VI. De-escalation of Control Measures

Supplement E: Managing International Travel-Related Transmission Risk

Public Health Guidance for Community-Level Preparedness and Response to Severe Acute Respiratory Syndrome (SARS) Version 2/3

Objective 1

Downgrade or remove travel notifications as appropriate.

Activities

• CDC will downgrade a travel health warning to a travel health precaution when there is:
  • Adequate and regularly updated reporting of surveillance data from the area
  • No evidence of ongoing transmission outside defined settings for for 20 days (two incubation periods) after date of onset of symptoms for the last confirmed case without an epidemiologic link, as reported by public health authorities.
    
    
• CDC will remove a health precaution when there is:
  • Adequate and regularly updated reporting of surveillance data from the area
  • No evidence of new cases for 30 days (three incubation periods) after the date of onset of symptoms for the last case, as reported by public health authorities.
  • Limited or no recent instances of exported cases from the area. An exported case is an ill person who meets the definition for a probable or confirmed case of SARS-CoV disease and who acquired SARS-CoV infection in the area in question and then traveled outside the affected area to another region and was diagnosed there (i.e., the person was not identified as a part of contact tracing activities, and travel was not restricted). This criterion excludes intentional or planned evacuations.

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Objective 2

Reduce measures used for inbound travelers as appropriate.

Activities

For all passengers arriving from areas with SARS-CoV transmission:

• Continue general education for passengers from a particular area until the travel health precaution has been lifted (30 days after the onset of symptoms for the last case in that area). Because travel patterns may make it difficult to determine passengers' points of origin, it may be more practical to continue general education until travel health precautions have been lifted for all areas.
• Continue evaluating travelers who report symptoms of SARS during travel until the travel health precaution for that area has been lifted (30 days after the onset of symptoms for the last case from that area).

For passengers arriving from areas under a travel health warning:

• Continue the use of screening questionnaires until the area of origin is downgraded from a travel health warning to a travel health precaution.
• Continue meeting conveyances from SARS-affected areas and visually inspecting passengers until the area of origin is downgraded from a travel health warning to a travel health precaution.

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Objective 3

Reduce other measures used for outbound travelers as appropriate.

Activities

• Continue pre-departure fever and symptom screening for passengers departing from areas with ongoing unlinked transmission, but consider discontinuing these activities 20 days after the onset of symptoms for the last unlinked case.
• Continue stop lists until there are no longer any cases under isolation or contacts under quarantine.

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Objective 4

Reduce measures for management of passengers with SARS-CoV disease on conveyances as appropriate.

Activities

• Continue meeting any flight with an ill passenger on board who has SARS-like symptoms. If the passenger is seriously ill, evaluate and follow-up according to established protocols.
• Continue to collect locating information as long as the passenger has symptoms compatible with SARS-CoV disease and has traveled from an area with ongoing unlinked transmission (under a travel advisory). For areas that have been downgraded to a travel health precaution, locating information may not be needed unless the ill passenger meets the epidemiologic criteria for likely exposure to SARS-CoV (See Supplement B, Appendix B1).
• The need for monitoring and quarantine of contacts of a passenger from an area on travel health precaution should be determined after the ill passenger has been fully evaluated.

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