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Enhancing Public Health Response to Emerging Infectious Diseases

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Title: Enhancing Public Health Response to Emerging Infectious Diseases


1
Enhancing Public Health Response
to Emerging Infectious Diseases
  • 2009HAVE WE ELIMINATED THE
    THREAT?

2
A Reason for Optimism?
Summer 2007
3
THE EID THREAT IS A GLOBAL ONE
4
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5
Enhancing Public Health Response
to Emerging Infectious Diseases
  • 2009WHY DOES THE THREAT
    STILL EXIST?

6
WHAT IS PUBLIC HEALTH?
  • The art and science of preventing
  • disease and disability, prolonging life,
  • promoting health of populations, and
  • ensuring a healthful environment
  • through organized community effort

7
Factors in Infectious Disease Emergence
  • Human demographics and behavior
  • International travel and commerce
  • Technology and industry
  • Human susceptibility to infection
  • War and famine
  • Lack of political will
  • Poverty and social inequality
  • Intent to harm
  • Breakdown in
  • public health
  • Microbial
  • adaptation
  • and change

Emergence
  • Ecological factors
  • Zoonotic diseases
  • Economic development and land use
  • Climate and weather

8
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9
ADDRESSING THE THREAT OF
EMERGING INFECTIOUS DISEASES
  • The Publics Role in Public Health

10
  • Bioterrorism
  • A Threat to National Security
  • or
  • Public Health-Defining Issue?
  • MMI 554
  • September 10, 2009

11
BIOTERRORISM
  • The intentional or threatened use of
    microorganisms or biologic toxins to kill or
    incapacitate people, animals or crops.
  • Everything you want to know
  • www.bt.cdc.gov

12
Terrorism Why?
  • Create terror, panic, uncertainty/uneasiness
  • Advance political/religious/apocalyptic beliefs
  • Asymmetrical response a.k.a. even the playing
    field
  • Doable and affordable
  • Effective

13
Terrorism
Methods of Choice
14
Advantages of Biologics as Weapons
  • Easy to obtain
  • Inexpensive to produce
  • Potential for dissemination over large geographic
    area
  • Creates panic
  • Can overwhelm medical services
  • Perpetrators escape easily

15
Bioterrorism Is
this the real deal?
  • U.S. vulnerability
  • Is the countrys emergency response and public
    health infrastructure adequate?
  • Historical precedence
  • Capabilities exist worldwide
  • Actual BT Events

16
BIOLOGICAL AND CHEMICAL
TERRORISM AND WARFARE
A Historical
Perspectivehttp//www.cns.miis.edu/research/cbw/
pastuse.htm
  • Early Attempts
  • 429 BC - Spartans ignite pitch and sulfur to
    create toxic fumes in the Peloponnesian war.
  • 1346-47 - Mongols catapult corpses contaminated
    with plague over the walls into Kaffa.
  • 1763 - During the French and Indian wars, the
    British give small pox - contaminated blankets to
    hostile Indian tribes.

17
BIOLOGICAL AND CHEMICAL TERRORISM
AND WARFARE A Historical Perspective
  • Modern Era (I)
  • 1914-1918 - Widespread use of BW and CW during
    WWI
  • June 17, 1925 - Geneva Protocol for the
    Prohibition of the Use in War of Asphyxiating,
    Poisonous or Other Gases and of Bacteriological
    Methods of Warfare.
  • 1932-1945 - Japan conducts BW research
  • 1940 - Japan uses BW on China and Manchuria
  • 1942 - U.S. begins offensive BW program

18
BIOLOGICAL AND CHEMICAL TERRORISM
AND WARFARE A Historical
Perspective
  • Modern Era (II)
  • 1969-70 - President Nixon unilaterally dismantles
    U.S. offensive BW and CW programs
  • April 10, 1972 - Convention on the Prohibition
    of the Development, Production and Stockpiling of
    Biological and Toxin Weapons and on Their
    Destruction. , The BWC is developed
  • 1972 to present - Suspected or proven violations
    of the BWC

19
An Opportunity for the Soviet Union
20
For some sleepless nightswww.nlm.nih.gov/nichsr/
esmallpox/biohazard_alibek.pdf
21
Believe it or not, there was reason for concern
22
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23
Actual BT Events An
awakening to the threat
24
Past U.S. Incidents of
Food Bioterrorism
  • When November, 1996
  • Where Texas
  • What Contamination of muffins with Shigella
    dysenteriae, medical center lab - staff breakroom
  • Who Disgruntled employee
  • Why ?
  • Outcome 12/45 staff ill, 4 hospitalized, 0
    deaths
  • When Sept. Oct., 1984
  • Where The Dalles, Oregon
  • What Contamination of salad bars with Salmonella
  • Who Members of the Rajneeshi religious commune
  • Why Incapacitate voters in upcoming election
  • Outcome 751 ill, 45 hospitalized, 0 deaths

25
President Clintons Awakening?
-1998-
26
Anthrax 2001
27
Anthrax 2001 The Outcome
  • 4-5 letters containing anthrax spores sent in
    mail
  • 4 regions initially affected in US
  • Florida
  • New York City / New Jersey
  • Washington Metro
  • Connecticut
  • Mild contamination of other US postal facilities
  • 22 human cases in US
  • 11 inhalation
  • (5 deaths)
  • 11 cutaneous
  • 10,000 people prophylaxed
  • Nationwide Effects
  • Concerns/panic

28
Anthrax 2001 What We
Really Learned!
  • THE POWER
  • OF
  • PANIC

29
Anthrax 2001 The rest
of the story
  • Who was responsible for the attack?
  • www.promedmail.org
  • http//pubs.acs.org/journals/ancham/news/2008/09/1
    8/cp_anthrax.html
  • www.washingtonpost.com/wp-dyn/content/
  • article/2008/10/26/AR2008102602522_pf.html
  • A new science is born
  • Microbial Forensic Analysis

30
Priority Bioterrorism Agents
http//www.bt.cdc.gov/bioterrorism/
  • Category A Agents
  • Anthrax (Bacillus anthracis)
  • Botulism (Clostridium botulinum toxin)
  • Plague (Yersinia pestis)
  • Smallpox (variola major)
  • Tularemia (Francisella tularensis)
  • Viral hemorrhagic fevers (e.g., Ebola, Marburg,
    Lassa)
  • Category B Agents
  • Brucellosis (Brucella)
  • Epsilon toxin of C. perfringens
  • Food Threats (e.g., Salmonella, E. coli O157H7,
    Shigella)
  • Glanders (Burkholderia mallei)
  • Melioidosis (B. pseudomallei)
  • Psittacosis (C. psittaci)
  • Q Fever (Coxiella burnetii)
  • Ricin toxin from castor beans
  • Staphylococcal enterotoxin B
  • Typhus fever (R. prowazekii)
  • Viral encephalitis (e.g., EEE)
  • Water threats

31
A headline in follow-up to the anthrax
event...
  • Smallpox offensive Vaccinations now
  • - HEADLINE, WISCONSIN STATE
    JOURNAL, SEPTEMBER 2002 -
  • ...whod a thunk it!

32
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33
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34
SMALLPOX -Why is it a threat?
www.bt.cdc.gov/agent/smallpox/index.asp
  • Potential clandestine stockpiles
  • Satisfy most criteria of a good BW
  • Aerosol infectivity highly infectious
  • Communicability
  • Long incubation period
  • Potential for large scale production
  • Highly pathogenic high mortality
  • Lack of population immunity
  • Induce panic

35
SMALLPOX
Prevention and Control - 2007
  • Vaccination
  • Pre-exposure Preventive Vaccination
  • Post-release Vaccination
  • Ring Vaccination and mass vaccination
  • Community Containment Strategy
  • Identify cases
  • Isolate cases (to break chain of transmission)
  • Isolate at home if possible
  • Institutional isolation
  • Designated hospitals
  • Hotels, old nursing homes, etc.
  • Observation of close contacts for 17 day
  • Fever (gt 101) watch
  • Is forced quarantine acceptable, doable?

36
Bioterrorism
  • This is the real deal!
  • VS
  • This is an unlikely threat

37
Biological Terrorism
An Unlikely threat?
  • Infrequent use of CBW
  • Technical difficulties
  • Need for a weapons system
  • Moral and social constraints
  • Hazard to perpetrator
  • Unpredictability
  • Fear of retribution
  • but dont forget Autumn of 2001!

38
BIOLOGICAL TERRORISM
  • The bottom line circa 2009
  • The threat is very real!
  • A low probability, high consequence threat
  • It will happen somewhere, sometimeagain!
  • BT preparedness and response planning is no
    longer a national priority, however
  • preparedness should continue, following an
    all-hazards philosophy.

39
Recent EID Threats and the list
continues to grow
  • Pandemic Influenza swine flu
  • E.coli O157H7/Salmonella
  • Norovirus
  • MDR, XDR tuberculosis
  • Community-acquired MRSA/ Epidemic C. difficile
  • Mumps, Measles, Rubella
  • Pertussis (Whooping Cough)
  • Monkeypox
  • SARS
  • West Nile Virus
  • Anthrax, ricin and other bioterrorism agents

40
CDC Program Announcement
99051Public Health Preparedness Response to
Bioterrorism EMERGENCY SUPPLEMENTAL
2002-200-
  • Preparedness Planning and Readiness Assessment
  • Surveillance Epidemiology Capacity
  • Laboratory Capacity - Biological Agents
  • Laboratory Capacity - Chemical Agents
  • Health Alert Network
  • Communication and
  • Health Info Dissemination
  • Education and Training
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