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| Severe Acute
Respiratory Syndrome (SARS) |
The rapid
global spread of SARS-CoV in 2003 was facilitated by international
travel, as illustrated by the initial dissemination of the SARS outbreak
from Hong Kong. Although travelers visiting SARS-affected areas are
potentially at risk of contracting SARS-CoV disease, SARS-CoV transmission
is generally localized and often limited to specific settings (e.g.,
hospitals) or households of SARS patients, even in settings with
large outbreaks. Consequently, the overall of risk of SARS-CoV disease
for outbound travelers who are not exposed to these settings is low.
Nevertheless, nearly all U.S. laboratory-confirmed SARS cases were
in travelers to SARS-affected areas. Screening and evaluating travelers
for SARS-like symptoms, educating them about SARS, and reporting
illness should therefore decrease the risk of travel-associated SARS.
Because SARS-CoV can sometimes be transmitted on conveyances (e.g.,
airplanes), it is also important to prevent spread from an ill passenger
with a SARS-like illness and to identify and monitor contacts on
the conveyance for SARS-like illness.
Because
of the significant impact of travel on the spread of communicable
diseases such as SARS-CoV disease, legal authority exists at local,
state, federal, and international levels to control the movement
of persons with certain communicable diseases within and between
jurisdictions. Measures that might be used to modify the risk of
travel-related SARS-CoV disease range from distribution of health
alert notices and arrival screening to quarantine of new arrivals
and restrictions or prohibitions on nonessential travel. Although
the states have authority for movement restrictions within states,
federal laws govern movement between states and across international
borders. Thus, airports and other ports of entry are sites of multiple
overlapping jurisdictions where the interplay between various authorities
must be clearly understood (See Section
VII: Roles and Responsibilities, below).
The overall goals for the management of international travel-related SARS-CoV transmission risk are to:
- Prevent the introduction of SARS-CoV (and spread from an introduction) into the United States from SARS-affected areas.
- Prevent exportation of SARS-CoV from the United States if domestic transmission presents an increased risk of exportation.
- Reduce the risk of SARS among outbound travelers to SARS-affected areas.
- Prevent the spread of SARS-CoV to passengers on a conveyance with a SARS patient, and evaluate or monitor other passengers to detect SARS-like illness and prevent further spread.
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