1. Overview of Terrorism Research at the CDC
Dixie E. Snider, M.D., MPH.
Associate Director for Science
Presented at 2003 Medical Research Summit
March 6, 2003

3. All Hazards Approach

4. Major Program Components
Preparedness and Response Planning
Public Health Interventions
Rapid Disease Detection and Investigation
Biological and Chemical Laboratory Capacity
Application of Information Systems and Technology
Public and Media Risk Communications
Training
Worker Safety
Environmental Monitoring
Select Agent Monitoring
Public Health Law

5. Public Health’s System of Preparedness, Response, and Recovery
Detection
Response
Recovery
Response
Planning
Command and control
Exercising
Partnering
Training
System building
Testing
Surveillance
Clinician training
Laboratory diagnostics
Reporting
Communicating
Clinicians
Public health
General public
Responders
Intervention
Medical therapies
Quarantine
Contact tracking
Coordination
Monitoring health impact
Community mental health
Lessons learned – continuous response improvement

6. CDC Components Involved in Terrorism Preparedness
National Center for Infectious Diseases (NCID)— infectious agents
National Center for Environmental Health (NCEH)– chemical and radiologic agents
National Institute for Occupational Safety and Health (NIOSH)—worker protection
National Immunization Program (NIP) – immunization programs
Agency for Toxic Substances and Diseases Registry (ATSDR) – risk assessment and mitigation

7. All Hazards Preparedness and Response: Chemical / Radiation / Biological
Chemical Terrorism
Choking agents (phosgene / chlorine)
Blood agents (cyanides)
Blister agents (mustard gas)
Nerve agents (sarin, soman, tabun, etc.)
Radiation Terrorism
Dirty bombs
Food / water supply contamination
Power plants

8. Biological Agents of Highest Concern (Category A Agents)
Variola major (Smallpox)
Bacillus anthracis (Anthrax)
Yersinia pestis (Plague)
Francisella tularensis (Tularemia)
Botulinum toxin (Botulism)
Filoviruses and Arenaviruses (Viral hemorrhagic fevers)
These six diseases were chosen because: 1) the potential public health impact if an outbreak occurred is huge; 2) they can be weaponized; 3) public health needs to be ready if such an outbreak occurs; and 4) the high level of perception the public has regarding these diseases

9. Examples of Priority Areas of Smallpox Research
Evaluation of immune response to smallpox vaccination and risk factors for adverse reactions
Assessment of duration of immunity
Comparison of cellular and humoral immunity in previously vaccinated vs recently vaccinated persons
Assessment of vaccination site care regimens
Evaluation of VIG and cidofovir for treatment of adverse reactions to vaccination

10. Examples of Priority Areas of Anthrax Research
Development of model for cutaneous anthrax
Rapid detection methods, including powder analysis
Host response, including infectious dose
Integration of human and veterinary surveillance systems
Assessment of antitoxin therapy

11. Examples of Priority Areas of Botulism Research
Production of heptavalent antitoxin
Production of an immune globulin
Rapid assays to detect toxins

12. Examples of Priority Areas of Plague Research
Safety and efficacy of gentamycin vs. streptomycin or doxycycline for treatment
Rapid diagnostic methods

13. National Institute for Occupational Safety and Health (NIOSH)
Respiratory protective equipment
Recommendations for use
Testing & certification of equipment
Sampling and analysis
Toxic industrial chemicals
Biological agents
Workforce screening and health tracking
Guidance for enhancing building preparedness
Related research & surveillance
If you can only use ONE SLIDE, this describes our past activities. See last slide in this presentation file for future research needs if you want to limit this to TWO SLIDES.
NIOSH provided input on emergency response efforts during for both the World Trade Center response and for the following anthrax attacks. NIOSH’s mission, to protect workers, met the needs by providing recommendations for personal protective equipment (including respirators), as well as for sampling strategies and methods for toxic chemicals, dusts, and biological agents found at the attack sites. NIOSH also provided valuable input on worker screening efforts for emergency responders.

14. Medical Screening Program
Mt. Sinai & Consortium of Health Clinics
Voluntary clinical examination of WTC responders
Focus:
Respiratory effects
Musculoskeletal disorders
Chronic effects from injuries
Psychological conditions
NIOSH is supporting Mt. Sinai School of Medicine and a consortium of occupational health clinics in NY/NJ metro area and around the country to provide baseline clinical exams of workers and volunteers involved in rescue and recovery efforts at the WTC site. This program will determine whether rescue and recovery workers and volunteers who worked at the World Trade Center disaster site are experiencing related illnesses or injuries. The goal of the project is to have a system in place that will help employers and public health professionals identify symptoms, injuries or conditions that may indicate long-term illness as a result of their work at the World Trade Center, so that interventions can be pursued.

15. Future Work and Research Needs
CBRN standards for additional classes of respirators
Improved sensors and detectors
for protective equipment (service-life indicators)
for field sampling instruments
Improved worker screening and health tracking tools
Working with employers, workers, and responders to address other needs
IF YOU ARE LIMITED TO TWO SLIDES – PLEASE USE THIS AS #2.
NIOSH is planning additional work to develop new respirator certification standards for first responders. Having completed and begun approving self-contained breathing apparatus, more work is needed to extend the process to include other types of units including air-purifying respirators. This is a critically important need.
Another area is to develop rugged direct-reading instruments for rapid field assessment of chemical and biological agents.
Finally, NIOSH needs to design and develop systems for health screening and tracking of emergency responders, both from the ranks of professional hazardous incident teams as well as the many volunteers and cross-jurisdictional responders that may arrive at a mass casualty site such as the World Trade Center.

16. Critical Next Steps to Support The Public Health System of Response
CDC:
Office of Terrorism Preparedness and Response established
Strategic direction
Coordination of resources
Accountability
Priorities:
Improve readiness with a focus on critical threats (i.e., Smallpox, VX, Dirty Bomb, Mass Trauma events)
Drive to exercise national, state, and local capacities to demonstrate response proficiency
Support Public Health Information Network
Research new ways to detect and diagnose disease presence in the population and develop new vaccines, antibiotics and other treatments
Train, train, train…