An integrative review of the limited evidence on international travel bans as an emerging infectious disease disaster control measure


  • Nicole A. Errett, PhD, MSPH
  • Lauren M. Sauer, MS
  • Lainie Rutkow, PhD, JD, MPH



emerging infectious diseases, SARS, Zika, Ebola, control measure, policy, travel bans, MERS


In our increasingly interconnected world, the potential for emerging infectious diseases (EIDs) to spread globally is of paramount concern. Travel bans--herein defined as the complete restriction of travel from at least one geographic region to at least one other international geographic region--are a potential policy solution to control the global spread of disease. The social, economic, and health-related consequences of travel bans, as well as the available evidence on the effectiveness of travel restrictions in preventing the global spread of influenza, have been previously described. However, the effectiveness of travel bans in reducing the spread of noninfluenza EIDs, characterized by different rates and modes of transmission, is less well understood. This study employs an integrative review approach to summarize the minimal evidence on effectiveness of travel bans to decrease the spread of severe acute respiratory syndrome (SARS), Middle Eastern respiratory syndrome (MERS), Ebola virus disease (EVD), and Zika virus disease (ZVD). We describe and qualify the evidence presented in six modeling studies that assess the effectiveness of travel bans in controlling these noninfluenza EID events. We conclude that there is an urgent need for additional research to inform policy decisions on the use of travel bans and other control measures to control noninfluenza EIDs in advance of the next outbreak.

Author Biographies

Nicole A. Errett, PhD, MSPH

Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, Washington

Lauren M. Sauer, MS

Department of Emergency Medicine, Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, Maryland

Lainie Rutkow, PhD, JD, MPH

Department of Health Policy and Management, Johns Hopkins University, Baltimore, Maryland


Centers for Disease Control and Prevention: Background and goals--Emerging Infectious Disease Journal--CDC. Emerging Infectious Diseases journal. Available at Accessed May 26, 2019.

WHO: International Health Regulations (IHR). 2017. Available at Accessed May 26, 2019.

WHO: International Health Regulations (2005) Third Edition. Geneva, Switzerland: World Health Organization, 2016. Available at Accessed May 26, 2019.

Pattani R: Unsanctioned travel restrictions related to Ebola unravel the global social contract. CMAJ. 2015; 187(3): 166-167.

Nuzzo JB, Cicero AJ, Waldhorn R, et al.: Travel bans will increase the damage wrought by ebola. Biosecur Bioterror. 2014; 12(6): 306-309.

WHO: Statement from the Travel and Transport Task Force on Ebola virus disease outbreak in West Africa. Available at Accessed May 26, 2019.

WHO: Ebola travel: Vigilance, not bans. 2015. Available at Accessed May 26, 2019.

Folayan M, Brown B: Ebola and the limited effectiveness of travel restrictions. Disaster Med Public Health Prep. 2015; 9(1): 92.

Taravella S: AIDS travel restriction policy challenged. Mod Healthc. 1990; 20(2): 36.

Preston J: Obama Lifts a Ban on Entry Into U.S. by H.I.V.-Positive People. The New York Times, 2009. Available at Accessed May 26, 2019.

Border restrictions and HIV/AIDS: A public health policy disaster. AIDS Health Promot Exch. 1993;(1):12-13.

Rhymer W, Speare R: Countries’ response to WHO’s travel recommendations during the 2013-2016 Ebola outbreak. Bull World Health Organ. 2017; 95(1): 10-17.

Burkle FM Jr, Hanfling D: Political leadership in the time of crises: Primum non Nocere. PLoS Curr. 2015; 7. doi:10.1371/currents.dis.fd8aaf6707cd5dd252e33c771d08b949.

Mateus ALP, Otete HE, Beck CR, et al.: Effectiveness of travel restrictions in the rapid containment of human influenza: a systematic review. Bull World Health Organ. 2014; 92(12): 868-880.

SARS: Home | Severe acute respiratory syndrome | SARS-CoV Disease | CDC. 2019. Available at Accessed May 26, 2019.

MERS-CoV: Travel Guidance | Middle East Respiratory Syndrome | CDC. 2019. Available at Accessed May 26, 2019.

Public Health Planners: Notes on the Interim U.S. Guidance for Monitoring and Movement of Persons with Potential Ebola Virus Exposure | Cleaning and Decontamination | Public Health Planners | Ebola (Ebola Virus Disease) | CDC. 2019. Available at Accessed May 26, 2019.

Zika Travel Information: Travelers’ Health | CDC. Available at Accessed May 26, 2019.

Russell CL: An overview of the integrative research review. Prog Transplant. 2005; 15(1): 8-13.

Whittemore R, Knafl K: The integrative review: Updated methodology. J Adv Nurs. 2005; 52(5): 546-553.

Bogoch II, Creatore MI, Cetron MS, et al.: Assessment of the potential for international dissemination of Ebola virus via commercial air travel during the 2014 west African outbreak. Lancet. 2015; 385(9962): 29-35.

Gomes MFC, Pastore Y Piontti A, et al.: Assessing the international spreading risk associated with the 2014 West African Ebola outbreak. PLoS Curr. 2014; 6. doi:10.1371/currents.outbreaks.cd818f63d40e24aef769dda7df9e0da5.

Poletto C, Gomes MF, Pastore y Piontti A, et al.: Assessing the impact of travel restrictions on international spread of the 2014 West African Ebola epidemic. Euro Surveill. 2014; 19(42).

Otsuki S, Nishiura H: Reduced risk of importing Ebola virus disease because of travel restrictions in 2014: A retrospective epidemiological modeling study. PLoS One. 2016; 11(9): e0163418.

Cope RC, Cassey P, Hugo GJ, et al.: Assessment of the risk of Ebola importation to Australia. PLoS Curr. 2014; 6. doi:10.1371/currents.outbreaks.aa0375fd48a92c7c9422aa543a88711f.

Hufnagel L, Brockmann D, Geisel T: Forecast and control of epidemics in a globalized world. Proc Natl Acad Sci U S A. 2004; 101(42): 15124-15129.

Adalja AA, Henderson DA: Optimization of interventions in Ebola: Differential contagion. Biosecur Bioterror. 2014; 12(6): 299-300.

Lloyd-Smith JO, Schreiber SJ, Kopp PE, et al.: Superspreading and the effect of individual variation on disease emergence. Nature. 2005; 438(7066): 355-359.

Dietz K: The estimation of the basic reproduction number for infectious diseases. Stat Methods Med Res. 1993; 2(1): 23-41.

Delamater PL, Street EJ, Leslie TF, et al.: Complexity of the basic reproduction number (R0). Emerg Infect Dis. 2019; 25(1): 1-4.

Lurie N, Manolio T, Patterson AP, et al.: Research as a part of public health emergency response. N Engl J Med. 2013; 368(13): 1251-1255.

CDC: Measles cases and outbreaks. Centers for Disease Control and Prevention. 2019. Available at Accessed August 16, 2019.

Centers for Disease Control and Prevention (CDC): Federal air travel restrictions for public health purposes--United States, June 2007-May 2008. MMWR Morb Mortal Wkly Rep. 2008; 57(37): 1009-1012.

Sun LH: Officials fighting U.S. measles outbreaks threaten to use rare air travel ban. The Washington Post. 2019. Available at Accessed August 16, 2019.

Riley S, Fraser C, Donnelly CA, et al.: Transmission dynamics of the etiological agent of SARS in Hong Kong: Impact of public health interventions. Science. 2003; 300(5627): 1961-1966.

Camitz M, Liljeros F: The effect of travel restrictions on the spread of a moderately contagious disease. BMC Med. 2006; 4: 32.

Jungerman MR, Vonnahme LA, Washburn F, et al.: Federal travel restrictions to prevent disease transmission in the United States: An analysis of requested travel restrictions. Travel Med Infect Dis. 2017; 18: 30-35.

Kelly B, Squiers L, Bann C, et al.: Perceptions and plans for prevention of Ebola: Results from a national survey. BMC Public Health. 2015; 15: 1136.

Brockmann D, Schaade L, Verbeek L. 2014 Ebola outbreak: Worldwide air-transportation, relative import risk and most probable spreading routes an interactive network analysis. Berlin, Germany: Robert Koch Institute, 2014. Available at Accessed May 26, 2019.