摘要：From April 2004 through December 2004, we reviewed the express legal authorities of the 10 most populous US states to restrict the movement of persons to control communicable diseases. All 10 of the states possessed express legal authority to quarantine and isolate individuals, but the laws varied substantially. In the absence of declared emergencies, only 4 states had express authority to conduct area quarantine, and only 2 states had express authority to conduct group quarantine. During declared emergencies, 7 states had additional authorities for area quarantine. Express authorities are only part of states’ legal powers to employ such movement restrictions, but substantial variation in express authorities across states could present potential challenges for the coordination of large national or regional epidemics. QUARANTINE (THE SEPARATION and restriction of movement of well persons exposed to a communicable disease) and isolation (the separation and restriction of persons ill with such a disease) are among public health’s traditional tools for the control of communicable disease. 1 , 2 In the United States, legal powers to restrict the movement of persons to control communicable diseases trace back to colonial times, 3 but the use of these powers has declined since the introduction of effective antibiotics and vaccines. In recent times, states’ powers to restrict the movement of persons (abbreviated here as RMP powers) have been used mainly to detain persons with highly infectious pulmonary tuberculosis who refuse to comply with antibiotic treatment regimens 4 and occasionally for measles 5 or HIV-infected persons who persistently practice unsafe transmission behaviors despite counseling. 6 Despite waning use, the continuing importance of RMP powers was underscored in 2003 with the advent of severe acute respiratory syndrome (SARS). Although the United States experienced only a small number of SARS cases and did not use RMP to any great extent, RMP was a major tool for controlling the disease in other countries. 7 , 8 In Ontario, Canada, for example, where an outbreak of SARS occurred, officials put 23 000 persons into voluntary quarantine to interrupt transmission of the virus. 9 In the United States, the federal government can take measures to prevent the introduction or transmission of communicable diseases from foreign countries into the United States or from one state or possession into another. This includes the power to quarantine and isolate persons with specified communicable diseases who are arriving into the United States from a foreign country, moving from one state or possession into another state or possession, or who are likely to infect others who will then be moving from one state or possession into another. 10 – 12 However, the legal power to use RMP for communicable disease control within individual states resides in the states’ police power, a residual prerogative of sovereignty that the states retained when the US Constitution was ratified and the Tenth Amendment was adopted. 13 , 14 Thus, in times of serious regional or national epidemics, whether natural or human made, state law, as well as federal law, will govern RMP actions. In this article, we report the findings of a study of the legal powers for RMP in the 10 most populous US states in 2004, where in over half of the US population resides. This study was prompted by the rising specter of imported communicable diseases, both natural (e.g., pandemic influenza 15 ) or human made, which have heightened the need for federal, state, and local agencies to review their legal authorities for public health interventions, including RMP. 16 Exercises designed to test emergency public health procedures and capabilities, such as TOPOFF (Top Officials) and Dark Winter, 17 , 18 have exposed the need for an improved understanding of public health laws. In addition, some legal commentators and expert panels have suggested the need to modernize these laws. 19 , 20 The 10 states chosen for this review have large populations and are likely to be crucial to the control of any large epidemic that affects the United States. In addition, these states have key ports of entry (by air or sea) and may be among the first to experience and amplify imported epidemics.
