quarantine tm quarantine and the emerging influenza pandemic steven l harris, md, msc quarantine...

Download Quarantine TM Quarantine and the Emerging Influenza Pandemic Steven L Harris, MD, MSc Quarantine Medical Officer CDC / Houston Quarantine Station 30 March

Post on 25-Dec-2015

225 views

Category:

Documents

0 download

Embed Size (px)

TRANSCRIPT

  • Slide 1
  • Quarantine TM Quarantine and the Emerging Influenza Pandemic Steven L Harris, MD, MSc Quarantine Medical Officer CDC / Houston Quarantine Station 30 March 2007 Steven L Harris, MD, MSc Quarantine Medical Officer CDC / Houston Quarantine Station 30 March 2007
  • Slide 2
  • Quarantine TM Definitions Quarantine Separation and restriction of movement of well persons presumed to have been exposed to contagion often at home or residential facility may be voluntary or mandatory Quarantine Separation and restriction of movement of well persons presumed to have been exposed to contagion often at home or residential facility may be voluntary or mandatory
  • Slide 3
  • Quarantine TM Definitions Isolation Separation and restricted movement of ill persons with contagious disease Often in a hospital setting Primarily individual level, may be applied to populations Often voluntary, but may be mandatory Fundamental, commonly used public health practice Isolation Separation and restricted movement of ill persons with contagious disease Often in a hospital setting Primarily individual level, may be applied to populations Often voluntary, but may be mandatory Fundamental, commonly used public health practice
  • Slide 4
  • Quarantine TM Historic roots of Quarantine Biblical accounts of quarantine practices for persons with leprosy Epidemic plague in 14th C. Europe had profound impact on commerce 1485: Venice established 40-day (Lat. Quadragina) harbor detention, i.e., quarantine 1626: First Quarantine Station, Marseille The Quarantine Flag: Became the Q flag in the international maritime code of flag signals Biblical accounts of quarantine practices for persons with leprosy Epidemic plague in 14th C. Europe had profound impact on commerce 1485: Venice established 40-day (Lat. Quadragina) harbor detention, i.e., quarantine 1626: First Quarantine Station, Marseille The Quarantine Flag: Became the Q flag in the international maritime code of flag signals
  • Slide 5
  • Quarantine TM Quarantine in the United States Quarantine in Colonial America handled locally by each colony Massachusetts Bay Colony (1647) Yellow Fever outbreak in Philadelphia (1793) Governor declared cordon sanitaire National Quarantine Act (1878) Shift of quarantine powers from state to federal government Public Health Service Act (1944) Basis for current federal quarantine powers Quarantine in Colonial America handled locally by each colony Massachusetts Bay Colony (1647) Yellow Fever outbreak in Philadelphia (1793) Governor declared cordon sanitaire National Quarantine Act (1878) Shift of quarantine powers from state to federal government Public Health Service Act (1944) Basis for current federal quarantine powers
  • Slide 6
  • Quarantine TM Purpose of Quarantine Range of community containment strategies for infectious diseases Applied to persons exposed but not ill, ie, contacts (not cases) Designed to meet two objectives: Facilitate early recognition of symptoms of a contagious disease, should they develop Reduce risk of transmission before progression to disease has been recognized Range of community containment strategies for infectious diseases Applied to persons exposed but not ill, ie, contacts (not cases) Designed to meet two objectives: Facilitate early recognition of symptoms of a contagious disease, should they develop Reduce risk of transmission before progression to disease has been recognized
  • Slide 7
  • Quarantine TM Quarantine Dichotomy Quarantine is a dirty word Black Death, yellow fever, Pandemic influenza Detention camps equate disease with crime Stigmatizes victims (e.g., foreign born) Historical abuses of power Quarantine works Effective tool to prevent spread of contagion As good or better than other tools in the box Quarantine is a dirty word Black Death, yellow fever, Pandemic influenza Detention camps equate disease with crime Stigmatizes victims (e.g., foreign born) Historical abuses of power Quarantine works Effective tool to prevent spread of contagion As good or better than other tools in the box
  • Slide 8
  • Quarantine TM Legal Authority Legal right to take a particular action based on statute, regulation, or other legal precedent Important tool, but not a substitute for Resources Planning Communication Authority does not necessarily equal policy Legal right to take a particular action based on statute, regulation, or other legal precedent Important tool, but not a substitute for Resources Planning Communication Authority does not necessarily equal policy
  • Slide 9
  • Quarantine TM Quarantine: Statutory Authority Intrastate quarantine power Considered a police power -- an inherent authority to protect health and welfare of citizens Reserved to states (10 th Amendment) Local or state public health officials have authority for quarantine when an infectious disease outbreak confined within state border Intrastate quarantine power Considered a police power -- an inherent authority to protect health and welfare of citizens Reserved to states (10 th Amendment) Local or state public health officials have authority for quarantine when an infectious disease outbreak confined within state border
  • Slide 10
  • Quarantine TM Interstate Quarantine Regulations: 42 CFR Part 70 Report of communicable disease to local health authority Provision for Federal travel permit requirement Written permit for travel from one state to another Written permit for operators of conveyances Must comply with applicable state travel permits Intrastate federal intervention only if local control inadequate Report of communicable disease to local health authority Provision for Federal travel permit requirement Written permit for travel from one state to another Written permit for operators of conveyances Must comply with applicable state travel permits Intrastate federal intervention only if local control inadequate
  • Slide 11
  • Quarantine TM Quarantine: Statutory Authority Foreign and interstate quarantine Considered essential in regulation of foreign and interstate commerce Federal authority (Commerce clause) Executive decision by the President CDC manages federal quarantine, with possible utilization of assets from other agencies CDC may intervene in intrastate incidents if requested by state or if local control efforts considered inadequate Foreign and interstate quarantine Considered essential in regulation of foreign and interstate commerce Federal authority (Commerce clause) Executive decision by the President CDC manages federal quarantine, with possible utilization of assets from other agencies CDC may intervene in intrastate incidents if requested by state or if local control efforts considered inadequate
  • Slide 12
  • Quarantine TM Foreign Quarantine Regulations: 42 CFR Part 71 Reporting of ill persons defined by Fever (100 F or 38 C) persisting 48 hours Fever and rash, glandular swelling, or jaundice Diarrhea (3 stools in 24 hours or greater than normal amount) Medical surveillance of arriving persons Sanitary measures over inbound carriers, cargo Quarantine of arriving persons with diseases listed in the Presidential Executive Order Reporting of ill persons defined by Fever (100 F or 38 C) persisting 48 hours Fever and rash, glandular swelling, or jaundice Diarrhea (3 stools in 24 hours or greater than normal amount) Medical surveillance of arriving persons Sanitary measures over inbound carriers, cargo Quarantine of arriving persons with diseases listed in the Presidential Executive Order
  • Slide 13
  • Quarantine TM Executive Order 13295: Revised List of Quarantinable Communicable Diseases Executive Order 13295: Revised List of Quarantinable Communicable Diseases (a)Cholera; Diphtheria; infectious Tuberculosis; Plague; Smallpox; Yellow Fever; and Viral Hemorrhagic Fevers (Lassa, Marburg, Ebola, Crimean-Congo, South American, and others not yet isolated or named) (b) Severe Acute Respiratory Syndrome (SARS) (c) Influenza caused by novel or reemergent influenza viruses that are causing, or have the potential to cause, a pandemic (a)Cholera; Diphtheria; infectious Tuberculosis; Plague; Smallpox; Yellow Fever; and Viral Hemorrhagic Fevers (Lassa, Marburg, Ebola, Crimean-Congo, South American, and others not yet isolated or named) (b) Severe Acute Respiratory Syndrome (SARS) (c) Influenza caused by novel or reemergent influenza viruses that are causing, or have the potential to cause, a pandemic President George W. Bush April 1, 2005 President George W. Bush April 1, 2005
  • Slide 14
  • Quarantine TM Functions of Quarantine Stations Respond to reports of illnesses on cruise ships, cargo ships, and airplanes Inspect animal and human products posing threat to human health Monitor health and collect, distribute, and manage medical information for new immigrants, refugees, and parolees Respond to reports of illnesses on cruise ships, cargo ships, and airplanes Inspect animal and human products posing threat to human health Monitor health and collect, distribute, and manage medical information for new immigrants, refugees, and parolees
  • Slide 15
  • Quarantine TM Functions of Quarantine Stations Inspect cargo and hand-carried items for potential vectors of human infectious diseases Distribute immunobiologics and investigational drugs Provide travelers with essential health information Respond to migration emergencies Planning for emergency response Inspect cargo and hand-carried items for potential vectors of human infectious diseases Distribute immunobiologics and investigational drugs Provide travelers with

Recommended

View more >