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Martin Cetron

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Martin Cetron, MD, is an expert in global health security, humanitarian response, immigration and migration with a focus on emerging infections, tropical diseases, and vaccine-preventable diseases in mobile populations. He was a leader in public health emergency preparedness and response activities at CDC, most recently serving as the Director for the Division of Global Migration and Quarantine (DGMQ). Over the last 30 years, Dr. Cetron has co-authored more than 200 publications of his epidemiologic research in more than 15 countries and numerous CDC Immigration Health and Quarantine Regulations. He developed global health policy, led domestic and international investigations including all high-profile international emergency responses to emerging infectious disease outbreaks, and served as an expert consultant on numerous domestic and global security, epidemic and emergency response committees. Dr. Cetron has received numerous national honors for his public health service, including the CDC William C Watson Jr. Medal of Excellence in 2021, CDC’s Highest Honor Award. He received his B.A. from Dartmouth College, his M.D. from Tufts University, and his training in Internal Medicine at the University of Virginia and Infectious Diseases at the University of Washington before joining the CDC’s Epidemic Intelligence Service and becoming a Commissioned Officer in the U.S. Public Health Service (PHS) in 1992. Dr. Cetron holds faculty appointments at Emory University School of Medicine and Rollins School of Public Health.

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Papers by Martin Cetron

Notifications of Public Health Events under the International Health Regulations - 5 Year U.S. Experience

Online Journal of Public Health Informatics, Mar 9, 2014

Migrant, Immigrant, and Refugee Health

Elsevier eBooks, 2011

Crossing Borders: One World, Global Health

Clinical Infectious Diseases, Sep 2, 2011

Selecting Nonpharmaceutical Strategies to Minimize Influenza Spread: The 2009 Influenza A (H1N1) Pandemic and beyond

Public Health Reports, Nov 1, 2012

Shortly after the influenza A (H1N1) 2009 pandemic began, the U.S. government provided guidance t... more Shortly after the influenza A (H1N1) 2009 pandemic began, the U.S. government provided guidance to state and local authorities to assist decision-making for the use of nonpharmaceutical strategies to minimize influenza spread. This guidance included recommendations for flexible decision-making based on outbreak severity, and it allowed for uncertainty and course correction as the pandemic progressed. These recommendations build on a foundation of local, collaborative planning and posit a series of questions regarding epidemiology, the impact on the health-care system, and locally determined feasibility and acceptability of nonpharmaceutical strategies. This article describes recommendations and key questions for decision makers.

The US‐Certified Yellow Fever Vaccination Center Registry: A Tool for Travelers, State Health Departments, and Vaccine Providers

Journal of Travel Medicine, 2006

A Tale of Many Cities: A Contemporary Historical Study of the Implementation of School Closures during the 2009 pA(H1N1) Influenza Pandemic: Table 1

Journal of Health Politics Policy and Law, Feb 26, 2016

Applying qualitative historical methods, we examined the consideration and implementation of scho... more Applying qualitative historical methods, we examined the consideration and implementation of school closures as a nonpharmaceutical intervention (NPI) in thirty US cities during the spring 2009 wave of the pA(H1N1) influenza pandemic. We gathered and performed close textual readings of official federal, state, and municipal government documents; media coverage; and academic publications. Lastly, we conducted oral history interviews with public health and education officials in our selected cities. We found that several local health departments pursued school closure plans independent of CDC guidance, that uncertainty of action and the rapidly evolving understanding of pA(H1N1) contributed to tension and pushback from the public, that the media and public perception played a significant role in the response to school closure decisions, and that there were some notable instances of interdepartmental communication breakdown. We conclude that health departments should continue to develop and fine-tune their action plans while also working to develop better communication methods with the public, and work more closely with education officials to better understand the complexities involved in closing schools. Lastly, state and local governments should work to resolve lingering issues of legal authority for school closures in times of public health crises.

Nonpharmaceutical Interventions Implemented by US Cities During the 1918–1919 Influenza Pandemic

International Journal of Infectious Diseases, Dec 1, 2008

Context A critical question in pandemic influenza planning is the role nonpharmaceutical interven... more Context A critical question in pandemic influenza planning is the role nonpharmaceutical interventions might play in delaying the temporal effects of a pandemic, reducing the overall and peak attack rate, and reducing the number of cumulative deaths. Such measures could potentially provide valuable time for pandemic-strain vaccine and antiviral medication production and distribution. Optimally, appropriate implementation of nonpharmaceutical interventions would decrease the burden on health care services and critical infrastructure. Objectives To examine the implementation of nonpharmaceutical interventions for epidemic mitigation in 43 cities in the continental United States from September 8, 1918, through February 22, 1919, and to determine whether city-to-city variation in mortality was associated with the timing, duration, and combination of nonpharmaceutical interventions; altered population susceptibility associated with prior pandemic waves; age and sex distribution; and population size and density. Design and Setting Historical archival research, and statistical and epidemiological analyses. Nonpharmaceutical interventions were grouped into 3 major categories: school closure; cancellation of public gatherings; and isolation and quarantine. Main Outcome Measures Weekly excess death rate (EDR); time from the activation of nonpharmaceutical interventions to the first peak EDR; the first peak weekly EDR; and cumulative EDR during the entire 24-week study period. Results There were 115 340 excess pneumonia and influenza deaths (EDR, 500/ 100 000 population) in the 43 cities during the 24 weeks analyzed. Every city adopted at least 1 of the 3 major categories of nonpharmaceutical interventions. School closure and public gathering bans activated concurrently represented the most common combination implemented in 34 cities (79%); this combination had a median duration of 4 weeks (range, 1-10 weeks) and was significantly associated with reductions in weekly EDR. The cities that implemented nonpharmaceutical interventions earlier had greater delays in reaching peak mortality (Spearman r=−0.74, PϽ.001), lower peak mortality rates (Spearman r=0.31, P =.02), and lower total mortality (Spearman r = 0.37, P =.008). There was a statistically significant association between increased duration of nonpharmaceutical interventions and a reduced total mortality burden (Spearman r = −0.39, P =.005). Conclusions These findings demonstrate a strong association between early, sustained, and layered application of nonpharmaceutical interventions and mitigating the consequences of the 1918-1919 influenza pandemic in the United States. In planning for future severe influenza pandemics, nonpharmaceutical interventions should be considered for inclusion as companion measures to developing effective vaccines and medications for prophylaxis and treatment.

First confirmed cases of Middle East respiratory syndrome coronavirus (MERS-CoV) infection in the United States, updated information on the epidemiology of MERS-CoV infection, and guidance for the public, clinicians, and public health authorities - May 2014

PubMed, May 16, 2014

Since mid-March 2014, the frequency with which cases of Middle East respiratory syndrome coronavi... more Since mid-March 2014, the frequency with which cases of Middle East respiratory syndrome coronavirus (MERS-CoV) infection have been reported has increased, with the majority of recent cases reported from Saudi Arabia and United Arab Emirates (UAE). In addition, the frequency with which travel-associated MERS cases have been reported and the number of countries that have reported them to the World Health Organization (WHO) have also increased. The first case of MERS in the United States, identified in a traveler recently returned from Saudi Arabia, was reported to CDC by the Indiana State Department of Health on May 1, 2014, and confirmed by CDC on May 2. A second imported case of MERS in the United States, identified in a traveler from Saudi Arabia having no connection with the first case, was reported to CDC by the Florida Department of Health on May 11, 2014. The purpose of this report is to alert clinicians, health officials, and others to increase awareness of the need to consider MERS-CoV infection in persons who have recently traveled from countries in or near the Arabian Peninsula. This report summarizes recent epidemiologic information, provides preliminary descriptions of the cases reported from Indiana and Florida, and updates CDC guidance about patient evaluation, home care and isolation, specimen collection, and travel as of May 13, 2014.

Effect of Predeparture Testing on Postarrival SARS-CoV-2–Positive Test Results Among International Travelers — CDC Traveler-Based Genomic Surveillance Program, Four U.S. Airports, March–September 2022

MMWR. Morbidity and Mortality Weekly Report

Beginning December 6, 2021, all international air passengers boarding flights to the United State... more Beginning December 6, 2021, all international air passengers boarding flights to the United States were required to show either a negative result from a SARS-CoV-2 viral test taken ≤1 day before departure or proof of recovery from COVID-19 within the preceding 90 days (1). As of June 12, 2022, predeparture testing was no longer mandatory but remained recommended by CDC (2,3). Various modeling studies have estimated that predeparture testing the day before or the day of air travel reduces transmission or importation of SARS-CoV-2 by 31%-76% (4-7). Postarrival SARS-CoV-2 pooled testing data from CDC's Traveler-based Genomic Surveillance program were used to compare SARS-CoV-2 test results among volunteer travelers arriving at four U.S. airports during two 12-week periods: March 20-June 11, 2022, when predeparture testing was required, and June 12-September 3, 2022, when predeparture testing was not required. In a multivariable logistic regression model, pooled nasal swab specimens collected during March 20-June 11 were 52% less likely to be positive for SARS-CoV-2 than were those collected during June 12-September 3, after adjusting for COVID-19 incidence in the flight's country of origin, sample pool size, and collection airport (adjusted odds ratio [aOR] = 0.48, 95% CI = 0.39-0.58) (p<0.001). These findings support predeparture testing as a tool for reducing travel-associated SARS-CoV-2 transmission and provide important real-world evidence that can guide decisions for future outbreaks and pandemics. The Traveler-based Genomic Surveillance Program conducts surveillance of travelers at international airports for early detection of new and emerging SARS-CoV-2 variants and to fill gaps in international surveillance (8). International travelers aged ≥18 years arriving at airports

1525. The Impact of Traveler-Based Genomic Surveillance on SARS-CoV-2 Variant Detection in Arriving International Air Travelers– United States, November 29, 2021-April 24, 2022

Open Forum Infectious Diseases

Background International travel facilitates SARS-CoV-2 spread globally. Early detection of varian... more Background International travel facilitates SARS-CoV-2 spread globally. Early detection of variants among arriving international travelers could provide viral information about introduction of variants with differing infectivity, virulence, and vaccine effectiveness, enabling adjustments to treatment and prevention strategies. We initiated a genomic surveillance program at 4 US airports to detect SARS-CoV-2 variants among arriving international travelers. Methods Between November 29, 2021-April 24, 2022, we enrolled arriving air travelers (≥18 years) from flights originating in 16 countries on 5 continents. At four airports, participants self-collected nasal swab samples that were pooled with 5–25 other samples by country of flight. Participants were also given a take-home saliva collection kit; saliva was collected 3-5 days after arrival and mailed back to the laboratory. SARS-CoV-2 reverse transcription–polymerase chain reaction (RT-PCR) was performed on all samples at the laborat...

Early detection of SARS-CoV-2 variants using traveler-based genomic surveillance at four US airports, September 2021- January 2022

We enrolled arriving international air travelers in SARS-CoV-2 genomic surveillance, using molecu... more We enrolled arriving international air travelers in SARS-CoV-2 genomic surveillance, using molecular testing of pooled nasal swabs, and sequencing positive samples for viral lineage. Traveler-based genomic surveillance provided early warning variant detection; we reported the first U.S. Omicron BA.2 and first BA.3 in North America, weeks before next reported detection.

COVID-19 Case Investigations Among Federally Quarantined Evacuees From Wuhan, China, and Exposed Personnel at a US Military Base, United States, February 5-21, 2020

Public Health Reports, 2021

In February 2020, during the early days of the COVID-19 pandemic, 232 evacuees from Wuhan, China,... more In February 2020, during the early days of the COVID-19 pandemic, 232 evacuees from Wuhan, China, were placed under federal 14-day quarantine upon arrival at a US military base in San Diego, California. We describe the monitoring of evacuees and responders for symptoms of COVID-19, case and contact investigations, infection control procedures, and lessons learned to inform future quarantine protocols for evacuated people from a hot spot resulting from a novel pathogen. Thirteen (5.6%) evacuees had COVID-19–compatible symptoms and 2 (0.9%) had laboratory-confirmed SARS-CoV-2. Two case investigations identified 43 contacts; 3 (7.0%) contacts had symptoms but tested negative for SARS-CoV-2 infection. Daily symptom and temperature screening of evacuees and enacted infection control procedures resulted in rapid case identification and isolation and no detected secondary transmission among evacuees or responders. Lessons learned highlight the challenges associated with public health respo...

First travel-related case of 2019 novel coronavirus detected in United States : press release, Tuesday, January 21, 2020

Transcript of 2019 novel coronavirus response press briefing transcript : Friday, January 24, 2020

Please Note: This transcript is not edited and may contain errors.For the latest information on t... more

Yellow fever vaccine

Vaccines, 2008

Risk Assessment and Management of COVID-19 Among Travelers Arriving at Designated U.S. Airports, January 17–September 13, 2020

MMWR. Morbidity and Mortality Weekly Report, 2020

Cruise Ship Travel in the Era of Coronavirus Disease 2019 (COVID-19): A Summary of Outbreaks and a Model of Public Health Interventions

Clinical Infectious Diseases, 2021

Background Cruise travel contributed to severe acute respiratory syndrome coronavirus 2 (SARS-CoV... more Background Cruise travel contributed to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission when there were relatively few cases in the United States. By 14 March 2020, the Centers for Disease Control and Prevention (CDC) issued a No Sail Order suspending US cruise operations; the last US passenger ship docked on 16 April. Methods We analyzed SARS-CoV-2 outbreaks on cruises in US waters or carrying US citizens and used regression models to compare voyage characteristics. We used compartmental models to simulate the potential impact of 4 interventions (screening for coronavirus disease 2019 (COVID-19) symptoms; viral testing on 2 days and isolation of positive persons; reduction of passengers by 40%, crew by 20%, and reducing port visits to 1) for 7-day and 14-day voyages. Results During 19 January to 16 April 2020, 89 voyages on 70 ships had known SARS-CoV-2 outbreaks; 16 ships had recurrent outbreaks. There were 1669 reverse transcription polymerase chain reac...

Reducing travel-related SARS-CoV-2 transmission with layered mitigation measures: symptom monitoring, quarantine, and testing

BMC Medicine, 2021

Background Balancing the control of SARS-CoV-2 transmission with the resumption of travel is a gl... more Background Balancing the control of SARS-CoV-2 transmission with the resumption of travel is a global priority. Current recommendations include mitigation measures before, during, and after travel. Pre- and post-travel strategies including symptom monitoring, antigen or nucleic acid amplification testing, and quarantine can be combined in multiple ways considering different trade-offs in feasibility, adherence, effectiveness, cost, and adverse consequences. Methods We used a mathematical model to analyze the expected effectiveness of symptom monitoring, testing, and quarantine under different estimates of the infectious period, test-positivity relative to time of infection, and test sensitivity to reduce the risk of transmission from infected travelers during and after travel. Results If infection occurs 0–7 days prior to travel, immediate isolation following symptom onset prior to or during travel reduces risk of transmission while traveling by 30–35%. Pre-departure testing can fur...

Economic analysis of CDC's culture- and smear-based tuberculosis instructions for Filipino immigrants

The International Journal of Tuberculosis and Lung Disease, 2018

Setting: In 2007, CDC revised its Tuberculosis Technical Instructions for panel physicians who ad... more Setting: In 2007, CDC revised its Tuberculosis Technical Instructions for panel physicians who administer mandatory medical examinations of U.S.-bound immigrants. Many U.S.-bound immigrants come from the Philippines, which has high tuberculosis prevalence. Objective: To quantify economic and health impacts of smear-based versus culture-based tuberculosis screening. Design: Decision tree modeling compared three Filipino screening programs: (1) 'No Screening', (2) 'Smear-based', and (3) 'Culture-based'. The model incorporated pre-departure tuberculosis screening results from Filipino panel physicians and CDC databases with post-arrival follow-up outcomes. Costs (2013 USD) were examined from societal, immigrant, U.S. public health department and hospitalization perspectives. Results: With 'No Screening', an annual cohort of 35,722 Filipino immigrants would include an estimated 450 tuberculosis patients with 264 hospitalizations with societal cost of $9.90 million. 'Culture-based' versus 'Smear-based' screening would result in fewer imported cases (80.9 vs. 310.5), hospitalizations (19.7 vs. 68.1), and treatment costs ($1.57 million vs. $4.28 million). Societal screening costs including U.S. follow-up were greater for 'Culture-based" ($5.98 million) than "Smear-based' ($3.38 million). 'Culture-based' requirements increased immigrants' costs by 61% ($1.7 million), but reduced costs for U.S. public health department (22%, $750,000) and hospitalization (70%, $1,020,000) perspectives. Conclusion: 'Culture-based' screening reduced imported tuberculosis and U.S. costs among Filipino immigrants.

Notes from the Field: Contact Tracing Investigation after First Case of Andes Virus in the United States - Delaware, February 2018

MMWR. Morbidity and mortality weekly report, Jan 19, 2018

Notifications of Public Health Events under the International Health Regulations - 5 Year U.S. Experience

Online Journal of Public Health Informatics, Mar 9, 2014

Migrant, Immigrant, and Refugee Health

Elsevier eBooks, 2011

Crossing Borders: One World, Global Health

Clinical Infectious Diseases, Sep 2, 2011

Selecting Nonpharmaceutical Strategies to Minimize Influenza Spread: The 2009 Influenza A (H1N1) Pandemic and beyond

Public Health Reports, Nov 1, 2012

Shortly after the influenza A (H1N1) 2009 pandemic began, the U.S. government provided guidance t... more Shortly after the influenza A (H1N1) 2009 pandemic began, the U.S. government provided guidance to state and local authorities to assist decision-making for the use of nonpharmaceutical strategies to minimize influenza spread. This guidance included recommendations for flexible decision-making based on outbreak severity, and it allowed for uncertainty and course correction as the pandemic progressed. These recommendations build on a foundation of local, collaborative planning and posit a series of questions regarding epidemiology, the impact on the health-care system, and locally determined feasibility and acceptability of nonpharmaceutical strategies. This article describes recommendations and key questions for decision makers.

The US‐Certified Yellow Fever Vaccination Center Registry: A Tool for Travelers, State Health Departments, and Vaccine Providers

Journal of Travel Medicine, 2006

A Tale of Many Cities: A Contemporary Historical Study of the Implementation of School Closures during the 2009 pA(H1N1) Influenza Pandemic: Table 1

Journal of Health Politics Policy and Law, Feb 26, 2016

Applying qualitative historical methods, we examined the consideration and implementation of scho... more Applying qualitative historical methods, we examined the consideration and implementation of school closures as a nonpharmaceutical intervention (NPI) in thirty US cities during the spring 2009 wave of the pA(H1N1) influenza pandemic. We gathered and performed close textual readings of official federal, state, and municipal government documents; media coverage; and academic publications. Lastly, we conducted oral history interviews with public health and education officials in our selected cities. We found that several local health departments pursued school closure plans independent of CDC guidance, that uncertainty of action and the rapidly evolving understanding of pA(H1N1) contributed to tension and pushback from the public, that the media and public perception played a significant role in the response to school closure decisions, and that there were some notable instances of interdepartmental communication breakdown. We conclude that health departments should continue to develop and fine-tune their action plans while also working to develop better communication methods with the public, and work more closely with education officials to better understand the complexities involved in closing schools. Lastly, state and local governments should work to resolve lingering issues of legal authority for school closures in times of public health crises.

Nonpharmaceutical Interventions Implemented by US Cities During the 1918–1919 Influenza Pandemic

International Journal of Infectious Diseases, Dec 1, 2008

Context A critical question in pandemic influenza planning is the role nonpharmaceutical interven... more Context A critical question in pandemic influenza planning is the role nonpharmaceutical interventions might play in delaying the temporal effects of a pandemic, reducing the overall and peak attack rate, and reducing the number of cumulative deaths. Such measures could potentially provide valuable time for pandemic-strain vaccine and antiviral medication production and distribution. Optimally, appropriate implementation of nonpharmaceutical interventions would decrease the burden on health care services and critical infrastructure. Objectives To examine the implementation of nonpharmaceutical interventions for epidemic mitigation in 43 cities in the continental United States from September 8, 1918, through February 22, 1919, and to determine whether city-to-city variation in mortality was associated with the timing, duration, and combination of nonpharmaceutical interventions; altered population susceptibility associated with prior pandemic waves; age and sex distribution; and population size and density. Design and Setting Historical archival research, and statistical and epidemiological analyses. Nonpharmaceutical interventions were grouped into 3 major categories: school closure; cancellation of public gatherings; and isolation and quarantine. Main Outcome Measures Weekly excess death rate (EDR); time from the activation of nonpharmaceutical interventions to the first peak EDR; the first peak weekly EDR; and cumulative EDR during the entire 24-week study period. Results There were 115 340 excess pneumonia and influenza deaths (EDR, 500/ 100 000 population) in the 43 cities during the 24 weeks analyzed. Every city adopted at least 1 of the 3 major categories of nonpharmaceutical interventions. School closure and public gathering bans activated concurrently represented the most common combination implemented in 34 cities (79%); this combination had a median duration of 4 weeks (range, 1-10 weeks) and was significantly associated with reductions in weekly EDR. The cities that implemented nonpharmaceutical interventions earlier had greater delays in reaching peak mortality (Spearman r=−0.74, PϽ.001), lower peak mortality rates (Spearman r=0.31, P =.02), and lower total mortality (Spearman r = 0.37, P =.008). There was a statistically significant association between increased duration of nonpharmaceutical interventions and a reduced total mortality burden (Spearman r = −0.39, P =.005). Conclusions These findings demonstrate a strong association between early, sustained, and layered application of nonpharmaceutical interventions and mitigating the consequences of the 1918-1919 influenza pandemic in the United States. In planning for future severe influenza pandemics, nonpharmaceutical interventions should be considered for inclusion as companion measures to developing effective vaccines and medications for prophylaxis and treatment.

First confirmed cases of Middle East respiratory syndrome coronavirus (MERS-CoV) infection in the United States, updated information on the epidemiology of MERS-CoV infection, and guidance for the public, clinicians, and public health authorities - May 2014

PubMed, May 16, 2014

Since mid-March 2014, the frequency with which cases of Middle East respiratory syndrome coronavi... more Since mid-March 2014, the frequency with which cases of Middle East respiratory syndrome coronavirus (MERS-CoV) infection have been reported has increased, with the majority of recent cases reported from Saudi Arabia and United Arab Emirates (UAE). In addition, the frequency with which travel-associated MERS cases have been reported and the number of countries that have reported them to the World Health Organization (WHO) have also increased. The first case of MERS in the United States, identified in a traveler recently returned from Saudi Arabia, was reported to CDC by the Indiana State Department of Health on May 1, 2014, and confirmed by CDC on May 2. A second imported case of MERS in the United States, identified in a traveler from Saudi Arabia having no connection with the first case, was reported to CDC by the Florida Department of Health on May 11, 2014. The purpose of this report is to alert clinicians, health officials, and others to increase awareness of the need to consider MERS-CoV infection in persons who have recently traveled from countries in or near the Arabian Peninsula. This report summarizes recent epidemiologic information, provides preliminary descriptions of the cases reported from Indiana and Florida, and updates CDC guidance about patient evaluation, home care and isolation, specimen collection, and travel as of May 13, 2014.

Effect of Predeparture Testing on Postarrival SARS-CoV-2–Positive Test Results Among International Travelers — CDC Traveler-Based Genomic Surveillance Program, Four U.S. Airports, March–September 2022

MMWR. Morbidity and Mortality Weekly Report

Beginning December 6, 2021, all international air passengers boarding flights to the United State... more Beginning December 6, 2021, all international air passengers boarding flights to the United States were required to show either a negative result from a SARS-CoV-2 viral test taken ≤1 day before departure or proof of recovery from COVID-19 within the preceding 90 days (1). As of June 12, 2022, predeparture testing was no longer mandatory but remained recommended by CDC (2,3). Various modeling studies have estimated that predeparture testing the day before or the day of air travel reduces transmission or importation of SARS-CoV-2 by 31%-76% (4-7). Postarrival SARS-CoV-2 pooled testing data from CDC's Traveler-based Genomic Surveillance program were used to compare SARS-CoV-2 test results among volunteer travelers arriving at four U.S. airports during two 12-week periods: March 20-June 11, 2022, when predeparture testing was required, and June 12-September 3, 2022, when predeparture testing was not required. In a multivariable logistic regression model, pooled nasal swab specimens collected during March 20-June 11 were 52% less likely to be positive for SARS-CoV-2 than were those collected during June 12-September 3, after adjusting for COVID-19 incidence in the flight's country of origin, sample pool size, and collection airport (adjusted odds ratio [aOR] = 0.48, 95% CI = 0.39-0.58) (p<0.001). These findings support predeparture testing as a tool for reducing travel-associated SARS-CoV-2 transmission and provide important real-world evidence that can guide decisions for future outbreaks and pandemics. The Traveler-based Genomic Surveillance Program conducts surveillance of travelers at international airports for early detection of new and emerging SARS-CoV-2 variants and to fill gaps in international surveillance (8). International travelers aged ≥18 years arriving at airports

1525. The Impact of Traveler-Based Genomic Surveillance on SARS-CoV-2 Variant Detection in Arriving International Air Travelers– United States, November 29, 2021-April 24, 2022

Open Forum Infectious Diseases

Background International travel facilitates SARS-CoV-2 spread globally. Early detection of varian... more Background International travel facilitates SARS-CoV-2 spread globally. Early detection of variants among arriving international travelers could provide viral information about introduction of variants with differing infectivity, virulence, and vaccine effectiveness, enabling adjustments to treatment and prevention strategies. We initiated a genomic surveillance program at 4 US airports to detect SARS-CoV-2 variants among arriving international travelers. Methods Between November 29, 2021-April 24, 2022, we enrolled arriving air travelers (≥18 years) from flights originating in 16 countries on 5 continents. At four airports, participants self-collected nasal swab samples that were pooled with 5–25 other samples by country of flight. Participants were also given a take-home saliva collection kit; saliva was collected 3-5 days after arrival and mailed back to the laboratory. SARS-CoV-2 reverse transcription–polymerase chain reaction (RT-PCR) was performed on all samples at the laborat...

Early detection of SARS-CoV-2 variants using traveler-based genomic surveillance at four US airports, September 2021- January 2022

We enrolled arriving international air travelers in SARS-CoV-2 genomic surveillance, using molecu... more We enrolled arriving international air travelers in SARS-CoV-2 genomic surveillance, using molecular testing of pooled nasal swabs, and sequencing positive samples for viral lineage. Traveler-based genomic surveillance provided early warning variant detection; we reported the first U.S. Omicron BA.2 and first BA.3 in North America, weeks before next reported detection.

COVID-19 Case Investigations Among Federally Quarantined Evacuees From Wuhan, China, and Exposed Personnel at a US Military Base, United States, February 5-21, 2020

Public Health Reports, 2021

In February 2020, during the early days of the COVID-19 pandemic, 232 evacuees from Wuhan, China,... more In February 2020, during the early days of the COVID-19 pandemic, 232 evacuees from Wuhan, China, were placed under federal 14-day quarantine upon arrival at a US military base in San Diego, California. We describe the monitoring of evacuees and responders for symptoms of COVID-19, case and contact investigations, infection control procedures, and lessons learned to inform future quarantine protocols for evacuated people from a hot spot resulting from a novel pathogen. Thirteen (5.6%) evacuees had COVID-19–compatible symptoms and 2 (0.9%) had laboratory-confirmed SARS-CoV-2. Two case investigations identified 43 contacts; 3 (7.0%) contacts had symptoms but tested negative for SARS-CoV-2 infection. Daily symptom and temperature screening of evacuees and enacted infection control procedures resulted in rapid case identification and isolation and no detected secondary transmission among evacuees or responders. Lessons learned highlight the challenges associated with public health respo...

First travel-related case of 2019 novel coronavirus detected in United States : press release, Tuesday, January 21, 2020

Transcript of 2019 novel coronavirus response press briefing transcript : Friday, January 24, 2020

Please Note: This transcript is not edited and may contain errors.For the latest information on t... more

Yellow fever vaccine

Vaccines, 2008

Risk Assessment and Management of COVID-19 Among Travelers Arriving at Designated U.S. Airports, January 17–September 13, 2020

MMWR. Morbidity and Mortality Weekly Report, 2020

Cruise Ship Travel in the Era of Coronavirus Disease 2019 (COVID-19): A Summary of Outbreaks and a Model of Public Health Interventions

Clinical Infectious Diseases, 2021

Background Cruise travel contributed to severe acute respiratory syndrome coronavirus 2 (SARS-CoV... more Background Cruise travel contributed to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission when there were relatively few cases in the United States. By 14 March 2020, the Centers for Disease Control and Prevention (CDC) issued a No Sail Order suspending US cruise operations; the last US passenger ship docked on 16 April. Methods We analyzed SARS-CoV-2 outbreaks on cruises in US waters or carrying US citizens and used regression models to compare voyage characteristics. We used compartmental models to simulate the potential impact of 4 interventions (screening for coronavirus disease 2019 (COVID-19) symptoms; viral testing on 2 days and isolation of positive persons; reduction of passengers by 40%, crew by 20%, and reducing port visits to 1) for 7-day and 14-day voyages. Results During 19 January to 16 April 2020, 89 voyages on 70 ships had known SARS-CoV-2 outbreaks; 16 ships had recurrent outbreaks. There were 1669 reverse transcription polymerase chain reac...

Reducing travel-related SARS-CoV-2 transmission with layered mitigation measures: symptom monitoring, quarantine, and testing

BMC Medicine, 2021

Background Balancing the control of SARS-CoV-2 transmission with the resumption of travel is a gl... more Background Balancing the control of SARS-CoV-2 transmission with the resumption of travel is a global priority. Current recommendations include mitigation measures before, during, and after travel. Pre- and post-travel strategies including symptom monitoring, antigen or nucleic acid amplification testing, and quarantine can be combined in multiple ways considering different trade-offs in feasibility, adherence, effectiveness, cost, and adverse consequences. Methods We used a mathematical model to analyze the expected effectiveness of symptom monitoring, testing, and quarantine under different estimates of the infectious period, test-positivity relative to time of infection, and test sensitivity to reduce the risk of transmission from infected travelers during and after travel. Results If infection occurs 0–7 days prior to travel, immediate isolation following symptom onset prior to or during travel reduces risk of transmission while traveling by 30–35%. Pre-departure testing can fur...

Economic analysis of CDC's culture- and smear-based tuberculosis instructions for Filipino immigrants

The International Journal of Tuberculosis and Lung Disease, 2018

Setting: In 2007, CDC revised its Tuberculosis Technical Instructions for panel physicians who ad... more Setting: In 2007, CDC revised its Tuberculosis Technical Instructions for panel physicians who administer mandatory medical examinations of U.S.-bound immigrants. Many U.S.-bound immigrants come from the Philippines, which has high tuberculosis prevalence. Objective: To quantify economic and health impacts of smear-based versus culture-based tuberculosis screening. Design: Decision tree modeling compared three Filipino screening programs: (1) 'No Screening', (2) 'Smear-based', and (3) 'Culture-based'. The model incorporated pre-departure tuberculosis screening results from Filipino panel physicians and CDC databases with post-arrival follow-up outcomes. Costs (2013 USD) were examined from societal, immigrant, U.S. public health department and hospitalization perspectives. Results: With 'No Screening', an annual cohort of 35,722 Filipino immigrants would include an estimated 450 tuberculosis patients with 264 hospitalizations with societal cost of $9.90 million. 'Culture-based' versus 'Smear-based' screening would result in fewer imported cases (80.9 vs. 310.5), hospitalizations (19.7 vs. 68.1), and treatment costs ($1.57 million vs. $4.28 million). Societal screening costs including U.S. follow-up were greater for 'Culture-based" ($5.98 million) than "Smear-based' ($3.38 million). 'Culture-based' requirements increased immigrants' costs by 61% ($1.7 million), but reduced costs for U.S. public health department (22%, $750,000) and hospitalization (70%, $1,020,000) perspectives. Conclusion: 'Culture-based' screening reduced imported tuberculosis and U.S. costs among Filipino immigrants.

Notes from the Field: Contact Tracing Investigation after First Case of Andes Virus in the United States - Delaware, February 2018

MMWR. Morbidity and mortality weekly report, Jan 19, 2018