Volume 26, Number 5—May 2020
Nonpharmaceutical Measures for Pandemic Influenza in Nonhealthcare Settings—International Travel-Related Measures
|Objective||Screening travelers||Travel restriction||Border closure|
|Delaying introduction of case
||• Likely delay by 4 d with detection rate of 37% travelers identified from the port of entry at the border (10)*
• Associated with mean additional delay of case importation (7–12 d, 95% CI 0–30days, 2009 H1N1 pandemic) (11)*
• Might delay 3 d reaching 20 infected cases at risk-country (R0 = 1.5 with 400 travelers/day) (12)
• Might delay importation of infected case-patientss (21–1555 d, 2009 H1N1 pandemic) (13)
||• The mean time delays for exporting the infected case is 5.3 d (80% restriction), 11.7 d (90%), and 131.7 d (99%) (R0 = 1.8 with implementation of 20 d from first case occurred) (20)*
• Among 17 Pacific Island countries and territories, with 99% restriction, 6 countries (with R0 = 1.5) and 4–5 countries (with R0 >2.25) would likely escape the pandemic influenza with >50% probability (implemented at very beginning of pandemic) (21)
• Full children-selective travel restriction might delay an epidemic by 19–35 d (R0 = 1.2), and less than 15 d (R0 = 1.6 and 2.0, implemented after pandemic declared) (22)
• Mean delay of the first imported case in influenza-unaffected countries was estimated <3 d (40% restriction), and ≈2 weeks (90% restriction) with R0 = 1.7 and implementation after pandemic declared (23)
• Likely delay interval between first global case and the importation of the first cases by 7–37 d (R0 = 1.4, 1.7, or 2; 90% or 99% restriction; implemented 30 d after first global case occurrence) (24)
• Might delay the first passage time of infected case-patient from 18 d to 31 d (outbreak originated from Hong Kong) and from 7 d to 27 d (from Sydney) with R0 = 1.7 (25)
• A 99% restriction of air-only, both air and land, and all modes of transportation might delay the interval between the first imported case and 100 infected case-patients passed the border by a week, 1–2 weeks, and 2 mo, respectively (R0 = 1.4; implemented on the day after the first global case reported) (26)
||• Arrival of influenza pandemic was significantly delayed and reduced compare with the other Pacific Island Jurisdictions (29)*
|Delaying the epidemic peak
||• Not available
||• Imported infections might delay the epidemic peak of the United States by 1.5 wks (90% restriction), 3 wks (99%), or 6 wks (99.9%) with R0 = 1.4–2.0 (implemented 30 d into global pandemic) (19)
• Might delay pandemic peak by 6–39 d (R0 = 1.4, 1.7, or 2; 90% or 99% restriction; implemented 30 d after first global case occurrence) (24)
• Might delay epidemic peak by 2 wks (99% air travel restriction), 3.5 wks (99% air and land travel restriction), and 12 wks (99% all mode of transportation) with R0 = 1.4 (26)
• Might delay median epidemic peak by 7–102 d (R0 = 1.8–5; 50%–99.9% restriction) (27)
• Peak of influenza mortality delayed by 2 wks (27% international flight volume reduction) (28)
||• Not available
|Reducing the size of the peak||• Not available||• Not available||• Not available|
- Dawood FS, Jain S, Finelli L, Shaw MW, Lindstrom S, Garten RJ, et al.; Novel Swine-Origin Influenza A (H1N1) Virus Investigation Team. Emergence of a novel swine-origin influenza A (H1N1) virus in humans. N Engl J Med. 2009;360:2605–15.
- The Lancet Infectious Diseases. The Lancet Infectious Diseases. How to be ready for the next influenza pandemic. Lancet Infect Dis. 2018;18:697.
- Smith RD, Keogh-Brown MR, Barnett T, Tait J. The economy-wide impact of pandemic influenza on the UK: a computable general equilibrium modelling experiment. BMJ. 2009;339(nov19 1):b4571.
- World Health Organization. Draft thirteenth general programme of work, 2019–2023. 2018 [cited 2019 Jul 10]. http://apps.who.int/gb/ebwha/pdf_files/WHA71/A71_4-en.pdf
- Bell D, Nicoll A, Fukuda K, Horby P, Monto A, Hayden F, et al.; World Health Organization Writing Group. Non-pharmaceutical interventions for pandemic influenza, national and community measures. Emerg Infect Dis. 2006;12:88–94.
- European Centre for Disease Prevention and Control. Infection prevention and control measures for Ebola virus disease: entry and exit screening measures. 2014 [cited 2019 Jul 10]. https://www.ecdc.europa.eu/en/publications-data/infection-prevention-and-control-measures-ebola-virus-disease-entry-and-exit
- US Homeland Security Council. National strategy for pandemic influenza implementation plan. 2006 [cited 2019 Jul 10]. https://www.cdc.gov/flu/pandemic-resources/pdf/pandemic-influenza-implementation.pdf
- Mateus AL, Otete HE, Beck CR, Dolan GP, Nguyen-Van-Tam JS. Effectiveness of travel restrictions in the rapid containment of human influenza: a systematic review. Bull World Health Organ. 2014;92:868–880D.
- Lee VJ, Lye DC, Wilder-Smith A. Combination strategies for pandemic influenza response - a systematic review of mathematical modeling studies. BMC Med. 2009;7:76.
- Yu H, Cauchemez S, Donnelly CA, Zhou L, Feng L, Xiang N, et al. Transmission dynamics, border entry screening, and school holidays during the 2009 influenza A (H1N1) pandemic, China. Emerg Infect Dis. 2012;18:758–66.
- Wu JT, Cowling BJ, Lau EH, Ip DK, Ho LM, Tsang T, et al. School closure and mitigation of pandemic (H1N1) 2009, Hong Kong. Emerg Infect Dis. 2010;16:538–41.
- Caley P, Becker NG, Philp DJ. The waiting time for inter-country spread of pandemic influenza. PLoS One. 2007;2:
- Malone JD, Brigantic R, Muller GA, Gadgil A, Delp W, McMahon BH, et al. U.S. airport entry screening in response to pandemic influenza: modeling and analysis. Travel Med Infect Dis. 2009;7:181–91.
- Khan K, Eckhardt R, Brownstein JS, Naqvi R, Hu W, Kossowsky D, et al. Entry and exit screening of airline travellers during the A(H1N1) 2009 pandemic: a retrospective evaluation. Bull World Health Organ. 2013;91:368–76.
- Read JM, Diggle PJ, Chirombo J, Solomon T, Baylis M. Effectiveness of screening for Ebola at airports. Lancet. 2015;385:23–4.
- Hale MJ, Hoskins RS, Baker MG. Screening for influenza A(H1N1)pdm09, Auckland International Airport, New Zealand. Emerg Infect Dis. 2012;18:866–8.
- Sakaguchi H, Tsunoda M, Wada K, Ohta H, Kawashima M, Yoshino Y, et al. Assessment of border control measures and community containment measures used in Japan during the early stages of Pandemic (H1N1) 2009. PLoS One. 2012;7:
- Priest PC, Jennings LC, Duncan AR, Brunton CR, Baker MG. Effectiveness of border screening for detecting influenza in arriving airline travelers. Am J Public Health. 2013;103:1412–8.
- Ferguson NM, Cummings DA, Fraser C, Cajka JC, Cooley PC, Burke DS. Strategies for mitigating an influenza pandemic. Nature. 2006;442:448–52.
- Hollingsworth TD, Ferguson NM, Anderson RM. Will travel restrictions control the international spread of pandemic influenza? Nat Med. 2006;12:497–9.
- Eichner M, Schwehm M, Wilson N, Baker MG. Small islands and pandemic influenza: potential benefits and limitations of travel volume reduction as a border control measure. BMC Infect Dis. 2009;9:160.
- Lam EH, Cowling BJ, Cook AR, Wong JY, Lau MS, Nishiura H. The feasibility of age-specific travel restrictions during influenza pandemics. Theor Biol Med Model. 2011;8:44.
- Bajardi P, Poletto C, Ramasco JJ, Tizzoni M, Colizza V, Vespignani A. Human mobility networks, travel restrictions, and the global spread of 2009 H1N1 pandemic. PLoS One. 2011;6:
- Ciofi degli Atti ML, Merler S, Rizzo C, Ajelli M, Massari M, Manfredi P, et al. Mitigation measures for pandemic influenza in Italy: an individual based model considering different scenarios. PLoS One. 2008;3:
- Epstein JM, Goedecke DM, Yu F, Morris RJ, Wagener DK, Bobashev GV. Controlling pandemic flu: the value of international air travel restrictions. PLoS One. 2007;2:
- Chong KC, Ying Zee BC. Modeling the impact of air, sea, and land travel restrictions supplemented by other interventions on the emergence of a new influenza pandemic virus. BMC Infect Dis. 2012;12:309.
- Cooper BS, Pitman RJ, Edmunds WJ, Gay NJ. Delaying the international spread of pandemic influenza. PLoS Med. 2006;3:
- Brownstein JS, Wolfe CJ, Mandl KD. Empirical evidence for the effect of airline travel on inter-regional influenza spread in the United States. PLoS Med. 2006;3:
- McLeod MA, Baker M, Wilson N, Kelly H, Kiedrzynski T, Kool JL. Protective effect of maritime quarantine in South Pacific jurisdictions, 1918-19 influenza pandemic. Emerg Infect Dis. 2008;14:468–70.
- Fang LQ, Wang LP, de Vlas SJ, Liang S, Tong SL, Li YL, et al. Distribution and risk factors of 2009 pandemic influenza A (H1N1) in mainland China. Am J Epidemiol. 2012;175:890–7.
- Wood JG, Zamani N, MacIntyre CR, Beckert NG. Effects of internal border control on spread of pandemic influenza. Emerg Infect Dis. 2007;13:1038–45.
- Aledort JE, Lurie N, Wasserman J, Bozzette SA. Non-pharmaceutical public health interventions for pandemic influenza: an evaluation of the evidence base. BMC Public Health. 2007;7:208.
- World Health Organization. Comparative analysis of national pandemic influenza preparedness plans. 2011 [cited 2019 Jul 10]. https://www.who.int/influenza/resources/documents/comparative_analysis_php_2011_en.pdf
- World Health Organization. Ethical consideration in developing a public health response to pandemic influenza. 2007 [cited 2019 Jul 10]. https://www.who.int/csr/resources/publications/WHO_CDS_EPR_GIP_2007_2c.pdf
- World Health Organization. Guidance for managing ethical issues in infectious disease outbreaks. 2016 [cited 2019 Jul 10]. http://www.who.int/iris/handle/10665/250580
- Boyd M, Baker MG, Mansoor OD, Kvizhinadze G, Wilson N. Protecting an island nation from extreme pandemic threats: Proof-of-concept around border closure as an intervention. PLoS One. 2017;12:
- Bell D, Nicoll A, Fukuda K, Horby P, Monto A, Hayden F, et al.; World Health Organization Writing Group. Non-pharmaceutical interventions for pandemic influenza, international measures. Emerg Infect Dis. 2006;12:81–7.
- World Health Organization. Pandemic influenza risk management. 2017 [cited 2019 Jul 10]. https://www.who.int/influenza/preparedness/pandemic/influenza_risk_management
- World Health Organization. International Health Regulations (2005), 3rd edition. 2016 [cited 2019 Jul 10]. https://apps.who.int/iris/handle/10665/246107
- Saunders-Hastings P, Crispo JAG, Sikora L, Krewski D. Effectiveness of personal protective measures in reducing pandemic influenza transmission: A systematic review and meta-analysis. Epidemics. 2017;20:1–20.
Page created: April 16, 2020
Page updated: April 16, 2020
Page reviewed: April 16, 2020
The conclusions, findings, and opinions expressed by authors contributing to this journal do not necessarily reflect the official position of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors' affiliated institutions. Use of trade names is for identification only and does not imply endorsement by any of the groups named above.