Legal authorities for isolation and quarantine--information from CDC.

Introduction

* Isolation and quarantine are two common public health strategies designed to protect the public by preventing exposure to infected or potentially infected people.

* In general, isolation refers to the separation of people who have a specific infectious illness from those who are healthy, as well as restriction of their movement, to stop the spread of the illness. Today, isolation is a standard procedure used for patients with tuberculosis and certain other infectious diseases.

* Quarantine, by contrast, generally refers to the separation and restriction of movement of people who, while not yet ill, have been exposed to an infectious agent and therefore may become infectious. Quarantine, like isolation, is intended to stop the spread of infectious disease.

* Both isolation and quarantine may be conducted on a voluntary basis or compelled on a mandatory basis through legal authority.

State and Local Law

* A state's authority to compel isolation and quarantine within its borders is derived from its inherent "police power"--the authority of a state government to enact laws and promote regulations to safeguard the health, safety, and welfare of its citizens. As a result of this authority, the individual states are responsible for intrastate isolation and quarantine practices, and they conduct their activities in accordance with their respective statutes.

* State and local laws and regulations regarding the issues of compelled isolation and quarantine vary widely. Historically, some states have codified extensive procedural provisions related to the enforcement of these public health measures, whereas others rely on older statutory provisions that can be very broad. In some jurisdictions, local health departments are governed by the provisions of state law; in other settings, local health authorities may be responsible for enforcing either state laws or more stringent local measures. In many states, violation of a quarantine order constitutes a criminal misdemeanor.

* Examples of other public health actions that can be compelled by legal authorities include disease reporting, immunization for school attendance, and tuberculosis treatment.

Federal Law

* The Secretary of Health and Human Services (HHS) has statutory responsibility for preventing the introduction, transmission, and spread of communicable diseases from foreign countries into the United States (e.g., at international ports of arrival) and from one state or possession into another.

* The communicable diseases for which federal isolation and quarantine are authorized are set forth through executive order of the President and include cholera, diphtheria, infectious tuberculosis, plague, smallpox, yellow fever, and viral hemorrhagic fevers. Severe acute respiratory syndrome (SARS) was added to this list in April 2003.

* By statute, U.S. Customs and Coast Guard officers are required to aid in the enforcement of quarantine rules and regulations. Violation of federal quarantine rules and regulations constitutes a criminal misdemeanor, punishable by fine, imprisonment, or both.

* Federal quarantine authority includes the authority to release people from quarantine on the condition that they comply with medical monitoring and surveillance requirements.

Interplay Between Federal and State or Local Laws

* States and local jurisdictions have primary responsibility for isolation and quarantine within their borders. The federal government has authority under the Commerce Clause of the U.S. Constitution to prevent the interstate spread of disease.

* The federal government has primary responsibility for preventing the introduction of communicable diseases from foreign countries into the United States.

* By statute, the HHS Secretary may accept state and local assistance in the enforcement of federal quarantine regulations and may assist state and local officials in the control of communicable diseases.

* It is possible for federal, state, and local health authorities to have separate but concurrent legal quarantine power in a particular situation (e.g., an aircraft arriving at a large city airport).

* Because isolation and quarantine are "police power" functions, public health officials at the federal, state, and local levels may occasionally seek the assistance of their respective law enforcement counterparts to enforce a public health order.

For more information on isolation and quarantine, visit CDC's Web site at www.cdc.gov/ncidod/dq/.