1. Bioterrorism: A Changing World and What You Can Do
Mark Oberle, MD, MPH
UW School of Public Health and Community Medicine
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

2. 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

3. 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)

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

5. Source: RT Ravenholt, 1961

6. 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)

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

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

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

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

11. HYGIENE: THE BIG 4 Handwashing Keep it cold Hotholding
Avoid cross contamination

12. 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)

13. Bioterrorism: Some websites of interest
Public Health-Seattle & King County - Communicable Disease Bioterrorism
Washington State Dept. of Health
Public Health Emergency Preparedness and Response – CDC
Center for the Study of Bioterrorism and Emerging Infections from St. Louis University

14. Bioterrorism: Some websites of interest
Center for Civilian Biodefense Studies from Johns Hopkins University
Northwest Center for Public Health Practice
Crisis in Context: Human Dimensions
Coping with bioterrorism anxiety

15. “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

16. 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

17. “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