BACKGROUND AND METHODS

After the World Health Organization issued a global alert for the occurrence of a novel pandemic influenza (H1N1) in 2009, most international airports in Germany implemented intensified public health measures to delay local transmission. At Hamburg airport it was decided not to implement a general entry and exit screening of all travelers during the pandemic influenza (H1N1) 2009. Travelers were advised on symptoms and protective measures by public information displayed in the airport. A mobile Airport Medical Assessment Center (AMAC) for up to 260 persons was used which barred 6 gates from traffic for this reason. Travelers were medically examined by the public health authority after notification from the flight captain according to Article 28 (4) of the International Health Regulations or were referred to the medical assessment by other service providers such as the information desk in the airport. From May to August 2009 n=108 affected travelers were medically examined and advised by the public health authority at the airport. 9 out of 108 affected travelers (8.3%) who presented to the public health service at the airport were diagnosed with pandemic influenza (H1N1) 2009. Overall, only 0.002% of all travelers through the airport in the given time-frame were seen by the service. Most of the affected travelers presented themselves to the public health service before embarkation or after disembarkation. On 6 occasions the pilots declared a person with illness on board to the public health authority. Out of the 6 persons 4 were diagnosed with pandemic influenza (H1N1) 2009. In the case of notification, the delay in traveling for contact persons ranged from 30 min to 2 h. None of the sick travelers was referred to a hospital, all returned home. In addition to the medical assessment of affected travelers the public health authority issued "free-pratique" according to Article 28 (3) of the International Health Regulations, after talking to the cabin crew or flight captain. Out of 167 (0.3% of all flights to Hamburg) inspected airplanes only in one case was a notification not issued by the pilot despite a known case of sickness on the plane.

CONCLUSIONS

To avoid unnecessary interference with travel, the public health service at airports must be able to react in a timely manner to notifications of disease. During the influenza pandemic (H1N1) 2009, 4 out 9 (36%) of the cases that were diagnosed with pandemic influenza (H1N1) 2009 were notified to the public health authority via the aircraft. It is the authors' experience during the pandemic influenza (H1N1) 2009 that the notification requirement of the pilot is of importance because it enables the public health service to react before disembarkation. However, more often affected persons sought advice from the public health service before or after the flight. A prerequisite for this is that the public health service is known to the relevant bodies at the airport and accessible to the public. Routine health inspections of airplanes with visual inspection of travelers result in high manpower requirements. In the authors' view these routine inspections of airplanes are only justified if there is a suspicion of disease on board, or to train the staff of public health authorities. It can be concluded from the experiences during the pandemic influenza (H1N1) 2009 that the core capacities required for designated airports according to Annex 1 B of the International Health Regulations must include trained medical professionals, communication and transportation infrastructure amongst appropriate facilities. One must distinguish between medical facilities for some affected travelers in the public areas of the airport, and a medical assessment area in the security area of the airport that is appropriate for the number of persons that may be carried by the largest vessel to that destination.