Bioterrorism: A Changing World and What You Can Do Mark Oberle, MD, MPH UW School of Public Health and Community Medicine moberle@u.washington.edu Patrick O’Carroll, MD, MPH U.S. Centers for Disease Control and Prevention Alonzo Plough, PhD, MPH Public Health-Seattle & King County November 27, 2001 1

Examples of Bioterrorism Agents Bacteria B. anthracis Y. pestis S. typhi S. typhimurium Shigellae species F. tularensis Parasites Giardia lamblia Schistosoma species Toxins Botulinum toxin Ricin Tetrodotoxin Snake venom Diphtheria toxin Cholera endotoxin Viruses Yellow fever Ebola Smallpox Hemorrhagic fevers

Bioterrorism & Biological Disaster Preparedness Agents of Particular Concern Anthrax (Bacillus anthracis) Smallpox (Variola major) Plague (Yersinia pestis) Botulism (Clostridium botulinum) Tularemia (Franciscella tularensis) Viral hemorrhagic fevers (Filoviruses,arenaviruses) Viral encephalitis (Venezuelan equine encephalitis)

Epidemics and Prevention Rehabilitation Tertiary Prevention Routine surveillance; Contact tracing Secondary Prevention Clean water; Immunization Primary Prevention “Natural” Outbreak

Source: RT Ravenholt, 1961

NATURAL VS INTENTIONAL OUTBREAKS Rehabilitation services Rehabilitation Tertiary Prevention Syndromic surveillance Outbreak investigation Routine surveillance; Secondary Prevention Clean water; Immunization Primary Prevention Intentional Outbreak “Natural” Outbreak Global intelligence Addressing 1o Causes? (e.g., international aid)

MMWR: November 02, 2001 / 50(43);941-8

DEATHS BY CAUSE, USA OCTOBER 2001 Anthrax: 4 Tobacco related deaths: 34,000

FACTORS IN ASSESSING RISK Benign disease ----------> Lethal Voluntary Risk ----------> Involuntary Risk Risk factors known ----------> Risk factors unknown

WHAT YOU CAN DO Support public health and emergency preparedness Personal emergency preparedness Hygiene: the Big 4 Keep the world in perspective

HYGIENE: THE BIG 4 Handwashing Keep it cold Hotholding Avoid cross contamination http://www.foodsafe.com/

SPECIAL PROGRAMS ON BIOTERRORISM Anthrax Nov. 29, 10:30 - noon Dec. 3, 5:00-6:30 PM Smallpox Dec. 13, 12:00-2:00 PM Dec. 17, 5:00-7:00 PM Site: USPHS Region X office (6th & Blanchard)

Bioterrorism: Some websites of interest Public Health-Seattle & King County - Communicable Disease Bioterrorism http://www.metrokc.gov/health/bioterrorism/ Washington State Dept. of Health http://www.doh.wa.gov/bioterr/default.htm Public Health Emergency Preparedness and Response – CDC http://www.bt.cdc.gov/ Center for the Study of Bioterrorism and Emerging Infections from St. Louis University http://bioterrorism.slu.edu/

Bioterrorism: Some websites of interest Center for Civilian Biodefense Studies from Johns Hopkins University http://www.hopkins-biodefense.org/ Northwest Center for Public Health Practice http://healthlinks.washington.edu/nwcphp/ Crisis in Context: Human Dimensions http://www.lib.washington.edu/about/sept11/human.html Coping with bioterrorism anxiety http://www.psych.org/disaster/bioterrorism102201.pdf

“Preparedness” and Public Health Infrastructure Public Health Workforce - well trained, well staffed, fully prepared Laboratory Capacity Epidemiology and Surveillance Information Systems - Secure, accessible, authoritative information Communication – swift, two-way; public/policy makers Assessment and Evaluation capability – e.g., for priority setting Preparedness and Response capability – e.g., response plans

Centers for Public Health Preparedness ACADEMIC CENTERS SPECIALTY CENTERS LOCAL HEALTH AGENCIES Univ. of Washington Sch. Of PH Columbia Univ. Sch. of PH, with New York City HD Univ. of Illinois at Chicago, Sch. of PH Univ. of NC Sch of PH Dartmouth Medical Sch., Interactive Media Lab. -Collaboratory in Applied Communications Technology Johns Hopkins Sch. of PH & Hygiene, w/ Georgetown Univ. Law Center-Collaborating Center in PH Law St. Louis Univ. Sch. of PH- Center for Bioterrorism Studies Dekalb County Bd. of Health, GA Denver Health and Denver Public Health, CO Monroe County Health Department, NY

“Preparedness” and Public Health Infrastructure Public Health Workforce - well trained, well staffed, fully prepared Laboratory Capacity Epidemiology and Surveillance Information Systems - Secure, accessible, authoritative information Communication – swift, two-way; public/policy makers Assessment and Evaluation capability – e.g., for priority setting Preparedness and Response capability – e.g., response plans