Surveillance and Response to Imported Infectious Disease Gabe Palumbo, MBA, MPH Officer in Charge CDC Detroit Quarantine Station CENTERS FOR DISEASE CONTROL & PREVENTION Division of Global Migration and Quarantine (DGMQ)

CDC Quarantine Stations 2007 Jurisdictions AK ME Seattle Minneapolis Anchorage Chicago VT NH WA MT ND Detroit MA Boston MN NY RI CT CT WI MI New York OR ID SD PA NJ Newark WY MD DE IA Philadelphia OH NE No.CA IN WV IL NV Washington, D.C. San Francisco VA UT CO MO KY KS NC TN So.CA OK Dallas SC AR Atlanta Map of the 20 Quarantine Stations CDC has been expanding the Q System from 8 stations in 2004 to 20 currently The Detroit Station ahs responsibility for 3 states and all ports of entry in those states Los Angeles AZ NM North TX AL MS GA San Diego West TX East TX LA El Paso FL Houston Miami Honolulu GU HI PR San Juan CDC Quarantine Station

Migration and Health Strategy Division of Global Migration and Quarantine Travelers’ Health Zoonoses Team Africa and Americas Region Migration and Health Strategy Asia & European Region The Division has three main branches which includes Geographic medicine and health promotion ( travelers health and zoonoses) 2) immigrant , refugee and migrant health and 3) Quarantine and border health service branch under which fall the quarantine station . Notice that in 2004 there were only 8 QS’s. By Dec of 2005, there are now 18 QSs All branches collaborate with each other to fulfill the mission of the Division Quarantine Stations 8 in 2004 20 in 2007

Our Mission … To protect the health of the public from communicable diseases through science, partnerships, and response at U.S. ports

Accomplishing Our Mission (42 CFR Parts 70 and 71) Regulate importations Process migrant documentation Respond to notification of illness in international travelers

Quarantine Diseases Executive Order of the President 13295 CHOLERA DIPTHERIA INFECTIOUS TB PLAGUE SMALLPOX YELLOW FEVER VIRAL HEMORRHAGIC FEVERS SARS NOVEL OR RE-EMERGENT INFLUENZA

Definitions Isolation: Separation of ill persons with contagious disease Often in a hospital setting Applied to individual or group level

Definitions (cont.) Quarantine Restriction of well persons presumed exposed Applied at the individual or community level May be voluntary or mandatory

Responding to Illness Passive surveillance: We wait for notification of illness from- Airline / vessel pilots Federal partners Police, fire, EMTs Health departments Family, work colleagues

Responding to Illness (cont.) Active surveillance: We wait at arrival of each conveyance and visually examine each traveler Interview those who are ill Continue to respond to reports of illness

Responding to Illness (cont.) Evaluation of ill person: Identify symptoms and travel itinerary Determine if ill person should be isolated and further evaluated Identify potentially exposed travelers

Symptoms of Interest Fever (> 100° F) Rash (smallpox, measles, etc.) Severe diarrhea (cholera) Glandular swelling (plague) Jaundice (yellow fever) Stiff neck (meningitis) Unusual bleeding (viral hemorrhagic fevers) Respiratory distress (SARS, pan flu)

Notification DGMQ notifies state and local health authorities if ill travelers sent to hospital DGMQ identifies all travelers potentially exposed to the ill passenger

Online Resources Division of Global Migration and Quarantine: www.cdc.gov/ncidod/dq/index.htm Centers For Disease Control and Prevention: www.cdc.gov l

Quarantine Medical Officer DGMQ Staff in Detroit Gabe Palumbo, MBA, MPH Officer in Charge Tel: 734-955-6197 gjp0@cdc.gov Curi Kim, MD, MPH Quarantine Medical Officer cnk6@cdc.gov