IV. Activities Directed to Outound 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

Activities related to outbound travelers will vary based on the extent of SARS-CoV transmission in the United States and at the destination (Appendix E1). If there is little SARS-CoV transmission in the United States, the goal is to inform travelers about the risk of SARS and appropriate measures to reduce the risk of acquiring SARS-CoV infection during travel. If there is extensive SARS-CoV transmission in the United States, then preventing the exportation of SARS-CoV will be an added objective.

Objective

Minimize outbound travelers’ risk for exposure to SARS-CoV during travel or the risk of spreading SARS-CoV to other localities.

Basic Activities

Issue travel notifications (see Box).
Provide educational materials to travelers on measures to reduce the risk of SARS-CoV disease.

Enhanced Activities

If there are locations with extensive SARS-CoV transmission where control measures do not appear to be effective, further travel restrictions (e.g., cancellation of flights) to those locations may be considered (see Section VII: Roles and Responsibilities).
If the level of SARS-CoV transmission in the United States presents an increased risk for exportation, then some or all of the following might be implemented:
- Pre-departure screening (e.g., temperature screening, visual screening) of outbound travelers
- Health certifications, i.e., requiring travelers to have a medical examination before departure, with a doctor’s statement that they are free of SARS-CoV symptoms and have not had close contact to a SARS-CoV patient in the past 10 days
- Stop lists, i.e., maintaining lists of SARS cases and close contacts at ports of departure against which travelers’ names can be checked to prevent them from traveling

Travel Notice Definitions

CDC issues different types of notices for international travelers. On May 20, 2004, these definitions were refined to make the announcements more easily understood by travelers, healthcare providers, and the general public. The definitions provided below describe both the levels of risk for the traveler and the recommended preventive measures for each level of risk.

Notice	Scope¹	Risk for travelers²	Preventive measures³
In the News	Reports of sporadic cases	No increased risk over baseline for travelers observing standard recommendations	Keep travelers informed, and reinforce standard prevention recommendations
Outbreak Notice	Outbreak in a limited geographic area or setting	Increased but definable risk that is limited to specific settings	Remind travelers about standard and enhanced recommendations for the region
Travel Health Precaution	Outbreak of greater scope affecting a larger geographic area	Increased risk in some settings, along with risk for spread to other areas	Inform travelers about specific precautions to reduce risk during the stay and what to do before and after travel
Travel Health Warning	Evidence that outbreak is expanding outside the area or populations initially affected	Increased risk because of evidence of transmission outside defined settings and/or inadequate containment measures	In addition to the specific precautions cited above, postpone nonessential travel

Footnotes

The term “scope” incorporates the size, magnitude, and rapidity of spread of an outbreak.
Risk for travelers is dependent on patterns of transmission, as well as severity of illness.
Preventive measures other than the standard advice for the region may be recommended depending on the circumstances (e.g., travelers may be requested to monitor their health for a certain period after their return, or arriving passengers may be screened at ports of entry).

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