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 Laura B. Sivitz, Kathleen Stratton, and Georges C. Benjamin, Editors Board on Global Health Board on Population Health and Public Health Practice THE NATIONAL ACADEMIES PRESS Washington, D.C. www.nap.edu THE NATIONAL ACADEMIES PRESS • 500 FIFTH STREET, N.W. • Washington, DC 20001 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 Na- tional Academy of Sciences, the National Academy of Engineering, and the Institute of Medi- cine. 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 Mea- sures 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 Additional copies of this report are available from the National Academies Press, 500 Fifth Street, N.W., Lockbox 285, Washington, DC 20055; (800) 624-6242 or (202) 334-3313 (in the Washington metropolitan area); Internet, http://www.nap.edu. For more information about the Institute of Medicine, visit the IOM home page at www.iom.edu. Copyright 2006 by the National Academy of Sciences. All rights reserved. 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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 Coun- cil 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. www.national-academies.org 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 1 JOAN M. ARNOLDI, D.V.M., 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 2 KATHLEEN E. TOOMEY, M.D., M.P.H., 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 1 Dr. Arnoldi resigned from the committee on December 21, 2004. 2 Dr. Toomey resigned from the Georgia State Health Department effective January 15, 2005, and from the committee on March 16, 2005. v 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 stan- dards 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 indi- viduals 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 vii viii REVIEWERS 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 EXECUTIVE SUMMARY 1 Strategic Public Health Leadership at the Nation’s Gateways, 2 Background and Framework, 3 Recommendations for the Quarantine Core, 9 References, 13 1 INTRODUCTION 14 Study Methods, 18 Framing the Issue, 23 Structure of This Report, 26 References, 26 2 CONTEXT AND CONTENT OF THE CDC QUARANTINE STATION EXPANSION PLAN 28 The Emergence of New Infectious Diseases and the Threat of Bioterrorism, 28 Expansion Plan for CDC Quarantine Stations at U.S. Ports of Entry, 29 References, 34 3 TODAY’S CDC QUARANTINE STATIONS AT U.S. PORTS OF ENTRY 36 Statutory and Regulatory Foundation of CDC Quarantine Station Activities, 36 ix