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.