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Summary Sick people travel by air every day. They board with common colds, mild cases of influenza, and sometimes more serious illnesses. This requires that airports and their public health partners be pre- pared to respond when a sick passenger is on an arriving flight, particularly when a passenger has a highly contagious illness. An effective response requires an established partnership among airport and public health authorities and a well-conceived and practiced communicable disease response plan. Ebola, influenza A virus subtype H1N1 (often called swine flu), Middle East respiratory syndrome coronavirus (MERS-CoV), influenza A virus subtype H5N1 (sometimes called Asian avian influenza), influenza virus A subtype H7N9 (an avian influenza), tuberculosis, and Zikaâthis is only a partial list of the myriad communicable diseases that have threatened global public health in the past decade. Disease outbreaks have become more visible in an era of mass travel, with air travel serving as a power ful means of transmission. The primary strategy of the public health sectorâfrom the World Health Organization (WHO) to the Centers for Disease Control (CDC), Public Health Agency of Canada (PHAC), and state, provincial, county, and local health partnersâis to mitigate the risks from a communicable disease to contain its spread within the outbreak area. This involves heighten- ing awareness among the public, mobilizing risk-mitigation efforts, promoting social distancing, and applying the use of prophylactic medicines and vaccines. To strengthen these efforts, the aviation sector can provide support by helping to reduce the likelihood of sick individuals traveling outside the outbreak area and transmitting illness to others. This synthesis examines current disease preparedness and response practices among U.S. and Canadian airports and their public health partners. Recent outbreaks, including those listed previously, have caused airports and public health agencies and departments to forge strong relationships and engage in joint planning to protect community health and well-being and ensure business continuity. In short, the aviation and public health sectors need each other; neither sector can act effectively alone, and both require the detailed knowledge and expertise of the other as well as numerous additional stakeholders. Although larger airports that receive international flights are most likely to experience the challenges associated with these events, the preparedness and response lessons are transferable more widely to the aviation sector. The findings presented in this report are based on survey responses from a purposive sample of 50 airports and 39 public health departments, a review of peer-reviewed and gray literature, six detailed case examples involving interviews with aviation and public health partners, and interviews with representatives of five leading international, national, and regional airport and public health organizations to provide expert validation of the studyâs findings and suggestions for future research. Effective comprehensive planning is necessary to ensure airport safety and operational continuity and protect public health. This synthesis presents major conclusions in the following six areas: ⢠Comprehensive planning ⢠Partnership and stakeholder engagement ⢠Legal issues ⢠Strategic communications ⢠Exercising, drilling, training, and education ⢠Evaluation and continuous improvement. PreParing airPortS for CommuniCable DiSeaSeS on arriving flightS
2 The research also identified six areas for future research, which are presented here in the form of analytical questions: ⢠What procedures are in place to get prompt passenger information that is timely and complete to the agencies that need it? ⢠What security issues face public health responders in an airport setting? ⢠What additional information on the risk of disease transmission on aircraft and in other aviation settings is needed, and how is this information obtained? ⢠What are the sociocultural factors that shape reaction to a communicable disease involving avia- tion, and how do airports and public health stakeholders use established and emerging media tech- nologies to inform the public and engage them as partners in response? ⢠What are the most effective means to disseminate information about communicable disease in an airport setting to the general population and the traveling public? ⢠How effective are exit screening and other border exclusion strategies for protecting the public from disease threats? The information presented in this synthesis report is intended for use by senior airport leader- ship, airport responders and emergency planners, airport emergency response partners, public health officials, other health providers, and airlines.
