National Biosurveillance Systems: BioWatch and the Public Health System

[Guest guest]

National Biosurveillance Systems: BioWatch and the Public Health System

http://www.iom.edu/CMS/3740/58811/62347.aspx

Released On: February 10, 2009

For many years, concerns about bioterrorism and emerging infectious

diseases have drawn attention to the need for strong surveillance

systems. Experts are working to develop new and better ways to detect

these biological threats as quickly as possible so that appropriate

action can minimize illnesses and deaths. One effort in this area is

the Department of Homeland Security’s BioWatch program, through which

air samples collected in more than 30 major localities are tested for

the presence of certain pathogens.

To evaluate the effectiveness of the BioWatch program, the Institute

of Medicine (IOM) and National Research Council (NRC) convened the

Committee on Effectiveness of National Biosurveillance Systems:

BioWatch and the Public Health System. The evaluation includes a

comparison of costs and benefits for the current generation and

planned next generation of BioWatch technology; the costs and benefits

of an enhanced national surveillance system that relies on U.S.

hospitals and the U.S. public health system; and the effectiveness of

this approach compared to that of the current BioWatch program.

This interim report contains no findings and recommendations, but

outlines the committee’s initial progress in addressing the major

issues under consideration. A final report, expected in June 2009,

will present the committee’s findings and recommendations.

http://www.nap.edu/catalog.php?record_id=12599

INTRODUCTION

In 2001, the United States experienced the effects of bioterrorism

when envelopes containing anthrax spores were sent through the postal

service to several different recipients, including two U.S. senators.

It is likely that several thousand people were exposed to anthrax,

with antibiotic prophylaxis widely prescribed for those whose exposure

was known or suspected. The consequences of this event included five

deaths from inhalational anthrax and another 17 inhalational or

cutaneous anthrax infections, as well as substantial economic costs

and significant operational challenges in public health and health

care from the federal level down to the community level (Gursky et

al., 2003).

The experience with the anthrax letters combined with long-standing

concerns about the threat of biological warfare to give new urgency to

ongoing efforts to strengthen domestic biodefense capabilities.

Overlapping the “biodefense†concept are related efforts to ensure the

capacity to respond effectively to naturally occurring health threats

that may arise, such as pandemic influenza or unfamiliar emerging

infectious diseases. A presidential policy statement, Biodefense for

the 21st Century (The White House, 2004), articulated four “pillarsâ€

of a national biodefense program: threat awareness, prevention and

protection, surveillance and detection, and response and recovery.

Implementation of a biodefense program depends on federal, state, and

local components in collaboration with hospitals and health care

providers in the private sector, as well as many others. At the

federal level, much of the responsibility for civilian biodefense

rests with the Department of Homeland Security (DHS) and with the

Department of Health and Human Services (HHS). But formal legal

authority for public health actions rests with the individual states,

and it is exercised at the local level across nearly 2,900 county and

city health departments.

Surveillance for and detection of disease outbreaks is a traditional

responsibility of public health authorities, which rely heavily on

diagnosis and case reporting by health care providers and

laboratories. The threat of bioterrorism has spurred interest in

finding ways to detect health threats as quickly as possible so that

preventive measures or treatment can be administered in time to reduce

illnesses and deaths. One approach to early detection has focused on

developing techniques for collecting and analyzing data streams from

health care settings and other sources in an attempt to identify

anomalies that might signal impending health events sooner than

standard diagnosis and case reporting. Another approach to earlier

detection of health threats has been the BioWatch program, under which

DHS has deployed air samplers, primarily in outdoor locations, in more

than 30 major cities with the aim of early detection and

characterization of aerosolized biological threats.

BioWatch air samplers were first deployed in 2003. An available

technology package—the Biological Aerosol Sentry and Information

System (BASIS)—was adapted to allow for rapid implementation of

outdoor air monitoring for six major biological threat agents,

including the organisms that cause anthrax (CRS, 2003; DHS, 2008). The

current version of this technology, referred to as Generation 2.0,

requires daily manual collection and testing of air filters from each

monitor. Newer technologies being considered by DHS (Generation 2.5

and Generation 3.0) promise to automate the testing process within the

monitoring station, which has the potential to produce results more

quickly and at lower cost. The Generation 3.0 devices may also

eventually have the capability to test for a greater number of threat

agents. DHS plans include deploying the next generation of BioWatch

monitors in indoor locations.

Questions have been raised about the BioWatch program, including the

technological capabilities of BioWatch monitoring devices, operational

aspects of the Generation 2.0 deployment, planning for the

introduction of Generation 2.5 and Generation 3.0 (e.g., O’Toole,

2007a,b; Downes, 2008; GAO, 2008). Questions have also been raised

about the relationship of BioWatch to other surveillance efforts based

in the health care and public health sectors, including its

contribution to the effectiveness of surveillance and response by the

health sectors (e.g., O’Toole, 2007b; Price, 2008), and about the

effectiveness of techniques of epidemiologic surveillance such as

syndromic surveillance.

Because of such questions, the Congress, through the Subcommittee on

Homeland Security of the House Appropriations Committee, directed the

Office of Health Affairs (OHA) in DHS to ask the National Academies to

evaluate the effectiveness of the BioWatch program, to compare the

costs and benefits of the current and planned versions of BioWatch

monitoring systems, to examine the costs and benefits of an enhanced

national surveillance system that relies on hospitals and the public

health system, and to compare the effectiveness of BioWatch to such an

enhanced system.1

Sharon Noonan Kramer

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