Regional Public Health Officials Simulate Bioterrorist Attack To Test APL-Developed Disease Surveillance System

Public health officials from the District of Columbia, Maryland and the Commonwealth of Virginia gathered today at The Johns Hopkins University Applied Physics Laboratory (APL) in Laurel, Md., to demonstrate the utility of the National Capital Region (NCR) Disease Surveillance Network.

Concerns about the potential for a large-scale bio-terrorist attack or an outbreak of an infectious disease have prompted a growing number of jurisdictions across the nation to launch electronic tracking systems to quickly detect outbreaks. By compiling data from emergency rooms, poison control centers and other sources, disease surveillance can serve as an early warning alarm.

The NCR network uses the Electronic Surveillance System for the Early Notification of Community-based Epidemics (ESSENCE), developed by the Lab with the Walter Reed Army Institute of Research. ESSENCE compiles data containing health indicators, performs analysis and provides information to local and regional public health officials on statistical anomalies that occur to help them identify bio-events early. Such irregularities would include upward trends in rashes, fevers and unexplained deaths, or a sudden surge in over-the-counter drug sales. It is the first system to integrate military and civilian data.

Each local and state public health jurisdiction in the NCR network responds independently to public health alerts and to ensure the health and safety of its residents. With an unprecedented collaborative network among public health programs, the NCR disease surveillance system offers a first line of defense in the national capital area.

Today's exercise was designed to test the system, using a simulated terrorist attack to observe the response from public health authorities. (The scenario was based on a hypothetical situation and was not intended as a forecast of future events.)

"This is giving us an opportunity to see, in real time, how health data are provided under this framework to different people to support a decision-making process that turns into action, and to see if it's done in a coordinated manner" said Thomas J. Lockwood, the U.S. Department of Homeland Security's director of the Office of National Capital Region Coordination. "This exercise is a key building block in protecting our citizens against a bioterrorist attack. NCR's ESSENCE is not the only protective tool we have in this regard, but it's an important one."

The purposes of the exercise were: to reinforce existing partnerships for an integrated response, including strengthening communications between NCR public health jurisdictions; to familiarize jurisdictional leaders with how public health officials use ESSENCE to apply knowledge in the early detection and monitoring of an intentional or naturally occurring emerging pathogen; to identify areas for improvement and enhancement within the system architecture; and to identify specific education and training needs of participants.

"What we've seen in this exercise is that the public health experts from the regions have been able to identify events that have occurred and determine their significance by sharing knowledge across the jurisdictions," said APL's Joseph S. Lombardo, who led the development of the ESSENCE system. "We noticed that when the health departments are so engaged the way they are, enhanced surveillance really does work."

The NCR network is comprised of independent operation centers — known as surveillance nodes — in the District of Columbia, Maryland and Virginia, with a central "regional integration node" operated by APL for performing surveillance across jurisdictional boundaries. It operates 365 days a year, providing information to local and state public health departments.

This exercise culminates the network's first year of operation using ESSENCE. Since it was formed in April 2004, the network has created an Enhanced Surveillance Operating Group to oversee the regional collaboration and formalized its data-sharing agreement. "As we enter our second year, we will formalize our response plan," said APL's Sheryl H. Lewis, the project manager for NCR. "We will also provide the local jurisdictions with the materials to quickly train their personnel on using ESSENCE and continue to fine-tune the system's algorithms based on comments from today's participants."