Border health measures

Border health measures exist to protect human health and safety on an international scale. There is a variety of core protection measures and controls which may be applied individually or together to prevent the spread of infectious disease and other public health risks.

Quarantine and isolation

The word quarantine is often used in the border health context. Human quarantine procedures seek to prevent an event that may adversely affect human health. They can help identify and control the spread of diseases, including those that are airborne, foodborne and waterborne, or spread by vectors such as rats and mosquitoes.

Quarantine rules can restrict the activities of well persons or animals that have been exposed to an infectious disease during the period when the disease was contagious. Quarantine procedures also deal with matters such as:

  • The provision of potable water at airports and ports
  • Passenger surveillance
  • Ship and aircraft arrivals
  • Sanitation control
  • General and contingency planning for quarantinable and other communicable diseases.

To many people, the word quarantine means the segregation or isolation of ill people – or animals, plants, or other risk goods – from others. In fact, the term has a more specific meaning in the border health protection context. The International Health Regulations 2005 defines ‘quarantine’ as meaning:

… the restriction of activities and/or separation from others of suspect persons who are not ill or of suspect baggage, containers, conveyances, or goods in such a manner as to prevent the possible spread of infection or contamination.

In the border health context, the term ‘isolation’ covers the separation of ill or contaminated people or affected baggage or cargo from others, to prevent the spread of infection or contamination.

Measures such as ‘quarantine’ or ‘isolation’ are only two of a range of border health protection measures or controls that might be applied – and are generally at the more extreme end of the spectrum.

Selecting the most appropriate health measure(s)

The range of different measures are described below, and are grouped as follows:

  • Travel measures at international points of entry
  • Management of symptomatic travellers
  • Management of exposed travellers (who may not be symptomatic)
  • Exit measures.

Some measures are more invasive than others. It is important that any measures taken against a public health threat are proportional to the level of risk, and take into account the potential health, social, and economic impacts of their implementation, along with the compliance costs to implement them.

Travel measures at international points of entry

Health advisories or alerts for travellers

Authorities can publicise information to raise the awareness of the public and incoming/outgoing travellers, and to promote personal hygiene and appropriate behaviours.

Entry screening for travellers

Screening aims to identify ill or potentially ill travellers at the border before they enter the country. There are a number of ways of doing such screening, including:

  • Inspections on board aircraft/vessels to identify ill travellers prior to arrival/departure
  • Requiring Health Declarations from some or all travellers
  • Visual screening to identify travellers who are visibly ill
  • Temperature screening to detect travellers with a fever
  • Rapid laboratory investigations, which can increase the specificity of screening and help determine the likelihood of infection in symptomatic travellers
  • Screening of risk goods, cargo, or conveyances such as aircraft and ships.

International travel advisories

In order to prevent or delay the introduction of the disease into a non-affected country, authorities can issue advisories aimed at reducing travel to and from certain countries or areas. Advisories can come in a number of forms, such as discouraging ill people from travelling or discouraging non-essential travel to affected areas.

Travel restrictions

Restrictions can be placed on travel to and from selected countries or areas, in order to prevent or delay the introduction of a disease into a non-affected country.

Diversion of conveyances to another airport or seaport

Diversion aims to delay or prevent introduction of public health threat and  ensure the most appropriate venue and facility to provide a public health response.

Border closures

Travel to and from selected countries or areas can be prohibited (eg, by refusing international flights), in order to prevent or delay the introduction of a disease into a non-affected country. In practice, this measure is very unlikely to ever be applied, given the range of other controls that can be used.

Measures focused on managing symptomatic travellers

Passenger locator information

Contact information can be collected from travellers for future follow-up if necessary.

Medical assessment

Arriving or departing travellers with symptoms can be assessed in order to determine the likelihood of infection.

Rapid laboratory investigations

Investigations can be launched to increase the specificity of screening and help determine the likelihood of infection in symptomatic travellers.

Isolation

Ill or contaminated people can be separated from others, as can affected baggage and cargo. Isolation could occur at home, in a facility such as a hospital, hotel or marae, or at the airport/seaport of entry/exit.

Treatment

Authorities can treat infected individuals in order to reduce the severity of the illness and minimise complications.

Contact tracing and/or prophylaxis

Authorities can identify other travellers who have been in close contact with the symptomatic traveller and provide prophylaxis (eg, preventative medication or a vaccination).

Measures focused on managing exposed travellers

Some people may have been exposed to a disease but it is uncertain whether they have actually contracted it. The following measures are options that may be applied to such people.

Passenger locator information

Contact information can be collected from travellers for future follow-up if necessary.

Measures on board aircraft to manage suspected cases and contacts

Implementing measures on board aircraft can reduce the severity of illness and minimise complications in infected individuals.

Self health monitoring and illness reporting

People can be asked to monitor their own health status, and report illness. This may help identify infected individuals amongst exposed crew/passengers.

Quarantine

Authorities can restrict the activities of suspect persons who are not ill, or separate them from others. They may also separate suspect baggage or other cargo in order prevent the possible spread of infection or contamination.

There are different types of quarantine measure available:

  • Voluntary quarantine, where potentially infected people are encouraged to quarantine themselves until their state of health is confirmed
  • Home quarantine, which requires people to stay at their places of residence and is intended to identify individuals and break the transmission cycle
  • Institutional quarantine, which requires people to stay at an institution or facility (eg, hospital or hotel) and is intended to identify individuals and break the transmission cycle.

Exit measures

  • Many of the measures mentioned above can also be applied to aircraft, vessels and travellers wanting to depart from New Zealand. 
  • To be effective, exit measures need to be applied from the time potential travellers are considering decisions about whether and where to travel rather than solely at the point of departure.
  • Exit measures would likely only be used at the recommendation of the World Health Organization and/or at the request of the country of destination.
  • Implications for business, trade and tourism in the countries of destination may be significant so the public health risk would need to be greater than the impacts of the measures (eg, effects on income, food security, etc).
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