CDC: Ebola confirmed in Dallas patient

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DALLAS — A patient in a Dallas hospital has been confirmed to have the deadly Ebola virus, the Centers for Disease Control said Tuesday.

That person has been held in “strict isolation” at Texas Health Presbyterian Hospital Dallas as he was evaluated for possible exposure to the virus.

This is the first case of Ebola confirmed in the United States.

“There is no doubt in my mind that we will stop it,” said Dr. Tom Frieden, director of the Centers for Disease Control and Prevention at a Tuesday afternoon news conference in Atlanta.

According to the CDC, the patient acquired the virus in West Africa, though they are not sure how he was infected. He was not involved in stopping the Ebola outbreak in Africa.

Frieden also gave a brief timeline of the patient’s infection in his comments Tuesday afternoon. The patient, an adult male, first showed symptoms of Ebola on Sept. 24, then first sought care on Sept. 26, before he was admitted to the hospital on Sept. 28.

Early symptoms of Ebola include sudden fever, fatigue, and headache. Symptoms may appear anywhere from two to 21 days after exposure.

 

The CDC will decide whether it is necessary to move the patient to another facility. There are five medical facilities in the U.S. that have high level isolation facilities. The CDC will also investigate how many people the patient has had contact with.

Frieden said the next steps are to care for the patient and keep to a minimum the chance the virus may spread while identifying all people the patient was in contact with while he could transmit the virus. Those people will be monitored for 21 days and isolated if they develop a fever during that time.

Frieden said that others may have been infected in the United States, but said there was “no doubt” in his mind that the infection will be contained to the current patient and anyone they may have had contact with.

Medical reporter Janet St. James discusses the latest information about a patient at a Dallas hospital confirmed to have the Ebola virus. Janet St. James / WFAA

In a statement issued Monday night, Texas Health Presbyterian Hospital Dallas said the patient was admitted based on symptoms and “recent travel history.”

The hospital, located at Greenville Avenue and Walnut Hill Lane in Northeast Dallas, said it’s complying with all recommendations from the Centers for Disease Control and the Texas Department of Health to ensure the safety of other patients and medical staff.

Zachary Thompson, the director of the Dallas County Health and Human Services, said Tuesday morning the Centers for Disease Control was mobilizing as if the patient had tested positive for the virus.

Thompson said Dallas County is ready to care for the patient.

“This is not Africa,” Thompson said. “We have a great infrastructure to deal with an outbreak.”

The World Health Organization said it has confirmed more than 3,000 Ebola-related deaths in West Africa during the current outbreak, which has spread to five countries: Guinea, Liberia, Nigeria, Senegal and Sierra Leone.

Fort Worth physician Dr. Kent Brantly, who became infected while working in Liberia, recovered after being moved to a hospital in Atlanta.

Earlier this month, President Barack Obama announced that the U.S. would offer military and medical help to combat the disease in West Africa which has now reached epidemic proportions.

Several other U.S. hospitals have previously raised alerts in connection with patients who presented Ebola-like symptoms, but all those cases tested negative for the virus

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US Centers for Disease Control and Prevention Director Dr. Tom Frieden (Reuters/Jonathan Ernst)
2014 Ebola Outbreak in West Africa - Outbreak Distribution Map (US Centers for Disease Control and Prevention)

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Legal Authorities for Isolation and Quarantine

Isolation and Quarantine

Isolation and quarantine are public health practices used to stop or limit the spread of disease.

Isolation is used to separate ill persons who have a communicable disease from those who are healthy. Isolation restricts the movement of ill persons to help stop the spread of certain diseases. For example, hospitals use isolation for patients with infectious tuberculosis.

Quarantine is used to separate and restrict the movement of well persons who may have been exposed to a communicable disease to see if they become ill. These people may have been exposed to a disease and do not know it, or they may have the disease but do not show symptoms. Quarantine can also help limit the spread of communicable disease.

Isolation and quarantine are used to protect the public by preventing exposure to infected persons or to persons who may be infected.

In addition to serving as medical functions, isolation and quarantine also are “police power” functions, derived from the right of the state to take action affecting individuals for the benefit of society.

Federal Law

The federal government derives its authority for isolation and quarantine from the Commerce Clause of the U.S. Constitution.

Under section 361 of the Public Health Service Act (42 U.S. Code § 264), the U.S. Secretary of Health and Human Services is authorized to take measures to prevent the entry and spread of communicable diseases from foreign countries into the United States and between states.

The authority for carrying out these functions on a daily basis has been delegated to the Centers for Disease Control and Prevention (CDC).

CDC’s Role

Under 42 Code of Federal Regulations parts 70 and 71, CDC is authorized to detain, medically examine, and release persons arriving into the United States and traveling between states who are suspected of carrying these communicable diseases.

As part of its federal authority, CDC routinely monitors persons arriving at U.S. land border crossings and passengers and crew arriving at U.S. ports of entry for signs or symptoms of  communicable diseases.

When alerted about an ill passenger or crew  member by the pilot of a plane or captain of a ship, CDC may detain passengers and crew as  necessary to investigate whether the cause of the illness on board is a communicable disease.

State, Local, and Tribal Law

States have police power functions to protect the health, safety, and welfare of persons within their borders. To control the spread of disease within their borders, states have laws to enforce the use of isolation and quarantine.

These laws can vary from state to state and can be  specific or broad. In some states, local health authorities implement state law. In most states, breaking a quarantine order is a criminal misdemeanor.

Tribes also have police power authority to take actions that promote the health, safety, and welfare of their own tribal members. Tribal health authorities may enforce their own isolation and quarantine laws within tribal lands, if such laws exist.

Who Is in Charge

The federal government

  • Acts to prevent the entry of communicable diseases into the United States. Quarantine and isolation may be used at U.S. ports of entry.
  • Is authorized to take measures to prevent the spread of communicable diseases between states.
  • May accept state and local assistance in enforcing federal quarantine.
  • May assist state and local authorities in preventing the spread of communicable diseases.

State, local, and tribal authorities

  • Enforce isolation and quarantine within their borders.

It is possible for federal, state, local, and tribal health authorities to have and use all at the same time separate but coexisting legal quarantine power in certain events. In the event of a conflict, federal law is supreme.

Enforcement

If a quarantinable disease is suspected or identified, CDC may issue a federal isolation or quarantine order.

Public health authorities at the federal, state, local, and tribal levels may sometimes seek help from police or other law enforcement officers to enforce a public health order.

U.S. Customs and Border Protection and U.S. Coast Guard officers are authorized to help enforce federal quarantine orders.

Breaking a federal quarantine order is punishable by fines and imprisonment.

Federal law allows the conditional release of persons from quarantine if they comply with medical monitoring and surveillance.

Federal Quarantine Rarely used

Large-scale isolation and quarantine was last enforced during the influenza (“Spanish Flu”) pandemic in 1918–1919. In recent history, only a few public health events have prompted federal isolation or quarantine orders.

Specific Laws and Regulations Applying to Quarantine and Isolation

Visit the Specific Laws and Regulations Governing the Control of Communicable Diseases page.

Guidance for Importation of Human Remains into the United States for Interment

Visit the Guidance for Importation of Human Remains into the United States for Interment or Subsequent Cremation page.

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Specific Laws and Regulations Governing the Control of Communicable Diseases

The Secretary of the Department of Health and Human Services has statutory responsibility for preventing the introduction, transmission, and spread of communicable diseases in the United States. Under its delegated authority, the Division of Global Migration and Quarantine works to fulfill this responsibility through a variety of activities, including

  • the operation of Quarantine Stations at ports of entry
  • establishment of standards for medical examination of persons destined for the United States, and
  • administration of interstate and foreign quarantine regulations, which govern the international and interstate movement of persons, animals, and cargo.

The legal foundation for these activities is found in Titles 8 and 42 of the U.S. Code and relevant supporting regulations.

Legal Authorities for Isolation and Quarantine

The federal government derives its authority for isolation and quarantine from the Commerce Clause of the U.S. Constitution. Read more on the Legal Authorities for Isolation and Quarantine page.

United States Federal Laws and Regulations for Control of Communicable Diseases

United States Code

The United States Code is a consolidation and codification by subject matter of the general and permanent laws of the United States. Sections 264-272 of the following portion of the code apply: Title 42 – The Public Health and Welfare, Chapter 6A – Public Health Service, Subchapter II – General Powers and Duties, Part G – Quarantine and Inspection. Links are provided by the Government Printing Office.

Code of Federal Regulations

The Code of Federal Regulations (CFR) is the official and complete text of the general and permanent rules published in the Federal Register. These regulations are established by the executive departments and agencies of the Federal Government. The CFR is divided into various titles that represent broad subject areas of Federal regulation. CDC’s regulations fall under Title 42: Public Health, Chapter 1 – Public Health Service, Department of Health and Human Services.

Links are from the Office of the Federal Register, National Archives and Records Administration on the United States Government Printing Office web site. Specifically, Parts 70 and 71 of the following portion of the CFR apply:

Recent Updates

<span class=”red-color”>New!</span> Issuance and Enforcement Guidance for Dog Confinement Agreements expanded

On July 10, 2014, the Department of Health and Human Services (HHS) and the Centers for Disease Control and Prevention (CDC) posted guidance on the issuance and enforcement of dog confinement agreements. This guidance describes the factors that HHS/CDC will consider in deciding whether to issue a dog confinement agreement or deny entry of a dog being imported into the United States that has not been adequately vaccinated against rabies. Dog confinement agreements are covered under 42 CFR 71.51. This guidance becomes effective on August 11, 2014 (30 days after publication).

More

Final Rule on Regulations for the Importation of Nonhuman Primates collapsed

Regulations to Establish a User Fee for Filovirus Testing of Nonhuman Primates collapsed

Regulations to Establish a User Fee for Filovirus Testing of Nonhuman Primates collapsed

Executive Orders

Executive Orders specify the list of diseases for which federal quarantine is authorized, which is required by the Public Health Service Act. On recommendation of the HHS Secretary, the President may amend this list whenever necessary to add new communicable diseases, including emerging diseases that are a threat to public health.

Amendment to Executive Order 13295: Quarantinable Communicable Diseases
Federal Register Archives, signed April 4, 2003, amended by 13375 on April 1, 2005 and and by 13674 on July 31, 2014.

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