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ATLANTA Federal health officials are seeking to update quarantine and contact-tracing regulations, hoping changes such as easier access to airline passenger lists could better protect Americans from foreign infectious diseases, including bird flu.
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Links in this box are all to PDF documents on CDC web site, index page at: http://www.cdc.gov/ncidod/dq/nprm/index.htm Control of Communicable Disease Proposed 42 CFR Parts 70 and 71 This document contains the notice for proposed rule making and regulatory impact analysis that was completed for this NPRM, including the economic impact analysis. Submit Comments about the Control of Communicable Disease Proposed 42 CFR Parts 70 and 71 Date:
November 22, 2005 |
The proposed changes, announced Tuesday by the federal Centers for Disease Control and Prevention, include easier CDC access to airline and ship passenger lists, a clearer appeals process for people subjected to quarantines and explicit authority to offer vaccinations and medical treatment to quarantined people.
The changes are part of an attempt to guard against infectious agents from abroad. In the past 1 1/2 years, the CDC also has increased the number of quarantine stations at airports, ship ports and land-border crossings to 18 from eight.
Concerns about a potentially deadly bird flu migrating from Asia are among the motivators for the change, said Dr. Martin Cetron, director of the CDC's division of global migration and quarantine. Health officials fear this form of bird flu could spark a pandemic.
CDC officials say this is the first substantial overhaul of such regulations in at least 25 years.
States have laws for the isolation and quarantine of sick or infected individuals, and use those powers occasionally. Federal powers are exercised less oftenthe last time the U.S. government ordered someone quarantined was in 1962, CDC officials said.
The need for new federal regulations was made clear during international outbreaks of the SARS virus in 2003, when public health officials had difficulty getting passenger information from airlines to trace the contacts of people who had been infected, Cetron said.
"SARS put it really front and center where the gaps were," he said.
One proposal would require airlines and cruise lines to maintain passenger and crew lists and submit them electronically to CDC upon request. The measure could cost as much as $108 million a year for airlines and $800,000 for cruise lines, according to one government estimate. However, that assumes a dramatic revamping of electronic record-keeping, which may not be necessary, Cetron said.
The airline industry hasn't yet calculated the cost of changing data systems, said Katherine Andrus, assistant general counsel for the Air Transport Association, a Washington-based trade organization.
The association is still reviewing the proposal, she said. Airlines want to protect their customers' privacy, but they don't expect much protest from passengers if providing the information helps contain an epidemic, she added.
"We believe most people would want to cooperate voluntarily because their own health may be at stake," Andrus said.
Another CDC proposal would set the legal rights of a person placed under quarantine, including the right to request a hearing. Some legal scholars said such guidelines are missing from federal law, and their absence could lead to a legal tangle that might stall government quarantine actions.
CDC officials say they hope to make the regulations final by next spring.
source: http://www.chicagotribune.com/news/nationworld/chi-0511230172nov23,1,6508720.story?coll=chi-newsnationworld-hed 23nov2005
Washington Travelers entering the U.S. with fever and other flu-like symptoms would be reported by the airline or ship that brought them, under new rules proposed today, a U.S. public-health official said.
The rules would expand the list of conditions that airlines and ships are required to report among travelers crossing some state lines and for those arriving from abroad, the U.S. Centers for Disease Control and Prevention said in an e-mailed statement. The regulation changes also clarify an appeals process for people placed under quarantine, the Atlanta-based agency said.
The regulations "will allow the CDC to move more swiftly" when attempting to avert outbreaks, said Martin Cetron, director of the CDC's Division of Global Migration and Quarantine, on a conference call with reporters today. "What we have now is a very passive system."
The proposed changes were prompted by the epidemic of SARS in 2002 and 2003 that sickened 8,096 people and killed 774 on three continents in about nine months. U.S. government officials estimate a global pandemic of avian influenza, if such a virus becomes contagious in humans, would kill as many as 1.9 million Americans and hospitalize 9.9 million. The frequency of international travel will spread the disease, CDC officials said.
Symptoms
Under the rules, a sick person who should be reported would have a fever of 100.4 degrees Fahrenheit or higher that has lasted at least 48 hours or is combined with a rash, swollen lymph nodes, headache or wavering consciousness; diarrhea; or bleeding, jaundice, difficulty breathing or a cough with bloody sputum.
When "compatible symptoms are noticed in a passenger on a flight or ship, there will be a requirement for the captain to report it to the quarantine station that has jurisdiction over that port of entry" for medical personnel to assess them, Cetron said today. "We're not talking about quarantining anybody for a sniffle."
Ideally, a captain would call in a report of an evidently- ill passenger before arriving at the destination, where public- health-service officials could handle the matter, Cetron said.
The proposal also outlines procedures for government orders to quarantine people, and for how a person may appeal an order. For example, the CDC director would schedule a hearing within one day of such a request.
Quarantine
In quarantine, a person's movement and contact with others is restricted for the amount of time it takes a certain disease to incubate, to prevent transmission to others. The person is released if symptoms don't develop during the period.
Diseases that qualify for quarantine are: plague, cholera, tuberculosis, yellow fever, diphtheria, smallpox and the hemorrhagic fevers Ebola, Marburg and Crimean-Congo. Influenza, when caused by a new or reemerging viral strain with the potential to cause a pandemic, is also among communicable diseases for which the federal health service is authorized to order a quarantine.
The CDC has 18 quarantine stations nationwide. The public has 60 days to comment on the proposed regulations.
Industry Costs
Ships and airlines also would be required make passenger and crew lists available in electronic format for at least 60 days after arrival, and be able to submit them within 12 hours of a CDC request. The lists should include names, contact information and seat assignments.
Cetron said the lists will be vital for tracing contacts quickly during a disease's incubation period, and would improve on the response time achieved during the SARS outbreak, when health officials had to reconstruct contacts based on incomplete and delayed information.
The travel and transportation industries would pay the expenses for collecting and storing information, either at the time a ticket is purchased or at departure, and for updating computer systems, according to a government-funded analysis included in the proposed rule.
Complying with the changes would cost airlines about $108 million to $356 million a year for 10 years, depending on when they collect passenger information and counting only international flights and interstate flights from large and medium-sized U.S. airport hubs, the report said. Including interstate flights from all U.S. airports might raise the cost to $386 million a year. Estimated costs for cruise lines were as high as $39 million a year.
"The proposed rule would have a significant impact on the private sector, particularly air carriers," according to the document's text.
source: http://www.bloomberg.com/apps/news?pid=10000103&sid=a7_LFiIF4Z8U&refer=us# 23nov2005
Canada has confirmed that an H5 strain of avian influenza was found in two wild ducks just outside Vancouver, British Columbia, but states that it was not the H5N1 strain currently so prevalent in Asia.
In response, the United States banned imports of poultry from British Columbia, but may scale back the ban once more information is received from Canadian authorities.
Although the virus is not the form currently the focus of much media attention, it still carries the risk that poultry in the vicinity may become infected with the virus and that virus could then mutate.
Local authorities have culled 56,000 birds on the farm where the ducks were found, and have quarantined four other farms within a three-mile radius.
Japan also banned all Canadian poultry as a result of the announcement. Taiwan and Hong Kong have imposed temporary bans on poultry from British Columbia.
Meanwhile:
source: http://www.upi.com/ConsumerHealthDaily/view.php?StoryID=20051122-115517-1127r 23nov2005
The federal Centers for Disease Control and Prevention released a phone-book-thick proposed rule yesterday that would give the federal government new powers to track the comings and goings of individual travelers and expand the circumstances under which passengers exposed to a serious communicable disease could be isolated or quarantined.
The proposed changes are the latest in a series of preparatory moves aimed at solidifying federal health officials' legal authority to take actions aimed at slowing the spread of emerging contagious diseases, such as pandemic flu.
The new provisions the costs of which would fall mostly on the travel industry call for greater scrutiny of passengers for signs of illness and greater efforts by airlines and others to obtain personal contact information from travelers. They also broaden the list of symptoms that would make people subject to quarantine.
Although the rules strengthen federal authority to isolate passengers suspected of being infected, they also spell out in unprecedented detail key legal rights, including appeals processes, for citizens. The agency will accept public comment for 60 days before issuing a final regulation.
Officials said they are confident that the vast majority of Americans will support the changes so the government could better protect them from a major outbreak whether naturally occurring or from a bioterrorism attack.
"We're not talking about quarantining anybody for a sniffle or a cough," said Martin Cetron, director of the CDC's division of global migration and quarantine, in a conference call with reporters.
He added that although travelers would be asked to provide more personal information including phone numbers and e-mail addresses the goal is simply to be able to contact people if it becomes apparent they sat near an infected person while traveling.
"There are some very rigorous standards of privacy with which this information will be treated," Cetron said.
Many of the proposed changes are the result of lessons learned from the 2003 outbreak of SARS, or severe acute respiratory syndrome, when federal and international health officials realized how hard it was to track down passengers who had shared flights or other transportation with an individual who had the contagious disease.
Flight manifests are sometimes destroyed within days, they found, and customs documents being on paper were not easily transmitted to health authorities and were often illegible.
The proposed regulation requires airlines operating out of major airports and international cruise operators to request detailed contact information from passengers; maintain that information along with the passenger's seat location electronically for at least 60 days; and transmit it to the CDC within 12 hours of a request.
As proposed, passengers could refuse to give personal contact information and still travel. The agency would destroy the information after a year, by which time it would no longer be useful for tracing disease.
The rule also demands that ship and airline captains report to the CDC any deaths or signs of significant illness on board, preferably before arriving at their destination. Existing requirements are less explicit and call for reporting to local health departments instead of federal officials.
The rule spells out a somewhat broadened array of circumstances or symptoms that can result in a passenger being held in quarantine or isolation upon arrival. (The term "quarantine" refers to the time a person is restricted because of suspicion of exposure to a disease but with no sign of illness; "isolation" refers to the time a person is restricted while ill and presumed able to spread the disease.) Practically speaking, the responsibility for detaining passengers falls largely on federal quarantine officers, who are eyeballing and questioning arriving passengers at a growing number of U.S. airports and other transport hubs.
Agency documents supporting the rule emphasize that the courts have long found that public health concerns can trump individual rights, including certain expectations of privacy, freedom of movement and Fourth Amendment protections against unreasonable search and seizure.
A yellow fever epidemic in 1796 prompted Congress to pass the first federal quarantine legislation, and provisions have expanded since then. The government can now quarantine people "reasonably expected to be infected with or exposed to" any of nine diseases: cholera, diphtheria, infectious tuberculosis, plague, smallpox, yellow fever, viral hemorrhagic fevers (including Ebola), SARS and pandemic flu.
Under the new proposal, the criteria used to presume infection are broadened to include a fever of 100.4 degrees Fahrenheit or higher in conjunction with other symptoms, to make sure anyone with pandemic flu is included.
Although quarantine is generally seen as a last resort, the CDC documents state, it can be especially important in bioterrorism incidents in which the disease agent has been bioengineered to be especially contagious, drug-resistant or vaccine-resistant.
Federal courts have varied in their rulings on how long the government may hold someone before that person must be afforded an administrative hearing. The proposed rule would allow detention for three business days without a hearing, with an option to extend if medical tests confirm the need.
No one could be forcibly isolated for longer than the amount of time it takes for the suspected disease to be no longer communicable less than a month for most diseases.
The CDC estimated that the costs of implementing the new rule nationwide could be $185 million to $865 million per year. That would be a bargain, the agency calculated, given the potential direct and indirect costs of a major outbreak.
The proposed rule is to be published in the Federal Register today and can be viewed at http://www.cdc.gov/ncidod/dq
source: http://www.washingtonpost.com/wp-dyn/content/article/2005/11/22/AR2005112201700.html 23nov2005
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