Quarantine Stations at Ports of Entry Protecting the Public's Health (2006) / Chapter Skim
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4 Bridge from Present to Future: Vision and Recommendations
4 Bridge from Present to Future: Vision and Recommendations
Pages 70-94
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From page 70... ...
homeland security infrastructure have increased the complexity of the organizational environment in which the CDC quarantine stations function. This organizational environment, the Quarantine System, lacks effec 1Definition: A microbial threat of public health significance causes serious or lethal human disease and is transmissible from person to person, from animal to person, or potentially both; it also may be transmissible from food or water to people.
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From page 71... ...
population from microbial threats of public health significance that originate abroad. To fill this void, the primary activities of the CDC quarantine stations should shift from the legacy and historical activity of inspection to the provision of strategic national public health leadership for Quarantine System activities.
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From page 72... ...
Central to the Quarantine Network from a domestic perspective is a System that comprises the people and organizations on the front lines of public health activities at U.S ports of entry. The Core consists of the quarantine stations, DGMQ headquarters, and the national scientific and organizational capacity of CDC.
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From page 73... ...
Development of a National Strategic Plan by the Quarantine Core On the basis of its collective experience in public health practice, law, and governance, the committee concluded that a national strategic plan developed by the Core would provide the people of the United States with the best possible framework for protection against importation of microbial threats of public health significance. With its focus on human communicable disease, the Quarantine Core's national strategic plan would complement those plans formulated by the Department of Homeland Security to protect the American public.
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From page 74... ...
As noted earlier, the Core alone possesses the appropriate expertise, resources, and experience to provide strategic national public health leadership to the Quarantine Network. The Core should, however, collaborate closely with its federal partners while strategically leading the country's efforts to minimize the risk of microbial threats of public health significance entering the United States.
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For the Core to exercise national strategic public health leadership, there is a need for coordination of federal, state, and local authority for the exercise of public health powers. At present, legal and regulatory authority,
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Financial resources Along with sufficient legal authority, the Core should have sufficient funds for both DGMQ HQ and the quarantine station staff to carry out their responsibilities under the strategic plan. The Core also should make every effort to assure that all of its partners are fully aware of and trained to carry out any public health functions delegated to them under the strategic plan.
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Under such arrangements, the quarantine stations should be held just as accountable as the states and localities. Finally, as the Core implements the strategic plan, it must assure the local health departments' ability to take on delegated responsibilities while continuing to provide essential public health services.
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From page 78... ...
Electronic Passenger Manifests One gap DGMQ has clearly identified is the difficulty of collecting passenger information in a timely manner in connection with a communicable disease investigation, as discussed in Chapter 3. Local public health authorities and the quarantine stations usually can trace only a fraction of exposed passengers, even with a great effort, increasing the risk of dispersal of microbial threats of public health significance and endangering the health of travelers after they arrive in this country.
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From page 79... ...
In summary, measures that strengthen the Immigrant, Refugee, and Migrant Health Branch are likely to promote and support the goals of the quarantine stations. Zoonotic Diseases The adequacy of animal health screening for zoonotic6 diseases is another weakness in the Quarantine System.
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From page 80... ...
, the Core should work toward a comprehensive national strategy for preventing the importation of zoonotic disease. In addition, the highest ranking officials of the Core should continue to highlight the absence of sufficient staff who are qualified, trained, and tasked to inspect arriving travelers and crews for signs of communicable disease of public health significance.
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The infrastructure of the Quarantine System is inadequate to support its current role, let alone the role envisioned for it under the expansion plan. Only a limited amount of resources are available to the quarantine stations and their partners in the System for their work in mitigating the risks posed by microbial threats of public health significance at U.S.
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From page 82... ...
However, the competences outlined in the interim letter report, reprinted in Appendix A, remain compelling to the committee. The CDC quarantine station staff and their colleagues at headquarters require competences to execute historical and statutory functions, to plan, to conduct surveillance for public health threats, to perform clinical and public health assessment and response, to perform health and risk communication, and to develop collaborative relationships with all members of the Network.
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From page 83... ...
· The quarantine stations should have access to translators in the languages of the travelers and crews who typically arrive at their ports. In addition, the quarantine station staff should be able to demonstrate knowledge of and sensitivity to the cultural norms in interpersonal communication and health care of travelers and crews who typically arrive at their port.
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From page 84... ...
Furthermore, electronically scanned medical records of immigrant and refugees could be transmitted to the quarantine stations and local public health departments before the individuals arrive in the United States, creating an opportunity to review the records in advance. The electronic transmittal of immigrant and refugee medical records would also reduce the processing delays and errors noted in Chapter 3.
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From page 85... ...
While a volume-based risk assessment seems reasonable, based on available data, the Core should periodically evaluate changes in patterns of global travel and trade, as well as models of infectious disease outbreaks, international spread, and efficacy of interventions. DGMQ selected the locations of the 17 new quarantine stations with several goals in mind.
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From page 86... ...
In addition, DGMQ should consider having its staff participate -- as resources allow -- in response and planning efforts for local public health emergencies. This would not only help foster closer relationships and stronger partnerships with state and local partners but also ensure that DGMQ staff maintain and develop important emergency response skills.
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From page 87... ...
· Virtual teams, mobile teams, or both that can nimbly shift their attention and resources to any one of numerous ports of entry as risks or real events dictate.9 Such teams could be based at DGMQ headquarters, regional quarantine stations, or other stations. CDC could assemble a team from its emergency command center via videoconference, or a quarantine station could temporarily relocate staff to a port of entry that lacks a permanent station.
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From page 88... ...
Therefore, the stations should devote only a small fraction of their time to the visual inspection of disembarking passengers. Just as consumers and payers of medical care increasingly base their choices on data about the efficacy of drugs and treatment regimens, so the quarantine stations should scrutinize their methods in a scientific, quantitative way.
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. Questions to be asked and answered should include: · Given an array of perceived microbial threats, each of a different nature, which method or methods of exit screening10 would most effectively identify infected individuals?
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Measuring Performance Recommendation 7: The committee recommends that the Quaran tine Core develop scientifically sound tools to measure the effec tiveness and quality of all operational aspects of the Quarantine System. The Core should routinely assess the performance of criti cal quarantine functions by individual CDC quarantine stations, DGMQ headquarters, partner organizations, and the System as a whole.
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The CDC quarantine stations at U.S. ports of entry should provide this
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From page 92... ...
ports of entry when and where CDC quarantine station staff are absent. To achieve this capability, the Core needs sufficient financial and human resources to train its surrogates and acquire information technology that permits rapid, real-time communication and data-sharing among the stations and their System partners.
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2003b. Reinventing CDC Quarantine Stations: Proposal for CDC Quarantine Sta tion Distribution.
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