CDC to Enhance Airport Surveillance Program for Flu and RSV at Select Major Airports

Additional precautions may be taken during airport screenings this holiday season.

The Centers for Disease Control and Prevention (CDC) is widening its surveillance initiative that tests international air travelers for flu, RSV (respiratory syncytial virus), COVID-19, and other viruses.

The CDC plans to conduct voluntary nasal swabs and collect wastewater from international flights to evaluate samples for virus detection. Any positive test will be sequenced and uploaded to public databases to assist in monitoring illnesses entering the United States.

Brad Hutton, MPH, an infectious-disease epidemiologist and former deputy commissioner of public health at the New York State Department of Health, told Health that this program provides comprehensive surveillance data on the virus strains currently circulating globally.

Hutton highlighted the importance of this program, as it fills a crucial information gap due to a decrease in global sequencing and reporting of pathogen data.

This initiative will function as an early warning system for identifying infection risks in real-time, explained Hutton. It may also aid in preventing the spread of contagious diseases.

The following is information about the new program, affected airlines, and how this added travel step could warn of impending pandemics.

Termed the Traveler-based Genomic Surveillance (TGS) program, this trial program will span several months and is backed by Ginkgo Bioworks and XpresCheck.

At present, seven airports are participating in the program. Six of them will collect voluntary nasal swabs: Seattle, San Francisco, Los Angeles, New York City (JFK), Newark, and Washington D.C.

In Boston, no nasal swabs will be collected. However, the airport will gather aircraft wastewater using a triturator (or a set collection point), which secures samples from multiple flights excluding any terminal waste.

In Seattle, Los Angeles, Newark, and Washington D.C., only nasal swabs will be collected. Both wastewater and nasal swabs will be collected at New York City (JFK) and San Francisco.

Nasal swabs are collected voluntarily and anonymously. Travelers participating are asked to complete a brief survey to aid decision-making in the event of virus detection.

Hutton explained that the expanded TGS pilot could assist in monitoring global RSV and influenza patterns, detect antiviral-resistant strains, or identify new, emerging SARS-CoV-2 strains with numerous concerning mutations.

Brian Labus, PhD, MPH, REHS, an infectious disease expert at the University of Nevada, Las Vegas, School of Public Health, described disease surveillance initiatives like TGS are crucial in current climate assessment and predicting future conditions.

He compared it to weather tracking and prediction, which allows us to prepare better and lessen the disease impact on populations.

Despite a robust system for infectious disease identification, Labus identified a weakness in understanding variants emerging globally. This initiative aims to mitigate that by testing international travelers to identify and characterize the variants they carry, helping predict potential circulating variants in the US.

Experts generally agree that individuals should participate in the TGS program if given the opportunity.

Labus clarified that participation is simple and cost-free. If you’re departing from an airport collecting only wastewater, no effort is required. If an airport includes voluntary nasal swab collection, just complete a questionnaire and submit your swab.

He described this method as a straightforward approach to comprehending disease threats in our population.

Diverse surveillance programs are in place to identify diseases in US citizens returning from international travel, international visitors, and migrants, according to Labus. Health departments nationwide investigate numerous disease reports weekly to determine if travel contributed to an illness.

“We screen people during their travel to make sure they are not bringing infectious diseases into the country, and we require health exams and vaccinations before people move to the United States,” he said. “We also spend considerable time and effort screening animals and food arriving in the country.”

Other strategies to prevent the influx of disease include monitoring the travel histories of patients newly detected with infectious diseases in the U.S.

Hutton clarified that while the new program and current surveillance methods are helpful, they’re not necessarily a way to prevent future pandemics—just potentially provide an earlier warning.

This would give health officials additional time to implement strategies to protect the public.

Keep in mind, too, that TGS only has test results from passengers who are willing to participate.

“Many other passengers could be infected and transmitting to others,” Hutton said. “[Plus], it takes one to two weeks to complete testing and whole genome sequencing as part of TGS, which further limits the potential to prevent spread.”

And ultimately, infectious disease surveillance programs only provide insight into what is happening in the world, said Labus.

To prevent a pandemic, these programs would need to be tied to specific public health actions.

“Preventing a pandemic is fighting against nature, and nature is much better at it than we are,” Labus said. “The goal of projects like this is to understand the threat better, and in doing so, we can hopefully minimize the impact of disease in the population.”