Large-scale quarantine following biological terrorism in the United States - Scientific examination, logistic and legal limits, and possible consequences
Large-scale quarantine following biological terrorism in the United States - Scientific examination, logistic and legal limits, and possible consequences
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DOI：
10.1001/jama.286.21.2711
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发表时间：
2001-12-05
影响因子：
120.7
通讯作者：
Layton, M
中科院分区：
文献类型：
--
作者：
Barbera, J;Macintyre, A;Layton, M
最近，对可能造成大规模伤亡的生物恐怖袭击的关注有所增加。特别注意的是故意向平民释放天花等能够在人与人之间传播的生物剂的情况。在这种情况下，多种公共卫生干预措施可以有效遏制疾病。在各种情况下经常提出的一种疾病控制措施是对可能接触的人群实施大规模或地理隔离。虽然在美国近代历史上没有实施过大规模的隔离，但它已在小规模的生物恶作剧中使用，并在联邦资助的生物恐怖主义演习中使用。本文综述了与检疫可能有效性有关的科学原理、实施检疫的后勤障碍、大规模检疫引起的法律的问题以及检疫行动可能产生的不利后果。在大多数可以想象得到的情况下，强制实施大规模隔离措施-强制隔离可能接触的人群或在某些地理区域内进行人类隔离，以防止传染病的传播-不应被视为主要的公共卫生战略。在大多数情况下，其他不太极端的公共卫生行动可能比隔离更有效，产生的意外不良后果也更少。行动和未来的研究，政策制定和应对规划工作的领域。
Concern for potential bioterrorist attacks causing mass casualties has increased recently. Particular attention has been paid to scenarios in which a biological agent capable of person-to-person transmission, such as smallpox, is intentionally released among civilians. Multiple public health interventions are possible to effect disease containment in this context. One disease control measure that has been regularly proposed in various settings is the imposition of large-scale or geographic quarantine on the potentially exposed population. Although large-scale quarantine has not been implemented in recent US history, it has been used on a small scale in biological hoaxes, and it has been invoked in federally sponsored bioterrorism exercises. This article reviews the scientific principles that are relevant to the likely effectiveness of quarantine, the logistic barriers to its implementation, legal issues that a large-scale quarantine raises, and possible adverse consequences that might result from quarantine action. Imposition of large-scale quarantine-compulsory sequestration of groups of possibly exposed persons or human confinement within certain geographic areas to prevent spread of contagious disease-should not be considered a primary public health strategy in most imaginable circumstances. In the majority of contexts, other less extreme public health actions are likely to be more effective and create fewer unintended adverse consequences than quarantine. Actions and areas for future research, policy development, and response planning efforts are provided.