Large-scale quarantine following biological terrorism in the United States- Scientific examination, logistic and legal limits, and possible consequences

Concern for potential bioterrorist attacks causing mass casualties has incr eased 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 interve ntions are possible to effect disease containment in this context. One dise ase 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 implemente d in recent US history, it has been used on a small scale in biological hoa xes, and it has been invoked in federally sponsored bioterrorism exercises. This article reviews the scientific principles that are relevant to the li kely effectiveness of quarantine, the logistic barriers to its implementati on, 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 pe rsons or human confinement within certain geographic areas to prevent sprea d of contagious disease-should not be considered a primary public health st rategy in most imaginable circumstances. In the majority of contexts, other less extreme public health actions are likely to be more effective and cre ate fewer unintended adverse consequences than quarantine. Actions and area s for future research, policy development, and response planning efforts ar e provided.