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3 authority derives from the U.S. Constitution, which provides Travelers crossing state or international borders may be that "Congress shall have the power to regulate commerce legally detained and isolated for purposes of preventing the with foreign nations and among the several states." This is the spread of a quarantinable disease under the provisions of state basis of the Public Health Service Act, which authorizes the law and the Public Health Service Act. International travelers, Surgeon General "to make and enforce such regulations as including U.S. citizens, are under federal authority and con- in his judgment are necessary to prevent the introduction, trol and must go through a federal clearance process before transmission, or spread of communicable diseases from for- they re-enter the country. The CDC can issue a federal iso- eign countries into the States or possessions, or from one lation order to keep a person under their observation. Law State or possession into any other State or possession." enforcement officers can assist in the detention of the per- The Public Health Service Act also authorizes the "appre- son(s) to permit health officials to make an assessment. Local hension, detention, or conditional release of individuals" for the and state law enforcement officers have similar authority to purpose of preventing the introduction, transmission, or spread enforce local health codes or public health orders. Neither the of communicable diseases specified by Executive Orders of the federal government nor any state has issued an enforceable President. Under Executive Order 13295 the federal govern- quarantine in the past 50 years. ment currently can declare quarantine for persons suspected of In November 2005, CDC proposed new regulations that being ill with the following diseases: would allow CDC to order a "provisional quarantine," lasting up to 3 business days. The proposed regulations would give 1. Cholera CDC time to determine if the suspected disease was present. 2. Diphtheria Lab tests are required to confirm the diseases and generally 3. Infectious Tuberculosis that takes 3 working days. If more time was needed or if lab 4. Plague tests came back positive for one of the quarantinable illnesses 5. Smallpox listed above, a formal quarantine order would be issued by 6. Yellow Fever state authorities. 7. Viral Hemorrhagic Fevers It is unclear at this time whether the federal or state gov- 8. SARS (Severe Acute Respiratory Syndrome) ernment would have primary authority to quarantine air 9. Influenza, from a novel or re-emergent source travelers on a domestic flight (i.e., entirely within the United States). Therefore, for planning purposes, this report assumes A detailed description of these communicable diseases, in- that the arriving flight subject to quarantine would be an in- cluding their respective symptoms, incubation period, mode ternational flight (i.e., originating outside the United States) of transmission, and methods of diagnosis can be found in which would be clearly under the primary authority of the Appendix A. The types of diseases on the list can be amended federal government. in response to emerging diseases. For example, in 2003, SARS was added, and, more recently, influenza that has the poten- Federal Quarantine Stations tial to trigger a pandemic joined the list. Other illness such as mumps, measles and chicken pox, while contagious and rec- The CDC, through its Division of Global Migration and ognized as serious public health threats, are not listed as quar- Quarantine (DGMQ) operates quarantine stations at 19 air- antinable in the Executive Order. Other federal regulations, ports and one land crossing (El Paso, TX). These airports are such as the airline reporting requirement discussed below, the following: may apply to these diseases and state or local laws may exceed the federal requirements and require different actions, but the Anchorage nine diseases listed in the Executive Order are the only ones Atlanta under which the federal government can order a quarantine. Boston State and local governments have the authority to under- Chicago take quarantine measures per their "police powers" to protect Dallas/Ft. Worth the welfare of their citizens, including managing outbreaks of Detroit communicable diseases. This authority, which derives from Honolulu the inherent sovereignty of governments, was recognized in Houston the 10th Amendment to the U.S. Constitution that reserves Los Angeles powers not specifically granted to the federal government to Miami the state government. Some states require court orders before Minneapolis quarantine is permitted while others may limit quarantine to New York (JFK) a single disease. The length of time for quarantine may also Newark differ from state to state. Philadelphia