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 (DHS, 2004; Gerberding, 2005). Consequently, CDC 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.1 IOM convened the Committee on Measures to Enhance the Effectiveness of the CDC Quarantine Station Expansion Plan for U.S. Ports of Entry in October 2004; this is the committee’s final report to CDC.
The traditional, primary activities of the CDC quarantine stations no longer protect the U.S. population sufficiently against microbial threats of public health significance that originate abroad, the committee concluded. In 2004, for example, a man suffering from fever, chills, severe sore throat, and diarrhea flew from Sierra Leone to Newark, NJ. By the time he died from Lassa fever less than a week after arrival, he had exposed 188 persons to the disease (CDC, 2004). Another recent failure of the U.S. quarantine system to prevent the importation of serious communicable disease occurred in 2003, when several infected rodents imported from Africa apparently caused a multistate outbreak of human monkeypox (CDC, 2003).
Many of the stations’ legacy activities focus on the detection of disease in persons, animals, cargo, and conveyances during the window of time shortly before and during arrival at U.S. gateways. Yet the pace of global trade and travel has narrowed that window dramatically. Consequently, infected individuals and animals do not necessarily develop signs of disease while in transit or by the time of arrival, and available noninvasive diagnostics cannot always identify infected travelers with reasonable sensitivity, specificity, and speed. With 120 million people traveling to and from the United States by air annually (Office of Aviation Policy and Plans, 2005), the quarantine stations face a daunting task in adequately screening arriving passengers and protecting the country from microbial threats of public health significance.
Moreover, the consequences of globalization and the development of the U.S. homeland security infrastructure have increased the complexity of the organizational environment in which the CDC quarantine stations function. This organizational environment, called the Quarantine System in this report, comprises entities that span sectors and jurisdictions. Yet the Quarantine System lacks effective leadership. No entity has principal responsibil-