Video 8.6: International measures including travel restrictions and entry screening

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Do curso por The University of Hong Kong

Epidemics

23 classificações

The University of Hong Kong

Epidemics

23 classificações

“If history is our guide, we can assume that the battle between the intellect and will of the human species and the extraordinary adaptability of microbes will be never-ending.” (1) Despite all the remarkable technological breakthroughs that we have made over the past few decades, the threat from infectious diseases has significantly accelerated. In this course, we will learn why this is the case by looking at the fundamental scientific principles underlying epidemics and the public health actions behind their prevention and control in the 21st century. This course covers the following four topics: 1. Origins of novel pathogens; 2. Analysis of the spread of infectious diseases; 3. Medical and public health countermeasures to prevent and control epidemics; 4. Panel discussions involving leading public health experts with deep frontline experiences to share their views on risk communication, crisis management, ethics and public trust in the context of infectious disease control. In addition to the original introductory sessions on epidemics, we revamped the course by adding: - new panel discussions with world-leading experts; and - supplementary modules on next generation informatics for combating epidemics. -------------------------------------------------------- (1) Fauci AS, Touchette NA, Folkers GK. Emerging Infectious Diseases: a 10-Year Perspective from the National Institute of Allergy and Infectious Diseases. Emerg Infect Dis 2005 Apr; 11(4):519-25. What you'll learn - Demonstrate knowledge of the origins, spread and control of infectious disease epidemics - Demonstrate understanding of the importance of effective communication about epidemics - Demonstrate understanding of key contemporary issues relating to epidemics from a global perspective

Na lição

Theme Three: Control (Non-pharmaceutical intervention (NPI))

Theme Three Summary

Week 8 Introduction1:42

Week 8.1: Non-pharmaceutical interventions overview and John Snow4:34

Week 8.2: Control of Cholera8:37

Week 8.3: Hygiene and other personal interventions6:23

Video 8.4: Isolation and quarantine and contact tracing6:02

Video 8.5: School closure7:49

Video 8.6: International measures including travel restrictions and entry screening4:40

Video 8.7: Zoonoses - market closure6:18

Conheça os instrutores

Gabriel M. Leung (HKU)
Dean
Li Ka Shing Faculty of Medicine
Joseph T. Wu (HKU)
Associate Professor
Li Ka Shing Faculty of Medicine
Kwok-Yung Yuen (HKU)
Professor
Li Ka Shing Faculty of Medicine
Tommy Lam (HKU)
Assistant Professor
Li Ka Shing Faculty of Medicine
Maria Huachen Zhu (HKU)
Associate Professor
Li Ka Shing Faculty of Medicine
Guan Yi (HKU)
Chair Professor
Li Ka Shing Faculty of Medicine
Benjamin Cowling (HKU)
Professor
Li Ka Shing Faculty of Medicine
Thomas Abraham (HKU)
Associate Professor
Journalism and Media Studies Centre
Mark Jit (LSHTM)
Professor
Department of Infectious Disease Epidemiology
Malik Peiris (HKU)
Chair Professor
Li Ka Shing Faculty of Medicine
Marc Lipsitch (Harvard)
Professor
Department of Epidemiology

In this part, I will talk about

national and international-level measures

to control and mitigate epidemics.

The objectives of this part are:

to define entry screening;

to define exit screening;

and to discuss the potential benefits

and limitations of travel restrictions

and entry screening for pandemic influenza.

When infectious diseases emerge or re-emerge,

considerable efforts may be made

to contain the new pathogen geographically,

and stop it from traveling across

national or international borders.

For example, during the SARS epidemic in 2003,

the World Health Organization

advised people not to travel

to affected areas including Hong Kong,

Toronto, Beijing, and some other areas.

Some countries established entry screening,

for example in Hong Kong all arriving

travelers were required to complete

a health declaration form,

and have their body temperature checked.

This is known as entry screening.

For busy airports such as the one in Hong Kong,

millions of passengers arrive every month,

and so entry screening can be

labour-intensive and very costly.

In Singapore, 400,000 passengers

were screened in a few months in 2003,

and while no SARS cases were identified,

it was suggested that the expense

was justified in light of the major political,

social and economic impact if even

a single case arrived in the country.

Later in the SARS epidemic,

in Hong Kong health declaration forms were

also required for outbound passengers,

as a form of exit screening.

In the years following 2003,

a series of simulation studies

considered the potential application of

travel restrictions and border screening

in controlling the next influenza pandemic.

Those studies consistently found that

travel restrictions would need to be extreme,

with more than a 99% drop in travelers,

in order to delay importation of

pandemic influenza for just a few weeks.

Meanwhile, the economic costs of

travel restrictions could be considerable.

One motivation for travel restrictions

and entry screening would be to buy time

while a vaccine is being developed and produced.

However, Cooper and colleagues

suggested that even very intensive measures

could only delay epidemic spread

for a few weeks, and that resources

might be better directed

to local control measures.

Entry screening was unlikely to be useful

because many persons infected with influenza

have no symptoms or only very mild symptoms,

and some travelers may be incubating disease,

that is infected but not yet symptomatic,

at the time they pass across national borders.

Nevertheless, when swine flu

emerged in North America in 2009,

many countries implemented

some form of entry screening,

as much for political considerations

as for public health.

In China, Mexican travelers were

rounded up and quarantined,

while some countries cancelled

direct flights from Mexico.

We assessed the measures implemented

by 35 selected locations and identified

four broad approaches to entry screening

used alone or in combination

with other measures.

First, temperature checks were performed

onboard aircraft prior to disembarkation.

Second, health declaration forms

were collected from every traveller

or all travellers from countries

identified with confirmed H1N1 cases.

Third, arriving travellers were observed

by alert staff for influenza symptoms

such as cough.

Fourth, travellers were scanned

for elevated body temperature

by thermal scanners.

Based on the idea that entry screening

should delay the onset of local transmission,

we determined the dates of the

first confirmed imported cases,

and the dates of the first local case –

that is a case not epidemiologically

linked with imported cases –

and compared these dates for various locations.

We found that locations which implemented

some form of entry screening

did tend to have longer delays,

but only by around 1-2 weeks.

The uncertainty bound of the delay estimates

ranged from no delay

up to 20-30 days delay.

In general, a delay of 1-2 weeks

might be useful if the additional time

permitted more comprehensive planning

and preparation for a local epidemic,

or shortened the time required

for other pandemic mitigation measures

such as school closures to be sustained.

However any benefits of local screening

should be balanced against

the considerable resources required

to implement screening.

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