Leveraging Bioterrorism Preparedness for Nonbioterrorism Events: A Public Health Example

Abstract

When a local health department in Virginia learned that a deceased hospital-based nurse had worked for several months with undiagnosed and untreated active tuberculosis, it mounted an extraordinary effort to find, screen, test, and potentially treat numerous contacts. In responding to this challenge, it adapted plans, concepts, and equipment that had been recently developed or acquired for responding to acts of bioterrorism. The improved coordination and integration with community partners and participating agencies, fostered through bioterrorism preparedness planning, were keys to success. Using procedures developed and exercised to distribute prophylactic medication in the Strategic National Stockpile, the health department shifted philosophically from a program-specific response to a more integrated approach. Implementation of this mass tuberculosis-screening program was based on the principles of the Incident Command System (ICS). Owing to the efficiency of the operation, more than 2,500 people were quickly screened, and the rate of return for skin test readings was 91.6%, ranking it extremely high compared to the benchmarks. Overall, 5.9% of those tested were found to be infected with tuberculosis, and no cases of active tuberculosis were identified. This outcome demonstrated public health's improved ability to react, as a result of bioterrorism preparedness activities, to "traditional" public health mass events and non-bioterrorism emergencies.

Biological Warfare Plan in the 17th Century—the Siege of Candia, 1648–1669

“…In addition, the experience of preparing for bioterrorist attacks can be useful in control of other resurgent infectious diseases and nonbioterrorism emergencies ( 38 ). For resurgent infectious diseases and microbes classified as agents of biological terrorism, such as Mycobacterium tuberculosis , the health care community should have an infection control plan as a part of an overall control program ( 39 ).…”

Lessons Learned from Historic Plague Epidemics: The Relevance of an Ancient Disease in Modern Times

“…Some people asserted that such bioterrorism preparedness efforts diverted resources from other important public health needs, while others stated that the development of bioterrorism response programs leverage public health programs through improved infrastructure, planning, and exercises, thus improving one's ability to counter emerging and re-emerging infectious diseases. The authors of a comprehensive review published in 2005 on this very topic, concluded that the programs developed in the spirit of bioterrorism preparedness could in fact be used to improve the public health infrastructure in general, and specifically in its response capability to emerging and re-emerging infectious diseases [88]. It is apparent that in today's times various public health agencies worldwide are the key stakeholders in developing responses to emerging infectious disease threats.…”

Assessing Public Health Emergency Preparedness: Concepts, Tools, and Challenges

“…Other jurisdictions have used annual flu clinics to test mass dispensing procedures for the SNS program, which alleviates some of the costs associated with recruiting volunteers to act as test patients. Similarly, a local jurisdiction in Virginia recently used a tuberculosis screening process as an opportunity to stand up and exercise incident command structures (45). We refer to these sorts of activities as embedded assessments because they seek to embed preparedness assessment activities in routine activities and processes.…”