Airports' Strategies To Combat Disease Outbreaks

Airports are hotspots for the spread of infectious diseases due to the sheer number of people passing through them daily. In the past year, over 135 million passengers traveled to the US from other countries, presenting 135 million opportunities for an outbreak to occur. Airports have become even more vigilant in their cleaning and sanitizing procedures since the COVID-19 pandemic, but there are still concerns about the potential for disease outbreaks. Airports with reported outbreaks include JFK International Airport and LAX, with measles and Ebola being two of the most commonly mentioned diseases.

Testing wastewater from airplanes for viral pathogens

The CDC's Traveler Genomic Surveillance Program, launched in September 2021, tests wastewater from airplanes for pathogens that may have travelled with passengers on long-haul international flights. This program is currently operational in four major airports in the US: Boston, San Francisco, New York's John F. Kennedy, and the Washington, D.C. area's Dulles. Technicians collect wastewater samples from airplane lavatories while baggage is being unloaded, and these samples are then shipped to a lab for analysis. Researchers examine the genetic material in the samples, searching for infectious pathogens.

Wastewater testing has several advantages over individual testing. It can detect viruses 1-2 weeks ahead of publicly available clinical datasets, as was the case with Omicron, which was found in wastewater before individuals displayed symptoms and opted for clinical testing. Wastewater testing can also help distinguish between viruses with similar symptoms, such as COVID-19, influenza, and RSV, providing valuable information for healthcare providers and government officials about true community viral activity. This, in turn, helps in tailoring treatment and community protection approaches, which vary depending on the specific virus. Furthermore, wastewater testing captures data from asymptomatic cases, which might be missed by individual testing.

Despite the benefits of wastewater testing, there are concerns about the limited scope of the current program. Experts worry that testing at only four airports may not be sufficient to reliably detect all incoming pathogens, considering the large number of international airports in the US.

Contact tracing

One of the key challenges for airports is to quickly identify infected individuals and their close contacts, and then direct these individuals into isolation. This process is crucial in controlling the spread of the disease, as it helps to reduce the number of people that an infected person can transmit the disease to. Airports have implemented various technologies to facilitate this, including contact tracing apps and the use of QR codes. For example, the Philippines introduced the Traze app, which requires users to scan QR codes at various points in the airport, including the airport entrance, check-in counter, immigration counter, departure gate, and arrival gate. This automation replaces the manual process of filling out contact tracing forms and helps to streamline the contact tracing process.

In addition to technological solutions, airports have also had to evaluate their guidelines and procedures to reduce the likelihood and severity of an outbreak. This includes considering how to manage and respond to the pandemic, as well as how to identify and isolate potentially infected individuals. Airports have also had to consider the impact of updated CDC time guidelines, which emphasize that it is not just contact but prolonged contact that is a critical factor in disease transmission.

The effectiveness of contact tracing at airports relies on a combination of technological solutions and organizational measures. By implementing these strategies, airports can play a crucial role in controlling the spread of infectious diseases and protecting the health and safety of travellers and staff.

Vaccination rates

One of the primary concerns regarding vaccination rates and airports is the risk of importing and spreading infectious diseases. Measles, for example, is a highly contagious disease that can be introduced into a community by a single infected traveller. In 2025, a measles outbreak at New York's JFK International Airport was caused by an unvaccinated child who had arrived on a China Airlines flight. This incident led to a potential exposure of the disease to numerous individuals, including those on the shuttle bus to Philadelphia and at various clinics.

To prevent such outbreaks, it is crucial to maintain high vaccination rates in the community. Experts recommend a minimum threshold of 95% vaccination coverage to establish herd immunity and effectively prevent measles outbreaks. However, falling vaccination rates have been observed in certain communities, such as Gaines County, Texas, which has a large Mennonite community that has traditionally avoided the healthcare system. As a result, vaccination rates among kindergarten students in the county have been as low as 46%, far below the required threshold, increasing the community's vulnerability to measles outbreaks.

To address this challenge, health officials emphasize the importance of routine vaccinations. They advise travellers to ensure their vaccinations are up to date before embarking on their journeys. Additionally, during an outbreak, staff in affected areas should follow World Health Organization guidelines by wearing personal protective equipment, such as face masks, and practising good hand hygiene with hand disinfectants.

By improving vaccination rates and adhering to preventive measures, airports can play a crucial role in disease control and help minimise the impact of outbreaks.

Food safety protocols

Regulatory Compliance and Collaboration:

Airports should ensure that all food establishments within their premises strictly adhere to food safety regulations and public health guidelines. This includes compliance with hygiene protocols, safe food handling practices, and proper sanitation procedures. Airports should collaborate with local health authorities, such as the Food and Drug Administration (FDA), to implement and oversee these regulations. Regular inspections and audits should be conducted to identify any violations or areas of improvement.

Emphasis on Hygiene and Sanitation:

All food handling staff should be trained and educated on proper hygiene practices, including frequent handwashing, glove usage, and the importance of maintaining clean surfaces. Airports should provide adequate sanitation facilities, such as easily accessible handwashing stations, for both staff and passengers. Regular cleaning and disinfection of food preparation areas, dining spaces, and equipment should be mandatory to prevent the spread of pathogens.

Temperature Control and Food Storage:

Maintaining proper temperatures during food storage, preparation, and service is crucial. Airports should ensure that food establishments have adequate refrigeration and heating facilities to store perishable items at safe temperatures. Open refrigeration units should be monitored closely, as they may not maintain temperatures as effectively as closed-door refrigeration. Proper thawing and cooking procedures must be followed to prevent the growth of harmful bacteria.

Safe Food Handling Practices:

Airports should enforce strict protocols for food handling to minimize the risk of contamination. This includes proper training for food preparation staff, enforcing the use of hairnets or hats, gloves, and face masks, and ensuring that staff members exhibiting signs of illness do not handle food. Airports should also promote good personal hygiene among passengers, encouraging frequent handwashing and the use of hand sanitizers, especially before consuming food.

Food Safety Awareness and Training:

Regular training programs and workshops should be conducted for all food handling staff to ensure they are up-to-date with the latest food safety practices and regulations. These programs can cover topics such as identifying and preventing foodborne illnesses, proper food storage and handling, and responding to potential food safety hazards. Airports can also raise food safety awareness among passengers by providing educational materials or signage, encouraging them to make informed food choices and practice good personal hygiene.

Incident Response and Reporting:

Airports should establish clear protocols for responding to suspected food contamination incidents or outbreaks. This includes prompt reporting to the relevant health authorities, conducting thorough investigations, and implementing corrective actions to prevent similar incidents in the future. Collaboration with public health partners is crucial to identify the root cause of outbreaks and implement effective prevention strategies.

By implementing these comprehensive food safety protocols, airports can significantly reduce the risk of foodborne illnesses and protect the health and well-being of travelers and staff, especially during a disease outbreak. These measures not only enhance food safety but also contribute to overall public health and help maintain trust in the aviation industry.

Screening procedures

In addition to wastewater testing, health officials may implement screening measures that focus on questioning and testing passengers, particularly those arriving from specific regions. For instance, during the Ebola outbreak, the US government announced the development of new screening procedures, likely involving health officials interacting with passengers from West Africa. Quarantine centers at airports are also part of the screening infrastructure, with the CDC maintaining such facilities at 20 US airports.

When dealing with highly contagious diseases like measles, contact tracing and public advisories become crucial. In the case of a measles outbreak linked to a child who travelled through JFK International Airport, health officials urged anyone who may have come into contact with the patient to get tested. This included passengers on the same shuttle bus and individuals who visited specific clinics around the same time as the infected child.

To further enhance screening procedures, airports can leverage technological advancements. For example, the CDC's airplane wastewater testing program has successfully identified new COVID-19 variants ahead of their detection in municipal wastewater and clinical settings. This early warning system is invaluable in providing healthcare providers and public health officials with the necessary lead time to prepare and respond effectively.

While screening procedures are essential, they must be complemented by other preventive measures. The WebMD Chief Medical Officer, Dr. John Whyte, emphasizes the importance of wearing masks, maintaining hand hygiene, and being vigilant about one's surroundings when travelling during a measles outbreak. Additionally, he highlights the effectiveness of the measles, mumps, and rubella (MMR) vaccine, which offers strong protection against infection.

Frequently asked questions