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x i i P R E F A C E â¢ Dr. Julie Morita, Commissioner of the Chicago Department of Public Health, facilitated audience question-and-answer sessions and panel discussions. â¢ Emergency management officials from two airports facilitated an interactive exercise, during which audi- ence members evaluated a hypothetical disease out- break scenarioâpassengers on an arriving flight with an unknown illness. â¢ Multiple activities outside the official program included a screening of the documentary Unseen Enemy, a fire- side chat with the filmâs 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 â¢ Visit the ACRP Insight Event website at http:// www.trb.org/ACRP/ACRP-Insight-Events.aspx. â¢ E-mail Marci Greenberger, the ACRP project manager for this event, at firstname.lastname@example.org. â¢ 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.
1 CHAPTER 1 Challenge Airports and Communicable Disease Transmission todayâs world tremendously interconnected: Dr. Cetron noted that travelers can now move from isolated rural villages to virtually any major city worldwide in less than 36 hours. Thus, a contagious traveler from an area with a disease outbreak can quickly spread dis- ease to other regions and countries, as demonstrated by localized transmission of Ebola virus disease in Nigeria, Middle East respiratory syndrome (MERS) in South Korea and Hong Kong, and severe acute respiratory syndrome (SARS) in Toronto. In each of these cases, localized disease transmission was traced to a single passenger infected with the disease arriving on an inter- national flight from an affected country. Complicat- ing matters, the incubation period for some diseases is longer than the time that it takes to travel worldwide; and, in some cases, infected passengers can travel on airplanes and pass through airports before they show symptoms or even know they are sick. Moreover, con- firmation of illness is not immediate because many diseases do not have rapid diagnostic tests. For these and other reasons, Dr. Cetron, the Insight Eventâs key- note speaker, stated that âA health threat anywhere is a health threat everywhere.â However, as the threats for communicable disease transmission have grown, so have prevention, prepared- ness, and response efforts among air travel interests and the public health community. At the national level, CDC works to prevent the introduction, transmission, and spread of communicable diseases, whether through regulation, research, preparedness, and response. The agencyâs Division of Global Migration and Quarantine (DGMQ) focuses on preventing importation and spread of communicable diseases, in part by building systems and programs to prevent, detect, and respond to disease transmission between immigrants, refugees, travelers, expatriates, and other globally mobile populations. Dr. Cetron discussed DGMQâs previous and ongoing work with air travel interests and public health part- ners, with examples ranging from responding to com- municable disease inquiries to disease investigations with contact tracing. As is noted in this proceedings, a much broader network of local, regional, national, Air travel is vital in todayâs world, as underscored by statistics and anecdotes shared by Dr. Cetron of CDC and Dr. Kamran Khan of the University of Toronto. In 2016, the total distance traveled world- wide by commercial flights was 6.7 trillion kilometers, with half of that travel accounted for by flights originating in just 10 countries. This statistic is part of a continuing trend: in a recent 10-year period, the total distance trav- eled in domestic and international travel increased by more than 50%. Air travel has indeed made the world an increasingly interconnected place, as recent statistics suggest that more than 100 million passengers arrive on international flights at U.S. airports every year. Sustained operations at airports are critical for many reasons. Not only do airports help move travelers and goods but they also deliver direct and indirect economic benefits to local communities. For instance, large airports support thousands of jobs, and arriv- ing travelers spend money at hotels, restaurants, rental car companies, entertainment venues, tourist attrac- tions, and numerous other local businesses. By some estimates, large domestic airports can deliver billions of dollars of economic benefits each year to their host metropolitan areas. Moreover, as underscored by Dr. Petra Illig of Aviation Medical Services, during dis- ease outbreaks, sustained air travel to affected regions is essential for delivering humanitarian assistance. Even short-term interruptions at major hubs can have substantial ripple effects throughout the commercial aviation sector: Dr. Walter Gaber of the Frankfurt International Airport indicated that a 3-hour shutdown at his airport would cause more than 25,000 passengers to miss flights and more than 4,000 tons of freight to be delivered late. These observations underscore the fact that continuity of operations at airports is essential. Communicable disease outbreaks have the potential to affect air travel and public health interests. Concerns about travel and spread of communicable disease are not new, as documented outbreaks of cholera, yellow fever, and other diseases associated with marine travel date back hundreds of years. What has changed in recent decades is how transportation modesâespecially air travelâmake