RODS Laboratory, Center for Biomedical Informatics, University of Pittsburgh, Pittsburgh, Pennsylvania
Lieutenant Colonel, US Army, Uniformed Services, University of the Health Sciences, Washington, DC
Kenneth L. Cox
Colonel, US Air Force, Force Health Readiness, Tricare Management Activity/Deployment Health Support Directorate, Washington, DC
Nick M. Cirino
Biodefense Laboratory, Wadsworth Center, New York State Department of Health, Albany, NY
This chapter completes our review of the organizations listed in Table 1.2 (Chapter 1). In particular, we explore the biosurveillance roles of the U.S. Department of Homeland Security (DHS), transportation systems (planes, trains, and ships), the U.S. Postal System (USPS) and the U.S. Department of Defense (DoD). Like the other organizations we discussed in Part II, these organizations have counterparts in most other countries. We also discuss the World Health Organization (WHO), the United Nations agency responsible for advancing health.
2. DEPARTMENT OF HOMELAND SECURITY_
The DHS was established in March 2003 as a result of the terrorism events of 2001. According to Homeland Security Presidential Directive 10, the Secretary of Homeland Security is the principal federal official for domestic incident management and is responsible for coordinating domestic federal operations to prepare for, respond to, and recover from biological weapons attacks (White House, 2004). The Secretary of Homeland Security coordinates with the heads of other federal departments and agencies to accomplish this mission.
DHS plays a principal role in the monitoring of air for pathogens and has broad responsibilities for situational awareness (of which biosurveillance is but one dimension) for terrorism threats and events.
DHS is comprised of five major divisions or directorates: the Science and Technology Directorate, Border and Transportation Security, Emergency Preparedness and Response, Information Analysis and Infrastructure Protection, and Management. Besides the five directorates, several other agencies are folding into the new department or being newly created. They include the Federal Emergency Management Agency (www.fema.gov), Customs and Border Protection (www.cbp.gov), Immigration and Customs Enforcement (www.ice.gov), and the U.S. Citizenship and Immigration Services (http://uscis.gov/graphics/). The Science and Technology Directorate is active in biosurveillance. DHS has an annual budget of approximately $40 billion.
DHS initiatives in biosurveillance include increasing the deployed level of capability at the city and state level as well as the ability to integrate data from all sources (intelligence, human, animal, and agricultural surveillance) to form a national view. Table 12.1 presents a U.S. General Accounting Office summary of DHS biosurveillance information technology initiatives in 2005.
DHS has spent over $200 million on the BioWatch program (Lipton, 2005), whose goal is to detect the presence of biological agents in the air, and thus provide warning of a surreptitious release prior to victims' development of symptoms (U.S. Department of Homeland Security Science and Technology Division). The BioWatch program has deployed approximately 500 air sampling devices in 31 cities (Bridis, 2003). BioWatch devices continuously draw air through a collecting filter. The air samples are taken daily to laboratories for testing for several biological agents, including B. anthracis, Y. pestis, the smallpox virus, and F. tularensis (Bridis, 2003). DHS deploys additional sampling devices and mobile laboratory facilities during special events.
The current density of deployed devices is sparse relative to the estimated need. Although the devices are positioned to maximize the probability of detecting an attack (under assumptions about the most likely release points, agents, and quantity of material released), a detection probability of 1.0 is difficult to achieve with approximately 10 devices that exist in most cities (Lipton, 2005). In recognition of this problem, the
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table 12.1 Department of Homeland Security Biosurveillance Initiatives
Biological Warning and Incident Characterization System (BWICS) BioNet
Biowatch Signal Interpretation and Integration Program (BWSIIP)
A system that is expected to integrate data from environmental monitoring and health surveillance systems with incident characterization toolsa in order to provide timely warning of a biological attack and to help guide an effective response. BWICS is also expected to provide secure distribution of information to different types of users. A cooperative program between DHS's S&T Directorate and DOD (established as a demonstration project in May 2004) that is expected to integrate civilian and military capabilities at the local level for detecting and responding to the use of biological agents. The BioNet initiative is being developed in one city. It includes the use of a syndromic surveillance system known as the Electronic Surveillance System for the Early Notification of Community-based Epidemics (ESSENCE).b DHS plans now call for BioNet to be terminated in fiscal year 2005 with lessons learned, tools, and capabilities transferred to the BWICS initiative. An early-warning environmental monitoring system that collects air samples from high-threat cities in order to detect trace amounts of biological materials. BioWatch consists of three IT components: a sample management tracking system, a lab analysis tracking system, and an electronic reporting system. BioWatch labs use the reporting system to send data to CDC, who then sends a monthly report of negative results to DHS. A surveillance program pilot that is intended to evaluate public data feeds for their usefulness in biomonitoring signal interpretation to provide BioWatch metropolitan areas, in the event of a signal detection, with the ongoing collection and analysis of appropriate medical information (with personally identifying information removed) that would support rapid interpretation of the signal and integration into consequence management operations. Once BWSIIP is deployed as part of BWICS, plans call for local public health agencies to use locally existing or publicly available biosurveillance tools provided by DHS, such as ESSENCE, or the Real-Time Outbreak and Disease Surveillance (RODS) software.c An effort at the federal level to combine multiple data streams from sector-specific agencies—those with medical, environmental, agricultural, and intelligence data—to give DHS situational awareness that is expected to allow earlier detection of events and to assist in response actions.
a Incident characterization tools are designed to integrate information from surveillance, environmental monitoring, plume hazard predictions, epidemiological forecasts, and population and critical infrastructure databases. b ESSENCE is a syndromic surveillance software package available through free licensing agreements with the Johns Hopkins University Applied Physics Lab. The software is available to federal, state, and local health organizations that wish to deploy a Web-based syndromic surveillance system using their own data. DOD uses the system worldwide. The Department of Veterans Affairs and about 26 states and localities are implementing ESSENCE. c RODS, developed by the University of Pittsburg, is a syndromic surveillance system used by several states that collects data from hospital emergency room visits. This system identifies patients' chief medical complaints, classifies the complaints according to syndrome, and aggregates those data in order to look for anomalous increases in certain syndromes that may reveal an infectious disease outbreak. Source: U.S. Government Accounting Office, 2005. Information Technology: Federal Agencies Face Challenges in Implementing Initiatives to Improve Public Health Infrastructure. Report No. GAO-05-308 (http://www.gao.gov/new.items/d05308.pdf).
BioWatch program is expanding the number of devices per city (Divis, 2005), but as many as 60 may be needed for a high probability of detection (Lipton, 2005).
The Homeland Security Advanced Research Projects Agency (HSARPA) is contracting for development of "next-generation" devices (Simon, 2004) that can measure the air every three hours (as opposed to the current daily testing of samples) for up to 20 biological agents (Divis, 2005). A second next-generation device is the rapid automated biological identification system, or RABIS, which is the goal of a program to develop a detector that warns of a bioterrorist attack in less than two minutes. The intent is that RABIS units will be attached to building heating and air conditioning systems and will be able to shut down ventilation sections in the event of a release, limiting the spread of a pathogen will prevent others in the building from being exposed.
Despite the potential for the BioWatch program to provide early warning of an aerosol attack, it is still necessary to monitor for human and animal illness. As an event that occurred in Houston demonstrated, biological agents such as F. tularensis exist naturally in the environment and can trigger the BioWatch system (Divis, 2004, Bridis, 2003). Terrorists might deliberately release inactive agents to cause false positives and panic (Divis, 2005). At present, the BioWatch system monitors for approximately 10 biological agents (Mintz, 2003) with future systems targeted to test for 20 organisms (Divis, 2005). If terrorists released an aerosol of either a biological agent for which the system does not test or a sufficiently genetically modified strain of an organism, the release would go undetected. Thus, monitoring of human health is also necessary to distinguish between real events and Houston-like events or deliberate triggering of sensors with harmless agents from threats to human health. Monitoring of human health is also necessary to detect outbreaks that are missed due to the sparse density of the BioWatch network.
Table 12.1 also lists DHS projects whose goals include integration of biosurveillance data from military and civilian sources (BioNet), and data from animal, human health, intelligence, and agricultural surveillance (BWICS and the National Biosurveillance Integration System). We discuss BioNet in the section on the DoD. The other two programs are still in development.
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This is common knowledge that disaster is everywhere. Its in the streets, its inside your campuses, and it can even be found inside your home. The question is not whether we are safe because no one is really THAT secure anymore but whether we can do something to lessen the odds of ever becoming a victim.