Introduction to Health Care and Public Health in the U.S.

1. Introduction to Health Care and Public Health in the U.S. Public Health, Part 2 Lecture b This material (Comp 1 Unit 8) was developed by Oregon Health & Science University, funded by the Department of Health and Human Services, Office of the National Coordinator for Health Information Technology under Award Number 90WT0001. This work is licensed under the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by-nc-sa/4.0/.

2. Public Health, Part 2Learning Objectives - 1 • Give examples of and explain the general program categories of public health, including communicable disease, chronic disease, terrorism response, and environmental public health (Lecture a) • Discuss the activities and achievements of public health in the realm of communicable disease (Lecture a )

3. Public Health, Part 2Learning Objectives - 2 • Compare and contrast the different types of terrorism and the different public health responses (Lecture b) • Describe chronic disease activities and achievements of public health, and the work of public health in the realm of environmental health hazards (Lecture c)

4. Terrorism and Public Health • The specter of terrorism continues to concern U.S. government and public • Emergency Preparedness and Response – public health programs • Categories of Terrorism • Bioterrorism • Agricultural terrorism • Chemical terrorism • Nuclear/radiation terrorism

5. Bioterrorism (BT) • Definition: intentional use of microorganisms or their derived products, to produce death or disease in humans, animals, or plants

6. Overt versus Covert Bioterrorism • Classified as Overt (announced) or Covert (unannounced) • Overt attacks - intend to create psychological (panic) damage along with physical damage, as well as to encourage spread of an agent (exposed people fleeing spread the agent) • Covert attacks - intend to cause maximum damage before a response can be mounted. Methods debated for detection for covert attacks include laboratory results and syndromic surveillance

7. Bioterrorism in the U.S.:History - 1 • 1984 Rajneeshi attack – The Dalles, OR • First BT incident on U.S. soil? • 751 cases of foodborne illness • Discovered by a small clinical laboratory, which noticed high numbers of Salmonella typhimurium results and alerted public health officials • Eventually determined that central Oregon cult of the Rajneeshees intentionally contaminated salad bars in The Dalles

8. Bioterrorism in the U.S.:History - 2 • 2001 Letters containing anthrax were mailed to various targets, resulting in five casualties • 2003 Greenville, SC, and 2004 Washington DC. Ricin letter incidents

9. CDC Bioterrorism Categories Table 8.1. CDC Bioterrorism categories. Based onNIAID, 2016.

10. Terrorism Public Health Preparedness and Response • Planning, monitoring, and education are three of the main activities • The Laboratory Response Network is an important part of public health activities

11. Laboratory Response Network (LRN) • LRN - national network of local, state, and federal public health laboratories • Provide response capacity for biological and chemical terrorism, as well as other public health emergencies • More than 150 biological and 62 chemical LRN labs • Most are state public health labs, but veterinary, military, and international labs are also important participants

12. Agricultural Terrorism - 1 • Chemical and biological weapons are often manufactured from readily-available raw materials • Usually in common use or found in nature • Agriculture, a building block of all civilizations, is an attractive target

13. Agricultural Terrorism - 2 • Although there have been an unfortunately large number of introductions of agricultural pests and pathogens (example, chestnut blight, which effectively exterminated the American chestnut tree), they have been caused by accident, neglect, or ignorance - not terrorism. • The USDA Animal and Plant Inspection Service (APHIS) attempts to prevent importation of agricultural hazards

14. Chemical Terrorism • Results from covert or overt exposure of chemical hazards to the population • A wide variety of chemical compounds are potential vehicles of chemical terrorism

15. CDC Hazardous Chemical Categories • Categorized by chemical type and exposure effects (13 total) -Examples of content type categories: • Bio-toxins: Poisons from plants or animals • Metals: Agents consisting of metallic poisons • Examples of exposure effects categories: • Caustics (acids): Burn or corrode skin, eyes, and mucus membranes • Incapacitating agents: Cause mental confusion or altered state of consciousness

16. Chemical Terrorism and Public Health • Chief surveillance agency in the U.S.: CDC’s Agency for Toxic Substances and Disease Registry (ATSDR) • National Toxic Substance Incidents Program (NTSIP) • Launched in 2009 • Successor to the HSEES program

17. Components of NTSIP - 1 • National Toxic Substance Incidents Database • Collects information related to chemical spills • Sources include: • Emergency response systems • State fire marshals • U.S. Coast Guard National Response Center (NRC) • Reporting point-of-contact for all U.S. oil, chemical, radiological, and biological discharges into the environment

18. Components of NTSIP - 2 • State partnerships for incident surveillance • 15 states as of 2016 • Assessment of Chemical Exposures (ACE) Program • Provides local authorities resources to do epidemiological assessment

19. Nuclear or Radiation Terrorism • Both the sun and the earth are sources of natural, background radiation • Man-made radiation occurs from sources such as TV sets, microwave ovens, X-rays • A variety of tactics are used to disperse radioactive material

20. Nuclear Terrorism Threats: Categories • Categorized based on dispersal method: • Radiological Dispersion Devices (RDDs), also known as "dirty bombs“ • Radioactive contamination of drinking water or food supplies • Direct attacks on nuclear power plants or nuclear fuel reprocessing facilities • Use of nuclear weapons • Placing radioactive source in heavily populated area

21. Response to Nuclear Terrorism Threats • Public Health Preparedness and Response includes: • Education and information for the public • Education and information for health care providers

22. Public Health, Part 2Summary – Lecture b • Four main categories of terrorism: • Bioterrorism • agricultural terrorism • chemical terrorism • nuclear/radiation terrorism • Categorization of bioterrorism agents • Laboratory Response Network

23. Public Health, Part 2References – 1 – Lecture b References Agency for Toxic Substances and Disease Registry: National Toxic Substance Incidents Program (NTSIP). (n.d.). Retrieved January 31, 2017, from https://www.atsdr.cdc.gov/ntsip/ Centers for Disease Control and Prevention, Emergency Preparedness and Response, Specific Hazards, Chemical Emergencies, Chemical Categories. (n.d.). Retrieved January 31, 2017, from https://emergency.cdc.gov/agent/agentlistchem-category.asp Centers for Disease Control and Prevention, Emergency Preparedness and Response, Specific Hazards, Chemical Emergencies, Chemical Categories. (n.d.). Retrieved January 31, 2017, from https://emergency.cdc.gov/chemical/index.asp Centers for Disease Control and Prevention, Emergency Preparedness and Response, Information on Specific Types of Emergencies, Radiation Emergencies. (n.d.). Retrieved January 31, 2017, from https://emergency.cdc.gov/radiation/index.asp National Institute of Allergy and Infectious Diseases, NIAID Emerging Infectious Diseases/Pathogens, NIAID Biodefense Research. (n.d.). Retrieved January 31, 2017, from https://www.niaid.nih.gov/research/emerging-infectious-diseases-pathogens

24. Public Health, Part 2References – 2 – Lecture b Charts, Tables, Figures 8.1 Table:CDC Bioterrorism categories. Based on: National Institute of Allergy and Infectious Diseases. (2016). Biodefense category A, B, C pathogens. Retrieved from https://www.niaid.nih.gov/research/emerging-infectious-diseases-pathogens

25. Introduction to Health Care and Public Health in the U.S.Public Health, Part 2Lecture b This material was developed by Oregon Health & Science University, funded by the Department of Health and Human Services, Office of the National Coordinator for Health Information Technology under Award Number 90WT0001.