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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 S T A T E L O C A L LAW F E D E R A L 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