September 26, 2002
Center for Biologic Counterterrorism & Emerging Diseases
By Daniel R. Lucey, MD MPH,
Welcome to BEPAST.org -- website of the Center for Biologic Counterterrorism and Emerging Diseases. The Center, based in Washington DC, is hosted by the Medstar Health group, one of the nation's largest not-for-profit hospital groups. Washington Hospital Center, the physical home of CBCED, is located just north of the Capitol building -- about one minute away by helicopter. WHC is the largest hospital in the District of Columbia by a substantial margin, and includes the largest and busiest emergency room, a flight program with four helicopters, a major trauma center, and the regional burn center. Because of its unique location and special programs, the hospital received all major burn victims from the 9/11 attack on the Pentagon, and was also at the epicenter of the anthrax exposure events in the Autumn of 2001.
This website provides information relevant to Mitigation, Preparedness, Response, and Recovery from the medical sequelae of a terrorist attack involving biological weapons. An equally important focus will be on preparation for and response to naturally occurring outbreaks of emerging diseases, particularly outbreaks of significant national proportions. The website name “BEPAST” is our acronym for the six major “Category A” bioterrorism agents:
· Ebola and other viral hemorrhagic fevers
Regional Preparedness Forums
We recommend that each concerned medical community should establish monthly bioterrorism preparedness forums for interested medical, public health, and first-responder personnel. Such forums have been underway in the DC Metropolitan region (DC, Maryland, and Virginia) since the beginning of 2002, and are open to all interested persons. All major Category A agents have been discussed, with an early emphasis on anthrax and smallpox. Speakers in our region have included experts from MedStar, The National Institutes of Health, Howard University, Johns Hopkins University, the National Naval Medical Center, Walter Reed Army Institute of Research, and the Army Medical Command.
Hospital preparation for a potential bioterrorism event begins with the distribution of written information on the diagnosis, treatment, and containment of the major bioterrorism agents. The next step is to obtain a sufficient supply of additional antibiotics and respiratory (N-95) masks – both for hospital personnel and for potential patients. For the best balance of cost, efficiency, and readiness, we recommend that rapid-response antibiotics be bottled in three day supplies. It's important to rehearse protocols with the microbiology laboratory to ensure that any clinical suspicion is communicated to the laboratory and to establish protocols for early alerting when suspicious bacterial isolates are identified. In view of the potentially devastating effects of a smallpox outbreak, it is now time for most centers to establish a training module in the use of the special bifurcated needle, providing hands-on training with an artificial deltoid muscle to allow practice in carrying out the required 15 intradermal insertions of the needle. CBCED has developed and deployed such a training module, and can offer advice based on our limited experience.
Planning for smallpox vaccination -- whether as a preparedness measure or as a response to a confirmed case of the disease -- depends on assessments of risk, benefit, and rationale. At this writing, the CDC has just released an updated CDC Smallpox Response Plan and Guidelines document that will be discussed in an upcoming issue of Updates in Bioterrorism. Optimizing the safety of the vaccination process will be essential to maintain public health and also to maintain the public’s trust in this effort; pragmatic issues that need to be addressed and standardized include:
Ř How best to screen vaccine volunteers for contraindications to vaccine (such as immunodeficiency and a history of eczema)
Ř Whether persons vaccinated should stay home from work to minimize transmission of vaccinia virus to contacts
Ř How best to care for the vaccination site to minimize risk of spreading the vaccinia virus
Ř How to manage liability issues
Ř How to address financial issues related to time lost from work.
We hope the Center for Biologic Counterterrorism and Emerging Diseases will be a useful resource for the nation's health community. Welcome to our website.
Daniel R. Lucey, MD, MPH
Director, Center for Biologic Counterrorism and Emerging Diseases