Federal Quarantine & Communicable Disease Control

The Surgeon General's quarantine authority — codified at 42 U.S.C. §§ 264–272 — is the federal government's primary legal tool for stopping the spread of communicable diseases across state lines or from foreign countries into the United States. These provisions were the legal basis for COVID-19 restrictions including the Title 42 border expulsion policy, the cruise ship quarantines of 2020, and CDC's eviction moratorium (which courts later struck down as exceeding the statute's scope). The authority is broad but not unlimited: the Surgeon General may detain, examine, and conditionally release individuals, but the regulations must be narrowly tailored to disease prevention and may not be used for unrelated government objectives. Understanding these provisions is essential to understanding the legal framework of any U.S. public health emergency. For emergency preparedness infrastructure that complements quarantine authority, see public health emergency preparedness.

Current Law (2026)

Legal Authority

• 42 U.S.C. § 264 — Core quarantine authority: the Surgeon General may make and enforce regulations "necessary to prevent the introduction, transmission, or spread of communicable diseases" from abroad or interstate; specifically authorizes apprehension, examination, detention, and conditional release of individuals who are "reasonably believed to be infected" with a listed disease; regulations must be no more restrictive than necessary
• 42 U.S.C. § 265 — Foreign source suspension: whenever the Surgeon General determines that a communicable disease in a foreign country poses "serious danger" of introduction into the U.S. that is increased by travel from that country, the Surgeon General may suspend entries — this was the basis for the "Title 42" COVID border policy from 2020–2023
• 42 U.S.C. § 266 — Wartime quarantine: in time of war, the Secretary may require detention and examination of individuals to protect military forces and war workers
• 42 U.S.C. § 267 — Quarantine stations: the Surgeon General controls, directs, and manages all U.S. quarantine stations and grounds; may designate quarantine anchorages for vessels
• 42 U.S.C. § 268 — Consular and customs cooperation: consular officers report health conditions at foreign ports; customs and Coast Guard officers aid in enforcement of quarantine laws
• 42 U.S.C. § 269 — Bills of health: vessels departing foreign ports for U.S. destinations must obtain health clearance certificates from U.S. consular or public health officers; rules for vessels arriving without bills of health
• 42 U.S.C. § 270 — Aviation: quarantine regulations apply to civil aviation and aircraft to the extent the Surgeon General deems necessary — the legal basis for aircraft quarantine and health screening at airports
• 42 U.S.C. § 271 — Criminal penalties: 1 year imprisonment or fine for violations of §§ 264–266 regulations or unauthorized departure from quarantine stations

Implementing Regulations

The CDC's implementing regulations for foreign quarantine live at 42 CFR Part 71 — Foreign Quarantine (20 sections — the operational rules for CDC quarantine officers and carriers at U.S. ports of entry, implementing the Surgeon General's authority under 42 U.S.C. §§ 264–271):

• § 71.2 — Penalties: persons who violate Part 71 are subject to fines up to $100,000 per violation and one year in prison; violations by organizations can reach $200,000 per violation; the criminal penalties at 42 U.S.C. § 271 (1 year imprisonment) apply for willful violations; these are among the oldest federal health penalties — originally set in the 1890s and repeatedly updated
• § 71.11 — Bills of health (maritime health declarations): carriers at foreign ports clearing for U.S. destinations must obtain a bill of health from the U.S. consular or public health officer at the foreign port certifying the port's health status; vessels arriving without a proper bill of health are subject to detention and inspection upon arrival; this requirement mirrors the WHO's International Health Regulations (IHR) requirements for maritime health declarations
• § 71.20 — Detection measures at ports of entry: the CDC Director (through quarantine officers stationed at 20 airports and select seaports) may conduct public health prevention measures to detect communicable disease — including direct observation, questioning, review of travelers' documentation (vaccination records), temperature screening, and collection of contact information; during COVID-19, Part 71's detection authority underpinned passenger attestation forms, temperature screening programs, and CDC Passenger Locator Forms at international airports
• § 71.21 — Illness reporting: the master of any ship destined for a U.S. port must report to the CDC quarantine station within 24 hours of arrival (or as soon as practicable) any death or illness of any person on board during the voyage; the captain must report if any crew member or passenger: died during the voyage; is currently ill; has signs/symptoms suggesting communicable disease; or if any animal on board has died or appears ill; airline captains have analogous reporting obligations for ill passengers under parallel aviation regulations
• § 71.29 — Administrative records: CDC must maintain records of all quarantine, isolation, or conditional release orders; individuals subject to quarantine must be served with a written order explaining the basis, duration, and their rights to appeal; this record-keeping requirement implements the due process requirements that courts have held apply to federal public health detention
• § 71.31 — Vessel inspection exemption: vessels that have been abroad for 15 or fewer days and have no illness on board are generally exempt from inspection upon arrival; vessels arriving from non-infected areas with no ill persons are similarly exempt; inspections are focused on vessels from areas with active communicable disease outbreaks or where the CDC director has reason to suspect illness
• § 71.32 — Authority over persons, carriers, and things: whenever CDC has reason to believe that any arriving person, vessel, vehicle, aircraft, animal, or cargo may be infected with or exposed to a listed communicable disease, CDC may detain, isolate, or conditionally release it for examination; "things" includes biological materials, cargo, and mail that could carry pathogens
• § 71.33 — Isolation and surveillance: when CDC orders isolation, it must arrange (or ensure the carrier arranges) for adequate food and water, shelter, clothing, medicine, and other necessities for the isolated individual; isolated persons may not depart from isolation without CDC authorization; conditional release (quarantine) allows the person to travel or function with conditions (check-ins, symptom monitoring, movement restrictions)
• § 71.36 — Medical examinations: CDC may require an individual arriving in the U.S. to submit to a medical examination if there is reason to believe the individual may be infected; refusal to submit to examination is itself a violation of Part 71; medical examinations must be conducted by licensed physicians and must be limited to what is necessary to determine whether the individual is infected with a listed communicable disease
• § 71.37 — Federal quarantine/isolation orders: CDC must issue a written order before placing any individual under federal quarantine or isolation (distinct from a short-term detention for examination); the order must state the factual basis, the listed disease involved, and the person's right to request a review of the order within 3 business days; CDC must provide free legal representation to individuals who cannot afford counsel in federal isolation proceedings — a requirement added in the 2017 regulations following due process litigation arising from a 2007 TB quarantine case

The 20 CDC Quarantine Stations — located at major international airports (JFK, LAX, ORD, ATL, SFO, MIA, and others) and select seaports — are the operational implementation of Part 71; quarantine officers are CDC public health officers with authority to detain travelers, inspect vessels, and coordinate with CBP and airport authorities. During COVID-19, the quarantine station network was overwhelmed by scale: the system was designed for targeted interventions against individual ill travelers, not universal screening of millions of international arrivals. CDC's response required new authorities under emergency orders separate from Part 71. Recent rulemakings: 82 FR 6975 (January 2017) — comprehensive rewrite of 42 CFR Parts 70 and 71, adding the due process protections for individual orders, the contact information collection authorities, and the "do not board" order procedures for airline passengers with communicable diseases.

The interstate quarantine counterpart to Part 71 lives at 42 CFR Part 70 — Interstate Quarantine (covering domestic transportation and movement within the United States):

• § 70.10 — Detection at domestic airports and terminals: CDC may conduct public health prevention measures at U.S. airports, seaports, railway stations, and bus terminals to detect communicable disease — including questioning, observation, review of documents, and collection of contact information; this authority is the domestic analog to Part 71's port-of-entry authority and covers travelers moving between U.S. states (not just arriving from abroad)
• § 70.11 — Airline illness reporting: the pilot in command of an interstate commercial flight must report to CDC any death, illness with symptoms suggesting a communicable disease, or unusual pattern of illness among passengers; reporting must occur as soon as practicable, with the expectation of report before landing when possible; this mirrors the foreign carrier obligation in Part 71 and creates a nationwide surveillance network using airlines as frontline disease detection assets
• § 70.12 — Medical examinations: CDC may require individuals in interstate travel to submit to medical examination for quarantinable communicable diseases; refusal is a violation; examinations must be conducted by licensed physicians with findings documented in CDC's administrative record
• § 70.14 — Due process for federal quarantine orders: before issuing a federal quarantine, isolation, or conditional release order in the interstate context, CDC must: serve the individual with a written order explaining the factual and legal basis; inform the individual of the right to request a medical review within 72 hours; and provide free legal representation for those who cannot afford counsel; the order must specify the communicable disease involved, the duration of quarantine, and the conditions under which the individual may be released; these procedural requirements parallel Part 71 and trace to the 2017 comprehensive revision that added constitutional safeguards
• § 70.13 — Payment for care and treatment: CDC may authorize payment for care and treatment of individuals subject to federal quarantine or isolation under Part 70 — recognizing that the government cannot detain individuals and simultaneously require them to bear the financial cost of mandatory isolation; in practice, this authority has rarely been exercised, with most quarantine costs borne by state health departments or individuals

The Part 70 interstate quarantine authority is distinct from, and overlapping with, state quarantine powers: states have the primary public health authority for quarantine within their borders, but federal authority applies when disease spread involves interstate commerce, transportation, or federal facilities. The 2017 revision to Part 70 significantly strengthened due process protections following litigation challenges to CDC's authority to detain travelers without clear procedural safeguards.

How These Authorities Work

Interstate quarantine: CDC has authority to detain individuals at airports, train stations, and other interstate transit points who are reasonably believed to be infected with a listed communicable disease. In practice, CDC issues federal isolation orders to airlines and travelers and relies on state public health departments for on-the-ground implementation. The federal authority is a backstop for the much larger apparatus of state quarantine laws.

International quarantine: CDC operates quarantine stations at 20 major U.S. ports of entry including JFK, LAX, Honolulu, San Francisco, Miami, and Chicago O'Hare. Inspectors screen arriving travelers and may direct them to be assessed by medical personnel. Individuals who show symptoms of listed diseases can be detained for examination.

Vessel quarantine: The § 269 "bill of health" system — an international certification from the port of departure that the vessel has no communicable disease cases — originated in 19th-century maritime practice. A vessel without a clean bill of health is subject to inspection and possible quarantine before passengers and crew may disembark.

The listed diseases: Not every communicable disease triggers quarantine authority. Executive Order 13295 (as amended) designates the diseases subject to federal quarantine: cholera, diphtheria, infectious tuberculosis, plague, smallpox, yellow fever, viral hemorrhagic fevers (Ebola, Marburg, Lassa, etc.), SARS, and "influenza caused by novel or reemergent influenza viruses that are causing, or have the potential to cause, a pandemic." COVID-19 was added to the list by Executive Order 13994 in 2021.

The "Title 42" Border Policy Controversy (2020–2023)

During the COVID-19 pandemic, the Trump administration invoked § 265 to implement what became known as the "Title 42" border expulsion policy — rapidly expelling migrants arriving at the southern border without processing their asylum claims, on the grounds that their entry posed a COVID-related public health risk. The Biden administration initially continued the policy; it was terminated in May 2023 when the COVID public health emergency ended.

The Title 42 policy generated significant legal and policy debate:

• Courts were split on whether § 265 permits the use of disease authority to manage migration flows rather than disease spread
• Critics argued the policy used a public health law as an immigration enforcement tool
• The name "Title 42" refers to this portion of the U.S. Code, not to the Internal Revenue Code's Chapter 42

The CDC Eviction Moratorium (2020–2021)

During COVID-19, the CDC issued an eviction moratorium under § 264, arguing that housing stability was necessary to prevent the spread of COVID-19. In Alabama Association of Realtors v. HHS (2021), the Supreme Court held that the CDC lacked authority to impose a nationwide eviction moratorium under § 264 — the provision authorizes disease-prevention measures like "cleaning, fumigation, and sanitation," not broad economic interventions. The ruling established that § 264 must be read narrowly to match its historical disease-control purpose.

How It Affects You

If you arrive at a U.S. port of entry from a high-disease-risk area: CDC operates federal quarantine stations at 20 major U.S. ports of entry — including JFK, LAX, O'Hare, Miami, Honolulu, Dallas/Fort Worth, Atlanta, and San Francisco international airports. If you appear ill, report having symptoms, or come from an area with an active outbreak of a listed disease (Ebola, plague, cholera, pandemic influenza, etc.), CDC quarantine officers may direct you for a medical assessment. This is distinct from CBP immigration screening — it's specifically health-focused. In most cases, screening is brief and you are released. If you are detained for examination, you must be informed of the basis and have access to medical care. Federal quarantine authority applies to all arriving persons regardless of citizenship. If you are showing symptoms that could indicate a listed communicable disease, do not try to conceal them — doing so and then violating a resulting quarantine order is a federal criminal offense under § 271 (up to 1 year imprisonment or fine).

If you are subject to a federal isolation or quarantine order: You have constitutional due process rights that courts have recognized even in public health detention contexts. You must be informed of the legal basis for the order. You may contest the order, typically by seeking habeas corpus review in federal district court. In practice, federal quarantine orders are short-term (days, not months) pending medical examination — courts have upheld them as consistent with the government's compelling interest in preventing communicable disease spread, particularly for listed diseases. If you are ordered into quarantine and believe it is improper, contact an attorney immediately; civil liberties organizations including the ACLU have legal resources specifically for individuals detained under public health authority. Deliberate departure from a quarantine station is a criminal offense; if you have concerns about the order's legality, contest it through legal channels, not by leaving.

If you operate an airline, cruise line, or international maritime vessel: You have mandatory reporting and cooperation obligations under 42 C.F.R. Part 70 (interstate quarantine) and Part 71 (foreign quarantine). Airlines must report any ill traveler who died or required medical attention in-flight, or who may have a communicable disease. Cruise ships must report specific illness thresholds via the CDC's Vessel Sanitation Program (vsp.cdc.gov). Vessels arriving from foreign ports must maintain a maritime health declaration under 42 C.F.R. § 71.21. Failure to report can expose the carrier to civil penalties and enforcement action. During outbreak events, CDC may issue vessel-specific or flight-specific quarantine orders that restrict disembarkation — the carrier is responsible for holding passengers until CDC clears the vessel. Maintain current contacts for your CDC quarantine station liaison as part of standard operations.

If you are a state or local public health official: Federal quarantine authority is a backstop and an international/interstate layer — it does not preempt your state's own quarantine powers. Your state's quarantine statutes likely give you broader authority within your jurisdiction than the federal Surgeon General authority does. The practical relationship is collaborative: CDC's quarantine officers at ports of entry handle the initial screening and federal isolation orders; state and local health departments typically execute the on-the-ground enforcement (monitoring quarantined individuals at home, coordinating hospital isolation, managing contact tracing). If a CDC order and state law appear to conflict, the general principle is that federal authority governs at ports of entry and in interstate transport, while state authority governs within the state. Contact your state epidemiologist and CDC's Emergency Operations Center (770-488-7100) when coordinating on active quarantine situations.

State Variations

Every state has its own quarantine and public health emergency law. State authority is generally broader in scope than federal authority within the state, while federal authority applies at ports of entry and in interstate situations. During COVID-19, states implemented widely varying quarantine, isolation, and mask requirement rules independently of federal CDC authority.

Pending Legislation

No major changes to federal quarantine statutory authority are currently pending as of April 2026. Post-COVID pandemic preparedness legislation has focused on stockpile maintenance and interagency coordination rather than the quarantine statute itself.

Recent Developments

• H5N1 avian influenza (bird flu) in dairy cattle and humans — preparedness testing quarantine authorities: The H5N1 avian influenza outbreak in U.S. dairy cattle (confirmed March 2024) and sporadic human cases among farm workers tested federal communicable disease response infrastructure short of a full pandemic. USDA's animal quarantine authorities (separate from CDC's human quarantine authority) governed cattle movement restrictions; CDC coordinated monitoring of farm workers with state health departments. As of April 2026, human H5N1 cases in the U.S. remain rare and no confirmed human-to-human transmission has occurred. The response revealed coordination gaps between USDA/APHIS (animal disease authority) and HHS/CDC (human disease authority) in zoonotic spillover situations — exactly the scenario the One Health framework is designed to address.
• COVID public health emergency ended (May 2023) — but the legal framework remains: The Biden administration's formal COVID-19 Public Health Emergency declaration ended May 11, 2023, winding down the emergency authorities that had supported extended quarantine powers. The Trump administration's subsequent approach to pandemic preparedness has been skeptical of emergency declarations as regulatory mechanisms. The underlying quarantine statute (42 U.S.C. §§ 264-272) and CDC's 2017 quarantine regulations remain on the books, but the political and institutional will to invoke them for future outbreaks is uncertain given the backlash to COVID restrictions.
• CDC quarantine regulations still awaiting 2017-promised updates: CDC's current quarantine regulations (42 CFR Parts 70-71) were last comprehensively revised in 2017 — creating a framework that CDC acknowledged needed regular review to address advances in diagnostics, new disease threats, and lessons from COVID-era implementation. The Trump administration has not prioritized the regulatory update; CDC's Office of Public Health Preparedness and Response has focused on other implementation priorities. The 2017 regulations' provisions for "public health contact information" collection and "do not board" orders for airline passengers with communicable diseases remain in effect but may not fully address digital disease surveillance capabilities.
• Title 42 border expulsions ended — authority scope clarified by courts: The Biden administration's May 2023 termination of Title 42 border expulsions — which had used 42 U.S.C. § 265 (prohibition on entry from disease-affected areas) as the legal basis for mass expulsion of migrants during COVID — resolved the most politically charged use of quarantine authority in decades. Courts had split on whether § 265 authorized mass expulsions unrelated to individualized disease risk assessment; the termination mooted those legal questions without a definitive ruling. The Trump administration's immigration enforcement approach relies on other legal authorities (INA, Alien Enemies Act) rather than § 265.