Comprehensive Plan Needed To Protect Against Importation Of Infectious Diseases And Bioterrorism Agents At U.S. Ports Of Entry

"CDC quarantine stations and the broader quarantine system serve as thenation's insurance policy against catastrophes that might arise fromthe importation of naturally occurring infectious agents, such as theSARS virus, or man-made threats like an attack using a dangerousbiological agent," said Georges Benjamin, executive director of theAmerican Public Health Association, Washington, D.C., and chair of thecommittee that wrote the report. "But no single entity currently hasthe responsibility, authority, and resources to orchestrate all theactivities of the quarantine system, and the traditionalresponsibilities of quarantine personnel are no longer sufficient tomeet the challenges posed by the rapidly increasing pace of globaltrade and travel and the emergence of new microbial threats.Consequently, we recommend the establishment of clear leadership andlines of communication among all parties involved in protecting thepublic from infectious agents that originate abroad."

Every year, roughly 120 million people travel into or out of thecountry through the nation's 474 airports, seaports, and land-bordercrossings. In 2003 Congress began to allocate funds to bring the numberof quarantine stations from eight to 25. The 25 cities that wouldcomprise the expanded quarantine station system together receive morethan 75 million international travelers and immigrants annually. Theyalso receive 31 percent of the cargo imported by sea. Currently, 11quarantine stations staffed by CDC personnel are fully active inAtlanta; Chicago; El Paso, Texas; Honolulu; Houston; Los Angeles;Miami; New York City; San Francisco; Seattle; and Washington, D.C. CDCwill open stations by the end of the year in Anchorage, Alaska; Boston;Detroit; Minneapolis; Newark, N.J.; San Diego; and San Juan, PuertoRico. Additional cities under consideration are Charlotte, N.C.;Dallas; Denver; Kansas City, Mo.; New Orleans; Philadelphia; andPhoenix.

The individual quarantine stations and the CDC's Division of GlobalMigration and Quarantine screen travellers, refugees, immigrants,animals, and cargo for disease agents shortly before and during theirarrival at U.S. gateways. However, preventing, detecting, andresponding to microbial threats also involves many other organizationsranging from local public health departments and hospitals to customsand border protection agents, agriculture inspectors, and the U.S.departments of State and Homeland Security.

Quarantine station personnel and the Division of Global Migration andQuarantine should shift their primary focus from inspecting people andcargo at individual ports to assuming leadership of the activities ofthe broader quarantine system across local, state, and national levels.Given the various jurisdictions involved, CDC should take extra care towork collaboratively with its partners as it exerts leadership overthis one aspect of their many responsibilities. Federal and state lawsshould ensure that quarantine personnel have clear authority to carryout their tasks, such as tracking and controlling the spread of diseasecarried by international travelers or cargo across state lines.Currently, legal and regulatory authority is fragmented among variouslevels of government, the report notes.

A national strategic plan devised by CDC quarantine personnel is neededto provide the best possible framework for protecting the public fromthe importation of dangerous biological agents, the committeeconcluded. CDC quarantine staff should assess the risks posed byinfectious agents that could enter the country via travelers, refugees,immigrants, and cargo and develop a plan focused on communicablediseases that would complement other security plans devised by theDepartment of Homeland Security, the report recommends. The new planshould pinpoint the greatest potential risks and outline the roles andresponsibilities of each partner. This will ensure that finiteresources are used effectively and that those involved know who is incharge of different activities in routine and emergency situations.

One significant gap in the current quarantine system is the difficultyinvolved in quickly locating airline passengers who may have beenexposed to a high-risk infectious agent such as the SARS virus during aflight. Often, travelers have to be found days after the flight isover. The report supports the targeted use of passenger locator cardsas an interim solution. These cards -- which would be distributed onflights to and from countries where a disease outbreak is occurring orwhen a passenger or crew member becomes ill during a flight -- wouldrecord passenger contact information and seat numbers in a scannableformat so that the data could be retrieved and transmitted easily.

Historically, more than 500 people once staffed 55 federal quarantinestations, but the perception that microbial threats had been broughtunder control led to the dismantling of most of the quarantine systemin the 1970s. However, nearly 40 new infectious diseases wereidentified between 1973 and 2003. In addition, terrorism in general andbioterrorism in particular have become grave concerns.

The report was sponsored by theCenters for Disease Control and Prevention. The Institute of Medicineis a private, nonprofit institution that provides health policy adviceunder a congressional charter granted to the National Academy ofSciences. A committee roster follows.