Guinea: screening for Ebola at Conakry International Airport
Before getting to the airline check-in counters of the Conakry International Airport, Mr Dominique Ba, a Guinean hotel industry professional travelling to Morocco on official business, had to fill in a questionnaire about symptoms of Ebola virus disease and possible contacts with Ebola patients. He considered it no trouble.
“I fully support these surveillance measures. Ebola is a frightening disease, and if we don’t want to become isolated by other countries, we need to start stopping it here,” he says. Mr Ba’s temperature was taken twice and, just before boarding the plane, it was to be taken again.
Only passengers whose body temperature is less than 38 degrees Celsius are permitted to enter a departing aircraft.
Stopping the international spread
WHO and its partners have recommended exit screening at airports and land-border crossings in countries affected by Ebola, and it is now an established practice. WHO stresses that only 2 categories of people should not travel: those who are infected and those identified as their close contacts as they may be infected with Ebola virus. Since not every traveller from an Ebola-affected country is aware of having been exposed to the disease, completion of a screening questionnaire and testing for the presence of fever represent the best available indicators of risk.
Spread of the disease through international travel has, to date, been minimal, and airport exit screening could have prevented at least 1 case. A man who travelled from Monrovia, Liberia to Lagos, Nigeria on 20 July was visibly ill. On arrival he was transported immediately to a health facility.
"I fully support these surveillance measures. Ebola is a frightening disease, and if we don’t want to become isolated by other countries, we need to start stopping it here."
Mr Dominique Ba, a Guinean hotel industry professional
The worst possible scenario became a reality: an Ebola-infected person travelled by air starting a new transmission chain in another country. Since then, Nigeria has registered 20 cases of Ebola and 8 deaths. The Nigerian government had to use its resources to trace and monitor the health of close to 700 contacts.
Exit screening clearly cannot be 100% effective for preventing international transmission. In late September, a Liberian citizen travelled to Dallas, Texas from Monrovia. He did not have a fever or become ill until after arrival, which meant that he could not transmit the infection during air travel. However, this event has drawn attention to the need for all countries to be alert and prepared to deal with introduced cases of Ebola.
Keeping the borders open
The Ebola outbreak has prompted a number of carriers to suspend flights to affected countries including Guinea. “From 57 international flights arriving weekly to Conakry before the outbreak we are now down to 17,” says Elisabeth Harton, Public Health Advisor with the United States Centers for Disease Control and Prevention (CDC), who is currently serving as Team Leader for Airport and Land Border Screening.
WHO has called on countries not to impose travel restrictions on affected countries and is actively working with relevant international organizations and airlines to facilitate a clearer understanding of the situation and restore suspended flights. Exit screening is a key measure to establish confidence among carriers that crews will be safe during flights. Airline crew and airport staff worldwide are also being trained in handling suspected Ebola patients using WHO-developed guidance.
The Conakry example
Around 3000 people are screened weekly at the Conakry airport entrance including passengers and airport staff.
Exit screening was initially organized by WHO, Guinea’s ministries of health and transportation, airport management and locally active airline companies. Since early August 2014, the CDC has been training screeners and general airport staff. WHO has provided the personnel with protective equipment and cash incentives for screeners.
Eighteen medical students are involved in leading the operation; “I am learning a lot, especially in the area of infection control and prevention as well as about the Ebola response,” says fifth-year medical student Patrice Loua. All airport staff are screened at the entrance before starting work each day and are also trained in disinfection and the use of personal protective equipment.
In Conakry, 5 to 10 people are prevented from flying each week because of elevated body temperature. They are examined at the airport by a doctor and if necessary are sent to the city’s main hospital for testing. The airline companies and airport authorities are committed to issuing them with another ticket free of additional charge once they have been cleared to travel.