Transcript Dallas County Bioterrorism Program: Overview and Highlights

Dallas County Bioterrorism Program:
Overview and Highlights
David Buhner MD MS
Epidemiologist
Dallas County Department of Health
and Human Services
OVERVIEW
Large-scale terrorism in
the US is a reality
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1993—World Trade Center bombing
1996—Alfred P. Murrah Federal
Building bombing in Oklahoma City
2001—Destruction of the World Trade
Center
Chemical and biological
attacks are a reality
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1978—Deliberate contamination of
Israeli citrus exports with mercury
1982—Deliberate contamination of
Tylenol with cyanide
1984—Deliberate contamination of
salad bars with Salmonella in Oregon
1995—Tokyo Sarin gas attack
2001—The US anthrax attacks
The Scope of the Threat
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Office of Technology Assessment:
Used under optimal conditions
biological weapons could have an
impact similar to a small nuclear
device.
The Toxin of C. botulinum
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C. botulinum lives in the soil.
Evenly dispersed and inhaled 1 gram
of botulinum toxin could kill 1 million
people.
After the 1991 war, Iraq admitted to
the possession of 19,000 liters of
concentrated toxin, 10,000 liters
loaded into military weapons.
Potential Agents of Bioterrorism
Toronto SARS Epidemic
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361 cases reported between 2/23/03
and 6/7/03, with 33 (9%) deaths
Some control measures used:
-over 18,000 people quarantined
-closure of businesses
-closure of schools
Economic losses projected at
1,000,000,000 dollars
The Latest in Feline Fashion
Historical Epidemics
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The European Black Death (bubonic
plague) of the 1300’s is estimated to
have killed 1/3 of the European
populace within 2 years.
Epidemics due to Old World diseases
introduced into the New World with
the arrival of Europeans are
estimated to have killed 90% of the
native inhabitants.
Public Health:
Epidemic Disease Defense
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Traditional role: control of infectious,
communicable diseases of “natural”
origin in the local populace.
There is little debate about the
decades-long deterioration that has
been allowed to take place in the
local public health infrastructure in
the US.
Unique Features of Bioterrorism
Unlike other forms of terrorism:
 Public health system is THE crucial factor
in an effective response.
 Bioterrorism may be covert, with a delay,
due to the incubation period of the illness,
in the appearance of the problem.
 Bioterrorism can be self-propagating due
to person-to-person spread; early
identification and institution of effective
public health measures can limit what
otherwise might be a catastrophic
outbreak of disease.
New Role for Public Health:
Watchdog for Bioterrorism
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Good news: the skill set, personnel, and
physical resources required for this role
are little different from those required for
traditional public health functions
Bad news: public health infrastructure
deterioration and failure to keep up with
the modern pace of technological change
critically compromise local public health’s
ability to respond with the speed and
efficacy required to limit the damage from
a large-scale attack of bioterrorism
Federal Response
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In 1999 The Centers for Disease
Control and Prevention (CDC) first
received congressionally
appropriated funds to enter into
multi-year cooperative agreements
aimed at upgrading state and local
health department preparedness and
response capabilities relative to
bioterrorism.
1. Preparedness Planning
and Readiness Assessment
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The worst time to determine how to
respond to an emergency situation is
during the emergency.
Need adequate planning and
preparation
Need training exercises to assess
the adequacy of the plans and
preparation
2. Surveillance and
Epidemiologic Capacity
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Rapid disease detection requires a
sensitive surveillance system.
Detected cases must be investigated by
epidemiologists to:
1) discriminate sporadic cases from
outbreaks of disease
2) discriminate natural from intentional
3) identify the population at risk so
they may be treated
4) identify appropriate control
measures to limit spread to the unaffected
3. Laboratory Capacity
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Rapid and correct identification of the
particular biological agent in an outbreak
is of fundamental importance because
1) public health consequences differ
2) control measures differ
A well-equipped lab with highly trained
personnel is a critical necessity.
4. Communications and
Information Technology
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Public health surveillance and outbreak
response require that large amounts of
real-time data must be collected, stored,
sorted, integrated, analyzed, and
interpreted and the results communicated
to the appropriate person(s).
Effective communications systems must
link public health officials, first
responders, government officials,
physicians, and all other agencies and
organizations likely to be involved in a
large-scale outbreak of illness.
5. Risk Communication and Health
Information Dissemination
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The importance of informed, timely ,
and effective communication with the
public and the media, especially
during a public health crisis, cannot
be overstressed.
6. Education and Training
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All individuals involved in a
response to bioterrorism must
possess the up-to-date skills and
knowledge necessary to carry
out their responsibilities.
Highlights of the Dallas
County Bioterrorism Program
Highlight I
Regional and
Organizational
Cooperation
The Importance of a Regional
Approach
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Substantial population flow takes
place daily between Collin, Dallas,
Denton, and Tarrant counties, as well
as to and from more distant
counties.
The effects of bioterrorism are
unlikely to respect jurisdictional
boundaries.
The Problem of Caring for
Victims of Bioterrorism
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Hospitals lack the empty beds and staff to
manage a sudden influx of large numbers
of patients (no surge capacity). This is a
nationwide problem.
No hospital wishes to accept the role of
epidemic disease hospital in the event of
an outbreak.
Where will large numbers of suddenly ill
patients be cared for in the event of an
outbreak?
A Regional Quarantine and
Treatment Facility
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Representatives of the four counties
(public health and government),
DFWHC, PMH, JPS, the VA, NTCOG,
local medical societies, and others
have been meeting regularly for
more than a year to address this
problem.
Highlight II
Dallas County
Laboratory
DCHHS Bioterrorism Preparedness
and Response Laboratory
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A state-of-the-art, CDC-sanctioned, LRN
laboratory (operating at BSL-3) capable of
conducting CDC-validated confirmatory
testing for a wide variety of organisms (a
Confirmatory lab)
Provides services to all of North Texas
including Collin, Dallas, Denton, Tarrant
counties, and TDH Region 2/3
Provides critical training and support to
local hospital and clinical laboratories
(Sentinel labs)
Highlight III
Epidemiologic
Response Teams
The Benefits of Public Health
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Institution of effective treatment as soon
as possible after exposure can save the
lives of individuals epidemiologically
identified as having been exposed to
infectious diseases and/or toxins.
Implementation of effective control
measures can prevent the spread of
communicable illnesses from exposed,
infected individuals to the previously
unexposed and uninfected.
Epidemiologic Response Teams
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Rapid investigation of reported cases can
take maximum advantage of the lag time
(incubation period) between exposure and
the onset of illness.
Dallas County has provided for a rapid and
flexible response to outbreaks of illness by
forming response teams consisting of, as
necessary, physicians, epidemiologists,
nurses, laboratorians, and the appropriate
equipment and supplies.
These teams are available 24/7 and capable
of managing multiple, simultaneous
outbreak investigations.