Preparations stepping up against bioterrorist attack

Preparations for a bioterrorist attack include efforts at both the federal and local levels and experts at Carson-Tahoe Hospital could play a key role in containing any outbreak here.

"The Centers for Disease Control in Atlanta has named smallpox, anthrax, pneumonic plague, tularemia, and botulism as the five organisms most likely to be employed in a bioterrorist attack," said Doris Dimmitt, infection control coordinator at Carson-Tahoe. "We have to do everything we can to recognize those organisms as quickly as possible. The quicker the action, the more effective we will be."

The discovery of even one case sends up a red flag because these organisms aren't typically isolated, according to Dimmitt.

"A good part of it is surveillance, which is something we do all time anyway," she said. "For example, tularemia is always reported to the state health department. They know the number of cases that are normal for Nevada and if two or three come up, they will look into it."

Carson-Tahoe acts in an advisory capacity with the Carson City's Local Emergency Planning Commission and Emergency Management Action Committee.

Fire and police departments work with hospital personnel in coordinated practice drills and all feed into the local emergency management plan.

The hospital's Infection Control Department is part of the initial response team and hospital officials are in close contact with the Nevada State Health Department as well as the Centers for Disease Control and Prevention in Atlanta.

Once a suspected organism has been identified, officials at Carson-Tahoe will notify the state health department, who will in turn notify the Centers for Disease Control and the Federal Bureau of Investigation.

The federal government has assembled a national pharmaceutical stockpile to supplement local and state resources, which includes immediate response "push packages," caches of pharmaceuticals, antidotes and medical supplies designed to address a variety of biological or chemical agents.

These packages are positioned in secure regional warehouses, ready for deployment within 12 hours of a federal decision.

When these stores are depleted, the program is supplemented with a vendor-managed inventory program which aims at ensuring the continual supply of pharmaceuticals, antidotes and medical supplies to any affected area.

Infection control at Carson-Tahoe Hospital has received a number of calls concerning smallpox and anthrax vaccinations. The following is the latest information from the Washoe County Health District.

- The last case of smallpox occurred in Somalia in 1977 and in 1980, the World Health Organization certified smallpox had been eradicated from the planet.

The only known samples of the virus are held at the Centers for Disease Control and Prevention in Atlanta, Georgia and the Institute for Viral Preparations in Koltsovo, Russia.

Smallpox vaccine was removed from the commercial market in 1983, but the United States Public Health Services maintains an emergency stockpile of about 15 million doses.

Presently, smallpox vaccine is supplied only to certain laboratory workers at risk of infection with smallpox-like viruses due to their occupation.

Plans for a response to a terrorist event are being developed, but do not now include widespread use of smallpox vaccine.

- Anthrax vaccine is available only through the military and is given due to risk of exposure. At this time, public health officials do not recommend routine vaccination of civilians, especially children under 18.