Public Health and Bioterrorism

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Public Health and Bioterrorism

• By Courtney Parsons
• Emergency Preparedness Coordinator

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Outline

• Bioterrorism
• Funding
• Goals
• Emergency Preparedness Regions
• Infrastructure State and Regional Levels
• Challenges of Bioterrorism
• My Role as the Emergency Preparedness Coordinator
• Local Emergency Response Updates
• Conclusions
• Smallpox
• The Vaccine
• Side Effects
• Contraindications
• Updates Federal, State, Region, and Local
• Conclusions

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Bioterrorism Funding

• Two awards were designated by the Federal
  government to improve bioterrorism preparedness.
• CDC Award
• HRSA Award

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The CDC Award

• Purpose to upgrade state and local health
  departments preparedness for, and in response to
  bioterrorism, other outbreaks of infectious
  disease, and other public health threats and
  emergencies.
• Source of my position as Emergency Preparedness
  Coordinator
• The grant is defined by seven focus areas.
• Award time period is mid-May, 2002 through August
  2003.

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Focus Areas of the CDC Grant for Public Health

• Focus area A Preparedness Planning
  Readiness Assessment
• Focus Area B Surveillance Epidemiology
  Capacity
• Focus Area C Laboratory Capacity -Biological
• Focus Area D Laboratory Capacity Chemical
  (increased funding is expected next year)
• Focus Area E HAN/ Communication and
  Information Technology
• Focus Area F Communicating Health Risks
  Health Information Dissemination
• Focus Area G Education Training

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The HRSA Award

• Purpose To upgrade the preparedness of the
  nations hospitals and collaborating entities to
  respond to bioterrorism.
• Grant has two phases
• Phase I Needs assessment, planning, and initial
  implementation.
• Phase II Full implementation

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The Goals of theFederal Funding

• A statewide coordinated system of hospitals,
  physicians, laboratories, public health, law
  enforcement, and emergency responders
• Education for all health officials regarding
  biological and chemical agents and improve
  ability to diagnose
• Improve the capacity and responsiveness of public
  health.

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Goals (cont.)

• A statewide communications system for all
  agencies involved in a public health emergency.
• Facilitate a rapid response
• A communication system for the public which would
  allow for immediate and accurate updates at the
  time of an emergency.
• Health Alert Network

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Current Results of the Funding

• The State has been divided into 8 Emergency
  Preparedness Regions.
• Shiawassee County is located in Region 1
• Infrastructure has been developed at the State
  and Regional levels to facilitate a coordinated
  response to major emergencies.
• Emergency Preparedness Coordinators are required
  at every health department in the State.

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Results of the Funding (cont.)

• Technology improvements for the state and local
  health departments.
• Broadcast fax machine
• Cell phone
• New computers both desktop and notebook
• Training sessions for public health employees to
  improve knowledge of potential bioterrorism
  events.
• Bioterrorism Response and Planning Conference
• Public Information Officer class
• Incident Management Training

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Emergency PreparednessRegions

• We fit into Region 1.
• There are 9 Counties and 8 health departments in
  our Region.
• Other Counties in our Region are
• Clinton County
• Eaton County
• Gratiot County
• Hillsdale County
• Ingham County
• Jackson County
• Lenawee County
• Livingston County

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Regional Infrastructure

• State employees
• Regional Epidemiologist
• This position is currently vacant for Region 1
• Regional National Pharmaceutical Stockpile
  Planner
• Sandra Gray is our NPS Planner
• Employed by Region 1
• Regional Medical Director
• Don Edwards, D.O.
• Regional Bioterrorism Coordinator
• Byron Callies

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Roles within each Region

• Regional Epidemiologist
• Provide epidemiology support to local public
  health department and the Michigan Disease
  Surveillance System
• Regional analysis of public health data
• Provide expertise to Regional Medical Advisory
  Committees
• Regional National Pharmaceutical Stockpile
  Planner
• Develop regional plan to receive and distribute
  pharmaceutical supplies
• Assess and identify pharmaceutical resources
  within the region
• Assist local health departments in development of
  mass prophylaxis plans

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National Pharmaceutical Stockpile

• The federal government can deliver 50 tons of
  medical supplies to any city in the United States
  within 12 hours.
• Communities must be ready to take control of
  these supplies from the airport. They must have
  transportation and security for the supplies and
  a place to distribute them. They need people who
  can repackage huge cartons of antibiotics into
  individual doses. (Newsweek October 2002)

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Infrastructure at the State Level

• Office of Public Health Preparedness
• Director
• Policy, Legislative Specialist
• CDC/HRSA Liaison
• Assessment Coordinator
• Bioterrorism Coordinator
• Health Alert Network Coordinator
• Emergency Management Coordinator
• Risk Communication Coordinator
• Bioterrorism Hospital Coordinator
• Public Health Training Coordinator
• National Stockpile Planner Coordinator
• Laboratory Training Coordinator
• Hazmat Response Coordinator
• Program Administrator

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Challenges Facing Public Health regarding
Bioterrorism

• UNPREDICTIBILITY!!!
• Bioterrorism is public health in reverse
• Biological weapons are used to cause disease and
  public health is dedicated to preventing disease
• A bioterrorism attack may be a covert act which
  complicates our ability to respond.
• A delay in diagnosis is probable due to the
  incubation period of each biological weapon.

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Responding to the Challenges of Bioterrorism

• Communication
• Among agencies and within our own agency
• With the public
• Education
• For the staff
• For the public
• Develop and Implement Improved Bioterrorism Plans
  and Procedures
• Test Policies and Procedures
• Participate in Mock Disasters

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My Role as the Emergency Preparedness Coordinator

• Facilitate a coordinated response to all
  emergencies and develop relationships with the
  emergency responders.
• Serve as a point of contact for all agencies
  involved with emergency response.
• Represent the health department at State and
  Regional meetings.
• Coordinate the development of improved emergency
  response specifically to a bioterrorism event.
• Ensure participation in all response exercises
  and training activities.

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The Importance of an EmergencyPreparedness
Coordinator

• As the new protocols are developed at the state
  and regional levels it is crucial that the voice
  of the health department is heard.
• Due to the number of agencies involved in
  emergency response it is necessary to have a
  liaison in place to coordinate the efforts of
  each agency.
• Disseminate information to the public and the
  other agencies involved in the emergency
  response.
• Relationships and communication must be
  established and kept current prior to an
  emergency in order to efficiently and
  productively respond to the emergency.

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What is Happening Locally?

• We are working closely with the Sheriffs
  Department to improve emergency response plans
• Coordinating our response plans
• Updating information Contacts, Emergency
  Operations Center, Emergency Action Guidelines
• Local Emergency Planning Commission (LEPC)
• We are an active participant in all State and
  Regional planning activities regarding emergency
  response and bioterrorism

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Conclusions

• Bioterrorism is UNPREDICTABLE!!!
• Improve relationships among the agencies involved
  with emergency response
• This aspect of Public Health is EXCITING,
  EVOLVING, and very COMPLEX!
• Complex process
• Many agencies involved
• Numerous avenues of information (technology)
• Explosion of knowledge
• Urgency of Information

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Conclusions (cont.)

• A successful response to Bioterrorism must
  include
• A COORDINATED response effort
• Awareness and Education Efforts for our Staff and
  Residents of Shiawassee County
• Practice/Training Exercises for all agencies to
  test procedures put in place.
• The Shiawassee County Health Department is ready,
  willing, able, and committed to meeting the
  challenges of Bioterrorism!

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Smallpox VaccinationPlanning
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Smallpox

• This biological weapon is causing concern for the
  entire nation.
• Smallpox has a death rate of about 30
• Smallpox is generally spread by direct and fairly
  prolonged face-to-face contact with an infected
  individual
• It can also be spread from direct contact with
  infected bodily fluids or contaminated objects

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Smallpox Continued

• Steps are being taken at the Federal, State,
  Regional and the Local Levels to respond to a
  smallpox outbreak
• We at the health department are preparing for the
  potential vaccination of the population
• Smallpox vaccinations would be given on a
  VOLUNTARY basis if directed by the federal
  government

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Smallpox Vaccine

• Live-virus vaccine made from the vaccinia virus
• Does NOT contain the actual smallpox virus
• Developed from calves, sheep, and water buffalo
  and can protect against other viruses such as
  monkey pox and cowpox
• Currently there is enough vaccine to vaccinate
  the entire US population

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Receiving the Vaccine

• It is not a shot
• A bifurcated (two-pronged) needle containing a
  droplet of the vaccine is used to poke the skin
  about 15 times
• If successful the vaccination site will produce
  1-2 drops of blood
• Keep the site CLEAN and COVERED after vaccination
• Because the virus is live you can spread the
  Vaccinia virus to other people and/or other parts
  of your body

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Side Effects/Reactions to theSmallpox Vaccination

• Common side effects from the smallpox vaccine
  include fever, weakness and lymph gland swelling
  or tenderness occurring about a week after
  immunization.
• Some reactions can be very severe and even
  life-threatening
• Previously vaccinated individuals are less likely
  to have a severe reaction
• Severe complications
• Range from 15-1,200 per million vaccinated
• Life-threatening complications
• Range from 1-40 per million vaccinated

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Contraindications of SmallpoxVaccine

• Who is at adverse risk?
• Pregnant women
• Those with compromised immune systems such as
  those with Lupus, HIV, organ transplant
  recipients or on oral steroids
• Those with current (or history of) Eczema or
  atopic dermatitis
• Anyone allergic to the vaccine or its components
• Anyone under the age of 18

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Smallpox Federal Level

• President Bush is expected to announce 500,000
  health workers be vaccinated against smallpox
• 15,000 - 20,000 people in Michigan
• Approximately 2000 people in Region 1
• Primary focus is on Hospitals Emergency Room
  Employees, Infectious Disease Specialists,
  Intensive Care Workers, Public Health Nurses
• Currently the CDC does not recommend smallpox
  vaccinations be given to the general public

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Phases of Vaccination

• Phase I
• 500,000 health workers in the United States
• 15,000-20,000 health workers in Michigan
• Phase II
• 7-10 million more health workers, firefighters,
  police, and 1st responders in the United States
• Phase III
• The general public
• Currently the CDC does NOT recommend the smallpox
  vaccine be distributed to the public unless there
  is an outbreak of smallpox

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Smallpox State Level

• The Office of Public Health Preparedness is the
  liaison for the Federal officials and Local
  representatives
• Updates from the CDC come to the health
  department from the State
• The State of Michigan just submitted a plan to
  the CDC regarding mass vaccination strategy

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Smallpox Regional Level

• Each Region has established Regional Smallpox
  Planning Team (RSPT)
• Responsibilities
• Regional Smallpox Vaccination Planning
• Administering the Vaccine in the public health
  and Medical Network within each Region
• Plans are currently underway detailing how and
  where Phase I vaccinations will be done if deemed
  necessary by the Federal government

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Regional Smallpox Planning Teams (RSPT)

• Representatives (Team Members)
• Local Public Health Department Medical Director
• Medical Control Authority
• Health Officer from Local Health Department
• Emergency Preparedness Coordinator
• Regional Bioterrorism Coordinator
• Local Hospitals
• Regional Epidemiologist
• Regional NPS Planner

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Smallpox Local Level

• SCHD is communicating regularly with Federal,
  State, and Regional representatives regarding
  Smallpox
• We are an active participant in the planning
  process
• We are in the process of developing an
  educational presentation for the public regarding
  smallpox and the vaccine to be put on our website
• The information is changing daily and we are
  involved and preparing for each potential
  scenario

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Conclusion

• Although Smallpox is a major challenge facing
  public health we at the health department are
  prepared to meet this challenge head on
• SCHD is prepared to protect the publics health
  by providing the necessary information and
  services to the public
• Smallpox is a very dangerous weapon however the
  necessary plans are in motion so that we all will
  be prepared if and when the time comes
• Questions?
• Handouts