Transcript BIOTERRORISM AND THE PUBLIC HEALTH SECTOR

BIOTERRORISM
AND THE PUBLIC HEALTH SECTOR
Richard McCluskey MD, PhD
Center for Disaster Management and Humanitarian Assistance
College of Public Health
University of South Florida
WHY PUBLIC HEALTH ?
CHEMICAL
effects immediate and
obvious
victims localized by
time and place
overt
illicit immediate
response
first responders are
police, fire, EMS
BIOLOGICAL
effects delayed and
not obvious
victims dispersed in
time and place
no first responders
unless announced,
attack identified by
medical and public
health personnel
WHY PUBLIC HEALTH ?
Tokyo subway 1995 / Sarin
Effects within minutes
Victims self-reported to authorities, selftransported to hospitals
First responders
fire, police, EMS
Agent identified: 3 hrs
Event over: 12-24 hrs
WHY PUBLIC HEALTH ?
Oregon USA 1984 / Salmonella
County Health Department
first reports of foodborne illness: several days
two waves of illness over 5 weeks
County Health Department and CDC
751 victims and 10 restaurants identified:
weeks - months
Criminal investigation
source identified: 12 months
criminal charges: 18 months
PUBLIC HEALTH
Examples of biological assaults:
note: all incidents were discovered by public health officials
and initially presented as an unusual cluster in time and place
of an uncommon disease
1996
1984
1970
1966
1965
Shigella dysenteriae
Salmonella
Ascaris suum
Typhoid
Hepatitis
USA
USA
Canada
Japan
USA
PUBLIC HEALTH
Announced attack
Primary response: law enforcement, EMS
Hoax
Variation on announced attack
Increasing occurrence
1992: 1 event affecting 20 people
1998: 37 events affecting 5529 people
PUBLIC HEALTH
Bioterrorism Alleging Use of Anthrax and
Interim Guidelines for Management -United States, 1998
MMWR February 5, 1999 48(04);69-74
http://www.cdc.gov/epo/mmwr/preview/
mmwrhtml/rr4904a1.htm
PUBLIC HEALTH
Preparedness and prevention
Detection and surveillance
Diagnosis and characterization of agents
Response
Communication
PUBLIC HEALTH
Preparedness and prevention
Coordinated preparedness plans
Coordinated response protocols
Performance standards
self-assessment, simulations, exercises
PUBLIC HEALTH
Detection and surveillance
Develop mechanisms for detecting,
evaluating, and reporting suspicious events
Integrate surveillance for illness and injury
resulting from WMD terrorism into disease
surveillance system
PUBLIC HEALTH
Diagnosis and characterization of agents
Multilevel laboratory response network
link clinical labs and public health agencies in all
states, districts, territories, and selected cities and
counties to CDC and other labs
Transfer diagnostic technology from federal
to state level
CDC Rapid Response and Technology Lab
PUBLIC HEALTH
Response
Epidemiologic investigation
if requested by state health agency, CDC will
deploy response teams to investigate unexplained
or suspicious illness
Medical treatment and prophylaxis
vaccine / antibiotic stockpile and transportation
Environmental decontamination
PUBLIC HEALTH
Communication
Effective communication with the public
use news media to limit panic and disruption of
daily life
Effective communication with health care and
public health personnel
coordination of activities
access emergency information
rapid notification and information exchange
PUBLIC HEALTH
Effective planning and response to a
biological terrorist incident will require
collaboration with federal, state, and local
groups and agencies including:
-public health organizations
-medical research centers
-health-care providers and their
networks
-professional societies
-medical examiners
-emergency response units and
organizations
-safety and medical equipment
manufacturers
-US Office of Emergency Management
-other federal agencies
CRITICAL BIOLOGICAL AGENTS
CATEGORY A
High priority agents that pose a threat to
national security because they:
can be easily disseminated or transmitted
person-to-person
cause high mortality, with potential for major
public health impact
might cause panic and social disruption
require special public health preparedness
CRITICAL BIOLOGICAL AGENTS
CATEGORY A
 Variola major (smallpox)
 Bacillus anthracis (anthrax)
 Yersinia pestis (plague)
 Clostridium botulinum toxin (botulism)
 Francisella tularensis (tularemia)
 Filoviruses
Ebola hemorrhagic fever
Marburg hemorrhagic fever
 Arenaviruses
Lassa (Lassa fever)
Junin (Argentine hemorrhagic fever) and related viruses
CRITICAL BIOLOGICAL AGENTS
CATEGORY B
Second highest priority agents that
include those that:
are moderately easy to disseminate
cause moderate morbidity and low mortality
require specific enhancements of CDC’s
diagnostic capacity and enhanced disease
surveillance
CRITICAL BIOLOGICAL AGENTS
CATEGORY B
Coxiella burnetti (Q fever)
Brucella species (brucellosis)
Burkholderia mallei (glanders)
Alphaviruses
Venezuelan encephalomyelitis
eastern / western equine encephalomyelitis
Ricin toxin from Ricinus communis (castor bean)
Epsilon toxin of Clostridium perfringens
Staphylococcus enterotoxin B
CRITICAL BIOLOGICAL AGENTS
CATEGORY B
Subset of Category B agents that include
pathogens that are food- or waterborne
Salmonella species
Shigella dysenteriae
Escherichia coli O157:H7
Vibrio cholerae
Cryptosporidium parvum
CRITICAL BIOLOGICAL AGENTS
CATEGORY C
Third highest priority agents include emerging
pathogens that could be engineered for mass
dissemination in the future because of:
availability
ease of production and dissemination
potential for high morbidity and mortality and
major health impact
Preparedness for Category C agents requires
ongoing research to improve detection,
diagnosis, treatment, and prevention
CRITICAL BIOLOGICAL AGENTS
CATEGORY C
Nipah virus
Hantaviruses
Tickborne hemorrhagic fever viruses
Tickborne encephalitis viruses
Yellow fever
Multidrug-resistant tuberculosis
ISSUES
Existing local, regional, and national
surveillance systems
Adequate to detect traditional agents
Inadequate to detect potential biowarfare
agents
Specific training for health care
professionals
clinical personnel will be “first responders”
ISSUES
Civilian biodefense plans are usually
based on HAZMAT models
Assumes responders enter a high exposure
environment near the source
Assumes site of exposure is separate from
the health care facility
Assumes no time pressure for
decontamination
Maximum protection is provided for a
minimum number of workers / rescuers
ISSUES
HAZMAT
OSHA mandates use of PPE based on site
hazard, but site hazards are more easily
defined at the point of release
Traditional HAZMAT products are expensive,
take time to set up, and are inadequate for
large numbers of patients
Difficult to train and maintain proficiency in a
civilian work force with high turnover
BIOTERRORISM
AND THE PUBLIC HEALTH SECTOR
CONCLUSIONS
Preparation for a biological mass disaster
requires coordination of diverse groups of
medical and non-medical personnel
Preparation can not occur without support
and participation by all levels of government
Preparation must be a sustained and
evolutionary process