Chapter 14 - Health measures at points of entry as prevention tools

Abstract

Health screening at points of entry (PoE) remains an integral part of preventing disease importation and exportation at borders. However, a large gap exists in information about health measures at PoE. There is a debate about the effectiveness of health measures at PoE because of limited evidence of a strong effect in decreasing the transmission of infectious diseases. The authors conducted a systematic literature review using peer-reviewed and gray literature to determine evidence for health measures as prevention tools to highlight current practices and potential improvements at PoE. We also present the incident regarding the Diamond Princess cruise ship as a case study. The systematic literature review showed that there were limitations with health screening measures at PoE. The use of thermal body scanners, self-report questionnaires, and visual checks often misses true cases. Many believe that resources for health measures at PoE could be diverted to other preventative measures that have higher success rates. However, health measures at PoE work toward promoting positive health outcomes, discouraging ill citizens from traveling, improving risk awareness, educating the public, and enhancing communication between public health specialists and travel authorities. Despite concerns about efficacy, there are justifications for health measures at PoE, including health screening, temperature checks, contact tracing, and vector control. Limitations with temperature checks, self-report questionnaires, and visual checks are evident, but the way forward is clear. There is a need to empower Member States to improve and restructure their approach to health measures at PoE by closing gaps in staff shortages, funding, and external communications with the general public. Future revisions of the International Health Regulations addressing public health surveillance, internal communications between PoE authorities, and risk mitigation would also improve the efficacy of health measures at PoE.