To mitigate the risks posed by microbial threats of public health significance originating abroad, the Centers for Disease Control and Prevention (CDC) places small groups of staff at major U.S. airports. These staff, their offices, and their patient isolation rooms constitute quarantine stations, which are run by CDC's Division of Global Migration and Quarantine (DGMQ). Congress began to allocate funds in fiscal 2003 for the establishment of new quarantine stations at 17 major U.S. ports of entry that comprise airports, seaports, and land-border crossings. In a significant departure from the recent past, both the preexisting 8 quarantine stations and the new 17 are expected to play an active, anticipatory role in nationwide biosurveillance. Consequently, DGMQ asked the Institute of Medicine (IOM) to convene an expert committee to assess the present CDC quarantine stations and recommend how they should evolve to meet the challenges posed by microbial threats at the nation's gateways. DGMQ specifically requested "an assessment of the role of the federal quarantine stations, given the changes in the global environment including large increases in international travel, threats posed by bioterrorism and emerging infections, and the movement of animals and cargo." To conduct this assessment and provide recommendations, IOM convened, in October 2004, the Committee on Measures to Enhance the Effectiveness of the CDC Quarantine Station Expansion Plan for U.S. Ports of Entry. At the sponsor's request, the committee released the interim letter report Human Resources at U.S. Ports of Entry to Protect the Public's Health in January 2005 to provide preliminary suggestions for the priority functions of a modern quarantine station, the competences necessary to carry out those functions, and the types of health professionals who have the requisite competences (Appendix A). This, the committee's final report, assesses the present role of the CDC quarantine stations and articulates a vision of their future role as a public health intervention. Table of Contents Front Matter Executive Summary 1 Introduction 2 Context and Content of the CDC Quarantine Station Expansion Plan 3 Today's CDC Quarantine Stations at U.S. Ports of Entry 4 Bridge from Present to Future: Vision and Recommendations Appendix A: Human Resources at U.S. Ports of Entry to Protect the Public's Health: Interim Letter Report Appendix B: Agendas of Open Sessions of Committee Meetings Appendix C: Methodology Used by the Division of Global Migration and Quarantine to Select Sites for New Quarantine Stations Appendix D: Commissioned Paper on US Seaports and the CDC Quarantine Station System Appendix E: Microbial Threats of Public Health Significance Originating in Animals or Animal Products at U.S. Ports of Entry Appendix F: International Legal Considerations for the Quarantine Station Expansion Appendix G: Excerpts from a Standard Memorandum of Agreement Between CDC and Local Hospitals Appendix H: Committee Biographies