Maria An der Heiden

Zusammenfassung: COVID-19 stellt unsere Gesellschaft seit Januar 2020 vor große Herausforderungen. Durch den globalen Reiseverkehr konnte sich das neue Coronavirus rasch weltweit ausbreiten. In diesem Artikel sollen übersichtsartig die Herausforderungen bei der Implementierung von Maßnahmen im Flug- und Schiffsverkehr aus Sicht des Öffentlichen Gesundheitsdienstes (ÖGD) dargestellt werden. Dies erfolgt anhand einer Auswahl von Ereignissen und Maßnahmen zwischen Januar und August 2020. Die gewonnenen Erkenntnisse werden diskutiert.Während der COVID-19-Pandemie bewegt sich der ÖGD in einem Spannungsfeld, das sich aus der Dynamik wissenschaftlicher Erkenntnisse, politischer Entscheidungen und der Akzeptanz und Zustimmung in der Gesellschaft ergibt. An Grenzübergangsstellen wie Flug- und Seehäfen gibt es besondere Herausforderungen. Dazu gehören insbesondere Personalengpässe und die Notwendigkeit, Maßnahmen mit hohem organisatorischen Aufwand sehr kurzfristig umzusetzen, wie etwa gesundheitsbehördliche Passagierkontrollen direkt an Luftfahrzeugen, die Einrichtung von Testzentren an Grenzübergangsstellen sowie die Überprüfung der Einhaltung von Quarantänevorgaben. Erschwerend kommt hinzu, dass Passagierlisten, die zur effektiven Kontaktpersonennachverfolgung notwendig sind, oft fehlen oder unvollständig sind. Ebenso fehlen digitale Tools für das Kontaktpersonenmanagement, aber z. B. auch für den Austausch personenbezogener Daten innerhalb des ÖGD. Weitere Schwierigkeiten beim Ausbruchsmanagement ergeben sich durch die engen Verhältnisse an Bord von Schiffen und durch die mögliche psychische Belastung von Besatzung und Passagieren, die in den Maßnahmen noch nicht ausreichend berücksichtigt werden.Angesichts all dieser Herausforderungen ist es notwendig, den ÖGD langfristig zu stärken – allgemein und an den Grenzübergangsstellen – und den Bund-Länder-Austausch im Flug- und Schiffsverkehr zu intensivieren.

A scoping search and a systematic literature review were conducted to give an insight on entry and exit screening referring to travelers at points of entry, by analyzing published evidence on practices, guidelines, and experiences in the past 15 years worldwide. Grey literature, PubMed. and Scopus were searched using specific terms. Most of the available data identified through the systematic literature review concerned entry screening measures at airports. Little evidence is available about entry and exit screening measure implementation and effectiveness at ports and ground crossings. Exit screening was part of the World Health Organisation’s (WHO) temporary recommendations for implementation in certain points of entry, for specific time periods. Exit screening measures for Ebola Virus Disease (EVD) in the three most affected West African countries did not identify any cases and showed zero sensitivity and very low specificity. The percentages of confirmed cases identified out of the total numbers of travelers that passed through entry screening measures in various countries worldwide for Influenza Pandemic (H1N1) and EVD in West Africa were zero or extremely low. Entry screening measures for Severe Acute Respiratory Syndrome (SARS) did not detect any confirmed SARS cases in Australia, Canada, and Singapore. Despite the ineffectiveness of entry and exit screening measures, authors reported several important concomitant positive effects that their impact is difficult to assess, including discouraging travel of ill persons, raising awareness, and educating the traveling public and maintaining operation of flights from/to the affected areas. Exit screening measures in affected areas are important and should be applied jointly with other measures including information strategies, epidemiological investigation, contact tracing, vaccination, and quarantine to achieve a comprehensive outbreak management response. Based on review results, an algorithm about decision-making for entry/exit screening was developed.

In July 2013, a passenger died of infectious extensively drug-resistant tuberculosis (XDR-TB) on board of an aircraft after a 3-hour flight from Turkey to Germany. Initial information indicated the patient had moved about the aircraft coughing blood. We thus aimed to contact and inform all persons exposed within the aircraft and to test them for newly acquired TB infection. Two-stage testing within 8 weeks from exposure and at least 8 weeks after exposure was suggested, using either interferon gamma release assays (IGRAs) or tuberculin skin test (TST). The TST cut-off was defined at a diameter > 10 mm; for differentiation between conversion and boosting, conversion was defined as increase of skin induration > 5 mm. Overall, 155 passengers and seven crew members were included in the investigation: the questionnaire response rate was 83%; 112 (69%) persons were tested at least once for TB infection. In one passenger, who sat next to the area where the patient died, a test conversion was registered. As of March 2017, no secondary active TB cases have been reported. We describe an unusual situation in which we applied contact tracing beyond existing European guidelines; we found one latent tuberculosis infection in a passenger, which we consider probably newly acquired.