Epidemiology of bioterrorism

• Epidemiology is defined as the study of factors that

influence the health and disease of a given population
OR
• Epidemiology is defined as the study of the frequency,
distribution, and determinants of disease in
populations, with the ultimate goal of prevention and
control.
• The frequency, pattern (person, place, and time), and
number of health events within a given population are
all fundamental attributes to successful epidemiological
practice and application.
• It is used to study past and future trends in
health illness, and it can be applied to
describe the overall health of a particular
community.
• One component of this is outbreak
epidemiology, which is employed to control
outbreaks of infectious diseases in the
community.
 Process of Epidemiologic investigation
• First, laboratory and/or clinical evidence confirms
that a disease outbreak has occurred.
• A case definition is created for ‘‘confirmed’’ and
‘‘suspected’’ patients to assist in determining the
attack rate.
• Refining the case definition to minimize false-
positive cases while maximizing the opportunity
for identifying potential or suspected cases.
• The incidence and prevalence of the outbreak
is compared with the background rates of the
same disease within the community to
determine whether the rate deviates from
rates of previous years.
• The environmental investigation and
laboratory analysis: These findings establish
control measures to be implemented to
prevent additional cases during an outbreak.
• The last step of investigation involves
conducting additional studies on the event
and communicating the findings to the public.
• The epidemiologic curve: uses data acquired
on cases over a period of time to elucidate
patterns of disease occurrence and to
distinguish between a natural outbreak and an
intentional event.
• The curve can also indicate the time of initial exposure,
which allows for measurement of incubation periods
(period from time of exposure to onset of disease).
• A typical epidemiologic curve for an intentional
bioterrorism event will demonstrate a very steep initial
spike, with many cases presenting early. This initial spike
represents persons exposed at the time of the agent’s
release.
• The epidemic curve for communicable bioterrorism
agents (e.g., the smallpox virus) would then have
secondary and tertiary spikes, smaller than that of the
initial outbreak, indicating transmission of disease from
person to person.
• epidemiology will provide important
information to assist public health
professionals and medical responders in
identifying the scope of the attack, the source
of exposure, the epidemic progress, and the
relative success of intervention methods for
any bioterrorism incident.
• The future of epidemiology in the field of
bioterrorism preparedness is focused on increasing
syndromic surveillance activities, including passive
and active surveillance.
• It is critical for local health agencies and related
organizations to become more proactive in
reporting notifiable diseases to their respective
state health agency.
• Additionally, education and training are at the
forefront of strengthening this response.
 SURVEILLANCE
• Surveillance is defined by the Centers for
Disease Control and Prevention (CDC) as the
ongoing systematic collection, analysis, and
interpretation of health data essential to the
planning, implementation, and evaluation of
public health practice, and it is closely
integrated with the timely dissemination of
these data to those who need to know (CDC,
2001).
• Surveillance can be characterized as either active or
passive, depending on the methodology employed to
enumerate cases.
• Active surveillance: results from direct contact with the
reporting agent or agency, and it is used for monitoring
endemic levels or for recognizing epidemic levels of
infectious disease.
• Passive surveillance: involves notification and/or
reporting of infectious diseases to authoritative figures,
such as a local or state health department, generally by
phone, mail, or both.
• Active surveillance produces information that is
more complete but requires extensive time,
resources, and money as compared with passive
surveillance methods.
• Passive surveillance is reasonably accurate for rare
diseases, a lack of judicious reporting may lead to
missed cases of some of the more common diseases.
• Once an unusual trend in surveillance data is
identified, proper intervention methods can be
implemented.
• The major goals of surveillance related to
bioterrorism are early detection of an event,
enhanced disease tracking of that event, and
effective intervention to minimize the event.