Quarantine is defined as a restriction of the activities of healthy persons or animals who have been exposed to a communicable disease. The aim is to prevent transmission of the disease from potentially infected persons to healthy persons during the incubation period. Quarantine can take two forms: absolute or complete quarantine, which consists of a limitation of freedom for a period equal to the longest usual incubation period of the disease; and modified quarantine, which involves selective or partial limitation of movement, based on known differences in susceptibility. Examples of a modified quarantine are the exclusion of children from school and the confining of military personnel to their base. Modified quarantine includes personal surveillance, medical supervision, and segregation of the individual or group; or the establishment of a cordon sanitaire (a boundary zone between uninfected and infected or exposed persons).
The word "quarantine" derives from the Italian quaranta dei (forty days), a reminder that the custom of segregating putatively infected persons, and the ships on which they were traveling, originated in the maritime empire of Venice in the fourteenth century. The length of time probably relates to the biblical story of the forty days Jesus spent in the wilderness, not to any real knowledge of the mode of transmission of infection. The rise of the practice, however, suggests that there was some understanding of the concept of contagion even if there was no empirical knowledge of infective periods and incubation times of the plagues that afflicted medieval Europe. Few infectious diseases have an incubation time or infective period greater than forty days. An exception is rabies, which may not declare itself for many months. That is why animals that may have been exposed to rabies are quarantined for many months when they arrive in countries where rabies does not exist.
Animal and plant quarantine procedures are often more important than human quarantine now that many of the most dangerous contagious diseases can be kept under observation without such draconian restrictions as formerly required. The economic importance of agriculture and animal husbandry in many countries makes it absolutely essential to exclude diseases that might wipe out valuable cattle herds or destroy a season's harvest. A very important human disease with an incubation time that can, and probably usually does, exceed forty days is HIV (human immunodeficiency virus) infection, but for reasons that have more to do with human rights than epidemiological insights there is no quarantine for persons exposed to HIV infection.
Quarantine as a way to control the spread of contagious diseases is an extreme form of isolation, which has several less severe variations. Bedside isolation, in which patients suffering from an infectious disease are barrier nursed to break the chain of transmission, is the mildest variation. More dangerous varieties of contagious disease, such as pulmonary tuberculosis with excretion of tubercle bacilli, diphtheria, and cholera, are preferably isolated in a special hospital or closed ward. Until recently, patients with such diseases as typhoid, paralytic poliomyelitis, and meningococcal meningitis were strictly isolated and every effort was made to preserve a cordon sanitaire around them. Their contacts were quarantined under public health laws in some jurisdictions, even though epidemiologically this made little or no sense as a means of preventing transmission of infection. Powerful antibiotics and better understanding have made quarantine unnecessary for these and many other diseases. Infected patients are now often treated in a general hospital rather than in one dedicated to infectious diseases. The practice of universal precautions is a modified form of quarantine in which patients with a contagious disease (such as HIV/AIDS [acquired immunodeficiency syndrome]) are barrier nursed and otherwise cared for so as to minimize the risk of HIV transmission.
Quarantine goes further than isolation because it includes the compulsory segregation of contacts of infectious cases. It therefore involves infringing upon the liberty of outwardly healthy people, and this has both legal and ethical implications. Any restriction of a person's freedom to move must be justified, and such a restriction sanctioned by public health laws and regulations in many nations. In the early twentieth century most industrial nations had lengthy lists of contagious diseases to which quarantine laws applied. By the 1960s most of these diseases could be controlled without such severe restrictions, and in 1969 the World Health Organization issued international health regulations for just four designated quarantinable diseases: cholera, plague, yellow fever, and smallpox. Smallpox was proclaimed eradicated by WHO in 1979, and the other diseases on the list (except cholera in some parts of the world and, occasionally, yellow fever in others) are now rarely encountered or respond well to medical treatment. The quarantine stations that were formerly a feature of large seaports around the world have been abandoned, dismantled, or turned into holiday resorts. Quarantine law and regulations still apply in many countries, however, to protect animals and plants of economic importance from exotic diseases.
Public health officials who invoke quarantine laws or regulations must justify this action ethically—on the grounds that it is in the interests of the greater good of the community. In the past, this police power of public health officials was accepted by most people as a necessary measure to control the spread of contagious disease. Community values changed in the late twentieth century, however, and there is now emotional and political resistance to restricting freedom in the interests of safeguarding the public's health. It is regarded as ethically unacceptable to quarantine promiscuous persons who are HIV-positive, even though it might be in the best interests of the general public to do so. In some places, public health officials have invoked the police power of their quarantine regulations and, sometimes with the assistance of local police forces, they have incarcerated incorrigibly promiscuous persons infected with HIV/AIDS. AIDS activists and civil rights advocates oppose this, and a debate that played out in relation to detention of polio contacts in the early twentieth century is being reprised.
John M. Last
(see also: Barrier Nursing; Communicable Disease Control; Ethics of Public Health; Isolation; Notifiable Diseases )
The first known law of segregation on account of disease was enacted by the Emperor Justinian in ad 542. The earliest definite regulations against the spread of disease were, however, developed by Italian city states under the threat of bubonic plague in the fourteenth century. Venice, the great entrepôt of trade with the east, probably issued regulations as early as 1127, and was the first city to issue a complete quarantine code in 1448. This code provided the model for all subsequent regulations over the next four centuries. Initially these European quarantines were limited to the exclusion of goods and people from stricken localities, but as time went on they were increasingly extended to foreign places as well, especially in sea ports.
By the sixteenth century the practice of quarantine was well established across Europe, and British governments also began to adopt the policy. It was not until the eighteenth century, however, that comprehensive codes of practice were put into place in response to the last outbursts of plague on the European continent — in the Baltic states between 1709 and 1712, and at Marseilles in 1721. These early eighteenth-century regulations were apparently successful at staving off the menace of plague, and were repeatedly revised and renewed over the next hundred years.
The arrival of Asiatic cholera in Europe in 1830, against which quarantines proved singularly ineffective, heralded the demise of the system. In England, commercial and trade interests were already beginning to protest against the restrictions imposed by the system in the mid 1820s, and the experiences with cholera in 1832 and 1848 confirmed commercial opposition to the practice. Both England and France, as colonial trading powers with wide international interests, increasingly questioned the necessity of quarantine, and in 1851 an international congress was called to consider the issue. In following decades, opposition from countries like Spain, Portugal, Greece, and Sweden was gradually eroded at a series of international congresses, and by the successful development by the British of a rival system of surveillance and port supervision. Indeed, the development of the electric telegraph, which so greatly facilitated international communications, permitted the dissemination not only of information on local disease prevalences, but also on the route, condition, and expected arrival of individual ships. Technological developments, as much as commercial pressures, were critical in undermining the rationale for international quarantine systems. At the congresses of Venice and Dresden in 1892 and 1893, the international quarantine system was largely dismantled, to be replaced by supervision systems on the British model. For some years, however, quarantine remained an issue with regard to India, partly because of her reputation as the home of cholera and of plague, and partly because of the complications of the annual pilgrimages of Indian Muslims to Mecca and Medina.
Even into the twentieth century, quarantines were occasionally imposed under the threat of invading epidemics, as when Sydney was quarantined by other Australian states on the outbreak of plague there in 1900. On the smaller scale, too, informal domestic household quarantines continued to be adopted, until well into the twentieth century, for children and adults potentially incubating infectious diseases such as measles and chicken-pox.
See also infectious diseases.
quar·an·tine / ˈkwôrənˌtēn/ • n. a state, period, or place of isolation in which people or animals that have arrived from elsewhere or been exposed to infectious or contagious disease are placed: many animals die in quarantine.• v. [tr.] impose such isolation on (a person, animal, or place); put in quarantine.
A. (leg.) period of forty days during which a widow had the right to remain in her husband's chief mansion house
B. period of isolation of persons and animals suspected of contagious disease. XVII. In sense A — medL. qua(d)rantēna, f. *quadranta, for L. quadrāgintā forty; in sense B — It. quarantina, f. quaranta forty; see -INE1.
Quarantine ★★½ 1989 (R)
Quarantine camps for carriers of a fatal virus are the serious measures taken by the nation. The solution is clear to a rebel and an inventor; all must be liberated or exterminated. 92m/C VHS . Beatrice Boepple, Garwin Sanford, Jerry Wasserman, Charles Wilkinson; D: Charles Wilkinson; W: Charles Wilkinson.