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21st. Century. Public Health. (Are we having fun yet?). Building Legal Preparedness for Public Health Emergencies National Association of Attorneys General East Lansing, Michigan – April 19, 2005. Ed Thompson, MD, MPH Chief of Public Health Practice

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21st

Century

Public Health

(Are we having fun yet?)

Building Legal Preparedness for Public Health Emergencies

National Association of Attorneys General

East Lansing, Michigan – April 19, 2005

Ed Thompson, MD, MPH

Chief of Public Health Practice

Centers for Diseases Control and Prevention


Mississippi

CSTE

State Department of Health


LOCAL

F

EDERAL

S

T

A

T

E

The American Public Health System

LAW


ANTHRAX

BIOTERRORISM

Flu

West Nile Virus

SMALLPOX

SARS

Monkeypox


ANTHRAX

West Nile Virus

SARS


ANTHRAX


West Nile Virus


West Nile Virus

ANTHRAX

Disease Surveillance

Reporting of Disease


Gram stain of CSF, first Florida case

From Jernigan, et.al., in CDC: Emerging Infectious Disease Nov.-Dec., 2001


MMWR October 19, 2001:

Florida

On October 2, the Palm Beach County Health Department (PBCHD) and the Florida Department of Health (FDOH) were notified of a possible anthrax case in Palm Beach County. The suspected case was identified when a gram stain of cerebrospinal fluid (CSF) revealed a gram-positive bacilli. An epidemiologic investigation was initiated by FDOH, PBCHD, and the FDOH state laboratory. The state laboratory and CDC confirmed B. anthracis from a culture of CSF on October 4. Later the same day, FDOH and CDC epidemiologists and laboratory workers arrived in Palm Beach County to assist PBCHD with the investigation. As of October 16, two confirmed cases of inhalational anthrax have been identified.


MMWR October 19, 2001:

Florida

On October 2, the Palm Beach County Health Department (PBCHD) and the Florida Department of Health (FDOH) were notified of a possible anthrax case in Palm Beach County. The suspected case was identified when a gram stain of cerebrospinal fluid (CSF) revealed a gram-positive bacilli. An epidemiologic investigation was initiated by FDOH, PBCHD, and the FDOH state laboratory. The state laboratory and CDC confirmed B. anthracis from a culture of CSF on October 4. Later the same day, FDOH and CDC epidemiologists and laboratory workers arrived in Palm Beach County to assist PBCHD with the investigation. As of October 16, two confirmed cases of inhalational anthrax have been identified.

On October 2, the Palm Beach County Health

Department (PBCHD) and the Florida Department

of Health were notified of a possible anthrax case

in Palm Beach County.


Outbreak of West Nile-Like Viral Encephalitis -- New York, 1999

An outbreak of arboviral encephalitis was first recognized in New York City in late August and has since been identified in neighboring counties in New York state. Although initially attributed to St. Louis encephalitis (SLE) virus based on positive serologic findings in cerebrospinal fluid (CSF) and serum samples using a virus-specific IgM-capture enzyme-linked immunosorbent assay (ELISA), the cause of the outbreak has been confirmed as a West Nile-like virus based on the identification of virus in human, avian, and mosquito samples.

On August 23, 1999, an infectious disease physician from a hospital in northern Queens contacted the New York City Department of Health (NYCDOH) to report two patients with encephalitis. On investigation, NYCDOH initially identified a cluster of six patients with encephalitis, five of whom had profound muscle weakness (with axonal neuropathy by electromyelogram and requiring respiratory support [n=four]).


Outbreak of West Nile-Like Viral Encephalitis -- New York, 1999

An outbreak of arboviral encephalitis was first recognized in New York City in late August and has since been identified in neighboring counties in New York state. Although initially attributed to St. Louis encephalitis (SLE) virus based on positive serologic findings in cerebrospinal fluid (CSF) and serum samples using a virus-specific IgM-capture enzyme-linked immunosorbent assay (ELISA), the cause of the outbreak has been confirmed as a West Nile-like virus based on the identification of virus in human, avian, and mosquito samples.

On August 23, 1999, an infectious disease physician from a hospital in northern Queens contacted the New York City Department of Health (NYCDOH) to report two patients with encephalitis. On investigation, NYCDOH initially identified a cluster of six patients with encephalitis, five of whom had profound muscle weakness (with axonal neuropathy by electromyelogram and requiring respiratory support [n=four]).

On August 23, 1999, an infectious disease physician from a hospital in northern Queens contacted the New York City Department of Health (NYCDOH) to report two patients with encephalitis.


CDC

Public

Health

Department

FEEDBACK

REPORTING

Practitioners

Recognition of

Disease

Natural Infection

Induced Infection

Occurrence

of Disease


Nationally Notifiable Disease

Surveillance System

Authority: Police Powers of the States

Reporting to State (and sometimes local) health departments

is mandatory under state law and/or regulation

Reports from practitioners to states typically include names.


Nationally Notifiable Disease

Surveillance System

Reporting by states to CDC is voluntary by agreement

Reports from states to CDC do not include names


ACTION

Health

Department

FEEDBACK

REPORTING

Practitioners

Recognition of

Disease

Natural Infection

Induced Infection

Occurrence

of Disease


SARS

Isolation and Quarantine

Contact Tracing


SARS

Isolation

  • Restriction of activity / separation of sick infected person(s) with contagious disease;

  • usually in a hospital setting, but can also be at home or in a dedicated isolation facility

Quarantine

  • Restriction of activity / separation of well person(s) exposed to contagious disease;

  • usually at home, but can also be in a dedicated quarantine facility

  • Individuals or community/population


SARS

Potentially fatal lung disease.

Isolation and quarantine

Among proven tools


TB

Potentially fatal lung disease.

Isolation and quarantine

Among proven tools


ANTHRAX

BIOTERRORISM

Flu

West Nile Virus

SMALLPOX

SARS

Monkeypox


HIPAA


Community Public Health Legal Preparedness Building Effective Public Health-Health Care Legal Partnerships


www.cdc.gov/privacyrule


www.CDC.gov


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