Bioterrorism surveillance

Until October 2001, no deaths from bioterrorism were reported in the U.S. On September 11, 2001, after the attacks on New York City and Washington, the Centers for Disease Control recommended that the nation increase its surveillance for unusual disease occurrences or clusters, asserting that they could be sentinel indicators of bioterrorist attacks. As predicted, cases of anthrax were reported in Florida, New York City, the District of Columbia, and New Jersey. Over the years, it has become evident that not only is biological warfare attractive to governments, it is equally attractive to terrorist cells because the agents are relatively inexpensive and easy to make. 

This chapter provides a brief overview of systems currently in piace for the detection of biological events, either naturaiiy occurring disease outbreaks or deliberate bioterror events. Basic concepts related to infectious disease epidemiology and surveillance are presented. Different types of surveillance systems, including syndromic surveillance, are described. The roles of the... 

WHAT SURVEILLANCE INITIATIVES HAVE OCCURRED IN RESPONSE TO BIOTERROR THREATS ... 

An often over-looked aspect of surveillance for bioterror events is surveillance of animal populations. Several of the agents considered to have bioterror potential are diseases of animals, for example, anthrax and brucellosis (Franz et al., 2001 Inglesby et al., 1999 USAM-RIID, 2005). A covert attack may first become apparent when animals become ill. The need to coordinate information from medical and veterinary sources was illustrated by the epidemiologic investigation during the 1999 West Nile Virus outbreak in New York City. Investigators found that there had been an outbreak in birds several weeks prior to the human outbreak (Fine Lay-ton, 2001). The current surveillance plan for monitoring West Nile Virus infection in the U.S. includes sentinel surveillance of several animal populations (CDC, 2003). 

Recognition by routine surveillance systems (local, state, and federal) may be the first indicator of a bioterror event (Institute of Medicine [lOM] National Research Council, 1999). Background data on disease occurrence are needed so that an unusual pattern can be detected above the endemic (i.e., usual noise ) level. Current public health surveillance systems related to bioterrorism preparedness, including syndromic surveillance systems, are discussed in detail in chapter 20. 

Buehler, J. W, Berkelman, R. L., Hartley, D. M., Peters, C. J. (2003). Syndromic surveillance and bioterrorism-related epidemics [Electronic version]. Emerging Infectious Diseases, 9, 1197-1204. 

Centers for Disease Control and Prevention (2003b). Syndrome definitions for diseases associated with critical bioterrorism-associated agents. Retrieved March 10,2006, from http //www. bt.cdc.gov/surveillance/syndromedef/... 

Lober, W. B., Karras, B. T., Wagner, M. M., Overhage, J. M., Davidson, A. J., Fraser, H., et al. (2002). Roundtable on bioterrorism detection Information system-based surveillance [Electronic version]. Journal of the American Medical Informatics Association, 9, 105-115. 

In 1999, the University of Pittsburgh s Center for Biomedical Informatics deployed the first automated bioterrorism detection system, called RODS (Real-Time Outbreak Disease Surveillance). RODS is designed to draw collect data from... 

Reingold, A. If syndromic surveillance is the answer, what is the question 2003. Biosecur. Bioterror. 1 1-5. 

Green, M.S. Kaufman, Z. 2002. Surveillance for early detection and monitoring of infectious disease outbreaks associated with bioterrorism. Isr. Med. Assoc. J. 4 503-506. 

Centers for Disease Control and Prevention (CDC). 2002. Syndromic surveillance for bioterrorism following the attacks on the World Trade Center-New York City, 2001. MMWR Morb. Mortal. Wkly. Rep. 51(Spec. No.) 13-15. 

The U.S. FDA more recently had a major expansion in its surveillance and contaminant enforcement authority with respect to potential threats of terrorist acts against the U.S. food supply (1) the Homeland Security Act of 2002 (PL 107-296 116 Stat. 2135) and (2) the Public Health Security and Bioterrorism Preparedness and Response Act of 2002 [PL 107—188 116 Stat. 594]. These two statutes prompted the development of the HACCP program within the agency s CFSAN. For example, an episode of deliberate... 

Modem surveillance measures relating to bioterrorism agents must be capable of detecting, investigating and responding to deliberate attacks and also discriminating these from natural outbreaks. Such systems must be consistent, reliable and accurate as well as acceptable to the health workers using them. The features of an effective surveillance system are listed in Boxes 4.6 and 4.7. 

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