Hawaii begins testing some arriving travelers for flu

Jun 6, 2008 (CIDRAP News) – The first real test of a new program to screen some arriving passengers at the Honolulu airport for flu-like illness went smoothly this week, according to an official with the Hawaii State Department of Health (DOH).

The guinea pigs for the voluntary program were the passengers on a Hawaiian Airlines flight from Sydney, Australia, who were asked to fill out a questionnaire during the flight and turn it in at the airport. The purpose of the effort is to prepare for health screening that might be imposed during an influenza pandemic or other infectious disease outbreak.

"The pilot [screening operation] went extremely well," said Sarah Park, MD, deputy chief of the DOH Disease Outbreak Control Division. "I think everyone was extremely happy about how it went. It was a good demonstration of a strong collaborative process. Basically, 149 passengers were screened in about 10½ minutes."

The questionnaire responses showed there were no sick passengers on the flight, Park reported. If any had had flu-like symptoms, they would have been asked to submit to a voluntary rapid flu test requiring a throat swab.

The new screening program is being funded with $289,000 from the Centers for Disease Control and Prevention (CDC). The DOH is collaborating on it with US Customs and Border Protection (CBP), the Hawaii Department of Transportation, and Hawaiian Airlines.

Park said the screening is strictly voluntary. The general procedure is that passengers are given the health questionnaires while in flight and asked to complete them before landing. The forms include questions about any illness symptoms and travel history, along with demographic details. On arrival, passengers are asked to hand the questionnaires to screeners, who scan them quickly for reports of key signs and symptoms, primarily fever.

Those who have symptoms are asked to submit to a rapid flu test, which takes only a couple of minutes, Park said. A person who tests positive will be given information about flu and released, assuming all signs suggest it is ordinary seasonal flu. A sample is also sent to the DOH laboratory for polymerase chain reaction testing, and the patient is later told the result.

But if a passenger's medical condition and travel history suggest the possibility of avian flu or some other serious disease, the DOH will call the CDC quarantine station at the airport, and the CDC would decide what to do from there, she said.

Park said the initial goal of the program is to screen the passengers and crew of one arriving international flight per week. "As the process becomes more routine, eventually we'll go to three flights per week and finally top off at four flights per week. It's never been the intention to screen every international flight, but just do more of a sampling." As of 2005, the Honolulu airport had 167 arriving international flights per week, she said.

Hawaii is the first US state to launch voluntary screening for flu-like illness, the DOH said in a Jun 4 news release.

"During SARS other countries screened for flu-like illness at airports," Director of Health Chiyome Fukino, MD, said in the release. "It makes sense for the U.S. to investigate this strategy, given the very real concerns for a potential influenza pandemic. Being a global travel destination, Hawaii is a good place to start. We hope to share what we learn with the rest of the nation."

The screening program is an active surveillance effort that supplements the passive surveillance already in place for arriving international flights, Park explained. Technically, every pilot flying into the United States is required to report ahead to the airport if they are aware of a sick person on board, she said. When that happens, the CDC or an airport medical team is supposed to meet and evaluate the sick person on arrival.

At the Honolulu airport, officials began testing arriving sick passengers for flu as part of the passive surveillance program in November 2005, Park said. The test is "not required, but most people agree," she said. "There maybe have been one or two that didn't want to do it."

In the debut of the new screening program on Jun 4, the DOH used 14 people to scan the completed questionnaires, Park reported. A key contributor to the test's success was providing the questionnaires during the flight so people could complete them in advance. "There were no ill passengers this time, so that contributed to the efficiency of the process as well," she said. It also helped that all the passengers spoke English.

"They were all very agreeable to the process," she said. When some passengers were asked afterward what they thought of the program, "some actually said they wondered why we didn't ask more questions and why we didn't ask for contact information up front. It prompted us to wonder if other travelers would be so amenable."

See also:

Hawaii DOH news release

Mar 17 CIDRAP News story "CDC pandemic exercise highlights drug, mitigation, travel issues"

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