KING COUNTY, WASHINGTON - National political leaders as well as security public health experts have determined that the civilian population of the U.S. is vulnerable to a bioterrorist attack. This addresses the roles of Public Health and health care providers in increasing our ability to effectively recognize and respond to a potential bioterrorist event or other biological disaster such as pandemic influenza.
The most likely first indicator that a biological attack has occurred is an increased number of patients presenting with signs and symptoms caused by the disseminated disease agent. The demand for clinical services by both infected persons and the worried well has the potential to overwhelm the health care infrastructure. Preparedness planning can maximize our ability to respond effectively through early detection and by making optimal use of available resources.
What is the role of Public Health?
The Centers for Disease Control and Prevention (CDC) created the Epidemic Intelligence Service in 1951 to train medical epidemiologists in surveillance and disease investigation as a response to threat of a bio-warfare attack on the US during the cold war. Today, maintaining strong communicable disease surveillance and disease investigation capacity at the local health department level is the foundation on which plans for responding to all biological emergencies, including outbreaks, can be built. Only through having reliable data on the endemic rates of illnesses in the community can changes in disease incidence that potentially indicate a biological emergency be detected and understood.
Once a potential communicable disease problem is detected, epidemiologic investigations assist in identifying pathogen/etiology and facilitate appropriate treatment and preventive therapy, determine the population affected by characterizing who is at risk and routes of exposure, and facilitate follow-up of exposed persons. Such data is also valuable in estimating resources needed and gauging the magnitude of the medical and public health response.
Other key roles of Public Health include coordinating the local, State and Federal responses to biological disasters and providing technical assistance and information to health care professionals and the public.
What is the role of the health care providers and health care institutions?
Developing carefully considered bioterrorism response plans and familiarizing all staff with the plans will minimize confusion and maximize ability to respond appropriately and effectively. In addition to the remote possibility of a bioterrorist attack, preparedness activities will be important tools when naturally occurring biological disasters and emergencies occur including the inevitable next influenza pandemic as well as large outbreaks of endemic diseases and unexpected new diseases such as West Nile Virus.
Forewarned is forearmed: early recognition is the key to improving survival and executing an optimal overall response.
Therefore, health care providers need to have 1) an ongoing awareness of the potential for biological terrorism, 2) an appreciation for epidemiologic clues of a bioterrorist event, and 3) a basic understanding of the classes of agents that have been and can be weaponized and their effects after inhalation.
The following points describe epidemiologic clues that may indicate bioterrorism or other communicable disease outbreak. Clinicians, laboratorians, infection control professionals or other health care professionals who detect any of the following indicators and, in the absence of another explanation, believe that a potential bioterrorist attack or communicable disease may be occurring should contact Public Health immediately.
- Recognition of a change in disease pattern: naturally occurring epidemics show a gradual rise in disease incidence while bioterrorism is characterized by a rapid peak in incidence of disease consistent with a "point source" outbreak
- A disease with an unusual geographic or temporal distribution (i.e. plague in King County)
- Unexplained increase in disease incidence
- Illness that is unusual in a given population or age group (an outbreak of measles-like rash in adults)
- Unusual disease presentation (pulmonary anthrax)
- Combinations of unusual diseases in the same patient
- Aerosol route of infection or other atypical pattern of disease transmission
- Unusually high morbidity and mortality
- Illness limited to a circumscribed geographic area
- Low attack rates in persons who work in areas with filtered or closed ventilation systems
- Unusual diseases among animals preceding or coincident with human illness
- Large numbers of persons ill with a similar disease or syndrome or unexplained deaths
- Higher morbidity or mortality in association with a common disease or failure of persons to respond to conventional therapy
- Single case of disease caused by an uncommon agent
- Several unusual or unexplained diseases coexisting in the same patient
Health care professionals familiar with the above epidemiologic clues can serve as the eyes and ears of the Public Health bioterrorism surveillance and disease investigation system to the benefit of the entire community.
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