlanta International Airport (ATL). This program also allowed federal authorities to educate travelers, obtain their contact information, and link them with state and local partners to facilitate health monitoring, as appropriate, and prompt referral for care if they became ill. Of 1,993 travelers screened during October 11–November 10, 86 (4.3&#37 were referred to CDC public health officers for additional evaluation, and seven (8.1%) of the 86 were symptomatic and referred for medical evaluation (Table 1). None of the seven were diagnosed with Ebola.

        The 1,993 travelers arrived in the United States after transit in at least one other country and had final destinations in 46 states; the most common destinations were New York (19%), Maryland (12%), Pennsylvania (11%), Georgia (9%), and Virginia (7%) (Figure). Entry screening provided public health departments with contact information for travelers to facilitate monitoring and provided an added layer of protection for the U.S. public.

        On August 8, 2014, the International Health Regulations Emergency Committee determined that the Ebola outbreak in West Africa met the conditions for a Public Health Emergency of International Concern (1). The committee advised that WHO member states with Ebola transmission "should conduct exit screening of all persons at international airports, seaports and major land crossings, for unexplained febrile illness consistent with potential Ebola infection."
        ...
        continues at; http://www.cdc.gov/mmwr/preview/mmwr...=mm63e1209a1_w
        Twitter: @RonanKelly13
        The views expressed are mine alone and do not represent the views of my employer or any other person or organization.

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