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June 2013

We Are Public Health 2013-06

This story features the work of the CDC Anchorage Quarantine Station.

We are public health.
We work to limit infectious diseases entering the United States.

Alaska is a major cruise ship destination, and the summertime cruise ship passenger population of one million exceeds the state’s wintertime resident population of approximately 731,000. This influx is perhaps most dramatically seen in towns like Whittier where the population can surge from approximately 200 to 3,500 when a cruise ship comes into port. In addition to the large and globally mobile passenger populations onboard cruise ships, the close quarters and prolonged voyage durations increase the risk of transmission and spread of infectious diseases such as influenza-like illness (ILI) on cruise ships.

Protecting the health of these travelers is a multi-agency task. CDC Quarantine Stations are one part of a comprehensive system that serves to limit the introduction of infectious diseases into the United States at ports of entry. Quarantine stations are all located at 20 ports of entry into the United States. Personnel at these stations respond to reports of illness on airplanes, maritime vessels, and at land-border crossings. The Anchorage Quarantine Station is located at the Anchorage International Airport but assists with ill travelers who come in on ships as well.

The master of a ship destined for a United States port of entry is required by federal regulations to immediately contact the nearest CDC Quarantine Station to report when passengers have signs and symptoms of an infectious disease or if a passenger dies.

Ships can report via phone, fax, or e-mail. Quarantine station on-call duty officers can be reached 24/7 for consultation about medical evaluation, coordination of testing, isolation procedures, and outbreak response.

Maritime disease reporting to state and federal public health agencies in Alaska has been inconsistent in the past and underreporting is a concern. Early and consistent reporting of ill travelers by ship medical staff and land-based physicians who may be called upon to treat passengers is essential for rapid response to illnesses. The Anchorage Quarantine Station contacts every ship visiting Alaska at the beginning of the cruise ship season to share reporting requirements and contact information. Additionally, staff regularly board ships arriving in Anchorage or the port of Whittier to meet ship medical teams and discuss ways to collaborate in responding to illness, such as ILI.

Several large ILI outbreaks have occurred on ships in Alaska. Examples include a 1998–99 ILI outbreak involving more than 2,800 tourists in Alaska and the Yukon and a 2009 outbreak in crew members of a cruise ship, later confirmed to be the pandemic strain of H1N1 influenza.

The Anchorage Quarantine Station and its partners have developed a Multi-Agency Maritime Communicable Disease Response Plan and regularly conduct preparedness exercises to make sure they are ready to respond when an illness or outbreak arises. In an illness response scenario, the quarantine station staff would work with ships to first isolate the ill individual(s), and then coordinate with local and state health authorities for the medical evacuation and treatment of ill people as needed.