Fall 2005 Vol. 5 No. 3
Every year, some 120 million people pass in and out of America's many airports, seaports, and border crossings. Millions of tons of livestock, food products, and other cargo move through these ports of entry as well. And hitchhiking in any of these goods or people may be microbes capable of spreading a dangerous infectious disease.
For decades, a cadre of quarantine personnel from the U.S. Centers for Disease Control and Prevention stationed at national entry points has provided frontline defense against microbial threats from abroad by inspecting travelers and cargo for signs of infection or contamination. At one time, more than 500 personnel staffed 55 federal quarantine stations. But the perceived triumph over infectious disease led to the dismantling of most of the quarantine system in the 1970s. As of the beginning of this year, eight quarantine stations remained.
The emergence of nearly 40 new infectious diseases since 1973 -- including SARS and more recently a new strain of bird flu -- and the heightened fear of bioterrorism rekindled concern about the nation's capacity to intercept and respond to microbial agents arriving through the nation's ports of entry. Earlier this year, CDC embarked on a plan to increase the number of quarantine stations to as many as 25. The agency asked the Institute of Medicine to offer insights on enhancing the effectiveness of these stations and the broader quarantine system.
Given the rapid pace of modern trade and transport and the new threats posed by bioterrorism, the committee convened to study the issue concluded that the traditional functions of quarantine stations -- such as observing passengers as they disembark from planes -- have their place, but by themselves are no longer sufficient to meet the modern challenges.
"Quarantine has to evolve into a system of clearly defined connections among a range of individuals and agencies with the skills and resources to detect and respond to a serious communicable disease or bioterrorism," said committee chair Georges Benjamin, executive director of the American Public Health Association. "And that network should be led by CDC and guided by a comprehensive national plan."
Dealing with microbial threats involves many organizations and individuals, ranging from local public health departments and hospitals staffs to customs and border protection agents, agriculture inspectors, and the U.S. departments of State and Homeland Security. Currently, it is not clear who would have the ultimate authority for coordinating a response should another SARS virus or a pandemic flu reach U.S. shores through international travel and trade. CDC is the appropriate agency to assume this leadership role, the committee said, but in doing so the agency should work collaboratively with its many partners, recognizing the various jurisdictions involved and taking into account local resources and emergency response plans already in place. Federal and state laws should ensure that quarantine personnel have clear authority to carry out their tasks.
Because foresight is crucial to ensuring the most coordinated and effective response, CDC quarantine officials should begin assessing the risks posed by various infectious agents that could enter the country via people or cargo and develop a national strategic plan based on the results, the committee said. The plan should outline the roles and responsibilities for the various organizations that would participate in a response and spell out the lines of authority and communication that should be followed. 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.
-- Christine Stencel
Quarantine Stations at U.S. Ports of Entry Protecting the Public. Committee on Measures to Enhance the Effectiveness of the CDC Quarantine Station Expansion Plan for U.S. Ports of Entry, Board on Global Health and Board on Population Health and Public Health Practice, Institute of Medicine (2005, approx. 300 pp.; ISBN 0-309-09951-X; available from the National Academies Press, tel. 1-800-624-6242; $42.00 plus $4.50 shipping for single copies).
The committee was chaired by Georges C. Benjamin, executive director, American Public Health Association, Washington, D.C. The study was funded by the U.S. Centers for Disease Control and Prevention.