1. Public Health Issues Associated with Biological and Chemical Terrorism Scott Lillibridge, MD Director Bioterrorism Preparedness and Response Activity National Center for Infectious Diseases Centers for Disease Control and Prevention

2. HHS Activities Related to Biological and Chemical Terrorism n Office of Emergency Preparedness n National Institutes of Health n Food and Drug Administration n Centers for Disease Control and Prevention

3. Lessons from the 1994 Sarin Release in Tokyo n Health communications n Syndrome response n Surveillance (biological, chemical) n Laboratory preparedness n Importance of health care providers

4. Public Health and Medical Concerns Related to Biological and Chemical Terrorism n Agents that cause morbidity n Agents that cause mortality

5. Health Presentations at the Community Level n Overt event n Event of unknown etiology n Threats and hoaxes

6. Public Health Issues Associated with Chemical Terrorism n Localized casualties n Limited secondary spread n Limited delayed onset

7. Public Health Issues Associated with Biological Terrorism n Event spread over days to weeks n Victims migrate n Unexplained deaths may be first clue n Secondary spread

8. Special Public Health Considerations Related to Biological & Chemical Terrorism n Wide range of biological and chemical threats n Person to person spread - most worrisome n Severity/lethality n Availability of a therapy

9. Key Issues Related to Public Health Preparedness n Threats trigger public health and medical action n Clinical presentation linked to alert n Community health assets linked to state and federal responders

10. Critical Tasks for Public Health Response n Means of transmission n Population at risk n Suggest control measures n Coordinate lab assays n Geographic area n Implement surveillance

11. FY99 CDC Bioterrorism Funding $121,750,000 Stockpile (Vaccine, Drugs) $51M Planning $3M Health Alert (Communications) $28M Response (Surveillance & Epidemiology) $16.75M Laboratory $23M

12. Priority CDC Extramural Activities n n Preparedness planning n n Surveillance and epidemiology n n Laboratory capacity for biologic and chemical agents n n Health communication systems n n Training n n Establish key liaisons

13. Priority CDC Intramural Activities n n Expand CDC’s capacities for epidemiologic response n n Create a rapid diagnosis laboratory system n n Maintain a National Drug & Device Stockpile n n Training n n Administer the Select Agent Rule

14. Selected CDC Collaborations for Biological and Chemical Preparedness n USAMRC: Chemical and Biological Preparedness/Training n Air Force/Army: Epidemic Intelligence Service Training n VA: Pharmaceutical Stockpile

15. The “Ideal” Who Should Health Care Providers Call for Assistance Regarding Biological or Chemical Emergencies Health Provider Clinic/Hospital Authorities (Infectious Disease Authorities/Poison Control) County Health Officer/Epidemiologist State Health Officer/Epidemiologist Federal Health Partners-CDC

16. CONCLUSION Key Issues for Health Providers n Training n Linkages/coordination n Early identification of covert release n Building critical infrastructure

17. Points of Contact n US Public Health Service –1-800-872-6367 –www.cdc.gov/ncidod/diseases/bioterr.htm n Domestic Preparedness Information Line –1-800-368-6498 –www.nbc-med.org n National Response Center –1-800-424-8802 n National Disaster Preparedness Office (DoJ) –(202) 324 8186 n USAMRIID –1-888-USA-RIID (1-888-872-7443)

18. n U.S. Army Medical Research Institute of Infectious Diseases (USAMRIID) –Commander n (301) 619-2833 –Operational Medicine Division n (301) 619-4276 –24 hr Biological Incident Hot Line n 1-888-USA-RIID (1-888-872-7443) –www.usamriid.army.mil n U.S. Army Medical Research Institute for Chemical Defense (USAMRICD) –Chemical Casualty Care Division n (410) 671-3393