[Factors to be considered in decision making for quarantine detention with emergence of a novel influenza virus]

Abstract

Objectives: In the early phase of the emergence of influenza A (H1N1) 2009 abroad, quarantine detention measures based on exposure assessment of infected persons at airports were enacted in Japan. Detention, while being a step needed to protect safety and health of citizens, restricts healthy individuals' activities for several days until they can be confirmed to be not infected. Thus, the number of persons detained must be minimized in the interest of human rights. In this study, we reviewed factors to be considered in decision-making to carry out optimal detention in the early phase of emergence of a novel influenza virus in the future.

Methods: We reviewed manuscripts on contagiousness of influenza, cases of infections in public transportation such as airplanes, and the effectiveness of detention, and interviewed persons who were involved in detentions in the early phase of the influenza A(H1N1) 2009 pandemic.

Results: When a decision is made about detention, it is essential to assess the necessity of detention, the measures for minimizing the scope of individuals to be detained, the measures for ensuring the human rights of individuals affected, and possible means to substitute for detention. Assessment of the necessity of detention should cover the following: (1) whether or not the novel influenza is a sufficiently severe threat to public health to justify detention; (2) whether or not detention at a given point of time can delay the beginning of a domestic epidemic; and (3) who is responsible and how revision of the once decided detentions should be made. Regarding measures for minimizing the scope of individuals to be detained, discussions are needed as to: (1) giving advice to the nation to refrain from getting aboard an airplane when aware of flu-like symptoms so that exposure of people to infected individuals may be avoided; and (2) whether or not selection of individuals to be detained is going to be made, taking into account the level of exposure to infected individuals. To ensure the human rights of the individuals affected by detention, assessment is needed as to: (1) whether or not the detention period is as short as possible; (2) whether or not human rights (privacy, comfort at the detention facility) will be protected during detention; (3) whether or not adequate measures can be taken to ensure mental health and management of chronic disease of the detained; and (4) whether or not adequate explanations can be given to foreigners to be detained, with their mother language taken into account. Regarding substitutes for detention, alternatives such as keeping the individuals at their own home as home quarantine should be considered.

Conclusion: The decision on detention has to be made in the early phase of an influenza pandemic when information available about pathogenicity and other relevant information are limited. To date, sufficient evidence useful in making a decision as to detention has not been obtained. Under such circumstances, it is essential to make an optimum decision as to the necessity and means of detention based on assessment of multiple aspects and factors.