CDC to Expand Airport Surveillance Program For Flu and RSV at These Major Airports

Fact checked by Nick Blackmer

• The CDC is expanding its testing of international air travelers for flu, RSV, COVID-19, and other viruses.

• Seven U.S. airports are participating in some fashion, either collecting voluntary nasal swabs or aircraft wastewater—or both.

• Experts recommend people take advantage of the opportunity to participate in the program, to help prevent the spread of viruses.

Travelers may have an additional step at the airport this holiday season.

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

Through voluntary nasal swabs and wastewater collection from airplanes that fly internationally, the CDC will be evaluating collected samples to check for viruses. Anything that tests positive will be sequenced and uploaded to public databases, which will be used to help monitor illnesses being brought into the United States.

“[This program] provides a robust set of surveillance data on the strains of viruses currently circulating around the globe,” Brad Hutton, MPH, an infectious-disease epidemiologist, former deputy commissioner of public health at the New York State Department of Health, and a public health consultant, told Health.

“This fills a critical gap in information as fewer countries are sequencing and reporting pathogen data to...repositories such as the Global Initiative on Sharing All Influenza Data (GISAID),” he said.

This program will serve as an early warning system that can be used to identify threats of infection in real-time, Hutton explained.

It also may help prevent the spread of communicable diseases.

Here’s what you need to know about the new program, what airports are impacted, and how this additional travel step may help provide warning of future pandemics.

The New Program Will Collect Nasal Swabs and Wastewater

Known as the Traveler-based Genomic Surveillance (TGS) program, this pilot program will last several months and is being supported by Ginkgo Bioworks and XpresCheck.

Currently, seven airports are participating in the program, but only six will collect voluntary nasal swabs: Seattle, San Francisco, Los Angeles, New York City (JFK), Newark, and Washington D.C.

In Boston, nasal swabs will not be collected, but the airport will collect aircraft wastewater using a triturator (or a set collection point), which captures samples from multiple flights but does not include any terminal waste.

In Seattle, Los Angeles, Newark, and Washington D.C., just nasal swabs will be collected. But in New York City (JFK) and San Francisco, both wastewater and nasal swabs will be collected.

Nasal swabs are collected voluntarily and are anonymous. Participating travelers also are asked to answer a short survey, which is used to help inform decision-making should a virus be discovered.

“This expanded TGS pilot [program] could help monitor global patterns of RSV and influenza, detect strains that are resistant to antivirals, or identify the arrival of new, emerging SARS-CoV-2 strains that are being closely monitored due to concerning numbers of mutations,” Hutton said.

Related: What Is Human Metapneumovirus? CDC Reports Unusual Spike of Respiratory Virus

What Are the Benefits of This Program?

Disease surveillance, like the TGS program, tells us where we are, and more importantly, it can allow us to predict what's going to happen next, explained Brian Labus, PhD, MPH, REHS, an expert in infectious diseases and an assistant professor in the department of epidemiology and biostatistics at the University of Nevada, Las Vegas, School of Public Health.

“[It] is similar to tracking and predicting the weather,” he said. “Those predictions allow us to be better prepared to minimize the impact of diseases on our populations.”

Though this system for identifying infectious diseases is fairly robust, Labus noted that the country’s one blind spot is in understanding the variants that are emerging elsewhere in the world.

“This system seeks to remedy that by testing international travelers to identify and characterize the variants with which they are infected,” he said. “By doing so, we can better predict the types of COVID variants [and other viruses] that we might see circulating in the United States.”

Most experts agree that if you have the opportunity to participate in the TGS program, you should do so.

Labus explained that participation is easy and free. If you’re flying out of an airport that is just collecting wastewater, there’s no effort needed to participate. If you’re flying out of an airport with a voluntary nasal swab collection, all you have to do is fill out a brief questionnaire and submit your swab.

“This is a simple approach to understanding disease threats in our population,” he said.

Related: FDA Approves First-Ever RSV Vaccine for Adults 60 and Older

Monitoring the Influx of Diseases and Staying Aware of Pandemic Threats

According to Labus, several surveillance programs are being used to identify diseases in U.S. citizens returning from travel abroad, international visitors, refugees, and migrants.

He explained that health departments around the country investigate thousands of reports of disease every week to identify if travel played a role in someone becoming ill.

“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.”

Related: Who Is Eligible for a Second Bivalent Booster? New CDC Recommendations, Explained

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