Transcript Luthi_2016_PHAP_Summer_Seminar_oralpresentation.pptx

Saving Lives. Protecting People.
Office for State, Tribal, Local
and Territorial Support Overview
Derek Luthi
Centers for Disease Control and Prevention
Office for State, Tribal, Local and Territorial Support
2016 PHAP Summer Seminar
May 16, 2016
A Case Study from Honolulu, HI
THE PREVENTION OF TUBERCULOSIS
(TB) EXPOSURE THROUGH FEDERAL
TRAVEL RESTRICTIONS
U.S. Ports of Entry and
CDC Quarantine Stations
Minneapolis
Seattle
Chicago
Anchorage
Detroit
Boston
New York
Newark
Philadelphia
San Francisco
Washington
DC
Atlanta
Los Angeles
San Diego
El Paso
Honolulu
Dallas
Houston
CDC Quarantine Station (n=20)
U.S. Port of Entry (> 300)
*Derived from Quarantine and Border Health Service Branch SharePoint partner training materials.
Miami
San Juan
CDC Quarantine Station Activities
• Respond to reports of illnesses on
airplanes, ships, and at land-border
crossings
• Inspect animals, cargo, and other
items that pose a potential threat
to human health
• Distribute life-saving
immunobiologics
and investigational drugs
• Provide international travelers
with important health information
• Enter data into electronic surveillance and
data reporting systems
*Derived from Quarantine and Border Health Service Branch SharePoint partner training materials.
CDC Quarantine Station Activities
• Monitor the health of and collect
medical information about new
immigrants, refugees, asylees, and
parolees
• Support response to mass migration
emergencies
• Plan and prepare for emergency
response
• Build strategic partnerships for disease
surveillance and control
• Support travel restrictions
*Derived from Quarantine and Border Health Service Branch SharePoint partner training materials.
Public Health Travel Restriction Tools
The Department of Homeland Security (DHS) places a
person on the federal Do Not Board and Lookout lists at
CDC’s request when a person meets certain criteria.
Do Not Board
– Prevents the issuance of airline boarding passes for any flight
inbound to, outbound from, or within the United States
– Implemented by Transportation Security Administration (TSA)
Public Health Lookout
– Prompts U.S. Customs and Border Protection (CBP) to notify
CDC Quarantine Station staff when such persons attempt to
enter the U.S. at any port
– Applies at airports, seaports, and land borders
*Derived from Quarantine and Border Health Service Branch SharePoint partner training materials.
Case Study - Background


55 y/o individual in Honolulu, HI, diagnosed initially
with extrapulmonary TB during hospitalization
During subsequent evaluation, the following were
determined:
 Additionally had infectious pulmonary TB
 Sputum TB-positive
 Chest X-ray left upper lobe cavitary lesion
 Poor adherence to treatment
 Stopped showing up to health department (HD) for treatment
 Ceased answering calls
 Intention to travel
 Informed private physician of plans to travel internationally for
treatment
Criteria for DNB/LO Addition*
A person must:
1. be known or believed infectious with, or at risk for, serious
contagious disease that poses public health threat to others during
travel
AND
2. not be aware of his or her diagnosis, have been told about the diagnosis
and not be following public health recommendations, or be unable to be
located
or
3. be likely to travel on a commercial airplane into, through, or from the United
States or travel internationally by any means
or
4. need to be placed on the DNB and Lookout list to respond to a public health
outbreak or to help enforce a public health order.
*CDC requires that the first criterion be met, as well as one of the other three.
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Criteria for DNB/LO Removal
Demonstrate non-infectiousness
or
Remain well after incubation
period for the disease of
exposure has passed
Case Study - Methods





Hawaii Department of Health (HIDOH)  Honolulu
Quarantine Station (HNLQS) initial request to review
individual for use of federal travel restrictions
Conference call convened with HIDOH, HNLQS, & CDC Travel
Restrictions and Interventions Activity (TRIA)
Determined through consensus that DNB criteria were met
Internal CDC approval process
CDC  DHS request to place individual on DNB



DHS agreed
Notified TSA and CBP who implemented DNB and Lookout
Individual notified of DNB and requirements for travel
QS Roles
Receives DNB/LO
requests from
state/local HD
Collects and
reviews clinical
information
Consults with
QMO for possible
DNB action
(QMO = Quarantine
Medical Officer)
Works with HD
to obtain
updated clinical
and lab info
Keeps QARS up
to date
(QARS = Quarantine
Activity Reporting
System)
Informs QMO
and TRIA of any
new information
*Derived from Travel Restriction and Intervention Activities Team training for Region III Quarantine Stations.
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Case Study - Results


Individual received notification of DNB and requirements for
travel
Agreed to return to treatment


Confirmed noninfectious



Direct observed therapy (DOT) via SKYPE 5x/week
≥ 2 weeks of treatment
3 negative sputum smears
Individual was removed from DNB
Implications for Public Health Practice
Preventing travel for persons who meet criteria through
use of federal travel restrictions tools
 Prevents the potential spread of serious communicable
diseases across international borders during
commercial travel
 May prevent the need for subsequent airplane contact
investigations.
Thank you
Derek Luthi
[email protected]
For more information, please contact CDC’s Office for State, Tribal, Local and Territorial Support
4770 Buford Highway NE, Mailstop E-70, Atlanta, GA 30341
Telephone: 1-800-CDC-INFO (232-4636)/TTY: 1-888-232-6348
E-mail: [email protected]
Web: http://www.cdc.gov/stltpublichealth
The findings and conclusions in this presentation are those of the authors and do not necessarily represent the official position of the
Centers for Disease Control and Prevention.
Centers for Disease Control and Prevention
Office for State, Tribal, Local and Territorial Support