Local Emergency Response to Biohazardous Incidents Dr. Elizabeth Whalen, MD Medical Director Albany County Health Department April 8, 2005 Northeast Biological Safety Association

Healthcare Emergency Operations Coordinating Committee (HEOCC) MUTUAL ASSISTANCE AGREEMENT “In order to ensure that the hospitals, healthcare services, emergency management, health departments, and public safety in the Albany Area are prepared to respond to a critical event, a coordinated mutual assistance plan is required.”

Albany County Health Department : Preparedness Efforts Planning Planning Improved Surveillance Improved Surveillance Epidemiologic Capabilities Epidemiologic Capabilities Laboratory Diagnostics Laboratory Diagnostics Enhanced Communications Enhanced Communications Medical Therapeutics Stockpiling Medical Therapeutics Stockpiling

Planning Efforts Executive Committee Executive Committee BT Team BT Team Communicable Disease Workgroup Communicable Disease Workgroup Information Technology: Secure web based communication- Health Information Network/Health Provider Network/ ECLRS Information Technology: Secure web based communication- Health Information Network/Health Provider Network/ ECLRS NYSDOH Communicable Disease Reporting Requirements NYSDOH Communicable Disease Reporting Requirements NYSDOH NYSDOH CDC CDC

“Public Health Assessment of Potential Biological Terrorism Agents” Emerging Infectious Diseases/ CDC February 2002 Identifies biological agents towards which efforts should be targeted Identifies biological agents towards which efforts should be targeted Placed in priority order Placed in priority order Biological agents causing illness in humans, and capable of affecting public health and medical infrastructures on a large scale. Biological agents causing illness in humans, and capable of affecting public health and medical infrastructures on a large scale.

Agents are Category A, B or C Category A- greatest potential for adverse public health impact with mass casualties- most require broad based public health preparedness efforts. Category A- greatest potential for adverse public health impact with mass casualties- most require broad based public health preparedness efforts. Category B- some potential for large scale dissemination, but generally less illness and death Category B- some potential for large scale dissemination, but generally less illness and death Category C-could emerge as future threats Category C-could emerge as future threats

Biological Agent Disease Category A: Variola Major Bacillus Anthracis Yersinia Pestis Clostridium Botulinum Francisella tularensis Filoviruses and Arenaviruses (e.g. Ebola virus, Lassa virus) SmallpoxAnthraxPlagueBotulismTularemia Viral Hemorrhagic Fevers Category B: Coxiella burnetti Brucella spp. Burkholderia mallei Burkholderia pseudomallei Alphaviruses (VEE,EEE,WEE) Rickettsia prowazekii Toxins ( Ricin, Staphlococcal entertoxin B) Chlamydia psittaci Food Safety threats (Salmonella, E. Coli 0157 Water Safety threats (Vibrio cholerae,Cryptosporidium parvum) Q Fever BrucellosisGlandersMeliodosisEncephalitis Typhus fever Toxic Syndromes Psittacosis Category C: Emerging threat agents (Nipah virus, hantavirus)

Post Event Response Plans: Smallpox Response Plan Smallpox Response Plan Anthrax Post Exposure plan with USPS Anthrax Post Exposure plan with USPS SARS SARS Avian Influenza Avian Influenza Pandemic Influenza Pandemic Influenza

Local Emergency Response to Biohazardous Incidents: Depends on agent Depends on agent Depends on incident Depends on incident Public Health Response Team (PHRT) Public Health Response Team (PHRT) Involvement and communication with community partners, NYSDOH, and CDC Involvement and communication with community partners, NYSDOH, and CDC Resource for information and investigation Resource for information and investigation Communication is essential Communication is essential

Scenario 1: Laboratory worker working with SARS Co-V develops respiratory symptoms and fever: Role of LHD- Notification via Emergency Department medical personnel/ infection control practitioner Notification via Emergency Department medical personnel/ infection control practitioner Review Personal Protective Equipment/ Infection Control Strategies Review Personal Protective Equipment/ Infection Control Strategies Expedite laboratory testing Expedite laboratory testing Liaise with NYSDOH/ CDC Liaise with NYSDOH/ CDC

Scenario 1 (continued) Epidemiologic investigation Epidemiologic investigation Contact tracing Contact tracing Isolation Isolation Quarantine Quarantine Surveillance Surveillance Risk Communication Risk Communication

Scenario 2: Case of Smallpox All of above plus: Ring vaccination- vaccination of contacts and their contacts Ring vaccination- vaccination of contacts and their contacts Mass vaccination- large scale clinic to vaccinate 300,000 Albany County residents in 10 days (or fewer) Mass vaccination- large scale clinic to vaccinate 300,000 Albany County residents in 10 days (or fewer) Vaccine delivery, security, volunteer mobilization; 9 clinic sites 24-hours/day Vaccine delivery, security, volunteer mobilization; 9 clinic sites 24-hours/day

Scenario 3: Positive BDS alarm for Anthrax at USPS Protocol implementation- decontamination Protocol implementation- decontamination Laboratory confirmatory testing:Wadsworth Laboratory confirmatory testing:Wadsworth Mobilization and dispensation post exposure prophylaxis medication and vaccination at clinic site Mobilization and dispensation post exposure prophylaxis medication and vaccination at clinic site Information to medical community/ public Information to medical community/ public

Local Response to Biohazardous Incidents- Summary: Albany County Health Department’s response plans coordinate activities at federal, state, county, hospital, and community levels Albany County Health Department’s response plans coordinate activities at federal, state, county, hospital, and community levels Incorporate readiness and response to biological / chemical/ radiological agents Incorporate readiness and response to biological / chemical/ radiological agents Resource for information and investigation Resource for information and investigation Communication is essential Communication is essential