Abstract
A scoping search and a systematic literature review were conducted to give an insight on entry and exit screening referring to travelers at points of entry, by analyzing published evidence on practices, guidelines, and experiences in the past 15 years worldwide. Grey literature, PubMed. and Scopus were searched using specific terms. Most of the available data identified through the systematic literature review concerned entry screening measures at airports. Little evidence is available about entry and exit screening measure implementation and effectiveness at ports and ground crossings. Exit screening was part of the World Health Organisation’s (WHO) temporary recommendations for implementation in certain points of entry, for specific time periods. Exit screening measures for Ebola Virus Disease (EVD) in the three most affected West African countries did not identify any cases and showed zero sensitivity and very low specificity. The percentages of confirmed cases identified out of the total numbers of travelers that passed through entry screening measures in various countries worldwide for Influenza Pandemic (H1N1) and EVD in West Africa were zero or extremely low. Entry screening measures for Severe Acute Respiratory Syndrome (SARS) did not detect any confirmed SARS cases in Australia, Canada, and Singapore. Despite the ineffectiveness of entry and exit screening measures, authors reported several important concomitant positive effects that their impact is difficult to assess, including discouraging travel of ill persons, raising awareness, and educating the traveling public and maintaining operation of flights from/to the affected areas. Exit screening measures in affected areas are important and should be applied jointly with other measures including information strategies, epidemiological investigation, contact tracing, vaccination, and quarantine to achieve a comprehensive outbreak management response. Based on review results, an algorithm about decision-making for entry/exit screening was developed.
Highlights
Public health events can cause serious crises and damage to the human population if effective frameworks and systems are not in place to prevent, early detect, and respond in a timely manner to health threats
114 identified documents of scoping research can be categorized into the following categories: (a) Assessment for imported cases notification of infectious diseases (b) Dengue entry screening at airports (c) Preparedness and response planning for Ebola Virus Disease (d) Entry/exit screening measures for Ebola Virus Disease experience (e) Studies about evolution and predictions of Ebola Virus Disease spread (f) Entry/exit screening measures for infectious diseases (g) Influenza (h) Pandemic influenza preparedness (i) International air travel and infectious diseases (j) Preparedness planning for infectious disease (k) Screening measures at ground crossing (l) Sever Acute Respiratory Syndrome (m) Zika Virus Disease
For preparedness purposes and to be ready to respond to any unexpected public health event, all countries should have the capacities to implement entry and exit screening at designated ports, airports, and ground crossings
Summary
Public health events can cause serious crises and damage to the human population if effective frameworks and systems are not in place to prevent, early detect, and respond in a timely manner to health threats. Screening measures on travelers at points of entry including airports, ports, and ground crossings can be implemented to prevent international transmission of disease by detecting and prohibiting travel to exposed or ill travelers from affected areas [1,2]. The International Health Regulations (IHR) 2005 states in articles 5, 13, 18, 19, and Annex 1B that World Health Organisation (WHO) recommendations in response to a Public Health Emergency of International Concern (PHEIC) may include screening measures at points of entry. Decision 1082/2013/European Union (EU) of the European Parliament and of the Council on serious cross-border threats to health requires that “Member States and the European Commission shall consult each other within the Health Security Committee (HSC) . Decision 1082/2013/European Union (EU) of the European Parliament and of the Council on serious cross-border threats to health requires that “Member States and the European Commission shall consult each other within the Health Security Committee (HSC) . . . That consultation shall be aimed at “ . . . supporting the implementation of core capacity requirements for surveillance and response as referred to in Articles 5 and 13 of the IHR” [4], including capacities in implementing screening measures at borders
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