Infected terrorists could bring bugs across border
Infected terrorists could bring bugs across border
New infections, bioterror challenge dated system
A popular plot device in fictionalized accounts of bioterrorist attacks calls for terrorist to infect themselves with an infectious agent and then disperse into populated areas as they become symptomatic. This low-tech attack method has the terrorists, like so many drug "mules," carrying a pathogenic payload within their bloodstreams.
It would not be as easy as it is often depicted, particularly if the attacks used one of the virulent pathogens typically listed as potential bioweapons. The terrorists would have to maximize their exposures to the target in the narrow window between the end of the incubation period for the pathogen and the onset of obvious, debilitating symptoms and likely death. Still, it is a logical concern, given the widespread acceptance of suicide as a means to deliver terrorist attacks.
Of course, traversing some sparsely populated border area is always a concern. But how difficult would it be for someone to intentionally infect themselves with a pathogen and clear U.S. customs at a port of entry? Unfortunately — even if the terrorists were already symptomatic — it may not be difficult enough. Take the intentionality out and the problem remains. An infection emerging anywhere could be at our borders within a human host in a very short time.
The system of using Centers for Disease Control and Prevention quarantine stations is no longer sufficient to protect the population against microbial threats of public health significance that originate abroad, according to a recent report by the Institute of Medicine (IOM).1
In 2004, for example, a man suffering from fever, chills, severe sore throat, and diarrhea flew from Sierra Leone to Newark, NJ. He died from Lassa fever less than a week after arrival, having exposed 188 people to the disease.
One significant gap in the current quarantine system is the difficulty involved in quickly locating airline passengers who may have been exposed to a high-risk infectious agent such as the severe acute respiratory syndrome (SARS) virus during a flight, the IOM reported. Often, travelers have to be found days after the flight is over. The IOM report supports the targeted use of passenger locator cards as an interim solution. The cards — which would be distributed on flights to and from countries where a disease outbreak is occurring or when a passenger or crew member becomes ill during a flight — would record passenger contact information and seat numbers in a scannable format so that the data could be retrieved and transmitted easily.
"Many of the [quarantine] stations’ legacy activities focus on the detection of disease in persons, animals, cargo and conveyances during the window of time shortly before and during arrival at U.S. gateways," the IOM warned. "Yet the pace of global trade and travel has narrowed that window dramatically. Consequently, infected individuals and animals do not necessarily develop signs of disease while in transit or by the time of arrival, and available noninvasive diagnostics cannot always identify infected travelers with reasonable sensitivity, specificity, and speed."
The system for intercepting microbial threats at the nation’s airports, seaports, and borders needs strategic leadership and a comprehensive plan to meet the challenges posed by emerging diseases and bioterrorist threats, the IOM recommended.
The IOM urged that the CDC Division of Global Migration and Quarantine be given the responsibility, authority, and resources to lead the effort to protect the public from microbial threats that originate abroad. The CDC also should work with national, state, and local partners to develop a more comprehensive strategic approach that clearly delineates each partner’s roles and responsibilities, the IOM recommended.
"CDC quarantine stations and the broader quarantine system serve as the nation’s insurance policy against catastrophes that might arise from the importation of naturally occurring infectious agents, such as the SARS virus, or man-made threats like an attack using a dangerous biological agent," says Georges Benjamin, executive director of the American Public Health Association, Washington, DC, and chair of the IOM committee that wrote the report. "But no single entity currently has the responsibility, authority, and resources to orchestrate all the activities of the quarantine system, and the traditional responsibilities of quarantine personnel are no longer sufficient to meet the challenges posed by the rapidly increasing pace of global trade and travel and the emergence of new microbial threats."
Stations to be tripled
Every year, roughly 120 million people travel into or out of the country through the nation’s 474 airports, seaports, and land-border crossings. In 2003, Congress began to allocate funds to bring the number of quarantine stations from eight to 25. The 25 cities that would comprise the expanded quarantine station system together receive more than 75 million international travelers and immigrants annually. They also receive 31% of the cargo imported by sea.
Currently, 11 quarantine stations staffed by CDC personnel are fully active in Atlanta; Chicago; El Paso, TX; Honolulu; Houston; Los Angeles; Miami; New York City; San Francisco; Seattle; and Washington, DC. CDC will open stations by the end of the year in Anchorage, Alaska; Boston; Detroit; Minneapolis; Newark, NJ; San Diego; and San Juan, Puerto Rico. Additional cities under consideration include Charlotte, NC; Dallas; Denver; Kansas City, MO; New Orleans; Philadelphia; and Phoenix.
Airlines and ships are required to notify quarantine officials of symptomatic passengers with conditions such as jaundice, blood-producing cough, persistent diarrhea, and fever with flulike symptoms.
The current list of federally authorized quarantinable communicable diseases includes:
- cholera;
- diphtheria;
- infectious tuberculosis;
- plague;
- smallpox;
- yellow fever;
- viral hemorrhagic fevers (Lassa, Marburg, Ebola, Crimean-Congo, South American, and others not yet isolated or named);
- SARS;
- influenza caused by novel or re-emergent influenza viruses that are causing, or have the potential to cause, a pandemic.
Reference
- Institute of Medicine Committee on Measures to Enhance the Effectiveness of the CDC Quarantine Station Expansion Plan for U.S. Ports of Entry. Quarantine Stations at Ports of Entry: Protecting the Public’s Health. Washington, DC: National Academies Press; 2005.
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