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Placing Bioterrorism in its Context

Placing Bioterrorism in its Context. Dr. C. de Ville de Goyet. The Anthrax great scare. A demonstration of the superiority of informal reporting systems Six deaths: A society overwhelmed with fear Not a new threat!. Anthrax Threats Reported to FBI.

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Placing Bioterrorism in its Context

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  1. Placing Bioterrorism in its Context Dr. C. de Ville de Goyet

  2. The Anthrax great scare • A demonstration of the superiority of informal reporting systems • Six deaths: A society overwhelmed with fear • Not a new threat!

  3. Anthrax Threats Reported to FBI Source: M. Lyons, CDC from FBI personal communication to Dr. Eric Noji

  4. A critical look at some slides from CDC Most of the slides used are from Dr. Eric Noji Presentation at the PAHO Senior Managers Meetings in Nov 2001. Those slides have a blue background

  5. Public Health Response to… Bio-terrorism • Detection & surveillance • Rapid laboratory diagnosis • Epidemiologic investigations • Implementation of control measures

  6. 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?

  7. Bioterrorism Surveillance • 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

  8. 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

  9. Syndrome Surveillance • The monitoring of illnesses based upon a constellation of symptoms and/or findings • Provides an “early warning system” for outbreaks, emerging pathogens

  10. Agents Anthrax Plague Q-fever Tularemia Smallpox Initial Symptoms Fever Cough Malaise Headache Likely BT Agents: Initial Symptoms

  11. Current Challenges • Identification of localized clusters • Sustainability of surveillance system • Development of response protocols

  12. 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?

  13. The “Unasked” Questions • What is the real risk of terrorism act in the Caribbean? • How much to invest (i.e. divert resources from other health priorities) for terrorism counter-measures? • Cost-effectiveness?

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