Physicians and other health care professionals are likely to be the "first responders" to a bioterrorist event. Your role is a critical one in our ability to detect and respond to such an event. I wrote to you in October 2001 with information about anthrax because New York and the nation were experiencing an anthrax outbreak. This letter is to inform you of recent additions to the reportable disease list and contains information and reference materials about other potential bioterrorism agents, including smallpox. I want to stress that we have no information about a specific threat related to these agents. However, given the events of September 11, 2001, and the subsequent anthrax outbreak, we must be prepared to deal with any eventuality, however unlikely. Please familiarize yourself with these materials and keep them in your files.
Physicians have a critical role in the early recognition and immediate reporting of illnesses that may represent a bioterrorist event. Prompt reporting of cases of communicable disease also allows public health agencies at the local, state and federal levels to identify newly emerging infectious diseases, detect naturally occurring disease outbreaks, prevent secondary transmission and evaluate the effectiveness of control measures. All of these efforts may be compromised when cases are not reported in a timely manner. Physicians, healthcare facilities, laboratories, and local and State health departments all share the responsibility for reporting, follow-up, and control of communicable diseases.
Many of the agents considered by national experts to be likely bioterrorist weapons are already on the reportable disease list of the New York State Sanitary Code (10NYCRR2). Current reportable diseases include anthrax, botulism, brucellosis, plague, and tularemia. Effective November 20, 2001, on an emergency basis, six new diseases were added to the reportable disease list (section 2.1), and the list of diseases requiring the submission of specimens for laboratory testing (section 2.5). The Department of Health is already working to make these regulatory changes permanent.
The new diseases added to the reportable disease list include:
- Q fever
- Staphylococcal enterotoxin B poisoning (SEB)
- Viral hemorrhagic fever
In addition, any disease outbreak or unusual disease is now a reportable event. Unusual disease is defined as a "newly apparent or emerging disease or syndrome of uncertain etiology that a health care provider or the State Commissioner of Health has reason to believe could possibly be caused by a transmissible infectious agent or microbial toxin."
Enclosed is an updated list of the reportable communicable diseases mandated under New York State Sanitary Code (Attachment 1). Suspected or confirmed cases of the diseases shown in bold print should be reported immediately by phone to the local health department where the patient resides. Diseases not in bold print must be reported by phone, mail, facsimile or other electronic means to the local health department where the patient resides within 24 hours of diagnosis. A list of local health department phone numbers for business hours is enclosed (Attachment 2).
In order to assist you in detecting and responding to potential bioterrorist events, the following educational items are enclosed:
- Information on the New York State Department of Health's Health Provider Network (HPN) (Attachment 3). The HPN is a secure, internet-based communication system that the New York State Department of Health uses as its principal means for disseminating and gathering important and sensitive information and data regarding bioterrorism preparedness, surveillance and response. I urge you to sign up for an HPN account using the enclosed (printer ready) forms if you have not done so already. If you are unsure if you have an HPN account or have one and want information on its status, you may call 1-866/529-1890 or email HINWEB@health.state.ny.us .
- The article, "Smallpox as a Biological Weapon: Medical and Public Health Management," Journal of the American Medical Association 1999; 281:2127-2137. The authors, Donald A. Henderson, MD, MPH, Thomas V. Inglesby, MD, John G. Bartlett, MD, et al., provide specific recommendations, developed by nationally renowned members of a workgroup, for measures to be taken by medical and public health professionals in the event that smallpox is used as a biological weapon against a civilian population (Attachment 4 - PDF format, 361KB).
- A listing of references and websites for additional clinical information on specific pathogens (Attachment 5)
- A "Bioterrorism Rapid Response Card" (PDF format, 57KB) developed by the New York State Department of Health. The card is designed as an easily carried reference tool for recognizing and diagnosing bioterrorism-related illnesses. The card also provides general treatment and prophylaxis information, as well as infection control precautions for biological agents.
- A poster entitled, "Ten Critical Steps for Handling Possible Bioterrorist Events." The poster emphasizes the need to monitor for diseases caused by bioterrorist agents, and details the appropriate response to potential bioterrorist events. Please note: this poster contained outdated information and has been removed.
I hope you find these materials useful. For further information, please contact your local health department or the New York State Department of Health, Bureau of Communicable Disease Control at (518) 473-4439.
Antonia C. Novello, M.D., M.P.H., Dr.P.H.
Commissioner of Health
- Local Health Departments
- New York City Department of Health Mental Hyigene
- NYSDOH Regional Offices
- Hospital CEOs