"CDC quarantine stations and the broader quarantine system serve as the nation's insurance policy against catastrophes that might arise from the importation of naturally occurring infectious agents, such as the SARS virus, or man-made threats like an attack using a dangerous biological agent," said Georges Benjamin, executive director of the American Public Health Association, Washington, D.C., and chair of the committee that wrote the report. "But no single entity currently has the responsibility, authority, and resources to orchestrate all the activities of the quarantine system, and the traditional responsibilities of quarantine personnel are no longer sufficient to meet the challenges posed by the rapidly increasing pace of global trade and travel and the emergence of new microbial threats. Consequently, we recommend the establishment of clear leadership and lines of communication among all parties involved in protecting the public from infectious agents that originate abroad."
Every year, roughly 120 million people travel into or out of the country through the nation's 474 airports, seaports, and land-border crossings. In 2003 Congress began to allocate funds to bring the number of quarantine stations from eight to 25. The 25 cities that would comprise the expanded quarantine station system together receive more than 75 million international travelers and immigrants annually. They also receive 31 percent of the cargo imported by sea. Currently, 11 quarantine stations staffed by CDC personnel are fully active in Atlanta; Chicago; El Paso, Texas; Honolulu; Houston; Los Angeles; Miami; New York City; San Francisco; Seattle; and Washington, D.C. CDC will open stations by the end of the year in Anchorage, Alaska; Boston; Detroit; Minneapolis; Newark, N.J.; San Diego; and San Juan, Puerto Rico. Additional cities under consideration are Charlotte, N.C.; Dallas; Denver; Kansas City, Mo.; New Orleans; Philadelphia; and Phoenix.
The individual quarantine stations and the CDC's Division of Global Migration and Quarantine screen travellers, refugees, immigrants, animals, and cargo for disease agents shortly before and during their arrival at U.S. gateways. However, preventing, detecting, and responding to microbial threats also involves many other organizations ranging from local public health departments and hospitals to customs and border protection agents, agriculture inspectors, and the U.S. departments of State and Homeland Security.
Quarantine station personnel and the Division of Global Migration and Quarantine should shift their primary focus from inspecting people and cargo at individual ports to assuming leadership of the activities of the broader quarantine system across local, state, and national levels. Given the various jurisdictions involved, CDC should take extra care to work collaboratively with its partners as it exerts leadership over this one aspect of their many responsibilities. Federal and state laws should ensure that quarantine personnel have clear authority to carry out their tasks, such as tracking and controlling the spread of disease carried by international travelers or cargo across state lines. Currently, legal and regulatory authority is fragmented among various levels of government, the report notes.
A national strategic plan devised by CDC quarantine personnel is needed to provide the best possible framework for protecting the public from the importation of dangerous biological agents, the committee concluded. CDC quarantine staff should assess the risks posed by infectious agents that could enter the country via travelers, refugees, immigrants, and cargo and develop a plan focused on communicable diseases that would complement other security plans devised by the Department of Homeland Security, the report recommends. The new plan should pinpoint the greatest potential risks and outline the roles and responsibilities of each partner. This will ensure that finite resources are used effectively and that those involved know who is in charge of different activities in routine and emergency situations.
One significant gap in the current quarantine system is the difficulty involved in quickly locating airline passengers who may have been exposed to a high-risk infectious agent such as the SARS virus during a flight. Often, travelers have to be found days after the flight is over. The report supports the targeted use of passenger locator cards as an interim solution. These cards -- which would be distributed on flights to and from countries where a disease outbreak is occurring or when a passenger or crew member becomes ill during a flight -- would record passenger contact information and seat numbers in a scannable format so that the data could be retrieved and transmitted easily.
Historically, more than 500 people once staffed 55 federal quarantine stations, but the perception that microbial threats had been brought under control led to the dismantling of most of the quarantine system in the 1970s. However, nearly 40 new infectious diseases were identified between 1973 and 2003. In addition, terrorism in general and bioterrorism in particular have become grave concerns.
The report was sponsored by the Centers for Disease Control and Prevention. The Institute of Medicine is a private, nonprofit institution that provides health policy advice under a congressional charter granted to the National Academy of Sciences. A committee roster follows.
Pre-publication copies of QUARANTINE STATIONS AT PORTS OF ENTRY PROTECTING THE PUBLIC'S HEALTH are available from the National Academies Press; tel. 202-334-3313 or 1-800-624-6242 or on the Internet at HTTP://WWW.NAP.EDU. Reporters may obtain a copy from the Office of News and Public Information (contacts listed above).
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INSTITUTE OF MEDICINE
Board on Global Health
and
Board on Population Health and Public Health Practice
COMMITTEE ON MEASURES TO ENHANCE THE EFFECTIVENESS OF THE CDC QUARANTINE
STATION EXPANSION PLAN FOR U.S. PORTS OF ENTRY
GEORGE C. BENJAMIN, M.D. (CHAIR)
Executive Director
American Public Health Association
Washington, D.C.
BARBARA BLAKENEY, M.S., R.N.
President
American Nurses Association
Silver Spring, Md.
LAWRENCE O. GOSTIN, J.D.
Professor of Law
Georgetown University Law Center
Washington, D.C.
MARGARET A. HAMBURG, M.D.
Vice President for Biological Programs
Nuclear Threat Initiative
Washington, D.C.
FARZAD MOSTASHARI, M.D., M.S.P.H.
Assistant Commissioner
Bureau of Epidemiological Services
Department of Health
New York City
WILLIAM A. PETRI JR., M.D., PH.D.
Chief
Division of International Health and Infectious Diseases
University of Virginia Health System
Charlottesville
ARTHUR L. REINGOLD, M.D.
Professor of Epidemiology
School of Public Health
University of California
Berkeley
RONALD K. ST. JOHN, M.D., M.P.H.
Director General
Centre for Emergency Preparedness and Response
Public Health Agency of Canada
Ottawa
MARY E. WILSON, M.D.
Associate Professor of Infectious Diseases
Harvard Medical School
Cambridge, Mass.
INSTITUTE STAFF
KATHLEEN STRATTON, PH.D.
Study Director
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Chris Dobbins, Media Relations Assistant
Office of News and Public Information
202-334-2138; e-mail news@nas.edu