Travel
Notices, Including Outbreaks
BY DECREASING LEVEL OF RISK TO TRAVELERS
October
21,
2004
|
Travel
Health Warnings: None |
Travel
Health Precautions: None |
Outbreaks: |
|
In
the News |
- Update:
Yellow Fever Cases, Venezuela
(Updated
October 21, 2004)
- Update:
Viral Meningitis Cases Waning, Puerto Rico
(Updated October 20, 2004)
- Dengue
Fever Cases Waning, Southeast Asia
(Updated October 20, 2004)
- Update
on Avian Influenza A (H5N1)
(Updated
August 12, 2004)
- Update
on SARS and Avian Influenza A (H5N1): Current Situation,
Surveillance, and Diagnostic Recommendations
(Released
June 10, 2004)
- See
Also: Influenza Vaccine Information 2004-2005
(Updated regularly)
|
TRAVEL
NOTICE DEFINITIONS |
CDC
issues different types of notices for international travelers.
As of May 20, 2004, these definitions have been refined to
make the announcements more easily understood by travelers,
health-care providers, and the general public. The definitions
are laid out below. They describe both levels of risk for the
traveler and recommended preventive measures to take at each
level of risk. |
|
Type
of Notice/ Level of Concern |
Scope* |
Risk
for Travelers† |
Preventive
Measures |
Example
of Notice |
Example
of Recommended Measures |
In the
News |
Reports of sporadic cases |
No increased risk over baseline for travelers observing standard recommendations |
Keeping travelers informed and reinforcing standard prevention recommendations |
Report
of cases of dengue in Mexico, 2001 |
Reinforced
standard recommendations for protection against insect
bites |
|
Outbreak in limited geographic area or setting |
Increased but definable and limited to specific settings |
Reminders about standard and enhanced recommendations for the region |
Outbreak
of yellow fever in a state in Brazil in 2003 |
Reinforced
enhanced recommendations, such as vaccination |
|
Outbreak of greater scope affecting a larger geographic area |
Increased in some settings, along with risk for spread to other areas |
Specific precautions to reduce risk during the stay, and what to do before
and after travel‡ |
Outbreak
of avian influenza among poultry and humans in several
countries in Southeast Asia in early 2004 |
Recommended
specific precautions including avoiding areas with live
poultry, such as live animal markets and poultry farms;
ensuring poultry and eggs are thoroughly cooked; monitoring
health |
|
Evidence that outbreak is expanding outside the area or populations initially
affected |
Increased because of evidence of transmission outside defined settings
and/or inadequate containment measures |
In addition to the specific precautions cited above, postpone nonessential
travel‡ |
SARS
outbreak in Asia in 2003 |
Recommended
travelers to postpone nonessential travel because
of level of risk |
|
|
*The term “scope” incorporates
the size, magnitude, and rapidity of spread of an outbreak.
†Risk for travelers is
dependent on patterns of transmission, as well
as severity of illness.
‡Preventive
measures other than the standard
advice for the region may
be recommended depending
on the circumstances (e.g.,
travelers may be requested
to monitor their health for
a certain period after their
return, or arriving passengers
may be screened at ports
of entry). |
|
Travel Notices:
Interim Definitions and Criteria
As of May 20, 2004
A. Rationale
CDC issues different types of notices for international
travelers. We are refining these definitions to make the announcements
more easily understood by travelers, health-care providers, and the
general public. In addition, defining and describing levels of risk
for the traveler will clarify the need for the recommended preventive
measures. From the public health perspective, scalable definitions
will enhance the usefulness of the travel notices, enabling them to
be tailored readily in response to events and circumstances.
1. In the News: notification by CDC
of an occurrence of a disease of public health significance affecting
a traveler or travel destination. The purpose is to provide information
to travelers, Americans living abroad, and their health-care providers
about the disease. The risk for disease exposure is not thought to
be increased beyond the usual baseline risk for that area, and only
standard guidelines are recommended.
2. Outbreak Notice: notification by
CDC that an outbreak of a disease is occurring in a limited geographic
area or setting. The purpose of an outbreak notice is to provide accurate
information to travelers and resident expatriates about the status
of the outbreak and to remind travelers about the standard or enhanced
travel recommendations for the area. Because of the limited nature
of the outbreak, the risk for disease exposure is thought to be increased
but defined and limited to specific settings.
3. Travel
Health Precaution: CDC
does NOT recommend against travel to the area. A
travel health precaution is notification by CDC that a disease
outbreak of greater scope is occurring in a more widespread geographic
area. The purpose of a travel health precaution is to provide accurate
information to travelers and Americans living abroad about the
status of the outbreak (e.g., magnitude, scope, and rapidity of
spread), specific precautions to reduce their risk for infection,
and what to do if they become ill while in the area. The risk for
the individual traveler is thought to be increased in defined settings
or associated with specific risk factors (e.g., transmission in
a health-care or hospital setting where ill patients are being
cared for).
4. Travel
Health Warning: CDC
recommends against nonessential travel to the area. A
travel health warning is a notification by CDC that a widespread,
serious outbreak of a disease of public health concern is expanding
outside the area or populations that were initially affected. The
purpose of a travel health warning is to provide accurate information
to travelers and Americans living abroad about the status of the
outbreak (e.g., its scope, magnitude, and rapidity of spread),
how they can reduce their risk for infection, and what to do if
they should become ill while in the area. The warning also serves
to reduce the volume of traffic to the affected areas, which in
turn can reduce the risk of spreading the disease to previously
unaffected sites. CDC recommends
against nonessential travel to the area because the risk for
the traveler is considered to be high (i.e., the risk is increased
because of evidence of transmission outside defined settings and/or
inadequate containment). Additional preventive measures may be recommended,
depending on the circumstances (e.g., travelers may be requested to
monitor their health for a certain period after their return; arriving
passengers may be screened at ports of entry).
B. Criteria
for Instituting Travel Notices
- Disease transmission: The modes of transmission and
patterns of spread, as well as the magnitude and scope of the outbreak
in the area, will affect the decision for the appropriate level of
notice. Criteria include the presence or absence of transmission
outside defined settings, as well as evidence that cases have spread
to other areas.
- Containment measures: The presence or absence of
acceptable outbreak control measures in the affected area can influence
the decision for what level of notice to issue. Areas where the disease
is occurring that are considered to have poor or no containment measures
in place have the potential for a higher risk of transmission to
exposed persons and spread to other areas.
- Quality of surveillance: Criteria include whether
health authorities in the area have the ability to accurately detect
and report cases and conduct appropriate contact tracing of exposed
persons. Areas where the disease is occurring that are considered
to have poor surveillance systems may have the potential for a higher
risk of transmission.
- Quality and accessibility of medical care: Areas
where the disease is occurring that are considered to have inadequate
medical services and infection control procedures in place, as well
as remote locations without access to medical evacuation, present
a higher level of risk for the traveler or Americans living abroad.
C. Criteria
for Downgrading or Removing Notices.
To downgrade a travel health warning to
a travel
health precaution, there should be—
- Adequate and regularly updated reports of surveillance
data from the area
- No evidence of ongoing transmission outside defined
settings for two incubation periods after the date of onset of symptoms
for the last case, as reported by public health officials.
To remove a travel precaution,
there should be—
- Adequate and regularly updated reports of surveillance
data from the area
- No evidence of new cases for 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; this criterion excludes intentional or planned evacuations.
In the News and Outbreak
Notices will
be revisited at regular intervals and will be removed when no longer
relevant or when the outbreak has resolved.
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