Placing Bioterrorism in its ContextPlacing Bioterrorism in its Context

Dr. C. de Ville de GoyetDr. C. de Ville de Goyet

The Anthrax great scareThe Anthrax great scare

• A demonstration of the superiority of informal A demonstration of the superiority of informal reporting systemsreporting systems

• Six deaths: A society overwhelmed with fearSix deaths: A society overwhelmed with fear

• Not a new threat!Not a new threat!

Anthrax Threats Reported to FBI

0

50

100

150

200

250

1996 1997 1998 1999*

* first four months of 1999

Source: M. Lyons, CDC from FBI personal communication to Dr. Eric Noji

A critical look at some slides from CDCA critical look at some slides from CDC

Most of the slides used are from Dr. Eric Noji Most of the slides used are from Dr. Eric Noji Presentation at the PAHO Senior Managers Presentation at the PAHO Senior Managers

Meetings in Nov 2001.Meetings in Nov 2001.

Those slides have a blue backgroundThose slides have a blue background

• Detection & surveillance• Rapid laboratory diagnosis• Epidemiologic investigations• Implementation of control

measures

Public Health Response to…Bio-terrorism

Public Health Role in “Bioterrorism”

“Detect and control the epidemic”

Comments: Is it not the normal role of the Ministry of Health? Can you detect terrorist outbreaks

without detecting first normal epidemics?

• Early, rapid recognition of unusual clinical syndromes or deaths & of increase above “expected levels” of common syndromes, diseases, or death

• Rapid etiologic diagnosis

• Rapid response

Bioterrorism Surveillance

Bioterrorism Surveillance

• Key features– Real time data real time epidemiology– Syndrome-based reporting– Sentinel surveillance sites– Pro-active (high profile potential target

events, ongoing surveillance in sentinel sites)– Reactive (monitoring and response)– Aberration Detection

Syndrome Surveillance

• The monitoring of illnesses based upon a constellation of symptoms and/or findings

• Provides an “early warning system” for outbreaks, emerging pathogens

Likely BT Agents: Initial Symptoms

• Agents– Anthrax

– Plague

– Q-fever

– Tularemia

– Smallpox

• Initial Symptoms– Fever

– Cough

– Malaise

– Headache

Current Challenges

• Identification of localized clusters

• Sustainability of surveillance system

• Development of response protocols

Unanswered Questions• What is the threshold that initiates response• What is the sensitivity and specificity of

surveillance systems• Usefulness and feasibility of aggregate data

from hospital admissions, ICD-9 codes on a large scale

• Do we have an answer to these questions for normal surveillance?

The “Unasked” QuestionsThe “Unasked” Questions

• What is the real risk of terrorism act in the What is the real risk of terrorism act in the Caribbean?Caribbean?

• How much to invest (i.e. divert resources from How much to invest (i.e. divert resources from other health priorities) for terrorism counter-other health priorities) for terrorism counter-measures?measures?

• Cost-effectiveness?Cost-effectiveness?