humans. The communication limitations during the outbreak, the changes to the electronic network capabilities, and the increased on the network for sharing information have increased awarenes need for established electronic data-sharing mechanisms. New York State officials told us that the state has invested heavil communication infrastructure and has created an advanced infor system, but at a national level some local health departments stil have access to modern communication technologies. A 1999 surv National Association of County and City Health Officials found th third of health departments serving fewer than 25,000 people did access to the Internet or electronic mail. Similarly, more than hal agencies surveyed had neither continuous, high-speed access to Internet nor broadcast facsimile transmission capabilities. en Public and The West Nile events illustrate the value of communication betwe and animal health communities, the latter including those dealing domestic animals, wildlife, and other animals such as zoo animal infectious diseases, including West Nile, are zoonotic, that is, cap infecting both animals and people. According to recent research, approximately three of every four emerging infectious diseases r humans through animals.18 Of over 1,700 known pathogens affect humans, including viruses and bacteria, 49 percent are zoonotic. pathogens associated with emerging diseases, 73 percent are zoo Many of the viruses or other pathogens considered most likely by be used in a bioterrorist incident are zoonotic, such as anthrax, p brucellosis, tularemia, and the equine encephalitic viruses. An of the USGS National Wildlife Center noted that many zoonotic path become established in wildlife before they are transmitted to hur domestic animals. The November 1998 Institute of Medicine worl reported that, because of their familiarity with a number of these agents, the veterinary medicine community should not be overlo surveillance efforts. 19 Moreover, veterinarians and veterinary labo workers are likely to have been vaccinated against many zoonoti and are used to working with zoonotic pathogens. 18M. Enserink, "Origins of New, Booming Diseases," http://sciencenow.sciencemag.org/cgi/content/full/2000/717/1 (cited July 17, 200 19 Chemical and Biological Terrorism, p. 68. West Nile outbreak shows how domestic, wild, and zoo animals can be sidered “sentinels,” providing an early warning device for diseases that harm people. Even for a deliberate biological attack, animals may be first victims, unintentionally or as part of an effort to avoid discovery, ording to the Institute of Medicine and National Research Council.20 In case of the West Nile outbreak, USDA and USGS National Wildlife ter laboratories were involved in early or mid-September in testing bird ples prior to the identification of the West Nile virus. However, because se laboratories lacked reagents21 for the virus, they were unable at the e to specifically identify it. perience with the West Nile outbreak also illustrates how links between animal and public health communities were missing. For example, Some key public health officials, such as the city health department's Director of the Bureau of Communicable Disease, indicated that they were not aware of the similarities in the clinical symptoms occurring in the birds and humans until many days or weeks after the human outbreak began. Officials said they believe that communication was indered even further because, even within the animal health community, there is fragmentation at the state and federal level in what agencies are responsible for different types of animals. For example, domestic animals, such as cats and dogs, are usually the responsibility of state and local health departments. Livestock, such as cattle and swine, are often the responsibility of state agricultural agencies. Wildlife, such as birds, are under the state environmental or wildlife agencies. When wildlife health officials approached the state public health aboratory to test the bird samples, they were told their samples should be tested at another laboratory, because the state laboratory did not have the reagents to perform animal (bird) testing. According to a New York State animal health official, not having adequate capacity within he state laboratory to test animal samples can create administrative and cost barriers to getting samples tested. For example, many veterinary laboratories will test samples only on a fee basis and not for public health purposes. In some areas of the country, such as the emical and Biological Terrorism, p. 72. agents are chemicals used in laboratory tests to indicate the presence of a virus or other tance. GAO/HEHS-00-180 West Nile Virus Outbreak Southwest, where zoonotic diseases such as hantavirus are e the animal population, integration of the animal and public he communities is considered to be better. • Several persons involved in the outbreak commented that the community is currently left out of the animal and public healt paradigm, even though zoo animals may be useful sentinels. Z generally receive close attention from veterinarians, and in so pathologists track health care and disease causes, creating de health records and storing tissue samples for future analysis. indicated that because zoo animals are not considered to be v domestic animals, they do not fall within the jurisdiction of ar health agencies such as the USGS, which tracks wildlife issue USDA, which tracks concerns related to domestic animals. Th Zoo pathologist tried many different channels in order to find laboratories willing to prioritize performing additional tests o samples and to provide advice on needed safety precautions f laboratory personnel working with the bird samples. 22 Many officials provided other examples of where communication public and animal health communities had not worked well and i that the West Nile events pointed to a need for better partnership these communities. This opinion was voiced even by those who a disregarded animal health officials' views and questions about the links between the animal and the human outbreaks. For example own internal assessment of the West Nile events, CDC concluded relationships between public health agencies at the federal, state, levels and their counterparts in public and private agencies that veterinary health should be strengthened. There are indications t of this greater collaboration has begun. Since the outbreak, archi samples from zoo animals drawn in past years have been analyze 22During the outbreak, one of the biggest concerns of the veterinary pathologist Zoo was the safety of laboratory workers at the zoo who were handling sick or At one point before the virus was identified, a veterinarian who was euthanizin flamingo stuck himself with a needle. Because the pathologist surmised that the human outbreaks were related, this event heightened her concerns about identi virus. the ongoing investigation to determine when and how West Nile was roduced.23 other frequently cited lesson was the need for improved laboratory rastructure and technologies for responding to outbreaks and newly erging viruses. While the concerns were wide-ranging, three common mes emerged: broadening laboratory capabilities, ensuring adequate ffing and expertise, and improving ability to deal with work surges in ting needs. Since the extent to which public health and other oratories across the country are capable of safely testing dangerous hogens is unknown, a first step in addressing these concerns may be to nplete assessments of inventory and core capacity needs. At the same e, lessons from the West Nile outbreak point to the need to improve rent linkages among laboratories. e need for enhanced laboratory capabilities was frequently mentioned by cials involved in the West Nile outbreak, as well as in various essments. Officials pointed out the need for more laboratory capacity identifying and handling infectious agents of high concern to human lth, particularly emerging or exotic ones. For example, they said that at time of the outbreak, only two or three laboratories in the country had reagents necessary to identify the West Nile virus. One of these was C's laboratory in Fort Collins, which did not initially use this reagent ce the first test it had performed was consistent with the related St. is encephalitis virus.24 Because New York State's laboratory was sidered less equipped to perform the diagnostic testing on the human iples once the outbreak was identified, CDC performed the bulk of se tests. In this regard, the need to "expect the unexpected," a phrase quently quoted in outbreak assessments, expresses the importance of eloping a broader awareness within the laboratories of the potential for ecifically, according to information provided by a Wildlife Health Sciences, Wildlife servation Society researcher, a serologic survey of the Wildlife Conservation ety/Bronx Zoo collection was performed to confirm infection of clinical cases, assess xtent of West Nile exposure, and investigate when the virus was introduced to the ction. cording to CDC, West Nile virus was not included in the original battery of antigens in ests performed at this point because there are 30 possible antigens to include and West had never before been seen in the Western Hemisphere. Other experts indicated that was a reasonable conclusion at the time. 26 GAO/HEHS-00-180 West Nile Virus Outbreak new agents to appear and, concurrent with such awareness, dev broader testing capacity. One federal laboratory official suggeste example, that federal policy should consider a broader dissemin methods for identifying more exotic pathogens-perhaps those that are more likely to be introduced to the country through inte travel or otherwise. |