21st

1. 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

2. Mississippi CSTE State Department of Health

3. LOCAL F EDERAL S T A T E The American Public Health System LAW

4. ANTHRAX BIOTERRORISM Flu West Nile Virus SMALLPOX SARS Monkeypox

5. ANTHRAX West Nile Virus SARS

6. ANTHRAX

7. West Nile Virus

8. West Nile Virus ANTHRAX Disease Surveillance Reporting of Disease

9. Gram stain of CSF, first Florida case From Jernigan, et.al., in CDC: Emerging Infectious Disease Nov.-Dec., 2001

10. 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.

11. 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.

13. 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]).

14. 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.

15. CDC Public Health Department FEEDBACK REPORTING Practitioners Recognition of Disease Natural Infection Induced Infection Occurrence of Disease

16. 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.

17. Nationally Notifiable Disease Surveillance System Reporting by states to CDC is voluntary by agreement Reports from states to CDC do not include names

18. ACTION Health Department FEEDBACK REPORTING Practitioners Recognition of Disease Natural Infection Induced Infection Occurrence of Disease

19. SARS Isolation and Quarantine Contact Tracing

20. 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

21. SARS Potentially fatal lung disease. Isolation and quarantine Among proven tools

22. TB Potentially fatal lung disease. Isolation and quarantine Among proven tools

24. ANTHRAX BIOTERRORISM Flu West Nile Virus SMALLPOX SARS Monkeypox

25. HIPAA

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

28. www.cdc.gov/privacyrule

29. www.CDC.gov