Questions and Answers about the Federal Register Notice: Criteria for Recommending Federal Travel Restrictions for Public Health Purposes, Including for Viral Hemorrhagic Fevers

On March 27, 2015, the Department of Health and Human Services and the CDC published a Notice in the Federal Register titled Criteria for Recommending Federal Travel Restrictions for Public Health Purposes, Including for Viral Hemorrhagic Fevers. The Notice describes the tools the federal government has to ensure that people who pose a public health risk do not board flights or enter into the United States without a public health evaluation. It also explains the criteria CDC uses in deciding whether to use such tools.

What is the purpose of this Notice?

This Notice informs the public of the factors CDC considers in deciding whether or not to recommend that someone be placed on a list managed by the Department of Homeland Security (DHS) that prevents the person from boarding a flight or entering into the U.S. through any port of entry (e.g., seaport or land border) without a public health evaluation.

Why is CDC publishing this Notice now?

When this list was developed, CDC published a set of criteria for using these lists in the Morbidity and Mortality Weekly Report. Since 2007 these criteria have been refined based on their use and practice in protecting the public’s health with these lists. CDC is publishing this Notice now to inform the public about the updated criteria that are being used today to help prevent the spread of diseases including the current Ebola outbreak.

What is the public health Do Not Board (DNB) list?

In 2007, CDC and DHS developed a public health Do Not Board (DNB) list so that U.S. and international public health officials can recommend adding a person to the list if he or she has an illness that poses a public health threat of spreading during travel and meets specific criteria. A person on the DNB list can be restricted from boarding commercial flights that have a starting or end point in the United States. This includes domestic and international flights. Once a person is placed on the DNB list, airlines are instructed not to issue a boarding pass to the person. The DNB is used together with a Public Health Border Lookout to ensure the person’s travel is stopped at any U.S. port of entry until he or she has been evaluated by public health officials.

What is the Public Health Border Lookout?

The Lookout, also developed by CDC and DHS, ensures that any person placed on the DNB list is found if he or she tries to enter the United States through any port of entry (e.g., seaport or land border crossing) or leave through an airport or seaport. People on the DNB are also placed on the Lookout record. The Lookout prompts Customs and Border Protection staff to notify CDC if a person on the DNB list arrives in the United States, so that the person can be evaluated and referred for additional public health follow-up if needed.

When did CDC begin to restrict travel? Is this because of the Ebola outbreak?

CDC and DHS developed the public health DNB list and Lookout in 2007. To date, the DNB list and Lookout have mostly been used to stop the travel of people with infectious tuberculosis. These public health lists can be used for any serious disease that can spread during travel, including viral hemorrhagic fevers such as Ebola.

Why does CDC want to restrict travel?

People with certain contagious diseases who travel on commercial airplanes could spread disease to other passengers and crew onboard. To protect the public’s health, CDC and DHS partner to prevent these people from boarding commercial airplanes or traveling internationally.

What type of illnesses would prevent a person from travelling?

The DNB list and Public Health Border Lookout are only used for serious contagious diseases that could spread during travel and pose a serious public health threat. To date, these tools have been used to restrict travelers with infectious tuberculosis and measles, and people who were exposed to Ebola who could become contagious during travel.

How does CDC become aware of a sick person who plans to travel?

State and local public health officials, public health officials in foreign countries, or U.S. Embassy staff can alert CDC about any person’s plan to travel if they believe that the person has an illness that poses a public health threat.

CDC may also become aware of an ill traveler through alerts from airlines or other partners at any of the U.S. ports of entry.

Who can be added to the DNB list or Lookout?

Adding a person to the DNB list and Lookout involves careful review of available information and discussion between the recommending public health officials and CDC. To add a person to the DNB list and Lookout CDC requires that the first criteria be met, as well as one of the three that follow. A person must:

1. be known or believed to be infectious with, or at risk for, a serious contagious disease that poses a public health threat to others during travel;
   and
2. not be aware of his or her diagnosis, have been told about the diagnosis and not be following public health recommendations, or be unable to be located;
   or
3. be likely to travel on a commercial airplane into, through, or from the United States or travel internationally by any means;
   or
4. need to be placed on the DNB and Lookout list to respond to a public health outbreak or to help enforce a public health order.

For specific details about these criteria, please visit the FRN.

Can a person placed on the DNB or Lookout lists appeal this decision if he or she feels it was made in error?

Yes. When travelers are informed they have been placed on these lists, they are given instructions on how they can appeal this decision if they believe it was made in error, including whom to contact and what information they should provide for the review process.

When is a person removed from the DNB list and Lookout?

Once public health authorities confirm that a person is no longer contagious (confirmed by a doctor or public health authority) or no longer likely to become contagious (time has passed and no symptoms developed), the person is removed from the DNB list and Lookout. This usually happens within 24 hours after CDC is informed that a person is no longer contagious. CDC also reviews the records of all people on the DNB list every two weeks to check whether they can be removed.

Who has access to the list? How is the traveler’s information protected?

CDC is committed to protecting people’s privacy as required by the Privacy Act. Efforts are made to secure and protect personal information. The list is used only by organizations and people who need to use it to protect public health. For more information please see CDC’s System of Records Notice.