Quarantine

:"For other uses see Quarantine (disambiguation)"

Quarantine is voluntary or compulsory isolation, typically to contain the spread of something considered dangerous, often but not always disease. The word comes from the Italian (seventeenth century Venetian) language Italian "quarantena", meaning forty day period.

In practice

The quarantining of people often raises questions of civil rights, especially in cases of long confinement or segregation from society, such as that of Mary Mallon (aka Typhoid Mary), a typhoid fever carrier.

Quarantine periods can be very short, such as in the case of a suspected anthrax attack, in which persons are allowed to leave as soon as they shed their potentially contaminated garments and undergo a decontamination shower. For example, an article entitled "Daily News workers quarantined" describes a brief quarantine that lasted until people could be showered in a decontamination tent. (Kelly Nankervis, Daily News).

The February/March 2003 issue of "HazMat Magazine" suggests that people be "locked in a room until proper decon could be performed", in the event of "suspect anthrax".

"Standard-Times" senior correspondent Steve Urbon (February 14 2003) describes such temporary quarantine powers:

Civil rights activists in some cases have objected to people being rounded up, stripped and showered against their will. But Capt. Chmiel said local health authorities have "certain powers to quarantine people."

The purpose of such quarantine-for-decontamination is to prevent the spread of contamination, and to contain the contamination such that others are not put at risk from a person fleeing a scene where contamination is suspect.

The first astronauts to visit the Moon were quarantined upon their return at the specially built Lunar Receiving Laboratory.

To reduce the risk of introducing rabies from Continental Europe, the United Kingdom used to require that dogs, and most other animals introduced to the country spend six months in quarantine at an HM Customs and Excise pound; this policy was abolished at the beginning of the twenty-first century in favour of a scheme generally known as Pet Passports, where animals can avoid quarantine if they have documentation showing they are up to date on their appropriate vaccinations.

The United States puts immediate quarantines on imported products if the disease can be traced back to a certain shipment or product. All imports will also be quarantined if the diseases breakout in other countries. Up until nowwhen it was becoming a less strict policy but with the harmful chemicals and diseases coming from Chinese products it is becoming strict again.

History

The bible mentions the separation of infected people in order to prevent the spread of disease as early as 1513 BC, as recorded in Leviticus chapter 13 of the Old Testament.

The discovery of the contagious nature of infectious diseases and the use of quarantine to limit the spread of contagious diseases was introduced by Abū Alī ibn Sīnā (Avicenna) in "The Canon of Medicine", "circa" 1020. [David W. Tschanz, MSPH, PhD (August 2003). "Arab Roots of European Medicine", "Heart Views" 4 (2).]

The word "quarantine" originates from the Venetian dialect form of the Italian "quaranti giorni", meaning 'forty days'. This is due to the 40 day isolation of ships and people prior to entering the city of Dubrovnik in Dalmatia - Croatia (formerly known as Ragusa). This was practiced as a measure of disease prevention related to the plague (Black Death). Between 1348 and 1359 the Black Death wiped out an estimated 30% of Europe's population, as well as a significant percentage of Asia's population. The original document from 1377, which is kept in the Archives of Dubrovnik, states that before entering the city, newcomers had to spend 30 days in a restricted location (originally nearby islands) waiting to see whether the symptoms of plague would develop. Later on, isolation was prolonged to 40 days and was called quarantine.

Other diseases lent themselves to the practice of quarantine before and after the devastation of the Plague.Those afflicted with leprosy were historically isolated from society, the attempts to check the invasion of syphilis in northern Europe about 1490, the advent of yellow fever in Spain at the beginning of the nineteenth century and the arrival of Asiatic cholera in 1831.

Venice took the lead in measures to check the spread of plague, having appointed three guardians of the public health in the first years of the Black Death (1348). The next record of preventive measures comes from Reggio in Modena in 1374. The first lazaret was founded by Venice in 1403, on a small island adjoining the city; in 1467 Genova followed the example of Venice; and in 1476 the old leper hospital of Marseille was converted into a plague hospital. The great lazaret of that city, perhaps the most complete of its kind, having been founded in 1526 on the island of Pomgue. The practice at all the Mediterranean lazarets was not different from the English procedure in the Levantine and North African trade. On the approach of cholera in 1831 some new lazarets were set up at western ports, notably a very extensive establishment near Bordeaux, afterwards turned to another use.

British quarantine rules after 1711

The plague had disappeared from England, never to return, for more than thirty years before the practice of quarantine against it was definitely established by an act of British Parliament of Queen Anne's reign (1710). The first act was called for, owing to an alarm, lest plague should be imported from Poland and the Baltics; the second act of 1721 was due to the disastrous prevalence of plague at Marseille and other places in Provence; it was renewed in 1733 owing to a fresh outbreak of the malady on the continent of Europe, and again in 1743, owing to the disastrous epidemic at Messina. In 1752 a rigorous quarantine clause was introduced into an act regulating the Levantine trade; and various arbitrary orders were issued during the next twenty years to meet the supposed danger of infection from the Baltics. Although no plague cases ever came to England all those years, the restrictions on traffic became more and more stringent (following the movements of medical dogma), and in 1788 a very oppressive Quarantine Act was passed, with provisions affecting cargoes in particular. The first year of the nineteenth century marked the turning-point in quarantine legislation; a parliamentary committee sat on the practice, and a more reasonable act arose on their report. In 1805 there was another new act, and in 1823-24 again an elaborate inquiry followed by an act making the quarantine only at discretion of the privy council, and at the same time recognizing yellow fever or other highly infectious disorder as calling for quarantine measures along with plague. The steady approach of cholera in 1831 was the last occasion in England of a thoroughgoing resort to quarantine restrictions. The pestilence invaded every country of Europe despite all efforts to keep it out. In England the experiment of hermetically sealing the ports was not seriously tried when cholera returned in 1849, 1853 and 1865-66. In 1847 the privy council ordered all arrivals with clean bills from the Black Sea and the Levant to be admitted to free pratique, provided there had been no case of plague during the voyage; and therewith the last remnant of the once formidable quarantine practice against plague may be said to have disappeared.

For a number of years after the passing of the first Quarantine Act (1710) the protective practices in England were of the most haphazard and arbitrary kind. In 1721 two vessels laden with cotton goods from Cyprus, then a seat of plague, were ordered to be burned with their cargoes, the owners receiving 23,935 as indemnity. By the clause in the Levant Trade Act of 1752 vessels for the United Kingdom with a foul bill (i.e. coming from a country where plague existed) had to repair to the lazarets of Malta, Venice, Messina, Leghorn, Genoa or Marseille, to perform their quarantine or to have their cargoes sufficiently opened and aired. Since 1741 Stangate Creek (on the Medway) had been made the quarantine station at home; but it would appear from the above clause that it was available only for vessels with clean bills. In 1755 lazarets in the form of floating hulks were established in England for the first time, the cleansing of cargo (particularly by exposure to dews) having been done previously on the ships deck. There was no medical inspection employed, but the whole routine left to the officers of customs and quarantine. In 1780, when plague was in Poland, even vessels with grain from the Baltic had to lie forty days in quarantine, and unpack and air the sacks; but owing to remonstrances, which came chiefly from Edinburgh and Leith, grain was from that date declared to be a non-susceptible article. About 1788 an order of the council required every ship liable to quarantine, in case of meeting any vessel at sea, or within four leagues of the coast of Great Britain or Ireland, to hoist a yellow flag in the daytime and show a light at the main topmast head at night, under a penalty of 200 pounds. After 1800, ships from plague-countries (or with foul bills) were enabled to perform their quarantine on arrival in the Medway instead of taking a Mediterranean port on the way for that purpose; and about the same time an extensive lazaret was built on Chetney Hill near Chatham at an expense of 170,000 ponds, which was almost at once condemned owing to its marshy foundations, and the materials sold for 15,000 pounds. The use of floating hulks as lazarets continued as before. In 1800 two ships with hides from Mogador (Morocco) were ordered to be sunk with their cargoes at the Nore, the owners receiving 15,000 pounds. About this period it was merchandise that was chiefly suspected: there was a long schedule of susceptible articles, and these were first exposed on the ships deck for twenty-one days or less (six days for each instalment of the cargo), and then transported to the lazaret, where they were opened and aired forty days more. The whole detention of the vessel was from sixty to sixty-five days, including the time for reshipment of her cargo. Pilots had to pass fifteen days on board a convalescent ship. The expenses may be estimated from one or two examples. In 1820 the "Asia", 763 tons, arrived in the Medway with a foul bill from Alexandria, laden with linseed; her freight was 1475 and her quarantine dues 610. The same year the "Pilato", 495 tons, making the same voyage, paid 200 quarantine dues on a freight of 1060. In 1823 the expenses of the quarantine service (at various ports) were 26,090, and the dues paid by shipping (nearly all with clean bills) 22,000. A return for the United Kingdom and colonies in 1849 showed, among other details, that the expenses of the lazaret at Malta for ten years from 1839 to 1848 had been 53,553. From 1846 onwards the establishments in the United Kingdom were gradually reduced, while the last vestige of the British quarantine law was removed by the Public Health Act of 1896, which repealed the Quarantine Act of 1825 (with dependent clauses of other acts), and transferred from the privy council to the Local Government Board the powers to deal with ships arriving infected with yellow fever or plague, the powers to deal with cholera ships having been already transferred by the Public Health Act of 1875.

The British regulations of ninth November 1896 applied to yellow fever, plague and cholera. Officers of the Customs, as well as of Coast Guard and Board of Trade (for signalling), were empowered to take the initial steps. They certified in writing the master of a supposed infected ship, and detained the vessel provisionally for not more than twelve hours, giving notice meanwhile to the port sanitary authority. The medical officer of the port boarded the ship and examined every person in it. Every person found infected was certified of the fact, removed to a hospital provided (if his condition allow), and kept under the orders of the medical officer. If the sick could be removed, the vessel remained under his orders. Every person suspected (owing to his or her immediate attendance on the sick) could be detained on board for 48 hours or removed to the hospital for a similar period. All others were free to land on giving the addresses of their destinations to be sent to the respective local authorities, so that the dispersed passengers and crew could be kept individually under observation for a few days. The ship was then disinfected, dead bodies buried at sea, infected clothing, bedding, etc., destroyed or disinfected, and bilge-water and water-ballast (subject to exceptions) pumped out at a suitable distance before the ship entered a dock or basin. Mails were subject to no detention. A stricken ship within 3 miles of the shore had to fly at the main mast a yellow and black flag borne quarterly from sunrise to sunset.

International conventions

Since 1852 several conferences have been held between delegates of the European powers, with a view to uniform action in keeping out infection from the East and preventing its spread within Europe; all but that of 1897 were occupied with cholera. No result came of those at Paris (1852), Constantinople (1866), Vienna (1874), and Rome (1885), but each of the subsequent ones has been followed by an international convention on the part of nearly one-half of the governments represented. The general effect has been an abandonment of the high quarantine doctrine of constructive infection of a ship as coming from a scheduled port, and an approximation to the principles advocated by Great Britain for many years. The principal countries which retained the old system at the time were Spain, Portugal, Turkey, Greece and Russia (the British possessions at the time, Gibraltar, Malta and Cyprus, being under the same influence). The aim of each international sanitary convention had been to bind the governments to a uniform minimum of preventive action, with further restrictions permissible to individual countries. The minimum specified by international conventions were very nearly the same as the British practice, which had been in turn adapted to continental opinion in the matter of the importation of rags.

The Venice convention of 1892 was on cholera by the Suez Canal route; that of Dresden, 1893, on cholera within European countries; that of Paris, 1894, on cholera by the pilgrim traffic; and that of Venice, in 1897, was in connection with the outbreak of plague in the East, and the conference met to settle on an international basis the steps to be taken to prevent, if possible, its spread into Europe.

One of the first points to be dealt with in 1897 was to settle the incubation period for this disease, and the period to be adopted for administrative purposes. It was admitted that the incubation period was, as a rule, a comparatively short one, namely, of some three or four days. After much discussion ten days was accepted by a very large majority. The principle of disease notification was unanimously adopted. Each government had to notify to other governments on the existence of plague within their several jurisdictions, and at the same time state the measures of prevention which are being carried out to prevent its diffusion. The area deemed to be infected was limited to the actual district or village where the disease prevailed, and no locality was deemed to be infected merely because of the importation into it of a few cases of plague while there has been no diffusion of the malady. As regards the precautions to be taken on land frontiers, it was decided that during the prevalence of plague every country had the inherent right to close its land frontiers against traffic. As regards the Red Sea, it was decided after discussion that a healthy vessel could pass through the Suez Canal, and continue its voyage in the Mediterranean during the period of incubation of the disease the prevention of which is in question. It was also agreed that vessels passing through the Canal in quarantine might, subject to the use of the electric light, coal in quarantine at Port Said by night as well as by day, and that passengers might embark in quarantine at that port. Infected vessels, if these carry a doctor and are provided with a disinfecting stove, have a right to navigate the Canal, in quarantine, subject only to the landing of those who were suffering from plague.

U.S. quarantine law

Quarantine law began in Colonial American in 1663, when in an attempt to curb an outbreak of smallpox, the city of New York established a quarantine. In the 1730s, the city built a quarantine station on the Bedloe's Island.cite web |url= http://www.ushistory.org/laz/history/index.htm |title=Lazaretto Quarantine Station, Tinicum Township, Delaware County, PA: History |accessdate= 2008-04-24 |last= |first= |coauthors= |date= |work= |publisher= ushistory.org]

The Philadelphia Lazaretto was the first quarantine hospital in the United States, built in 1799, in Tinicum Township, Delaware County, Pennsylvania.cite web |url= http://www.phila.gov/Health/Commissioner/History/ContagiousDiseaseControl.html
title=Contagious Disease Control, The Lazaretto | accessdate= 2007-11-21 |last= |first= |coauthors= |date= |work= |publisher=City of Philadelphia]

There are similar national landmarks such as Ellis Island and Angel Island.

The United States had isolation facilities at every port of entry in the 1950s and 1960s. The last federal order of involuntary quarantine, prior to the 2007 tuberculosis scare, was issued in 1963.

Modern implementation

New developments for quarantine include new concepts in quarantine vehicles such as the Ambulance bus, mobile hospitals, and lockdown/invacuation (inverse evacuation) procedures, as well as docking stations for an ambulance bus to dock to a facility that's under lockdown.

Other uses

U.S. President John F. Kennedy euphemistically referred to the U.S. Navy's interdiction of shipping en route to Cuba during the Cuban missile crisis as a "quarantine" rather than a blockade, because a quarantine is a legal act in peacetime, whereas a blockade is defined as an act of aggression under the U.N. Charter.

In computer science, it describes putting files infected by computer viruses into a special directory, so as to eliminate the threat they pose, without irreversibly deleting them.

Notable quarantines

*Eyam was a village in Britain that chose to isolate itself to stop the spread of the Plague northward in 1665. They were hindered in this by the time's limited knowledge of the disease: what caused it, what forms infection took, what animal vectors carried it, how it spread.

*Typhoid Mary was quarantined in New York in the early twentieth Century. She was an asymptomatic typhoid carrier and was considered a public health hazard.

*The astronauts on Apollo 11 were put into quarantine for a couple of days in the Lunar Receiving Laboratory to make sure that they didn't carry any unknown diseases from the moon.

*The 1972 outbreak of smallpox in Yugoslavia was the final outbreak of smallpox in Europe. The WHO fought the outbreak with extensive quarantine, and the government instituted martial law.

*Ted DeVita had severe aplastic anemia and lived in a sterile hospital environment for 8 years due to his compromised immune system.

*David Vetter suffered from a rare genetic disorder and lived his entire life in an isolated sterile environment.

*During World-war II (1942) the British forces tested out their biological weapons programme on Gruinard Island and infected it with Anthrax. The quarantine was lifted in 1990 when the island was declared safe and a flock of sheep were released onto the island.

*Robert Daniels was quarantined in 2007 for having the deadliest form of Tuberculosis in an Arizona hospital, partly for not wearing a mask during his time in the outside world when he was diagnosed with the disease. [ [http://www.npr.org/templates/story/story.php?storyId=9284375 NPR.org] ]

*Andrew Speaker was placed under U.S. Federal quarantine in 2007 after flying to Europe while knowing he had tuberculosis, then flying back after learning it was an extensively drug resistant strain. He is the first person since 1963 to be under Federal quarantine.

*The UK's anti rabies quarantine regulations were a major plot point in the 1987 episode of Yes Prime Minister, A Diplomatic Incident.

ee also

*Isolation (health care)
*Lazaretto

List of quarantine services in the world

* Australian Quarantine and Inspection Service
* MAF Quarantine Service, in the New Zealand
* Samoa Quarantine Service, in the West Samoa
* Quarantine, Western Australia [http://www.agric.wa.gov.au/quarantine.htm] for the Western Australian Government

External links

* [http://assets.cambridge.org/052181/9350/sample/0521819350ws.pdf Ayliffe GAJ, English MP, Hospital infection, From Miasmas to MRSA, Cambridge University Press, 2003]
* [http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11624707&dopt=Abstract Frati P: Quarantine, trade and health policies in Ragusa-Dubrovnik until the age of George Armmenius-Baglivi. Med Secoli. 2000;12(1):103-27.]
* [http://www.cdc.gov/ncidod/EID/vol8no1/cover.htm Emerging Infectious Diseases, Vol.8, No.1]
* [http://www.pbs.org/wgbh/nova/typhoid/quarantine.html History of quarantine (from PBS NOVA)]
* [http://my.opera.com/prosperingbear/blog/index.dml/tag/Bird%20Flu%20Quarantine Articles Critical Of Bird Flu Quarantine Efforts] From Age Of Tyranny News

References