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1 March 25th 2015 Usefulness and applicability of infectious disease control measures in air travel: a review Corien Swaan MD Consultant Inf Dis Control Head department Preparedness & Control LCI/CIb/RIVM

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1 March 25th 2015

Usefulness and applicability of infectious disease control measures in air travel: a review

Corien Swaan

MD Consultant Inf Dis Control

Head department Preparedness & Control

LCI/CIb/RIVM

2 March 25th 2015

March 25th 2015 3

http://openflights.org/data.html

Literature study

Aim

●to inventory experiences and applicability of infectious disease control measures:

– Added value in limiting transmission

– Analyze constraints in implementation

Methodology

●Literature search in Pubmed, period 1990 – 2013

●Using:

– Air travel terms (Ragida guidelines:http://www.ecdc.europa.eu/en/publications/publications/0906_ter_risk_assessment_guidelines_for_infectious_diseases_transmitted_on_aircraft.pdf )

– Intervention terms (Core capacity requirements IHR)

●Scoring on outcome, resources, required preparations, passenger inconvenience, compliance

March 25th 2015 4

Methodology

● Intervention terms:

– Exit and entryscreening

– Information provision to passengers

– Isolation, quarantine and health monitoring

– Contact tracing

– Hygiene measures

– Travel restrictions

– Animal care

– Vector control

– Contaminated goods

March 25th 2015 5

Methodology

● scoring: Criteria for analysis of experiences and applicability of interventions

March 25th 2015 6

Criteria Description Scoring ++: very positive, +: positive, +/- neutral -: negative, --: very negative

Outcome Extent to which measures are expected to prevent disease transmission

Measures able to prevent disease spread to a large extent: ++. Measures able to prevent disease spread to some extent: +. Measures hardly effective: +/- Measures ineffective: -

Resources Required funds, supplies and personnel

Measures that were considered applicable with very few additional resources: + + Measures that were considered applicable with few additional resources:+ Measures that were considered “rather resource-intensive”: - Measures that were considered “very resource-intensive”: --

Required preparation

Required preparation efforts to install the measure in a timely manner

Measures considered easy to set up and implement ad hoc: + Measures requiring extensive preparation: -

Passenger inconvenience

Burden on passengers Passengers are barely affected by a measure: ++ A few passengers are affected by the measures: – Inconvenience to a number or majority of passengers: --

Compliance Extent to which compliance by the passengers is necessary for prevention in transmission

Measures little dependent on compliance: ++ Measures require some compliance: + Measures that completely depend on passengers’ willingness to comply: -

● Pubmed

861 records

100 records

●Selection on abstract and title

●Inclusion criteria:

-Description of cases

-Description of models

-Description of experiments

-Infectious disease control in the context of commercial air travel

•Exclusion criteria:

- language other than English,

100 records

●Check reference lists for additional articls

Selection strategy

March 25th 2015 7

Results

Intervention Exit and entry screening Includes entry- en exitscreening: health

declarations, medical examination, thermal screening

Effectiveness depends on: prevalence, detectability, quality of scr method, Quantative information on

Influenza and SARS

Information provision To passengers, and cabin crew, and medical authorities

Not resource intensive, compliance passengrs questionable

Isolation, quarantine and health monitoring Quarantaine of passengers can help delay spread/introduction, however very resourcefull and

inconvenient for passengers. Isolation: more effective, less resources, better compliance. HM:

little published

Contact tracing Effectiveness differs per disease. Resource intensive.

Hygiene measures Effect not well documented, standardised procedures, not resourcefull

Travel restrictions Strictly implemented to have effect. Modeling studies: only effective with few cases.Inconvenient

for passengers Animal care Literature limited

Vector control One study: malaria transmission reduced. Limited resources. Compliance passengers not needed

Contaminated goods Literature limited

Total

March 25th 2015 8

Overview of experiences and applicability of control measures

March 25th 2015 9

●[1

Outcome Resources Required prepara-tion

Passenger inconve-nience

Compliancerequired

Total

1. Entry and exit screening +/- -- - -- + -4

2. Providing information to travelers & self-reports

+/- ++ + ++ - 4

3a. Quarantine +/- -- - -- + -4

3b. Isolation ++ + + - + 4

3c. Health monitoring + + + - + 3

4. Contact tracing +/- - - ++ + 1

5. Hygiene measures + -- + ++ + 3

6. Travel restrictions - - + -- - -4

7. Animal care l.o.i. l.o.i. l.o.i. l.o.i. l.o.i.

8. Vector control + + - + ++ 3

9. Control of goods l.o.i. l.o.i. l.o.i. l.o.i. l.o.i.

++ very positive, + positive, +/- neutral, - negative, -- very negative. l.o.i.= lack of information

For total, the total of the other columns was taken (1).

Conclusion

● Measures best experiences and most applicable to prevent infectious disease spread:

– information to passengers (little resources, inconvenience limited)

– Isolation of patients (prevention transmission)

● Measures limitations in applicability and positive experiences:

– Exit and entry screening (resource intensive, inconvenient for passengers)

– Quarantine (idem)

– travel restrictions (inconvenient for passengers, compliance quesionable, limited effect on outcome)

March 25th 2015 10

● Discussion:

– added value of measures might differ per disease

– Political reasons to implement measures

● Recommendation

● Research comparing the effectiveness of different measures for different infectious diseases, in order to:

– Determine proportionateness of measures (fe contact tracing, entry- and exit screening)

– Invest in preparedness (collect and store passenger information details, quarantaine facilities)

March 25th 2015 11

12 March 25th 2015

● Acknowledgements:

● Yvonne Huizer

● Katrin Leitmeyer (ECDC)

● Aura Timen (LCI/RIVM)

● Maria an der Heiden (RKI)

● Andreas Gilsdorf (RKI)

Results

June 17th 2014 13

Search terms

# of articles found

# of articles selected

Intervention terms

Exit and entry screening Entry screening; exit screening; border screening; thermal scanning; thermal screening; health declarations; self-declarations; medical exam; medical examination; laboratory testing

76 37

Information Travel information; informing public; traveler; informing authorities 51 9

Isolation, quarantine and health monitoring

Quarantine; patient isolation 94 8

Contact tracing Contact tracing; passenger contacts; locator cards 59 14

Hygiene measures Hygiene measures; facial mask; facemask; hand washing; disinfection 50 10

Travel restrictions Travel restrictions; cancel 36 8

Animal care Animal; animal travel; animal care 7 2

Vector control Vector control; reservoir; reservoir control; disinsection; insecticide 141 12

Contaminated goods Contaminated materials; contaminated merchandises; infected materials; infected merchandises; luggage; baggage; contamination; cargo

347 0