The Southern California Physician, February, 2002 |
|
BIOTERRORISM-A LOCAL PERSPECTIVE FROM SAN BERNARDINO COUNTY By Thomas J. Prendergast, Jr, MD Health Officer &
Alison Rue, MPH, Epidemiologist There are two important bioterrorism epidemics currently of interest. The first is a national epidemic of anthrax cases, both skin and respiratory. This epidemic so far is mostly confined to the mail system and highly visible mail recipients in Washington DC, New York and Florida. By contrast, an epidemic of fear and anxiety affects a much broader geographic area, and number of people. This second epidemic has the potential to disrupt business, interrupt vacations, and strike terror in the hearts of people experiencing relatively minor, nonthreatening illnesses. While there have been no anthrax cases in San Bernardino County or elsewhere in the Western United States, the steps we have taken and plans we are developing for the future are designed to identify anthrax and other diseases should they occur, as well as reduce unnecessary fear and anxiety in the public. Our Public Health response to anthrax and bioterrorism in general has both environmental and medical surveillance components. The environmental surveillance component consists primarily of powder and specimen identification, whereas the medical component consists of three types of disease surveillance in the community.
Individuals concerned about letters, powders or smells encountered in unexpected places start the investigative process by calling 911 and speaking with local law enforcement or the County Sheriff. Once law enforcement classifies powders or items as suspicious, they contact the Hazardous Materials Unit (HAZMAT) of County Fire who then arranges to visit the scene, assess the situation, recover the suspect material, if appropriate, and transport it securely to the Public Health Laboratory where preliminary tests for anthrax are conducted. Local law enforcement staff, HAZMAT, the FBI and Public Health regularly communicate with each other about specimens to be tested, and results of the tests. The HAZMAT team performs a critical function by conducting the public health risk assessment in the field, as well as safely packaging and transporting suspect objects or materials. In the first 10-12 days of bioterrorism awareness, the Public Health Department lab tested 70 specimens. By December staff assessed 80 more specimens. No items contained anthrax and only two grew gram positive organisms. These two were forwarded to the State designated Public Health lab in San Diego for further study with definitive testing reagants. Neither of these specimens contained anthrax. The Public Health lab developed a catalog for future reference of powder sources, unknown letters and other objects of concern to individual citizens. For example, law enforcement and Public Health have received several calls regarding powder found in coin rolls. The lab tested several of these rolls and determined that it is standard packaging to include talcum powder with coins to facilitate packing and removal from the plastic and paper. Staff find it easier to reassure the public when we know from experience coin rolls normally contain white powder. In another case physicians and business people in San Bernardino County and elsewhere have received letters that look suspicious - no return address, and postmarked from West Africa. Law enforcement and the lab have studied several of these letters identifying them as a money-laundering scheme based out of Nigeria. The letters ask the recipient to put money in an account, typically 30 thousand dollars, and promise a 100% return on their investment. This is only a money scam and no biological threat has been associated with it. This testing and cataloging of items has allowed the Public Health Department to reassure the public, fire and law personnel, and Public Health staff of the absence of anthrax in our jurisdiction up to this point. The HAZMAT and Public Health response to suspicious incidents and powders allowed law enforcement, specifically the FBI, to concentrate on other matters during this chaotic time. Individual Case Surveillance-Public Health With these combined approaches we hope to be able to document the specific clinical illnesses which become common during a typical winter "flu season" and to reassure people of two things: anthrax is not occuring, and the viruses-influenza and others that we identify in the lab--provide an adequate explanation for clinical illnesses occurring in the population. Hopefully this will also help the public and clinicians avoid the inappropriate use of Cipro or other antibiotics.
A second form of case surveillance has always been in place, but was recently expanded to include a broader category of illness presentation. In addition to reporting diagnosed infectious illnesses, clinicians are now required to report specific conditions to Public Health, including severe or unusual cases of possible infectious diseases immediately, even before a definitive diagnosis is made. Not only is this communication crucial, but it encourages consultation with colleagues as well as with Public Health. If clusters of disease syndromes are identified, this information can be linked to other forms of surveillance and clinical evaluations to assure the public that illnesses are being closely monitored, and to detect diseases that might be deliberately caused. Syndromic Surveillance All county health departments have been seriously challenged to respond
to the current bioterrorist threats and to future possibilities only
minimally predictable. The efforts in San Bernardino represent a set
of choices driven by concern for mitigating excessive anxiety and fear
as well as the need to detect anthrax. We are available to answer questions
and discuss cases, and we welcome comments and suggestions on how to
improve our efforts in the future. County of San Bernardino Contact Numbers: Health officer, Dr. Thomas Prendergast: Epidemiology and Disease Control: Public Health after-hours, weekends, and holidays: Local Sheriff's Department:
High Desert: (760) 245-4211 |
|
Send mail to the Messenger Editor with questions or comments about the publication.Send mail to webmaster@sbcms.org with questions or comments about this web site. |
