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Volume 31, Supplement—April 2025
SUPPLEMENT ISSUE
Supplement

Leveraging a Strategic Public–Private Partnership to Launch an Airport-Based Pathogen Monitoring Program to Detect Emerging Health Threats

Cindy R. FriedmanComments to Author , Robert C. Morfino, and Ezra T. Ernst
Author affiliation: Centers for Disease Control and Prevention, Atlanta, Georgia, USA (C.R. Friedman); Gingko Bioworks, Boston, Massachusetts, USA (R.C. Morfino); Xwell, New York, New York, USA (E.T. Ernst)

Main Article

Table

Leveraging public-private partnerships to expand CDC’s Traveler-based Genomic Surveillance airport-based pathogen monitoring program, September 2021­–August 2024*

Milestones 2021
 2022 2023 Jan–Aug 2024
Sep 29–Nov 27 Nov 28–Dec 31
Launch
 Launched 6-week pilot, demonstrating operational feasibility and detection and genomic sequencing of SARS-CoV-2 in samples from travelers
 Expanded pilot for Omicron surge; identified Omicron subvariants BA.2 and BA.3 six weeks before those variants were reported globally (2)
 Launched airplane wastewater pilot at JFK (5); demonstrated retroactively that US predeparture test requirement during COVID-19 pandemic reduced postarrival positivity by 50% (8); enhanced surveillance for 2022 FIFA World Cup (9)
 Expanded coverage of flights from China and surrounding hubs during China’s removal of its “zero- COVID” policy and subsequent surge of cases; detected first BA.2.86 in a traveler from Japan (10); detected FLiRT† mutations in wastewater samples 3 weeks before reported globally
 Launched transatlantic airplane wastewater pilot in collaboration with United Kingdom Health Security Agency; enhanced surveillance during Hajj and 2024 Summer Olympics
Airports involved
 EWR, JFK T4, SFO
 ATL, EWR, JFK T4, SFO
 ATL, EWR, IAD, JFK T4, SFO
 ATL, BOS, EWR, IAD, JFK T4, JFK T8, LAX, SEA, SFO
 BOS, EWR, IAD, JFK T4, JFK T8, LAX, MIA, SEA, SFO
Modalities
 Nasal sampling in airport; at-home saliva sampling with questionnaire
 Nasal sampling in airport; at-home saliva sampling with questionnaire
 Nasal sampling in airport and traveler questionnaire; discontinued at-home saliva sampling; airplane wastewater sampling
 Nasal sampling in airport and traveler questionnaire; airplane wastewater sampling; airport triturator;‡ air monitoring
 Nasal sampling in airport and traveler questionnaire; airplane wastewater sampling; airport triturator; air monitoring
Median (range) participants per week§
 535 (19–1395)
 1,434 (1,334–1,746)
 1,217 (325–3,490)
 6,320 (1,689–9,321)
 7,249 (4,366–12,628)
Median (range) traveler countries of origin per week§
 1
 6
 43 (6–87)
 123 (56–138)
 143 (116–161)
Wastewater samples collected
 0
 0
 89
 417
 783
Air samples collected
 0
 0
 0
 95
 438
Laboratory methods used
 RT-PCR, amplicon-based sequencing
 RT-PCR, amplicon-based sequencing
 RT-PCR, amplicon-based sequencing, target enrichment sequencing
 RT-PCR, dRT-PCR, amplicon-based sequencing, target enrichment sequencing
 RT-PCR, dRT-PCR, amplicon-based sequencing, target enrichment sequencing
Pathogen targets SARS-CoV-2 SARS-CoV-2 SARS-CoV-2, influenza A and B pilot SARS-CoV-2, influenza A and B, RSV testing of nasal samples, air, and wastewater; Mycoplasma pneumoniae testing of nasal samples in response to global outbreak reports; mpox testing of airplane and triturator‡ wastewater Expanded multipathogen enrichment sequencing panel for up to 66 viruses deployed for wastewater samples

*ATL, Atlanta Hartsfield-Jackson International Airport, Atlanta, Georgia, USA; BOS, Logan Airport, Boston, Massachusetts, USA; CDC, Centers for Disease Control and Prevention; dRT-PCR, digital reverse transcription PCR; EWR, Newark Liberty International Airport, Newark, New Jersey, USA; FIFA, Fédération Internationale de Football Association; JFK T4 and T8, John F. Kennedy International Airport Terminal 4 and Terminal 8, Queens, New York, USA; IAD, Washington Dulles International Airport, Dulles, Virginia, USA; LAX, Los Angeles International Airport, Los Angeles, California, USA; MIA, Miami International Airport, Miami, Florida, USA; RSV, respiratory syncytial virus; RT- PCR, reverse transcription PCR; SEA, Seattle-Tacoma International Airport, Seattle, Washington, USA; SFO, San Francisco International Airport, San Francisco, California, USA. †SARS-CoV-2 variants characterized by specific spike mutations-F to L at position 456 and R to T at position 346-enhancing their transmissibility and immune evasion capabilities. ‡A consolidation point, that captures wastewater samples from multiple flights and does not include airport terminal waste. §Nasal swab sampling.

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References
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