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The Anthrax Outbreak of 2001, Lessons Learned in California

It has been more than six months since the last case of human anthrax attributed to the release of B. anthracis spore contaminated letters in the eastern United States. Although California experienced no cases of anthrax connected with this outbreak, the emergency response, public health and community health care systems were stressed while responding to public concern over the events. This putative bioterrorist event allowed California to test many aspects of its bioterrorism response plan and illustrated how catastrophic health events within California would fit in to our Standardized Emergency Management System (SEMS). It is appropriate at this point in time to reflect on some lessons learned from this event.

Public health and emergency response systems can be stressed even with a relatively geographically constrained event

Although no cases of human anthrax occurred in California (an unrelated outbreak in cattle occurred in Santa Clara county during this time) the resources of the California Department of Health Services(DHS), The California Emergency Services Authority (EMSA), The Governors Office of Emergency Services (OES), as well as local health and emergency response agencies were consumed by coordinating California's response to the epidemic. It is fair to say that had a case occurred within the state or been imported into the state the response demands would have been significantly higher. The lack of cases with California was an important epidemiologic tool that allowed emergency response organizations to appropriately conduct risk assessments on thousands of "white powder" cases and hundreds of persons who presented to health care facilities concerned that they may have symptoms of anthrax. This was an opportunity for California to gauge the resources that will be required to respond to, and coordinate the State's response to future disease outbreaks. It has been more than six months since the last case of human anthrax attributed to the release of B. anthracis spore contaminated letters in the eastern United States. Although California experienced no cases of anthrax connected with this outbreak, the emergency response, public health and community health care systems were stressed while responding to public concern over the events. This putative bioterrorist event allowed California to test many aspects of its bioterrorism response plan and illustrated how catastrophic health events within California would fit in to our Standardized Emergency Management System (SEMS). It is appropriate at this point in time to reflect on some lessons learned from this event.

Information is hard to coordinate and disseminate

The information flow early in this anthrax outbreak was scant, incomplete and often contradictory. Even though California was about as geographically distant as a state could be from this event, health professionals needed real time details that were not reported in the media so as to make the best recommendations to state leaders as to the appropriate response and relative priorities to California in protecting its citizens and workers. Because of the multitude of disciplines responsible for portions of the bioterrorism response, as well as the need for the security of some information related to the investigation of the event it became obvious that one single direction communication system was insufficient to meet the varied needs of the health community. The development of secure, redundant, asynchronous, real time communication networks has been fostered by these events. Development of health specific communication networks, such as the health alert network (HAN) will facilitate communication at the Federal, State and Local levels.

Health providers need accurate timely information on these subjects

The needs of health providers for accurate information was identified early in the event. Health providers play a vital role in early detection of additional cases, medical treatment of infected persons, as well as sources of trusted information to their patients. The need for rapid, accurate, practical information in a format suited to a needs of a diverse clinical audiences was illuminated by this incident. This has led to new communication links between practicing local clinicians and their public health departments, showcased the power of the internet, as well as enhanced distance learning techniques in the rapid communication of clinical information to multiple providers of care.

Fear responds to truth

The importance of health officials who were able to communicate with, and be respectful of, the information needs of the public were illustrated in this anthrax outbreak. The need for the general public to perform a "personal risk assessment" illustrated that truthful information will be central in reducing fear and panic.

Conclusion

The solutions suggested by these lessons are currently being implemented at local, regional, and state levels. Although devastating in both personal and economic terms, this anthrax incident has improved the ability of California to respond to future incidents of bioterrorism.

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