title: Effectiveness of traveller screening for emerging pathogens is shaped by epidemiology and natural history of infection.
abstract: During outbreaks of high-consequence pathogens, airport screening programs have been deployed to curtail geographic spread of infection. The effectiveness of screening depends on several factors, including pathogen natural history and epidemiology, human behavior, and characteristics of the source epidemic. We developed a mathematical model to understand how these factors combine to influence screening outcomes. We analyzed screening programs for six emerging pathogens in the early and late stages of an epidemic. We show that the effectiveness of different screening tools depends strongly on pathogen natural history and epidemiological features, as well as human factors in implementation and compliance. For pathogens with longer incubation periods, exposure risk detection dominates in growing epidemics, while fever becomes a better target in stable or declining epidemics. For pathogens with short incubation, fever screening drives detection in any epidemic stage. However, even in the most optimistic scenario arrival screening will miss the majority of cases.
authors.affiliation: Department of Ecology and Evolutionary Biology, University of California, Los Angeles, Los Angeles, United States.
authors.forename: Katelyn M
authors.initials: KM
authors.lastname: Gostic
authors.affiliation: Centre for the Mathematical Modelling of Infectious Diseases, Department of Infectious Disease Epidemiology, London School of Tropical Hygiene and Medicine, London, United Kingdom.
authors.forename: Adam J
authors.initials: AJ
authors.lastname: Kucharski
authors.affiliation: Department of Ecology and Evolutionary Biology, University of California, Los Angeles, Los Angeles, United States.
authors.forename: James O
authors.initials: JO
authors.lastname: Lloyd-Smith
mesh_terms: D004196:Disease Outbreaks; D006801:Humans; D008962:Models, Theoretical; D014195:Travel
keywords: ecology; emerging diseases; entry screening; epidemiology; fever screening; global health; incubation period; pathogen natural history; viruses