Recommendations of the CDC Strategic Planning Workgroup
The following CDC staff members prepared this report:
Ali S. Khan, M.D.
Alexandra M. Levitt, M.A., Ph.D.
National Center for Infectious Diseases
Michael J. Sage, M.P.H.
National Center for Environment Health
in collaboration with the CDC Strategic Planning Workgroup
Samuel L. Groseclose, D.V.M., M.P.H.
Epidemiology Program Office
Edwin Kent Gray
Elaine W. Gunter
Alison B. Johnson, M.P.A.
Anne L. Wilson, M.S.
National Center for Environmental Health
David A. Ashford, D.V.M., M.P.H., D.Sc.
Robert B. Craven, M.D.
Robert P. Gaynes, M.D.
Stephen A. Morse, Ph.D.
Clarence J. Peters, M.D.
Richard A. Spiegel, D.V.M., M.P.H.
David L. Swerdlow, M.D.
National Center for Infectious Diseases
Scott D. Deitchman, M.D., M.P.H.
National Institute for Occupational Safety and Health
Paul K. Halverson, Dr.P.H., M.H.S.A.
Public Health Practice Program Office
Joseph Hughart, M.P.H.
Agency for Toxic Substances and Disease Registry
Patricia Quinlisk, M.D.
Iowa Department of Health
Des Moines, Iowa
Biological and Chemical Terrorism:Strategic Plan
for Preparedness and Response
Recommendations of the CDC Strategic Planning Workgroup
". . . and he that will not apply new remedies must expect new evils; for time is
the greatest innovator. . . ."
--The Essays by Sir Francis Bacon, 1601
Summary
The U.S. national civilian vulnerability to the deliberate use of biological
and chemical agents has been highlighted by recognition of substantial
biological weapons development programs and arsenals in foreign countries, attempts
to acquire or possess biological agents by militants, and high-profile
terrorist attacks. Evaluation of this vulnerability has focused on the role public health
will have detecting and managing the probable covert biological terrorist incident
with the realization that the U.S. local, state, and federal infrastructure is
already strained as a result of other important public health problems. In partnership
with representatives for local and state health departments, other federal
agencies, and medical and public health professional associations, CDC has developed
a strategic plan to address the deliberate dissemination of biological or
chemical agents. The plan contains recommendations to reduce U.S. vulnerability
to biological and chemical terrorism --- preparedness planning, detection
and surveillance, laboratory analysis, emergency response, and
communication systems. Training and research are integral components for achieving
these recommendations. Success of the plan hinges on strengthening the
relationships between medical and public health professionals and on building new
partner-ships with emergency management, the military, and law enforcement professionals.
INTRODUCTION
An act of biological or chemical terrorism might range from dissemination of
aerosolized anthrax spores to food product contamination, and predicting when and how
such an attack might occur is not possible. However, the possibility of biological or
chemical terrorism should not be ignored, especially in light of events during the past 10
years (e.g., the sarin gas attack in the Tokyo subway
[1] and the discovery of military bioweapons programs in Iraq and the former Soviet Union
[2]). Preparing the nation to address this threat is a formidable challenge, but the consequences of being
unprepared could be devastating.
The public health infrastructure must be prepared to prevent illness and injury
that would result from biological and chemical terrorism, especially a covert terrorist
attack. As with emerging infectious diseases, early detection and control of biological or
chemical attacks depends on a strong and flexible public health system at the local, state,
and federal levels. In addition, primary health-care providers throughout the United
States must be vigilant because they will probably be the first to observe and report
unusual illnesses or injuries.
This report is a summary of the recommendations made by CDC's Strategic
Planning Workgroup in Preparedness and Response to Biological and Chemical Terrorism: A
Strategic Plan (CDC, unpublished report,
2000), which outlines steps for strengthening
public health and health-care capacity to protect the United States against these
dangers. This strategic plan marks the first time that CDC has joined with law enforcement,
intelligence, and defense agencies in addition to traditional CDC partners to address a
national security threat.
As a reflection of the need for broad-based public health involvement in
terrorism preparedness and planning, staff from CDC's centers, institute, and offices participated
in developing the strategic plan, including the
National Center for Infectious Diseases,
National Center for Environmental Health,
Public Health Practice Program Office,
Epidemiology Program Office,
National Institute for Occupational Safety and Health,
Office of Health and Safety,
National Immunization Program, and
National Center for Injury Prevention and Control.
The Agency for Toxic Substances and Disease Registry (ATSDR) is also participating
with CDC in this effort and will provide expertise in the area of industrial chemical
terrorism. In this report, the term CDC includes ATSDR when activities related to chemical
terrorism are discussed. In addition, colleagues from local, state, and federal agencies;
emergency medical services (EMS); professional societies; universities and medical
centers; and private industry provided suggestions and constructive criticism.
Combating biological and chemical terrorism will require capitalizing on advances
in technology, information systems, and medical sciences. Preparedness will also require
a re-examination of core public health activities (e.g., disease surveillance) in light of
these advances. Preparedness efforts by public health agencies and primary health-care
providers to detect and respond to biological and chemical terrorism will have the
added benefit of strengthening the U.S. capacity for identifying and controlling injuries
and emerging infectious diseases.
U.S. VULNERABILITY TO BIOLOGICAL
AND CHEMICAL TERRORISM
Terrorist incidents in the United States and elsewhere involving bacterial
pathogens (3), nerve gas (1), and a lethal plant toxin (i.e., ricin)
(4), have demonstrated that the United States is vulnerable to biological and chemical threats as well as
explosives. Recipes for preparing "homemade" agents are readily available
(5), and reports of arsenals of military bioweapons
(2) raise the possibility that terrorists might have access
to highly dangerous agents, which have been engineered for mass dissemination as
small-particle aerosols. Such agents as the variola virus, the causative agent of smallpox,
are highly contagious and often fatal. Responding to large-scale outbreaks caused by
these
agents will require the rapid mobilization of public health workers, emergency
responders, and private health-care providers. Large-scale outbreaks will also require rapid
procurement and distribution of large quantities of drugs and vaccines, which must be
available quickly.
OVERT VERSUS COVERT TERRORIST ATTACKS
In the past, most planning for emergency response to terrorism has been
concerned with overt attacks (e.g., bombings). Chemical terrorism acts are likely to be overt
because the effects of chemical agents absorbed through inhalation or by
absorption through the skin or mucous membranes are usually immediate and obvious. Such
attacks elicit immediate response from police, fire, and EMS personnel.
In contrast, attacks with biological agents are more likely to be covert. They
present different challenges and require an additional dimension of emergency planning
that involves the public health infrastructure (Box 1). Covert dissemination of a
biological agent in a public place will not have an immediate impact because of the delay
between exposure and onset of illness (i.e., the incubation period). Consequently, the first
casualties of a covert attack probably will be identified by physicians or other primary
health-care providers. For example, in the event of a covert release of the contagious
variola virus, patients will appear in doctors' offices, clinics, and emergency rooms during
the first or second week, complaining of fever, back pain, headache, nausea, and other
symptoms of what initially might appear to be an ordinary viral infection. As the
disease progresses, these persons will develop the papular rash characteristic of
early-stage smallpox, a rash that physicians might not recognize immediately. By the time the
rash becomes pustular and patients begin to die, the terrorists would be far away and
the disease disseminated through the population by person-to-person contact. Only a
short window of opportunity will exist between the time the first cases are identified and
a second wave of the population becomes ill. During that brief period, public health
officials will need to determine that an attack has occurred, identify the organism, and
prevent more casualties through prevention strategies (e.g., mass vaccination or
prophylactic treatment). As person-to-person contact continues, successive waves of
transmission could carry infection to other worldwide localities. These issues might also be
relevant for other person-to-person transmissible etiologic agents (e.g., plague or certain
viral hemorrhagic fevers).
Certain chemical agents can also be delivered covertly through contaminated food
or water. In 1999, the vulnerability of the food supply was illustrated in Belgium,
when
chickens were unintentionally exposed to dioxin-contaminated fat used to make
animal feed (6). Because the contamination was not discovered for months, the dioxin, a
cancer-causing chemical that does not cause immediate symptoms in humans, was
probably present in chicken meat and eggs sold in Europe during early 1999. This
incident underscores the need for prompt diagnoses of unusual or suspicious health
problems in animals as well as humans, a lesson that was also demonstrated by the recent
outbreak of mosquitoborne West Nile virus in birds and humans in New York City in
1999. The dioxin episode also demonstrates how a covert act of foodborne biological or
chemical terrorism could affect commerce and human or animal health.
FOCUSING PREPAREDNESS ACTIVITIES
Early detection of and response to biological or chemical terrorism are crucial.
Without special preparation at the local and state levels, a large-scale attack with
variola virus, aerosolized anthrax spores, a nerve gas, or a foodborne biological or
chemical agent could overwhelm the local and perhaps national public health
infrastructure. Large numbers of patients, including both infected persons and the "worried
well," would seek medical attention, with a corresponding need for medical supplies,
diagnostic tests, and hospital beds. Emergency responders, health-care workers, and
public health officials could be at special risk, and everyday life would be disrupted as a
result of widespread fear of contagion.
Preparedness for terrorist-caused outbreaks and injuries is an essential
component of the U.S. public health surveillance and response system, which is designed to
protect the population against any unusual public health event (e.g., influenza pandemics,
contaminated municipal water supplies, or intentional dissemination of
Yersinia pestis, the causative agent of plague
[7]). The epidemiologic skills, surveillance methods,
diagnostic techniques, and physical resources required to detect and investigate unusual
or unknown diseases, as well as syndromes or injuries caused by chemical accidents,
are similar to those needed to identify and respond to an attack with a biological or
chemical agent. However, public health agencies must prepare also for the special features
a terrorist attack probably would have (e.g., mass casualties or the use of rare
agents) (Boxes 2-5). Terrorists might use combinations of these agents, attack in more than
one location simultaneously, use new agents, or use organisms that are not on the
critical list (e.g., common, drug-resistant, or genetically engineered pathogens). Lists of
critical biological and chemical agents will need to be modified as new information
becomes available. In addition, each state and locality will need to adapt the lists to local
conditions and preparedness needs by using the criteria provided in CDC's strategic plan.
Potential biological and chemical agents are numerous, and the public health
infrastructure must be equipped to quickly resolve crises that would arise from a
biological or chemical attack. However, to best protect the public, the preparedness efforts
must be focused on agents that might have the greatest impact on U.S. health and
security, especially agents that are highly contagious or that can be engineered for
widespread dissemination via small-particle aerosols. Preparing the nation to address these
dangers is a major challenge to U.S. public health systems and health-care providers.
Early detection requires increased biological and chemical terrorism awareness among
front-line health-care providers because they are in the best position to report
suspicious illnesses and injuries. Also, early detection will require improved communication
systems between those providers and public health officials. In addition, state and
local
health-care agencies must have enhanced capacity to investigate unusual events
and unexplained illnesses, and diagnostic laboratories must be equipped to identify
biological and chemical agents that rarely are seen in the United States. Fundamental to
these efforts is comprehensive, integrated training designed to ensure core competency
in public health preparedness and the highest levels of scientific expertise among
local, state, and federal partners.
KEY FOCUS AREAS
CDC's strategic plan is based on the following five focus areas, with each area
integrating training and research:
preparedness and prevention;
detection and surveillance;
diagnosis and characterization of biological and chemical agents;
response; and
communication.
Preparedness and Prevention
Detection, diagnosis, and mitigation of illness and injury caused by biological
and chemical terrorism is a complex process that involves numerous partners and
activities. Meeting this challenge will require special emergency preparedness in all cities
and
states. CDC will provide public health guidelines, support, and technical assistance
to local and state public health agencies as they develop coordinated preparedness
plans and response protocols. CDC also will provide self-assessment tools for terrorism
preparedness, including performance standards, attack simulations, and other exercises.
In addition, CDC will encourage and support applied research to develop innovative
tools and strategies to prevent or mitigate illness and injury caused by biological and
chemical terrorism.
Detection and Surveillance
Early detection is essential for ensuring a prompt response to a biological or
chemical attack, including the provision of prophylactic medicines, chemical antidotes, or
vaccines. CDC will integrate surveillance for illness and injury resulting from biological
and chemical terrorism into the U.S. disease surveillance systems, while developing
new mechanisms for detecting, evaluating, and reporting suspicious events that might
represent covert terrorist acts. As part of this effort, CDC and state and local health
agencies will form partnerships with front-line medical personnel in hospital emergency
departments, hospital care facilities, poison control centers, and other offices to enhance
detection and reporting of unexplained injuries and illnesses as part of routine
surveillance mechanisms for biological and chemical terrorism.
Diagnosis and Characterization of Biological and
Chemical Agents
CDC and its partners will create a multilevel laboratory response network
for bioterrorism (LRNB). That network will link clinical labs to public health agencies in
all states, districts, territories, and selected cities and counties and to state-of-the-art
facilities that can analyze biological agents (Figure 1). As part of this effort, CDC will
transfer diagnostic technology to state health laboratories and others who will
perform
initial testing. CDC will also create an in-house rapid-response and advanced technology
(RRAT) laboratory. This laboratory will provide around-the-clock diagnostic confirmatory
and reference support for terrorism response teams. This network will include the
regional chemical laboratories for diagnosing human exposure to chemical agents and
provide links with other departments (e.g., the U.S. Environmental Protection Agency, which
is responsible for environmental sampling).
Response
A comprehensive public health response to a biological or chemical terrorist
event involves epidemiologic investigation, medical treatment and prophylaxis for
affected persons, and the initiation of disease prevention or environmental
decontamination measures. CDC will assist state and local health agencies in developing resources
and expertise for investigating unusual events and unexplained illnesses. In the event of
a confirmed terrorist attack, CDC will coordinate with other federal agencies in accord
with Presidential Decision Directive (PDD) 39. PDD 39 designates the Federal Bureau of
Investigation as the lead agency for the crisis plan and charges the Federal
Emergency Management Agency with ensuring that the federal response management is
adequate to respond to the consequences of terrorism (8). If requested by a state health
agency, CDC will deploy response teams to investigate unexplained or suspicious illnesses
or
unusual etiologic agents and provide on-site consultation regarding medical
management and disease control. To ensure the availability, procurement, and delivery of
medical supplies, devices, and equipment that might be needed to respond to
terrorist-caused illness or injury, CDC will maintain a national pharmaceutical stockpile.
Communication Systems
U.S. preparedness to mitigate the public health consequences of biological and
chemical terrorism depends on the coordinated activities of well-trained health-care and
public health personnel throughout the United States who have access to up-to-the
minute emergency information. Effective communication with the public through the news
media will also be essential to limit terrorists' ability to induce public panic and disrupt
daily life. During the next 5 years, CDC will work with state and local health agencies
to develop a) a state-of-the-art communication system that will support disease
surveillance; b) rapid notification and information exchange regarding disease outbreaks
that are possibly related to bioterrorism; c) dissemination of diagnostic results and
emergency health information; and d) coordination of emergency response activities.
Through this network and similar mechanisms, CDC will provide terrorism-related training
to epidemiologists and laboratorians, emergency responders, emergency department
personnel and other front-line health-care providers, and health and safety personnel.
PARTNERSHIPS AND IMPLEMENTATION
Implementation of the objectives outlined in CDC's strategic plan will be
coordinated through CDC's Bioterrorism Preparedness and Response Program. Program
personnel are charged with a) helping build local and state preparedness, b) developing U.S.
expertise regarding potential threat agents, and c) coordinating response activities
during actual bioterrorist events. Program staff have established priorities for 20002002
regarding the focus areas (Box 6).
Implementation will require collaboration with state and local public health
agencies, as well as with other persons and groups, including
public health organizations,
medical research centers,
health-care providers and their networks,
professional societies,
medical examiners,
emergency response units and responder organizations,
safety and medical equipment manufacturers,
the U.S. Office of Emergency Preparedness and other Department of Health
and Human Services agencies,
other federal agencies, and
international organizations.
RECOMMENDATIONS
Implementing CDC's strategic preparedness and response plan by 2004 will
ensure the following outcomes:
U.S. public health agencies and health-care providers will be prepared to
mitigate illness and injuries that result from acts of biological and chemical terrorism.
Public health surveillance for infectious diseases and injuries --- including
events that might indicate terrorist activity --- will be timely and complete, and
reporting of suspected terrorist events will be integrated with the evolving,
comprehensive networks of the national public health surveillance system.
The national laboratory response network for bioterrorism will be extended
to include facilities in all 50 states. The network will include CDC's
environmental health laboratory for chemical terrorism and four regional facilities.
State and federal public health departments will be equipped with
state-of-the-art tools for rapid epidemiological investigation and control of suspected
or confirmed acts of biological or chemical terrorism, and a designated stock
of terrorism-related medical supplies will be available through a
national pharmaceutical stockpile.
A cadre of well-trained health-care and public health workers will be available
in every state. Their terrorism-related activities will be coordinated through a
rapid and efficient communication system that links U.S. public health agencies
and their partners.
CONCLUSION
Recent threats and use of biological and chemical agents against civilians have
exposed U.S. vulnerability and highlighted the need to enhance our capacity to detect
and control terrorist acts. The U.S. must be protected from an extensive range of
critical biological and chemical agents, including some that have been developed and
stockpiled for military use. Even without threat of war, investment in national defense
ensures preparedness and acts as a deterrent against hostile acts. Similarly, investment in
the
public health system provides the best civil defense against bioterrorism. Tools
developed in response to terrorist threats serve a dual purpose. They help detect rare
or unusual disease outbreaks and respond to health emergencies, including naturally
occurring outbreaks or industrial injuries that might resemble terrorist events in
their unpredictability and ability to cause mass casualties (e.g., a pandemic influenza
outbreak or a large-scale chemical spill). Terrorism-preparedness activities described in
CDC's plan, including the development of a public health communication infrastructure, a
multilevel network of diagnostic laboratories, and an integrated disease surveillance
system, will improve our ability to investigate rapidly and control public health threats
that emerge in the twenty first century.
References
Okumura T, Suzuki K, Fukuda A, et al. Tokyo subway sarin attack; disaster
management, Part 1: community emergency response. Acad Emerg Med 1998;5:613-7.
Davis, CJ. Nuclear blindness: an overview of the biological weapons programs of
the former Soviet Union and Iraq. Emerg Infect Dis 1999;5:509-12.
Török TJ, Tauxe RV, Wise RP, et al. Large community outbreak of Salmonellosis caused
by intentional contamination of restaurant salad bars. JAMA 1997;278:389-95.
Tucker JB. Chemical/biological terrorism: coping with a new threat. Politics and the
Life Sciences 1996;15:167-184.
Ashraf H. European dioxin-contaminated food crisis grows and grows [news].
Lancet 1999;353:2049.
Janofsky M. Looking for motives in plague case. New York Times. May 28, 1995:A18.
Federal Emergency Management Agency. Federal response plan. Washington,
DC: Government Printing Office, 1999. Available at <http://www.fema.gov/r-n-r/frp>.
Accessed February 3, 2000.
Because the initial detection of a covert biological or chemical attack will
probably occur at the local level, disease surveillance systems at state and local
health agencies must be capable of detecting unusual patterns of disease or
injury, including those caused by unusual or unknown threat agents.
Because the initial response to a covert biological or chemical attack will
probably be made at the local level, epidemiologists at state and local health agencies
must have expertise and resources for responding to reports of clusters of rare,
unusual, or unexplained illnesses.
Return to top.
Box 2
BOX 2. Preparing public health agencies for biological attacks
Steps in Preparing for Biological Attacks
Enhance epidemiologic capacity to detect and respond to biological attacks.
Supply diagnostic reagents to state and local public health agencies.
Establish communication programs to ensure delivery of accurate information.
Enhance bioterrorism-related education and training for health-care professionals.
Prepare educational materials that will inform and reassure the public during
and after a biological attack.
Stockpile appropriate vaccines and drugs.
Establish molecular surveillance for microbial strains, including unusual or
drug- resistant strains.
The U.S. public health system and primary health-care providers must
be prepared to address varied biological agents, including pathogens that are
rarely seen in the United States. High-priority agents include organisms that pose a
risk to national security because they
can be easily disseminated or transmitted person-to-person;
cause high mortality, with potential for major public health impact;
might cause public panic and social disruption; and
require special action for public health preparedness (Box 2).
Category A agents include
variola major (smallpox);
Bacillus anthracis (anthrax);
Yersinia pestis (plague);
Clostridium botulinum toxin (botulism);
Francisella tularensis (tularaemia);
filoviruses,
Ebola hemorrhagic fever,
Marburg hemorrhagic fever; and
arenaviruses,
Lassa (Lassa fever),
Junin (Argentine hemorrhagic fever) and related viruses.
Category B
Second highest priority agents include those that
are moderately easy to disseminate;
cause moderate morbidity and low mortality; and
require specific enhancements of CDC's diagnostic capacity and
enhanced disease surveillance.
Category B agents include
Coxiella burnetti (Q fever);
Brucella species (brucellosis);
Burkholderia mallei (glanders);
alphaviruses,
Venezuelan encephalomyelitis,
eastern and western equine encephalomyelitis;
ricin toxin from Ricinus
communis (castor beans);
epsilon toxin of Clostridium
perfringens; and
Staphylococcus enterotoxin B.
A subset of List B agents includes pathogens that are food- or waterborne.
These pathogens include but are not limited to
Salmonella species,
Shigella dysenteriae,
Escherichia coli O157:H7,
Vibrio cholerae, and
Cryptosporidium parvum.
Category C
Third highest priority agents include emerging pathogens that could
be engineered for mass dissemination in the future because of
availability;
ease of production and dissemination; and
potential for high morbidity and mortality and major health impact.
Category C agents include
Nipah virus,
hantaviruses,
tickborne hemorrhagic fever viruses,
tickborne encephalitis viruses,
yellow fever, and
multidrug-resistant tuberculosis.
Preparedness for List C agents requires ongoing research to improve
disease detection, diagnosis, treatment, and prevention. Knowing in advance which
newly emergent pathogens might be employed by terrorists is not possible;
therefore, linking bioterrorism preparedness efforts with ongoing disease surveillance
and outbreak response activities as defined in CDC's emerging infectious
disease strategy is imperative.*
* CDC. Preventing emerging infectious diseases: a strategy for the 21st century.
Atlanta, Georgia: U.S. Department of Health and Human Services, 1998.
Return to top.
Box 4
BOX 4. Preparing public health agencies for chemical attacks
Steps in Preparing for Chemical Attacks
Enhance epidemiologic capacity for detecting and responding to
chemical attacks.
Enhance awareness of chemical terrorism among emergency medical
service personnel, police officers, firefighters, physicians, and nurses.
Stockpile chemical antidotes.
Develop and provide bioassays for detection and diagnosis of chemical injuries.
Prepare educational materials to inform the public during and after a
chemical attack
Return to top.
Chemical agents that might be used by terrorists range from warfare agents
to toxic chemicals commonly used in industry. Criteria for determining
priority chemical agents include
chemical agents already known to be used as weaponry;
availability of chemical agents to potential terrorists;
chemical agents likely to cause major morbidity or mortality;
potential of agents for causing public panic and social disruption; and
agents that require special action for public health preparedness (Box 4).
Categories of chemical agents include
dioxins, furans, and polychlorinated biphenyls (PCBs);
explosive nitro compounds and oxidizers,
ammonium nitrate combined with fuel oil;
flammable industrial gases and liquids,
gasoline,
propane;
poison industrial gases, liquids, and solids,
cyanides,
nitriles; and
corrosive industrial acids and bases,
nitric acid,
sulfuric acid.
Because of the hundreds of new chemicals introduced internationally
each month, treating exposed persons by clinical syndrome rather than by
specific agent is more useful for public health planning and emergency medical
response purposes. Public health agencies and first responders might render the
most aggressive, timely, and clinically relevant treatment possible by using
treatment modalities based on syndromic categories (e.g., burns and trauma,
cardiorespiratory failure, neurologic damage, and shock). These activities must be linked
with authorities responsible for environmental sampling and decontamination.
BOX 6. Implementation Priorities Regarding Focus Areas for 2000-2002
Preparedness and Prevention
Maintain a public health preparedness and response cooperative agreement
that provides support to state health agencies who are working with local agencies
in developing coordinated bioterrorism plans and protocols.
Establish a national public health distance-learning system that
provides biological and chemical terrorism preparedness training to health-care
workers and to state and local public health workers.
Disseminate public health guidelines and performance standards on
biological and chemical terrorism preparedness planning for use by state and local
health agencies.
Detection and Surveillance
Strengthen state and local surveillance systems for illness and injury
resulting from pathogens and chemical substances that are on CDC's critical agents list.
Develop new algorithms and statistical methods for searching medical
databases on a real-time basis for evidence of suspicious events.
Establish criteria for investigating and evaluating suspicious clusters of human
or animal disease or injury and triggers for notifying law enforcement of
suspected acts of biological or chemical terrorism.
Diagnosis and Characterization of Biological and Chemical Agents
Establish a multilevel laboratory response network for bioterrorism that
links public health agencies to advanced capacity facilities for the identification
and reporting of critical biological agents.
Establish regional chemical terrorism laboratories that will provide
diagnostic capacity during terrorist attacks involving chemical agents.
Establish a rapid-response and advanced technology laboratory within CDC
to provide around-the-clock diagnostic support to bioterrorism response teams
and expedite molecular characterization of critical biological agents.
Response
Assist state and local health agencies in organizing response capacities to
rapidly deploy in the event of an overt attack or a suspicious outbreak that might be
the result of a covert attack.
Ensure that procedures are in place for rapid mobilization of CDC
terrorism response teams that will provide on-site assistance to local health
workers, security agents, and law enforcement officers.
Establish a national pharmaceutical stockpile to provide medical supplies in
the event of a terrorist attack that involves biological or chemical agents.
Establish a national electronic infrastructure to improve exchange of
emergency health information among local, state, and federal health agencies.
Implement an emergency communication plan that ensures rapid
dissemination of health information to the public during actual, threatened, or suspected acts
of biological or chemical terrorism.
Create a website that disseminates bioterrorism preparedness and
training information, as well as other bioterrorism-related emergency information,
to public health and health-care workers and the public.
Return to top.
All MMWR HTML versions of articles are electronic conversions from ASCII text
into HTML. This conversion may have resulted in character translation or format errors in the HTML version.
Users should not rely on this HTML document, but are referred to the electronic PDF version and/or
the original MMWR paper copy for the official text, figures, and tables.
An original paper copy of this issue can be obtained from the Superintendent of Documents,
U.S. Government Printing Office (GPO), Washington, DC 20402-9371; telephone: (202) 512-1800.
Contact GPO for current prices.
**Questions or messages regarding errors in formatting should be addressed to
mmwrq@cdc.gov.
