Quarantine Stations at Ports of Entry Protecting the Public's Health (2006) / Chapter Skim
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3 Today's CDC Quarantine Stations at U.S. Ports of Entry
3 Today's CDC Quarantine Stations at U.S. Ports of Entry
Pages 36-69
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From page 36... ...
The chapter begins with a description of the broad statutory and regulatory foundation of the CDC quarantine stations' activities. A conceptual framework for understanding the stations' organizational environment follows.
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From page 37... ...
. QUARANTINE CORE, SYSTEM, AND NETWORK The committee found the CDC quarantine stations to be one component of a large, complex network of organizations whose collective actions provide limited protection to residents of and travelers to the United States from microbial threats of foreign origin.
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From page 38... ...
The Quarantine Core At the center of the diagram is what the committee has dubbed the "Quarantine Core," which consists of the CDC quarantine stations, DGMQ headquarters, and the organizational and scientific capacity of CDC (Figure 1.1 illustrates the relationship among these entities)
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From page 39... ...
The circle around the Core is a dotted line to reflect the interdependence of the quarantine stations and their partners in the System. CBP, EMS, LPHAs, and State PHAs are bolded to reflect the especially close collaboration of those entities with the stations on virtually a daily basis.
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From page 40... ...
Additional threats of public health significance of concern to the quarantine stations include the release of chemical or radiological substances and of biological substances other than microbes (e.g., microbial toxins)
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From page 41... ...
The larger the port and community, the greater the likely impact of an ineffective Quarantine System. Visual Screening of Passengers and Crew for Signs of Illness With tremendous growth in the volume of international air traffic, significant cuts in the Quarantine Core's resources, and limited federal investment to fill the gap, the CDC quarantine stations inspect just a small
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From page 42... ...
territory. Partners in the Identification of Ill Passengers Aircraft Commanders and Ship Masters The quarantine stations rely not only on CBP but also on airline crews and ship masters to identify ill passengers.
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From page 43... ...
. Three of the five quarantine stations visited by the committee, as well as DGMQ HQ officials, agreed that many pilots do not follow the regulatory notification procedures and instead radio intermediaries, such as MedLink, a service available to most commercial airlines that directly links pilots to emergency care physicians4 (Committee, 2005; MedAire, 2005)
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From page 44... ...
For every full-timeequivalent quarantine station staff member, there are approximately 300 CBP field officers.5 Consequently, the Core relies on CBP inspectors to watch for ill passengers at most ports and to carry out other regulatory responsibilities on their behalf. In addition, because the CDC quarantine stations are not open 24 hours a day, 7 days a week, on-site CBP personnel sometimes act as surrogates for quarantine inspectors during their offhours.
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From page 45... ...
SOURCE: CBP, 2005d. on-the-job training for this function when they are newly hired; they receive additional training from CDC quarantine station staff when new diseases of public health significance are detected.
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From page 46... ...
. The extent to which CBP staff inspect passengers, animals, and cargo for disease appears to be influenced in part by the goodwill that quarantine station staff have fostered through relationships with their CBP counterparts; these relationships are strongest at ports that contain quarantine stations or that quarantine station staff have recently visited to conduct onsite training sessions.
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From page 47... ...
But the back-up that CBP provides to the CDC quarantine stations clearly falls outside the domain for which CBP officials are hired and for which they are best trained. The port
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From page 48... ...
Table 3.2 presents the number of cases of illness reported to or found by the quarantine stations in 2003 and the types of medical control measures taken in response. Although the Quarantine Core does not have jurisdiction over departing flights, the quarantine stations provide advice upon request to CBP, port authorities, or airlines regarding suspected cases of illness among passengers on departing flights (Committee, 2005)
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From page 49... ...
Local public health authorities also will occasionally contact a quarantine station to alert the staff that a departing passenger may be infectious. In such cases, the quarantine station notifies the airline, which almost always follows the Quarantine Core's advice regarding the health risk posed by the passenger (Committee, 2005)
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From page 50... ...
The CDC quarantine station staff do not provide medical treatment, even since the decision in 2004 to begin hiring physicians (generally one per 8In cases when the patient is thought to carry one of the most lethal kinds of infectious agents, such as Ebola virus, the samples would be sent to a biosafety level 4 laboratory, which might be located out of state.
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From page 51... ...
. The difficulty in obtaining passengers' contact information to alert them to a microbial threat of public health significance has several detrimental consequences: first, the quarantine stations cannot identify or locate a significant percentage of potentially exposed passengers; second, by the time many passengers are contacted, it may be too late to implement effective preventive measures; and third, affected passengers may spread the disease among their close contacts, as happened during the outbreak of SARS (Personal communication, P
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The American airline industry would reportedly welcome a regulatory change that compels airlines to give the quarantine stations access to elec
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From page 53... ...
A study conducted by the CDC quarantine station in Hawaii and the Hawaii Department of Health concluded that the information from passenger manifests should be supplemented by other information sources to conduct rapid contact tracing of airline passengers after they have disembarked (Lasher et al., 2004)
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From page 54... ...
port of entry from an area experiencing an outbreak of communicable disease of public health significance. These paper notices are one of the Quarantine Core's principal tools for educating international travelers who have potentially been exposed to a microbial threat.
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Thus, the following discussion is limited, and the topic is ripe for further study. Some quarantine stations spend more time on immigrant and refugee health than any other issue (Committee, 2005)
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If one or more sputum samples test positive, the individual has infectious TB -- a Class A communicable disease -- and may not enter the United States without a special waiver (DQ, 1991; LoBue and Moser, 2004; Royce, 2005)
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From page 57... ...
. A small-scale, unpublished study conducted by DGMQ in 1999, as well as anecdotal evidence, suggests that both the CDC quarantine stations at ports of entry and CBP miss a significant percentage of immigrants who have medically notifiable conditions and are admissible into the United
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From page 58... ...
The CDC quarantine stations are ultimately responsible for identifying immigrants with Class A or B diseases. Anecdotal evidence suggests that a significant number of immigrants who have Class A or B diseases are missed because of human error in the scanning of paperwork (Committee, 2005; personal communication, P
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From page 59... ...
is dedicated to immigrant and refugee health. Many of this branch's accomplishments in 2003 illustrate overlap and potential synergy with the branch containing the quarantine stations.
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From page 60... ...
. The CDC quarantine stations are technically responsible for inspecting all imports of animals under their authority to ensure that the animals do not display signs of communicable disease.
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From page 61... ...
. For instance, CBP inspectors at a seaport in a major agricultural state did not receive an alert in 2004 about an outbreak of a highly pathogenic, zoonotic strain of avian influenza until a week after the warning was issued (GAO, 2005)
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. A liaison from Veterinary Services frequently visits the CDC quarantine stations and speaks with them about zoonotic diseases.
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From page 63... ...
, and the Wild Bird Conservation Act to prohibit the importation of any wild animals or animal products that may threaten native wildlife or violate state, federal, or local wildlife laws. · CDC has jurisdiction under the Public Health Service Act to prohibit the importation of animals and animal products and to regulate foreign quarantine to prevent introduction of communicable diseases that threaten public health.
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From page 64... ...
CBP inspectors do not actively seek animal products and related items of public health concern, but as a courtesy, they generally notify CDC quarantine station staff if they come across such an item in the course of their work. At times, local law enforcement officials, individuals from airlines and cargo carriers, local veterinarians, and local health groups also inform the Quarantine Core when they perceive a possible public health threat in imported animals or animal products (Appendix E)
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From page 65... ...
CDC quarantine stations that have jurisdiction over an especially large volume of cargo shipments frequently request assistance from state and local partners to enforce quarantine regulations over imported animals and animal products perceived to be a potential public health threat. The Quarantine Core also requests assistance at times from private individuals, such as local veterinarians, or from local law enforcement officers.
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. CONCLUSION This chapter has illustrated the complexity of the Network within which the CDC quarantine stations operate.
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From page 67... ...
Notes on Site Visits to DGMQ Quarantine Stations.
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From page 68... ...
1991. Technical Instructions for Medical Examination of Aliens.
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From page 69... ...
2005. Quarantine Stations and the Control of M
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