Public Health Guidance for Community-Level Preparedness and Response to
Severe Acute Respiratory Syndrome (SARS) Version 3

Supplement E: Managing International Travel-Related Transmission Risk

VI\. De-Escalation of Control Measures

**Objective 1:** Downgrade or remove travel notifications as
appropriate.

> **Activities**

-   CDC will downgrade a travel health warning to a travel health
    precaution when there is:

    -   Adequate and regularly updated reporting of surveillance data
        from the area

    -   No evidence of ongoing transmission outside defined settings for
        for 20 days (two incubation periods) after date of onset of
        symptoms for the last confirmed case without an epidemiologic
        link, as reported by public health authorities.

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-   CDC will remove a travel health precaution when there is:

    -   Adequate and regularly updated reporting of surveillance data
        from the area

    -   No evidence of new cases for 30 days (three incubation periods)
        after the date of onset of symptoms for the last case, as
        reported by public health authorities.

    -   Limited or no recent instances of exported cases from the area.
        An *exported case* is an ill person who meets the definition for
        a probable or confirmed case of SARS-CoV disease and who
        acquired SARS-CoV infection in the area in question and then
        traveled outside the affected area to another region and was
        diagnosed there (i.e., the person was not identified as a part
        of contact tracing activities, and travel was not restricted).
        This criterion excludes intentional or planned evacuations.

> **Objective 2:** Reduce measures used for inbound travelers as
> appropriate.
>
> **Activities**
>
> [For all passengers arriving from areas with SARS-CoV
> transmission]{.underline}:

-   Continue general education for passengers from a particular area
    until the travel health precaution has been lifted (30 days after
    the onset of symptoms for the last case in that area). Because
    travel patterns may make it difficult to determine passengers'
    points of origin, it may be more practical to continue general
    education until travel health precautions have been lifted for all
    areas.

-   Continue evaluating travelers who report symptoms of SARS during
    travel until the travel health precaution for that area has been
    lifted (30 days after the onset of symptoms for the last case from
    that area).

[For passengers arriving from areas under a travel health
warning]{.underline}:

-   Continue the use of screening questionnaires until the area of
    origin is downgraded from a travel health warning to a travel health
    precaution.

-   Continue meeting conveyances from SARS-affected areas and visually
    inspecting passengers until the area of origin is downgraded from a
    travel health warning to a travel health precaution.

**Objective 3**: Reduce other measures used for outbound travelers as
appropriate.

> **Activities**

-   Continue pre-departure fever and symptom screening for passengers
    departing from areas with ongoing unlinked transmission, but
    consider discontinuing these activities 20 days after the onset of
    symptoms for the last unlinked case.

-   Continue stop lists until there are no longer any cases under
    isolation or contacts under quarantine.

**Objective 4**: Reduce measures for management of passengers with
SARS-CoV

disease on conveyances as appropriate.

**Activities**

-   Continue meeting any flight with an ill passenger on board who has
    SARS-like symptoms. If the passenger is seriously ill, evaluate and
    follow-up according to established protocols.

-   Continue to collect locating information as long as the passenger
    has symptoms compatible with SARS-CoV disease and has traveled from
    an area with ongoing unlinked transmission (under a travel
    advisory). For areas that have been downgraded to a travel health
    precaution, locating information may not be needed unless the ill
    passenger meets the epidemiologic criteria for [likely]{.underline}
    exposure to SARS-CoV (See Supplement B, Appendix B1).

-   The need for monitoring and quarantine of contacts of a passenger
    from an area on a travel health precaution should be determined
    after the ill passenger has been fully evaluated.

For more information, visit
[www.cdc.gov/ncidod/sars](http://www.cdc.gov/ncidod/sars/) or call the
CDC public response hotline\
at (888) 246-2675 (English), (888) 246-2857 (Español), or (866) 874-2646
(TTY)