CDC leads effort to increase antibiotic stockpile in case of attack. (Bioterrorism).

NEW ORLEANS -- The Centers for Disease Control and Prevention (CDC) has ramped up efforts to cooperate with local communities in bioterrorism preparedness efforts, notably by increasing the number of emergency "push packages" of antibiotics in case of an attack, industry learned here Dec. 10.

Stephen Morse, Ph.D., associate director for Science, Bioterrorism Preparedness and Response Program told attendees of the Parenteral Drug Assn's (PDA) annual meeting here Dec. 10: "Bioterrorism preparedness efforts have to begin at the local level," Morse explained. A cooperative agreement between CDC and the states, begun in September 1999, was developed to help states meet this challenge.

Morse identified the four parts of the public health response to bioterrorism as detection, rapid laboratory diagnosis, epidemiologic investigations, and implementation of control measures. "As a result of the anthrax attacks last fall, an emergency supplemental of $1 billion was given out to the states to upgrade their ability in each of these areas to respond to a bioterrorism attack," he said.

Morse used the National Pharmaceutical Stockpile (NPS) as an example of how the cooperative agreement works (the NPS will soon be moved to the brand-new Department of Homeland Security). The NPS comprises a number of "push packages" that are kept at secure locations around the country.

There currently exist eight push packages, Morse said, but this number will soon be increased to 12. A push package is designed to supplement local medical supplies. Each package is composed of more than 100 specialized cargo containers, weighs 94,424 pounds, and measures 10,329 cubic feet. Each contains antibiotics for plague, tularemia, and anthrax. One package can provide prophylaxis for 357,000 people for seven days and therapeutic treatment for 6,000 people for seven days.

"A push package can be moved to any location in the United States within 12 hours of deployment," Morse said. The CDC is responsible for getting the package to its location. The state is responsible for dispensing its contents within its jurisdiction. "On 9/11, New York City requested a push package. The CDC pharmaceutical stockpile plane was one of only three planes flying that day. It got a push package to New York City within six hours."

Although antibiotics are part of the NPS, it does not currently contain vaccines. The smallpox vaccine will soon become part of the NPS, however.

Another part of CDC's public health improvement plan has been the upgrade of the Laboratory Response Network (LRN). The LRN is a nationwide partnership begun in 1999 through which lower-level labs perform rule-out testing on critical bioterrorism agents, and refer suspect agents to higher-level labs for further testing

Recognizing rapid identification of agents as the major factor in successful response to an attack, Morse said CDC has provided labs with algorithms whereby clinical labs could rapidly rule out specific agents. Each LRN also receives agent-specific protocols, standardized reagents and controls, a lab referral directory, secure communications, appropriate training, proficiency testing, and appropriate vaccinations for lab workers.

During the anthrax attacks in the Northeast U.S. in fall 2001, the LRN was used successfully to confirm the presence of anthrax in the first victim within a few hours. "The system worked, and worked well," Morse said.

Morse's presentation is $15 plus retrieval, Doc. 111663R