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

Appendix E1

Travel-Related SARS Response Matrices

### Matrix 1: Suggested Activities for Inbound Travelers

+----------------------+-----------------------------------------------+
| **Level of SARS-CoV  | **Suggested actions, by situation in          |
| transmission         | originating location**                        |
| activity in the      |                                               |
| United States**      |                                               |
+----------------------+-----------------------------------------------+
| No known SARS-CoV    | ## Imported case                              |
| transmission         | s; limited transmission in location of origin |
| worldwide **or**     |                                               |
| known SARS-CoV       | ## Dis                                        |
| activity but only    | tribute health alert notices to all arrivals. |
| imported cases       |                                               |
|                      | -   Implement passive monitoring of all       |
|                      |     arriving passengers for development of    |
|                      |     fever or respiratory symptoms.            |
|                      |                                               |
|                      | -   Advise persons who develop symptoms to    |
|                      |     self-report before presentation to        |
|                      |     healthcare provider.                      |
|                      |                                               |
|                      | -   Follow quarantine officer protocol for    |
|                      |     arriving ill passengers                   |
|                      |                                               |
|                      |     -   Follow procedures for ill contacts    |
|                      |                                               |
|                      |     -   Collect 30-day contact information    |
|                      |         for passengers on conveyances with    |
|                      |         ill passenger                         |
|                      |                                               |
|                      | -   Consider enhanced surveillance for ill    |
|                      |     passengers.                               |
|                      |                                               |
|                      | #### *Exten                                   |
|                      | sive transmission/effective control measures* |
|                      |                                               |
|                      | -   Implement active surveillance for ill     |
|                      |     passengers.                               |
|                      |                                               |
|                      | -   Implement symptom screening for all       |
|                      |     arriving passengers.                      |
|                      |                                               |
|                      | -   Medically evaluate all passengers with    |
|                      |     symptoms.                                 |
|                      |                                               |
|                      | -   Consider 10-day quarantine for            |
|                      |     asymptomatic arrivals.                    |
|                      |                                               |
|                      | -   Collect contact information on all        |
|                      |     arriving passengers.                      |
|                      |                                               |
|                      | ## Extens                                     |
|                      | ive transmission/ineffective control measures |
|                      |                                               |
|                      | -   Prohibit all non-essential arrivals.      |
|                      |                                               |
|                      | -   Conduct medical screening upon arrival.   |
|                      |                                               |
|                      | -   Implement mandatory 10-day quarantine for |
|                      |     all asymptomatic arrivals.                |
|                      |                                               |
|                      | -   Collect contact information on all        |
|                      |     arriving passengers.                      |
+----------------------+-----------------------------------------------+
| Extensive SARS-CoV   | ## Imported case                              |
| transmission in      | s; limited transmission in location of origin |
| United States and    |                                               |
| community, with      | -   Minimize non-essential travel.            |
| effective control    |                                               |
| measures             | -   Consider restricting travel within        |
|                      |     jurisdictions.                            |
|                      |                                               |
|                      | -   Advise arrivals to follow procedures      |
|                      |     based on situation in location of origin. |
|                      |                                               |
|                      | ***Extensive transmission/effective control   |
|                      | measures***                                   |
|                      |                                               |
|                      | -   Minimize non-essential travel.            |
|                      |                                               |
|                      | -   Consider restricting travel within        |
|                      |     jurisdictions.                            |
|                      |                                               |
|                      | -   Advise arrivals to follow procedures      |
|                      |     based on situation in location of origin. |
|                      |                                               |
|                      | ## Extens                                     |
|                      | ive transmission/ineffective control measures |
|                      |                                               |
|                      | -   Prohibit all non-essential arrivals.      |
|                      |                                               |
|                      | -   Conduct medical screening upon arrival.   |
|                      |                                               |
|                      | -   Implement mandatory 10-day quarantine for |
|                      |     all asymptomatic arrivals.                |
|                      |                                               |
|                      | -   Collect contact information on all        |
|                      |     arriving passengers.                      |
+----------------------+-----------------------------------------------+
| Extensive SARS-CoV   | ## Imported case                              |
| transmission in      | s; limited transmission in location of origin |
| United States and    |                                               |
| community, with      | -   Prohibit all non-essential arrivals.      |
| ineffective control  |                                               |
| measures             | -   Advise arrivals to follow procedures      |
|                      |     based on situation in location of origin. |
|                      |                                               |
|                      | ***Extensive transmission/effective control   |
|                      | measures***                                   |
|                      |                                               |
|                      | -   Prohibit all non-essential arrivals.      |
|                      |                                               |
|                      | -   Advise arrivals to follow procedures      |
|                      |     based on situation in location of origin. |
|                      |                                               |
|                      | ***Extensive transmission/ineffective control |
|                      | measures***                                   |
|                      |                                               |
|                      | -   Prohibit all non-essential arrivals.      |
|                      |                                               |
|                      | -   Conduct medical screening upon arrival.   |
|                      |                                               |
|                      | -   Implement mandatory 10-day quarantine for |
|                      |     all asymptomatic persons.                 |
|                      |                                               |
|                      | -   Collect contact information on all        |
|                      |     arriving passengers.                      |
+----------------------+-----------------------------------------------+

### Matrix 2: Suggested Activities for Outbound Travelers

+----------------------+-----------------------------------------------+
| # Level of S         | # Suggested actions                           |
| ARS-CoV transmission |                                               |
+----------------------+-----------------------------------------------+
| No known SARS-CoV    | -   No special activities                     |
| transmission         |                                               |
| worldwide            |                                               |
+----------------------+-----------------------------------------------+
| SARS activity in     | -   Issue travel health precautions and       |
| United States and    |     warnings for destinations based on        |
| community, but only  |     setting and transmission pattern.         |
| imported cases       |                                               |
|                      | -   Prohibit non-essential travel to          |
|                      |     countries where control measures are      |
|                      |     inadequate.                               |
|                      |                                               |
|                      | -   Consider:                                 |
|                      |                                               |
|                      |     -   Medical screening at all exit points  |
|                      |                                               |
|                      |     -   Travel prohibition for all persons    |
|                      |         meeting case definition with          |
|                      |         epidemiologic link to transmission    |
|                      |         setting                               |
|                      |                                               |
|                      |     -   Medical assessment for all with       |
|                      |         signs/symptoms without epidemiologic  |
|                      |         link                                  |
|                      |                                               |
|                      | -   Prohibit travel for persons under         |
|                      |     quarantine.                               |
+----------------------+-----------------------------------------------+
| Extensive SARS-CoV   | -   Issue international travel notifications  |
| transmission in      |     as above.                                 |
| United States and    |                                               |
| community, with      | -   Issue travel health precautions/warnings  |
| effective control    |     for domestic destinations based on        |
| measures             |     setting and transmission pattern.         |
|                      |                                               |
|                      | -   Initiate medical screening of departing   |
|                      |     passengers at all exit points.            |
|                      |                                               |
|                      | -   Prohibit travel for all persons meeting   |
|                      |     case definition.                          |
|                      |                                               |
|                      | -   Prohibit travel for all persons under     |
|                      |     quarantine.                               |
|                      |                                               |
|                      | -   Require health certificate for exit.      |
+----------------------+-----------------------------------------------+
| Extensive SARS-CoV   | -   Issue international travel notifications  |
| transmission in      |     as above.                                 |
| United States and    |                                               |
| community, with      | -   Issue domestic travel health              |
| ineffective control  |     precautions/warnings as above.            |
| measures             |                                               |
|                      | -   Prohibit nonessential outbound travel.    |
|                      |                                               |
|                      | -   Require health certificate for essential  |
|                      |     travel.                                   |
|                      |                                               |
|                      | -   Implement medical screening at all exit   |
|                      |     points.                                   |
|                      |                                               |
|                      | -   Prohibit travel for all persons meeting   |
|                      |     case definition.                          |
|                      |                                               |
|                      | -   Prohibit travel for all persons under     |
|                      |     quarantine.                               |
+----------------------+-----------------------------------------------+

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)