U.S. Public Health Travel Restriction and Intervention Tools - - PowerPoint PPT Presentation

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U.S. Public Health Travel Restriction and Intervention Tools - - PowerPoint PPT Presentation

May 14, 2023 183 likes •392 views

U.S. Public Health Travel Restriction and Intervention Tools Restriction and Intervention Tools Peter Houck, MD Quarantine and Border Health Services Branch May 2011 May 2011 CAPSCA Americas Project Bogot, Colombia Nat i onal Cent er f or

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U.S. Public Health Travel Restriction and Intervention Tools Restriction and Intervention Tools

Peter Houck, MD

Quarantine and Border Health Services Branch May 2011 May 2011 CAPSCA Americas Project Bogotá, Colombia

Nat i

  • nal

Cent er f

  • r

Em er gi ng and Zoonot i cI nf ec t i

  • us

Di s eas es Di vi s i

  • n
  • f

Gl

  • bal

M i gr at i

  • n

and Quar ant i ne

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Department of Homeland Security Tools il bl bli l h h i i Available to Public Health Authorities

Do Not Board (DNB) List

Do Not Board (DNB) List

Lookout (LO) List

Source: Robbi Behr, New York Times, May 2006

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Do Not Board List

 Transportation Security Administration (TSA)  Transportation Security Administration (TSA)  Prevents persons with (suspect or known) diseases  Prevents persons with (suspect or known) diseases

from obtaining boarding passes

 Established in June 2007

  • Stringent multi‐layered approval process

Stringent, multi layered approval process

  • CDC Ethics Workgroup
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Do Not Board List

 Applies to foreign nationals and U.S. citizens  All flights departing from, arriving into, and flying

ithi th U it d St t within the United States

 DNB list is NOT part of the “No Fly” List  International notifications

  • Canada and Mexico notified of every DNB actions

h f d l

  • Other countries notified per protocol
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k i Lookout List

 Customs and Border Protection (CBP)

( )

 Applies to international arrivals at U.S. airports,

seaports, and land borders

 Prompts CBP staff to notify CDC quarantine staff

when such persons attempt to enter the U.S.

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SLIDE 6

Do Not Board and Lookout Lists Do Not Board and Lookout Lists Placement Criteria

Person with disease of public health concern

Non‐adherent Expr es s ed Infectious

  • r

unaware of diagnosis Expr es s ed i nt ent i

  • n

t

  • t

r avel and and g

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Process for DNB/LO Requests Process for DNB/LO Requests

Starts with notification from

CDC QS

Starts with notification from local/state public health authority to CDC

CDC QS receives request

authority to CDC Quarantine Station (QS)

CDC and local/state health departments discuss and concur with request and concur with request CDC DGMQ Office of the Director

  • fficial approves the request

Official request sent to CDC Emergency Operations Center

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Process for DNB/LO Requests

Official request to q Health and Human Services Official request to DHS Notification to TSA Notification to CBP

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ll Follow Up

 Quarantine station staff notifies state and local  Quarantine station staff notifies state and local

health authorities when DNB/LO action confirmed

  • Health department staff notifies the individual
  • Quarantine station staff sends a letter to individual

explaining the action

 Health department staff work with individual to

meet criteria for removal from the lists

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Follow‐Up

  • QS staff can request that an airline waive

fees associated with changing travel date

  • TRIA lead initiates international notifications

f bli h lth i

  • f public health agencies

– Department of State Ministry of Health – Ministry of Health

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Removal from DNB List

  • Basically the reverse of addition

Wh h i di id l i i

  • When the individual is non‐contagious
  • Request for removal is made by the state TB

Controller and / or local health department

  • We review cases at least every 2

We review cases at least every 2

  • We notify the airlines for internal list removal to

avoid unnecessary inconvenience to passengers avoid unnecessary inconvenience to passengers

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Criteria for Removal from Lists

  • Clarified at time of

DNB/Lookout order DNB/Lookout order

– DGMQ applies algorithm developed by Division of TB Elimination Elimination

  • Generally requires

– If not MDR TB, at least 2 weeks ,

  • f adequate treatment and

demonstration of smear negativity – If MDR TB, at least 4 weeks of adequate treatment and demonstration of culture negativity negativity

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Time to Add or Remove Individuals from h i the Lists

 On average  On average

  • 8 hours to add
  • 10 hours to remove

10 hours to remove

 Emergency addition or removal may be requested

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Travel Restriction Data*

  • 190 total persons added to the DNB/LO
  • All because of pulmonary tuberculosis

All because of pulmonary tuberculosis

  • 18 persons added at Canada’s request
  • Removed 152 persons
  • Removed 152 persons
  • 2 persons intercepted by CBP at US‐Canada border

because of the lookout because of the lookout

  • 140 persons continued or returned to treatment

after listing after listing

* Data from May 2007 – April 21, 2011

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Number of DNB Additions & Removals b M h J 2007 A il 21 2011 by Month, June 2007– April 21, 2011

12 Additions (n=190) 8 10 Additions (n 190) Removals (n=152) 4 6 2 4

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Top 10 DNB/LO Countries of Origin p g

Country of Origin Frequency Percent (%) United States 45 23 7 United States 45 23.7 Mexico 22 11.6 India 19 10.0 Vietnam 12 6.3 Philippines 9 4.7 China 9 4.7 South Korea 7 3.7 Canada 7 3 7 Canada 7 3.7 Mongolia 4 2.1 Russia 4 2.1

TM
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DNB Additions by Source of Request, June 2007– December 2010

Seattle Minneapolis Anchorage

June 2007– December 2010

2 1

Chicago Seattle Newark New York Boston p Detroit Anchorage

1 2 4 10 5 2 2 8

CDC : 4 Dept of State: 3

1

San Francisco Washington, D.C. Newark Philadelphia

1 6 1 4 48 8

2

1 1

p Canada:14

2 1 1 1 1

San Diego Atlanta Los Angeles Dallas Dallas No additions 1 3 DNB Addition

2 2 7 48 21 1 1

Miami El Paso Houston San Juan Honolulu 1 ‐ 3 DNB Addition 4 ‐ 10 DNB Additions > 20 DNB Additions 11 ‐ 20 DNB Additions

7 5 21

San Juan

CDC Quarantine Station

7 1 Guam

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Resources

 List of CDC quarantine stations with contact  List of CDC quarantine stations with contact

information and respective jurisdictions:

http://www.cdc.gov/quarantine/QuarantineStationContactLi stFull.html

 Federal Air Travel Restrictions for Public Health

Purposes – United States, June 2007 – May 2008

  • Morbidity and Mortality Weekly Report September 19 2008
  • Morbidity and Mortality Weekly Report, September 19, 2008

http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5737a1 .htm

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Clearance of Patients with TB for Air Travel (not MDR)*

AFB MTB MDR Current Allow Criteria to remove DNB Smear Cx Tx to Board + + No N/A No 3 neg AFB smears and tx for ≥ No N/A No 3 neg AFB smears and tx for ≥ 2 weeks

  • +

No ≥1 week Yes N/A week

  • +

No <1week No Tx ≥ 1 week

*Adapted from CDC Do Not Board Algorithm MDR=Multi‐drug resistance; AFB=Acid‐fast bacilli; MTB=Mycobacterium tuberculosis; Cx=culture; y DNB=Do Not Board; N/A=not applicable; Neg=Negative; Tx=treatment

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Clearance of Patients with TB f Ai T l (MDR)* TB for Air Travel (MDR)*

AFB S MTB C MDR Current T Allow t Criteria to remove DNB Smear Cx Tx to Board + + Yes N/A No 3 neg AFB smears and ≥ 2 neg Cx obtained after ≥ 2 weeks of Tx and tx for ≥4 weeks

  • +

Yes N/A No ≥ 2 neg Cx obtained after ≥ 2 weeks of Tx and Tx for ≥ 4 weeks

*Adapted from CDC Do Not Board Algorithm MDR=Multi‐drug resistance; AFB=Acid‐fast bacilli; MTB=Mycobacterium tuberculosis; Cx=culture; MTB=Mycobacterium tuberculosis; Cx=culture; DNB=Do Not Board; N/A=not applicable; Neg=Negative; Tx=treatment