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Bioterrorism Presentation

Sharon F. Grigsby, MBA

Executive Director

Bioterrorism Preparedness Program

Public Health

Department of Health Services

County of Los Angeles

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The events of Fall 2001 Challenged Us All

Our Sense of Invulnerability

Our Self-Confidence

Our Awareness of Public Infrastructure,

and

Our Definitions of First Responders

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Will the first response to a BT attack be this……

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…. or this?

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It’s more likely to look like this….

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…or this.

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Government Responds

January 2002, President approves

$1.1 billion for Bioterrorism Preparedness

All fifty states, the territories and 4 major

metropolitan areas receive funding

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HHS Funding Sources

• Centers for Disease Control and Prevention• Focus on infectious disease control, public health needs• Los Angeles, Chicago, New York, D.C. funded• Los Angeles receives $24.6 million

• Health Resources and Services Administration• Funding to States for Hospital Preparedness • Los Angeles receives $3.6 million

• Office of Emergency Preparedness• Funding provided for Metropolitan Medical Response

Systems for 120 largest cities• LA, Long Beach, Glendale funded in LA County

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CDC Funds Public Health for Bioterrorism, Emerging InfectiousDiseases and other Public Health

Emergencies

• Develop Comprehensive BT Plans

• Upgrade Disease Surveillance and Investigation

• Implement HASTEN with Health Providers

• Enhance Public Health Laboratory Capability

• Develop Risk Communication Capacity

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Lessons Learned from Anthrax Threats

• Inadequate internal communication system

• Need real time communication with most physicians

• Public communication strategy essential

• Full time central coordination essential

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Los Angeles County Public Health Threat Activities Pre-Sept 11th

• 1999 CDC Funding of $800k• Development of Epidemiology & Surveillance

Capacity

• Development of Emergency Communications HASTEN

• Enhance Lab Capacity

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Being Prepared• Education of medical

community• Education of public• Training of special response teams• Participation in exercises for different scenarios• Development of communication systems• Development of interagency protocols

The Role of Public Health

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Initial Response to BT Induced Disease • Early detection through surveillance/ rapid

assessment of reports• Mobilize laboratory• Rapid confirmation of agent, site, initial at-risk

population, prophylaxis and/or treatment• Alert medical community, ERs, labs

• Implement disease specific plans (e.g. Smallpox)

• Determine resource needs and possible quarantine• Coordinate with partner agencies

(local/state/national)

The Role of Public Health

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Continued Response to BT Induced Diseases

• Closely monitor communication network for new information

• Provide, accurate, timely information to public

• Continue epidemiologic investigation to refine at risk population

• Assess environmental contamination

• Provide or coordinate testing/ prophylaxis/ treatment to at-risk population

• Access biological stockpiles as necessary

The Role of Public Health

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• Large geographical area/mobile population• real-time reporting & mapping applications

• Victims and/or those they infect may disperse before attack recognized• communication strategy focusing on effective use of

news media

• Victims may present at geographically dispersed medical offices and hospitals• health provider/facility communication and reporting

network

BT Challenges in Los Angeles

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• Early signs/symptoms nonspecific• Provider education through multiple means

• Medical and laboratory communities not familiar with rare BT diseases• establish syndromic surveillance• provide training to increase awareness• enhance collaboration between medical

community and Public Health

BT Challenges in Los Angeles

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CDC Public Health Bioterrorism Preparedness and Response Grant

• $24.6 million

• Six Focus Areas

• Planning

• Surveillance and Epidemiology

• Biological Laboratory Capacity

• Health Alert Network System

• Public Information and Risk Communication

• Training

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P U B L IC H E A L TH P R O G R A M S E M E R G E N C Y M E D IC A L S E R V IC E S A G E N C Y

Jon ath an E . F ie ld in g , M .D ., M .P .H .D irec to r o f P u b lic H ea lth an d H ea lth O fficer

D H S B io te rro rism C oord in a to r

Th om as L . G arth wa ite , M .D .D irec to r an d C h ie f M ed ica l O fficer

Jonathan E. Fielding, M.D., M.P.H.Director and Health Officer

John F. Schunhoff, Ph.D.Chief of Operations

-Surveillance-Bioterrorism

-Community-wide Disease Reporting-Health Community Communications

-Laboratory-Quarantine

-Mass Immunization & Prophylaxis-Smallpox Plan

Virginia Price HastingsDirector

John Celentano, M.D.Chief of Operations

-Operational Medicine/Departmental-Disaster Coordination

-Security-NPS Plan

-Hospital Preparation for PPE/Decon Education/Training for Hospitals, First Responders Force Protection and Others

-MMRS-DMAT and NMRT-West Teams

-Coordination with Fire, Law and State and Federal Government

Los Angeles County Department of Health ServicesBioterrorism Response

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Assessment and Planning

• Assess existing public health preparedness status, including legal preparedness.

• Prepare Countywide response plan.• Complete Regional response plan.• Plan and implement exercises to test all

aspects of response plans.• Develop plan for National Pharmaceutical

Stockpile use.

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Surveillance and Epidemiology

• Enhanced electronic disease surveillance

• Integrated Data Repository

• Establish and exercise mass prophylaxis plans

• Develop Epi Rapid Response Teams

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Enhanced Surveillance Activities

• Surveillance for influenza (data collected by state) • ACD-Coroner Project

• Collaborating with the Office of the Coroner to monitor unexplained deaths

• Provides data on all non-trauma coroner’s cases to monitor for possible infectious causes.

• Animal illness/death surveillance (web-based)

• ED Syndromic Surveillance• ReddiNet: CDC grant to explore adaptation for surveillance needs

• ED syndromic surveillance and rapid reporting pilot in 4 hospitals

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Laboratory Capacity

• Increase ability for rapid testing and identification of biological agents.

• Train local labs for bioterrorism preparedness.

• Increase availability of lab staff trained for bioterrorism.

• Relocate and renovate lab.

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Communications and Technology

• Develop systems for secure electronic exchange of public health information.

• Create mechanisms for broadcast messages and alert notifications.

• Improve communications technology: pagers, radios, satellite phones.

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Health Information and Risk Communications

• Develop public health bioterrorism messages for pre and post event use.

• Prepare materials in multiple languages.

• Train departmental spokespersons.

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Education and Training

• Assess public and staff needs for education on bioterrorism.

• Develop courses and curricula for bioterrorism preparedness.

• Develop partnerships with community stakeholders to disseminate information.

• Test effectiveness of educational programs and revise.

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Providing Information to the Public

• Bioterrorism website: www.labt.org• 52,800 hits in since October 1, 2001

• Health Info Line• Over 1,200 calls in October and November

• 55% related to anthrax

• Community Presentations• Over 200 since September 11, 2001

• Brochures• Over 35,000 distributed

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END