is also the lead agency in HHS for bioterrorism preparedness. In nt years, the President and Congress have been increasingly concerned ut the threat of terrorists using weapons of mass destruction, including ogical agents.1 Part of CDC's National Center for Infectious Diseases, Bioterrorism Preparedness and Response Program is responsible for lic health preparedness for potential acts of bioterrorism. In fiscal year ), HHS received $278 million of the $10.2 billion in counterterrorism ies allocated to federal agencies. Of the HHS funding, CDC received roximately $155 million for bioterrorism preparedness programs in al year 2000, approximately $40 million of which is to be awarded to e and local health departments for surveillance, epidemiology, ratory, and communications. Figure 2: Timeli Animal Outbrea ing the first recognized outbreak of West Nile virus in the United States, Human Outbreak June Detecting We Overview ough the chance that terrorists may use biological materials may increase over the next The Animal Outb st Nile: An tbreak The identification of a newly emerging infectious disease2 within months was due to the combined, considerable efforts of scores individuals and several agencies in the animal and the human pub fields and in academia. Here is an overview of the key events that Appendix II contains a more detailed chronology. No one is sure exactly when or how birds became infected. By la veterinarian at an animal health clinic in the New York City borou 2Emerging infectious diseases include those whose incidence in humans has inc within the past two decades or threatens to increase in the near future. ens had examined and treated several birds that appeared to have nwhile, near the end of August, a specialist in infectious diseases in a in the next week, however, the State Department of Health obtained The Two Res and More Lal Involved rding to a New York City Department of Health official, these patients were initially ɔy different physicians, as commonly occurs in any hospital, and it was not until a infectious disease consultant reviewed their cases that the opportunity to see these its as part of a cluster presented itself. ponses Converge poratories Become outbreaks to be unrelated. The cause of the outbreak in birds re unidentified, and, to help identify it, the zoo veterinarians and t wildlife pathologist enlisted the help of federal veterinary labor the U.S. Department of Agriculture (USDA) and the U.S. Geolog (USGS). By mid-September, both laboratories concluded that th disease was caused by a virus, that it did not appear to be any s Louis encephalitis or other avian virus they had previously teste they had insufficient laboratory capabilities to identify it more s The USDA veterinary laboratory sent its virus samples to the CI laboratory for further analysis. The test results in birds, along with repeated negative test result samples in the state health department laboratory, increased the some state health officials about whether the human disease ag been correctly identified as St. Louis encephalitis. On Septembe invited a visiting academic researcher from California to try out testing methods on tissue specimens from human patients. The week, a Connecticut agricultural laboratory involved in that stat mosquito surveillance reported isolating St. Louis encephalitis v both a dead bird and mosquitoes collected near the outbreak ar finding was significant in implying that, if the virus was St. Louis encephalitis, it was killing birds and possibly could be connecte human outbreak. At about the same time, CDC had begun testing and retesting m bird, and human specimens against a wider variety of flaviviruse to rule out the possibility of another closely related virus. Indep the head pathologist at the Bronx Zoo gained agreement from th Army Medical Research Institute of Infectious Diseases to attem identify the virus in birds. Beginning on September 23, the academic researcher and CDC c same general conclusion: the virus causing the outbreak was no encephalitis but, rather, a virus that had never before appeared i United States. By the week of September 27, CDC had confirme "West Nile-like" virus was responsible for both the animal and th outbreaks. e effort involved in addressing these outbreaks and identifying the cause Table 1: Example Agency New York State Hea Department (includi counties outside of York City and New Y State Department of Agriculture and Mark New York Departmen Environmental Conservation, Albany, N.Y. CDC's Division of Vector-Borne Infectiou Diseases, Fort Collins, Colo. U.S.Geological Surve National Wildlife Heal Center, Madison, Wis City Department of Health conducts surveillance for pesticide-related morbidity by itoring calls to the Department's Poison Control Center. GAOMEHS-00-180 West Nile Virus Outbreak |