State and local public health systems play a critical role in responding to emergencies and are central to the nation’s efforts to improve its preparedness for bioterrorism. Public health departments have faced some significant challenges over the years, and while there have been some successes the system as a whole has not always fared well. During the last half of the 20^thcentury, the capacity of state and local public health systems in the United States seriously declined (IOM, 1988, 2003). Problems in the system were graphically displayed during the anthrax terrorist attack in 2001, which revealed weaknesses in laboratory...

In this chapter, we provide some background on the four disease outbreaks covered in this report. Our goal is to lay out basic clinical and epidemiologic information and to provide an overview of the timeline for each outbreak in the United States.

We do not attempt to describe the public health response to these outbreaks, since that will be discussed in subsequent chapters. We do, however, discuss some critical milestones regarding each outbreak, particularly to provide a sense of how each disease developed over time. Additional information about the response in each state and local area visited can be found...

In this chapter we examine the public health assessment process used during the four outbreaks. Assessment is one of the three core functions of public health, and it includes efforts to collect, assemble, analyze, and make available information on the health of the community, and on community health needs (IOM, 1988). This chapter focuses on four key components of assessment in the context of public health preparedness: surveillance, epidemiological investigation, environmental monitoring, and laboratory analysis. Our goal is to understand which public health assessment activities were undertaken during the West Nile virus, SARS, monkeypox, and hepatitis A outbreaks and how...

This chapter focuses on two functional capacities: policy development and assurance. As one of the three core functions of public health, policy development includes developing recommendations to prevent further infections in health care and community settings and even enforcing quarantine laws (IOM, 1988). Assurance, another core function of public health, includes ensuring that individuals receive needed preventive care and disease treatment, whether it is directly provided by the health department or in private settings.

Regarding policy development, we focus here on the development of policies and procedures needed in the short term to control disease outbreaks during a public health...

Effective coordination and communication are important aspects of public health preparedness. Local public health departments stand at the nexus of a complex communications web linking those departments with health care providers (including hospitals, clinics, and physicians), other state and local governmental agencies, the media, government officials, and the public. Moreover, as the result of the history of federalism and the home-rule movement in the United States, public health authorities and resources are very diffuse. As a Constitutional matter, for instance, public health is primarily a state rather than a federal matter. In addition, many states grant substantial authorities to county,...

Clear, accurate, and timely communication with the public—often conducted through the media—is an important public health function, and as these case studies illustrate, such communication becomes especially critical during public health emergencies. Communication is important for educating the public about steps that individuals can take to reduce the spread of infectious disease and to protect themselves. During an emergency, and especially in an emergency caused by a bioterrorist attack, appropriate communication can reduce public concerns and anxiety, increase trust in public health officials, and increase the effectiveness of the response.

To illustrate these issues, this chapter focuses on...

In the previous chapters we have focused on several functional capabilities used by public health to respond to disease outbreaks. We now turn, in this and the next chapter, to a discussion of capacity-building activities, i.e., activities undertaken outside of the disease outbreaks in order to enable a more effective response. In this report, we have distinguished between policymaking that was done in the course of an outbreak (as discussed in Chapter 4) and long-term policy development. In this chapter, we discuss relevant activities that took place before some or all of the disease outbreaks under discussion, as well as...

We now focus on capacity-building activities related to infrastructure development. These include equipment and capabilities for public health departments and laboratories, such as equipment for lab testing as well as that needed for collecting and disseminating information (e.g., information technology improvements for disease reporting and alert notifications). The material covered in this chapter addresses two CDC Focus Areas: Focus Area C, Laboratory Capacity, and Focus Area E, Health Alert Networks/Communications and Information Technology.

The chapter is organized as follows. We first describe improvements in laboratory infrastructure. Then we describe information technology systems, including health alert networks and electronic reporting systems....

Between 1999 and 2004, state and local health departments around the United States were challenged with the emergence of mosquito-borne West Nile virus, the worldwide SARS epidemic, an outbreak of monkeypox, and a major food-borne hepatitis A outbreak. As described in the preceding chapters, these outbreaks tested many of the critical capabilities that the U.S. public health systems would need to respond to a bioterrorist attack. They also provided an opportunity for public health agencies to learn how to respond to similar events in the future, and about current problems in public health systems and gaps in resources.

In addition,...