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Appendix D: Commissioned Paper on US Seaports and the CDC Quarantine Station System
Pages 128-168

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From page 128...
... ports of entry. The assessment, titled Measures to Enhance the Effectiveness of the CDC Quarantine Station Expansion Plan for U.S.
From page 129...
... Customs and Border Protection, Department of Homeland Security (including legacy customs, immigration, and USDA inspection services) ; HDQ = Headquaters; USCG = DHS, U.S.
From page 130...
... with infectious diseases, mostly arriving from countries with specific disease outbreaks. At seaports, there is a limited level of international visiting passengers, so the human threats derive from returning U.S.-origin cruise passengers and the crews of both cruise and cargo vessels; the latter pose a greater threat because there is less scrutiny of ship sanitation and arrivals are from more distant ports of call.
From page 131...
... The limited number of onsite medical staff (until recently, some airport stations had no medical officers) forces dependence on local medical personnel for immediate response for both airport and seaport subports.
From page 132...
... In some cases, ports are structured as "landlord ports" (as opposed to "operating ports") , and the port authority itself has few if any facilities but rather leases the land to private operators.
From page 133...
... The current QSS system mostly depends on a "referral" system whereby partners identify a threat and then communicate it to QSS, possibly through secondary means. There are a variety of ways that a threat could be communicated to QSS, but not necessarily a standard one, particularly in regard to USCG or postvoyage threats identified by local health officials.
From page 134...
... · The stations' capability to make medical assessments at seaports is very limited, mostly because of the distance between airports and the covered seaports and the lack of 24-hour medical staffing. The stations rely primarily on local health agencies (including paramedics)
From page 135...
... · A potential source of contacts would be other agencies with responsibility for inspecting and holding cargo at the ports, most important the USDA (for live animals and "unprocessed" foods) and FDA (for food and drugs)
From page 136...
... GENERAL DESCRIPTION OF THE CDC QUARANTINE STATION SYSTEM (QSS) AT SEAPORTS The CDC QSS aims to minimize the risk that microbial threats5 of public health significance originating abroad will enter the United States through official ports of entry.
From page 137...
... seaports arrive via cruise vessels, most of them originating and terminating at a U.S. port on voyages ranging from a few hours ("day cruises")
From page 138...
... Vessels from Florida ports -- led by Miami, Port Everglades, and Port Canaveral -- sail primarily to Caribbean and Mexican Gulf Coast points. These three ports accounted for nearly two-thirds of total U.S cruise passengers in 2003.
From page 139...
... Miami 1,804,000 1,965,000 26% 9% Port Everglades 1,202,000 1,213,000 16% 1% Port Canaveral 1,028,000 1,089,000 15% 6% Tampa 317,000 409,000 6% 29% San Juan 298,000 325,000 4% 9% 4,649,000 5,001,000 67% 8% Southern California/Texas (LAX) Los Angeles 538,000 403,000 5% -25% Galveston 267,000 377,000 5% 41% Long Beach n/a 272,000 0% n/a San Diego 138,000 81,000 1% -41% Houston 6,500 15,000 0% 131% 949,500 1,148,000 15% 21% North Atlantic (JFK)
From page 140...
... 140 QUARANTINE STATIONS AT PORTS OF ENTRY Cargo Imports The United States is the world's largest import market, accepting a wide variety of basic commodities, agricultural products, and consumer goods from almost every country in the world. A vast majority of the import trade (as measured by weight)
From page 141...
... Cruise vessels require substantially larger crews, primarily for passenger services, and can average one crew member for every two passengers. Seaports may also have foreign-origin vessels that are unrelated to either passenger or cargo transportation, including: · Fishing vessels.
From page 142...
... · The volume of persons and cargo discharged from a vessel greatly surpasses that of a single airplane. Cruise vessels can disembark up to 4,000 persons at a time compared with over 400 for the largest airplane.
From page 143...
... The role of local and state health agencies in responding to (or even identifying) threats is basically the same, other than the location and hence the jurisdictional coverage.
From page 144...
... Most port activities involve a more diverse set of private firms than does an airport, where international air carriers will have staff at the airport to handle most functions. Except at primary ports for large liner operators, most carriers do not have local employees but rather use ship agents to manage their port calls and other local activities.9 Most vessel-related activities are contracted out to a variety of local companies or port agencies, including ship pilotage, vessel supply, inspection, and repairs.
From page 145...
... The U.S. seaport coverage by quarantine stations is summarized in Table D.3.
From page 146...
... Virgin Islands Port Everglades (2) Miami (12)
From page 147...
... Port Manatee is a niche port for inbound and outbound fruit, and Palm Beach serves the Caribbean cruise and cargo markets. San Juan is a large cruise and container port in the Caribbean that is also covered by the Miami station, as are the U.S.
From page 148...
... Processing and inspection of persons are carried out by U.S. Citizenship and Immigration Services, clearance of cargo by CBP, agriculture-related review by the Animal and Plant Health Inspection Service (APHIS)
From page 149...
... Citizenship and Immigration Services S, R Animal and Plant Health Inspection Service S, R U.S. Coast Guard S, R Other federal agencies U.S.
From page 150...
... A local health agency might con
From page 151...
... The problem is exacerbated by the significant restructuring of federal inspection services after 9/11. Another general problem is that physical access to the vast array of ports and terminals is difficult in the post-9/11 environment.
From page 152...
... are involved, communication between the groups had been a problem; another noted that getting information to local health authorities was once complicated by the communications route (e.g., local QSS to state to local health)
From page 153...
... Vessel Captain, Agent, or Operator The tradition of flying the yellow flag of quarantine on incoming vessels dates back centuries and is, in fact, the basis of the flag of the U.S. Public Health Service, which was started to deal with seaborne infectious diseases.
From page 154...
... (Several stations mentioned that they have used a ship agent's doctor to respond to situations, presumably someone called by the ship agent because they did not have in-house medical staff.) CDC CDC's role in identifying and responding to human health risks at seaports includes the following: · QSS: Responsible for nongastrointestinal infectious diseases on cruise vessels and all infectious diseases on other foreign-origin vessels using various port partners.
From page 155...
... The stations depend on local health agencies to deal with sick persons, but there seems to be no standard procedure. Some stations mentioned having formal MOAs, particularly with hospitals for quarantine cases; one respondent indicated that this was a generic CDC function.
From page 156...
... and much greater contact with the vessel and shore personnel. The VSP is paid for its inspection services and is selfsupporting and well staffed.
From page 157...
... CBP will often board vessels to do crew checks; it has access to USCG's National Vessel Movement Center (NVMC) data and may use them to see whether a vessel is eligible to enter.
From page 158...
... In any case, it was indicated that USCG might make a courtesy call to CDC but had no fixed protocols. One QSS contact indicated receiving USCG vessel tracking information during the SARS crisis, but it was only temporary; others did not mention it.
From page 159...
... In some cases, the station will work with local health agencies to devise a strategy (one station had a whole crew vaccinated once) .The appropriate government contact depends on the port's location and size; state agencies may be appropriate for certain areas (e.g., smaller remote ports)
From page 160...
... : · African rodents and "bush meat": There is a prohibition on these imports, although these commodities are likely to move by air. · Lucky bamboo: This plant commodity was shipped from Asia and was packed in a gel that somehow turned to water and contained mosquito larvae.
From page 161...
... CBP (U.S. Customs and Border Protection)
From page 162...
... (fy) 692,422 343,568 3,405,386 Port Everglades (FL)
From page 163...
... One QSS contact indicated that regulations limit the information that can be passed on to CDC and that the AMS protocols may need to be reviewed. (The example
From page 164...
... Quarantine Import Weight Station Port (Short Tons) Rank LAX Houston, TX 90,335,647 1 Beaumont, TX 63,336,752 3 Corpus Christi,TX 44,758,661 4 Texas City, TX 40,184,521 5 Long Beach, CA 37,969,522 6 Los Angeles, CA 29,962,253 8 Freeport, TX 22,665,591 11 Port Arthur, TX 14,259,432 21 Matgorda Ship Channel, TX 6,451,220 31 San Diego, CA 2,194,448 52 Brownsville, TX 1,865,561 54 Galveston, TX 1,064,833 66 Port Hueneme, CA 910,801 72 LAX Total 355,959,242 JFK New York, NY and NJ 70,251,263 2 Portland, ME 27,133,777 10 Baltimore, MD 18,984,957 13 Philadelphia, PA 18,615,848 15 Paulsboro, NJ 17,908,339 16 Marcus Hook, PA 16,077,374 19 Boston, MA 15,634,152 20 Hampton Roads, VA 10,155,182 24 Providence, RI 4,402,336 36 Portsmouth, NH 4,113,573 40 Camden-Gloucester, NJ 3,764,289 41 Wilmington, DE 3,400,014 43 New Haven, CT 2,954,309 46 Fall River, MA 1,954,888 53 Bridgeport, CT 1,850,626 55 Chester, PA 1,342,801 59 New Castle, DE 1,329,415 60 Albany, NY 1,325,761 61 Penn Manor, PA 1,205,420 64 Searsport, ME 996,205 69 Richmond, VA 288,106 90 JFK Total 223,688,635 ATL South Louisiana, LA, Port of 30,857,319 7 Lake Charles, LA 27,825,176 9 New Orleans, LA 20,889,868 12 Baton Rouge, LA 18,701,796 14 Mobile, AL 17,553,389 17
From page 165...
... 165 APPENDIX D TABLE D.6 Continued Quarantine Import Weight Station Port (Short Tons) Rank Pascagoula, MS 17,513,754 18 Savannah, GA 13,174,550 22 Charleston, SC 13,041,525 23 Plaquemines, LA, Port of 8,519,740 28 Wilmington, NC 2,739,522 48 Georgetown, SC 2,400,943 50 Gulfport, MS 1,228,417 63 Brunswick, GA 1,056,658 68 Morehead City, NC 703,318 74 ATL Total 176,205,975 MIA Jacksonville, FL 9,878,816 26 Tampa, FL 9,230,682 27 Port Everglades, FL 8,426,945 29 San Juan, PR 5,008,816 33 Miami, FL 4,915,706 35 Ponce, PR 3,266,582 44 Port Manatee, FL 3,189,814 45 Port Canaveral, FL 2,950,340 47 Palm Beach, FL 819,382 73 Panama City, FL 663,660 78 Pensacola, FL 292,732 88 MIA Total 48,643,475 SEA Seattle, WA 6,748,803 30 Tacoma, WA 5,702,602 32 Portland, OR 4,398,499 37 Anacortes, WA 1,492,029 57 Redwood City, CA 915,510 71 Longview, WA 698,574 75 Vancouver, WA 680,736 76 Port Angeles, WA 672,165 77 Grays Harbor, WA 323,006 84 Everett, WA 264,683 92 Nikishka, AK 226,934 94 Kalama, WA 219,889 95 Anchorage, AK 218,233 96 Coos Bay, OR 195,189 98 Olympia, WA 107,924 100 SEA Total 22,864,776 (continued)
From page 166...
... given concerned a prohibited item that was only generically described and had a "Call CDC" designation that resulted in contact of headquarters rather than the local QSS where the item was entering the United States. Another concern was that CBP requirements for documentation may not meet CDC's requirements when CBP is responsible for clearing shipments.
From page 167...
... . A local health agency involved in one previous incident noted that it had problems in getting timely information that allowed them to prepare for incoming shipments thought to pose a risk.
From page 168...
... 168 QUARANTINE STATIONS AT PORTS OF ENTRY Potential Gaps or Shortfalls Other than the concerns about access to and protocols of the AMS cited above, no gaps or shortfalls regarding cargo transportation were identified. Logically, the greatest threat would be cargoes that are unrelated to the responsibilities of complementary federal agencies (i.e., other than agricultural, live animals, foods, or drugs)


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