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The Do Not Board List

September 22, 2008

There’s a really interesting article in this week’s MMWR, a review of the CDC’s “Do Not Board” list. The list functions sort of like the “Do Not Fly” list that’s garnered so much praise, but for public health matters, and this one actually has rules and public oversight.

To get someone on the list, a federal agency, state or local health department, or foreign government contacts the CDC with the request to add someone. If that person is contagious, is unaware of their diagnosis or unadherent, and is likely to board a flight, the CDC can place the person on the list. The CDC notes that the list of diseases that can put someone on the DNB list is larger than the CDC quarantine/isolation list (cholera, diphtheria, infectious tuberculosis, plague, smallpox, yellow fever, viral hemorrhagic fevers, severe acute respiratory syndrome (SARS), and influenza caused by novel or reemergent influenza viruses that are causing, or have the potential to cause, a pandemic), meaning that if a person is contagious with something that can cause a public health crisis, they can be stopped from boarding.

In the last year (June ’07 – May ’08), the CDC was asked to place 42 people on the DNB list. 33 people eventually were placed on that list. Each of those put on the list were diagnosed with TB. The original requestee is supposed to contact the CDC when the person is deemed no longer contagious so they can be removed. In addition, the CDC also reviews the list monthly to see if anyone can be taken off the list.

Sounds like a great idea to me, personally. My first thought after reading this was, “why do they do this just for planes?” I mean, I understand that the recycled air and cramped quarters makes for a higher likelihood of transmission, but public health can happen anywhere, and there should be some mechanism to keep contagious folks from spreading. An editorial note after the article notes that the CDC also works with the Customs and Border Patrol and can issue a border lookout record to flag people from entering or leaving the country. And apparently, that was a good thing:

Two (6%) of the 33 persons on the public health DNB list during June 2007–May 2008 are known to have attempted to evade the U.S. air travel restriction. Both persons were successfully detected by CBP officers before they were admitted into the United States and were taken to local hospitals for evaluation and care of TB.

Now for my next concern. This really sounds like a well thought out system. It respects the ill person’s rights, protects the public from disease, and even saves money by reducing the amount of contact tracing that needs to be done after flights. Seriously, applause all around. But, what if there’s a wide ranging outbreak? The system keeps track of TB patients very well, generally because they’re pretty easily trackable, state and local health departments are pretty well on top of that. But what about a novel strain of influenza? Easily spread, possibility for pandemic, and the locals have to call in each case and get confirmation before placement on the list? In my mind, if the locals have a novel case of influenza in their midst, or worse yet, several, I can’t imagine that multiple calls to the DEOC are going to happen–they’ll be swamped!

Again, I think this is a great thing, really do. And maybe I’m picking nits here. I just wonder what happens when it gets bad, that’s all. Is there a mechanism to fast-track DNB sign-ups, or does a larger quarantine order go into effect? Or, is this just assumed to be the way it’ll work?

Photo credit: davipt

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