Border Crossing in West Africa
Official Land Border Crossings between Guinea, Liberia, and Sierra Leone
Although there are many informal border crossings in Guinea, Liberia, and Sierra Leone that change with the rainy season, efforts were made to monitor official border crossings. CDC assisted with training guards to note possible Ebola symptoms, to take health precautions, and to pass on information to health officials.
International Travel from Guinea, Liberia, and Sierra Leone
CDC’s Border Teams in Guinea, Liberia, and Sierra Leone worked with airport management, airlines, ministries of health, and seaport cargo management to write standard operation procedures for screening travelers before boarding international flights (exit screening) and for screening airport and seaport workers.
Typically, travelers were checked for fever three times: 1) at the gate of the airport, 2) after entering the airport, and 3) hours later before they boarded their flights. Local doctors, medical students, community health workers, and nurses were hired to operate the screenings, which included a health questionnaire about symptoms and proximity to Ebola patients. They recorded all travelers’ temperatures at each stage.
CDC, WHO, and other partners believe that screening outbound passengers in West Africa was one of the most highly effective measures for preventing the spread of Ebola. The screening process was also vital to ensuring that the few airlines that had not discontinued flights to West Africa kept flying so that aid workers and supplies could be brought in.
Screening People Traveling from West Africa to the U.S
Starting in October 2014, travelers arriving from Guinea, Liberia, or Sierra Leone were routed through five U.S. ports of entry: Atlanta, Chicago’s O’Hare, New York’s JFK, Newark, and Washington, D.C.’s Dulles airports for health assessments and Ebola screenings before entering the United States.
CDC’s Division of Global Migration and Quarantine worked with the quarantine stations and Customs and Border Protection partners at these five locations. It set up protocols for primary, secondary, and tertiary screenings and hired and trained surge staff to interview travelers and provide Check and Report Ebola (CARE) kits. These kits included a cell phone, thermometer, and information about Ebola. Travelers were also given contact information so that they could report their temperatures and any symptoms consistent with Ebola twice a day for 21 days to their destination state and local health departments.
These enhanced risk assessments were discontinued for travelers from Liberia on September 21, 2015; for travelers from Sierra Leone on December 22, 2015; and for travelers from Guinea on February 19, 2016. Of the over 38,000 travelers assessed from October 11, 2014 through February 19, 2016, only one had Ebola—detected through self-monitoring as recommended.