Guidance for Importation of Human Remains into the United States for Interment or Subsequent Cremation

Blood and other body fluids that leak from containers can cause a risk to human health. CDC has issued guidance for importing human remains into the United States that are intended for interment (e.g. burial or placement in a tomb) or subsequent cremation after entry into the United States. CDC already has regulations that govern importing the remains of a person who died from a contagious disease that is quarantinable.

This new guidance outlines all of CDC’s requirements about importing human remains intended for interment or subsequent cremation, no matter the cause of death. This guidance includes the basic requirement that all human remains be shipped in a leakproof container. All human remains imported to the United States must also be accompanied by a death certificate stating the cause of death.

Germs that can cause disease could be present in the blood or other body fluids of a deceased person even if the stated cause of death is not a contagious disease. Such germs include human immunodeficiency virus (HIV), hepatitis B virus, hepatitis C virus, and other germs that can be present in body fluids. This guidance is based on medical Standard Precautions to prevent exposure to infectious diseases carried in the blood and other body fluids.

This requirement is intended to protect the public as well as federal, airline, and airport employees from potential exposure to blood and other body fluids during transportation, inspection, or storage of human remains.

This guidance applies to human remains (i.e., the whole body or portion of the body of a deceased human being) intended for interment (e.g. burial or placement in a tomb) or subsequent cremation after entry into the United States.

There are no requirements for importation into the United States if human remains consist entirely of the following:

• clean, dry bones or bone fragments
• human hair
• teeth
• fingernails or toenails
• human remains that are cremated before entry into the United States

This guidance does not apply to the following items that are addressed under other U.S. Federal regulations:

• patient specimens or diagnostic specimens
• any agent already covered by 42 CFR Part 71.54 Etiologic Agents, Hosts, and Vectors
• tissues or organs that are legally imported into the United States for the purpose of transplantation as these items are regulated by the U.S. Food and Drug Administration (FDA)

Definitions for Terms Used in this Guidance

Communicable disease: An illness due to a specific infectious agent or its toxic products, which rises through transmission of that agent or its products from an infected person or animal or a reservoir to a susceptible host, either directly or indirectly through an intermediate animal host, vector, or the inanimate environment.

Cremated remains (ashes): The residual matter after human remains are completely reduced to ash by intense heat.

Cremation: The act of reducing human remains to ash by intense heat.

Death Certificate: An official document that states the cause of death and is signed by a coroner, physician, or other official authorized to make a declaration of cause of death.

Hermetically sealed casket: A casket that is airtight and secured against the escape of microorganisms. A casket will be considered hermetically sealed if accompanied by valid documentation that it has been hermetically sealed AND, on visual inspection, the seal appears not to have been broken.

Interment: The act of interring or preparing to inter human remains, as would typically occur in a grave, tomb, or other location.

Leakproof container: A container that is puncture-resistant and sealed in a manner so as to contain all contents and prevent leakage of fluids during handling, storage, transport, or shipping.

Quarantinable Communicable Disease: Any of the communicable diseases listed in an Executive Order, as provided under § 361 of the Public Health Service Act (42 U.S.C. § 264). Executive Order 13295 , of April 4, 2003, as amended by Executive Order 13375 of April 1, 2005, includes cholera, diphtheria, infectious tuberculosis, plague, smallpox, yellow fever, viral hemorrhagic fevers (Lassa, Marburg, Ebola, Crimean-Congo, or others not yet isolated or named), severe acute respiratory syndrome (SARS), and influenza caused by novel or reemergent influenza viruses that are causing or have the potential to cause a pandemic.

Standard Precautions (formerly referred to as Universal Precautions): An approach to infection control in which all human blood and certain human body fluids are considered to be infectious for the human immunodeficiency virus (HIV), hepatitis B virus, hepatitis C virus, or other bloodborne pathogens, and are handled accordingly.

Requirements for importing human remains through a U.S. port that are intended for interment or subsequent cremation

Human remains intended for interment or subsequent cremation after entry into the United States must be accompanied by a death certificate stating the cause of death. If the death certificate is in a language other than English, then it should be accompanied by an English language translation.

If the cause of death was a quarantinable communicable disease (i.e., cholera, diphtheria, infectious tuberculosis, plague, smallpox, yellow fever, viral hemorrhagic fevers, SARS, or pandemic influenza), the remains must meet the standards for importation found in 42 CFR Part 71.55 and may be cleared, released, and authorized for entry into the United States only under the following conditions:

• The remains are cremated; OR
• The remains are properly embalmed and placed in a hermetically sealed casket; OR
• The remains are accompanied by a permit issued by the CDC Director. The CDC permit (if applicable) must accompany the human remains at all times during shipment.
  • Permits for the importation of the remains of a person known or suspected to have died from a quarantinable communicable disease may be obtained through the CDC Division of Global Migration and Quarantine by calling the CDC Emergency Operations Center at 770-488-7100. If a CDC permit is obtained to allow importation of human remains, CDC may impose additional conditions for importation beyond those listed above.

If the cause of death was anything other than a quarantinable communicable disease, then the remains may be cleared, released, and authorized for entry into the United States under the following conditions:

• The remains meet the standards for importation found in 42 CFR Part 71.55 , (i.e., the remains are cremated, or properly embalmed and placed in a hermetically sealed casket, or are accompanied by a permit issued by the CDC Director); OR
• The remains are shipped in a leakproof container.

CDC may also require additional measures, including detention, disinfection, disinfestation, fumigation, or other related measures, if it has reason to believe that the human remains are or may be infected or contaminated with a communicable disease and that such measures are necessary to prevent the introduction, transmission, or spread of communicable diseases into the United States.