Issue 1 - April 2002: CDC RECOMMENDATIONS FOR BIOTERRORISM MONITORING

Bioterrorism...the next frontier.
Recent events have reminded us of the potential vulnerability of our U.S. civilian population to a terrorist biological attack. A bioterrorist attack could involve any number of pathogenic organisms. In addition to devastating human loss, such an attack has been estimated to cost between $478 million to $26 billion per 100,000 persons exposed.(1)Significantly before September 11th, public health interests in this country had recognized the vulnerability of the U.S. civilian population to a terrorist biological attack and had planned for a possible occurrence. The CDC developed a strategic plan to address "the deliberate dissemination of biological or chemical agents". (2) Published in April 2000, the plan dealt with "preparedness planning, detection and surveillance, laboratory analysis, emergency response, and communication systems."In addition, it was recognized early that surveillance for unusual or clusters of symptoms, this so-called "syndromic surveillance" would be the cornerstone to getting a jump on a true biologic attack.

Is your facility ready?
In response to the October 2001 Anthrax cases in Florida and New York, the Centers for Disease Control and Prevention issued warnings in the October 19th issue of the MMWR, regarding bioterrorism readiness. These included clinical indicators to monitor as well as laboratory monitoring and requirements for safe lab practice. Items mentioned: (3,4)Clinical Indicators to consider Monitoring...Utilization of medical servicesThe number of emergency department visitsICU admissionHospital admissionsIncreases in illness syndromesTemporal/geographic clustering of illness (e.g., patients attending same eventSeveral people with similar symptoms

Lab Practice Changes include...
Gram-positive bacilli should not be automatically considered a contaminant when it occurs in a suspicious clinical setting (e.g., multiple cases temporally associated)Alert responsible parties if an unusual number of samples require the same biologic media (e.g., blood and stool cultures)Send unidentifiable organisms to the appropriate health department laboratory

Helpful Bioterrism links:

www.bt.cdc.gov
The CDC's bioterrorism site. Excellent information regarding all biological agents including planning and emergency response, training and resources.

www.apic.org
APIC has both a news site and a bioterrorism products site, with training tools and documents.

www.bioterrorism.slu.edu
The Center for the Study of Bioterrorism & Emerging Infections at Saint Louis University. Interesting resource links plus PowerPoint slides on primary bioterrorism agents.

www.cdc.gov/mmwr/indexbt.html
Morbidity and Mortality Weekly Review. All MMWR documents on bioterrorism in PDF format.

www.niaid.nih.gov
National Institute of Allergy and Infectious Diseases at NIH. Multiple resources including Video and audiocasts of Dr Fauci talk about Bioterrorism in January 2002.

www.naccho.org
National Association of County and City Health Officials. Links, planning documents, and NACCHO testimony.

www.ama-assn.org
American Medical Association. AMA statements, articles from the Bioterrorism Working Group and a collection of articles on bioterrorism from JAMA and Archives.

www.osha.gov
Occupational Safety and Health Administration. Explanation of OSHA's "Risk Reduction Matrix" and prudent workplace practices for Anthrax.

www.icpa.net/redbat.htm
Information about RedBat - Syndromic Surveillance Software:References
1. The Texas Department of Health. Disease Prevention News. 2001; 61:20: Pages 6-7

2. Centers for Disease Control and Prevention. Biological and Chemical Terrorism: Strategic Plan for Preparedness and Response. MMWR2000; 49: RR-4:1-14

3. Hospital Infection Control. CDC: Infection control on front lines in bioterror war. January 2002:5-7

4. Centers for Disease Control and Prevention. Recognition of Illness Associated with the Intentional Release of a Biologic Agent. MMWR 2001; 50:41

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