OBJECTIVES: Historically, the most frequent cause of death reported to the Centers for Disease Control and Prevention (CDC) among travelers on conveyances has been cardiovascular disease, mirroring all-cause mortality in the US population. Infectious disease transmission, particularly during large-scale outbreaks, also poses a risk to travelers. To determine leading causes of death on conveyances and whether they were affected by the COVID-19 pandemic, we describe causes of death on conveyances reported to CDC from 2008 through 2022. METHODS: We queried CDC's Port Health Activity Reporting System for traveler deaths on, or immediately after disembarking from, an aircraft or maritime vessel or during land-border crossings reported to CDC from July 1, 2008, through December 31, 2022. We examined data on cause of death, age, travel mode, and traveler type (passenger vs crew). We also calculated crude annual mortality rates for each conveyance type. To assess factors associated with deaths due to infectious diseases (vs deaths due to noninfectious conditions), we performed logistic regression. RESULTS: During the analysis period, 2910 deaths on conveyances were reported. Across all conveyances, the most common causes were cardiovascular- or pulmonary-related conditions (2116 of 2910; 73%) for each year except 2020, when COVID-19 was the most common. Crew (vs passengers) had significant associations with death due to infectious causes (vs noninfectious causes; adjusted odds ratio = 2.12; 95% CI, 1.32-3.40). CONCLUSIONS: Travelers with cardiovascular- or pulmonary-related conditions should consult their health care providers prior to international travel. All travelers should check travel recommendations such as those currently available on CDC travel pages. Public health authorities should consider population-based mitigation measures aimed at transmission risk reduction to limit morbidity and mortality during infectious disease outbreaks.

BACKGROUND: On 20 September 2022, the Ugandan Ministry of Health declared an outbreak of Ebola disease caused by Sudan ebolavirus. METHODS: From 6 October 2022 to 10 January 2023, Centers for Disease Control and Prevention (CDC) staff conducted public health assessments at five US ports of entry for travellers identified as having been in Uganda in the past 21 days. CDC also recommended that state, local and territorial health departments ('health departments') conduct post-arrival monitoring of these travellers. CDC provided traveller contact information, daily to 58 health departments, and collected health department data regarding monitoring outcomes. RESULTS: Among 11 583 travellers screened, 132 (1%) required additional assessment due to potential exposures or symptoms of concern. Fifty-three (91%) health departments reported receiving traveller data from CDC for 10 114 (87%) travellers, of whom 8499 (84%) were contacted for monitoring, 1547 (15%) could not be contacted and 68 (1%) had no reported outcomes. No travellers with high-risk exposures or Ebola disease were identified. CONCLUSION: Entry risk assessment and post-arrival monitoring of travellers are resource-intensive activities that had low demonstrated yield during this and previous outbreaks. The efficiency of future responses could be improved by incorporating an assessment of risk of importation of disease, accounting for individual travellers' potential for exposure, and expanded use of methods that reduce burden to federal agencies, health departments, and travellers.

In 2021, the US government undertook Operation Allies Welcome, in which evacuees from Afghanistan arrived at 2 US ports of entry in Virginia and Pennsylvania. Because of the rapid evacuation process, the US government granted evacuees an exemption to a Centers for Disease Control and Prevention (CDC) requirement in place at that time-namely, that air passengers present a negative SARS-CoV-2 viral test result or documentation of recovery from COVID-19 before they boarded international flights bound for the United States. This study describes cases of SARS-CoV-2 infection detected among 65 068 evacuees who arrived at the 2 ports of entry in August and September 2021. Because evacuees were a population at increased risk for infection with diseases of public health concern, CDC staff helped coordinate on-site and on-arrival testing, visually observed evacuees for signs and symptoms of communicable disease, and referred evacuees for further evaluation and treatment as needed. CDC staff used antigen or nucleic acid amplification tests at the ports of entry to evaluate evacuees aged ≥2 years without documentation of recent SARS-CoV-2 infection. CDC staff isolated evacuees with confirmed SARS-CoV-2 infection and quarantined their close contacts, consistent with CDC guidance at the time, before evacuees rejoined the repatriation process. Of 65 068 evacuees, 214 (0.3%) were confirmed as having SARS-CoV-2 infection after port-of-entry testing. Cases of measles, varicella, pertussis, tuberculosis, hepatitis A, malaria, leishmaniasis, and diarrheal illness were also identified. Although the percentage of SARS-CoV-2 infection was low in this evacuated population, communicable disease detection at US ports of entry, along with vaccination efforts, was an important part of a multilayered approach to mitigate the transmission of disease in congregate housing facilities and into US communities.