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Bioterrorism Preparedness Takes on New Urgency.

WASHINGTON -- The threat of bioterrorism became much more immediate following the devastating airliner attacks on New York and Washington.

The Sept. 11 assault came just weeks after Department of Health and Human Services Secretary Tommy G. Thompson appointed a physician with expertise in bioterrorism preparedness to coordinate a medical and public health response effort.

Dr. Scott Lillibridge, the new HHS special assistant for bioterrorism, had an 11-year career at the Centers for Disease Control and Prevention. In 1998 he became the director of the CDC's bioterrorism preparedness and response program.

Dr. Lillibridge's appointment will help overcome the fragmentation that has long beset federal bioterrorism response plans, said a spokeswoman for Rep. Saxby Chambliss (R-Ga.), chairman of the Speaker's Working Group on Terrorism.

HHS has created the National Disaster Medical System, a joint project of the Office of Emergency Preparedness, the Federal Emergency Management Agency the Department of Defense, the Department of Veterans Affairs, and the private sector. (See related story on p. 4.)

Goals include improved surveillance through the CDC and state and local public health departments, and provision of adequate medical supplies, Mr. Thompson said at a July policy summit on domestic terrorism sponsored by the National Governors Association.

He and others voiced concern about the medical community's preparedness.

Dr. Thomas Ingelsby, a senior fellow at the Johns Hopkins Center for Civilian Biodefense Studies in Baltimore, cited deficiencies in the public health system, inadequate supplies of vaccines and medicines, and a shortage of hospital isolation rooms for highly contagious people.

Also, "American physicians are not trained to recognize anthrax, Ebola, or smallpox. Few have seen plague," he said.

Symptoms of anthrax, Ebola virus, and smallpox could easily be mistaken for those of influenza during the first few days of illness, said Lt. Col. Michael Roy, MC, USA, director of military internal medicine at the Uniformed Services University of the Health Sciences, Bethesda, Md.

Anthrax and Ebola virus infection initially present with flulike symptoms, such as fever; muscle aches; headaches; joint aches; and, sometimes, nausea and vomiting, Dr. Roy said in an interview Such symptoms predominate for the first 2-3 days, and for up to 4-6 days in some cases. Ebola virus infection also can cause coughing, diarrhea, sore throat, and chest pain.

Physicians who begin to see many patients with these symptoms are likely to suspect influenza or another viral epidemic. One clue could be a common denominator such as attendance at a major sports event, he said.

After 2-3 days, people with anthrax can become hypoxic and develop shortness of breath. Widening of the mediastinum on chest x-ray, caused by bleeding into the mediastinum, is a "fairly distinctive" sign of anthrax. Treatment is unlikely to help at this stage, but early identification of the outbreak could save subsequent patients.

Ciprofloxacin, approved last year for reducing the incidence or progression of inhalational anthrax after exposure, is effective when used early.

After a few days of the flulike stage, Ebola virus infection causes a fairly diffuse, nonspecific, maculopapular rash. About day 5, coma or significant neurologic deterioration occurs as do signs of bleeding into the skin, with bruising and petechiae.

CDC 'Push Package' Program Deployed

Sally Peters

A new rapid-response program within the Centers for Disease Control and Prevention that provides truckloads of medical supplies to disaster sites was activated for the first time in response to the terrorist attack on New York.

Created 2 years ago as part of a CDC plan to prepare for a bioterrorist attack, the National Pharmaceutical Stockpile (NPS) program provides backup supplies and support for medical personnel already on site. It can deploy "12-hour push packages" to any U.S. location within 12 hours; additional pharmaceuticals and medical supplies are shipped in a second-tier response.

Each "push package" consists of several truckloads of prepackaged pharmaceuticals, intravenous supplies, air-way supplies, bandages, dressings, and other materials. These supplies are cached in eight undisclosed storage facilities around the country.

A push package arrived in New York 7 hours after it was requested, a Department of Health and Human Services spokesman said. The city made the request at 2 p.m.; the supplies arrived at 9 p.m. and were distributed by the New York City Department of Health through local authorities. Eleven technical assistants from HHS accompanied the package to New York.

"Our emergency resources stand ready to be provided quickly to those who need them," HHS Secretary Tommy C. Thompson told the press.
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Comment:Bioterrorism Preparedness Takes on New Urgency.
Publication:Family Practice News
Article Type:Brief Article
Geographic Code:1USA
Date:Oct 1, 2001
Previous Article:Most FPs Strongly Recommend Pneumococcal Vaccine.

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