Biology Reference
In-Depth Information
threats, whether natural or man-made, typically evolve through a series of
phases, such as those of pre-impact, impact, and post-impact characteris-
tics of a natural disaster. This has been illustrated by our experiences with
Hurricanes Katrina and Rita. Information needs, as well as methods of data
collection and analysis, will vary by phase.
17.3.1 System Objectives Should Drive Design
The evolution of syndromic surveillance over the past decade illustrates the
importance of setting clear objectives in designing any surveillance sys-
tem. Initial bioterrorism funds to CDC during 1999-2000 were designed to
build “multi-purpose” public health infrastructures for preparedness and
response, and, thus, lacked specific directives regarding surveillance activi-
ties. Following the anthrax attacks in late 2001, however, CDC and its state
and local public health partners began to emphasize the need for early detec-
tion of health threats. This is not surprising, considering that the United
States felt under siege after the opening of spore-laden letters in the offices of
a national news organization and within the Senate mail room. The series of
sneak attacks heralded an unprecedented period of uncertainty and anxious
dread for health officials and the general public.
Methods for early detection of outbreaks caused by bioterrorist attacks
rose to paramount value in the months following 9/11, as concerns about
weapons of mass destruction flooded the media during the build up to
the 2003 invasion of Iraq (Weiner 2007). Aerial photographs of Saddam
Hussein's mobile laboratories for generating stockpiles of offensive bio-
logical weapons circulated first in the intelligence community, and then
in the mainstream media, providing additional justification for the mili-
tary buildup to the impending conflict in the Gulf. In December 2002, the
president announced a national program to vaccinate health care workers
against smallpox. Although some experts in public health viewed this sud-
den announcement of a national program to vaccinate 50,000 health care
workers with skepticism, citing the opaque uncertainty about the likelihood
of such an attack, others supported these initiatives and began developing
local vaccination strategies for their health care workers. All things consid-
ered, these concerns were scientifically credible; a widely cited hypotheti-
cal model of an aerosolized anthrax outbreak published in 1997 (Kaufman
et al. 1997) clearly demonstrated the value of early detection, particularly in
terms of lives saved and economic costs averted.
During the unsettling times between 9/11 and the start of the Gulf II con-
flict, the CDC states, academic researchers, and the military responded by
creating numerous new systems specifically for bioterrorism surveillance.
Fueling this growth in surveillance systems was the increasing availability
of electronic patient-based data, as well as new methods for analyzing and
displaying data (Bravata 2004). Very early detection of disease outbreaks was
revered as an “emerging science” (Wagner et al. 2001). Concerned public health
