1. Centers for Disease Control and Prevention Division of Global Migration and Quarantine Sena Blumensaadt Quarantine Inspector

2. Organization Department of Health and Human Services (DHHS) U.S. Public Health Service (PHS) Centers for Disease Control and Prevention (CDC) National Center for Infectious Diseases (NCID) Division of Global Migration & Quarantine (DGMQ) U.S. Quarantine Stations

3. Our Mission … to prevent the introduction, transmission, and spread of communicable disease from foreign countries into the United States.

4. Quarantine Stations, United States, 2004

5. Martha Remis, Officer In Charge Sena Blumensaadt, Quarantine Inspector Shannon Bachar, Quarantine Inspector Lisa Poray, Quarantine Inspector Andre Berro, Public Health Specialist Jaclyn Chapman, Public Health Specialist Lenkisha Jenkins, Administrative Assistant Chicago Quarantine Station

6. DGMQ Duties  Screening medical records of arriving permanent residents  Illness response  Layers of surveillance  Responding to notification of illness  Information sharing  Emergency response plans  Memoranda of Agreement  More illness response (what we can do for you!)

7. Screening Medical Records of Arriving Permanent Residents Refugees, Asylees, Parolees, Immigrants, (and dozens more designations!) Refugees, asylees: notify State health dept. If history of TB: notify state and local TB coordinators If untreated or partially treated syphilis: notify state STD manager If HIV positive: notify state health dept. If history of Hansen’s disease: notify Hansen’s Disease Center in Louisiana

8. Layers of Surveillance Flight crew Medical facility (under contract with airline) Airline arrivals staff Fire, Police, Paramedics Customs and Border Protection (CBP) Airport Wheelchair Service Family members and work colleagues

9. Illness Response (Passive Surveillance) Initial Steps  Flight crew notices that someone is ill on board and notifies the pilot  Pilot radios the ground crew  Ground crew radios closest quarantine station (airline required by law to notify closest quarantine station of illness or death on board)

10. Illness Response (Passive Surveillance) Quarantine Inspector and/or paramedic meets plane at gate as it arrives All passengers remain seated on board Ill person (or family or flight crew) is interviewed Others who may assist:  Paramedics, Customs and Border Protection inspectors, Police Dept., Local public health office (if suspected smallpox)

11. Illness Response (Passive Surveillance) If believed to be non-infectious:  All passengers released If believed to be potentially infectious:  Passenger is masked and transported to hospital by ambulance  Others on board provide “locator” info  Quarantine Station notifies the hospital, State and local health departments, CDC headquarters, other federal agencies, as needed

12. Illness Response (Active Surveillance) Meet each flight from countries with disease of interest (e.g., SARS) Ask lead flight attendant if any illness on board Watch each person disembark and isolate and interview all those exhibiting symptoms of illness Hand a health alert notice to every person

13. Presidential List of Quarantinable Diseases Cholera Diphtheria Infectious Tuberculosis Plague Smallpox Yellow Fever Viral Hemorrhagic Fevers Severe Acute Respiratory Syndrome (SARS)

14. Information Sharing Train federal partners to be familiar with our regulations and notify us, when necessary Remind airline staff of their responsibilities under 42 CFR Part 71 Update airport authorities on our activities at their airport Train emergency response staff (police, fire, paramedics, etc.) on public health regulations.

15. Information Sharing Review our regulations with vessel agencies who represent seagoing vessels so they understand vessel captains’ responsibilities under 42 CFR Part 71 Learn roles of others in public health (state and local) so we may better serve

16. Emergency Response Plans We are attempting to discover where assistance is needed:  In Chicago, we can stage a tabletop, then write the final document  Outside Chicago, we can participate in a tabletop and add our comments to the draft copy of the document Some Emergency Response Plans include airport plans, pandemic flu, SARS preparedness. Your suggestions welcome!

17. Definitions Isolation Separation of ill persons with contagious disease Often in a hospital setting Applied to individual level Quarantine Restriction of persons presumed exposed Applied at the individual or community level ►May be voluntary or mandatory

18. More Illness Response Please notify us of imported cases of infectious disease (measles, TB, diphtheria, etc.) so that we can:  Gather information from airline and CBP  Provide this passenger “locator” information to state/local public health depts. Please notify us if persons with airborne infectious disease attempt to fly overseas so that we can:  Provide you with airline information so you can request that they refuse boarding to this person

19. Phone:  24-hr Phone: 773-894-2960  Fax: 773-894-2970 E-mail:  Martha Remis (msr1@cdc.gov)  Sena Blumensaadt (sib1@cdc.gov) Office hours:  Mon-Fri 8 am-8 pm  Sat-Sun 12:00-8 pm Contact CDC (Chicago)

20. Contact CDC (Atlanta) DGMQ headquarters: 404-498-1600 CDC Emergency Operations Center (24- hour): 770-488-7100 BT Preparedness and Response Program: 404-639-0385 Emergency Preparedness and Response: http://www.bt.cdc.gov/emcontact/index.asp

21. Questions and Answers Please feel free to ask questions now or later by e-mail, fax, phone!!