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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2019. Airport Roles in Reducing Transmission of Communicable Diseases. Washington, DC: The National Academies Press. doi: 10.17226/25367.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2019. Airport Roles in Reducing Transmission of Communicable Diseases. Washington, DC: The National Academies Press. doi: 10.17226/25367.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2019. Airport Roles in Reducing Transmission of Communicable Diseases. Washington, DC: The National Academies Press. doi: 10.17226/25367.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2019. Airport Roles in Reducing Transmission of Communicable Diseases. Washington, DC: The National Academies Press. doi: 10.17226/25367.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2019. Airport Roles in Reducing Transmission of Communicable Diseases. Washington, DC: The National Academies Press. doi: 10.17226/25367.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2019. Airport Roles in Reducing Transmission of Communicable Diseases. Washington, DC: The National Academies Press. doi: 10.17226/25367.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2019. Airport Roles in Reducing Transmission of Communicable Diseases. Washington, DC: The National Academies Press. doi: 10.17226/25367.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2019. Airport Roles in Reducing Transmission of Communicable Diseases. Washington, DC: The National Academies Press. doi: 10.17226/25367.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2019. Airport Roles in Reducing Transmission of Communicable Diseases. Washington, DC: The National Academies Press. doi: 10.17226/25367.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2019. Airport Roles in Reducing Transmission of Communicable Diseases. Washington, DC: The National Academies Press. doi: 10.17226/25367.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2019. Airport Roles in Reducing Transmission of Communicable Diseases. Washington, DC: The National Academies Press. doi: 10.17226/25367.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2019. Airport Roles in Reducing Transmission of Communicable Diseases. Washington, DC: The National Academies Press. doi: 10.17226/25367.
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Below is the uncorrected machine-read text of this chapter, intended to provide our own search engines and external engines with highly rich, chapter-representative searchable text of each book. Because it is UNCORRECTED material, please consider the following text as a useful but insufficient proxy for the authoritative book pages.

C O N F E R E N C E P R O C E E D I N G S 5 5 Airport Roles in Reducing Transmission of Communicable Diseases Summary of a Workshop of the Airport Cooperative Research Program’s 2018 Insight Event John Wilhelmi Rapporteur March 6–7, 2018 National Academy of Sciences Building Washington, D.C. Organized by the Airport Cooperative Research Program Transportation Research Board 2019

Transportation Research Board Conference Proceedings 55 ISSN 1073-1652 ISBN 978-0-309-48007-9 Subscriber Categories Aviation; security and emergencies; terminals and facilities Transportation Research Board (TRB) publications are available by ordering individual publications directly from the TRB Business Office, through the Internet at www.TRB.org or national-academies.org/trb, or by annual subscription through organizational or individual affiliation with TRB. Affiliates and library subscribers are eligible for substantial discounts. For further information, contact the Transportation Research Board Business Office, 500 Fifth Street, NW, Washington, DC 20001 (telephone 202-334-3213; fax 202-334-2519; or e-mail TRBsales@nas.edu). © 2019 National Academy of Sciences. All rights reserved. Printed in the United States of America. NOTICE: This report has been reviewed by a group other than the authors according to the procedures approved by a Report Review Committee consisting of members of the National Academies of Sciences, Engineering, and Medicine. The members of the committee responsible for the project were chosen for their special competencies and with regard for appropriate balance. This conference was supported by Eastern Research Group, Inc. Any opinions, findings, conclusions, or recommendations expressed in this publication do not necessarily reflect the views of any organization or agency that provided support for the project. Suggested citation: Transportation Research Board. Conference Proceedings 55: Airport Roles in Reducing Transmission of Communicable Diseases. Summary of a Workshop of the Airport Cooperative Research Program’s 2018 Insight Event. Washington, D.C.: National Academies of Sciences, Engineering, and Medicine, 2019.

The National Academy of Sciences was established in 1863 by an Act of Congress, signed by President Lincoln, as a private, non-governmental institution to advise the nation on issues related to science and technology. Members are elected by their peers for outstanding contributions to research. Dr. Marcia McNutt is president. The National Academy of Engineering was established in 1964 under the charter of the National Academy of Sciences to bring the practices of engineering to advising the nation. Members are elected by their peers for extraordinary contributions to engineering. Dr. C. D. Mote, Jr., is president. The National Academy of Medicine (formerly the Institute of Medicine) was established in 1970 under the charter of the National Academy of Sciences to advise the nation on medical and health issues. Members are elected by their peers for distinguished contributions to medicine and health. Dr. Victor J. Dzau is president. The three Academies work together as the National Academies of Sciences, Engineering, and Medicine to provide independent, objective analysis and advice to the nation and conduct other activities to solve complex problems and inform public policy decisions. The National Academies also encourage education and research, recognize outstanding contributions to knowledge, and increase public understanding in matters of science, engineering, and medicine. Learn more about the National Academies of Sciences, Engineering, and Medicine at www.national-academies.org. The Transportation Research Board is one of seven major programs of the National Academies of Sciences, Engineering, and Medicine. The mission of the Transportation Research Board is to increase the benefits that transportation contributes to society by providing leadership in transportation innovation and progress through research and information exchange, conducted within a setting that is objective, interdisciplinary, and multimodal. The Board’s varied committees, task forces, and panels annually engage about 7,000 engineers, scientists, and other transportation researchers and practitioners from the public and private sectors and academia, all of whom contribute their expertise in the public interest. The program is supported by state transportation departments, federal agencies including the component administrations of the U.S. Department of Transportation, and other organizations and individuals interested in the development of transportation. Learn more about the Transportation Research Board at www.TRB.org.

Consensus Study Reports published by the National Academies of Sciences, Engineering, and Medicine document the evidence- based consensus on the study’s statement of task by an authoring committee of experts. Reports typically include findings, con- clusions, and recommendations based on information gathered by the committee and the committee’s deliberations. Each report has been subjected to a rigorous and independent peer-review process and it represents the position of the National Academies on the statement of task. Proceedings published by the National Academies of Sciences, Engineering, and Medicine chronicle the presentations and discussions at a workshop, symposium, or other event convened by the National Academies. The statements and opinions contained in proceedings are those of the participants and are not endorsed by other participants, the planning committee, or the National Academies. For information about other products and activities of the National Academies, please visit www.nationalacademies.org/about/ whatwedo.

Planning Committee for the Insight Event: Airport Roles in Reducing Transmission of Communicable Diseases Jeral Ahtone, American Airlines Paulo Magalhaes Alves, MedAire, Inc. Clive Brown, Centers for Disease Control and Prevention Edward Bushman, Los Angeles World Airports James M. Crites, James M. Crites LLC Kristen Rosdahl Ehresmann, Minnesota Department of Health Augustus Hudson, Hartsfield–Jackson Atlanta International Airport Julie Morita, Chicago Department of Public Health Mary Wilson, University of California, San Francisco Eastern Research Group, Inc. Breanna Detweiler Ian Todreas Maxwell Unterhalter John Wilhelmi Transportation Research Board Staff Marci A. Greenberger, Senior Program Officer Brittany Summerlin-Azeez, Program Coordinator CRP Publications Staff for Conference Proceedings 55 Eileen P. Delany, Director of Publications Natalie Barnes, Associate Director of Publications Linda A. Dziobek, Senior Editor Cover design by Beth Schlenoff, Beth Schlenoff Design

Contents Acronyms ................................................................................................................................................ ix Preface .................................................................................................................................................... xi CHAPTER 1: CHALLENGE: AIRPORTS AND COMMUNICABLE DISEASE TRANSMISSION .......... 1 CHAPTER 2: DISCUSSIONS: WHAT WE LEARNED ........................................................................... 3 Risk Management ................................................................................................................................ 3 Stakeholders ......................................................................................................................................... 7 Communications .................................................................................................................................. 9 Infrastructure ..................................................................................................................................... 11 Resources ........................................................................................................................................... 12 CHAPTER 3: LOOKING FORWARD .................................................................................................. 13 APPENDICES A. PROGRAM ....................................................................................................................................... 14 B. INVITED SPEAKERS AND ATTENDEES ....................................................................................... 15 C. RESOURCES IDENTIFIED DURING PRESENTATIONS ............................................................... 19 v i i

ACRP Airport Cooperative Research Program AOC ACRP Oversight Committee CDC Centers for Disease Control and Prevention CDRP Communicable Disease Response Plan DFW Dallas–Fort Worth International Airport DGMQ Division of Global Migration and Quarantine EMS emergency medical services ERG Eastern Research Group, Inc. FEMA Federal Emergency Management Agency ICAO International Civil Aviation Organization MERS Middle East respiratory syndrome OSHA Occupational Safety and Health Administration PDX Portland (Oregon) International Airport PHX Phoenix Sky Harbor International Airport PIO public information officer PPE personal protective equipment SARS severe acute respiratory syndrome TSA Transportation Security Administration WHO World Health Organization Acronyms i x

x i transmission of communicable diseases” is a highly com- plex topic that spans a wide range of issues, including different diseases and transmission modes, many pre- paredness and response actions, legal issues, and public relations approaches to addressing public perception of risk. Faced with this challenge, the planning committee planned the Insight Event to address the primary topic broadly rather than focus on a few specific matters, expe- riences, or issues. The planning committee identified four general subtopics for the Insight Event to address. They were risk management, stakeholders, communications, and infrastructure. Chapter 2 presents definitions of these subtopics and discussions of the subtopics during the 2-day Insight Event. ACRP and its Insight Event contractor, Eastern Research Group, Inc. (ERG), then developed a pro- gram based on the concepts outlined by the planning committee. Specifically, ACRP and ERG identified can- didate speakers, developed the Insight Event program and agenda, and promoted the Insight Event to airports, public health agencies, and other stakeholders. The 2-day Insight Event occurred on March 6 and 7, 2018, in Washington, D.C. Close to 100 individuals attended. The 2-day Insight Event included • Presentations from 13 invited speakers (listed in Appen- dix A), including a keynote address from Capt. Martin Cetron, M.D., Director of the Centers for Disease Con- trol and Prevention’s (CDC’s) Division of Global Migra- tion and Quarantine. The other speakers represented domestic and foreign airports, local public health agen- cies, an international aviation organization, and aca- demia. Appendix B lists invited speakers and attendees. The Airport Cooperative Research Program (ACRP) within the Transportation Research Board (TRB) of the National Academies of Sciences, Engineer- ing, and Medicine carries out applied research on prob- lems and issues that are of interest to airports and that are not being addressed by other federal research pro- grams. As the primary governing body of the program, the ACRP Oversight Committee (AOC) sets the agenda for the program’s annual research activities. In 2015, AOC decided to hold a series of Insight Events on topics of significance to airports. Insight Events are forums that foster dialogue among profes- sionals across sectors, institutions, and industries. Insight Events convene airport industry leaders and subject matter experts in various fields to encourage discussion and promote broader and deeper insight on topics of sig- nificance to airport operators. These in-depth, face-to- face gatherings are designed to promote communication and collaboration, foster innovation, and help identify areas of future interest and research, especially for topics of emerging importance. The decision to hold this event occurred toward the end of the 2014–2016 Ebola virus disease outbreak in West Africa. Concern about this outbreak’s implications for air travel, among other possible outbreaks, led AOC to have its first Insight Event focus on airport roles in reducing transmission of communicable diseases. Building on AOC’s idea, ACRP convened a planning committee of nine airport and public health officials to design and plan the Insight Event. This committee met in June 2017 to advise ACRP on how to proceed. The principal challenge before the planning committee was the breadth of the topic. “Airport roles in reducing Preface

x i i P R E F A C E • Dr. Julie Morita, Commissioner of the Chicago Department of Public Health, facilitated audience question-and-answer sessions and panel discussions. • Emergency management officials from two airports facilitated an interactive exercise, during which audi- ence members evaluated a hypothetical disease out- break scenario—passengers on an arriving flight with an unknown illness. • Multiple activities outside the official program included a screening of the documentary Unseen Enemy, a fire- side chat with the film’s creative director Janet Tobias, and a reception to facilitate networking between participants. The program for the event is available online at http:// www.trb.org/ACRP/ACRP-Insight-Event-Diseases.aspx. This conference proceedings highlights key discussion points at the Insight Event. The proceedings capture com- mon themes from the presentations and discussions, but this summary is not a transcript and does not elaborate on points beyond those made by invited speakers and attendees. While public health agencies, law enforce- ment, and various other stakeholders may respond to communicable disease outbreaks involving airports, these proceedings focus largely on strategies, best practices, and suggestions that pertain specifically to airports, as identi- fied by the invited speakers. Readers who are interested in more information about this Insight Event and other Insight Events and in the broader array of ACRP research activities are encouraged to • Visit the ACRP Insight Event website at http:// www.trb.org/ACRP/ACRP-Insight-Events.aspx. • E-mail Marci Greenberger, the ACRP project manager for this event, at mgreenberger@nas.edu. • Sign up to receive ACRP publications at http:// www.trb.org/ACRP/PubNotify.aspx. John Wilhelmi, Eastern Research Group, Inc., the rapporteur, prepared this proceedings, which is a compilation of the presentations and a factual summary of the ensuing discussions at the event. The planning com- mittee was responsible solely for organizing the Insight Event, identifying speakers, and overseeing activities during the event. The views contained in the proceedings are those of individual Insight Event participants and do not necessarily represent the views of all participants, the planning committee, TRB, or the National Academies of Science, Engineering, and Medicine. This conference proceedings was reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise in accordance with procedures approved by a Report Review Committee consisting of members of the National Academies of Sciences, Engi- neering, and Medicine. The purposes of this indepen- dent review are to provide candid and critical comments that will assist the institution in making the published proceedings as sound as possible and to ensure that the publication meets institutional standards for objectivity, evidence, and responsiveness to the project charge. The review comments and draft manuscript remain confi- dential to protect the integrity of the process. TRB thanks the following individuals for their review: Leila Barraza, University of Arizona, Tucson; Heidi Benaman, Faith Group, LLC, Portland, Oregon; Nicole Cohen, Division of Global Migration and Quarantine, Centers for Disease Control and Preven- tion, Atlanta, Georgia; Elizabeth Hall-Lipsey, University of Arizona, Tucson; Julie Morita, Chicago Department of Public Health; and Tim Riecker, Emergency Prepared- ness Solutions, Utica, New York. Although the reviewers listed above provided many constructive comments and suggestions, these reviewers did not see the final draft of the proceedings before its release. Robert Sproull of the University of Massachu- setts at Amherst and Susan Hanson of Clark University (emerita) oversaw the review of the final draft. They were responsible for making certain that an indepen- dent examination of this proceedings was performed in accordance with standards of the National Academies of Sciences, Engineering, and Medicine and that all review comments were carefully considered. Respon- sibility for the final content rests entirely with the rapporteur and the National Academies of Sciences, Engineering, and Medicine.

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TRB's Conference Proceedings 55: Airport Roles in Reducing Transmission of Communicable Diseases summarizes a 2-day Insight Event convened by the Airport Cooperative Research Program and its Insight contractor, Eastern Research Group, Inc., March 6 and 7, 2018, in Washington, D.C. The event addressed four subtopics: risk management, stakeholders, communications, and infrastructure. Discussions centered on the roles of airports in reducing transmission of communicable diseases. Speakers represented the federal government, domestic and foreign airports, local public health agencies, an international aviation organization, and academia. The conference proceedings focused largely on strategies, best practices, and suggestions that pertain specifically to airports and transmission of communicable diseases, as identified by the invited speakers.

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