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To mitigate the risks posed by microbial threats of public health
significance originating abroad, the Centers for Disease Control
and Prevention (CDC) places small groups of staff at major U.S.
airports. These staff, their offices, and their patient isolation
rooms constitute quarantine stations, which are run by CDC's
Division of Global Migration and Quarantine (DGMQ). Congress began
to allocate funds in fiscal 2003 for the establishment of new
quarantine stations at 17 major U.S. ports of entry that comprise
airports, seaports, and land-border crossings. In a significant
departure from the recent past, both the preexisting 8 quarantine
stations and the new 17 are expected to play an active,
anticipatory role in nationwide biosurveillance. Consequently, DGMQ
asked the Institute of Medicine (IOM) to convene an expert
committee to assess the present CDC quarantine stations and
recommend how they should evolve to meet the challenges posed by
microbial threats at the nation's gateways. DGMQ specifically
requested "an assessment of the role of the federal quarantine
stations, given the changes in the global environment including
large increases in international travel, threats posed by
bioterrorism and emerging infections, and the movement of animals
and cargo." To conduct this assessment and provide recommendations,
IOM convened, in October 2004, the Committee on Measures to Enhance
the Effectiveness of the CDC Quarantine Station Expansion Plan for
U.S. Ports of Entry. At the sponsor's request, the committee
released the interim letter report Human Resources at U.S. Ports of
Entry to Protect the Public's Health in January 2005 to provide
preliminary suggestions for the priority functions of a modern
quarantine station, the competences necessary to carry out those
functions, and the types of health professionals who have the
requisite competences (Appendix A). This, the committee's final
report, assesses the present role of the CDC quarantine stations
and articulates a vision of their future role as a public health
intervention. Table of Contents Front Matter Executive Summary 1
Introduction 2 Context and Content of the CDC Quarantine Station
Expansion Plan 3 Today's CDC Quarantine Stations at U.S. Ports of
Entry 4 Bridge from Present to Future: Vision and Recommendations
Appendix A: Human Resources at U.S. Ports of Entry to Protect the
Public's Health: Interim Letter Report Appendix B: Agendas of Open
Sessions of Committee Meetings Appendix C: Methodology Used by the
Division of Global Migration and Quarantine to Select Sites for New
Quarantine Stations Appendix D: Commissioned Paper on US Seaports
and the CDC Quarantine Station System Appendix E: Microbial Threats
of Public Health Significance Originating in Animals or Animal
Products at U.S. Ports of Entry Appendix F: International Legal
Considerations for the Quarantine Station Expansion Appendix G:
Excerpts from a Standard Memorandum of Agreement Between CDC and
Local Hospitals Appendix H: Committee Biographies
Infectious diseases have been a problem for military personnel
throughout history. The consequences in previous conflicts have
ranged from frequent illnesses disrupting daily activities and
readiness to widespread deaths. Preventive measures, early
diagnosis, and treatment greatly limit the exposures and acute
illnesses of troops today in comparison with those in armies of the
past, but infections and consequent acute illnesses still occur.
Thousands of US veterans of the Persian Gulf War have reported an
array of unexplained illnesses since the war ended in 1991. Many
veterans have believed that the illnesses were associated with
their military service in southwest Asia during the war. This
volume of Gulf War and Health evaluates the scientific literature
on chemical, biologic, and physical agents to which military
personnel in the gulf were potentially exposed and possible
long-term adverse health outcomes. Table of Contents Front Matter
Summary 1 Introduction 2 Methodology 3 Infectious Diseseases
Endemic to Southwest and South-central Asia the have Long-Term
Adverse Health Outcomes 4 Infectious Diseases Diagnosed in U.S.
Troops Who Served in the Persian Gulf War, Operation Enduring
Freedom, or Operation Iraqi Freedom 5 Levels of Association Between
Select Diseases and Long-Term Adverse Health Outcomes 6 Diseases
and Agents of Special Concern to Veterans of the Gulf War,
Operation Iraqi Freedom, and Operation Enduring Freedom A
Biographical Sketches for Members of the Committee Index
In Advancing Prion Science, the Institute of Medicinea (TM)s
Committee on Transmissible Spongiform Encephalopathies Assessment
of Relevant Science recommends priorities for research and
investment to the Department of Defensea (TM)s National Prion
Research Program (NPRP). Transmissible spongiform encephalopathies
(TSEs), also called prion diseases, are invariably fatal
neurodegenerative infectious diseases that include bovine
spongiform encephalopathy (commonly called mad cow disease),
chronic wasting disease, scrapie, and Creutzfeldt-Jakob disease. To
develop antemortem diagnostics or therapies for TSEs, the committee
concludes that NPRP should invest in basic research specifically to
elucidate the structural features of prions, the molecular
mechanisms of prion replication, the mechanisms of TSE
pathogenesis, and the physiological function of prionsa (TM) normal
cellular isoform. Advancing Prion Science provides the first
comprehensive reference on present knowledge about all aspects of
TSEsa "from basic science to the U.S. research infrastructure, from
diagnostics to surveillance, and from prevention to treatment.
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