Public Health Issues Associated withPublic Health Issues Associated withBiological and Chemical TerrorismBiological and Chemical Terrorism

Scott Lillibridge, MDScott Lillibridge, MDDirectorDirector

Bioterrorism Preparedness and Response Activity National Center for Infectious Diseases

Centers for Disease Control and Prevention

HHS Activities Related to HHS Activities Related to Biological and Chemical Biological and Chemical

TerrorismTerrorism

Office of Emergency PreparednessOffice of Emergency Preparedness National Institutes of HealthNational Institutes of Health Food and Drug AdministrationFood and Drug Administration Centers for Disease Control and Centers for Disease Control and

PreventionPrevention

Lessons from the 1994 Sarin Lessons from the 1994 Sarin Release in TokyoRelease in Tokyo

Health communicationsHealth communications Syndrome responseSyndrome response Surveillance (biological, chemical)Surveillance (biological, chemical) Laboratory preparednessLaboratory preparedness Importance of health care providersImportance of health care providers

Public Health and Medical Concerns Public Health and Medical Concerns Related to Biological and Chemical Related to Biological and Chemical

TerrorismTerrorism

Agents that cause morbidityAgents that cause morbidity Agents that cause mortalityAgents that cause mortality

Health Presentations at the Health Presentations at the Community LevelCommunity Level

Overt eventOvert event Event of unknown etiologyEvent of unknown etiology Threats and hoaxesThreats and hoaxes

Public Health Issues Associated Public Health Issues Associated with Chemical Terrorismwith Chemical Terrorism

Localized casualtiesLocalized casualties Limited secondary spreadLimited secondary spread Limited delayed onsetLimited delayed onset

Public Health Issues Associated Public Health Issues Associated with Biological Terrorismwith Biological Terrorism

Event spread over days to weeksEvent spread over days to weeks Victims migrateVictims migrate Unexplained deaths may be first clueUnexplained deaths may be first clue Secondary spreadSecondary spread

Special Public Health Considerations Special Public Health Considerations Related to Biological & Chemical Related to Biological & Chemical

TerrorismTerrorism

Wide range of biological and chemical Wide range of biological and chemical threatsthreats

Person to person spread - most worrisomePerson to person spread - most worrisome Severity/lethalitySeverity/lethality Availability of a therapyAvailability of a therapy

Key Issues Related to Public Key Issues Related to Public Health PreparednessHealth Preparedness

Threats trigger public health and medical Threats trigger public health and medical actionaction

Clinical presentation linked to alertClinical presentation linked to alert Community health assets linked to state Community health assets linked to state

and federal respondersand federal responders

Critical Tasks for Critical Tasks for Public Health ResponsePublic Health Response

Means of transmissionMeans of transmission Population at riskPopulation at risk Suggest control measuresSuggest control measures Coordinate lab assaysCoordinate lab assays Geographic areaGeographic area Implement surveillanceImplement surveillance

FY99 CDC Bioterrorism Funding$121,750,000

Stockpile(Vaccine, Drugs)

$51M

Planning$3M

Health Alert(Communications)

$28M

Response(Surveillance

& Epidemiology)$16.75M

Laboratory$23M

Priority CDC Extramural Activities

Preparedness planning Surveillance and epidemiology Laboratory capacity for biologic and

chemical agents Health communication systems Training Establish key liaisons

Priority CDC Intramural Activities

Expand CDC’s capacities for epidemiologic response

Create a rapid diagnosis laboratory system

Maintain a National Drug & Device Stockpile

Training Administer the Select Agent Rule

Selected CDC Collaborations for Selected CDC Collaborations for Biological and Chemical Biological and Chemical

PreparednessPreparedness

USAMRC: Chemical and Biological USAMRC: Chemical and Biological Preparedness/TrainingPreparedness/Training

Air Force/Army: Epidemic Intelligence Air Force/Army: Epidemic Intelligence Service TrainingService Training

VA: Pharmaceutical StockpileVA: Pharmaceutical Stockpile

The “Ideal”The “Ideal” Who Should Health Care Providers Call for Who Should Health Care Providers Call for

Assistance Regarding Biological or Chemical Assistance Regarding Biological or Chemical EmergenciesEmergencies

Health Provider

Clinic/Hospital Authorities(Infectious Disease Authorities/Poison Control)

County Health Officer/Epidemiologist

State Health Officer/Epidemiologist

Federal Health Partners-CDC

CONCLUSIONKey Issues for Health Providers

TrainingTraining Linkages/coordinationLinkages/coordination Early identification of covert releaseEarly identification of covert release Building critical infrastructureBuilding critical infrastructure

Points of ContactPoints of Contact

US Public Health ServiceUS Public Health Service– 1-800-872-63671-800-872-6367– www.cdc.gov/ncidod/diseases/bioterr.htm www.cdc.gov/ncidod/diseases/bioterr.htm

Domestic Preparedness Information LineDomestic Preparedness Information Line– 1-800-368-64981-800-368-6498– www.nbc-med.orgwww.nbc-med.org

National Response CenterNational Response Center– 1-800-424-88021-800-424-8802

National Disaster Preparedness Office (DoJ) National Disaster Preparedness Office (DoJ) – (202) 324 8186(202) 324 8186

USAMRIIDUSAMRIID– 1-888-USA-RIID (1-888-872-7443)1-888-USA-RIID (1-888-872-7443)

U.S. Army Medical Research Institute of Infectious Diseases U.S. Army Medical Research Institute of Infectious Diseases (USAMRIID)(USAMRIID)– CommanderCommander

(301) 619-2833(301) 619-2833– Operational Medicine DivisionOperational Medicine Division

(301) 619-4276(301) 619-4276– 24 hr Biological Incident Hot Line24 hr Biological Incident Hot Line

1-888-USA-RIID (1-888-872-7443)1-888-USA-RIID (1-888-872-7443)

– www.usamriid.army.milwww.usamriid.army.mil U.S. Army Medical Research Institute for Chemical Defense U.S. Army Medical Research Institute for Chemical Defense

(USAMRICD)(USAMRICD)– Chemical Casualty Care DivisionChemical Casualty Care Division

(410) 671-3393(410) 671-3393