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Quarantine Stations at Ports of Entry: Protecting the Public's Health (2006)

Chapter: Appendix D: Commissioned Paper on US Seaports and the CDC Quarantine Station System

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Suggested Citation:"Appendix D: Commissioned Paper on US Seaports and the CDC Quarantine Station System." Institute of Medicine. 2006. Quarantine Stations at Ports of Entry: Protecting the Public's Health. Washington, DC: The National Academies Press. doi: 10.17226/11435.
×

D
Commissioned Paper on U.S. Seaports and the CDC Quarantine Station System

Prepared by

Rex J. Edwards

April 4, 2005

SUMMARY AND CONCLUSIONS

The Centers for Disease Control and Prevention (CDC) has contracted with the Institute of Medicine (IOM) to conduct a study assessing the role of U.S. federal quarantine stations as a public health intervention at U.S. ports of entry. The assessment, titled Measures to Enhance the Effectiveness of the CDC Quarantine Station Expansion Plan for U.S. Ports of Entry, is being conducted in the context of numerous partners across sectors, jurisdictions, and national borders.

This paper examines the CDC quarantine station system (QSS) in the context of how it operates at U.S. seaports,1 with emphasis on identifying differences from operations at U.S. airports where all the existing stations are. The information in this paper was gathered mostly through phone and e-mail interviews of personnel at individual QSS stations, federal regulatory or inspection agencies, the local port sector, and local or state health agencies, a summary of which is included in Table D.1.2 This information was

1  

The term “seaport” applies to ports which handle ocean-going vessels, including those on the U.S. Great Lakes and ports on rivers (e.g., Portland on the Columbia River).

2  

The original statement of work anticipated interviewing a standard cross-section of QSS “partners” at a specified list of ports. The initial interviews indicated that knowledge of the QSS at the local level was very limited, as shown by the difficulty of finding port-level contacts that could comment on the system. This is probably a result of the relatively low frequency of incidents requiring QSS notification or response. Subsequently, the interview process was reoriented toward getting input at a national level for federal agencies and from as many local sources as possible without regard to port.

Suggested Citation:"Appendix D: Commissioned Paper on US Seaports and the CDC Quarantine Station System." Institute of Medicine. 2006. Quarantine Stations at Ports of Entry: Protecting the Public's Health. Washington, DC: The National Academies Press. doi: 10.17226/11435.
×

TABLE D.1 Organizations/Agencies Providing Information for Study

 

CDC

CBP

Other Federal Agencies

Local/State Health

Port Industry

Atlanta

QS*

-Savannah

-Atlanta (HDQ)

 

-GA Office of Public Health (State Epidemiologist)

-Port of Charleston (Port Director)

-New Orleans Steamship Assn.

-Maritime Endeavors Shipping

Chicago

QS

-Chicago*

 

Los Angeles

QS

-Los Angeles

-USCG (Los Angeles)

 

Miami

QS*

 

New York

QS*

 

-USCG-New York (Marine Safety Office)

-City of New York (Health Dept.)

-Port of NY/NJ (Port of Commerce Dept.)

San Francisco

QS

-San Francisco (Agricultural Inspector)

-USCG (San Francisco)

 

Seattle

QS

-Seattle

 

-King Co. Health Dept (Infectious Disease, Environmental Health Services)*

-Port of Portland

National

Vessel Sanitation Program

 

-USCG (National Vessel Movement Center)

-USDA (Foreign Agricultural Service)

 

Acronyms: QS = CDC Quarantine Station; CBP = DHS U.S. Customs and Border Protection, Department of Homeland Security (including legacy customs, immigration, and USDA inspection services); HDQ = Headquaters; USCG = DHS, U.S. Coast Guard

*Multiple contacts

Suggested Citation:"Appendix D: Commissioned Paper on US Seaports and the CDC Quarantine Station System." Institute of Medicine. 2006. Quarantine Stations at Ports of Entry: Protecting the Public's Health. Washington, DC: The National Academies Press. doi: 10.17226/11435.
×

supplemented with general information concerning the QSS and other federal agencies, information previously gathered by the IOM committee, and other secondary sources.

Overview of Results

The QSS was a significant presence at U.S. seaports until the 1960s, when foreign passenger travel shifted from sea to air transportation. The current system is oriented toward airports on the basis of priority of perceived threats (i.e., foreign visitors by air), the physical location of all stations at airports, the limited resources available to handle even the airport responsibilities, and most important, the infrequency of incidents at seaports. The current system at seaports is incident-driven and, in some cases, based on informal, ad hoc relationships; it is restricted by the lack of a physical presence and a lack of ability to train and interact with system “partners” over an array of ports that vary geographically and by type of activity. In some of the interviews, there was a perception that the QSS (or, more likely, “public health”), rather than a regulatory or inspection entity, was a resource to be called if there was a concern for the health of port personnel (public and private). In most respects, the scope of threats and the procedures for dealing with them are common to all ports of entry.

Similarities and Differences from Airport Environments

The primary differences between the airport and seaport systems are based on the following:

  • Source of threats. The primary “human” threats at airports are foreign-origin travelers (and crew) 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. The number of cargo-related incidents at seaports is very limited in both number and scale, primarily since live animals and the other primary threats are more likely to move in small shipments via air.

  • Operating environment. A seaport is a much more open environment than an airport and has higher levels and variety of international cargo and vessel activities. While cruise activity is concentrated at a limited number of U.S. ports and foreign ports of call, the market is expanding to secondary embarkation ports, many seasonal, and to more exotic foreign points (e.g., ecotourism). Over 100 U.S. ports handle import cargo, each

Suggested Citation:"Appendix D: Commissioned Paper on US Seaports and the CDC Quarantine Station System." Institute of Medicine. 2006. Quarantine Stations at Ports of Entry: Protecting the Public's Health. Washington, DC: The National Academies Press. doi: 10.17226/11435.
×

with a unique combination of commodities, vessel types, and foreign trade routes. Cargo vessels may operate on a nonscheduled basis, spend weeks at sea, and call at a wide variety of foreign ports. Cargo vessel crews are typically non-English-speaking, their nationalities may be unrelated to the vessel’s trade route, and crew members may be from countries susceptible to disease outbreaks. Unlike airplanes, vessels are typically boarded before they reach the dock and often before federal inspection.

  • Federal agency partners. For the most part, the same federal agency partners apply to both the airport and port systems with the notable exception of the U.S. Coast Guard (USCG), which has primary responsibility for vessel safety within port areas, covering a range of areas (e.g., adequacy of manning and safety equipment). The USCG receives the “notice of arrival” required for all foreign-origin vessels. This document contains information related to vessel itinerary, crew, passengers, and hazardous cargoes that is provided to USCG and other federal personnel at local ports (although not regularly to the QSS). The QSS also works cooperatively with another CDC agency, the Vessel Sanitation Program (VSP), which has primary responsibility for dealing with gastrointestinal illness aboard cruise vessels. With no stations at ports, the QSS relies on agency partners for surveillance and immediate response activities at ports, although they are no different from those at airport “subports” (i.e., those without a station). This is particularly so for “complementary” agencies, such as the U.S. Department of Agriculture (USDA) and the Food and Drug Administration (FDA) that have similar regulatory responsibilities but may have a greater presence at seaports.

  • Health sector partners. QSS relationships with local and state health agencies at seaports are basically the same and may be common to all CDC relationships, e.g., operating under memoranda of agreement (MOAs) with local hospitals. The infrequency of incidents at seaports results in little contact other than for (and sometimes including) the primary ports, many of which are those nearest the airport stations. The limited number of on-site 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.

  • Private sector partners. Perhaps the greatest differences are based on a private sector that is more decentralized and varied than airports (which are dominated by the airlines and the airport authority, albeit with a limited number of supporting contractors). Most ocean carriers will not have any personnel in most ports of call, especially for the noncontainerized cargo industry. Local port activities are typically managed by a ship agent who may deal with a particular vessel or carrier only infrequently. Responsibility for cargo unloading and certain vessel services may fall to third parties with limited contact with or relationship to the vessel operator. The

Suggested Citation:"Appendix D: Commissioned Paper on US Seaports and the CDC Quarantine Station System." Institute of Medicine. 2006. Quarantine Stations at Ports of Entry: Protecting the Public's Health. Washington, DC: The National Academies Press. doi: 10.17226/11435.
×

much wider variety and variability of activities, particularly on the cargo side, make it difficult to ensure that vessel captains and ship agents are aware of reporting requirements for sick or dead persons.

  • Port authority partners. Like airport authorities, the port authorities vary similarly with airport authorities in jurisdictional control (e.g., local, state, and county) and structure (e.g., multiairport), although ports are more likely to have private terminals that are primarily controlled by single carriers or industrial users. (Airports often have third-party-operated cargo and other facilities, but mostly all within the airport “fence” with access controlled by the airport.) 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. These ports have less direct contact with vessel and cargo activities and hence less control and ability to act as a “clearinghouse” for information and cooperation.

General System

On the basis of interviews with QSS and its partner agencies, several general observations can be made regarding the existing system at U.S. seaports, including:

  • The overall impression gained from the interviews was that the QSS has a very limited profile at individual seaports, even those where the station is at the local airport. Very few chronic incidents have had to be dealt with in recent years (as reported by QSS staff), so there has been little direct contact with QSS by port-level partners, and even less by the general port and health sectors.3 The system could benefit from more “face time” between the QSS staff and the public and private sectors, particularly as the partner agencies are typically much larger and undergo frequent turnover and rotations (exacerbated by significant internal reorganization by these agencies after 9/11).

  • A primary conclusion that resulted from the interviews was that the current system is ad hoc and incident-driven, mostly because there have been few notable incidents at just a few seaports and none of a chronic nature.

  • A general impression was that the stations were stretched just to cover airport responsibilities, and much more to expand their port activities, particularly without any evident threats. The stations have operated

3  

The level of contact varied by station; higher levels of contact were seemingly driven by contacts related to airport activities that also apply to local seaports.

Suggested Citation:"Appendix D: Commissioned Paper on US Seaports and the CDC Quarantine Station System." Institute of Medicine. 2006. Quarantine Stations at Ports of Entry: Protecting the Public's Health. Washington, DC: The National Academies Press. doi: 10.17226/11435.
×

with as few as one full-time person in the past, and it is difficult to provide adequate training to agency partners unless there is a specific threat of high interest (e.g., SARS).

  • Since the system is oriented toward airport threats, the assignment of seaports to the airport systems is geographically based, and individual stations cover wide ranges of both primary and “niche” ports, each with unique profiles of vessel, cruise, and cargo activity.

  • A general impression was that the ad hoc identification system for infrequent incidents leads to inconsistent responses. Most communication was said to occur by telephone, probably because of the infrequency of incidents. 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.

  • A general problem is that physical access to the vast array of ports and terminals is difficult in the post-9/11 environment. Different ports having different access standards and private terminals may have different rules for getting on-site when necessary.

  • A response to an incident is based on various factors, including level of threat, timing, location, and involved partners. The level of a threat dictates the type of response, and other factors will determine the extent to which a “joint response” is used, as opposed to a primarily CDC response. Timing and the location of the threat (relative to the station location) are constraints that must be dealt with. A station might also have a postincident diagnostic or policy role. One respondent noted that a key role of the QSS is (or could be) a familiarity with seaport operations (not available to general health personnel) that may useful in handling postcontact situations or response strategies.4

Passenger and Crew Threats
  • The primary source of information on possibly infectious passengers or crew members is the vessel itself, either directly or, more likely, via a ship agent, a cruise line’s medical consultant, or even a partner agency. Ship captains and, by extension, the ocean carriers and their local agents are required by law and international regulations to notify the QSS of “quarantinable” illness on board, but it is unclear whether there is a stan-

4  

For example, one station noted that familiarity with the role of various crew members on a cruise ship would be useful in identifying possible on-board contacts.

Suggested Citation:"Appendix D: Commissioned Paper on US Seaports and the CDC Quarantine Station System." Institute of Medicine. 2006. Quarantine Stations at Ports of Entry: Protecting the Public's Health. Washington, DC: The National Academies Press. doi: 10.17226/11435.
×

dard notification procedure. There were various opinions on how this system works in practice; many stations thought it worked well, while others thought that many agents and captains were unaware of the requirements. Again, this may be a result of the infrequency of incidents, but in any case the vessel personnel must know what to look for, and there is no ability to inform them other than during crisis situations (e.g., SARS). In general, it was thought that the vessel crew have an interest in identifying infectious persons and do a good job of on-board isolation, but the responsibility for dealing with specific on-board situations will differ significantly by type of ship and trade route (beyond its being ultimately the captain’s responsibility).

  • Cruise vessels are much more scrutinized than cargo vessels in terms of on-board sanitation, particularly by CDC’s VSP. Cargo crews are more likely to be on longer voyages from more disease-prone areas and living in cramped conditions.

  • In general, it was thought unlikely that partner agencies would visually identify sick persons, although there were a variety of opinions as to whether partner agencies routinely checked for illness (as opposed to reporting self-identified disease). In particular, the USCG’s vessel tracking system may collect sick crew or passenger information, but this information is not routinely processed by them at the national or local level. Training of partner agencies at subports is ad hoc and differs by port region.

  • Port personnel in both the private and public sectors are concerned about infectious conditions with respect to their own health and may identify sick persons. During the period when SARS was of high concern, some pilots and longshoremen refused to board vessels. The QSS should have a public communication role in these situations, particularly as port safety may be affected, and there is the potential for a widespread shutdown of foreign trade if an outbreak were to occur.

  • 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), although state agencies may have jurisdiction or be better able to deal with situations at smaller ports. The protocols for handling specific situations at all ports seemed to vary, again on the basis of the infrequency of occurrences. Some stations maintained direct contacts with local agencies or a database of health contacts and mentioned MOAs with quarantine-certified hospitals, although this may be a general CDC function. It may be possible to utilize medical staff available through federal partners (e.g., USCG).

  • In terms of possible gaps or shortfalls in the system, no contact provided any high level of concern. The main concern involved the ability to train partner agencies and the shipping community.

Suggested Citation:"Appendix D: Commissioned Paper on US Seaports and the CDC Quarantine Station System." Institute of Medicine. 2006. Quarantine Stations at Ports of Entry: Protecting the Public's Health. Washington, DC: The National Academies Press. doi: 10.17226/11435.
×
Cargo Threats
  • The scope of incidents from cargo at seaports is extremely limited and includes (1) the prohibition of certain live animals (e.g., African rodents, which are more likely to move by air) and (2) some cargo contamination (e.g., mosquito larvae in shipments of “Lucky” bamboo and used tires shipped exposed to standing water) and disease-carrying vessels (e.g., ships from South America with disease in their ballast water), each of which was diagnosed and dealt with on ad hoc basis. Some of the interviewees (including QSS personnel) could not recall a local incident related to cargo.

  • The Department of Homeland Security (DHS) U.S. Customs and Border Protection (CBP) has primary responsibility for clearing all foreign-origin cargo entering the United States (through its legacy U.S. customs function) by all ports of entry. As with airports, the CBP may have authority to clear cargo for the CDC unless a shipment is suspicious, some on a routine basis (e.g., for frequent shipments of medical samples to local hospitals). This supporting role is greatest at ports with no local airport station.

  • 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). These agencies typically have a much larger port presence, and USDA has their inspection personnel within CBP. The QSS or, more likely, the partner agency may identify a threat covered by another agency and then directly contact it. In the case of USDA, this may occur after CBP has referred an issue to its agricultural specialist, who then might contact the QSS.

  • As in an airport situation, the QSS is responsible for dealing with any cargo that is refused entry under its jurisdiction, which may include destroying or reexporting the shipment or ensuring that the cargo is not hazardous.

  • Most of the stations noted that they do not have access to CBP’s Automated Manifest System (AMS), which contains all the relevant information necessary to clear the cargo (origin/destination, shipper/consignee, and commodity). Access would enable them to monitor certain commodities and perhaps identify patterns creating new threats, but there is also concern as to whether they would have the capability to use the system at the local level.

  • One concern was that the protocols for contacting the QSS on the basis of AMS identifications of covered imports may not be clear. Another concern was that CBP requirements for documentation may not meet CDC’s requirements when CBP is responsible for clearing shipments.

  • There were no gaps or shortfalls that were otherwise identified regarding cargo transportation, although logically the greatest threat would

Suggested Citation:"Appendix D: Commissioned Paper on US Seaports and the CDC Quarantine Station System." Institute of Medicine. 2006. Quarantine Stations at Ports of Entry: Protecting the Public's Health. Washington, DC: The National Academies Press. doi: 10.17226/11435.
×

be cargoes that are unrelated to the responsibilities of complementary federal agencies (i.e., other than agricultural materials, live animals, food, and drugs).

In conclusion, the QSS has developed primarily as an airport system, most important in terms of where the stations are. The relative infrequency and limited severity of seaport incidents have resulted in an incident-driven ad hoc system that is almost entirely dependent on local port partners and, with respect to person-borne illnesses, mostly on a self-identified and referral basis.

A more expanded seaport role or the requirement to deal with new more expansive threats would require an increased local port presence at all subports, each of which may present a high level of risk. In particular, the QSS would need to develop better relationships with (1) the local port sector (port authority, carriers, and port service firms), (2) USCG because of its primary role for port safety, and (3) the relevant DHS partner agencies. Most important, the QSS would have to change the perception that it is merely a “public health” response option when there is a concern about infection (mostly as it applies to port personnel), rather than a partner agency for surveillance of and response to foreign-origin threats to the U.S. population.

The following section provides an overview of the QSS in terms of the general scope of the system’s responsibilities relative to the seaport environment, contrasting activities with those at U.S. airports. The QSS at seaports is described in general terms relative to the overall sources of threats, activities for surveillance of and response to threats, current protocols and communication patterns, and potential gaps or areas for improvement. The general system is then described in detail for the three primary areas of coverage: (1) cruise passengers, (2) vessel crews, and (3) cargo imports.

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. Because of a dramatic reduction in the size and resources of the QSS in the 1970s and 1980s, the stations now rely heavily on partner agencies, especially CBP, to carry out their regulatory

5  

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 either way; it also may be transmissible from food or water to people. Because of their potential for wide dispersal, concern is greatest for those microbes that spread readily from person to person.

Suggested Citation:"Appendix D: Commissioned Paper on US Seaports and the CDC Quarantine Station System." Institute of Medicine. 2006. Quarantine Stations at Ports of Entry: Protecting the Public's Health. Washington, DC: The National Academies Press. doi: 10.17226/11435.
×

responsibilities at the more than 280 ports of entry where CDC quarantine stations do not exist.

The QSS has the same jurisdiction over the persons and cargo on vessels as on aircraft:

Whenever the Director has reason to believe that any arriving person is infected with or has been exposed to any of the communicable diseases …, he/she may detain, isolate, or place the person under surveillance and may order disinfection or disinfestation as he/she considers necessary to prevent the introduction, transmission, or spread of the listed communicable diseases. (per 42 CFR Part 71.32). The communicable diseases include cholera, diphtheria, infectious TB, plague, smallpox, yellow fever, viral hemorrhagic fevers and SARS (per Executive Order 13295).

In general terms, the QSS (including both CDC and its federal partner agencies) is responsible for the surveillance of and response to communicable disease threats that could enter via U.S. seaports. Surveillance activities include specifying the scope of existing and emerging threats and identifying specific threats that might enter via a seaport. Response activities include isolating and assessing specific threats, preventing threats from entering the country (until safe), and taking (or stimulating) actions to eliminate threats (including hospitalization or quarantine of persons or reexport of cargo) and mitigate the impact of threats (identifying contacts).

In most respects, the scope of threats and the procedures for dealing with them are common to all ports of entry. The primary differences between the airport and seaport systems are related to the sources of threats, the operating environment, and the roles of and communication with various public and private partners.

Source of Threats

The QSS covers any person or cargo item arriving on a vessel from a foreign port, including cruise and other passengers, imported cargoes and personal items, crew members on cruise or cargo vessels, and illegal aliens (including stowaways).

Cruise Passengers

The majority of foreign-origin passengers that enter U.S. 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”) to 2 weeks or more. Some passengers arrive on cargo vessels, but there are no substantial differences from cruise passengers. Similarly, passengers who arrive from

Suggested Citation:"Appendix D: Commissioned Paper on US Seaports and the CDC Quarantine Station System." Institute of Medicine. 2006. Quarantine Stations at Ports of Entry: Protecting the Public's Health. Washington, DC: The National Academies Press. doi: 10.17226/11435.
×

Canada or Mexico on passenger ferries receive the same coverage by the QSS. The multiday-cruise industry (which is the highest priority in terms of infectious disease) is defined by a combination of:

  • Vessel type as determined by technology and passengers’ comfort wishes (e.g., luxury or sailing).

  • Destination market(s)—mostly foreign ports of call that are of interest to cruise visitors and can be reached within standard voyage lengths (mostly 7 days).

  • U.S. embarkation port—based on location relative to large population bases and ability to access via air, as well as the ability to accommodate the vessels.

There were 184 vessels serving the U.S. cruise market in 2003.6 Cruise vessels can vary from relatively small specialty vessels (e.g., Windjammer sailing vessels) to enormous vessels carrying almost 4,000 persons (e.g., the Queen Mary with 2,620 passengers and a crew of 1,253). The typical vessel carries 2,000 passengers and a crew of 950, creating a large processing problem at U.S. ports on the return voyages.

The U.S. cruise industry is oriented mostly toward the Caribbean and Southern California markets, which allow year-round sailing as shown in Table D.2. 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. The Southern California ports serve both the west coast of Mexico and Hawaii (which is not covered by the QSS). Other cruise markets include summer sailings to Alaska, New England, and Great Lakes points and multiweek itineraries (e.g., Panama Canal or trans-Atlantic).

In recent years, the originating ports for Caribbean and Gulf of Mexico cruises have expanded to include Galveston, New Orleans, and New York. This trend is expected to continue as the primary ports become more congested and new ports expand or emerge to handle local passengers or new itineraries.

Of potential interest for this study is the emergence of nontraditional foreign ports of call (particularly oriented toward ecotourism) that might create exposure to more remote areas.

6  

Source: International Council of Cruise Lines.

Suggested Citation:"Appendix D: Commissioned Paper on US Seaports and the CDC Quarantine Station System." Institute of Medicine. 2006. Quarantine Stations at Ports of Entry: Protecting the Public's Health. Washington, DC: The National Academies Press. doi: 10.17226/11435.
×

TABLE D.2 2002-2003 Cruise Passengers at U.S. Ports

Ports

2002

2003

% of Total

Annual Growth

Florida (MIA)

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)

New York

326,000

438,000

6%

34%

Boston

69,000

69,000

1%

0%

Baltimore

57,000

57,000

1%

0%

Philadelphia

1,500

24,000

0%

1500%

 

453,000

588,000

8%

30%

Pacific Northwest (SEA)

Seattle

118,000

158,000

2%

34%

Seward

151,000

147,000

2%

-3%

 

269,000

305,000

4%

13%

Other U.S.

New Orleans (ATL)

245,000

288,000

4%

18%

San Francisco (SFO)

32,000

51,000

1%

59%

All Other

32,000

51,000

1%

59%

United States

6,630,000

7,432,000

100%

12%

 

SOURCE: The Cruise Industry (2003 Economic Summary), International Council of Cruise Lines.

Suggested Citation:"Appendix D: Commissioned Paper on US Seaports and the CDC Quarantine Station System." Institute of Medicine. 2006. Quarantine Stations at Ports of Entry: Protecting the Public's Health. Washington, DC: The National Academies Press. doi: 10.17226/11435.
×
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 overseas origins (excluding transborder NAFTA trade) arrives on oceangoing vessels.

The key characteristics associated with oceanborne import trade include:

  • Vessel type. Includes large vessels carrying single commodities in bulk (e.g., petroleum, grains, and ores), general cargo vessels carrying mixed commodities either loose or on pallets, and container vessels with mixed commodities carried in standard marine containers that are sealed at origin and delivered unopened to the consignee (unless inspected). Most vessels have crews of about 20, with more on older vessels and vessels with more onboard equipment and fewer on vessels with expensive U.S. crews.

  • Service type. The majority of liquid and dry bulk vessels operate on irregular schedules and have itineraries between a single origin and destination port, often on a voyage charter basis (i.e., a vessel is leased for a limited number of voyages). Liner services (including most container services and some single-commodity trades, such as fruit) serve multiple shippers and use a rotation of vessels on a fixed-day schedule between selected ports in the United States and a single world area.7 Nonliner services, mostly limited to minor U.S. trade routes or certain commodity types, offer service between a general range of ports on a variable schedule, often calling on an inducement basis (i.e., based on a single shipper).

  • Cargo handling. Port activities are determined by the type of vessel and commodity. Vessels typically must use a designated terminal, often waiting at anchorage until a berth is available. Tankers and dry bulk vessels use bulk terminals that have free-flow equipment to quickly discharge cargoes into large tanks, grain elevators, or even open areas. These are often private terminals owned and operated by a single company and may be part of an industrial facility (e.g., a petrochemical plant). Most container vessels, particularly on the major East-West trades, use container terminals with large cranes for transferring containers to storage yards or directly to rail or truck. These terminals may be operated by an ocean carrier or a third party, possibly the port itself. General cargo vessels (including automobile vessels) use general cargo terminals that have cranes and ramps to lift or roll cargo to a warehouse or storage area. These terminals may be designated for a

7  

The exceptions are round-the-world services that combine multiple trade routes in a single voyage, typically to avoid operating both ways in an imbalanced trade.

Suggested Citation:"Appendix D: Commissioned Paper on US Seaports and the CDC Quarantine Station System." Institute of Medicine. 2006. Quarantine Stations at Ports of Entry: Protecting the Public's Health. Washington, DC: The National Academies Press. doi: 10.17226/11435.
×

particular commodity (e.g., coffee or bananas) and are often owned by the port because of the diversity of carriers and commodities.

The key factors relevant to the QSS include:

  • Commodities handled (in terms of being a threat).

  • Foreign ports of call (in terms of period of incubation during the voyage, contagious crew, or possible introduction of illegal substances).

  • Length and location of U.S. port of call (in terms of ability to inspect and identify threats).

Foreign-Origin Vessel Activity

All vessels entering a port require crew to operate at sea and in port, typically designated as officers, engine room, deck, and steward. Cargo vessels carry crew only for en route operations, using stevedores and longshoremen for cargo handling in port. Most cargo vessel crews are foreign; European or even American officers are usually coupled with crews from Third World countries. 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.

  • Vessels calling for repairs, supplies, or inspection.

  • Foreign military and other government vessels.

  • Offshore oil-rig transfer vessels.

  • Illegal alien or refugee vessels.

To the extent that individuals disembark these vessels, they interact with the QSS in ways similar to those of persons from cargo or passenger vessels. Any significant issues specific to these vessel types will be discussed in later sections.

The key factors relative to the QSS are the size and composition of the crew, the living conditions, the voyage length, and the location of origin ports. In addition to possible threats associated with vessel crews, there is a threat associated with the vessel itself. In an example provided below, cholera was arriving from South America in vessels’ ballast water (water carried in the vessel hold).

Similarities to and Differences from Airport Environments

A primary objective of this paper is to explore how the seaport environment for the QSS differs from the airport or land port environment. In

Suggested Citation:"Appendix D: Commissioned Paper on US Seaports and the CDC Quarantine Station System." Institute of Medicine. 2006. Quarantine Stations at Ports of Entry: Protecting the Public's Health. Washington, DC: The National Academies Press. doi: 10.17226/11435.
×

many respects, there are common elements that would apply regardless of how a particular person or commodity enters the country. No particular difference in the scope of infectious diseases is based on the type of port, other than that each type (or a specific port) deals with a unique mix of foreign origins and types of passengers or cargo, which thereby determines a port’s “sources” and level of threats.

The general procedures for identifying and responding to particular threats should be common to all situations regardless of whether they are of foreign origin and regardless of which type of port is involved. The primary differences are based on the physical environment in which activities occur and the entities that must be dealt with. One difference is that there are no QSS stations at seaports; each seaport is covered by an airport facility as a subport. In reality, this is of minor significance to this study because there is little difference between handling a remote airport and handling a remote seaport. The problems of distance and access do not differ by environment.

The following contrasts in general terms the seaport environment with the airport environment, where all the current stations are:

  • The number of seaports that handle significant amounts of import cargo is significantly higher than the number of airports that do so. In the case of airports, the top international gateways (New York, Chicago, Los Angeles, and Miami) handle the vast majority of inbound activity; secondary gateways have few daily flights. The QSS stations must handle a wider geographic range of ports, each with a unique profile.

  • Seaports handle much more diversified import cargo activities than airports, which mostly handle containerized cargoes on a small number of passenger aircraft and all cargo aircraft. Major ports handle a variety of bulk, container, and general cargo vessels at public and private terminals on either a scheduled or irregular basis. Even small ports can handle a wide range of vessels and cargoes, often on a single-voyage or irregular basis.

  • Most air cargoes have high value and are treated as such; many ocean cargoes are of low value and are moving to fill backhaul capacity (e.g., used tires or waste paper). Vessel crews, the majority of which in U.S. trades are now foreign, typically include low-paid deck crew from Third World countries who don’t speak English. The living conditions (and points of origin) of vessel crews can’t match those of an airplane and must be experienced for many weeks. Crew changes can occur en route during an ocean voyage.

  • 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. A cruise vessel’s crew can exceed 1,000, whereas a cargo vessel’s typically is 20 or more. Cargo vessels discharge hundreds of thousands of tons compared

Suggested Citation:"Appendix D: Commissioned Paper on US Seaports and the CDC Quarantine Station System." Institute of Medicine. 2006. Quarantine Stations at Ports of Entry: Protecting the Public's Health. Washington, DC: The National Academies Press. doi: 10.17226/11435.
×

with hundreds of thousands of pounds for all-cargo aircraft. The new megacontainerships will discharge several thousand containers at a port compared with dozens of much smaller containers at an airport. A refrigerated ship will discharge several hundred truckloads of bananas compared with a single pallet of fruit (if that) at an airport.

  • Ports are much more “open” environments than airports, which have a distinct area “within the fence.” Many ports cover large waterfront areas, some of which may have private facilities on private property, often covered by the owner’s security and having private gates. There is no fence protecting the wharves on the waterfront side and there may be harbor access by personal and other noncommercial vessels.8

  • The nature of an ocean voyage results in some unique sources of threats, including stowaways and illegal aliens or refugees. In terms of the QSS, the relatively long sea trips (10-20 days from China to New York) allow for more preparation and evaluation, but they can also result in en route contamination of cargo or the incubation of disease in crews. Vessels can stop at a number of foreign ports during a voyage, including some that are unscheduled. While vessels are required to give notice of arrival, arrival times can vary widely (compared with those of airlines), affecting the ability to schedule inspections. And vessels are often detained for several days for a variety of reasons.

  • A vessel may be held outside a port for some time, during which interactions with shore-based personnel can occur.

In terms of the specific environment for the QSS, the most significant differences involve the entities that must be dealt with in surveillance and response. Whereas the Federal Aviation Administration (FAA) is responsible for aircraft landing at airports, inbound vessels are regulated and controlled mostly by USCG, which deals with the vast array of vessels and operating patterns. In terms of federal “partners” for surveillance, the agencies operating at airports (e.g., DHS) have the same responsibilities at seaports and additional responsibilities for vessel inspection and safety handled by CDC and USCG. 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.

A primary difference involves the authorities that own or operate ports and airports and the industries or public entities involved in port opera-

8  

Since 9/11, there has been a significant increase in port security, including policing of private terminal gates and designation of harbor and port areas that are off limits to the public.

Suggested Citation:"Appendix D: Commissioned Paper on US Seaports and the CDC Quarantine Station System." Institute of Medicine. 2006. Quarantine Stations at Ports of Entry: Protecting the Public's Health. Washington, DC: The National Academies Press. doi: 10.17226/11435.
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tions. Like airports, port authorities are typically public or quasipublic (e.g., an independent nongovernment group appointed by public officials). Public ports can be run by cities, countries, states, or regional groups, sometimes combining multiple ports under a single authority. (Some port authorities combine airports and ports under a single authority, although each is managed separately.) Although airports often have private facilities, the scope of private and public activities at ports affects their operations more significantly. Some ports are “landlord” ports that only administer the port and lease land to private operations, as opposed to “operating” ports that own and operate public terminals and hence are more involved with port operations. This affects the ability of the QSS to design standard systems to deal with widely divergent port structures, particularly in gaining access to port facilities and wharf areas and interacting with the “port industry” through the port authority.

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. Cargo handling (and other services) may occur at a public or private terminal, the latter are operated by a major carrier or a third party. Cruise lines follow patterns similar to those of cargo vessels but may conduct more activities in house wherever a vessel is “home-ported” (e.g., its primary port of U.S. embarkation), particularly when multiple vessels or day cruises are involved.

Again, the general functions of port operations for persons and cargo are not significantly different from those of an airport, but the vast variety and irregularity affect the ability to design standard systems to monitor and interact with them. The next section describes the general structure of the QSS as it applies as seaports.

CURRENT OPERATING ENVIRONMENT OF CDC QSS AT SEAPORTS

Coverage of U.S. Seaports by QSS

The QSS stations are all at airports but have seaport responsibilities that can span multiple coasts (including offshore) and combine a vast vari-

9  

Some operations by international airlines may be contracted to a third party at some airports, but operations are generally limited to one or two fixed based operators and single daily flights.

Suggested Citation:"Appendix D: Commissioned Paper on US Seaports and the CDC Quarantine Station System." Institute of Medicine. 2006. Quarantine Stations at Ports of Entry: Protecting the Public's Health. Washington, DC: The National Academies Press. doi: 10.17226/11435.
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ety of activities. A port’s activity profile is dictated primarily by its location relative to domestic and international markets. Cruise ports provide good access to both desirable destination markets (i.e., they are reachable within limited voyage time) and U.S. population centers; some variation is based on seasonal markets and the desire to have embarkation points closer to major U.S. cities. Cargo ports for imports provide efficient links between foreign-origin markets and U.S. consumption points, which include major metropolitan areas for consumer products or industrial facilities for base or intermediate commodities. The QSS must cover over a 100 U.S. ports that handle import cargo, including 50 that handled containerized cargo in 2003 and over 20 with cruise line operations. The U.S. seaport coverage by quarantine stations is summarized in Table D.3.

The general role of the ports in each port range can summarized as follows:

  • Atlanta (South Atlantic and East Gulf): Gulf ports typically involve industrial bulk cargo activity in support of petroleum and chemical production and transfer of bulk commodities to the Mississippi River barge system. Charleston and Savannah are the top container ports for the south-eastern United States and are excellent gateways to the U.S. Southeast for East-West trade (e.g., U.S.-Europe and U.S.-Asia). New Orleans is the primary East Gulf container port for general cargoes, and Gulfport is a regional import center for containerized bananas and other fruit. Wilmington (NC), Mobile, and Lake Charles handle containers mostly for local markets. New Orleans is the only significant cruise port.

  • Chicago (Great Lakes): Because of long travel distances required to reach ocean trade lanes, the U.S. Great Lakes ports are mostly limited to bulk commodities destined for local industrial facilities. (The Port of Montreal does handle containers for the U.S. Midwest, based on good rail connections.) There are 20 Great Lakes ports in the top 100 U.S. import ports (as measured by weight), many of which are dedicated to a single commodity or terminal. Cruise lines operate on the Great Lakes during the summer, but they mostly call at other Great Lakes ports if at all (beyond the origin port).

  • Honolulu (Hawaii): Hawaiian ports serve the local Hawaii market including U.S. domestic and foreign cargo and cruise services. (The Hawaii station was not covered in the interviews because of the difficulty of telephone contact.)

  • Los Angeles (Southern California and Texas Gulf): The station located at LAX airport covers both Southern California and Texas Gulf ports. The Ports of Los Angeles and Long Beach are the largest U.S. container ports, serving both the large local market and inland markets via rail and truck intermodal services. The Port of Houston is the largest West Gulf

Suggested Citation:"Appendix D: Commissioned Paper on US Seaports and the CDC Quarantine Station System." Institute of Medicine. 2006. Quarantine Stations at Ports of Entry: Protecting the Public's Health. Washington, DC: The National Academies Press. doi: 10.17226/11435.
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TABLE D.3 Seaport Coverage by CDC Quarantine Station

Station Location

Geographic Coverage

Cruise

Container

General Cargo

Atlanta

South Atlantic (excluding Florida)

East Gulf (to Texas)

New Orleans (9)

Charleston (6)

Savannah (9)

So. Louisiana Pt. (7)

Lake Charles (9)

Chicago

Great Lakes

Minor seasonal

Minor via U.S. ports

Toledo (38)

Detroit (42)

Honolulu

Hawaii

Not originating location

Honolulu (13)

Kahului (26)

Honolulu (34)

Barbers Pt. (51)

Los Angeles

Southern California

Texas

Los Angeles (6)

Galveston (7)

Long Beach (9)

Los Angeles (1)

Long Beach (2)

Houston (11)

Houston (1)

Beaumont (2)

Long Beach (6)

Miami

Florida, Puerto Rico, U.S. Virgin Islands

Miami (1)

Port Everglades (2)

San Juan (7)

Miami (12)

Jacksonville (26)

Tampa (27)

New York

North Atlantic (to Virginia)

New York (4)

Boston (14)

New York (3)

Hampton Rds. (8)

Port of New York/New Jersey (2)

Portland, Maine (10)

San Francisco

Northern California

San Francisco (16)

Oakland (4)

San Francisco (38)

Richmond (25)

Oakland (39)

Seattle

Pacific Northwest

Alaska

Seattle (11)

Seward (12)

Tacoma (5)

Seattle (10)

Seattle (30)

Tacoma (32)

 

SOURCES: Tables D.2, D.5, and D.6.

Suggested Citation:"Appendix D: Commissioned Paper on US Seaports and the CDC Quarantine Station System." Institute of Medicine. 2006. Quarantine Stations at Ports of Entry: Protecting the Public's Health. Washington, DC: The National Academies Press. doi: 10.17226/11435.
×

container port serving the Texas and Oklahoma markets. Houston is the world’s largest petrochemical center and generates a significant amount of foreign bulk cargo in both directions. Other West Gulf ports generate similar flows of industrial stock commodities, as do Los Angeles and Long Beach. San Diego and Port Hueneme are “niche” ports in Southern California, specializing in fruit and automobile imports. Los Angeles is the largest West Coast cruise port serving both Mexican and Hawaiian destinations, although Galveston, Long Beach, and San Diego have emerged as new embarkation points.

  • Miami (Florida, Puerto Rico, and U.S. Virgin Islands): The Port of Miami, like Miami Airport, is the cargo gateway to Latin America for both containerized and general cargo. Miami has also been the leading cruise port for many years, although other ports have worked to attract this market. Port Everglades is a competing port for both container and cruise business, and Jacksonville and Tampa are the top bulk ports. 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. Virgin Islands.

  • New York (North Atlantic): The station at JFK international airport covers an area reaching from Maine to North Carolina, including ports of many sizes and activities. The Port of New York and New Jersey encompasses six terminal locations serving a wide range of cruise and cargo needs for the large New York metropolitan markets and inland destinations. Philadelphia, Baltimore, and Hampton Roads are all large international container ports and also serve other local needs, and smaller container operations are at Boston (based on barge transfers from New York), Wilmington (bananas and other fruit), Richmond, Portland (ME), and Albany. New York is the top cruise port offering seasonal voyages (mostly to Bermuda), and Boston, Philadelphia, Baltimore, and even Alexandria (VA) also offer some summer departures. The New York harbor includes a number of petroleum and chemical terminals that attract bulk commodities, as do 20 other ports in the station’s range.

  • San Francisco (Northern California): The San Francisco station covers the Ports of San Francisco and Oakland and other ports of San Francisco Bay and on the waterway all the way to Sacramento, which serves the central California agricultural markets, mostly outbound. Oakland is the primary container port serving both local and inland intermodal markets. San Francisco is the only cruise port providing U.S. and Canadian coastal services and serving as a port of call for cruises originating elsewhere. The San Francisco harbor contains a number of bulk terminals.

  • Seattle (Pacific Northwest and Alaska): The Ports of Seattle and Tacoma are major U.S. container ports serving both the local and inland

Suggested Citation:"Appendix D: Commissioned Paper on US Seaports and the CDC Quarantine Station System." Institute of Medicine. 2006. Quarantine Stations at Ports of Entry: Protecting the Public's Health. Washington, DC: The National Academies Press. doi: 10.17226/11435.
×

intermodal markets; they are the U.S. North American ports closest to Asia. Portland is also a major container port, and Anchorage handles U.S. origin and destination containers for the local market. Seattle and Seward are the top originating cruise ports for U.S.-Alaska services, but other ports, such as Bellingham, provide ferry services to Canada. The primary bulk terminals are at Seattle, Tacoma, and Portland, but a number of terminals are at smaller ports on the Oregon coast, the Columbia River, and Puget Sound.

General Overview of QSS Operations at Seaports

The QSS stations are responsible for surveillance of and response to infectious disease threats that might enter U.S. seaports via persons, cargo, or related transportation equipment or packaging (e.g., pallets). The following general information about the current system was developed from interviews with QSS personnel and members of their “partner” agencies and a review of secondary sources describing the agencies. The location of all QSS stations at airports and the manpower available to cover a wide geographic region require that most seaport activity must be conducted with surrogate agencies that have an active presence at the “subports” (i.e., airports or ports that don’t have colocated stations). These partners are summarized in Table D.4.

The general activities required by the QSS include surveillance of and response to threats. Surveillance involves identifying what the threats are (or may be) and then identifying specific threats by inspection or other means. Response activities include analyzing and isolating a threat, devising a strategy to deal with a specific incident (including possible exposure of other persons), monitoring the threat, and possibly devising a long-term strategy or policy.

The following summarizes the general role of each partner in the QSS:

  • CDC: The primary responsibility for keeping the specified threats from entering via a specific U.S. port resides with the QSS stations. The QSS headquarters in Atlanta is responsible for assisting the individual stations; facilitating the flow of information to, from, and between stations; specifying and analyzing threats; and training CBP personnel (according to one respondent). The VSP is responsible for dealing with gastrointestinal illness on cruise vessels calling at the U.S. ports. The VSP cooperates with and assists QSS with cruise-related incidents (and vice versa).

  • DHS: DHS now incorporates most of the inspection functions related to foreign-origin persons, cargoes, and vessels. 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) (formerly in USDA), and ves-

Suggested Citation:"Appendix D: Commissioned Paper on US Seaports and the CDC Quarantine Station System." Institute of Medicine. 2006. Quarantine Stations at Ports of Entry: Protecting the Public's Health. Washington, DC: The National Academies Press. doi: 10.17226/11435.
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TABLE D.4 Partners in CDC Quarantine Station System at Seaports

 

Persons

Cargo

CDC

Quarantine Station System

S, Ra

S, R

Vessel Sanitation Program

S

 

Headquarters

S, R

S, R

Department of Homeland Security

U.S. Customs and Border Protection

 

S

U.S. 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. Department of Agriculture

 

S, R

U.S. Fish and Wildlife Service

S

Food and Drug Administration

S, R

National Marines Fisheries

S, R

Port sector

Port authority

S, R

S, R

Ocean carrier

S, R

S, R

Port services

S, R

S, R

Health sector

Local and regional hospitals

S, R

 

Local and state health agencies

S, R

aS = Surveillance; R = Response

sels entering U.S. ports by USCG. In the interviews, most people generally referred to all the agencies as “CBP” except for USCG—a convention that will be used in the discussion.

  • Other federal agencies: In their various regulatory roles, certain agencies operate at seaports and may identify situations requiring QSS intervention and act cooperatively or provide support. USDA, in its general role of protecting U.S. agriculture, operates quarantine and veterinary services at ports, as well as maintaining overseas surveillance. FDA is responsible for protecting the U.S. food and drug supply from foreign threats, and U.S. Fish and Wildlife and National Marine Fisheries operate at ports mostly to prevent importation of restricted wildlife or marine animals.

  • Port sector: The primary role that the port sector has in this system is in identifying threats (particularly sick passengers or crew) and cooperating to deal with them.

  • Health sector: The primary role of the health sector is to provide support in evaluating, analyzing, and treating incidents where QSS personnel are not available; working with QSS to prevent exposure; and identify-

Suggested Citation:"Appendix D: Commissioned Paper on US Seaports and the CDC Quarantine Station System." Institute of Medicine. 2006. Quarantine Stations at Ports of Entry: Protecting the Public's Health. Washington, DC: The National Academies Press. doi: 10.17226/11435.
×

ing postvoyage threats that become manifest through contacts with local hospitals or doctors.

General Comments on Overall System

As stated above, the general scope of threats covered by seaports is very similar to that of airports, although on a more limited scale for passenger operations (because volumes from problem countries are lower), and for cargo activity (because levels of live “problem” animals are lower). The overall impression gained from the interviews was that the QSS has a very limited profile at individual seaports, even where the station is at a local airport. Very few chronic incidents have had to be dealt with in recent years (as reported by QSS staff), so there has been little direct contact with port-level partners by QSS and much less with the general port and health sectors. The main exceptions appear to result from areas where interaction on airport issues also covers nearby seaports.

In recent times, the only exception was the SARS crisis, which resulted in some training and local concerns over possible infection of ship pilots, longshoremen, and federal partner personnel. A higher level of interaction between the QSS and the ports was reported, but it was not uniform. (A CBP officer at a West Coast port that would have had substantial traffic from problem areas reported that not much happened at that port.)

A primary conclusion that resulted from the interviews was that the current system is ad hoc and incident-driven, mostly because there have been few notable incidents at just a few seaports and no chronic ones. A general impression was that the stations were stretched just to cover airport responsibilities, let alone expand their port activities, particularly without any evident threats. Low staffing affects the ability to deal with multiple or off-hour incidents, particularly in an environment with no consistent peaks. Ports or port ranges having a dominant type of activity may limit coverage of secondary activities (e.g., cruise vs. cargo, or container vs. breakbulk). A general disadvantage of not having a local presence is the inability to conduct regular training or to react faster, particularly during off hours.

General Comments on Surveillance

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 (e.g., via headquarters). There are a variety of ways that a threat could be communicated to the QSS. Each station must notify headquarters of all incidents of significance, and they are then reported in the Daily Incident Report and reviewed by all stations. High-level threats may result in direct contact between stations. A local health agency might con-

Suggested Citation:"Appendix D: Commissioned Paper on US Seaports and the CDC Quarantine Station System." Institute of Medicine. 2006. Quarantine Stations at Ports of Entry: Protecting the Public's Health. Washington, DC: The National Academies Press. doi: 10.17226/11435.
×

tact headquarters about a patient who had disembarked from a station’s port, and information might be communicated to the local station.

Similarly, other federal agencies, many of which have much higher staffing at subports, may identify a situation in the course of their own duties and communicate it to the local quarantine station. Several of the respondents referred to the service as “public health” and summarized the program by saying that they would call public health if there were a suspicion of infectious disease, often because of concerns for industry or agency personnel. A primary source of information on sick or dead persons aboard ship are the vessels themselves, either directly or via a ship agent or other carrier representative. There may be multiple sources identifying threats, but the low level of incidents suggested that there may be gaps in the system; at the very least, the protocols for notification may not be standardized unless there is a specific concern.

The “general” problem most frequently mentioned by QSS personnel (and somewhat reinforced by the lack of awareness at subports) was that the lack of personnel and funds limited personal interactions (“face time”) and training of partners at the subport level. There is a great imbalance between QSS’s staffing and that of its agency partners. It is difficult to maintain personal relationships because of high turnover or rotations of personnel (e.g., every 1-2 years for USCG) and the sheer size of some agencies (e.g., CBP has hundreds of employees at certain ports). One QSS contact said he/she tried to visit every subport at least once per year; others indicated that they didn’t have the time, manpower, or money to visit any. 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. Different ports having different access standards and private terminals may have different rules for getting on-site when necessary (e.g., some require a port badge, and others require being on a list or contacting the ship agent or CBP).

There was a general sense that stations needed to become more involved with general security efforts at the port level, but again, each port has a different structure and set of players. Some of the stations maintained relationships with local port groups (e.g., security committees), but it was typically only for the port near the station or the largest covered port for a station.

General Comments on Response

A response to an incident is based on several factors: level of threat, timing, location, and involved partners. The level of threat dictates the type of response, and other factors will determine the extent to which a “joint

Suggested Citation:"Appendix D: Commissioned Paper on US Seaports and the CDC Quarantine Station System." Institute of Medicine. 2006. Quarantine Stations at Ports of Entry: Protecting the Public's Health. Washington, DC: The National Academies Press. doi: 10.17226/11435.
×

response” is used, as opposed to a primarily CDC response. Timing and location (relative to the station location) are constraints that must be dealt with. Several contacts noted that it may take a long time just to get to various parts of a single port, let alone to a port that is far from the airport station. The QSS, often in consultation with headquarters and other partners, will evaluate, provide guidance, and resolve situations.

A station might also have a postincident diagnostic or policy role. For example, there were indications that South American cholera was entering the country via ships. In cooperation with other agencies (including vessel inspections), it was concluded that the disease was being carried in the ship’s ballast (water carried for weight), which resulted in a requirement that ballast water be flushed three times before U.S. port entry. (It was unclear whether this was accomplished at the local level or at headquarters.)

The role of local and state health authorities and providers appeared no different from what would apply for nonlocal airports. The QSS mostly depends on local and state health personnel to deal directly with illness. They can’t get to all points in a timely fashion, sometimes not even for a local port. Until recently, some stations did not have the expertise of medical officers. Local or state health authorities appear to respond easily when called, based on their responsibility once a threat clears the port. One respondent indicated having boarded vessels in the past with no problems.

One QSS respondent noted that a key role of the QSS is to provide an understanding of seaport operations not available to local health personnel. For example, one station noted that familiarity with crew positions may be useful in identifying on-board contact situations or in diagnosing a problem.

General Comments on Protocols and Communications and on Potential Gaps

A general impression was that the ad hoc identification procedures used for infrequent incidents leads to inconsistent responses. One QSS contact was concerned that national-level contact with CBP may not filter down to the local level. Most communication was said to occur by telephone, probably because of the infrequency of incidents. Two respondents indicated that when multiple parts of CDC (or other agencies) 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). This was characterized as an unwillingness of the federal agencies to share information on a timely basis.

One respondent noted that local (or state) health agencies technically do not have jurisdiction at international ports (or airports), although they have responsibility once a person or cargo leaves the port. It has not been a

Suggested Citation:"Appendix D: Commissioned Paper on US Seaports and the CDC Quarantine Station System." Institute of Medicine. 2006. Quarantine Stations at Ports of Entry: Protecting the Public's Health. Washington, DC: The National Academies Press. doi: 10.17226/11435.
×

problem, but the lack of formal protocols and agreements in a crisis situation might pose a problem, although there have been draft protocols in the past and one local health agency indicated it was working on a generic protocol with CDC. One concern was that it was unclear whether anyone could hold a ship thought to be a threat.

The participation in industry and multiagency forums where ideas could be exchanged varied by station, but there was a sense that this might be appropriate for an expanded system. Some stations met regularly with groups of related port agencies, first responders, and local and state health participants. It depended mostly on the location of the port, particularly if the airport had a port partner. One station suggested protocols to increase “face time” with federal and military partners.

CDC QSS AT SEAPORTS: PASSENGER AND CREW TRANSPORTATION

General Overview

The primary source of threats was thought to be vessel crews because they are more likely to get sick as a result of cramped living quarters. Cargo-vessel crews are more likely to get sick than cruise-vessel crews, which have better crew conditions and more scrutiny of sanitation and are required to have a medical officer on board. Cargo vessels are also more likely to originate in ports that have infection problems.

An associated problem is that cruise passengers often purchase restricted items overseas (knowingly or unknowingly), but that is covered under CBP clearance procedures for passengers. Similarly, illegal aliens and stowaways may present special problems or increased threats but similarly are handled with general procedures.

A central point made by many of the respondents was that the primary reason to call “public health” was not regulatory, but rather a concern by agency or industry personnel about personal exposure to infectious people. The following describes the roles, protocols, and communications for each of the partners in surveillance of and response to passenger and crew threats.

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. By international health regulations, ships are responsible for contacting a port of entry with “quarantinable” illnesses, even if just sitting at anchorage (i.e., moored in a harbor). There was some dispute as to how this

Suggested Citation:"Appendix D: Commissioned Paper on US Seaports and the CDC Quarantine Station System." Institute of Medicine. 2006. Quarantine Stations at Ports of Entry: Protecting the Public's Health. Washington, DC: The National Academies Press. doi: 10.17226/11435.
×

works; others cited USCG or CBP requirements. Some respondents thought it worked well and that the stations worked in primary ports to keep vessel operators and their agents informed; another station said only the old-timers who remember the 1960s were vigilant. One respondent noted that the shipping industry may be reluctant to accept additional security and scrutiny beyond what has occurred after 9/11.

In practice, the contact with the QSS is usually made by the ship agent unless there are local carrier personnel. The ship agents are responsible for reminding captains (via “Dear Captain” letters) of their responsibilities. A possible shortfall in this system is that it depends on captains knowing exactly what to report and to whom.

Cruise vessels are more likely to report incidents because they deal with the same set of ports over time and are more sensitive to infectious persons. Cruise ships (with 13 or more passengers) are required to have a medical officer on board and have strict guidelines for reporting gastrointestinal illnesses to the CDC’s VSP, which monitors medical records and procedures very closely. An incident on a cruise vessel might be reported directly from the ship or by a ship agent but more likely by the cruise line’s crew or passenger medical consultant at its home office.

There was some dispute as to whether sick crew needed to be reported in the “Notice of Arrival” that is required to be filed with USCG 96 hours before entry at a U.S. port.

In reality, vessel operators and crews are likely to be responsible with regard to possibly infectious individuals. Most operators (and their crews) don’t like it when crew members are sick or take medication on board, and they are generally good at isolating crew on board. The responsibility for dealing with specific on-board situations will differ significantly by type of ship and trade route (beyond its being ultimately the captain’s responsibility). Major container lines may handle medical situations at sea via corporate headquarters, and small single-voyage vessels may be the responsibility of a ship agent at a destination port. (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.

Suggested Citation:"Appendix D: Commissioned Paper on US Seaports and the CDC Quarantine Station System." Institute of Medicine. 2006. Quarantine Stations at Ports of Entry: Protecting the Public's Health. Washington, DC: The National Academies Press. doi: 10.17226/11435.
×
  • Headquarters: Provides support to stations by identifying and communicating threat information, assisting in a response with specialists and consultation, interacting with foreign governments, providing general training to partners at a national level, and dealing with issues concerning illegals and refugees.

  • VSP: Responsible for all gastrointestinal diseases on board cruise vessels and works cooperatively with QSS at the local port level.

The QSS stations, which in the past may have had only one or two people, depend on the various partners to fulfill their roles. During the SARS crisis, some ports reported a more active and visible role, particularly in training, although some did not indicate any significant difference. The role of the station varied by port as dictated by staffing and the location of problems. One station indicated that it might board vessels routinely (twice per week) to remind ship personnel about medical log requirements (although this may have been a VSP role). Others reported very little involvement with the seaports, particular if cruise activity was limited.

As with surveillance, the QSS role in responding to specific threats varies by location and circumstance. One station indicated that it might directly board vessels to evaluate a situation before other personnel, but only if at the local port.

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. Another station said that it had no formal MOAs but maintained a database of health officers to contact at various subports. One station emphasized that the appropriate health agency to contact will vary by port (or airport) with some smaller ports covered by state agencies, while ports in large metropolitan areas might have a range of options.

It is unclear whether one of QSS’s response roles is to notify other partners about infectious conditions, particularly if the information is received from another agency. This was a problem at one port where one of the partners was not informed by the agency that informed the station and was upset when they met the ship.

One station indicated that it conducts some of VSP’s functions at local ports that have limited cruise operations; another indicated that it might be asked to clear crew members before they return to ship.

For diagnostic purposes or to identify previous contacts, the QSS will request itinerary and crew list information from the vessel and may also monitor a patient’s status with scanned pictures. (It is unclear whether USCG provides some of this information.) One of the partners noted that there is no standard method for releasing crew and passenger information

Suggested Citation:"Appendix D: Commissioned Paper on US Seaports and the CDC Quarantine Station System." Institute of Medicine. 2006. Quarantine Stations at Ports of Entry: Protecting the Public's Health. Washington, DC: The National Academies Press. doi: 10.17226/11435.
×

that may be deemed personal and sensitive (that is also true for airports). A formal agreement might assist in identifying past contacts.

The relative infrequency of ad hoc incidents dictates the structure of the current response system; one station said that a more widespread problem might require a more comprehensive program. With respect to protocols for a suspected or identified threat, one station reported that it keeps everyone on-board until someone can arrive on board for an evaluation and determine whether others can disembark (after providing a “locater code” for future contact). In some cases, it uses paramedics to help in the initial response (at distant ports or during off hours) and evaluation, and it might also transport an ill or dead person.

All incidents are reported to headquarters and distributed in the Daily Activity Report, although one station indicated that an imminent threat might require direct station-to-station contact. Most communications are by telephone, although fax and e-mail were also mentioned; this contrasts with USCG’s report of a constant flow of e-mail for its vessel tracking system.

CDC’s VSP “protects passenger and crew health by minimizing the risk of gastrointestinal illness aboard cruise ships.” VSP accomplishes this mission through sanitation inspections, disease surveillance and investigations, on-site inspections of ship construction and renovation, and review of construction plans for new ships. VSP also trains crew in proper public health techniques, including food handling and preparation, drinkable-water system management, and pool and spa operation and maintenance”(source: www.cdc.gov/nceh/vsp/).

The VSP has a much larger presence in the major cruise ports (including an office in Fort Lauderdale) and much greater contact with the vessel and shore personnel. The VSP is paid for its inspection services and is self-supporting and well staffed. The primary surveillance role in regard to QSS for the VSP would be to identify nongastrointestinal cases that are reported to it (or that it is otherwise made aware of). It might also be called to respond to a vessel if QSS staff are unavailable and could cooperate in diagnosing a problem and developing a response (based on familiarity with medical officers, facilities, and recordkeeping).

CBP (Immigration Services)

In general, the immigration personnel of CBP are the “eyes and ears” of QSS at local ports. They indicated that they would be the first point of contact to identify problems with illness or death onboard in that the vessel (or its agent) must contact them to clear all passengers and crew. They have access to USCG’s vessel monitoring data, but it is unclear how the data are used.

Suggested Citation:"Appendix D: Commissioned Paper on US Seaports and the CDC Quarantine Station System." Institute of Medicine. 2006. Quarantine Stations at Ports of Entry: Protecting the Public's Health. Washington, DC: The National Academies Press. doi: 10.17226/11435.
×

It is unclear whether sick passengers or crew have to be reported to the CBP. One shipping-industry respondent noted that CBP had a space on the “1300 or 1301 form” that requested information regarding any sick crew on-board but that it is no longer requested on the new forms. Some CBP respondents said they routinely ask about sick crew members, but it was not consistently referred to.

The likelihood that CBP personnel visually identified sick persons varied in the stations’ responses. One station noted that cruise-passenger clearance was a “cattle call” and another noted that the same level of scrutiny is not applied at ports as at airports.

The primary response role of CBP is to detain and refuse entry to persons suspected of being infected, presumably at the direction of the QSS.

The level of training provided to CBP was of particular concern to the stations. Local training may be inadequate and possibly not related to the level of activity or threat (e.g., done only in low-incident or low-volume areas or for local area ports). Headquarters provides general training at CBP’s national training center, but the high number of port personnel and frequent turnover make it difficult to maintain any consistent communications between CBP and the QSS at the local level.

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.

USCG

USCG has a number of responsibilities in clearing a vessel to enter a port safely, including determining the adequacy and safety of manning, equipment, and the vessel itself, as well as checking whether that voyage documentation is complete and accurate. At a national level, the Ship Arrival Notification System and the NVMC together serve as a clearinghouse for the Notice of Arrival (NOA), a form that is required for all vessels arriving from a foreign port. The NOA provides information on the vessel’s itinerary, any hazardous cargoes, and crew and passengers, including name, birth date, nationality, crew position, and where embarked.

The NVMC reviews the NOAs for completeness and makes them available on a USCG database that can be accessed from all ports of call by the captain of the port or CBP. Before 9/11, ships were required to notify the USCG’s local Marine Safety Office (MSO) or the captain of the port within 24 hours of arrival time. Now, they must notify the NVMC within 96 hours of arrival at the first U.S. port and provide more information on crew and noncrew persons.

There was a great discrepancy in whether crew illness is reported through this system and, if so, whether it is reported to CDC or the local

Suggested Citation:"Appendix D: Commissioned Paper on US Seaports and the CDC Quarantine Station System." Institute of Medicine. 2006. Quarantine Stations at Ports of Entry: Protecting the Public's Health. Washington, DC: The National Academies Press. doi: 10.17226/11435.
×

station. One USCG respondent referred to a “statement of no SARS” as a part of the NOA, but that might have been a temporary measure. 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.

The NVMC indicated that it does not “process” crew-illness information, but if it is reported (although not required), it is attached to the NOA record for the local port’s use; it also noted the local MSO would not process it either.

At the local port level, the MSO conducts random inspections (under different responsibilities) of vessels guided by certain risk factors and the availability of vessel information. One MSO respondent thought that there was an item on the NOA about sick crew, although it is not on the standard form. It would be of importance to USCG only if sickness of a crew member results in substandard manning levels or if there were concern about boarding a vessel.

An MSO respondent indicated that in some cases, USCG may hold a ship at anchorage with an infectious-disease threat (perhaps under direction of the QSS) and wait out the incubation period. The respondent also indicated that the USCG has a doctor on staff that could assist with a response.10 Most crew notifications involve injuries, not illness, and one respondent indicated that calls to CDC are infrequent.

The relationship with USCG as reported by the QSS differed significantly. One station indicated that the MSO had first responsibility for onboard illness or death, that the operations manual provides questions to ask regarding health issues, and that vessels had to make health declarations. USCG can hold a vessel at anchorage, and one station reported that during SARS, it provided on-site surveillance of symptomatic persons.

Unlike CBP, CDC does not train USCG personnel at a national level, and local contacts and knowledge are difficult with personnel rotations every 1½ -2 years. One QSS contact suggested more frequent meetings and training for USCG.

The NVMC is looking to integrate all the information reported for Immigration, Customs, and USCG; this would provide a single point of contact for vessel reporting. Perhaps CDC can get access or provide data to this expanded system.

10  

The USCG medical staff deal primarily with USCG personnel and port or vessel injuries, which are the primary health problems at ports.

Suggested Citation:"Appendix D: Commissioned Paper on US Seaports and the CDC Quarantine Station System." Institute of Medicine. 2006. Quarantine Stations at Ports of Entry: Protecting the Public's Health. Washington, DC: The National Academies Press. doi: 10.17226/11435.
×
Port Industry (Port Authority and Vessel Services)

The primary role of the general port sector, other than the vessel operator itself, is to identify any health risks encountered in the course of general business. It is more likely that it would contact CDC (or more likely USCG) to determine whether it is safe to board a vessel. When the SARS epidemic first came out there was a period of time when the pilots requested specific information from the vessels, such as whether they had been to a port that was designated as a high-risk area or whether any crew on board had been diagnosed with SARS. One QSS contact commented that the QSS had a role in communicating the true level of threats during a crisis; the shipping sector could shut down if shore-based personnel refused to assist in the safe operation of vessels entering ports.

The primary role of the port authority is providing access for the QSS (or its agents) to restricted port areas, a major concern with the SARS crisis. As noted elsewhere, policies vary by port and even by terminal, and the infrequency of visits may not dictate maintaining badges at all ports.

Local and State Health Agencies

QSS relationships with local and state health agencies at seaports are basically the same and may be generic for all CDC relationships (e.g., MOAs with hospitals). The infrequency of incidents results in little contact other than for (and sometimes including) the primary ports, many of which are those nearest to the airport stations. The small number of on-site 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.

A station may use designated local hospitals or physicians (often those of the ship agent) when CDC personnel are not available (in a timely manner relative to distance or during off hours).“Quarantinable” illnesses require a higher level of response—they have designated civic hospitals (certified with memo agreements) that are equipped to handle quarantine and isolation. Most contact is via telephone or e-mail, particularly for distant ports. 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).

Passengers will often get sick only after returning home (particularly after cruises of 7 days or less), and local health officials may contact CDC (as they are supposed to) if it is known that a person visited abroad. It was thought that contact could come via headquaraters or directly.

Suggested Citation:"Appendix D: Commissioned Paper on US Seaports and the CDC Quarantine Station System." Institute of Medicine. 2006. Quarantine Stations at Ports of Entry: Protecting the Public's Health. Washington, DC: The National Academies Press. doi: 10.17226/11435.
×
Potential Gaps or Shortfalls

No contact showed any high level of concern about gaps or shortfalls in the system. A general concern involved the ability to train partner agencies and the shipping community. One possible gap is the possibility of off-shore contact between vessel crew and shore-based personnel (e.g., port pilots) or between off-shore vessels not calling at a foreign port and other off-shore vessels. That was not considered a concern by the interviewees. It was also noted that even private vessels must process through CBP if leaving U.S. waters.

Another possible gap involves illnesses diagnosed after people leave the U.S. that would probably be identified only for ships returning to the United States. One concern offered by a QSS contact involved stowaways, who may pose a problem if infectious disease is suspected and the appropriate agency staff refuse to deal with them until the problem is diagnosed. The general problem of dealing with non-English-speaking crew was also a concern.

CDC QSS AT SEAPORTS: CARGO TRANSPORTATION11

General overview

Incidents related to cargo at seaports are extremely few (as reported in the interviews):

  • 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. After diagnosis, the import of this commodity was closely monitored.

  • Used tires: Like lucky bamboo, some used tires imported from China were in containers with standing water that contained mosquito larvae. The problem was eventually diagnosed and eliminated.

  • Cholera in South American vessels’ ballast: Ships from South America were discovered to be carrying cholera in their ballast water (sea-water carried on the vessel for weight and other purposes). This discovery occurred after a joint task force (including FDA) inspected incoming vessels. The result was a policy requiring vessels to flush their ballast water at least three times before arriving at a U.S. port.

  • Contaminated equipment: One major port cited some repatriated

11  

See Tables D.5 and D.6 for data on levels of cargo traffic at U.S. seaports.

Suggested Citation:"Appendix D: Commissioned Paper on US Seaports and the CDC Quarantine Station System." Institute of Medicine. 2006. Quarantine Stations at Ports of Entry: Protecting the Public's Health. Washington, DC: The National Academies Press. doi: 10.17226/11435.
×

agricultural machinery that was contaminated and had to be fumigated (as its only cargo-related incident), although it was probably a USDA-related matter not involving the QSS.

Other than those incidents, some of the interviewees (including QSS personnel) could not recall a local incident related to cargo (and many of them cited the same incidents occurring in other regions). Based on the infrequency of threats, there was limited input from industry and agency partners. The following sections describe the little information that was gathered regarding cargo imports.

CDC

In the cases cited above, the QSS was mostly responsible for dealing with a problem once it was identified. No stations cited a case in which it had identified a threat and passed it on to its partners on a local basis. It is assumed that prohibited items are identified at a national level and communicated to CBP at that level. One QSS contact was concerned that this type of contact might not filter down to the local level.

As in an airport situation, the QSS is responsible for dealing with any cargo that is refused entry under its jurisdiction, which may include destroying or reexporting the shipment or ensuring that the cargo is not hazardous.

CBP (U.S. Customs and Border Protection)

CBP has primary responsibility for clearing all foreign-origin cargo entering the United States (through its legacy U.S. customs function) by all ports of entry. As with airports, CBP may have authority to clear cargo for CDC unless a shipment is suspicious, some on a routine basis (e.g., for frequent shipments of medical samples to local hospitals). This supporting role is greatest at ports with no local airport station.

The primary process involved includes a review of documentation as now filed via the AMS that contains all the relevant information necessary to clear the cargo (origin and destination, shipper and consignee, and commodity). CBP can also visually inspect or hold cargo suspected to be in violation of U.S. law. CBP contacts whichever agency has primary responsibility for a particular shipment but also has the ex-USDA unit of “agricultural specialists” to which any agricultural issue is probably referred. The general impression was that if there was a suspected problem with a shipment, CBP will contact the “logical” agency: USDA for agriculture, FDA for foods and drugs, and CDC (or “public health”) if there is a perceived possibility of disease.

Suggested Citation:"Appendix D: Commissioned Paper on US Seaports and the CDC Quarantine Station System." Institute of Medicine. 2006. Quarantine Stations at Ports of Entry: Protecting the Public's Health. Washington, DC: The National Academies Press. doi: 10.17226/11435.
×

TABLE D.5 2003 Containerized Traffic for U.S. Ports

Quarantine Station

Port

20-Foot Equivalent Units

# of Containers

Container Weight (MT)

Los Angeles (LAX)

Los Angeles (CA)

7,148,940

3,951,792

N/A

Long Beach (CA)

4,658,124

2,577,080

25,312,306

Houston (TX)

1,243,706

776,403

10,812,558

San Diego (CA)

86,136

43,068

876,669

Freeport (TX)

67,784

N/A

469,132

Hueneme (CA)

24,523

N/A

N/A

Galveston (TX)

9,911

4,961

62,232

 

13,239,124

7,353,304

37,532,897

New York (JFK)

New York/New Jersey

4,067,812

2,382,639

N/A

Hampton Roads (VA)

1,646,279

947,872

12,108,920

Baltimore (MD)

536,078

337,978

4,261,591

Wilmington (DE)

254,191

123,378

1,379,472

Boston (MA)

158,020

88,890

1,077,654

Philadelphia (PA)

147,413

103,156

1,132,134

Richmond (VA)

43,672

NA

386,765

Portland (ME)

3,587

2,109

32,547

Albany (NY)

892

521

4,055

 

6,857,944

3,986,543

20,383,138

Miami (MIA)

San Juan (PR) (fy)

1,665,765

694,069

6,589,677

Miami (FL) (fy)

1,028,565

363,336

7,874,579

Jacksonville (FL) (fy)

692,422

343,568

3,405,386

Port Everglades (FL) (fy)

569,743

324,600

3,298,591

Palm Beach (FL) (fy)

217,558

N/A

1,007,429

Ponce (PR) (fy)

32,497

20,718

205,605

Fernandina (FL)

22,096

14,799

108,264

Manatee (FL)

11,837

N/A

72,809

Tampa (FL) (fy)

8,173

N/A

38,480

Canaveral (FL) (fy)

678

678

N/A

 

4,249,334

1,761,768

22,600,820

Seattle (SEA)

Tacoma (WA)

1,738,068

906,434

11,154,908

Seattle (WA)

1,486,465

852,905

8,814,689

Anchorage (AK)

521,993

208,797

1,522,418

Portland (OR)

339,571

190,639

2,855,128

Everett (WA)

6,815

1,338

18,682

Vancouver (WA)

338

171

N/A

 

4,093,250

2,160,284

24,365,825

Suggested Citation:"Appendix D: Commissioned Paper on US Seaports and the CDC Quarantine Station System." Institute of Medicine. 2006. Quarantine Stations at Ports of Entry: Protecting the Public's Health. Washington, DC: The National Academies Press. doi: 10.17226/11435.
×

Quarantine Station

Port

20-Foot Equivalent Units

# of Containers

Container Weight (MT)

Atlanta (ATL)

Charleston (SC)

1,690,847

N/A

N/A

Savannah (GA)

1,521,728

848,502

10,045,117

New Orleans (LA)

251,187

159,707

2,769,754

Gulfport (MS)

199,897

107,398

1,434,571

Wilmington (NC)

96,453

54,048

562,568

Mobile (AL)

26,302

14,649

N/A

Lake Charles (LA)

19,000

20,000

15,400

Brunswick (GA)

118

59

1,469

 

3,805,532

1,204,363

14,828,879

San Francisco (SFO)

Oakland (CA)

1,923,104

1,079,479

N/A

San Francisco (CA)

20,633

13,533

501,000

 

1,943,737

1,093,012

501,000

Honolulu

Honolulu (HI) (fy)

980,840

589,587

4,922,168

Kahului (HI) (fy)

115,556

70,626

777,286

Hilo (HI) (fy)

60,942

37,113

377,594

Kawaihae (HI) (fy)

55,345

32,924

346,675

Nawiliwili (HI) (fy)

42,700

26,430

228,343

Kaunakakai (HI) (fy)

2,152

1,796

12,394

Barbers Point (HI) (fy)

18

18

196

 

1,257,553

758,494

6,664,656

Overseas

Apra (GU) (fy)

144,541

82,310

2,050,951

 

144,541

82,310

2,050,951

Grand Total

 

35,591,015

18,400,078

128,928,166

 

SOURCE: American Association of Port Authorities.

Most of the stations noted that they do not have access to the AMS. Access would enable them to monitor certain commodities and perhaps identify patterns creating new threats, but there is also concern about whether they would have the capability to use the system at the local level.

One concern was that the protocols within the AMS for contacting the QSS may not be clear. It was very unclear to what extent there are CDC-flagged items in the AMS and what occurs in such a case. 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

Suggested Citation:"Appendix D: Commissioned Paper on US Seaports and the CDC Quarantine Station System." Institute of Medicine. 2006. Quarantine Stations at Ports of Entry: Protecting the Public's Health. Washington, DC: The National Academies Press. doi: 10.17226/11435.
×

TABLE D.6 U.S. Waterborne Imports—Top 100 Ports by Weight and Customs District (2003)

Quarantine Station

Port

Import Weight (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

Suggested Citation:"Appendix D: Commissioned Paper on US Seaports and the CDC Quarantine Station System." Institute of Medicine. 2006. Quarantine Stations at Ports of Entry: Protecting the Public's Health. Washington, DC: The National Academies Press. doi: 10.17226/11435.
×

Quarantine Station

Port

Import Weight (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

 

Suggested Citation:"Appendix D: Commissioned Paper on US Seaports and the CDC Quarantine Station System." Institute of Medicine. 2006. Quarantine Stations at Ports of Entry: Protecting the Public's Health. Washington, DC: The National Academies Press. doi: 10.17226/11435.
×

Quarantine Station

Port

Import Weight (Short Tons)

Rank

ORD

Toledo, OH

4,243,476

38

Detroit, MI

3,493,535

42

Cleveland, OH

2,708,093

49

Burns Waterway Harbor, IN

1,269,905

62

Milwaukee, WI

1,119,290

65

Chicago, IL

1,057,337

67

Ashtabula, OH

960,441

70

Marysville, MI

584,298

79

Duluth-Superior, MN and WI

529,060

80

Buffalo, NY

402,376

81

Gary, IN

393,742

82

Lorain, OH

334,244

83

Muskegon, MI

321,516

85

Grand Haven, MI

318,215

86

Indiana Harbor, IN

314,107

87

Green Bay, WI

292,532

89

Marquette, MI

284,738

91

Fairport Harbor, OH

257,575

93

Manistee, MI

196,385

97

Conneaut, OH

177,899

99

ORD Total

 

19,258,764

 

SFO

Richmond, CA

10,017,014

25

Oakland, CA

4,203,403

39

San Francisco, CA

1,635,880

56

Stockton, CA

1,417,749

58

SFO Total

 

17,274,046

 

HNL

Honolulu, HI

4,918,596

34

Barbers Point, Oahu, HI

2,357,417

51

HNL Total

 

7,276,013

 

Grand Total

 

871,170,926

 

 

SOURCE: American Association of Port Authorities.

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.

Suggested Citation:"Appendix D: Commissioned Paper on US Seaports and the CDC Quarantine Station System." Institute of Medicine. 2006. Quarantine Stations at Ports of Entry: Protecting the Public's Health. Washington, DC: The National Academies Press. doi: 10.17226/11435.
×
USCG

As with passenger concerns, USCG is responsible for the safety of vessels entering a port. The NVMC database of NOAs contains information on “dangerous goods,” but there is no apparent protocol for identifying or handling QSS-related cargoes.

Other Federal Agencies

A primary source of contacts for the QSS is other agencies with responsibility for inspecting and holding cargo at the ports, especially the USDA (for live animals and “unprocessed” foods) and FDA (for foods and drugs). These agencies typically have a much larger port presence; in the case of USDA, inspection personnel are within CBP. The QSS or more likely the partner agency may identify a threat covered by another agency and then directly contact it. In the case of USDA, that may occur after CBP has referred an issue to its agricultural specialist, who then might contact the QSS. As with other concerns at the port, the priority and awareness of QSS concerns (to the extent that there are any) depend on communications with the other agencies at the local level.

In major agricultural areas, local or state agriculture agencies might also monitor and participate in the surveillance and response process. For example, mosquito-abatement agencies in the Los Angeles area will fumigate some containers before USDA inspection, and local agencies are very vigilant about threats to local agriculture.

Port Industry (Port Authority, Terminal, Stevedore, and Vessel Services)

The port industry and port authorities did not appear to have a major role with QSS cargo threats. None of the interviewees thought it likely that a customs broker would identify a threat unless there was obvious health risk to them.

Local and State Health Agencies

There were no examples of involvement of local or state health agencies in QSS-related cargo matters. As with passengers, some problems may be identified after entry (e.g., spoiled fish not properly smoked), but it is unclear whether a comprehensive response is necessary in that most are probably another agency’s responsibility (e.g., FDA for spoiled fish). 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.

Suggested Citation:"Appendix D: Commissioned Paper on US Seaports and the CDC Quarantine Station System." Institute of Medicine. 2006. Quarantine Stations at Ports of Entry: Protecting the Public's Health. Washington, DC: The National Academies Press. doi: 10.17226/11435.
×
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).

Suggested Citation:"Appendix D: Commissioned Paper on US Seaports and the CDC Quarantine Station System." Institute of Medicine. 2006. Quarantine Stations at Ports of Entry: Protecting the Public's Health. Washington, DC: The National Academies Press. doi: 10.17226/11435.
×
Page 128
Suggested Citation:"Appendix D: Commissioned Paper on US Seaports and the CDC Quarantine Station System." Institute of Medicine. 2006. Quarantine Stations at Ports of Entry: Protecting the Public's Health. Washington, DC: The National Academies Press. doi: 10.17226/11435.
×
Page 129
Suggested Citation:"Appendix D: Commissioned Paper on US Seaports and the CDC Quarantine Station System." Institute of Medicine. 2006. Quarantine Stations at Ports of Entry: Protecting the Public's Health. Washington, DC: The National Academies Press. doi: 10.17226/11435.
×
Page 130
Suggested Citation:"Appendix D: Commissioned Paper on US Seaports and the CDC Quarantine Station System." Institute of Medicine. 2006. Quarantine Stations at Ports of Entry: Protecting the Public's Health. Washington, DC: The National Academies Press. doi: 10.17226/11435.
×
Page 131
Suggested Citation:"Appendix D: Commissioned Paper on US Seaports and the CDC Quarantine Station System." Institute of Medicine. 2006. Quarantine Stations at Ports of Entry: Protecting the Public's Health. Washington, DC: The National Academies Press. doi: 10.17226/11435.
×
Page 132
Suggested Citation:"Appendix D: Commissioned Paper on US Seaports and the CDC Quarantine Station System." Institute of Medicine. 2006. Quarantine Stations at Ports of Entry: Protecting the Public's Health. Washington, DC: The National Academies Press. doi: 10.17226/11435.
×
Page 133
Suggested Citation:"Appendix D: Commissioned Paper on US Seaports and the CDC Quarantine Station System." Institute of Medicine. 2006. Quarantine Stations at Ports of Entry: Protecting the Public's Health. Washington, DC: The National Academies Press. doi: 10.17226/11435.
×
Page 134
Suggested Citation:"Appendix D: Commissioned Paper on US Seaports and the CDC Quarantine Station System." Institute of Medicine. 2006. Quarantine Stations at Ports of Entry: Protecting the Public's Health. Washington, DC: The National Academies Press. doi: 10.17226/11435.
×
Page 135
Suggested Citation:"Appendix D: Commissioned Paper on US Seaports and the CDC Quarantine Station System." Institute of Medicine. 2006. Quarantine Stations at Ports of Entry: Protecting the Public's Health. Washington, DC: The National Academies Press. doi: 10.17226/11435.
×
Page 136
Suggested Citation:"Appendix D: Commissioned Paper on US Seaports and the CDC Quarantine Station System." Institute of Medicine. 2006. Quarantine Stations at Ports of Entry: Protecting the Public's Health. Washington, DC: The National Academies Press. doi: 10.17226/11435.
×
Page 137
Suggested Citation:"Appendix D: Commissioned Paper on US Seaports and the CDC Quarantine Station System." Institute of Medicine. 2006. Quarantine Stations at Ports of Entry: Protecting the Public's Health. Washington, DC: The National Academies Press. doi: 10.17226/11435.
×
Page 138
Suggested Citation:"Appendix D: Commissioned Paper on US Seaports and the CDC Quarantine Station System." Institute of Medicine. 2006. Quarantine Stations at Ports of Entry: Protecting the Public's Health. Washington, DC: The National Academies Press. doi: 10.17226/11435.
×
Page 139
Suggested Citation:"Appendix D: Commissioned Paper on US Seaports and the CDC Quarantine Station System." Institute of Medicine. 2006. Quarantine Stations at Ports of Entry: Protecting the Public's Health. Washington, DC: The National Academies Press. doi: 10.17226/11435.
×
Page 140
Suggested Citation:"Appendix D: Commissioned Paper on US Seaports and the CDC Quarantine Station System." Institute of Medicine. 2006. Quarantine Stations at Ports of Entry: Protecting the Public's Health. Washington, DC: The National Academies Press. doi: 10.17226/11435.
×
Page 141
Suggested Citation:"Appendix D: Commissioned Paper on US Seaports and the CDC Quarantine Station System." Institute of Medicine. 2006. Quarantine Stations at Ports of Entry: Protecting the Public's Health. Washington, DC: The National Academies Press. doi: 10.17226/11435.
×
Page 142
Suggested Citation:"Appendix D: Commissioned Paper on US Seaports and the CDC Quarantine Station System." Institute of Medicine. 2006. Quarantine Stations at Ports of Entry: Protecting the Public's Health. Washington, DC: The National Academies Press. doi: 10.17226/11435.
×
Page 143
Suggested Citation:"Appendix D: Commissioned Paper on US Seaports and the CDC Quarantine Station System." Institute of Medicine. 2006. Quarantine Stations at Ports of Entry: Protecting the Public's Health. Washington, DC: The National Academies Press. doi: 10.17226/11435.
×
Page 144
Suggested Citation:"Appendix D: Commissioned Paper on US Seaports and the CDC Quarantine Station System." Institute of Medicine. 2006. Quarantine Stations at Ports of Entry: Protecting the Public's Health. Washington, DC: The National Academies Press. doi: 10.17226/11435.
×
Page 145
Suggested Citation:"Appendix D: Commissioned Paper on US Seaports and the CDC Quarantine Station System." Institute of Medicine. 2006. Quarantine Stations at Ports of Entry: Protecting the Public's Health. Washington, DC: The National Academies Press. doi: 10.17226/11435.
×
Page 146
Suggested Citation:"Appendix D: Commissioned Paper on US Seaports and the CDC Quarantine Station System." Institute of Medicine. 2006. Quarantine Stations at Ports of Entry: Protecting the Public's Health. Washington, DC: The National Academies Press. doi: 10.17226/11435.
×
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Suggested Citation:"Appendix D: Commissioned Paper on US Seaports and the CDC Quarantine Station System." Institute of Medicine. 2006. Quarantine Stations at Ports of Entry: Protecting the Public's Health. Washington, DC: The National Academies Press. doi: 10.17226/11435.
×
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Suggested Citation:"Appendix D: Commissioned Paper on US Seaports and the CDC Quarantine Station System." Institute of Medicine. 2006. Quarantine Stations at Ports of Entry: Protecting the Public's Health. Washington, DC: The National Academies Press. doi: 10.17226/11435.
×
Page 149
Suggested Citation:"Appendix D: Commissioned Paper on US Seaports and the CDC Quarantine Station System." Institute of Medicine. 2006. Quarantine Stations at Ports of Entry: Protecting the Public's Health. Washington, DC: The National Academies Press. doi: 10.17226/11435.
×
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Suggested Citation:"Appendix D: Commissioned Paper on US Seaports and the CDC Quarantine Station System." Institute of Medicine. 2006. Quarantine Stations at Ports of Entry: Protecting the Public's Health. Washington, DC: The National Academies Press. doi: 10.17226/11435.
×
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Suggested Citation:"Appendix D: Commissioned Paper on US Seaports and the CDC Quarantine Station System." Institute of Medicine. 2006. Quarantine Stations at Ports of Entry: Protecting the Public's Health. Washington, DC: The National Academies Press. doi: 10.17226/11435.
×
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Suggested Citation:"Appendix D: Commissioned Paper on US Seaports and the CDC Quarantine Station System." Institute of Medicine. 2006. Quarantine Stations at Ports of Entry: Protecting the Public's Health. Washington, DC: The National Academies Press. doi: 10.17226/11435.
×
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Suggested Citation:"Appendix D: Commissioned Paper on US Seaports and the CDC Quarantine Station System." Institute of Medicine. 2006. Quarantine Stations at Ports of Entry: Protecting the Public's Health. Washington, DC: The National Academies Press. doi: 10.17226/11435.
×
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Suggested Citation:"Appendix D: Commissioned Paper on US Seaports and the CDC Quarantine Station System." Institute of Medicine. 2006. Quarantine Stations at Ports of Entry: Protecting the Public's Health. Washington, DC: The National Academies Press. doi: 10.17226/11435.
×
Page 155
Suggested Citation:"Appendix D: Commissioned Paper on US Seaports and the CDC Quarantine Station System." Institute of Medicine. 2006. Quarantine Stations at Ports of Entry: Protecting the Public's Health. Washington, DC: The National Academies Press. doi: 10.17226/11435.
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Suggested Citation:"Appendix D: Commissioned Paper on US Seaports and the CDC Quarantine Station System." Institute of Medicine. 2006. Quarantine Stations at Ports of Entry: Protecting the Public's Health. Washington, DC: The National Academies Press. doi: 10.17226/11435.
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Suggested Citation:"Appendix D: Commissioned Paper on US Seaports and the CDC Quarantine Station System." Institute of Medicine. 2006. Quarantine Stations at Ports of Entry: Protecting the Public's Health. Washington, DC: The National Academies Press. doi: 10.17226/11435.
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Suggested Citation:"Appendix D: Commissioned Paper on US Seaports and the CDC Quarantine Station System." Institute of Medicine. 2006. Quarantine Stations at Ports of Entry: Protecting the Public's Health. Washington, DC: The National Academies Press. doi: 10.17226/11435.
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Suggested Citation:"Appendix D: Commissioned Paper on US Seaports and the CDC Quarantine Station System." Institute of Medicine. 2006. Quarantine Stations at Ports of Entry: Protecting the Public's Health. Washington, DC: The National Academies Press. doi: 10.17226/11435.
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Suggested Citation:"Appendix D: Commissioned Paper on US Seaports and the CDC Quarantine Station System." Institute of Medicine. 2006. Quarantine Stations at Ports of Entry: Protecting the Public's Health. Washington, DC: The National Academies Press. doi: 10.17226/11435.
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Suggested Citation:"Appendix D: Commissioned Paper on US Seaports and the CDC Quarantine Station System." Institute of Medicine. 2006. Quarantine Stations at Ports of Entry: Protecting the Public's Health. Washington, DC: The National Academies Press. doi: 10.17226/11435.
×
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Suggested Citation:"Appendix D: Commissioned Paper on US Seaports and the CDC Quarantine Station System." Institute of Medicine. 2006. Quarantine Stations at Ports of Entry: Protecting the Public's Health. Washington, DC: The National Academies Press. doi: 10.17226/11435.
×
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Suggested Citation:"Appendix D: Commissioned Paper on US Seaports and the CDC Quarantine Station System." Institute of Medicine. 2006. Quarantine Stations at Ports of Entry: Protecting the Public's Health. Washington, DC: The National Academies Press. doi: 10.17226/11435.
×
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Suggested Citation:"Appendix D: Commissioned Paper on US Seaports and the CDC Quarantine Station System." Institute of Medicine. 2006. Quarantine Stations at Ports of Entry: Protecting the Public's Health. Washington, DC: The National Academies Press. doi: 10.17226/11435.
×
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Suggested Citation:"Appendix D: Commissioned Paper on US Seaports and the CDC Quarantine Station System." Institute of Medicine. 2006. Quarantine Stations at Ports of Entry: Protecting the Public's Health. Washington, DC: The National Academies Press. doi: 10.17226/11435.
×
Page 166
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×
Page 168
Next: Appendix E: Microbial Threats of Public Health Significance Originating in Animals or Animal Products at U.S. Ports of Entry »
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To mitigate the risks posed by microbial threats of public health significance originating abroad, the Centers for Disease Control and Prevention (CDC) places small groups of staff at major U.S. airports. These staff, their offices, and their patient isolation rooms constitute quarantine stations, which are run by CDC's Division of Global Migration and Quarantine (DGMQ).

Congress began to allocate funds in fiscal 2003 for the establishment of new quarantine stations at 17 major U.S. ports of entry that comprise airports, seaports, and land-border crossings. In a significant departure from the recent past, both the preexisting 8 quarantine stations and the new 17 are expected to play an active, anticipatory role in nationwide biosurveillance. Consequently, DGMQ asked the Institute of Medicine (IOM) to convene an expert committee to assess the present CDC quarantine stations and recommend how they should evolve to meet the challenges posed by microbial threats at the nation's gateways. DGMQ specifically requested "an assessment of the role of the federal quarantine stations, given the changes in the global environment including large increases in international travel, threats posed by bioterrorism and emerging infections, and the movement of animals and cargo." To conduct this assessment and provide recommendations, IOM convened, in October 2004, the Committee on Measures to Enhance the Effectiveness of the CDC Quarantine Station Expansion Plan for U.S. Ports of Entry.

At the sponsor's request, the committee released the interim letter report Human Resources at U.S. Ports of Entry to Protect the Public's Health in January 2005 to provide preliminary suggestions for the priority functions of a modern quarantine station, the competences necessary to carry out those functions, and the types of health professionals who have the requisite competences (Appendix A). This, the committee's final report, assesses the present role of the CDC quarantine stations and articulates a vision of their future role as a public health intervention.

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