III. Activities Directed to Inbound Travelers

Supplement E: Managing International Travel-Related Transmission Risk

Public Health Guidance for Community-Level Preparedness and Response to Severe Acute Respiratory Syndrome (SARS) Version 2/3

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The nature and scope of activities related to travelers entering or in the United States will differ depending on the extent of SARS-CoV transmission in the United States and in the country or countries from which the passenger has traveled (Appendix E1). When SARS-CoV transmission is absent or limited in the United States, then efforts will focus on promptly identifying cases imported from SARS-affected areas and preventing further spread from such cases. Guidelines have been developed for various groups who might be arriving from areas affected by SARS-CoV. If active transmission of SARS-CoV is occurring in a U.S. city or area, then it will be important to prevent spread to other areas in the United States, possibly by limiting or restricting non-essential travel into or from the affected area.

Objective

Prevent spread from SARS-CoV-infected travelers entering the United States.

Basic Activities

• Inform incoming travelers about SARS, and provide guidance on monitoring their health and reporting illness to the appropriate authorities. This may be accomplished by use of:
  • Videos or public announcements on the conveyance just before arrival
  • Distribution of health alert notices before or upon arrival
  • Posters or public announcements in airports
• Evaluate travelers who report SARS-like symptoms (e.g., fever or respiratory symptoms) during travel, and collect locating information for the other passengers and crew (See Section V: Activities Related to SARS on Conveyances).
• Respond to reports of ill passengers on airplanes or other conveyances arriving from areas with SARS-CoV disease.

Enhanced Activities

• If the level of transmission in another country is high, incoming passengers from that country might require enhanced screening and evaluation through:
  • Visual inspection of all travelers as they disembark
  • Screening of travelers for symptoms of SARS-CoV disease and recent high-risk exposures to SARS-CoV (e.g., SARS-CoV patients or high-risk settings) through a self-administered questionnaire
  • Temperature screening
• Quarantine inspectors at CDC quarantine stations and public health workers in locations near other ports of entry may be required to meet all airplanes or other conveyances arriving from areas with SARS to question crew members about any ill passengers and to visually inspect passengers upon disembarkation.
• If the level of SARS-CoV transmission in a U.S. area is sufficiently high to present a substantial risk to travelers, then non-essential travel to this area may be limited, cancelled, or subjected to increased surveillance measures.
• Other activities that may be considered but whose effectiveness is unclear (especially given the resources required for implementation) include:
  • Ten-day quarantine of all passengers arriving from SARS-affected areas
  • Collection of locating information on all arriving passengers