Identifying travellers from affected countries and screening for symptoms and/or risk exposures on arrival Increases public awareness to identify possible cases or exposed travellers at the time of their entry in the country Enables information to be given to people who may be at higher risk Facilitates management of contacts Facilitates early management of cases detected Detects travellers who do not have adequate vaccination cover and enables them to be offered vaccination Requires travellers to (supported by information held by border officials) May be difficult to ensure accuracy of information (eg, contact details, fraudulent vaccination certificates) Language barriers need to be addressed Need to manage travellers’ personal data Management of self-reports Cost of providing vaccination (including vaccinations for staff) In the absence of World Health Organization recommendations, such measures must not cause significant delays for travellers Contact New Zealand Customs to seek their cooperation in identifying travellers from affected countries at arrivals desk (or SmartGate/eGate) and undertaking screening Identify screening criteria (eg, symptoms and/or exposure risk) Draft standard operating procedure for implementation, including reporting Provide advice to New Zealand Customs for drafting operational orders (including personal protective equipment) Provide training for Customs officers who are undertaking screening Travellers screened by Customs are isolated and given a more detailed health risk assessment by public health officers (including temperature monitoring if required): Identify isolation area Identify risk assessment criteria Provide advice/guidance to public health officers Train public health officers, ensure availability of all appropriate equipment Develop reporting templates and procedures Visual Screening of Travellers: Visual screening methods may be additional to screening travellers from affected countries for symptoms or high-risk exposures. It may assist in identifying ill travellers but only if there are obvious signs of illness, and it is unlikely that visual screening (as with screening measures in general) will assist in detecting all ill travellers. Arrangements for visual screening at international air and sea ports will require trained personnel and further medical assessment if ill travellers are detected. In some countries, initial medical assessment, including visual screening, has been implemented at designated points of entry, such as international airports. Potential benefits Limitations/consequences Action points (Actions required to prepare for implementing a measure, on planning, readiness and debriefs from responses or exercises, etc) Visual screening – aims to identify arriving ill travellers who might be visibly ill
May detect obviously ill travellers Supplements measures (eg, thermal scanning) Questionable efficacy Cost (including resources) Difficult to implement and minimal effectiveness in identifying ill travellers Low sensitivity and specificity Requires trained personnel Large opportunity costs as would take up considerable time of health authorities Poor compliance – some travellers may actively hide symptoms Apply screening criteria re sensitivity, specificity, ethics, etc Develop standard operating procedures with limitations and constraints clearly identified Temperature Screening: Temperature screening methods may augment screening travellers from affected countries for symptoms or high-risk exposures. However, thermal screening of travellers at international air and sea ports is not recommended by the World Health Organization as there is no reliable way to easily identify infected but pre-symptomatic or asymptomatic travellers. If temperature screening is to be conducted, it should be in conjunction with well-developed protocols on how to manage travellers who are detected with raised temperatures. Basic infection prevention and control measures should also be applied. Options for temperature screening include thermometers and electronic mass thermal screening devices. Potential target populations to screen could include: all arriving travellers (entry screening); travellers arriving from selected destinations (entry screening) and/or all departing travellers in affected countries, especially those with community-level outbreaks (exit measures). However, temperature screening will not detect cases that are mild and may not be febrile or are pre- or a-symptomatic. While the World Health Organization does not have official recommendations around exit screening, it is probably best considered by national authorities in situations where countries have community-level outbreaks. Countries should reconsider or discontinue entry screening once a disease is transmitting widely within the country. Potential benefits Limitations/consequences Action points (Actions required to prepare for implementing a measure, based on planning, readiness and debriefs from responses or exercises, etc) Temperature screening – aims to detect arriving travellers who have a fever
The International Health Regulations (2005) provide mechanisms for countries to implement additional measures. However, countries that measures that significantly interfere with international traffic (such as refusing international travellers’ entry or exit for more than 24 hours) must provide the World Health Organization with the public health rationale and scientific information for their actions under the International Health Regulations (2005). The World Health Organization will follow up such matters and has obligations to share such information with all member states. Potential benefits Limitations/consequences Action points (Actions required to prepare for implementing a measure, based on planning, readiness and debriefs from responses or exercises, etc) International travel restrictions – aim to reduce travel to and from affected countries or areas and prevent or delay disease introduction to a non-affected country Potentially reduces the number of ill individuals travelling May prevent or delay virus introduction May prevent or delay public health risk if travel restrictions are applied quickly enough and are in place for long enough Limited effect on stopping the spread of the virus internationally Interferes with international travel and Potential political and economic impacts Disrupts normal social functioning Need to clearly justify rationale Need to cover off human rights issues Can be difficult to define ‘affected’ Travellers may try to circumvent any restrictions Travel restrictions and quarantining travellers at international borders did not substantially delay disease introduction in past pandemics, except at some small island countries Travel restrictions are likely to impose significant economic costs on affected countries and may affect the provision of essential goods and medical services, etc Aircraft past the of no return would need to be able to land and then the travellers and crew quarantined/isolated Hinders efforts to assist affected countries (eg, prevents health care workers assisting with the response in affected countries) Develop triggers, standard operating procedures and templates to ensure appropriate information is available in a timely manner for key considering travel restrictions Prepare statutory notices and directions, including a pandemic notice Prepare to requisition quarantine facilities Liaise with suppliers of essential and services to determine the impacts of border closures Diversion of an individual conveyance (eg, if an aircraft has a novel infection on board or is contaminated) – aim to delay or prevent introduction of public health threat and ensure the most appropriate location to provide a public health response
Slows down and possibly delays infection transmission in a country Manages potentially infectious individuals Empowers people to take responsibility for managing their potential risk Requires a high level of awareness and self-responsibility Services must be available to provide basic necessities to those who live alone or have special needs Health monitoring and reporting system are required alternative arrangements for non-residents Potential risk of transmission to household members, if exposed individual is infected Employers and others may be reluctant to accept voluntary quarantine (eg, not allow sick leave to be used) Develop guidelines and advice Prepare templates for advisory notices Work with WorkSafe New Zealand to engage employer cooperation Work with the Ministry of Business, Innovation and Employment’s infrastructure group on the impacts on essential services, supplies and industries Public health officers have processes and procedures (including for implementing voluntary quarantine. Voluntary or mandatory quarantine: home quarantine of exposed travellers – to identify infected individuals and the transmission cycle Manages potentially infectious individuals Slows down and possibly delays infection transmission in a country Can be combined with other appropriate medical measures (treatments, isolation, testing, etc) at the onset of symptoms Detects new cases Less stressful on people to be quarantined at home than elsewhere Services must be available to provide basic necessities to those who live alone or have special needs Health monitoring and reporting systems are required Difficult to monitor compliance Need alternative arrangements for non-residents and travellers Potential risk of transmission to household members, if the exposed traveller is infected May cause undue concern, especially if the index case is not confirmed Compulsory quarantine is not feasible Develop guidelines and advice Prepare templates for advisory notices Work with WorkSafe New Zealand to engage employer cooperation Work with the Ministry of Business, Innovation and Employment’s infrastructure on impacts on essential services, supplies and industries Public health officers have processes and procedures (including forms) for implementing voluntary or mandatory quarantine. Voluntary or mandatory quarantine: institutional (including hotel) quarantine – to identify infected individuals and break transmission cycle
Manages potentially infectious individuals Slows down and possibly delays infection transmission in a country Ensures compliance with containment, health monitoring and illness reporting Can be combined with other appropriate medical measures (treatments, isolation, testing etc) at onset of symptoms Ensures rapid detection of new cases Very resource intensive – human and financial Logistically challenging and need to ensure provision of essential services (safe food, medicine and communication means, etc) Political, ethical and possibly legal implications from confinement of large number of travellers (especially foreigners) Potentially extremely stressful and disruptive for travellers The need to manage the direct and indirect cost and negative consequence of compulsory quarantine of international travellers can be very serious (including human right issue) May cause concerns about financial loss to international travellers (eg, business people) and need to address compensation issues Commercial facilities not secure enough for compulsory quarantine of non-compliant travellers Facilities for special needs people Develop guidelines and advice Prepare templates for advisory notices Work with employer organisations, unions and other relevant agencies to engage employer cooperation Work with suppliers of essential goods and services to consider the impacts on these industries Ensure arrangements with hotel chains, individual hotels (and other accommodation providers) for operation as quarantine facilities are in place Prepare templates for requisitioning facilities, compulsory quarantine, etc Consider establishing a ‘government’ quarantine facility Public health officers have processes and procedures (including forms) for implementing voluntary or mandatory quarantine.