While biological agent detection primarily is undertaken by SLTT public health authorities, there are federal resources that can assist in epidemiological investigations.
1.4.1 Assistance in Disease Investigations
When invited by SLTT jurisdictions, the CDC supports such jurisdictions in performing disease investigations and helps to coordinate a national picture. When requested, CDC provides technical assistance to a SLTT epidemiological investigation, for example, through the use of an Epidemiologic Assistance (Epi-Aid).38 Epi-Aid is an investigation of urgent public health problems such as disease outbreaks, unexplained illnesses, or natural or man-made disasters. When a public health authority requests assistance from CDC, an Epi-Aid enables rapid, short-term (one to three weeks) technical assistance by Epidemic Intelligence Service officers and other CDC subject matter experts (SMEs), generally provided onsite. The focus of an Epi-Aid investigation is to assist partners in making rapid, practical decisions for actions to prevent and control the public health problem.
Following a One Health approach that recognizes the interconnection between people, animals (domestic and wild), and their shared environment, CDC provides technical expertise in the One Health aspects of zoonotic disease investigations and also supports interagency coordination. In the event an investigation involves a zoonotic disease, CDC will coordinate with USDA APHIS Veterinary Services (VS) and other relevant partners. When responding to zoonotic disease incidents, animal health officials will coordinate with public health officials at both the state (e.g., State Animal Health Official) and federal levels (e.g., Area Veterinarian in Charge, USDA APHIS VS).
What Will You Need to Know?
- What federal resources are available to support SLTT response? Who is responsible for contacting them? What resources may they need when they arrive?
1.4.2 Select Agent Awareness
The Federal Select Agent Program is jointly comprised of the CDC Division of Select Agents and Toxins and the USDA APHIS Division of Agricultural Select Agents and Toxins. The Federal Select Agent Program oversees the possession, use, and transfer of biological select agents and toxins, which have the potential to pose a severe threat to public, animal or plant health, or to animal or plant products. The program greatly enhances the nation’s oversight of the safety and security of select agents by:39
- Developing, implementing, and enforcing Select Agent Regulations
- Maintaining a national database
- Inspecting entities that possess, use, or transfer select agents
- Ensuring that all individuals who work with these agents undergo a security risk assessment performed by the FBI Criminal Justice Information Services
- Providing guidance to regulated entities on achieving compliance to the regulations through the development of guidance documents, conducting workshops and webinars
- Investigating any incidents in which non-compliance may have occurred
An awareness of these biological agents with the potential to pose a severe threat to both human and animal health will help SLTT emergency management planners effectively communicate and collaborate with public health, animal health, and law enforcement partners during both the planning for and response to a biological incident.
1.4.3 Considerations for Criminal Investigations
The cause of a biological incident (e.g., intentional, accidental, or naturally occurring) may not be readily apparent, and the possibility that the incident resulted from a criminal act must be considered. While the FBI leads all criminal investigations related to the intentional threat or actual use of a biological agent, the interdisciplinary nature of a biological incident means that criminal investigations will likely occur concurrently with public health investigations. To facilitate this process, the FBI and CDC developed the concept of joint criminal and epidemiological investigations in which law enforcement and public health practitioners share information and draw on the unique expertise of both fields to maximize the effectiveness of characterization and response efforts. When criminal investigations are necessary, special attention will need to be paid to public communications strategies, as the public will likely be more distressed by an incident with intent to harm as well as the potential for follow-on malicious activity. To reassure the public, protect the safety of responders, and take the initial paucity of information into consideration, decision-making and the initiation of response activities should be approached cautiously and continually reviewed. Following an attack, the “unknowns” can quickly accumulate, and access to accurate information will lag significantly.
What Will You Need to Know?
Who will you consult to find out:
- The typical incubation period for the disease? Disease symptoms? If definitive diagnostic tests are available for this disease?
- If the pathogen has been modified (e.g., if the pathogen has been modified to be resistant to therapeutics)?
- What type of PPE is required to minimize the likelihood of contracting or spreading the disease?
- Are there pre-exposure prophylactics (PrEP) and post-exposure prophylactics (PEP) available?
- What are the morbidity and mortality rates for this disease?
- How is the disease transmitted?
- Via direct contact with contaminated fomites, individuals and/or animals?
- Via ingestion or inhalation?
- Via vectors?
- If the disease is contagious, should decontamination be part of the planning process for shelters and community reception centers?
- How is that decision made?
- What is the decontamination process and who participates in the process?
- Which populations are most vulnerable to exposure and infection?
- General population or selected segments (e.g., children, elderly, first responders, first receivers)?
- Animal or human?
- The source of the outbreak?
- How persistent the pathogen is in the environment? Is the pathogen susceptible to inactivation (i.e., natural attenuation or decontamination)?
- If the outbreak is limited to human-to-human transmission or if there is environmental contamination also? If there is environmental contamination, how will you find out the size of the affected area?
- What types of facilities (e.g., transit systems, schools, office buildings, etc.) and critical infrastructure are located within the affected area?
- How will you find out if it is a naturally occurring or intentional incident?
- For a suspected intentional release, how will you know:
- When and through what means the agent was dispersed?
- What the meteorological conditions were (e.g., temperature, humidity, wind speed and direction, cloud cover, etc.) at the time of the release?
- If the dispersion was from a point (e.g., sprayer) or moving source (e.g., airplane)?
- What do first responders and first receivers need to know about a biological incident (e.g., agent type, special considerations for treatment, PPE use, etc.)?