Experiences with pre-travel diagnostic PCR testing for SARS-CoV-2: challenges and opportunities

Abstract

The coronavirus disease of 2019 (COVID-19) pandemic considerably affects all areas of life,1 including the travel industry.2 The United Nations World Tourism Organization noted a decrease of ~72% among international tourist arrivals worldwide between January and October 2020, owing to ~900 million fewer travellers than in the same period in 2019.3 However, as pandemic containment strategies and specifically vaccination programmes advance, it is estimated that international travel activities will shortly resume.

Although many travel medicine centres have seen a temporary, but significantly reduced demand for their services, the current upsurge in requests related to travel and country entry requirements, quarantine regulations and the compulsory need for pre-travel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) tests for international mobility underscore the need for new concepts pertaining to appointment booking services, operating hours and so forth. Travel medicine centres should play a vital role in establishing such systems for diagnostic testing, clinical assessment and vaccination efforts.4 Here, we describe first experiences made during the implementation of such pre-travel COVID-19 testing.

This investigation was a retrospective single-centre study, which included all individuals presenting between 1 October 2020 and 31 January 2021 for a pre-travel diagnostic SARS-CoV-2 polymerase chain reaction (PCR) test to the outpatient clinic for travel medicine at the Saarland University Medical Center in Homburg, southwest Germany.

Appointments could be booked through an internet-based software tool, or through e-mail or telephone. Following registration, all individuals received a system-generated e-mail with a booking confirmation and a short clinical questionnaire (Supplementary Figure 1, Supplementary data are available at JTM online). A combined oro- and nasopharyngeal swab (eSwabs, Copan; Brescia, Italy) was taken from all individuals aged above 8 years. In younger individuals, only oropharyngeal swabs were obtained. Subsequently, samples were subjected on the same day to real-time reverse transcriptase PCR analysis using the VIASURE SARS-CoV-2 (N1 + N2) assay (CerTest Biotec; Zaragoza, Spain) on the BD MAX™ system (Becton Dickinson; Heidelberg, Germany). All individuals received a SARS-CoV-2 certificate with their individual test result in English and German language.

During the 4-month study period, the final study cohort of pre-travel tests comprised 521 individuals (Supplementary Figure 2, Supplementary data are available at JTM online). There were more males than females (55.1% vs. 44.9%) and the mean age was 43.7 years. The main reason for travel was holidays (45.3%), followed by individuals visiting friends and relatives (VFRs; 36.5%). Three individuals were diagnosed with SARS-CoV-2 infections (prevalence: 0.58%).

Countries in Europe (66.2%) and Asia (21.5%) were the most frequent travel destinations. Continent-stratified characteristics are displayed in Table 1. Approximately half of all SARS-CoV-2 tests were booked through the web-based tool (49.1%), and appointments were booked on average 9.23 days (± 8.36) before the test. Of note, VFRs traveling to a potential malaria area booked their tests significantly later than individuals traveling for business or leisure holidays (8.94 days vs. 12.44 days before departure; P < 0.05). About 41.3% of all tourists travelled to a known hepatitis A risk area and booked their test on average 13.6 days before departure. Thirty-five percent of all appointments were cancelled, mainly using the online system (53%), and frequently in response to new travel restrictions or post-travel quarantine regulations issued by the German government.