BioWatch and Public Health Surveillance Evaluating Systems for the Early Detection of Biological Threats: Abbreviated Version (2011) / Chapter Skim
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1 Introduction and Background
1 Introduction and Background
Pages 22-46
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Since the 1990s, growing concerns about bioterrorism and potential epidemics of emerging infectious diseases have spurred interest in developing new and better ways to detect biological threats as quickly as possible so that preventive measures or treatment can be started in time to reduce illnesses and deaths. After the 9/11 attacks and the anthrax letters in 2001, one response to the threat of bioterrorism was the initiation in 2003 of an environmental air monitoring program called BioWatch.
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is leading the federal activities with funding and other resources to support the development of a more robust capacity within the public health and the health care sectors to recognize unfamiliar illnesses or unusual clusters of cases, effectively assemble essential information to guide decision making, and speed deployment of an appropriate response. Despite improvements since 2001 in the nation's preparedness to detect and respond to bioterrorism or emerging infectious disease threats, some concerns remain.
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Committee members were selected to contribute expertise in areas that include biological threat assessments, evaluation of biological detection systems, environmental monitoring technologies, biological assays, microbiology, virology, epidemiology, syndromic surveillance, health information technology, the U.S. public health sector, hospital systems, emergency medicine, laboratory operations, statistical methods, systems engineering, operations research, and economic analysis.
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42) defines a catastrophic incident as "any natural or manmade incident, including terrorism, that results in extraordinary levels of mass casualties, damage, or disruption severely affecting the population, infrastructure, environment, economy, national morale, and/or government functions." The study considered detection of both deliberately introduced and naturally occurring infectious diseases -- that is, agents of bioterrorism and significant emerging infectious diseases such as pandemic influenza and SARS.
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The IOM/NRC shall provide sufficient staff support to organize meetings, generate reports and manage the contract. The IOM/NRC will: the federal, state, and local levels to mount a timely and effective response to the detection of a serious disease threat.
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The publication process for the final report will be completed following its public release. tially respond to international disease activity, did not examine disease surveillance systems in other countries or ones operated by international organizations.
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This includes the federal funding through CDC for public health surveillance activities, the cooperative agreement program to build state and local emergency preparedness capacity, and the Strategic National Stockpile.4 Excluding Project BioShield, the DHS funding includes the BioWatch program in OHA, the National Biosurveillance Integration Center, and research and development activities in the Science and Technology Directorate. Table 1-1 shows appropriated or proposed federal funding from FY 2007 through FY 2010 for specific activities in HHS and DHS.
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The amount of state and local support for disease surveillance and other activities related to bioterrorism is difficult to estimate because these activities are generally carried out as part of a system aimed at detecting and responding to naturally occurring diseases. BIOLOGICAL THREATS TO HUMAN HEALTH Potential Bioterrorism Agents Biological agents that might be deliberately introduced in an act of war or bioterrorism include a variety of bacteria, viruses, protozoa, multicellular parasites, and biological toxins.
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Epsilon toxin of Clostridium perfringens �ood safety threats, including national security community. In its work, the committee focused on surveillance for currently acknowledged bioterrorism threats, especially those addressed by the BioWatch program, but it recognizes the potential for other bioterrorism agents that may pose new surveillance challenges.
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However, aerosol dispersal is not the only way biological agents might be used. Detection of an alternative dispersal mode would require a means other than BioWatch.
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The potential for impacts similar to other national security threats provides the basis for the classification of bioterrorism agents as weapons of mass destruction. Naturally Occurring Infectious Disease Threats Among the potential emerging disease threats, a highly virulent, pandemic influenza is a leading concern.
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DETECTING BIOLOGICAL THREATS Routinely, health care providers, laboratories, and health departments work together to diagnose disease and recognize outbreaks that require a broader response than standard treatment provided for individual, unrelated cases. The BioWatch system is intended to provide an earlier warning to health departments of the aerosolized release of certain bioterrorism agents so that a rapid response can limit morbidity and mortality.
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For example, clinicians may recognize and report an increase in nonspecific manifestations of disease before syndromic surveillance systems yield statistical alarms. If laboratory testing of BioWatch samples were delayed, unusual trends in illness may be recognized before BioWatch yields an alert.
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However, the value of early detection may be less important or of unknown value for exposure to other agents, depending on the incubation period or the potential effectiveness of post-exposure prophylaxis. Furthermore, while failure to respond quickly in the face of a significant biological threat may have dire consequences, initiating an unnecessary response on the basis of misleading or erroneous information may have its own adverse results.
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With limited financial and personnel resources in state and local health departments to meet day-to-day responsibilities, it may prove challenging to maintain a specialized monitoring system for a low-probability, albeit potentially catastrophic, event. At the federal level as well, there are trade-offs to be made in allocating available resources for the full range of needed biosurveillance activities.
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defines biosurveillance as "the process of active data-gathering with appropriate analysis and interpretation of biosphere data that might relate to disease activity and threats to human or animal health -- whether infectious, toxic, metabolic, or otherwise, and regardless of intentional or natural origin -- in order to achieve early warning of health threats, early detection of health events, and overall situational awareness of disease activity." The full scope of biosurveillance as defined in HSPD-21 was beyond the scope of this report, which focuses on activities intended to detect threats to human health specifically from pathogens and biological toxins that might be used in bioterrorism or that might be associated with infectious diseases of public health significance. Detection may occur via means including environmental monitoring, clinical case finding, laboratory testing, or syndromic surveillance.
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. The organization and operation of public health services is implemented through various configurations of state and local health departments, working with federal agencies, health care providers and organizations, contractors, entities they regulate, and public–private
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In addition, both the health care and public health systems rely on an array of private- and public-sector laboratory services to detect, confirm, and report evidence of infectious disease. CONSIDERATIONS GUIDING THE COMMITTEE'S WORK This report focuses on the committee's assessment of BioWatch and its relation to infectious disease surveillance through the public health and health care systems for detection of bioterrorist attacks.
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The health care and public health systems, however, need the capacity to detect and respond both to the health threats posed by the aerosolized pathogens that BioWatch is designed to detect and to the full range of other infectious disease threats. Regardless of how a significant biological threat is detected, the response is likely to require an array of resources, including not only public health and health care but also emergency response and law enforcement.
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. The existence of the BioWatch program bears witness to a perceived threat to the nation from the intentional release of aerosolized biological agents.
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. Also ongoing are local, regional, and national efforts to advance the development and adoption of health information technology, including electronic medical records and health information exchanges.
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The issues being examined include the causes of and trends in the emergence and spread over the past several decades of agents of zoonotic origin; the risks of animal and human interactions, especially for diseases of international significance such as H5N1 influenza; lessons from previous human and animal health responses to emergent zoonotic diseases; the current state of and gaps in global systems for surveillance of zoonotic infections in human and animal populations; and the appropriate balance between emergency response to threats and sustainable global surveillance capacity. THE COMMITTEE'S REPORT This report provides a review and assessment of the effectiveness and costs of surveillance for and detection of disease threats through the BioWatch program and through the U.S.
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2004. Emerging infectious diseases: Review of state and federal disease surveillance efforts.
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Emerging Infectious diseases 8(10)
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2004. Homeland Security Presidential directive 0 (HSPd-0)
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