QUARANTINE STATIONS AT PORTS OF ENTRY
Protecting the Public’s Health
Laura B. Sivitz, Kathleen Stratton, and Georges C. Benjamin, Editors
THE NATIONAL ACADEMIES PRESS
Washington, D.C. www.nap.edu
THE NATIONAL ACADEMIES PRESS
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NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance.
This study was supported by Contract No. 200-2000-00629, Task Order No. 31 between the National Academy of Sciences and the Centers for Disease Control and Prevention. Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the author(s) and do not necessarily reflect the view of the organizations or agencies that provided support for this project.
Library of Congress Cataloging-in-Publication Data
Institute of Medicine (U.S.). Committee on Measures to Enhance the Effectiveness of the CDC Quarantine Station Expansion Plan for U.S. Ports of Entry.
Quarantine stations at ports of entry : protecting the public’s health / Committee on Measures to Enhance the Effectiveness of the CDC Quarantine Station Expansion Plan for U.S. Ports of Entry, Board on Global Health, Board on Population Health and Public Health Practice ; Laura B. Sivitz, Kathleen Stratton, and Georges C. Benjamin, editors.
p. ; cm.
“This study was supported by Contract No. 200-2000-00629, Task Order No. 31 between the National Academy of Sciences and the Centers for Disease Control and Prevention”—Galley.
Includes bibliographical references.
ISBN 0-309-09951-X (pbk. book)
1. Quarantine—United States. 2. Bioterrorism—United States—Prevention.
[DNLM: 1. Quarantine—United States. 2. Bioterrorism—prevention & control—United States. WA 234 I58 2005] I. Sivitz, Laura. II. Stratton, Kathleen R. III. Benjamin, Georges. IV. Title.
RA665.I57 2005
363.34′97—dc22
2005033697
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Copyright 2006 by the National Academy of Sciences. All rights reserved.
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The serpent has been a symbol of long life, healing, and knowledge among almost all cultures and religions since the beginning of recorded history. The serpent adopted as a logotype by the Institute of Medicine is a relief carving from ancient Greece, now held by the Staatliche Museen in Berlin.
COVER: The cover incorporates images from a colorized transmission electron micrograph taken by C. Goldsmith (CDC) of Avian influenza A H5N1 viruses (seen in gold) grown in MDCK cells (green). Executive Order 13,375 of April 1, 2005, added to the list of quarantinable communicable diseases influenza caused “by novel or reemergent influenza viruses that are causing, or have the potential to cause, a pandemic.”
THE NATIONAL ACADEMIES
Advisers to the Nation on Science, Engineering, and Medicine
The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Academy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Ralph J. Cicerone is president of the National Academy of Sciences.
The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding engineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineering programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. Wm. A. Wulf is president of the National Academy of Engineering.
The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Institute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Harvey V. Fineberg is president of the Institute of Medicine.
The National Research Council was organized by the National Academy of Sciences in 1916 to associate the broad community of science and technology with the Academy’s purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The Council is administered jointly by both Academies and the Institute of Medicine. Dr. Ralph J. Cicerone and Dr. Wm. A. Wulf are chair and vice chair, respectively, of the National Research Council.
COMMITTEE ON MEASURES TO ENHANCE THE EFFECTIVENESS OF THE CDC QUARANTINE STATION EXPANSION PLAN FOR U.S. PORTS OF ENTRY
GEORGES C. BENJAMIN, M.D. (Chair), Executive Director,
American Public Health Association
JOAN M. ARNOLDI, D.V.M.,1 Retired, Associate Administrator,
Animal and Plant Health Inspection Service, U.S. Department of Agriculture
BARBARA A. BLAKENEY, M.S., R.N., President,
American Nurses Association
LAWRENCE O. GOSTIN, J.D., L.L.D., Professor of Law,
Georgetown University Law Center;
Professor of Public Health,
Johns Hopkins University; and
Director,
Center for Law & the Public’s Health
MARGARET A. HAMBURG, M.D., Senior Scientist,
Nuclear Threat Initiative
FARZAD MOSTASHARI, M.D., M.S.P.H., Assistant Commissioner,
Bureau of Epidemiology Services, New York City Department of Health
WILLIAM A. PETRI, JR., M.D., Ph.D., Wade Hampton Frost Professor of Epidemiology, Professor of Medicine, Microbiology, and Pathology, and Chief,
Division of Infectious Diseases and International Health, University of Virginia Health System
ARTHUR L. REINGOLD, M.D., Professor of Epidemiology,
School of Public Health, University of California at Berkeley
RONALD K. ST. JOHN, M.D., M.P.H., Director General,
Centre for Emergency Preparedness and Response, Public Health Agency of Canada
KATHLEEN E. TOOMEY, M.D., M.P.H.,2 Director,
Division of Public Health, Georgia State Health Department
MARY E. WILSON, M.D., Associate Professor of Population and International Health,
Harvard School of Public Health and
Associate Clinical Professor of Medicine,
Harvard Medical School
STUDY STAFF
KATHLEEN STRATTON, Ph.D., Study Director
LAURA B. SIVITZ, M.S.J., Research Associate
DAVID W. GILES, Research Assistant
SHEYI LAWOYIN, M.P.H., Senior Program Assistant
NORMAN GROSSBLATT, ELS (D), Senior Editor
PATRICK KELLEY, M.D., Dr.P.H., Director,
Board on Global Health
ROSE MARIE MARTINEZ, Sc.D., Director,
Board on Population Health and Public Health Practice
Reviewers
This report has been reviewed in draft form by persons chosen for their diverse perspectives and technical expertise, in accordance with procedures approved by the National Research Council’s Report Review Committee. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making its published report as sound as possible and to ensure that the report meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process. We wish to thank the following individuals for their review of this report:
Donald S. Burke, M.D., Bloomberg School of Public Health, Johns Hopkins University
Kathleen F. Gensheimer, M.D., M.P.H., Maine Department of Health and Human Services
David Heymann, M.D., World Health Organization
Ann Marie Kimball, M.D., School of Public Health, University of Washington
Bonnie J. Kostelecky, R.N., M.S., M.P.A., Multnomah County Health Department, Portland, OR
Aileen Plant, Ph.D., M.P.H., Curtin University of Technology, Perth, Australia
K.W. Wheeler, D.V.M., Retired, Animal and Plant Health Inspection Service, U.S. Department of Agriculture
Although the reviewers listed above have provided many constructive comments and suggestions, they were not asked to endorse the conclusions or recommendations nor did they see the final draft of the report before its release. The review of this report was overseen by Elaine L. Larson, Ph.D., R.N., Columbia University. Appointed by the National Research Council, she was responsible for making certain that an independent examination of this report was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of this report rests entirely with the authoring committee and the institution.
The committee’s letter report released in January 2005 (Appendix A) was also subject to independent review. We wish to thank the following individuals for their review of the letter report:
Ruth L. Berkelman, M.D., M.P.H., Rollins School of Public Health, Emory University
Donald S. Burke, M.D., Bloomberg School of Public Health, Johns Hopkins University
Kathleen F. Gensheimer, M.D., M.P.H., Maine Department of Health and Human Services
Ann Marie Kimball, M.D., School of Public Health, University of Washington
Bonnie J. Kostelecky, R.N., M.S., M.P.A., Multnomah County Health Department, Portland, OR
Monitor appointed by IOM: Hugh H. Tilson, M.D., Dr.P.H., School of Public Health, University of North Carolina.
Contents
Tables, Figures, and Boxes
TABLES
1.1 |
Locations, Jurisdictions, and Staffing of CDC Quarantine Stations at U.S. Ports of Entry (Established and Nascent), May 2005 and October 2005 Forecast, |
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3.1 |
Number of Ports of Entry to the United States Compared with Number of Official Ports of Entry (POEs) Defined by U.S. Customs and Border Protection, 2005, |
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3.2 |
All Cases of Illness Reported to or Found by DGMQ in 2003 and Medical Control Measures Taken, |
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3.3 |
Number of Immigrants, Refugees, and Asylees Accepted into the United States, 2003, |
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3.4 |
Communicable Diseases of Public Health Concern Diagnosed in Immigrants and Refugees to the United States by Panel Physicians, 1999–2003, |
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A.1 |
Number of Employees and Contractors at Each CDC Quarantine Station at U.S. Ports of Entry, Mid-2004, |
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A.2 |
Types of Workers Who Could Conduct the Priority Functions Necessary for the Surveillance for, Detection of, and Response to Microbial Threats at U.S. Ports of Entry, |
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C.1 |
Summary Table, |
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D.1 |
Organizations/Agencies Providing Information for Study, |
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D.2 |
2002-2003 Cruise Passengers at U.S. Ports, |
D.3 |
Seaport coverage by CDC Quarantine Station, |
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D.4 |
Partners in CDC Quarantine Station System at Seaports, |
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D.5 |
2003 Containerized Traffic for U.S. Ports, |
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D.6 |
U.S. Waterborne Imports—Top 100 Ports by Weight and Customs District (2003), |
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E.1 |
Legal Authorities for Inspections at U.S. Borders, |
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E.2 |
DHS, Border and Transportation Security, U.S. Customs and Border Protection, and Components Addressing Animal Diseases, |
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E.3 |
Level of Funding, |
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E.4 |
CBP’s Inspection Staff for All POE Locations, FY 2001–2004, |
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E.5 |
Resources at CDC Quarantine Stations at Major U.S. Airports, |
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F.1 |
Public Health-Related Civil and Political Rights in the ICCPR, |
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F.2 |
Summary Table of Important Positive and Negative Obligations the United States Has Under International Law Relevant to the Expansion of the National Quarantine System, |
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F.3 |
Analysis of the Revised International Health Regulations: Implications for Plans to Expand the National Quarantine System, |
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F.4 |
Analysis of the WTO’s Agreement on the Application of Sanitary and Phytosanitary Measures (SPS Agreement): Implications for Plans to Expand the National Quarantine System, |
FIGURES
ES.1 |
The relationships among the Quarantine Core, System, and Network for U.S. ports of entry, |
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1.1 |
The relationships among the members of the Quarantine Core and their partner organizations in the Department of Health and Human Services, |
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2.1 |
The proposed geographic distribution of the 25 quarantine stations in the expanded system, |
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3.1 |
The relationships among the Quarantine Core, System, and Network for U.S. ports of entry, |
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3.2 |
CDC Health Alert Notice, |
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3.3 |
Algorithm for screening prospective immigrants, refugees, and asylees to the United States for tuberculosis (TB), |
4.1 |
The geographic boundaries of the United States’ 3,066 counties, |
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A.1 |
DGMQ’s proposed geographic distribution of the 25 quarantine stations in the expanded system, |
BOXES
ES.1 |
Class A and Class B Conditions, |
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ES.2 |
Quarantinable Communicable Diseases, |
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1.1 |
Statement of Task, |
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1.2 |
Class A and Class B Conditions, |
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1.3 |
Quarantinable Communicable Diseases, |
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3.1 |
The Role of U.S. Ports of Entry as Defined by the Department of Homeland Security, |
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3.2 |
Mission Statement of U.S. Customs and Border Protection, |
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3.3 |
Immigration Inspection Program: Mission and Role, |
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A.1 |
Statement of Task, |
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A.2 |
Quarantinable Communicable Diseases, |
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A.3 |
Class A and Class B Conditions, |
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A.4 |
Priority Functions, |
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F.1 |
The Revised IHR’s Decision Instrument (Annex 2), |
Abbreviations
AII
airborne infection isolation
AMS
Automated Manifest System
APHIS
Animal and Plant Health Inspection Service, U.S. Department of Agriculture
APHL
Association of Public Health Laboratories
APIS
Automated Passenger Information System
AQI
Agriculture Quarantine and Inspection, Animal and Plant Health Inspection Service
ASTHO
Association of State and Territorial Health Officials
ATA
Air Transport Association of America Inc.
BIDS
Border Infectious Disease Surveillance Project, Centers for Disease Control and Prevention
CBP
U.S. Customs and Border Protection
CDC
Centers for Disease Control and Prevention
CSTE
Council of State and Territorial Epidemiologists
DGMQ
Division of Global Migration and Quarantine, National Center for Infectious Diseases, Centers for Disease Control and Prevention
DHHS
U.S. Department of Health and Human Services
DHS
U.S. Department of Homeland Security
DOT
U.S. Department of Transportation
DQ
Division of Quarantine, National Center for Infectious Diseases, Centers for Disease Control and Prevention
EMS
emergency medical services
FAA
Federal Aviation Administration, U.S. Department of Transportation
FBI
Federal Bureau of Investigation
FDA
Food and Drug Administration
FTEs
full-time equivalents
GAO
Government Accountability Office
HIPAA
Health Insurance Portability and Accountability Act
HIV
human immunodeficiency virus
ICD-CM
International Classification of Diseases, Clinical Modification
ICU
intensive-care unit
IOM
Institute of Medicine
LPHA
local public health authority
MOA
memorandum of agreement
MSEHPA
Model State Emergency Health Powers Act
MSPHA
Model State Public Health Act
NACCHO
National Association of County and City Health Officials
NACO
National Association of Counties
NCID
National Center for Infectious Diseases, Centers for Disease Control and Prevention
NHP
nonhuman primates
NIH
National Institutes of Health
OIS
Office of Immigration Statistics, U.S. Department of Homeland Security
PHAC
Public Health Agency of Canada
POEs
Ports of Entry
SARS
severe acute respiratory syndrome
State
PHA state public health agency