Isolation & Quarantine Measures in Response to a Smallpox Emergency

Considerations During a Smallpox Response

When considering the implementation of these various levels of isolation/quarantine and other control measures, public health authorities and policy makers must be prepared for various things.

Communication will be essential. When people understand the reasoning behind the control measures such as quarantine, they may be more likely to voluntarily comply, making enforcement much easier. In addition, they must be kept informed of all developments. Information will help to prevent public panic. Must be given some idea of a timeline for how long control measure will be in place and what things may prompt relaxation of the levels of restrictions or increased duration of current restrictions so they will be prepared.

Authorities must also consider how various quarantine levels would impact the movement of critical personnel and supplies into and out of the area, and how to maintain essential services while at a certain level. As discussed earlier, larger quarantines will require larger amounts of enforcement personnel. If a community’s law enforcement resources are limited, planners should arrange for mutual aid with other law enforcement agencies for larger-scale quarantine measures.

Planners might consider the utilization of mass vaccination of the entire community if possible in order to shorten the time needed for quarantine restrictions if it is felt the outbreak may not be controlled quickly with more limited vaccination strategies. The advantages of a mass vaccination would be:

  1. It could decrease community panic and unrest.
  2. It could decrease level of restrictions needed, especially if higher levels difficult to implement and maintain.
  3. It may bring about more rapid control of outbreak.

The biggest challenge regarding the national and international control of an infectious disease in today’s society is the presence of a highly mobile society. People can travel all over the world within a day.

Unanswered questions remain about quarantine in modern day disease control:

  1. How well can authorities implement larger scale quarantine or isolation measures. Current day experience is really with individuals not communities.
  2. How quickly should quarantine measures that would restrict travel be implemented in order to prevent the spread of smallpox outside of an infected area?
  3. Should areas/countries that have less capabilities to respond to an important (i.e. limited vaccine or public health/medical resources) implement travel restrictions to/from an area with cases sooner and with greater enforcement than areas that are more prepared to detect and contain an importation? (Disparity in response capability makes standardized international guidelines for quarantine and travel restrictions difficult).
  4. How do we deal individual and economic impact of travel restrictions that may be in place for longer periods of time?

Planners must be prepared to deal with the limited public memory of population-based quarantine. The majority of the population will not have seen this public health measure in practice before, and planners will need to address current standards of civil liberties if they can expect to counteract resistance. These dialogues and educating the public about these issues need to take place before the panic of an outbreak is in place. Authorities are often reluctant to take on these issues, but given the very nature of bioterrorism, they must be addressed.

There are currently limited vaccine supplies in most areas of the world and these limited vaccine resources will probably always exist. We must also assume that there could be multiple locations that are affected. We even have to consider the unlikely, but potential scenario with a modified strain of smallpox that is not prevented by current vaccines. In this instance, quarantine measures may be the only method of slowing the spread of disease. 

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