1. Gabrielle Benenson, MPH Division of Global Migration & Quarantine
CDC’s Quarantine Branch: Building Partnerships and Enhancing Workforce Development
Gabrielle Benenson, MPH
Division of Global Migration & Quarantine
National Center for the Preparedness, Detection, and Control of Infectious Diseases Centers for Disease Control and Prevention (CDC)
Hello my name is [insert name and title].
I would also like to introduce [insert name and title of any co-presenters].
Learning Objectives for this session:
Define the mission of the Quarantine and Border Health Services Branch (QBHSB)
List 3 Quarantine Station functions
Describe workforce development activities for 2 quarantine system partners

2. Quarantine and Border Health Services Branch Mission
To protect the health of the public from communicable diseases through science, partnerships, and response at U.S. ports
The quarantine stations at our ports of entry are part of CDC’s Quarantine and Border Health Services Branch.
The mission of the Quarantine and Border Health Services Branch is to protect the health of the public from communicable diseases through science, partnerships, and response at U.S. ports.
Our partnership with EMS is invaluable – we included the term, “partnerships” in our mission statement because Quarantine Station personnel rely on the assistance of partner agencies to achieve the mission of protecting the health of the public. In particular, EMS is one of several partners at ports of entry that recognize and notify CDC of public health events.
Photo description: A Quarantine Public Health Officer responds to a call in San Francisco.
Photo credit: Ramesh Krishnamurthy, courtesy of the San Francisco Quarantine Station

3. “The war against infectious diseases has been won…”
— William H. Stewart
U.S. Surgeon General, 1969
Before 1967, the quarantine system had a large workforce- over 600 employees who did direct inspection.
Stewart’s quote in 1969 shows the belief at the time that we had infectious diseases under control.
Massive vaccination programs had all but routed polio, smallpox and yellow fever. The pharmaceutical revolution brought potent new antibiotics and medicine cocktails that drove away dozens of mosquito-borne diseases.
The quarantine system was reduced to 8 stations and 70 employees. In 2004, due to the emergence of new illnesses such as SARS and the threat of bioterrorism, sparked a revision of operations and expansion of stations and staff.

4. 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 KS MO KY NC TN
So.CA OK
Dallas SC AR
Atlanta
Los Angeles AZ NM
(Note to presenter: The map with contact list can be printed out as handouts from
To date, there are 326 ports of entry in the United States: 157 airports, 154 land ports, and 15 sea ports. We share 5,000 miles of border with Canada, 1,900 miles of border with Mexico, and have 95,000 miles of shoreline. Keeping this level of operation in mind, there are only 20 quarantine stations, with close to 100 staff at 18 airports and 2 land border crossings.
This map shows the 20 quarantine stations and their corresponding, color-coded jurisdictions, as redefined in Dallas and Philadelphia are our newest stations; they opened in Note that Texas is broken up by county lines; there are three areas that encompass this vast state – North, East, and West Texas, respectively. North Texas is managed by the Dallas station, East Texas is managed by the Houston station, and West Texas is managed by the El Paso station.
Note: If participants would like a copy of this map and contact information, they can locate it on the Internet at:
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

5. Federal Quarantine Authority
Public Health Service Act, section 361
(42 US Code § 264)
U.S. Secretary of Health and Human Services authorized to take measures to prevent the entry and spread of communicable diseases from foreign countries into the United States and between states*
Public Health Service Act
The Public Health Service Act of 1944 provided a clear statutory basis for the federal government's quarantine authority for the first time. The act gave the U.S. Public Health Service (PHS) responsibility for preventing the introduction, transmission, and spread of communicable diseases from foreign countries into the United States.
The HHS Secretary has statutory responsibility for preventing the introduction, transmission, and spread of communicable diseases from foreign countries into the United States, for example, at international ports of arrival, and from one state or possession into another. This authority has been delegated by the secretary to the Director of CDC.
The photo in this slide shows members of the Public Health Service in uniforms worn in 1912.
* Derived from Commerce Clause of U.S. Constitution

6. Executive Order 13295
Revised List of Quarantinable Communicable Diseases
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)
Severe acute respiratory syndrome (SARS)
Influenza caused by novel or reemergent influenza viruses that are causing, or have the potential to cause, a pandemic
Only in the case of these nine illnesses listed in the Executive Order signed by the President of the United States does CDC have the authority to quarantine. SARS and novel or reemergent influenza viruses, such as avian influenza, are the most recent additions.
President George W. Bush
April 1, 2005

7. CDC Quarantine Stations’ Functions
Respond to reports of illnesses on maritime vessels (cruise, cargo), airplanes, and at land crossings
Inspect animal and human products posing threat to human health
Distribute life-saving immunobiologics and investigational drugs
Quarantine stations achieve the mission of protecting the public from communicable diseases through a number of activities:
The primary activity of quarantine public health officers is responding to reports of illnesses on ships, aircrafts and at land border crossings.
Form partnerships, much like our current partnership with EMS, for disease surveillance and control.
Plan and prepare for emergency response.
And inspect animal and human products that may pose a threat to human health.
Note to presenter: no photo credits available.
Plan and prepare for emergency response

8. CDC Quarantine Stations’ Functions
Monitor health, and collect, distribute, and manage medical information of new immigrants, refugees, and parolees
Inspect cargo and hand-carried items for potential vectors of human infectious diseases
Provide travelers with essential health information
Respond to mass migration emergencies
Form partnerships for disease surveillance and control
In addition, Quarantine stations also:
Monitor health, and collect, distribute, and manage medical information of new immigrants, refugees, and parolees
Inspect cargo and hand-carried items for potential vectors of human infectious diseases
Distribute life-saving immunobiologic and investigational drugs
Provide travelers with essential health information
Respond to mass migration emergencies

9. Air Transport Assoc. of America
The Quarantine System
Air Transport Assoc. of America
Network
System
Core
Q Stations DGMQ HQ CDC
CBP
EMS
Int. Org. for Migration
State PHAs
Hospitals
Health-care providers
Port officials
USFWS
USDA APHIS
PH labs
Foreign Gov'ts
Courts
Int. Council of Cruise Lines
Canadian/ Mexican Border Authorities
PHAC
DHS
FAA
FBI
State Dept.
WHO
News Media
CSTE
NACCHO
ASTHO
BIDS
APHL
DOT
Media (general)
Int. Civil Aviation Org.
USCG
FBI (local)
LPHAs
Overseas Panel Physicians
USCG (local)
FDA
Source: IOM Report
The U.S. quarantine stations do not work alone. To fulfill our mission to protect the health of the public from communicable diseases, the U.S. quarantine system relies on a vital network of partnerships. This graphic shows the vital relationships and network of the quarantine system as depicted in the 2005 Institute of Medicine report on ”Quarantine Stations at Ports of Entry: Protecting the Public’s Health.”
[See:
At the core is CDC, DGMQ HQ, and the quarantine stations.
Our most important partners are Emergency Medical Services (EMS), Customs & Border Protection (CBP), and state and local public health agencies.
Note: Glossary of Acronyms
APHL – Association of Public Health Laboratories
ASTHO – Association of State and Territorial Health Officials
BIDS – Border Infectious Disease Surveillance project (at CDC)
CBP – Customs and Border Protection
CSTE – Council of State and Territorial Epidemiologists
DHS – Department of Homeland Security
DOT – Department of Transportation
EMS – Emergency Medical Service
FAA – Federal Aviation Administration
FBI – Federal Bureau of Investigation
FDA – Food and Drug Administration
LPHA – Local Public Health Authority
NACCHO – National Association of County and City Health Officials
PHA – Public Health Agency
PHAC – Public Health Agency of Canada
USCG – U.S. Coast Guard
USDA APHIS – U.S. Dept. of Agriculture, Animal and Plant Health Inspection Service
USFWS – U.S. Fish and Wildlife Service
WHO – World Health Organization
Relationships among the Quarantine Core System and Network for U.S. Ports of Entry

10. Quarantine Training & Education Team (QTET)
Provides training, education, and communication support and expertise for the Quarantine & Border Health Services Branch staff and partners
Needs Assessment: Partner Training, Education, and Communication
Customs and Border Protection Training
Training and Education Materials Development
RING Card – Customs and Border Protection
Travel Health Alert Notices (T-HANs) – Travelers
Fact Sheets – General Public
Posters – Travelers
Measles in Germany & Malaria/Dengue in Carribean (collaboration with GMHPB)
Website – General public
Pandemic Influenza Preparedness Activities
Training and Communication for Nonpharmaceutical Interventions
Surge Capacity Training
Internal Training and Communication
Annual conference/training
Q-Sphere Newsletter
Learning Management System

11. Overview of Systematic Approach to Health Education
Needs Assessment
Evaluation
Development
Build and strengthen relationships with key partners at ports of entry
Help develop appropriate training and education content and communication messages for delivery via preferred and effective formats
Implementation
Pilot-testing

12. Goals of Needs Assessment and Formative Evaluation Activities
Build and strengthen relationships with key partners at ports of entry
Develop appropriate training and education content and communication messages
Provide content through preferred and effective formats

13. Customs and Border Protection
Focus groups and interviews with CBP instructors and officers about training and job aids
Evaluation of basic training course
Roundtable discussions and Web-based survey planned

14. Airlines Focus group with American Airlines
Interviews and roundtable discussions planned
Focus group with American Airlines in Miami with 6 participants who are American Airlines managers and trainers. Discussed reporting of illness and barriers to reporting, communication mechanisms, training preferences and reviewed fact sheet developed for flight crews during emergency public health communication.
Planning interviews and roundtable discussions with Delta, United, American, Continental and flight crews and pilots.

15. EMS Roundtable discussions at EMS & CDC Collaborative Meeting
Roundtable discussions at Aircraft Rescue Firefighting Working Group Annual Meeting
Interviews with training coordinators planned
1 day event with presentations and discussions between EMS and CDC quarantine station staff. 70 attendees
2 hour discussion with 10 participants from firefighter units at international airports in the United States.
Provided information on training topics, communication methods, initial review of job-aids to support reporting, training methods and opportunities.

16. Travelers and General Public
Focus group on Travel Health Alert Notices (additional planned)
Message testing for quarantine and pandemic influenza messages

17. Public Health Practitioners
Review of fact sheets on community strategies for pandemic flu mitigation
Focus groups with physicians planned
Sent to ASTHO, NACCHO, CSTE, some local health departments and internal CDC subject matter experts for review and comment. Used a feedback form to solicit and collect comments during review.

18. Quarantine Station Staff
Evaluation and planning committee for annual conference
Web-based survey on training topics, formats, frequency, and location
Evaluations collected for each session and analyzed each year to plan for next conference/training. Formation of planning committee from conference attendees/participants to help plan for next year.
Survey conducted by RTI to assess preferred training topics, formats, frequency, and location for Quarantine staff.

19. Questions?