Introduction to Health Care and Public Health in the US

1. Introduction to Health Care and Public Health in the US Public Health (Part 2) Lecture b This material (Comp1_Unit8b) was developed by Oregon Health and Science University, funded by the Department of Health and Human Services, Office of the National Coordinator for Health Information Technology under Award Number IU24OC000015.

2. Introduction to Healthcare in the USLearning Objectives • Give examples of and explain the general program categories of public health, including communicable disease, chronic disease, terrorism response, and environmental public health (Lecture a) • Discuss the activities and achievements of public health in the realm of communicable disease (Lecture a ) • Compare and contrast the different types of terrorism and the different public health responses (Lecture b ) • Describe chronic disease activities and achievements of public health, and the work of public health in the realm of environmental health hazards (Lecture c ) Introduction to Healthcare and Public Health in the US Public Health, Part 2 Lecture b

3. Terrorism and Public Health • The specter of terrorism continues to concern US government and public • Emergency Preparedness and Response – public health programs • Categories of Terrorism • Bioterrorism • Agricultural terrorism • Chemical terrorism • Nuclear/radiation terrorism Introduction to Healthcare and Public Health in the US Public Health, Part 2 Lecture b

4. Bioterrorism • Definition: intentional use of microorganisms or their derived products, to produce death or disease in humans, animals, or plants • Classified as Overt (announced) or Covert (unannounced) • Overt attacks - intended to create psychological (panic) damage along with physical damage, as well as to encourage spread of an agent (exposed people fleeing an area take the agent with them) • Covert attacks - intended to cause maximum damage before a response can be mounted. Methods debated for detection for covert attacks include laboratory results and syndromic surveillance. Introduction to Healthcare and Public Health in the US Public Health, Part 2 Lecture b

5. Bioterrorism (continued) • In the United States, the history of bioterrorism is relatively short. Some of the most notable events were: • 1984 Oregon. Considered by some to be the first incident of BT on US soil (others disagree, citing examples such as the military’s apparently deliberate distribution of smallpox-contaminated blankets to Native Americans in the 1700s). The 1984 incident was discovered by a small clinical laboratory, which noticed high numbers of Salmonella typhimurium results and alerted public health officials. It was eventually determined that the central Oregon cult of the Rajneeshees intentionally contaminated salad bars in The Dalles, resulting in 751 cases of infection. • 2001. Letters containing anthrax were mailed to various targets. Five people were killed. • 2003 Greenville, SC, and 2004 Washington DC. Ricin letter incidents. Introduction to Healthcare and Public Health in the US Public Health, Part 2 Lecture b

6. Bioterrorism (continued) • Bioterrorism agents are separated into three categories by CDC, depending on their ease of transmission and severity of effect • Category A: Highest risk • Easily transmitted from person to person • High death rates (mortality) • Could cause public panic • Require special public health preparedness response • Examples: Anthrax, Botulism, Pneumonic Plague, Smallpox, Tularemia, Ebola • Category B: Next highest risk • Moderately easy to spread • Moderate illness rates, low death rates • Response would require specific enhancements of existing laboratory capacity and enhanced disease monitoring systems • Examples: Ricin Toxin, Brucellosis, Q Fever, Typhus, food and waterborne pathogens • Category C: Third highest risk – emerging pathogens • Easily available and spread • Potential for high illness (morbidity) and death (mortality) rates and major health impact • Examples: Nipah Virus, Hantaviruses, Yellow Fever, Multidrug-resistant Tuberculosis Introduction to Healthcare and Public Health in the US Public Health, Part 2 Lecture b

7. Terrorism Public Health Preparedness and Response • Planning, monitoring, and education are three of the main activities • The Lab Response Network is an important part of public health activities Introduction to Healthcare and Public Health in the US Public Health, Part 2 Lecture b

8. Lab Response Network – LRN • LRN - national network of local, state and federal public health, food testing, veterinary diagnostic, and environmental testing laboratories • Provide response capacity for biological and chemical terrorism, as well as other public health emergencies • More than 150 biological and 62 chemical LRN labs • Most are state public health labs, but veterinary, military, and international labs are also important participants Introduction to Healthcare and Public Health in the US Public Health, Part 2 Lecture b

9. Agricultural Terrorism • Chemical and biological (unlike nuclear) weapons are often manufactured from readily available raw materials, raw materials that are usually in common use or found in nature. • Agriculture, a building block of all civilizations, is an attractive target. • Although there have been an unfortunately large number of introductions of agricultural pests and pathogens (example, chestnut blight, which effectively exterminated the American chestnut tree), they have been caused by accident, neglect, or ignorance - not terrorism. • The USDA Animal and Plant Inspection Service (APHIS) attempts to prevent importation of agricultural hazards. Introduction to Healthcare and Public Health in the US Public Health, Part 2 Lecture b

10. Chemical Terrorism • As with other categories of terrorism, chemical terrorism could result from covert or overt exposure of chemical hazards to the population • One system dealing with chemical hazards is the Hazardous Substances Emergency Events Surveillance (HSEES) • Hazardous substance release information is gathered from various sources including emergency response systems, state fire marshals, and the National Response Center • 31 states as well as several territories and other jurisdictions provide info for the Agency for Toxic Substances and Disease Registry (ATSDR) national database Introduction to Healthcare and Public Health in the US Public Health, Part 2 Lecture b

11. Chemical Emergencies CDC categorizes hazardous chemicals by type of chemical and effects of exposure: • Bio-toxins —poisons from plants or animals • Blister agents —chemicals that severely blister the eyes, respiratory tract, and skin • Blood agents —poisons that affect the body by being absorbed into the blood • Caustics (acids) —chemicals that burn or corrode people's skin, eyes, and mucus membranes • Choking/lung/pulmonary agents —chemicals that cause severe irritation or swelling of the respiratory tract • Incapacitating agents —drugs that cause mental confusion or altered state of consciousness • Long-acting anticoagulants —poisons that prevent blood from clotting, which can lead to uncontrolled bleeding • Metals —agents that consist of metallic poisons • Nerve agents —highly poisonous chemicals that prevent the nervous system from working properly • Organic solvents —agents that damage the tissues of living things by dissolving fats and oils • Riot control agents/tear gas —highly irritating agents often by individuals for protection (for example, mace) • Toxic alcohols —poisonous alcohols that can damage the heart, kidneys and nervous system • Vomiting agents —chemicals that cause nausea and vomiting Introduction to Healthcare and Public Health in the US Public Health, Part 2 Lecture b

12. Nuclear or Radiation Terrorism • Both the sun and the earth are sources of natural, background radiation • Man-made radiation occurs from sources such as TV sets, microwave ovens, and X-rays • Nuclear terrorism threats are generally divided into • Radiological Dispersion Devices (RDDs), also known as "dirty bombs“. A means of dispersing radioactive materials • Radioactive contamination of drinking water or food supplies • Direct attacks on nuclear power plants or nuclear fuel reprocessing facilities • Use of nuclear weapons by countries • Locating radioactive sources in heavily populated areas • Public Health Preparedness and Response • Education and information for the public • Education and information for health care providers Introduction to Healthcare and Public Health in the US Public Health, Part 2 Lecture b

13. Public Health (Part 2)Summary – Lecture b • Four main categories of terrorism: • Bioterrorism • agricultural terrorism • chemical terrorism • nuclear/radiation terrorism • Categorization of bioterrorism agents • Laboratory Response Network Introduction to Healthcare and Public Health in the US Public Health, Part 2 Lecture b

14. Public Health (Part 2)References – Lecture b References Emergency Preparedness and Response - Bioterrorism Agents/Diseases. (n.d.). Retrieved December 6, 2011, from Centers for Disease Control and Prevention website: http://www.bt.cdc.gov/agent/agentlist-category.asp Emergency Preparedness and Response - Chemical Emergencies. (n.d.). Retrieved December 6, 2011, from Centers for Disease Control and Prevention website: http://www.bt.cdc.gov/chemical Emergency Preparedness and Response - Radiation Emergencies. (n.d.). Retrieved December 6, 2011, from Centers for Disease Control and Prevention website: http://www.bt.cdc.gov/radiation Introduction to Healthcare and Public Health in the US Public Health, Part 2 Lecture b