Homeland Security: A Quest for Public Health and Medical Preparedness

1
Homeland Security A Quest for Public Health
and Medical Preparedness

• Scott Lillibridge M.D.
• University of Texas- Houston
• School of Public Health

2
US Emergency Health and Medical Response
Organization

• Local Health Departments and Hospitals
• Regional Planning mostly for trauma
• State Health Department (50 states)
• Central Government Response (Volunteers Disaster
  Teams/ Military / VA)

3
(No Transcript)
4
20th Century Influenza

• 1918 Spanish Flu
• gt500,000 deaths (U.S.), young adults affected
• gt20 million worldwide
• 1957 Asian Flu
• 69,800 deaths (U.S.), mostly elderly
  chronically ill
• 1968 Hong Kong Flu
• 33,800 deaths (U.S.), mostly elderly and
  chronically ill
• Interpandemic Flu (U.S.)
• 20,000 deaths
• 114,000 hospitalizations
• 1-3 billion in direct medical costs

5
classroom
6
(No Transcript)
7
Fever Clinic 1
8
Fever Clinic 2
9
The Hong Kong connectionHotel M
February
March
A B C D E F G H I J K L M
Onset of symptoms
Stayed at Hotel M
10
The Hong Kong connectionHotel M
February
March
A B C D E F G H I J K L M
Onset of symptoms
Stayed at Hotel M
11
Spread from Hotel M Reported as of March 28, 2003
Guangdong Province, China
A
A
Hotel MHong Kong
12
Monkeypox hits the United States May 2003
13
Flu, SARS, and Monkeypox Demonstrates a Range of
Epidemic Control Concerns

• Pathogens mutate
• Cross-species infection
• Population growth
• Migration, Urbanization
• Aging Immunocompromised
• Air Travel, Commerce

14
Anthrax Attacks of October 2001Lessons for
Homeland Security

• Resulted in a major national public health
  infrastructure enhancement effort
• Focused on enhancement of State and Local Health
  Departments
• Health Infrastructure thought to be critical to a
  the Nations overall Preparedness

15
Anthrax Overview

• Primarily disease of animals
• Normally humans infected by contact with infected
  animals
• Soil reservoir
• Creates spores which can be inhaled

16
Anthrax Cutaneous

• Most common form (95)
• Direct contact of skin to spores
• Small papule --gt ulcer surrounded by vesicles
  (24-28h)
• Painless eschar with edema
• Death 20 untreated rare treated

Courtesy USAMRICD
17
(No Transcript)
18
Inhalation Anthrax Treatment

• Antibiotics
• Supportive care
• Standard precautions, no need for quarantine
• Early treatment improves prognosis

19
(No Transcript)
20
(No Transcript)
21
Essential features

• 22 illnesses 50 cutaneous 50 inhalational
• 5 fatalities all inhalational 5/11
• Molecular subtyping same
• 30,000 persons on medication to prevent illness

22
Epicurve 3
23
(No Transcript)
24
Investigation Response

• All sites characterized by multiple overlapping,
  simultaneous investigations
• Clinical (Finding Cases)
• Epidemiologic (Disease Tracking)
• Forensic (Crime investigation)
• Environmental (worker safety/clean up)

25
(No Transcript)
26
What functioned well?

• Deployment of pharmaceutical stockpile
• 143 sortees 3.75 million antibiotic tablets
• Laboratory response network
• Health Information Exchanges (e.g., CDC)

27
Lessons Learned

• Value of emergency operations center specific
  for health operations
• Public Health Infrastructure needed improvement
• Federal health assistance will be needed in key
  technical areas
• Laboratory Network was too small/not integrated
• IT needed for emergency health mission
• Development of international capacity

28
Key Areas to Support Public Health and Medical
Preparedness

• Leadership
• Training and Education
• Health Information Systems
• Local and Regional Planning
• Scientifically Credibility and Capacity

29
CDC director
30
Public Health and Medical Preparedness

• Leadership
• Institutes and Clinics
• Multi-specialty
• Policy Sessions
• Increase Understanding about Biological Agents,
  etc.

31
Public Health and Medical Preparedness

• Training and Education
• Standardization of Curriculum
• Regional Training Centers
• Academic Health Centers Involved (Particularly
  Schools of Public Health)
• Additional curriculum in professional Schools
• Multidiscipline dimension

32
Public Health and Medical Preparedness

• Health Information Systems
• Expanded Surveillance Capacities
• Integrated and Distributed Systems
• Information flow two-way
• Distance Learning Facilitated
• Teaming with Private Sector

33
Public Health and Medical Preparedness

• Local and Regional Planning
• Smallpox Plans
• Pandemic Flu Plans
• Drills and Field Training
• Transportation and Patient Transfer Protocols
• Managing Large Numbers of Patients
• Surge capacity

34
Public Health and Medical Preparedness

• Science and Credibility
• Research Agenda Established
• Bioscience Community Expanded
• Vaccines
• Diagnostics
• Therapeutics
• Workgroups focused on key Issues

35
Dr. L classroom
36
Conclusion

• Health Security is Critical to Modern Nations
  (Developed Economies)
• Such an effort will require the participation of
  academic heath partners, a supporting research
  agenda, key infrastructure enhancements, and the
  private sector