Collaboration between public health and law enforcement: new paradigms and partnerships for bioterrorism planning and response - Bioterrorism-Related Anthrax

Emerging Infectious Diseases, Oct, 2002 by Jay C. Butler, Mitchell L. Cohen, Cindy R. Friedman, Robert M. Scripp, Craig G. Watz

Table. Differences in public health and law enforcement investigations

Characteristics                             Public health

Method of event recognition      Event detected through public health
                                surveillance or calls from clinicians
Challenges to event            Few clinical syndromes that are clearly
recognition                     the result of bioterrorist attack; di-
                                fficulty distinguishing between disease
                                  of natural origin and bioterrorism
                                                attack
Initial data collection          Hypothesis generation, "shoe-leather
                                            epidemiology"
Confirmatory data collec-          Controlled epidemiologic studies
tion and analysis
Data validation                Presentation for scientific peer review
Goal of investigation          Effective disease prevention and control
                                               measures

Characteristics                            Law enforcement

Method of event recognition    Event announced by attacker or is
                                            evident
Challenges to event             Large number of hoaxes and noncredible
recognition                     threats not associated with an actual
                                 bioterrorist attack; delay in noti-
                                fication of possible event by public
                               health; "copycat" threats or attacks (9)
Initial data collection        Questioning of witnesses and suspects,
                                  follow-up of tips and intelligence
                                             information
Confirmatory data collec-      Collection and organization of evidence
tion and analysis
Data validation                   Indictment, arrest, and conviction
Goal of investigation            Prevention and deterrence of future
                                               attacks

Dr. Butler is an infectious diseases physician and is director of the Arctic Investigations Program, National Center for Infectious Diseases in Anchorage, Alaska. He served as the Centers for Disease Control and Prevention liaison to Federal Bureau of Investigation headquarters during November and December 2001.

References

(1.) Torok TJ, Tauxe RV, Wise RP, Livengood JR, Sokolow R, Mauvais S, et al. A large community outbreak of salmonellosis caused by intentional contamination of restaurant salad bars. JAMA 1997;278:389-95.

(2.) Kolavic SA, Kimura A, Simons SL, Slutsker L, Barth S, Haley CE. An outbreak of Shigella dysenteria type 2 among laboratory workers due to intentional food contamination. JAMA 1997;278:396-8.

(3.) Centers for Disease Control and Prevention. Notice to readers: ongoing investigation of anthrax--Florida, October 2001. MMWR Morb Mortal Wkly Rep 2001;50:877.

(4.) Bush LM, Abrams BH, Beall A, Johnson CC. Index case of fatal inhalational anthrax due to bioterrorism in the United States. N Engl J Med 2001;345:1607-10.