It is the role of the Centers for Disease Control and Prevention (CDC) to block the introduction of communicable diseases into the U.S. from abroad. What is less well known is that the commander of any aircraft destined for a U.S. port of entry has the same legal obligation.

In fact, the CDC requires under federal law that the commander of an aircraft entering the U.S. report to the U.S. quarantine station, or to other appropriate health authorities at the port of entry, the death or illness of any passenger or member of the crew.

The spread of communicable diseases has always been a health concern, taken at some points in history more seriously than at others. In the 1970s, many of mankind’s most infectious ailments appeared to have gone the way of the dinosaur, the dodo bird and common human civility. The CDC dutifully reduced the number of quarantine stations at U.S. ports of entry from 55 to a mere eight, and reporting procedures were given little–if any–thought by pilots. In some cases they were simply ignored.

But while common human civility appears to remain on the endangered list, infectious diseases are making a resurgence, and so is the CDC’s concern.

In no small way, the agency’s concerns stem from a number of relatively recent events, beginning with Sept. 11, 2001. It was followed by the domestic anthrax mailings and, in 2003, the SARS (severe, acute respiratory syndrome) outbreak, then by the spread of avian flu in 2005. And, most recently, the case of Atlanta personal injury lawyer Andrew Speaker, who made several airline flights after he was diagnosed with a multi-drug-resistant form of tuberculosis.

Advised not to travel, Speaker nevertheless embarked on a series of seven airline flights taking him from the U.S. to the Mediterranean and Europe before returning to the U.S. via Canada. Along the way, he potentially exposed hundreds of people to his condition. Perhaps most telling about the prevailing attitude toward the importance of quarantine was the fact that he and his fiancée drove through Canada to the U.S. border, where he was allowed entry by a U.S. Border Patrol agent who disregarded a warning to detain him.

Serious Threat Remains
In response to such incidents and the potential for a pandemic spread of communicable disease, the CDC is taking the threat more seriously and has increased the number of U.S. quarantine stations at U.S. ports of entry from eight to 20. While this might sound like a small number, according to John Neatherlin, officer in charge of the CDC quarantine station at Dallas/Fort Worth International Airport, those 20 stations collectively see about 85 percent of all air travelers entering the U.S. Neatherlin  also noted that another five centers will be opened outside the U.S. at airports that are major departure points for flights to the U.S.

Officers at a CDC quarantine station may, by executive order, deny entry into the U.S. to people with symptoms of cholera, diphtheria, infectious tuberculosis, plague, smallpox, yellow fever, viral hemorrhagic fevers, SARS and any form of flu that might result in a pandemic.

They also have the authority to order the isolation of ill people who have a communicable disease from those who are healthy. And they may order individuals who are believed to have been exposed to a disease, but who do not exhibit the symptoms, into quarantine until their medical condition has been determined.
Even so, quarantine station resources may be stretched thin. For example, there is one station in Anchorage, but there are two other international airports in Alaska and three other non-aviation ports.

The quarantine station in Anchorage also relies on observations by U.S. Customs and Border Protection Agents to spot and report individuals who show symptoms of a communicable disease. Some of the most apparent are a persistent cough and sneezing, nausea and vomiting and a skin rash.

Some of these symptoms, such as swollen glands, severe diarrhea and a fever in combination with a rash, may be more easily observed over a period of time by an aircraft crew, said Anchorage-based quarantine officer Dr. Petra Illig.

Dr. Illig has been assigned to interact in particular with the general aviation community. “We’re trying to work with the [business and private aviation] industry to increase awareness of the need to report possible cases of communicable diseases.”

Not only is it the responsibility under law for an airplane commander to report an incident of illness or death aboard an inbound flight, added Neatherlin, a failure to do so could result in the CDC’s turning the case over to state or federal authorities, who might choose to prosecute.

More information on CDC and quarantine and isolation is available from agency Web sites: www.cdc.gov/travel/contentInfoForTravelers.aspx; and The CDC Yellow Book of Health Information for International Travelers at www.cdc.gov/travel/pbToc.aspx. 

How About That!

• Nine communicable diseases are of particular concern to the Centers for Disease Control and Prevention: cholera, diphtheria, infectious tuberculosis, plague, smallpox, yellow fever, viral hemorrhagic fevers (ebola virus), SARS and flu that can cause a pandemic.
• The word “quarantine” comes from quadragesima, the Latin word for the number 40, the number of days in times long past that a ship might be refused entry to port if suspected of carrying a communicable disease.
• A federal mandate allows CDC to quarantine a person against his or her wishes.
• At its peak, the CDC had 55 quarantine stations and all incoming airplanes and ships were met by a quarantine officer.
• When alerted about an ill passenger or crewmember by an airplane commander, the CDC can detain passengers and crew as necessary to investigate whether the cause of the illness is a communicable disease.
• CDC has 30 “partners” considered important in support of the work of its U.S. quarantine stations, among them the Coast Guard, FBI, port officials, local emergency medical services, hospitals, Canadian and Mexican border authorities, the World Health Organization and state health authorities.