Public health measures at Swiss airports for the control

of infectious diseases:
acceptance, communication and information of air
passengers

A survey conducted at EuroAirport Basel-Mulhouse-Freiburg and

Unique Airport Zurich-Kloten

Nicole Senpinar-Brunner, Nicole.Senpinar@stud.unibas.ch

Basel, 31.10.2007
 potential public health measures at Swiss airports in case of a worldwide epidemic

Contacts

Nicole Senpinar-Brunner, SCIH, Swiss Tropical Institute, Master Student

Socinstrasse 57, P. O. Box, 4002 Basel, Switzerland
tel +41 61 284 81 87, fax +41 61 284 81 03,
e-mail Nicole.Senpinar@stud.unibas.ch, www.sti.ch

EuroAirport Basel-Mulhouse
P. O. Box 142, 4030 Basel
tel +41 61 325 31 11, fax +41 61 325 25 77
e-mail www.euroairport.com/EN/contact
website www.euroairport.com

Unique Airport Zurich

P. O. Box, 8058 Zurich-airport
tel +41 43 816 22 11, fax +41 43 816 50 10
e-mail info@unique.ch
website www.unique.ch

Acknowledgements
We hereby like to thank the EuroAirport Basel-Mulhouse-Freiburg and Unique Airport Zurich-Kloten
for their support, and all study participants for their participation during their travels!

Disclaimer
This document has been elaborated by the Swiss Centre for International Health of the Swiss
Tropical Institute in collaboration with the FOPH, Unique Zurich airport and EuroAirport Basel-
Mulhouse-Freiburg. The study was written as a Master Thesis within the context of the Master
study program of the University of Basel, at the affiliated Swiss Tropical Institute (STI) in Basel, and
was mandated by the Federal Office of Public Health (FOPH), Switzerland.

The airports bear no responsibility for, and are not in any way, committed to the views and
recommendations expressed herein, which are the responsibility of the author of this report.
Background
Infectious diseases do not know any borders. By air travel, they can spread quickly from
continent to continent, as the 2003 SARS epidemic showed. Therefore, it is important to
introduce public health measures at airports to protect passengers and employees, and to
delay or control the spread into the general population. Such measures include providing
health information to travellers, entry screening of travellers through questionnaires,
temperature measurements or health declarations, isolating case-patients, quarantining
close contacts, and enhancing infection control. To date, there is limited knowledge on the
acceptance of such public health measures by air passengers and how these should be
communicated.

Aims of the study

• to investigate in air passengers at Swiss airports the acceptance of potential public
health measures, that could be introduced in case of a worldwide epidemic of an
infectious respiratory disease
• to investigate possible means of information and communication of these measures
with regard of information status of concerning avian flu, means of communication,
languages, content and place
• to investigate the importance of socio-demographic characteristics and travel
destination with respect to information status and acceptance of possible public health
measures

Methods
Passengers 18 years or older departing to destinations in Europe, North America and Asia
by scheduled flights were surveyed. The survey was conducted from mid-June to the end of
July 2007 at EuroAirport Basel-Mulhouse among passengers departing to a European
destination, and at Unique Airport Zurich-Kloten among passengers departing to an Asian or
North American destination.
A questionnaire - containing 23 questions in German, French or English - was distributed in
the waiting areas of the departure section. It was filled out personally by the study
participants or the study conductor in case the participants were physically unable to do by
themselves. Data collection and analysis were strictly anonymous.

Results
Study participants: Within the timeframes granted by the airport authorities for data
collection, 1071 questionnaires were obtained at EuroAirport, and 796 at Zurich-Kloten.
Mean age of participants was 40 years, 54% were female, and 97% were currently feeling
healthy.

Information of air passengers: Passengers were asked about their information status
concerning occurrence of infectious diseases at their travel destination. While at Zurich-
Kloten more passengers sought pretravel advice on infectious diseases compared to
EuroAirport (30% vs. 17%), the opposite was true for noticing avian flu-posters. 26% of
passengers noticed posters informing about preventive measures against avian flu at
 potential public health measures at Swiss airports in case of a worldwide epidemic

EuroAirport compared to only 5% at Zurich-Kloten. The percentage of positive answers to

these two questions, and to questions concerning information seeking in the event of a
possible worldwide epidemic are shown in the figure below.

Information of air passengers, by airport

100

90
80 EuroAirport Basel, n=1055
positive responses (%)

Airport Zurich-Kloten, n=782

70

60
50
40
30

20
10

0
Sought pretravel Noticed avian flu Would seek Would seek info Would seek info
advice poster at airport pretravel info while traveling at airport during
during an during an an epidemic
epidemic epidemic

Acceptance of potential public health measures: Passengers were asked 7 questions:

1. “Would you have cancelled your current flight in case of a severe, worldwide epidemic?”
71% answered with yes.

2. “Suppose that, despite the epidemic you decide to travel. At the airport and on board the
airplane, passengers are asked to follow certain measures. Would you personally accept
and follow the following measures and recommendations?”
a) “to wear a face mask” (94% yes);
b) “to fill in a health questionnaire on possible symptoms (e.g. fever)” (93% yes);
c) “to have your body temperature taken” (89% yes); and
d) “to undergo a medical check (short physical examination) in case of fever” (88%
yes).

3. “Suppose in the airplane you are seated next to someone with a cough. Would you
accept and follow the following measures?”
a) “if feeling healthy, to stay at home or a hotel room for 7 days and observe your
health (quarantine)” (69% yes)
b) “if diagnosed with the epidemic disease to stay at home or a hotel room for 7 days
(isolation)” (92% yes).

The answers to these questions are shown in the next figure. There were no major
differences between the two airports. However, most public health measures would be
followed more often by male passengers, and by those with ages between 40 and 65 years.
 potential public health measures at Swiss airports in case of a worldwide epidemic

Acceptance of PH measures and recommendations in case of a worldwide epidemic

among air passengers, by airport
(EuroAirport: n=1055, Zurich-Kloten: n=782)

100%

90%

80%
not at all
70%

rather no 60%

50%
rather yes
40%

yes, absolutely 30%

20%

10%

0%
ZH-Kloten

ZH-Kloten

ZH-Kloten

ZH-Kloten

ZH-Kloten

ZH-Kloten

ZH-Kloten
EuroAirport

EuroAirport

EuroAirport

EuroAirport

EuroAirport

EuroAirport

EuroAirport
would have would wear a would fill in would have would undergo if contact with if diseased, to
cancelled face mask health body medical diseased stay in
current flight questionnaire temperature check, if persons, to isolation for 7
taken at having fever stay in days
airport quarantine

Preliminary conclusions: Most of the surveyed passengers would seek pre-travel advice
on PH measures in case of a world-wide epidemic. Those travelling from Zurich-Kloten
airport to overseas destinations more often sought pre-travel advice on infectious diseases
occurring at their travel destination (compared to passengers at EuroAirport). Although bird
flu is still an important challenge in many Asian, African and European countries, few
passengers at the airport noticed the posters informing about bird flu, in particular at Zurich-
Kloten airport. However, during an epidemic, public awareness is expected to be much
higher than the results from this study – which was performed in a non-epidemic period –
might suggest. This might be related to the number and positioning of these posters during
summer 2007. A majority of passengers would follow recommendations and public health
measures at airports, but 5 to 20% (mostly young travellers) would not follow some of the
measures at all. This should be taken into account when communicating these measures
and recommendations to international air passengers.
Data analysis is ongoing and will result in a scientific publication.