- A Public Health Threat
During the 14th Century, Mongol
raiders catapulted plague-infested cadavers onto a European trading post on the Black Sea.
Survivors of the attack retreated to Sicily, carrying a disease which would subsequently
wipe out a third of the European population, nearly 25 million people. Although acts of
bioterrorism have changed considerably over the years, the danger has not. Biological
agents are still easy to produce and readily available. Most agents are inexpensive,
easily distributed by natures forces, and simple to produce. Unlike most of their
chemical counterparts, harmful biological agents may also be odorless and tasteless. In
addition, some experts believe the threat of biological warfare may supercede that of
Biological weapons could have a greater impact than nuclear weapons as new
"super terrorists" want mass casualties; agents are readily available and arms
control is difficult, according to David Siegrist, of the Potomac Institute for Policy
Studies. In fact, while the threat of nuclear bombs continues to diminish, the possibility
of biological terrorism has assumed a stronger presence in recent months with a rash of
anthrax hoaxes. Three threats occurred within a three-week period of time in Utah,
including a Planned Parenthood health clinic, an LDS Church office building, and a milk
delivery truck. No biological agent was found.
The increase of threats in Utah cases represents a nationwide trend. In
fact, the majority of bioterrorism cases under investigation by the FBI are still anthrax
hoaxes and the agencys caseload has doubled since 1997. That year, the FBI had 71
cases, nearly a six-fold increase from the previous yearly average of 12; in 1998, the
bureau investigated 146 cases. This year the number of cases has already surpassed 100.
Many officials believe the hoaxes are aimed at "wearing down" the responders in
preparation for an actual terrorist attack. Health experts believe that anthrax and
smallpox pose the biggest threats to civilians, and are preparing accordingly by
re-engineering a safer smallpox vaccine and stockpiling prophylactic antibiotics and
vaccine for anthrax.
While some believe an actual attack with biological weapons is imminent,
others believe the possibility of a bioterrorist act remains relatively low. "The
likelihood is entirely unknown", said Donna Shalala, Secretary of Health and Human
Services. "It may never occur. But weve seen terrorism emerge as one of the
problems of the post-Cold War world. We must not be afraid, but we must be aware."
Health-care workers must be aware that, unlike fire or police personnel,
they will most likely be the first responders following a bioterrorist attack. The first
indication that a silent attack has occurred may be an outbreak of some unusual illness or
an abrupt, significant increase in the incidence of commonly observed symptoms. In such
covert attacks, how quickly the outbreak is detected, analyzed, understood, and addressed
will determine the timeliness and effectiveness of the medical and public health response
and, hence, the extent and severity of the impact upon the health and well-being of the
affected community, according to the Centers for Disease Control and Prevention (CDC). For
example, a silent release of a biological agent capable of producing a highly communicable
disease could afflict hundreds, even thousands of individuals over a wide geographic area
during a period of several weeks before a full medical and public health response could be
The delayed onset of symptoms is not the only problem confronting public
health. Many of the biologic agents most likely to be used by terrorists are not commonly
seen as clinical or public health threats in the U.S. The nation lacks the epidemiologic
and laboratory expertise and capacity to adequately deal with agents/diseases such as
anthrax, plague, and smallpox. "We are ill-prepared to deal with a terrorist attack
that employs biological weapons," said D.A. Henderson, director of the Johns Hopkins
Center for Civilian Biodefense Studies. "In countering civilian terrorism, the focus
has been almost wholly on chemical and explosive weapons. A chemical release or a major
explosion is far more manageable than the biological challenges posed by smallpox or
anthrax. After an explosion or a chemical attack, the worst effects are quickly over, the
dimensions of the catastrophe can be defined, the toll of injuries and deaths can be
ascertained, and efforts can be directed to stabilization and recovery. Not so following
the use of smallpox or anthrax. Day after relentless day, additional cases could be
expected and in new areas."
Much of the responsibility for addressing the health aspects of various
types of terrorist attacks falls on the state and local public health community. Urgent
health issues, including evaluation of the threat, identification of public health
response and prevention strategies, advising the public on protective actions, and
delineating procedures for first responders and health care providers, must be addressed
quickly. Close coordination and communication by health agencies with other relevant
organizations are essential for bioterrorism preparedness.
For more information on bioterrorism, a detailed report of the
"National Symposium on Medical and Public Health Response to Bioterrorism" is
posted on the Johns Hopkins University web site www.hopkins-biodefense.org
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The Lighter Side of Public Health: Germ
Many of us have read articles, both in
scientific and popular literature, that describe in vivid detail where germs thrive in
households. If you have ever read one of these articles and thought to yourself, "Why
(and how) would anyone study this?", you might gain some insight from excerpts
from an article about Dr. Charles Gerba ("On Germ Patrol, at the Kitchen Sink", New
York Times, February 23, 1999).
Dr. Charles Gerba is a professor of microbiology at the University of
Arizona. His primary area of interest is environmental microbiology. Most of his career
has been focused on uncovering how viruses and other organisms infiltrate our drinking
water. He first developed the method used to test water for cryptosporidium, and serves as
a consultant for cities in America and around the world on how to improve water quality.
In addition to his interest in drinking water, Dr. Gerba has become most interested in
what germs lurk in our homes and where they might be hiding.
Where do you keep your toothbrush? Dr. Gerbas obsession began
in the early 1970's when he was a postgraduate student at Baylor University in Houston,
studying viruses in water. "My adviser, Craig Wallace, dragged me into the bathroom.
Then he flushed the toilet a few times. Can you feel the aerosol?" he
kept asking. That experiment led Dr. Gerba to create what he calls a
"commodograph," a method of determining patterns of droplet emission from the
bowl. He also used a strobe light to shoot a time-lapse photograph of a flush, which shows
droplets of water, usually invisible, each containing thousands of bacteria and viruses,
being ejected from the bowl. "Keep your toothbrush in the medicine cabinet," Dr.
If you think the bathroom is bad, wait until you hear about the
kitchen. "In a study published last year in Applied Microbiology, Dr.
Gerba sampled spots all over the house and found that in most homes, the bathroom is much
cleaner than the kitchen. Because of contamination introduced by meat and vegetables,
sinks harbor the most dangerous bacteria, and people who appear cleanest -- who wipe down
counters regularly with their kitchen sponge -- tend to have that bacteria all over their
And you thought your laundry was clean... "Dr. Gerbas
latest project is the laundry, a task he believes Americans regard with not nearly enough
caution or diligence. He is preparing his latest paper for presentation this spring at the
meeting of the American Society of Microbiology. His study, survival of microbial
pathogens during laundry, examines how fecal bacteria infiltrate washing machines.
Focusing on four-person families in Tucson, Dr. Gerbas team randomly
visited 60 homes and washed a sterile washcloth in their machines. One-fifth of the
machines contained Escherichia coli, while a quarter were contaminated with fecal
matter. The laundry, Dr. Gerba contends, is becoming less clean. Fewer Americans wash
clothes in hot water, and only 5 percent use bleach, he said. Wash cycles are only 20
minutes, while the average drying time is only 28 minutes. Dr. Gerba found that some Salmonella
and hepatitis A survive through laundry -- including the dry cycle -- and remain on
clothes. "We have no idea how well we clean clothes," he said.
Dr. Gerbas own laundry machine yielded E. coli, prompting him
to change his washing habits. "I always washed my underwear last, in a separate load,
but I started using bleach, and now I run an empty wash, with just bleach, when Im
done. Its mouthwash for the machine."
Although Dr. Gerba says he has covered most of what he can in the
household, he has no fear that he will run out of material."
How clean are public bathrooms? Dr. Gerba also conducted studies of
public restrooms. In the mid-1970s he numbered squares of toilet paper in public restrooms
and checked them hourly to gauge how many were used. Twenty years later, with a grant from
the Scott Paper Company, he did the same experiment, this time with microprocessors in the
dispensers, and found that men used an average of two squares per visit and women used
He discovered which sex had dirtier bathrooms (women, by far), and where
the bacterial hot zones were in bathrooms (outside sanitary napkin disposals, the floor
and the sink, in that order; the doorknob is surprisingly clean). The average employee
uses the bathroom 3.3 times per working day, and women spend twice as much time in the
bathroom as men."
What does the future hold? Dr. Gerba "predicts that infectious
disease, or microbe-caused illness will become more prevalent, explaining that antibiotic
resistance, our aging drinking water infrastructure, and emerging pathogens will give
microbes the leverage they need in the next century. And his work may not be confined to
this planet. He is a consultant to the National Aeronautics and Space Administration,
advising it on dealing with human waste during extended space travel."
Table of Contents
of Diseases of Low Frequency Year-to-Date January 1 - March 31,
(including a comparison for same time period 1995 -1998)
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Utah Department of Health, Bureau of
Monthly Morbidity Summary - March
1999 - Provisional Data
The Epidemiology Newsletter is
published monthly by the Utah Department of Health, Division of Epidemiology and
Laboratory Services, Bureau of Epidemiology, to disseminate epidemiologic information to
the health care professional and the general public.
Send comments to: The Bureau of Epidemiology, PO Box 142104, Salt Lake City, UT
84114-2104, or call (801) 538-6191
Approval 8000008: Appropriation 3705
Rod Betit, Executive Director, Utah Department of Health
Charles Brokopp, Dr.P.H., Division of Epidemiology and Laboratory Services
Craig R Nichols, MPA, Editor, State Epidemiologist, Director Bureau of Epidemiology
Cristie Chesler, BA, Managing Editor
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