International Quarantine
International Quarantine
International Quarantine
period of time not longer than the longest usual incubation period of disease,
3. Segregation: which has been defined as ‘the separation for special consideration, control
of observation of some part of a group of persons (or domestic animals) from the others to
of immune persons’
CONT..
Quarantine represents a range of possible interventions that could be
applied at the level of the individual, small group, or community.
Quarantine may be used for:
Home Quarantine
CONT..
3. Work Quarantine:
have been exposed to cases and who may need to continue working
• Hospital Isolation
CONT..
• In contrast to isolation, quarantine applies to restrictions on the
healthy contacts of an infectious disease. Quarantine which was
once a popular method of disease control has now declined in
popularity. With better techniques of early diagnosis and
treatment, quarantine, as a method of disease control, has
become outdated. It has been replaced by surveillance
TERMINOLOGY AND ETYMOLOGY
• Plain yellow, green, and even black flags have been used to symbolize disease in
both ships and ports, with the color yellow having a long historical precedent, as
a color of marking for houses of infection, previous to its use as a maritime
marking color for the disease.
• Ships in Quarantine today would fly either the Q flag alone (meaning ‘My vessel
is “healthy” and I request free pratique‘or the double Q flag (QQ) (meaning ‘I
require health clearance‘).
ETHICAL AND PRACTICAL CONSIDERATIONS
• 'aimed at preventing disease or injury or providing care for the sick and
injured.'
• Limitations on rights (such as quarantine) must be 'strictly necessary,' meaning
that they must:
CONT..
• Respond to a pressing public or social need (health)
• Proportionately pursue a legitimate aim (prevent the spread of infectious disease)
• Be the least restrictive means required for achieving the purpose of the limitation
• Be provided for and carried out in accordance with the law
• Be neither arbitrary nor discriminatory
• Only limit rights that are within the jurisdiction of the state seeking to impose the
limitation.
CONT…
In addition, when quarantine is imposed, public health ethics specify that:
• All restrictive actions must be well-supported by data and scientific
evidence
• All information must be made available to the public
• All actions must be explained clearly to those whose rights are
restricted and to the public
• All actions must be subject to regular review and reconsideration.
CONT..
Finally, the state is ethically obligated to offer certain guarantees:
• Basic needs such as food, water, medical care, and preventive care will be provided.
• Patients will be compensated fairly for economic and material losses, including salary.
List of quarantine services in the world
• Australian Quarantine and Inspection Service
• Racehorse & Equine Quarantine Services, A company built & developed by Frankie
• Federal Service for Supervision of Consumer Rights Protection and Human Welfare,
enterica, the cause of typhoid fever, and was forcibly isolated from 1907
to 1910. At least 53 cases of the infection were traced to her, and three
her death in 1938. The presence of the bacteria in her gallbladder was
confirmed on autopsy
• East Samoa, 1918 (flu pandemic): During the 1918 flu pandemic, the then
influenza from infecting the population and thus achieving zero deaths within the
was among the hardest hit, with a 90% infection rate and over 20% of its adults
dying from the disease. This failure by the New Zealand government to prevent
Hickox, a Doctors Without Borders nurse from Maine, legally battled 21-
day quarantines imposed by the states of New Jersey and Maine after
returning home from treating Ebola patients in Sierra Leone. "Hickox was
new Ebola regulations the day she arrived. She eventually was allowed to
before trying and failing to create a buffer between her and others.
• COVID-19 pandemic, 2020–present: During the COVID-19
pandemic, multiple governmental actors enacted quarantines in
an effort to curb the rapid spread of the virus. On 26 March, 1.7
billion people worldwide were under some form of lockdown,
which increased to 2.6 billion people two days later—around a
third of the world's population.
• Hubei: In Hubei, the origin of the epidemic, a cordon sanitaire was
imposed on Wuhan and other major cities in China, affecting around
500 million people, which is unprecedented in scale in human history,
to limit the rate of spread of the disease. The 'lockdown' of Wuhan, and
subsequently a wider-scale 'lockdown' throughout Hubei province,
began on 23 January 2020. At this stage, the spread of the virus in
mainland China was running at approximately 50% growth in cases per
day. On 8 February, the daily rate of spread fell below 10%.
QUARANTINABLE DISEASES
• Cholera: In the nineteenth century and in the first quarter of the twentieth, cholera
has spread several times in pandemics from the areas where it is endemic into
Europe, North Africa and North America, and eastward into China and the
Philippines. For more than thirty years, however, Europe, America, Australia, and
Africa (except Egypt) have been completely free from the disease.
• The endemic foci proper are considered to be the deltaic region of the Ganges and
Brahmaputra, together with some less important foci in the same part of the world.
• Typhus: Louse-borne typhus used to be the inevitable companion of war
and other social disorganization. But in the Second World War, though
there were some important outbreaks, typhus never got out of hand.
• This was not because the infective micro-organism was less virulent or
because conditions were initially unfavorable to the louse, but because it
was controlled by the more efficient sanitary measures enforced by armies
and civil authorities; by antilouse dusting techniques, which became more
effective when DDT came into use, and by the degree of protection given
by anti-typhus vaccination.
• Plague: Plague was responsible for one of the most disastrous of the
known pandemics, the Black Death, which disorganized human society
in the fourteenth century.
• Plague has been frequent in China both in coastal areas and in the
interior and rat-caused plague has been entrenched in parts of South
China, as well as in the north-west of the country. In India particularly,
plague was a major cause of human mortality at the beginning of the
century but has steadily decreased in recent years.
• Relapsing Fever Louse-borne relapsing fever is perhaps the least
after the Second World War; it disappeared from Europe in 1949, and
• But because sporadic cases persist in some areas of Africa and Asia
from Asia where conditions seem favorable for it and where potential
and North America, but never Asia. The reason for this is unknown
and the possibility that yellow fever might spread to Asia is one of the
• Symptomatic treatment:
• Take plenty of rest.
• Drink fluids to prevent dehydration.
• Take medicine such as acetaminophen to relieve fever and pain.
• Do not take aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs),
like ibuprofen and naproxen.
• Consult your doctor.
EBOLA VIRUS DISEASE
• Ebola Virus Disease (formerly known as Ebola Hemorrhagic
Fever) is a Severe, often fatal illness, with a death of up to 90%.
The illness affects humans and non-human primates (monkeys,
gorillas and chimpanzees).
1. Cholera Two types of safe and effective oral cholera vaccine currently available. Given orally in two doses
between seven days and six weeks apart.
3. Typhoid Fever Two vaccines are available for prevention of typhoid. Typhoid polysaccharides vaccine is inject able
given subcutaneously or intramuscularly. One dose is required. Confers protection after 7 days. The
other is oral typ21 a vaccine, administered on 1,3 and 5 th day. Protective immunity achieved 7 days
after 3rd dose.
4. Influenza Inactivated vaccine is widely used. Two adequately spaced doses (1.0 ml each) of an aqueous or
saline vaccine are recommended for primary immunization, although one dose may be given when
an epidemic is threatened. The immunity lasts for about 3 to 6 months. Oil-adjuvant vaccine gives
immunity of longer duration, but they tend to produce unpleasant local reaction.
5. Yellow Fever The dose of the vaccine (17D vaccine) is 0.5 ml given subcutaneously. Immunity begins 10-12 days
after vaccination, and extends up to 10 years.
CURRENT UPDATES FOR COVID – 19
• According to MoHFW Guidelines for international arrivals (in
supersession of guidelines issued on the subject dated 24th May 2020) (to
be operational from 00.01 Hrs, 8th August 2020)
Before Planning for Travel:
• All travelers should submit self-declaration form on the online portal
(www.newdelhiairport.in) at least 72 hours before the scheduled travel.
• They should also give an undertaking on the portal that they would
undergo mandatory quarantine for 14 days i.e. 7 days paid institutional
quarantine at their own cost, followed by 7 days isolation at home with
self-monitoring of health.
• Only for compelling reasons/ cases of human distress such as
pregnancy, death in family, serious illness and parent(s) with
children of the age of 10 years or below, home quarantine may
be permitted for 14 days.
• If they wish to seek such exemption under para (iii) above, they
shall apply to the online portal (www.newdelhiairport.in) at
least 72 hours before boarding. The decision taken by the
government as communicated on the online portal will be final.
• Travelers may also seek exemption from institutional
quarantine by submitting a negative RTPCR test report on
arrival. This test should have been conducted within 96 hrs
prior to undertaking the journey.
• Thermal screening would be carried out in respect of all the passengers by the Health
officials present at the airport/ seaport/ Land port. The self-declaration form filled online
shall be shown (or a copy of physical self-declaration form to be submitted) to the airport
health staff.
• These passengers shall be kept under institutional quarantine for a minimum period of 7 days.
They shall be tested as per ICMR protocol available at
https://www.mohfw.gov.in/pdf/Revisedtestingguidelines.pdf
• If they test positive, they shall be assessed clinically.
– If they are assessed as asymptomatic / pre-symptomatic/ very mild
cases, they will be allowed home isolation or isolated in the Covid
Care Centre (both public & private facilities) as appropriate.
– Those having mild/ moderate/ severe symptoms will be admitted to
dedicated Covid Health facilities and managed accordingly.
• If found negative, they shall be advised to further isolate
themselves at home and self-monitor their health for 7 days.
• vii. In case, any symptoms develop they shall inform the
district surveillance officer or the state/national call center
(1075).
• "Coronavirus Disease 2019 (COVID-19)—Transmission". U.S. Centers for Disease Control and Prevention (CDC). 17 March 2020.
• Park. K. Preventive and social medicine. 25th ed. Jabalpur: Banarsidas Bhanot; 2019.
• Kishore J. National health programmes of India. 13 th ed. New Delhi: Century Publications; 2014.
• Government of India Ministry of Health & Family Welfare Directorate General of Health Services
https://www.mohfw.gov.in/pdf/RevisedguidelinesforInternationalArrivals02082020.pdf