infectious diseases were identified during the 30 years between 1973 and 2003 (GAO, 2004). The convergence of multiple interrelated factors is responsible for this phenomenon (IOM, 2003). Important factors include
rapid, high-volume international and transcontinental travel, commerce, and human migration;
mass relocation of rural populations to cities and the prevalence of overcrowded, unsanitary conditions there;
exponential growth of population and the number of individuals susceptible to infectious disease;
widespread changes in climate, ecology, and land use;
more frequent contact between people and wildlife;
reduced global investment in public health infrastructure;
development of antimicrobial resistance.
Numerous scientists, physicians, and public health officers in national and international organizations have voiced concern about these trends and their relationship to such naturally occurring public health threats as West Nile virus, SARS, and pandemic influenza. Also within the past two decades, terrorism in general and bioterrorism in particular have become grave concerns to the U.S. government and its citizens. Consequently, in the late 1990s, DGMQ began to explore ways that the quarantine stations at U.S. ports of entry might help protect U.S. citizens from the unintentional or intentional importation of dangerous infectious agents (Personal communication, D. Kim, DGMQ, October 13, 2004).
The outbreak of SARS in 2002 and 2003 dramatically demonstrated the need for strong, well-coordinated national and international systems for disease surveillance, detection, and response (DGMQ, 2003b). In the short term, the outbreak led to a modest addition of nine contract employees at the CDC quarantine stations (Personal communications: D. Kim, DGMQ, October 13, 2004; M. Remis, DGMQ, October 21, 2004).
Coupled with the microbial threats described above, SARS reinvigorated interest within the federal government to commit funding to biosecurity initiatives. A portion of the fiscal year 2004 budget appropriation went to DGMQ for the development of three new CDC quarantine stations at U.S. ports of entry: Houston Intercontinental Airport; the Mexico–