Abstract and Introduction
In response to the largest recognized Ebola virus disease epidemic now occurring in West Africa, the governments of affected countries, CDC, the World Health Organization (WHO), and other international organizations have collaborated to implement strategies to control spread of the virus. One strategy recommended by WHO calls for countries with Ebola transmission to screen all persons exiting the country for "unexplained febrile illness consistent with potential Ebola infection." Exit screening at points of departure is intended to reduce the likelihood of international spread of the virus. To initiate this strategy, CDC, WHO, and other global partners were invited by the ministries of health of Guinea, Liberia, and Sierra Leone to assist them in developing and implementing exit screening procedures. Since the program began in August 2014, an estimated 80,000 travelers, of whom approximately 12,000 were en route to the United States, have departed by air from the three countries with Ebola transmission. Procedures were implemented to deny boarding to ill travelers and persons who reported a high risk for exposure to Ebola; no international air traveler from these countries has been reported as symptomatic with Ebola during travel since these procedures were implemented.
On October 11, 2014, after the first imported Ebola case was identified in the United States, an enhanced U.S. entry screening program was started at five international airports as an added measure to identify travelers from the three countries with widespread Ebola transmission who might have been exposed to Ebola within 21 days before arrival or who currently had signs or symptoms of Ebola. Entry screening first began at John F. Kennedy International Airport (JFK) in New York City, then Newark Liberty International Airport (EWR), Washington-Dulles International Airport (IAD), Chicago O'Hare International Airport (ORD), and Hartsfield-Jackson Atlanta International Airport (ATL). This program also allowed federal authorities to educate travelers, obtain their contact information, and link them with state and local partners to facilitate health monitoring, as appropriate, and prompt referral for care if they became ill. Of 1,993 travelers screened during October 11–November 10, 86 (4.3%) were referred to CDC public health officers for additional evaluation, and seven (8.1%) of the 86 were symptomatic and referred for medical evaluation (Table 1). None of the seven were diagnosed with Ebola.
The 1,993 travelers arrived in the United States after transit in at least one other country and had final destinations in 46 states; the most common destinations were New York (19%), Maryland (12%), Pennsylvania (11%), Georgia (9%), and Virginia (7%) (Figure). Entry screening provided public health departments with contact information for travelers to facilitate monitoring and provided an added layer of protection for the U.S. public.
Number of travelers (N = 1,986*) arriving from Guinea, Liberia, and Sierra Leone who were screened for Ebola at U.S. airports, by state and county of destination — October 11–November 10, 2014
* Seven travelers were in transit and did not stay in the United States.
On August 8, 2014, the International Health Regulations Emergency Committee determined that the Ebola outbreak in West Africa met the conditions for a Public Health Emergency of International Concern. The committee advised that WHO member states with Ebola transmission "should conduct exit screening of all persons at international airports, seaports and major land crossings, for unexplained febrile illness consistent with potential Ebola infection."
Morbidity and Mortality Weekly Report. 2014;63(49):1163-1167. © 2014 Centers for Disease Control and Prevention (CDC)