The Anthrax Epidemiologic Tool Kit: An Instrument for Public Health Preparedness

Dori B. Reissman, Ellen B. Steinberg, Julie M. Magri, Daniel B. Jernigan

Disclosures

Biosecur Bioterror. 2003;1(2) 

In This Article

Background

The Centers for Disease Control and Prevention (CDC) has coordinated numerous bioterrorism preparedness activities since 1999, including collaborating with health departments to build response capacity at the state and local levels, and identifying a priority schema for biological agents that might be used in a bioterrorist attack.[1,2] Identification of the index case of inhalational anthrax in Florida in October 2001, followed by additional cases in both Florida and other jurisdictions, underscored the crucial importance of bioterrorism preparedness.[3,4] The complexity of the anthrax investigations in multiple states (Connecticut, Florida, Maryland, New Jersey, New York, Colorado, and Missouri) and the District of Columbia demanded rapid epidemiologic and laboratory response. CDC sent investigation teams into the field to assist state and local health departments on site in each of the affected geographic areas.[4] Logistic, scientific, and clinical teams based at the CDC Emergency Operations Center (EOC) supported the field investigation teams.

Because of the prolonged nature and intensity of simultaneous investigations in different geographic areas, CDC field team members were rotated off and between field and EOC teams at varying intervals throughout the emergency response effort to minimize burnout. This staff rotation contrasted with typical CDC fieldwork in which the entire investigation is conducted by the same team for both field training/education and efficiency. The field response to the first anthrax bioterrorist attack in the United States required the development of new investigation materials as the situation evolved. Although some materials were available at CDC headquarters, field teams often had to develop their own materials on site. Development or refinement of investigation materials on site has been the practice of CDC field teams in routine situations because of new information learned after field deployment. However, we soon discovered that both field and EOC teams were duplicating efforts in the creation of databases, questionnaires, and public and health care provider information documents in order to meet response demands at local, state, regional, and national levels. Thus, there was a need to modify CDC's usual field approach to streamline efforts on site for a more efficient epidemiologic response to bioterrorism-related exposure and disease. A compendium of epidemiologic tools was needed to facilitate rapid epidemiologic investigations and to promote timely prevention and control activities.

To document the specific approaches used in each field investigation and to aid current and future public health emergency response efforts, we created an anthrax epidemiologic tool kit. Compilation of the tools began early in November 2001, while CDC was in the middle of multiple field investigations for anthrax. Our specific objectives were to develop a reference set of investigation tools, to create an inventory of the enhanced surveillance strategies, to centralize available information, to reduce duplication of effort, and to assist health departments and on-site field investigation teams.

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