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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
2 R E D U C I N G T R A N S M I S S I O N O F C O M M U N I C A B L E D I S E A S E S and international stakeholders works to prevent, pre- pare for, and respond to communicable diseases as they relate to air travel. Reducing transmission of communicable diseases pre- sents an important challenge for airports, airlines, and other air travel interests. At the same time, a large commu- nity of stakeholders actively works to prevent, prepare for, and promptly respond to disease outbreaks. Dr. Cetron summed up this apparent dichotomy by saying that âThe world is safer than ever from global health threats; and the world is at greater risk than ever from global health threats.â The rest of this conference proceedings expands on the risks of communicable disease outbreaks and air travel and reviews efforts to manage those risks.