Download Ed Thompson, MD, MPH Building Legal Preparedness for Public Health Emergencies

Building Legal Preparedness for Public Health Emergencies
National Association of Attorneys General
East Lansing, Michigan – April 19, 2005
Ed Thompson, MD, MPH
Chief of Public Health Practice
Centers for Diseases Control and Prevention
Mississippi
State Department of Health
CSTE
The American Public Health System
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ANTHRAX
ANTHRAX
Disease Surveillance
Reporting of Disease
Gram stain of CSF, first Florida case
From Jernigan, et.al., in CDC: Emerging Infectious Disease Nov.-Dec., 2001
MMWR October 19, 2001:
Florida
On October 2, the Palm Beach County Health Department (PBCHD) and the
Florida Department of Health (FDOH) were notified of a possible anthrax case in
Palm Beach County. The suspected case was identified when a gram stain of
cerebrospinal fluid (CSF) revealed a gram-positive bacilli. An epidemiologic
investigation was initiated by FDOH, PBCHD, and the FDOH state laboratory.
The state laboratory and CDC confirmed B. anthracis from a culture of CSF on
October 4. Later the same day, FDOH and CDC epidemiologists and laboratory
workers arrived in Palm Beach County to assist PBCHD with the investigation.
As of October 16, two confirmed cases of inhalational anthrax have been
identified.
MMWR October 19, 2001:
Florida
On October 2, the Palm Beach County Health Department (PBCHD) and the
Florida Department of Health (FDOH) were notified of a possible anthrax case in
Palm Beach County. The suspected case was identified when a gram stain of
cerebrospinal fluid (CSF) revealed a gram-positive bacilli. An epidemiologic
investigation
was initiated
by FDOH,
PBCHD, County
and the FDOH
state laboratory.
On October
2, the
Palm Beach
Health
The state laboratory and CDC confirmed B. anthracis from a culture of CSF on
Department
(PBCHD)
andandthe
Florida
Department
October
4. Later the same
day, FDOH
CDC
epidemiologists
and laboratory
workers
in Palm
County
PBCHDanthrax
with the investigation.
ofarrived
Health
wereBeach
notified
oftoaassist
possible
case
As of October 16, two confirmed cases of inhalational anthrax have been
in Palm Beach County.
identified.
Outbreak of West Nile-Like Viral Encephalitis -New York, 1999
An outbreak of arboviral encephalitis was first recognized in New York City in late August
and has since been identified in neighboring counties in New York state. Although initially
attributed to St. Louis encephalitis (SLE) virus based on positive serologic findings in
cerebrospinal fluid (CSF) and serum samples using a virus-specific IgM-capture enzymelinked immunosorbent assay (ELISA), the cause of the outbreak has been confirmed as a
West Nile-like virus based on the identification of virus in human, avian, and mosquito
samples.
On August 23, 1999, an infectious disease physician from a hospital in northern Queens
contacted the New York City Department of Health (NYCDOH) to report two patients with
encephalitis. On investigation, NYCDOH initially identified a cluster of six patients with
encephalitis, five of whom had profound muscle weakness (with axonal neuropathy by
electromyelogram and requiring respiratory support [n=four]).
On August 23, 1999, an infectious disease physician
a hospital
in northern
Queens
contacted--the New
Outbreakfrom
of West
Nile-Like
Viral
Encephalitis
York CityNew
Department
Health (NYCDOH) to report two
York, of
1999
patients
with encephalitis.
An outbreak of arboviral
encephalitis
was first recognized in New York City in late August
and has since been identified in neighboring counties in New York state. Although initially
attributed to St. Louis encephalitis (SLE) virus based on positive serologic findings in
cerebrospinal fluid (CSF) and serum samples using a virus-specific IgM-capture enzymelinked immunosorbent assay (ELISA), the cause of the outbreak has been confirmed as a
West Nile-like virus based on the identification of virus in human, avian, and mosquito
samples.
On August 23, 1999, an infectious disease physician from a hospital in northern Queens
contacted the New York City Department of Health (NYCDOH) to report two patients with
encephalitis. On investigation, NYCDOH initially identified a cluster of six patients with
encephalitis, five of whom had profound muscle weakness (with axonal neuropathy by
electromyelogram and requiring respiratory support [n=four]).
Public
CDC
Health
Department
FEEDBACK
REPORTING
Practitioners
Recognition of
Disease
Natural Infection
Occurrence
of Disease
Induced Infection
Nationally Notifiable Disease
Surveillance System
Authority: Police Powers of the States
Reporting to State (and sometimes local) health departments
is mandatory under state law and/or regulation
Reports from practitioners to states typically include names.
Nationally Notifiable Disease
Surveillance System
Reporting by states to CDC is voluntary by agreement
Reports from states to CDC do not include names
ACTION
Health
Department
FEEDBACK
REPORTING
Practitioners
Recognition of
Disease
Natural Infection
Occurrence
of Disease
Induced Infection
Isolation and Quarantine
Contact Tracing
Isolation
SARS
Quarantine
Restriction of activity /
separation of sick
infected person(s) with
contagious disease;
Restriction of activity /
separation of well
person(s) exposed to
contagious disease;
usually in a hospital setting,
but can also be at home or
in a dedicated isolation
facility
usually at home, but can also
be in a dedicated quarantine
facility
Individuals or
community/population
SARS
Potentially fatal lung disease.
Isolation and quarantine
Among proven tools
TB
Potentially fatal lung disease.
Isolation and quarantine
Among proven tools
Building Effective Public HealthHealth Care Legal Partnerships
www.cdc.gov/privacyrule
www.CDC.gov