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Entry Screening for Infectious Diseases in Humans

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Abstract

In response to the severe acute respiratory syndrome (SARS) pandemic of 2003 and the influenza pandemic of 2009, many countries instituted border measures as a means of stopping or slowing the spread of disease. The measures, usually consisting of a combination of border entry/exit screening, quarantine, isolation, and communications, were resource intensive, and modeling and observational studies indicate that border screening is not effective at detecting infectious persons. Moreover, border screening has high opportunity costs, financially and in terms of the use of scarce public health staff resources during a time of high need. We discuss the border-screening experiences with SARS and influenza and propose an approach to decision-making for future pandemics. We conclude that outbreak-associated communications for travelers at border entry points, together with effective communication with clinicians and more effective disease control measures in the community, may be a more effective approach to the international control of communicable diseases.
In response to the severe acute respiratory syndrome
(SARS) pandemic of 2003 and the inuenza pandemic
of 2009, many countries instituted border measures as a
means of stopping or slowing the spread of disease. The
measures, usually consisting of a combination of border
entry/exit screening, quarantine, isolation, and communica-
tions, were resource intensive, and modeling and observa-
tional studies indicate that border screening is not effective
at detecting infectious persons. Moreover, border screening
has high opportunity costs, nancially and in terms of the
use of scarce public health staff resources during a time
of high need. We discuss the border-screening experienc-
es with SARS and inuenza and propose an approach to
decision-making for future pandemics. We conclude that
outbreak-associated communications for travelers at bor-
der entry points, together with effective communication with
clinicians and more effective disease control measures in
the community, may be a more effective approach to the
international control of communicable diseases.
Many countries instituted border screening in response
to the severe acute respiratory syndrome (SARS)
pandemic of 2003 and the inuenza A(H1N1)pdm09 virus
pandemic of 2009, and although not formally evaluated,
the experiences of several countries have been document-
ed (111). Given the recent emergence of the inuenza
A(H7N9) virus in many parts of China (12), Middle East
respiratory syndrome coronavirus in Saudi Arabia (13),
and the current, most widespread Ebola outbreak in Africa
(14), it seems timely to consider the costs and the effective-
ness of border screening, as shown by recent experiences.
Herein, we discuss the use of border-screening measures
instituted during the 2003 SARS pandemic and the 2009
inuenza pandemic.
Border screening, together with isolation of persons
identied with suspected cases of disease and quarantine of
their contacts, is implemented to delay or prevent the entry
of infected persons to a country/geographic area or to pre-
vent the global spread of a disease from a source country.
The intent of border screening is to detect possibly infec-
tious persons at the border, either on entry to or exit from
a country, so that they can be placed in isolation or pre-
vented from traveling and spreading the disease elsewhere;
however, this strategy is useful only if the intended goal
is successfully achieved. Other potential benets of border
screening relate to increasing public awareness about and
condence in protection from the disease in question, but
the scope of this article does not allow for a discussion of
these benets.
During the 2009 inuenza A(H1N1)pdm09 virus pan-
demic, the World Health Organization advised persons who
were ill with inuenza to delay travel (15). Early during the
SARS pandemic and in August 2014 during the Ebola virus
epidemic, the World Health Organization recommended
border exit screening of travelers from affected countries
(16,17). Border screening can be undertaken through self-
identication by means of health declaration cards, airline/
transit agency notication to health authorities of sick pas-
sengers, visual inspection of travelers, and/or fever screen-
ing of travelers implemented through the use of infrared
thermal image scanners (ITISs). Three key questions are
the following: How effective have these measures been at
detecting ill travelers? Are there situations in which border
screening is likely to be effective? If border screening is
not effective, are there any other measures that could be
implemented to prevent the spread of disease beyond the
source country? To explore these questions, we exam-
ined border-screening experiences during the inuenza
A(H1N1)pdm09 virus pandemic and the SARS pandemic.
Questions relating to the effectiveness of border screening
are relevant regardless of the situation in which they are
applied, including limited screening from one part of the
world or screening on isolated island countries, because the
experiences relate to the effectiveness of the measure itself
in detecting cases at the border.
Border Screening and the Inuenza
A(H1N1)pdm09 Virus Pandemic
Because of a short incubation period and consequent short
serial interval (i.e., time between the onset of the rst case
and the onset of subsequent case[s]), inuenza virus causes
explosive outbreaks despite its relatively low infectiv-
ity. Inuenza A(H1N1)pdm09 virus, which spread rapidly
throughout the world in 2009, was most likely established
in Australia (18) and Japan (19) before border screening
was initiated in those countries. Border screening to detect
Entry Screening for Infectious
Diseases in Humans
Linda A. Selvey, Catarina Antão, Robert Hall
Emerging Infectious Diseases • www.cdc.gov/eid • Vol. 21, No. 2, February 2015 197
PERSPECTIVE
Author afliations: Curtin University, Perth, Western Australia,
Australia (L.A. Selvey, C. Antão); Monash University, Melbourne,
Victoria, Australia (R. Hall)
DOI: http://dx.doi.org/10.3201/eid2102.131610
PERSPECTIVE
inuenza-infected travelers is likely to be unsuccessful be-
cause persons with asymptomatic cases can be infectious,
and fever is not a consistent symptom of inuenza (20).
This means that screening sensitivity is low and a substan-
tial proportion of infectious persons will not be detected
at the border, and those that are detected may well have
transmitted the virus to other persons before being iso-
lated. This was the experience of several countries during
the inuenza A(H1N1)pdm09 virus pandemic. For ex-
ample, in Singapore, of the rst 116 inuenza A(H1N1)
pdm09 virus–infected persons identied with a history of
recent international travel, only 15 (12.9%) were identi-
ed through screening at the airport (2). In Japan, intensive
border screening was in place at the main international air-
port during April 28–June 18, 2009. Of 151 inuenza cases
that might have been acquired during travel overseas, only
10 (6.6%) were detected as a result of border screening in
Japan (4). During the same period in New South Wales,
Australia, an estimated 6.7% (3/45) of imported cases were
detected at the border (9), and in Auckland, New Zealand,
5.8% (4/69) of the cases were detected at the airport (10).
Singapore, Japan, and Australia, but not New Zealand, used
ITISs to screen for fevers at their borders, even though the
sensitivity of this screening was similarly low at the sites.
Before the inuenza A(H1N1)pdm09 virus pandemic,
a modeling study suggested that the use of thermal scanners
at airports/entry points to screen incoming passengers or at
exit points from countries where inuenza virus is circulat-
ing could reduce the number of cases that would otherwise
occur during a pandemic (21). However, the study assumed
a 50% detection rate for all incoming infected persons, in-
cluding those with asymptomatic cases and those incubat-
ing the virus (21). In practice, detection was substantially
lower than that.
ITISs were used in many countries to detect febrile
passengers. A review of hospital-based studies examining
the efcacy of ITISs in detecting fever found that the sen-
sitivity of fever detection ranged from 4% to 89.6%, and
the positive predictive value with a 1% prevalence of fever
ranged from 3.5% to 65.4% (22). A more recent study in-
volving airline travelers estimated a positive predictive val-
ue of ITIS for fever detection of 0.9%–4.1% for detecting
fever of any cause and a positive predictive value of fever
for inuenza of 2.0%–2.8% for detecting inuenza-associ-
ated fever (3). Therefore, many persons with possible fever
would have to be identied before a case of inuenza was
detected, and screening for fever is unlikely to be sensitive
enough to detect sufcient numbers of inuenza cases to
prevent or slow the importation of a pandemic strain.
Several other models have assessed the role of travel
restrictions on the international spread of inuenza (23
25). These models concluded that unless travel restrictions
prevented >99% of travel, they would, at best, delay the
introduction of pandemic inuenza by 2–3 weeks, and be-
cause of the explosive nature of the epidemic, would have
no overall effect on the total number of cases (2325). The
results are effectively the same whether travel restrictions
are used (as in these models) or screening and isolation/
quarantine are used to limit the movement of possibly
infectious persons. However, the conclusion from these
models (i.e., that allowing only a small number of cases
to enter a country would result in an epidemic of the same
size as if travel restrictions were not in place) is applicable
to screening. It is probable that entry screening with a low
rate of detection of incoming cases would also be unlikely
to signicantly delay the commencement of an epidemic or
reduce the total number of cases. The models had also not
been validated using data from an inuenza pandemic (26).
Now that data from the inuenza A(H1N1)pdm09 virus
pandemic are available, there is an opportunity to validate
the models examine the efcacy of border measures.
A substantial amount of resources were expended on
border-screening measures in several countries, including
Australia. At a time when clinical and public health ser-
vices were stretched in responding to the pandemic, there
were major opportunity costs resulting from the application
of border screening (4,9). In New South Wales, it was es-
timated that the cost of stafng airport clinics was $50,000
AUD/case detected (9).
Border Screening and the SARS Pandemic
More than 10 years have elapsed since the SARS virus
emerged in China. From its emergence in November 2002
through July 2003, the virus, which has an incubation pe-
riod of 2–12 days (mean 4–5), infected >8,000 persons
across 30 countries (27). Despite the lack of antimicrobial
drugs or a vaccine, the epidemic was controlled worldwide
through a combination of early isolation of case-patients,
quarantine of contacts, and strict infection control mea-
sures (20,27).
Fraser et al. (20) modeled the control of communicable
diseases according to the diseases’ characteristics of infec-
tiousness during the incubation period and in asymptomatic
infections. According to this model, public health measures
are likely to be effective if persons are infectious only when
symptomatic, particularly if infectivity peaks after the onset
of symptoms. This means that infected persons are not infec-
tious during the incubation period or during asymptomatic
infection. During SARS virus infection, peak viremia (and
assumed infectivity) occurs 10 days after symptom onset
(28), and this timing coincides with the severity of symp-
toms. Persons with asymptomatic infection and persons in
the incubation period do not appear to be infectious (27,28).
Therefore if case-patients are isolated within 2–3 days of
infection, transmission will be limited (29). If contacts are
quarantined until beyond the incubation period, this will also
198 Emerging Infectious Diseases • www.cdc.gov/eid • Vol. 21, No. 2, February 2015
Border Entry Screening for Infectious Diseases
limit further transmission. High fever (>38°C) is a common
symptom among persons seeking medical care for SARS,
but case-patients with fever of <38°C or who were afebrile
have been described and have been implicated in the trans-
mission of SARS in a health care setting (3033). This in-
formation suggests that active case nding, isolation, strict
infection control, and contact tracing will limit the spread
of SARS, and modeling suggests that the combination of
these measures would be the most effective control strategy
(20,29). This information also suggests that border measures
that involve effective case detection (i.e., a high proportion
of cases detected), especially if associated with opportunities
for effective contact tracing (i.e., contacts quarantined within
2 days of case-patient contact), could be useful strategies for
delaying the entry of SARS into a country and limiting op-
portunities for the virus to spread. However, the long SARS
incubation period means that cases of imported disease could
easily occur through the border entry of infectious, asymp-
tomatic persons.
During the SARS epidemic, several countries insti-
tuted border measures, including travel warnings, educa-
tional information for travelers, and border screening. In
Australia, Canada, and Singapore, a combination of bor-
der screening measures was instituted, yet no conrmed
SARS cases were detected in any of the 3 countries (57).
In Australia, where ITISs were not used, 4 suspected/prob-
able SARS cases were detected at the border. Those 4 cases
represented 13.8% of the 29 persons detected in Australia
with suspected/probable SARS during the screening period
who were symptomatic at the time of arrival in the country
(5). Five suspected/probable SARS case-patients arrived in
Canada during the screening period; symptoms developed
in all 5 patients after arrival, and none of the cases were de-
tected at the border (6). The authors concluded that because
of the very low prevalence of infection among travelers, the
positive predictive value of any border screening would be
effectively zero (6).
Two independent modeling studies (29,34) modeled
the effect of entry screening for SARS on SARS impor-
tation and subsequent spread. Glass and Becker (29) con-
cluded that entry screening for SARS would not reduce the
probability of an outbreak of 100 cases by >7%; this con-
clusion is based on the assumption of screening effective-
ness equivalent to that estimated based on the Australian
experience. Goubar et al. (34) also concluded that entry
screening would play a minimal role in reducing the num-
ber of imported cases, on the basis that border screening
would miss infected travelers who are currently incubating
the infection (34). Both studies concluded that SARS trans-
mission within a country could be more effectively lim-
ited by gearing-up health services to enable early detection
and isolation of case-patients than by investing in border
screening (29,34).
To Screen or Not To Screen
We do not recommend border screening at any time during
the evolution of an inuenza pandemic because the sensitiv-
ity and specicity of inuenza screening are low, regardless
of the method (e.g., self-identication, thermal scanning,
and/or visual inspection). Border screening is resource in-
tensive, and there is a signicant opportunity cost for other
public health measures if border screening is in place. For
example, in Australia during May 2009 (i.e., during the in-
uenza pandemic), an average of 28,685 persons arrived at 8
airports via international air ights (1). Entry screening was
in place at the time, and each screening point with an ITIS re-
quired 1–2 operators at all times when ights were arriving.
Trained nurses were required to be present at each airport at
all times when there were incoming ights to provide fol-
low-up for any passengers identied through ITIS screening
or who self-identied as being unwell. An additional person
was employed at each airport at all times when ights were
arriving to assist with administrative activities. During April
28, 2009–June 1, 2009, a total of 15,457 (≈1.5%) airline
travelers arriving at airports across Australia were identied
as being unwell. Most (84%) of these persons self-identied
as being unwell on health declaration cards; only 0.5% were
identied by the use of an ITIS (1). Of these 15,457 persons,
only 154 were subsequently treated as if they were infected
with the pandemic inuenza virus.
Inuenza outbreaks are difcult to control without the
use of vaccines and antiviral drugs. The public health re-
sponse should focus on early identication and treatment
of cases at risk of becoming severe; social-distancing mea-
sures applied at the community level; infection control
measures; vaccination (when a vaccine becomes available);
and in some cases, antiviral prophylaxis. Focusing on these
measures instead of border screening will be more fruitful.
Compared with inuenza, SARS is more amenable to
border screening because fever is a more consistent symp-
tom and infected persons are not infectious when asymp-
tomatic or during the incubation period. However, persons
who are incubating the SARS virus will not be detected by
screening, and, given the low prevalence of infection even
in source countries, the positive predictive value of screen-
ing will be very low. Therefore, we also do not recommend
border screening for SARS. SARS is, however, amenable
to control through the use of a combination of measures:
early isolation of conrmed case-patients, quarantine of
case-patient contacts, and strict infection control (20,27).
Measures that will enable the early detection and isolation
of case-patients and quarantine of contacts should be the
focus of resource allocation.
Communication as a Border Measure
Communication with incoming travelers was a key com-
ponent of border activity during the SARS and inuenza
Emerging Infectious Diseases • www.cdc.gov/eid • Vol. 21, No. 2, February 2015 199
PERSPECTIVE
A(H1N1)pdm09 virus pandemics and during other disease
outbreaks (8,35,36). Communication can take many forms,
including informational videos, posters, signs, in-ight an-
nouncements, yers, and health alert notices (HANs) (36).
During the 2009 inuenza pandemic, 44% and 84% of trav-
elers identied as unwell on arrival in Singapore (2) and
Australia (1), respectively, self-identied as being ill; this
nding suggests that communication to incoming travel-
ers can be a useful mechanism to encourage self-reporting.
However, the evidence of the effectiveness of communica-
tion measures at borders is limited (6,36). Travel HANS (T-
HANs) have been used in the United States by the Centers
for Disease Control and Prevention (Atlanta, GA) since the
1970s as a communication tool directed to incoming trav-
elers. T-HANs provide travelers with information about a
current disease outbreak, symptoms of the disease, and ad-
vice about seeking medical care should symptoms occur.
T-HANs also include clinical guidance and resources for
physicians. Selent et al. (35) evaluated the effectiveness of
T-HANs in encouraging the self-identication and health
care–seeking behavior of incoming travelers from Haiti
during the cholera epidemic in that country in 2010. The
evaluation suggested that the T-HANs provided a small
positive inuence on health care–seeking behavior among
incoming travelers (35). The use of current communica-
tion technologies (e.g., the Internet or short text messages
to mobile phones) could also be investigated. SMS (short
message service) messages, for example, have been used
successfully in other areas of public health (37).
The use of T-HANs and other communication meth-
ods is a potentially worthwhile border measure that could
assist with the early identication and appropriate man-
agement of incoming passengers with a disease of inter-
est. Such measures need to be accompanied by the pro-
vision of appropriate health care for travelers who are
deemed ill, and must be easily understandable. As with
any health communication endeavor, effective commu-
nication requires multiple modes of communication and
tailored messages (38).
Although the provision of consistent and repeated ear-
ly warnings and information about infectious disease out-
breaks to local clinicians is not a border measure, it can be
highly effective in supporting the rapid recognition and iso-
lation of possibly infectious incoming travelers. This fact is
exemplied by the experience of SARS in Canada, where
alert clinicians in Vancouver, British Columbia, isolated a
patient with SARS within 15 minutes of his/her arrival at
the clinic and used appropriate respiratory protection, but
clinicians in Toronto, Ontario, did not quickly isolate a
patient with SARS or use adequate respiratory protection
when treating the patient. Both case-patients sought care
at a hospital on the same day during a time when signi-
cant SARS transmission was ongoing in Ontario but not in
Vancouver. Subsequent investigation identied well-com-
municated and repeated warnings about SARS to local
clinicians as being an important factor in limiting further
spread of SARS in Vancouver (39).
Conclusions
Historically, most attempts at border screening have been
ineffectual, as demonstrated by the pandemic spread of
SARS and inuenza A(H1N1)pdm09 to many countries
despite the use of border screening. Modeling and observa-
tional studies have indicated that border screening is likely
to be unsuccessful in preventing or delaying the entry of
such diseases into a country. Border screening generally
has high opportunity costs, both nancially and in terms of
the use of scarce public health staff resources at a time of
high need. We conclude that border screening should not
be used. Instead, the less costly measure of providing infor-
mation to arriving travelers is recommended, together with
effective communication with local clinicians and more ef-
fective disease control measures in the community.
This work was funded by the Australian Government Department
of Health.
The views expressed in this paper are not necessarily shared by
the Australian Government Department of Health.
Dr. Selvey is Director of Epidemiology and Biostatistics at the
Curtin University School of Public Health. Her research interests
include the epidemiology and control of communicable diseases.
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Address for correspondence: Linda A. Selvey, Curtin University, GPO
Box U1987, Perth, Western Australia, 6845, Australia; email:
linda.selvey@curtin.edu.au
Emerging Infectious Diseases • www.cdc.gov/eid • Vol. 21, No. 2, February 2015 201
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... In order to curtail and prevent the spread of disease, many countries have instituted border disease control measures as a response to a fast-spreading disease. Screening at border crossings, quarantine and isolation were some of the measures that were implemented during the SARS (severe acute respiratory syndrome) pandemic of 2003 and the influenza pandemic of 2009 [20]. In Africa especially, rapid and accessible long-distance road transportation facilitates the geographic spread of diseases, even those such as influenza, that have a short incubation period [20]. ...
... Screening at border crossings, quarantine and isolation were some of the measures that were implemented during the SARS (severe acute respiratory syndrome) pandemic of 2003 and the influenza pandemic of 2009 [20]. In Africa especially, rapid and accessible long-distance road transportation facilitates the geographic spread of diseases, even those such as influenza, that have a short incubation period [20]. ...
Article
Full-text available
Background For a country such as South Africa which is targeting malaria elimination, mobile and migrant populations pose a substantial risk to importation of malaria parasites. It has been hypothesized that halting cross-border movement of mobile and migrant populations will decrease the importation of malaria, however this option is not a politically, operationally, and financially viable prospect. It has social impacts as well, since families live on either side of the border and preventing travel will challenge family ties. Due to the COVID-19 pandemic and closure of ports of entry (land and air) for non-essential travel into South Africa, a unique opportunity arose to test the hypothesis. Methodology An interrupted time series analysis was done to assess whether the post-lockdown trends (April–December 2020) in monthly reported imported and local cases differed from the pre-lockdown trends (January 2015–March 2020). The analysis was conducted separately for KwaZulu-Natal, Mpumalanga, and Limpopo provinces. Results On average, imported cases were lower in the post-intervention period in all three provinces, and local cases were lower in Mpumalanga and Limpopo, though no results were statistically significant. Conclusion Since population movement continued after the travel restrictions were lifted, border screening with testing and treating should be considered for reducing parasite movement. Another option is reducing malaria cases at the source in neighbouring countries by implementing proven, effective vector and parasite control strategies and through a downstream effect reduce malaria entering South Africa.
... Thus, border screening is used in conjunction with isolating individuals diagnosed with suspected cases of disease and quarantining contacts to delay or prevent infectious individuals from entering the country/geographical region or to prevent the global spread of a disease from a source country. Border screening is intended to identify infected people on or near the border to segregate or prevent them from moving and spreading the disease to another country; however, this technique is successful only when the stated objective is accomplished efficiently (Selvey et al., 2015). According to Wagner (2021, p. 171), "New research activities may achieve this through ensuring an intelligent and risk-analysis-based approach to minimize risks and threats and challenges of balancing the two opposing ideals of mobility and security through the development of innovative tools, smoothly functioning work-flow procedures and solutions by using the latest technology." ...
... Border screening, isolation of suspected instances of illness, and quarantine of contacts are all done to delay or dissuade infected persons from entering the country/geographical area. The goal of border screening is to detect infectious individuals at or near the border so they may be separated or prevented from transmitting the illness to another nation (Selvey et al., 2015). ...
... Nature Medicine, 26, 1183-1192 borders to control the spread of infectious diseases, such as in the severe acute respiratory syndrome (SARS) outbreak. Selvey, Antão, & Hall, 2015, & Alwashmi, 2020. ...
Chapter
Full-text available
The use of modern technologies to meet individual and population health requirements during the pandemic is analyzed and discussed, including how these advances minimized healthcare delivery challenges and aided the public health response to the pandemic. To address healthcare and population requirements, the pandemic's unprecedented challenges call for new and cutting-edge tools, including telemedicine and digital public health. Telemedicine enables medical professionals to treat patients from a distance and allows patients to get care from their homes. Telemedicine enabled medical staff to avoid needless contact with COVID-19 patients, reducing the spread of diseases within healthcare facilities. Healthcare professionals were able to treat patients remotely because of telemedicine. The efficacy of telemedicine use in the healthcare community was put to the test by the coronavirus pandemic. The coronavirus pandemic assisted in developing policies for patient and professional safety and testing the effectiveness of the healthcare community's prior use of telemedicine.
... In 2009, around 25 percent of countries imposed import bans on pork products from H1N1-affected states despite WHO's recommendations against such policies given the virus could not spread through pork. During the 2014 Ebola outbreak in West Africa, again close to 25 percent of countries restricted visas or flights from the affected area even though characteristics of the virus and evidence from past outbreaks of SARS and influenza showed the limited utility of such restrictions for stopping spread ( Cooper et al. 2006 ;Ferguson et al. 2006 ;Colizza et al. 2007 ;Vincent et al. 2009 ;World Health Organization 2009 ;Cowling et al. 2010 ;Poletto et al. 2014 ;Selvey, Antão, and Hall 2015 ;Worsnop 2019 ). In 2014, at the height of the West Africa Ebola outbreak, the then DG Margaret Chan explained WHO's perspective: ...
Article
Why do some international agreements fail to achieve their goals? Rather than states’ engaging in cheap talk, evasion, or shallow commitments, the World Health Organization's (WHO) International Health Regulations (IHR)—the agreement governing states’ and WHO's response to global health emergencies—point to the unintended consequences of information provision. The IHR have a dual goal of providing public health protection from health threats while minimizing unnecessary interference in international traffic. As such, during major outbreaks WHO provides information about spread and severity, as well as guidance about how states should respond, primarily regarding border policies. During COVID-19, border restrictions such as entry restrictions, flight suspensions, and border closures have been commonplace even though WHO recommended against such policies when it declared the outbreak a public health emergency in January 2020. Building on findings from the 2014 Ebola outbreak, we argue that without raising the cost of disregarding (or the benefits of following) recommendations against border restrictions, information from WHO about outbreak spread and severity leads states to impose border restrictions inconsistent with WHO's guidance. Using new data from COVID-19, we show that WHO's public health emergency declaration and pandemic announcement are associated with increases in the number of states imposing border restrictions.
... Según información del 6 de agosto de 2020, como se puede observar en la tabla 1, la situación en El Paso fue muy diferente: 15 427 casos confirmados y 280 fallecidos (1.81%) (The New York Times, 2020). Los datos son absolutamente distintos en ambas ciudades, pero la frontera nunca ha sido un buen lugar para detectar a personas infectadas (Selvey, Antao y Hall, 2015), y aunque por el momento sólo cruzan ciudadanos y residentes estadounidenses, una gran proporción de ellos vive en Ciudad Juárez y cruza diariamente, por lo cual estas cifras son francamente incongruentes. El virus es el mismo en Estados Unidos y en México, pero las características de los ciudadanos y los sistemas de salud son diferentes. ...
Book
Versiones no oficiales de la pandemia. Covid-19 en México: textos críticos reúne voces de la sociedad civil, médicos, académicos, periodistas, economistas, investigadores, psicólogos, escritores, poetas, pacientes y profesionistas de distintas ramas, así como de distintas nacionalidades. Fueron invitados a escribir sin guión, sin partido y sin conflicto de interés acerca del Covid-19 en México; cada autor contribuyó con su prestigio, su inteligencia y su corazón para narrar desde su perspectiva su versión de la enfermedad. Esta pandemia ha estado repleta de datos, sin embargo, muchos de éstos desinforman, como las noticias falsas o no verificadas. Se solicitaron datos “duros” a los autores, traducidos a un lenguaje no experto, dirigidos a un público diverso, ávido de información confiable, tendiendo así un puente entre la comunidad científica y la población.
... However, in the modern world, fast air travel permits voyagers to traverse this globe within a day or less. The key reason for the rapid spread of COVID-19 across continents was that screening efforts at airports were relatively costly and unsuccessful (26). The common feature of in-flight transmission of the COVID-19 disease among passengers was also evident during the SARS outbreak (27,28). ...
Chapter
Full-text available
The newly identified virus COVID-19 has become one of the most contagious diseases in human history. The ongoing coronavirus has created severe threats to global mental health, which have resulted in crisis management challenges and international concerns related to health issues. As of September 9, 2021, there were over 223.4 million patients with COVID-19, including 4.6 million deaths and over 200 million recovered patients reported worldwide, which has made the COVID-19 outbreak one of the deadliest pandemics in human history. The aggressive public health implementations endorsed various precautionary safety and preventive strategies to suppress and minimize COVID-19 disease transmission. The second, third, and fourth waves of COVID-19 continue to pose global challenges to crisis management, as its evolution and implications are still unfolding. This study posits that examining the strategic ripostes and pandemic experiences sheds light on combatting this global emergency. This study recommends two model strategies that help reduce the adverse effects of the pandemic on the immune systems of the general population. This present paper recommends NPI interventions (non-pharmaceutical intervention) to combine various measures, such as the suppression strategy (lockdown and restrictions) and mitigation model to decrease the burden on health systems. The current COVID-19 health crisis has influenced all vital economic sectors and developed crisis management problems. The global supply of vaccines is still not sufficient to manage this global health emergency. In this crisis, NPIs are helpful to manage the spillover impacts of the pandemic. It articulates the prominence of resilience and economic and strategic agility to resume economic activities and resolve healthcare issues. This study primarily focuses on the role of social media to tackle challenges and crises posed by COVID-19 on economies, business activities, healthcare burdens, and government support for societies to resume businesses, and implications Zhou et al. Social Media Amid COVID-19 Crisis for global economic and healthcare provision disruptions. This study suggests that intervention strategies can control the rapid spread of COVID-19 with hands-on crisis management measures, and the healthcare system will resume normal conditions quickly. Global economies will revitalize scientific contributions and collaborations, including social science and business industries, through government support.
... However, in the modern world, fast air travel permits voyagers to traverse this globe within a day or less. The key reason for the rapid spread of COVID-19 across continents was that screening efforts at airports were relatively costly and unsuccessful (26). The common feature of in-flight transmission of the COVID-19 disease among passengers was also evident during the SARS outbreak (27,28). ...
Article
Full-text available
The new identified virus COVID-19 has become one of the most contagious diseases in human history. The ongoing coronavirus has created severe threats to global mental health, which have resulted in crisis management challenges and international concerns related to health issues. As of September 9, 2021, there were over 223.4 million patients with COVID-19, including 4.6 million deaths and over 200 million recovered patients reported worldwide, which has made the COVID-19 outbreak one of the deadliest pandemics in human history. The aggressive public health implementations endorsed various precautionary safety and preventive strategies to suppress and minimize COVID-19 disease transmission. The second, third, and fourth waves of COVID-19 continue to pose global challenges to crisis management, as its evolution and implications are still unfolding. This study posits that examining the strategic ripostes and pandemic experiences sheds light on combatting this global emergency. This study recommends two model strategies that help reduce the adverse effects of the pandemic on the immune systems of the general population. This present paper recommends NPI interventions (non-pharmaceutical intervention) to combine various measures, such as the suppression strategy (lockdown and restrictions) and mitigation model to decrease the burden on health systems. The current COVID-19 health crisis has influenced all vital economic sectors and developed crisis management problems. The global supply of vaccines is still not sufficient to manage this global health emergency. In this crisis, NPIs are helpful to manage the spillover impacts of the pandemic. It articulates the prominence of resilience and economic and strategic agility to resume economic activities and resolve healthcare issues. This study primarily focuses on the role of social media to tackle challenges and crises posed by COVID-19 on economies, business activities, healthcare burdens, and government support for societies to resume businesses, and implications Zhou et al. Social Media Amid COVID-19 Crisis for global economic and healthcare provision disruptions. This study suggests that intervention strategies can control the rapid spread of COVID-19 with hands-on crisis management measures, and the healthcare system will resume normal conditions quickly. Global economies will revitalize scientific contributions and collaborations, including social science and business industries, through government support.
... Border entry screening measures were also used in response to the global SARS pandemic during 2003 and the A(H1N1)pdm09 pandemic during 2009. These measures were often resource intensive, but have been found to have somewhat limited success at detecting infectious persons [15]. Border screening for persons with influenza is problematic because fever is often used as the symptom for detection, but fever is not a consistent symptom of influenza, and carriers of influenza can be asymptomatic [16]. ...
Article
Full-text available
During the COVID-19 pandemic, there has been an increasing rollout of non-contact fever screening solutions to assist in curbing the spread of disease. This study begins by describing how screening for disease has historically been performed. It proposes four measurement characteristics of an ideal screening solution: non-contact, effective, rapid and low-cost measurements. Next, it reviews the existing literature on fever-screening using non-contact infrared thermometer (NCIT) devices as well as infrared thermography (IRT) devices, as these are two technologies which have experienced increasing use. For this review, 185 research papers were identified, 21 research studies were included after inclusion and exclusion criteria were applied. A total of 35 experiments were identified for analysis and their results tabulated. Of these studies, 66% are IRT and 34% are NCIT, with a median sample size of 430 subjects. 26 experiments involve febrile participants, with a median febrile percentage of 11.22 % of population. The reported sensitivity of febrile detection using NCIT varies from 3.7% to 97% and when using IRT it varies from 15% to 100%. Both indoor and outdoor studies are investigated, as well as those conducted in acute and non-acute settings. The results of this review show a clear lack of consensus on the effectiveness of these systems. Overall, these results indicate that sensitivity and specificity are reduced when using IRT and NCIT technologies compared to other thermometers used in medical practice. Their use should be carefully assessed based on the risks present in each particular measurement scenario.
Thesis
Full-text available
Die aktuelle COVID-19-Pandemie zeigt deutlich, wie sich Infektionskrankheiten weltweit verbreiten können. Neben Viruserkrankungen breiten sich auch multiresistente bakterielle Erreger weltweit aus. Dementsprechend besteht ein hoher Bedarf, durch frühzeitige Erkennung Erkrankte zu finden und Infektionswege zu unterbrechen. Herkömmliche kulturelle Verfahren benötigen minimalinvasive bzw. invasive Proben und dauern für Screeningmaßnahmen zu lange. Deshalb werden schnelle, nichtinvasive Verfahren benötigt. Im klassischen Griechenland verließen sich die Ärzte unter anderem auf ihren Geruchssinn, um Infektionen und andere Krankheiten zu differenzieren. Diese charakteristischen Gerüche sind flüchtige organische Substanzen (VOC), die im Rahmen des Metabolismus eines Organismus entstehen. Tiere, die einen besseren Geruchssinn haben, werden trainiert, bestimmte Krankheitserreger am Geruch zu unterscheiden. Allerdings ist der Einsatz von Tieren im klinischen Alltag nicht praktikabel. Es bietet sich an, auf technischem Weg diese VOCs zu analysieren. Ein technisches Verfahren, diese VOCs zu unterscheiden, ist die Ionenmobilitätsspektrometrie gekoppelt mit einer multikapillaren Gaschromatographiesäule (MCC-IMS). Hier zeigte sich, dass es sich bei dem Verfahren um eine schnelle, sensitive und verlässliche Methode handelt. Es ist bekannt, dass verschiedene Bakterien aufgrund des Metabolismus unterschiedliche VOCs und damit eigene spezifische Gerüche produzieren. Im ersten Schritt dieser Arbeit konnte gezeigt werden, dass die verschiedenen Bakterien in-vitro nach einer kurzen Inkubationszeitzeit von 90 Minuten anhand der VOCs differenziert werden können. Hier konnte analog zur Diagnose in biochemischen Testreihen eine hierarchische Klassifikation der Bakterien erfolgen. Im Gegensatz zu Bakterien haben Viren keinen eigenen Stoffwechsel. Ob virusinfizierte Zellen andere VOCs als nicht-infizierte Zellen freisetzen, wurde an Zellkulturen überprüft. Hier konnte gezeigt werden, dass sich die Fingerprints der VOCs in Zellkulturen infizierter Zellen mit Respiratorischen Synzytial-Viren (RSV) von nicht-infizierten Zellen unterscheiden. Virusinfektionen im intakten Organismus unterscheiden sich von den Zellkulturen dadurch, dass hier neben Veränderungen im Zellstoffwechsel auch durch Abwehrmechanismen VOCs freigesetzt werden können. Zur Überprüfung, inwiefern sich Infektionen im intakten Organismus ebenfalls anhand VOCs unterscheiden lassen, wurde bei Patienten mit und ohne Nachweis einer Influenza A Infektion als auch bei Patienten mit Verdacht auf SARS-CoV-2 (Schweres-akutes-Atemwegssyndrom-Coronavirus Typ 2) Infektion die Atemluft untersucht. Sowohl Influenza-infizierte als auch SARS-CoV-2 infizierte Patienten konnten untereinander und von nicht-infizierten Patienten mittels MCC-IMS Analyse der Atemluft unterschieden werden. Zusammenfassend erbringt die MCC-IMS ermutigende Resultate in der schnellen nichtinvasiven Erkennung von Infektionen sowohl in vitro als auch in vivo.
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To examine the effectiveness of airport screening in New South Wales during pandemic (H1N1) 2009 influenza. Analysis of data collected at clinics held at Sydney Airport, and of all notified cases of influenza A(H1N1)pdm09, between 28 April 2009 and 18 June 2009. Case detection rate per 100 000 passengers screened, sensitivity, positive predictive value and specificity of airport screening. The proportion of all cases in the period detected at airport clinics was compared with the proportion detected in emergency departments and general practice. Of an estimated 625 147 passenger arrivals at Sydney Airport during the period, 5845 (0.93%) were identified as being symptomatic or febrile, and three of 5845 were subsequently confirmed to have influenza A(H1N1)pdm09, resulting in a detection rate of 0.05 per 10 000 screened (95% CI, 0.02-1.14 per 10 000). Forty-five patients with overseas-acquired influenza A(H1N1)pdm09 in NSW would have probably passed through the airport during this time, giving airport screening a sensitivity of 6.67% (95% CI, 1.40%-18.27%). Positive predictive value was 0.05% (95% CI, 0.02%-0.15%) and specificity 99.10% (95% CI, 99.00%-100.00%). Of the 557 confirmed cases across NSW during the period, 290 (52.1%) were detected at emergency departments and 135 (24.2%) at general practices, compared with three (0.5%) detected at the airport. Airport screening was ineffective in detecting cases of influenza A(H1N1)pdm09 in NSW. Its future use should be carefully considered against potentially more effective interventions, such as contact tracing in the community.
Article
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Since June 2012, 133 Middle East respiratory syndrome coronavirus (MERS-CoV) cases have been identified in nine countries. Two time periods in 2013 were compared to identify changes in the epidemiology. The case-fatality risk (CFR) is 45% and is decreasing. Men have a higher CFR (52%) and are over-represented among cases. Thirteen out of 14 known primary cases died. The sex-ratio is more balanced in the latter period. Nosocomial transmission was implied in 26% of the cases.
Article
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In China during March 4-April 28, 2013, avian influenza A(H7N9) virus testing was performed on 20,739 specimens from patients with influenza-like illness in 10 provinces with confirmed human cases: 6 (0.03%) were positive, and increased numbers of unsubtypeable influenza-positive specimens were not seen. Careful monitoring and rapid characterization of influenza A(H7N9) and other influenza viruses remain critical.
Article
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Background The volume of influenza pandemic modelling studies has increased dramatically in the last decade. Many models incorporate now sophisticated parameterization and validation techniques, economic analyses and the behaviour of individuals. Methods We reviewed trends in these aspects in models for influenza pandemic preparedness that aimed to generate policy insights for epidemic management and were published from 2000 to September 2011, i.e. before and after the 2009 pandemic. Results We find that many influenza pandemics models rely on parameters from previous modelling studies, models are rarely validated using observed data and are seldom applied to low-income countries. Mechanisms for international data sharing would be necessary to facilitate a wider adoption of model validation. The variety of modelling decisions makes it difficult to compare and evaluate models systematically. Conclusions We propose a model Characteristics, Construction, Parameterization and Validation aspects protocol (CCPV protocol) to contribute to the systematisation of the reporting of models with an emphasis on the incorporation of economic aspects and host behaviour. Model reporting, as already exists in many other fields of modelling, would increase confidence in model results, and transparency in their assessment and comparison.
Article
Severe acute respiratory syndrome (SARS) is a form of atypical pneumonia that apparently originated in Guangdong Province of the People’s Republic of China in late 2002. This first came to the world’s attention in late February 2003, and has since spread worldwide. As of June 23rd 2003, the disease had been reported from 32 countries or regions globally, affecting 8459 people; 805 individuals (9.5 % of the total affected) have died of the disease. A novel coronavirus, the SARS-associated coronavirus (SARS-CoV) has been found in various specimens taken from patients with SARS. Although there has been rapid development of tests to detect SARS Co-V, these tests presently have certain limitations. Definitions of suspected, confirmed and probable cases have been formulated. Measures currently used for the management of patients with SARS include isolation, ribavirin, corticosteroid therapy and mechanical ventilation. Unfortunately, almost 10 % of affected patients succumb to their illness, underlying the need for developing more effective therapy. It remains to be seen how long it will take to bring this epidemic under control.
Article
The evolution of mobile phone technology has introduced new possibilities to the field of medicine. Combining technological advances with medical expertise has led to the use of mobile phones in all healthcare areas including diagnostics, telemedicine, research, reference libraries and interventions. This article provides an overview of the peer-reviewed literature, published between 1 August 2006 and 1 August 2011, for the application of mobile/cell phones (from basic text-messaging systems to smartphones) in healthcare in both resource-poor and high-income countries. Smartphone use is paving the way in high-income countries, while basic text-messaging systems of standard mobile phones are proving to be of value in low- and middle-income countries. Ranging from infection outbreak reporting, anti-HIV therapy adherence to gait analysis, resuscitation training and radiological imaging, the current uses and future possibilities of mobile phone technology in healthcare are endless. Multiple mobile phone based applications are available for healthcare workers and healthcare consumers; however, the absolute majority lack an evidence base. Therefore, more rigorous research is required to ensure that healthcare is not flooded with non-evidence based applications and is maximized for patient benefit.