Infection prevention and control measures for Ebola virus disease: Entry and exit screening measures

The unprecedented magnitude and geographic extent of the Ebola virus disease (EVD) outbreak in West Africa has overwhelmed the local response capacity, posing an extreme challenge for outbreak containment. 

As the number of new cases continues to rise in Guinea, Liberia and Sierra Leone [1], there is an increasing possibility that infected persons will travel to the European Union. Persons infected with EVD may arrive in the EU by direct or indirect flights from affected countries or on board freighters or passenger ships. 

Following the declaration of the Public Health Event of International Concern (PHEIC) on 8 August 2014, WHO recommended that affected countries conduct exit screening of all persons at international airports, seaports and major land crossings for unexplained febrile illness consistent with potential Ebola infection. WHO also recommended that there should be no international travel of known Ebola cases or contacts of cases, unless the travel is part of an appropriate medical evacuation. 

All affected countries have implemented exit screening, supported by the US Centers for Disease Control and Prevention (CDC). The CDC has also produced guidelines on screening at points of departure in Ebola-affected countries. Following the importation of a first case of Ebola, the US has decided to implement, in a layered approach, entry screening at five airports through which 94% of travellers from affected countries enter into the US. At the same time, and in the absence of an evaluation of the effectiveness of the implementation of exit screening in West African affected countries, a number of European countries are considering entry screening as an additional measure to reduce the likelihood of importation of cases.

This document reviews the existing evidence on entry and exit screening in order to support decision making by EU public health authorities.