Amy Sebring: Welcome to the EIIP Library! Today we are featuring the Centers for Disease Control and Prevention (CDC) and their mandate in the area of bioterrorism, in a session entitled "Public Health Preparedness for Bioterrorism." Amy Sebring: We will start with a presentation, and then follow with a Q&A session for your questions and comments. Right before we begin the Q&A portion we will review the procedure. Amy Sebring: Please do NOT send direct messages to the speaker or moderator as it makes it difficult for us to follow the discussion. Amy Sebring: Background information for today's session may be found at http://www.emforum.org/vlibrary/010214.htm ... Amy Sebring: Now I am pleased to introduce Kim McCoy, who is a Program Analyst in the Management and Operations Section of the Bioterrorism Preparedness and Response Program at CDC. This is the office charged with enhancing CDC's capacities to assist States and other partners in responding to bioterrorism. Amy Sebring: Welcome Kim, and thank you for taking time to join us today. The floor is yours. Kim McCoy: Thanks, Amy. Kim McCoy: Good afternoon and thank you for being here today to discuss the public health implications of bioterrorism. I look forward to hearing your comments and questions. Kim McCoy: In 1998 the U.S. Department of Health and Human Services directed the Centers for Disease Control and Prevention (CDC) to lead the national effort to prepare public health and health care systems to respond to the threat of biological and chemical terrorism. Kim McCoy: This multi-faceted and complex effort was initiated via the establishment of the Bioterrorism Preparedness and Response Program (BPRP) at CDC in January 1999. Though BPRP is housed within the National Center for Infectious Diseases, the overall effort is conducted in partnership with the National Center for Environmental Health, the Epidemiology Program Office, the Public Health Practice Program Office, and the Office of Health and Safety. Kim McCoy: Before I provide more detailed information about the national public health initiative to prepare for bioterrorism, I think it may be helpful to describe the threat and potential implications of bioterrorism. Kim McCoy: Bioterrorism generally refers to the use of a biological agent or chemical to intentionally cause illness or injury in a population. Recent examples of bioterrorism include the sarin gas attack in the Tokyo subway and the dispersal of Salmonella in salad bars by a religious group in The Dalles, Oregon. Kim McCoy: Bioterrorism can be perpetrated through a variety of mechanisms including aerosol, food, water, or vectors. It can be announced, overt, or covert depending on the agent used and the intent of the terrorist. Kim McCoy: Attacks with a chemical agent tend to be overt because the impact of chemicals is more immediate and obvious. Biological terrorism is more likely to be covert in that the resulting illness may not become evident until days or weeks after the initial exposure. Kim McCoy: One of the first steps in developing national capacity for response to bioterrorism was to identify the agents that pose the greatest risk to national security and public health. Kim McCoy: The primary biologic agents of concern are those that 1) can be easily disseminated or transmitted from person to person, 2) cause high mortality, and 3) require special action for public health preparedness. They include Smallpox, Anthrax, Plague, Botulism, Tularemia, and Viral Hemorrhagic Fevers. Kim McCoy: The primary chemical agents of concern are those that 1) are already known to be used as weapons, 2) are available to terrorists, 3) cause major morbidity or mortality, and 4) require special action for public health preparedness. They include nerve agents, blister agents, pesticides, dioxins and a variety of other chemicals. Kim McCoy: CDC's strategic plan for developing national public health capacity to respond to bioterrorism is focused on the following elements: 1) preparedness and prevention, 2) detection and surveillance, 3) laboratory diagnosis and characterization, 4) response, 5) communication, and 6) training. Kim McCoy: Preparedness and prevention efforts include activities such as development of response plans, implementation and testing of notification protocols, coordination of partners, assessment of current capacity, and applied research. Kim McCoy: Detection and surveillance involves development and strengthening of methods, tools, and procedures for identification and investigation of unusual clusters of disease, syndromes, or injuries that may be indicative of bioterrorism. Kim McCoy: Laboratory diagnosis and characterization of agents is done in stages via a network of clinical and public health laboratories at local, state, and federal levels. Kim McCoy: The goal of this activity is to ensure rapid, accurate diagnosis and reporting of potential biologic and chemical threat agents. Kim McCoy: CDC, in collaboration with the Association of Public Health Laboratories, has established the National Laboratory Response Network which provides member laboratories across the nation with access to reagents, protocols, and technology for diagnosis of biologic agents. Kim McCoy: Response activities are focused on development of procedures for medical treatment and prophylaxis of infected persons and initiation of disease prevention or environmental decontamination measures. Kim McCoy: To assist with response efforts, CDC has established the National Pharmaceutical Stockpile, a cache of pharmaceuticals, medical supplies and equipment that may be delivered to the site of an incident in the continental U.S. within 12 hours of the decision to deploy. Kim McCoy: Finally, in the area of communications, CDC is working to upgrade information technology and systems throughout the country to facilitate rapid exchange of data and emergency information among public health, emergency response, law enforcement, public safety personnel and others. Kim McCoy: The Health Alert Network is a communications tool, established by CDC at the local level, to serve as a platform for distribution of emergency alerts and information, distance learning, national disease surveillance, and electronic laboratory reporting. Kim McCoy: Benefits of the Health Alert Network include high-speed, secure Internet connections for local health officials; access to on-line, Internet- and satellite-based distance learning systems; and early warning broadcast alert systems. Kim McCoy: Training is an underpinning of each element of preparedness for bioterrorism. Kim McCoy: CDC recently developed a National Bioterrorism Training Plan that will be implemented in phases over the next several years to ensure that public health officials are knowledgeable of and proficient in the relevant aspects of bioterrorism preparedness and response. Kim McCoy: Each of the elements I just described is being addressed at the state and local level as well as at CDC. A primary component of CDC's Bioterrorism Preparedness and Response Initiative is a cooperative agreement program that provides funding and technical assistance to public health officials nationwide. Kim McCoy: All 50 states, the 4 largest metropolitan areas, and 1 U.S. territory receive funding to build or enhance public health capacity for response to bioterrorism. Funding is provided for one or more of the following focus areas: 1) Preparedness Planning, 2) Epidemiology and Surveillance Capacity; 3) Laboratory Capacity for Biologic Agents, 4) Laboratory Capacity for Chemical Agents, and 5) Health Alert Network. Kim McCoy: In addition to State, local, and territorial health departments, CDC works with a broad range of partners to ensure a coordinated and comprehensive response to bioterrorism. Kim McCoy: Federal partners include agencies such as the FBI, which will be responsible for crisis management, and FEMA, which will be responsible for consequence management, in the event of a bioterrorist attack. We also work closely with the Departments of Defense, Justice, and Agriculture, and the Food and Drug Administration. Kim McCoy: Other partners include professional associations such as the National Association of City and County Health Officials and the Association of State and Territorial Health Officers, academic institutions such as Johns Hopkins University and St. Louis University, and a variety of public, private, and non-profit organizations. Kim McCoy: Recent terrorist threats to the U.S. civilian population have highlighted the need for increased public health capacity to respond to bioterrorism. Kim McCoy: Public health efforts that are being implemented across the nation will serve the dual purpose of preparing the nation for the threat of bioterrorism as well as shoring up the nation's ability to respond to infectious disease outbreaks and other public health emergencies. Kim McCoy: Again, thank you for being here today. I would be happy to respond to any questions that you have. Amy Sebring: Thank you Kim. Audience please enter a question mark (?) to indicate you wish to be recognized, go ahead and compose your comment or question, but wait for recognition before hitting the enter key or clicking on Send. Amy Sebring: We now invite your questions/comments. Elaine Sudanowicz: ? Mark DeMier: ? Amy Sebring: Elaine, when you are ready please. Jacqueline Cattani: ? Elaine Sudanowicz: Do you find any relationship between bioterrorism and an outbreak of pandemic flu? Kim McCoy: I'm not sure exactly what you mean by "relationship", but... Kim McCoy: certainly there is overlap between the activities... tom quail: ? Greg Banner: I have a consolidated list of web sites for WMD and bioterrorism. Anyone wants it can email. gregoryb@doh.state.ri.us Amy Sebring: Thanks Greg. Anybody else? Amy Sebring: Kim, you were speaking of the overlap with infectious diseases? Kim McCoy: Right, sorry about that... Kim McCoy: I was experiencing some technical difficulties. Amy Sebring: no problem, please continue. Kim McCoy: I was saying that many of the activities... Kim McCoy: that we implement for bioterrorism preparedness... Kim McCoy: are similar to those that are conducted in preparation... Kim McCoy: for pandemic influenza and other infectious disease outbreaks. Amy Sebring: Mark DeMier next please. Mark DeMier: Regarding the National Bioterrorism Training Plan, does CDC partner with Noble Training Center and/or DoJ's Center for Domestic Preparedness? If so, do you coordinate how CDC and DoJ assist state and local agencies financially? Kim McCoy: CDC does partner with DOJ and other federal partners... Kim McCoy: but as you can imagine, federal coordination can be difficult... Kim McCoy: the Noble Training Center project is coordinated by OEP... ray pena: ? Kim McCoy: OEP, is the federal Office of Emergency Preparedness... Kim McCoy: and they coordinate activities related to the medical response to bioterrorism... Kim McCoy: While we work with other federal agencies, funding is usually not... Kim McCoy: coordinated, rather, we try to coordinate activities and implement... Kim McCoy: complementary programs. Amy Sebring: Jacqueline next please. Jacqueline Cattani: Thanks Kim.... What is the CDC's role with the Dept. of Energy? Amy Sebring: ? Kim McCoy: CDC does coordinate with DOE but not extensively. Amy Sebring: Tom next please. tom quail: Thanks Kim..... I know the major cities are currently going through domestic preparedness training? Do you know how many of these cities , EMS and Fire Services, have completed the training? Kim McCoy: Tom, if you're talking about the MMRS program... Kim McCoy: 120 cities are involved ... Kim McCoy: not all of them have received training yet ... Kim McCoy: approximately 80 of the cities have been trained. Tom Reitz: ? Amy Sebring: Tom, was that what you were asking about? tom quail: exactly thank you Amy Sebring: Ray next please. ray pena: How do we find out what labs are members of the Nat'l Lab Response Network? Isabel McCurdy: ? Kim McCoy: We have a person in our labs who could provide that info ... Amy Sebring: or you can contact APHL directly. Amy Sebring: How are private physicians integrated into the detection and surveillance aspect? Kim McCoy: They are mostly being integrated at the state and local level... Kim McCoy: we work with state health departments ... Kim McCoy: and they in turn work with local and regional health officials. Kim McCoy: We are planning to do more work in that area ... Kim McCoy: particularly through our hospital infections program. Amy Sebring: Tom Reitz is next please. tom quail: ? Tom Reitz: What size are the cities in MMRS and what do you recommend for cities under 50,000 in population? Kim McCoy: First, I should clarify that MMRS is an OEP program... Kim McCoy: so I don't have all the details of what kind of progress they have made... Kim McCoy: and the specific activities that they are conducting... Kim McCoy: however, for smaller cities, that want to enhance their... Kim McCoy: public health preparedness, I suggest that they contact... Kim McCoy: their state health department to become involved in the planning... Kim McCoy: efforts that are happening at that level. Amy Sebring: Isabel next please. Isabel McCurdy: What is the MMRS Program? Isabel McCurdy: That was my question. Kim McCoy: Sorry, MMRS is Metropolitan Medical Response System. Amy Sebring: Tom Quail next please. tom quail: Thank you ....I understand that Poison Control Centers will be observing real time exposure data with a program through CDC. Are you aware of this? and can you comment? Amy Sebring: ? Kim McCoy: I am not aware of this, but I do know... Kim McCoy: that some state health departments are contracting... Kim McCoy: with their regional poison control centers to access... Kim McCoy: some of that data. Amy Sebring: It sounds like you are coordinating primarily through state public health agencies. Do you find that state emergency management agencies are typically involved? Kim McCoy: Yes, our cooperative agreement program is with the... Kim McCoy: health departments which are our primary partners...however... Kim McCoy: many states have bioterrorism task forces which include... Kim McCoy: a variety of state and local agencies and partners. Amy Sebring: Thanks Kim. Other questions/comments? Mark DeMier: FYI: I host a Website 'portal' of information related to these issues everyone may find useful at http://www.homelanddefense.org, and an online publication at http://www.homelanddefense.org/journal/ Amy Sebring: Thanks Mark. Carl Fraker: Detection at or near the time of release is a real challenge, have you heard of any breakthroughs on this side of the problem? Don Benedik: ? Kim McCoy: You're right, it is a huge challenge... Kim McCoy: we are constantly working to develop new techniques... Scott Green: ? Kim McCoy: and methods for surveillance and detection of these... Kim McCoy: types of events... Kim McCoy: I can't tell you about any specific solutions... Kim McCoy: but I would be happy to put you in touch with our epidemiology... Kim McCoy: staff if you would like more information about what they are doing. Amy Sebring: Don next please. Amy Sebring: ? Don Benedik: Are there agents that may affect crops? Where would we find info on this? Kim McCoy: Yes, there are agents that could affect crops or livestock... Kim McCoy: this is an emerging area of bioterrorism preparedness... Kim McCoy: some of the frontier states are doing some innovative work in this area... Kim McCoy: and I'm sure they would be happy to share some of their information... Kim McCoy: with you. Montana and Wyoming in particular are focusing... Kim McCoy: on agricultural issues. USDA could also offer some assistance. Amy Sebring: Scott next please. Scott Green: How would the medical supplies and medicines form the caches you mentioned get distributed during response to a WMD event? Kim McCoy: Scott, there are 8 caches of materials located around the US... Kim McCoy: these caches would be delivered to the airstrip nearest the site of the incident... Terry Storer: ? Kim McCoy: and then be transferred to state personnel who would break down the... Kim McCoy: caches and deliver them to the distribution sites... Kim McCoy: each state is responsible for developing a plan for dissemination... Kim McCoy: of the materials in the stockpile. Amy Sebring: Kim, is the Health Alert Network fully implemented or still under development? Kim McCoy: The Health Alert Network is in various stages of implementation... Kim McCoy: currently 40 states and localities receive funding to establish HAN... Kim McCoy: they work with their local health departments to set up the hardware and... Kim McCoy: software needed to implement the network... Kim McCoy: so it depends on the current capability of the localities as to... Kim McCoy: how quickly they are able to get the system up and running. Amy Sebring: Terry next please. Terry Storer: Do you feel that there will be a return to mass immunizations as a means to reduce bio threats ? Kim McCoy: Terry, that is not my area of expertise, but I know that it hasn't... Kim McCoy: been the focus of any discussions recently... Kim McCoy: I think its fairly unlikely, but as we are constantly finding out... Kim McCoy: bioterrorism issues change from day to day and depend... Kim McCoy: greatly on information that comes to us from US intelligence agencies... Kim McCoy: for instance, if we hear that smallpox... Kim McCoy: is becoming a greater threat, then plans could change rapidly. Amy Sebring: We have time for a few more questions or comments. Anyone else? Amy Sebring: Kim, perhaps you would like to mention the CDC Website at this point? Curt Mayfield: Any advanced technologies under consideration by CDC to improve surveillance and detection of bioagents? Kim McCoy: We are currently working on a temporary surveillance... Kim McCoy: system that can be implemented during special events such as... Kim McCoy: the World Trade Organization conference, the Olympics, etc... Kim McCoy: there are also some plans in the works for improving data collection... Kim McCoy: and reporting capabilities... Kim McCoy: again, I would be happy to put you in touch with our epidemiology and... Kim McCoy: surveillance staff for more information on aberration detection tools... Kim McCoy: syndromic surveillance methods and other activities that are in the works. Isabel McCurdy: ? Amy Sebring: Isabel please. Isabel McCurdy: Is the Health Alert Network American-based only or is there plans to be partnered internationally? Kim McCoy: right now our focus is on enhancing domestic capacity... Amy Sebring: ? Kim McCoy: so HAN has only been implemented in the U.S... Kim McCoy: however, there have been some discussions recently about... tom quail: ? Kim McCoy: how to expand our program to address international concerns. Amy Sebring: Does CDC host any national or regional conferences? Kim McCoy: yes. Our updated Website is scheduled... Kim McCoy: to go up tomorrow and will feature a list of upcoming events and conferences... Kim McCoy: last year we hosted a series of regional conferences, and we are... Kim McCoy: planning a national conference for 2002. However, bioterrorism issues... Kim McCoy: are often incorporated into conferences on other subjects such as Emerging Infectious Diseases. Amy Sebring: Tom, final question please. tom quail: Do you know what the progress is of the intra-net web site that Is being developed? And what specific agencies will have access? Kim McCoy: We are currently updating our public Web site to include... Kim McCoy: more information about federal, state and local bioterrorism activities... Kim McCoy: we also have some secure Web sites on specific topics that are accessible... Kim McCoy: to specific interest groups or agencies that we fund. Amy Sebring: Thank you very much Kim. We very much appreciate your time and effort. Please stand by a moment while we take care of some business. Amy Sebring: We will have a text transcript posted later today, and reformatted versions at the end of the week. Amy Sebring: If you are not on our mailing list and would like to receive weekly notices and our newsletter, please see http://www.speccomm.com:81/guest/RemoteListSummary/EIIP to subscribe. Amy Sebring: Next week we will have a Tech Arena session featuring Chemical Biological Response Aide (CoBRA), with Craig Levy, Deputy for Responder Services and Brad Gardner, Deputy for Product Development, Defense Group, Inc. Please join us then. Amy Sebring: Thanks to all our participants today. We will adjourn the session for now and you no longer need to use question marks. Please help us express our appreciation to Kim for today's presentation. Kim McCoy: If you need additional information, please feel free to contact me... Kim McCoy: at 404-639-0387 or kmccoy@cdc.gov. The Website address... Kim McCoy: is www.bt.cdc.gov .