Pathologists on the Frontlines of War Against Bioterrorism

November 19, 2001

NEW YORK (MedscapeWire) Nov 19 — "Pathologists and laboratory personnel are critical to the success of any response to bioterrorism," said Jared N. Schwartz, MD, PhD, FCAP, who recently moderated a special seminar on bioterrorism. The seminar, held October 20, was part of the 2001 American Society of Clinical Pathologists (ASCP)/College of American Pathologists (CAP) Annual Meeting and Exhibits in Philadelphia, PA.

Pathologists will be first to receive patient specimens for identification of agents that are likely to be used in bioterrorism, emphasized Dr. Schwartz. Prompt and accurate laboratory test results are crucial so that a potential outbreak can be detected.

The seminar featured four national experts and highlighted the important role pathologists play in the fight against terrorism. Speakers at the session included Amy E. Smithson, PhD, senior associate at the Henry L. Stimson Center in Washington, DC; Lawrence J. Halloran, staff director and counsel to the House Government Reform Subcommittee on National Security, Veterans Affairs and International Relations, Washington, DC, Stephen Morse, PhD, deputy director, Laboratory Services, Bioterrorism Preparedness and Response Program, Centers for Disease Control and Prevention (CDC) in Atlanta, Georgia, and Judith F. English, RN, MSN, CIC, head of the Infection Control Branch, Infectious Diseases Division, National Naval Medical Center, Bethesda, Maryland.

Dr. Smithson, as director of the Chemical and Biological Weapons Nonproliferation Project, provided first-hand information about the history of the current threat. From her experiences, she suggested that Iraq and the former Soviet Union certainly had offensive biowarfare programs and significant remnants of those programs remain in place. Dr. Smithson also indicated that the manufacture and dispersal of biological warfare agents is technically demanding and therefore likely to be beyond the ability of individuals or groups who do not have advanced technical capabilities.

She spoke to the need for disease outbreak readiness with an emphasis on local community and regional disaster planning. "We have to start somewhere and the medical community plays a key role," Dr. Smithson said. She urged pathologists and laboratories to maintain a state of readiness.

According to Dr. Smithson, the fact that small portions of the federal dollars designated for domestic preparedness find their way to the local or regional level is concerning, and Dr. Smithson stressed the need for regional hospitals to work together effectively when disaster strikes. "Your country is going to need you in the days ahead," she said.

Dr. Smithson called on pathologists to assist national policy makers in developing a plan to sustain readiness over the long term, strengthen the public health infrastructure, and continue to serve as a source of accurate information regarding chemical and biological weapons issues.

Mr. Halloran provided a political perspective from his role as staff director and counsel to the Subcommittee on National Security, Veterans Affairs and International Relations of the House Committee on Government Reform. The subcommittee's duties encompass all matters relating to national security, including antiterrorism efforts and intelligence gathering activities.

Current initiatives in Congress that would address readiness include hearings on issues associated with pharmaceutical stockpiles, vaccination readiness, public health infrastructure needs and lab capacity issues. Mr. Halloran emphasized that "'capacity' is not just equipment, but people."

Some of the policy issues that need to be addressed include the need to provide incentives for manufacturers to develop vaccines and rapid detection test kits, he said. Because Congress is currently redrafting the Biological Weapons Convention, Mr. Halloran asked the meeting attendees to think about and provide suggestions for ways the convention could be uuused to strengthen laboratory quality and readiness worldwide.

One way to strengthen laboratory readiness is through the CDC's Bioterrorism Preparedness and Response Program. The principal priority of this program is to upgrade the infrastructure and capacity to respond to a large-scale bioterrorist infectious disease outbreak, according to Dr. Morse, who participated in the seminar via video link. Dr. Morse's role at the CDC is to ensure that the laboratory response efforts enable the rapid identification and confirmatory diagnosis of biological agents, so that prevention and treatment efforts can be implemented quickly.

Dr. Morse has been working with the CAP over the past several weeks to alert laboratories to CDC anthrax protocols and to encourage them to take other measures to prepare laboratories for biological threats. He described how the CDC has categorized critical biological agents according to ease of dissemination, mortality, morbidity, and the degree that they represent threats to food or water safety.

Clues that should alert healthcare personnel to possible bioterrorism include outbreak of a rare or novel disease; outbreak of disease in nonendemic areas; seasonal disease during a different time of year; unusual clinical presentation or age distribution; known pathogen with unusual antimicrobial resistance pattern; known pathogen with other unusual epidemiological features; and the presence of a genetically identical pathogen in different areas.

Clinical labs have an important role in the CDC Laboratory Response Network (LRN) as a "rule-out" and forward function. Laboratories should become familiar with CDC protocols for anthrax and other suspect agents, Dr. Morse said. These protocols are designed to provide information about techniques to identify such agents, as well as information about what to do in the event an agent is identified.

"We are relying upon the clinical and public health laboratories in the United States," said Dr. Morse. He discussed a number of assays available or under development that will expand the capacity for rapid identification of critical agents. Dr. Morse's PowerPoint presentation is available at https://www.cap.org/HTML/GENERAL/SECURE/breakingnews_preparedness.html.

Ms. English, the current president of the Association for Professionals in Infection Control and Epidemiology, spoke to the need for hospitals and clinics to have infection control policies in place, so that clear lines of authority are recognized and prevention and control measures can be rapidly implemented in response to a suspected outbreak. Part of an infection control policy, she stressed, is a coordinated effort with local responders to secure isolation facilities in case of a large-scale outbreak.

Ms. English wrote the APIC/CDC Bioterrorism Readiness Plan, which has been embraced by the CDC as a model for healthcare institutions to follow in preparing a readiness plan.

She provided practical suggestions on how to prepare, including the need to centralize contact information for internal personnel such as the epidemiologist, pathologist, and healthcare administration. In addition, she stressed the importance of communicating with external contacts such as the local and state health department, FBI field office, and relevant CDC contacts.

Ms. English highlighted the need for familiarity with infection control procedures -- especially for agents such as pneumonic plague and smallpox that are highly contagious and not recently seen. She suggested the following websites for information relevant to bioterrorism readiness:

Additional information on bioterrorism preparedness is available on the CAP Web site at https://www.cap.org.<

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