Quarantine system needs revamp, study says

Brock N. Meeks Chief Washington correspondent • Profile • E-mail

WASHINGTON - The traditional duties of the U.S. quarantine system aren’t sufficient in today’s world to adequately thwart the intentional or accidental introduction of deadly viruses like bird flu on American soil, according to a group of U.S. health experts.

The quarantine system, run by the Centers Disease Control and Prevention, is in need of a strategic shift in how it operates on a day-to-day basis, said Dr. Georges Benjamin, head of the American Public Health Association and chairman of a group of health experts that produced a report on the U.S. quarantine system at CDC’s request.

Historically the quarantine stations focused on the “detection of disease in persons, animals, cargo and conveyances during the window of time shortly before and during arrival” at U.S. ports of entry, the study says.  However, the pace of global travel has dramatically changed, Benjamin said. “The environment [the CDC quarantine stations work in] has changed,” he said. “We have many more people, many more ports of entry and many more diseases.” 

In the 1930’s and 40’s, most people came into the country by boat, giving a disease time to incubate and therefore a greater likelihood that it could be detected at a U.S. quarantine station.  Today that incubation window has shrunk to nearly zero lead time.

“So you’re not going to pick up a person up, even if they have influenza, walking off an airplane,” Benjamin said, “you’re just going to miss that person. And it only takes one or two of those to cause a huge epidemic.”

The study recommends that the CDC be given broad new powers to oversee the U.S. quarantine system and put the agency in explicit control of monitoring for infectious disease. 

Currently there are 18 quarantine stations established or in the process of being finalized, said Jennifer Morcone, a CDC spokesperson.  That’s up from a mere eight stations in 2003.  By the end of fiscal year 2006 the CDC hopes to have 25 stations located at airports and border crossings throughout the U.S., she said.  When those 25 stations go operational they will cover about 75 million of the estimated 120 million that travel to the U.S. every year, according CDC’s commissioned report. 

But hundreds more staff are needed, the report says, as is a revamped strategy for training current staffers and “surrogates,” as Benjamin calls the employees of Customs and Border Protection and U.S. Coast Guard, that must step in to handle health inspection duties at the vast majority of the nation’s 474 official entry points.

“A lot of the work [the quarantine system does] is done through surrogates and because of that we wanted the CDC to take a strategic step back and become managers of the whole system,” Benjamin said.  “They kind of have the task already but it’s not explicit, there wasn’t a single person in charge and we felt they needed to be more explicit about them being in charge and managing the system.”

The entire quarantine system also is in need of more resources; the entire system was essentially dismantled over time.

Historically, there were quarantine stations at every U.S. port of entry, Morcone said.  “And if you were entering the United States you were screened for infectious diseases, like smallpox, before you entered the states.  However, “after we felt that we had licked infectious diseases, the quarantine station network was dismantled because it didn’t seem to be a prudent use of public health resources,” she said.

Then in 2003, in response to “to concerns about disease importation and bioterrorism and building on the SARS [severe acute respiratory syndrome] experience, the CDC realized the quarantine station network was a valuable asset and began to increase the number stations and enhance the training and response capability and modernize the functions of the quarantine stations at airports,” Morcone said.

The report says the CDC quarantine system should “shift their primary focus from inspecting people and cargo at individual ports to assuming leadership of activities of the broader quarantine system across local, state and national levels.”  However, the report also notes that the traditional duties of the quarantine system are valid and should not be abandoned altogether.

Morcone said the CDC is working on all the report’s recommendations, developing a national plan and working on forging closer ties with state and local health officials, a traditionally tough task. 

“Since colonial times, tension over the control of U.S. quarantine functions has existed between states and localities on one side and federal government on the other,” the report says. 

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