Bogoch Isaac I, Creatore Maria I, Cetron Martin S, Brownstein John S, Pesik Nicki, Miniota Jennifer, Tam Theresa, Hu Wei, Nicolucci Adriano, Ahmed Saad, Yoon James W, Berry Isha, Hay Simon I, Anema Aranka, Tatem Andrew J, MacFadden Derek, German Matthew, Khan Kamran
Department of Medicine, Division of Infectious Diseases, University of Toronto, Toronto, ON, Canada; Divisions of Internal Medicine and Infectious Diseases, University Health Network, Toronto, ON, Canada.
Centre for Research on Inner City Health, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada.
Lancet. 2015 Jan 3;385(9962):29-35. doi: 10.1016/S0140-6736(14)61828-6. Epub 2014 Oct 21.
The WHO declared the 2014 west African Ebola epidemic a public health emergency of international concern in view of its potential for further international spread. Decision makers worldwide are in need of empirical data to inform and implement emergency response measures. Our aim was to assess the potential for Ebola virus to spread across international borders via commercial air travel and assess the relative efficiency of exit versus entry screening of travellers at commercial airports.
We analysed International Air Transport Association data for worldwide flight schedules between Sept 1, 2014, and Dec 31, 2014, and historic traveller flight itinerary data from 2013 to describe expected global population movements via commercial air travel out of Guinea, Liberia, and Sierra Leone. Coupled with Ebola virus surveillance data, we modelled the expected number of internationally exported Ebola virus infections, the potential effect of air travel restrictions, and the efficiency of airport-based traveller screening at international ports of entry and exit. We deemed individuals initiating travel from any domestic or international airport within these three countries to have possible exposure to Ebola virus. We deemed all other travellers to have no significant risk of exposure to Ebola virus.
Based on epidemic conditions and international flight restrictions to and from Guinea, Liberia, and Sierra Leone as of Sept 1, 2014 (reductions in passenger seats by 51% for Liberia, 66% for Guinea, and 85% for Sierra Leone), our model projects 2.8 travellers infected with Ebola virus departing the above three countries via commercial flights, on average, every month. 91,547 (64%) of all air travellers departing Guinea, Liberia, and Sierra Leone had expected destinations in low-income and lower-middle-income countries. Screening international travellers departing three airports would enable health assessments of all travellers at highest risk of exposure to Ebola virus infection.
Decision makers must carefully balance the potential harms from travel restrictions imposed on countries that have Ebola virus activity against any potential reductions in risk from Ebola virus importations. Exit screening of travellers at airports in Guinea, Liberia, and Sierra Leone would be the most efficient frontier at which to assess the health status of travellers at risk of Ebola virus exposure, however, this intervention might require international support to implement effectively.
Canadian Institutes of Health Research.
鉴于2014年西非埃博拉疫情有进一步在国际传播的可能性，世界卫生组织宣布其为国际关注的突发公共卫生事件。全球的决策者需要实证数据来为应急响应措施提供信息并加以实施。我们的目的是评估埃博拉病毒通过商业航空旅行跨国传播的可能性，并评估在商业机场对旅行者进行出境筛查与入境筛查的相对效率。
我们分析了国际航空运输协会关于2014年9月1日至12月31日全球航班时刻表的数据，以及2013年以来的旅行者历史飞行行程数据，以描述经商业航空旅行离开几内亚、利比里亚和塞拉利昂的预期全球人口流动情况。结合埃博拉病毒监测数据，我们对国际输出的埃博拉病毒感染预期数量、航空旅行限制的潜在影响以及在国际出入境口岸对旅行者进行机场筛查的效率进行了建模。我们认为从这三个国家境内或国际机场出发的个人可能接触过埃博拉病毒。我们认为所有其他旅行者接触埃博拉病毒的风险不高。
根据截至2014年9月1日几内亚、利比里亚和塞拉利昂的疫情状况及往返这些国家的国际航班限制情况（利比里亚客运座位减少51%，几内亚减少66%，塞拉利昂减少85%），我们的模型预测，平均每月有2.8名感染埃博拉病毒的旅行者经商业航班离开上述三个国家。离开几内亚、利比里亚和塞拉利昂的所有航空旅行者中，91,547人（64%）的预期目的地是低收入和中低收入国家。对从三个机场出发的国际旅行者进行筛查，将能够对所有接触埃博拉病毒感染风险最高的旅行者进行健康评估。
决策者必须谨慎权衡对有埃博拉病毒活动的国家实施旅行限制所带来的潜在危害与埃博拉病毒输入风险的任何潜在降低。在几内亚、利比里亚和塞拉利昂的机场对旅行者进行出境筛查将是评估有接触埃博拉病毒风险的旅行者健康状况的最有效前沿，但这种干预措施可能需要国际支持才能有效实施。
加拿大卫生研究院。
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