Historically, the Florida department of Health (which includes the county health departments) has given ample evidence of its ability to respond effectively to individual cases of disease, disease outbreaks, and other public health emergencies. In the past five years alone, the department has responded to hurricanes, floods, wildfires, and outbreaks of West Nile virus, St. Louis encephalitis, meningococcal meningitis, hepatitis A (now ongoing), cyclosporiasis, and others. Each outbreak or event refines the process. The most strenuous test of the system occurred in October 2001, when the first case of anthrax was reported in Palm Beach County. With some minor perturbations, the system worked as it should. The suspect case was reported to the local health department, who sought consultation with the State Epidemiologist, who notified the State Health Officer. An epidemiology team was dispatched to Palm Beach County and arrived before the case was confirmed. When the case was confirmed, the governor and CDC were notified and a combined local, state and federal response was initiated. The epidemic response team organized according to the guidelines for outbreak management. An outbreak operations center was established, active surveillance was initiated in local hospitals, case contacts were investigated, vaccination campaigns were initiated, environmental samples taken, and media coordination began, all during the initial day of the event. This is classic outbreak response in Florida.

The possibility for such a response is dependent on the existence of important program components:

• The organizational structure of the FDOH (county health departments are organizational components of the FDOH) contributes to effective cooperation.

• Florida laws, statutes and rules strongly support disease control and outbreak management.

• The state has recently created regional domestic preparedness task forces to provide planning and strategic management of terrorist events.

• The FDOH has an emergency management structure that provides immediate logistical support.

• The Bureau of Epidemiology has a team of field epidemiologists who are available to travel throughout the state to provide epidemic assistance. That team has been strengthened recently by the creation of the Florida EIS corps.

• The FDOH has a statewide computer network and dedicated communications system.

• The FDOH maintains access to an epidemiologist 24 hours a day 7 days a week.

• The FDOH has a statewide web-based disease reporting and analysis system.

• The Bureau of Epidemiology manages the ongoing communicable disease reporting system as well as special surveillance programs for RSV, influenza, drug-resistant Streptococcus pneumoniae, arboviral diseases, and emergency department surveillance.

• The Bureau of Epidemiology provides ongoing forums for communication and discussion among epidemiologists across the state through its weekly Epi-Updates, monthly Grand Rounds, and periodic training programs.

• The county health departments and Bureau of Environmental Epidemiology maintain a statewide capacity to respond to food and waterborne disease outbreaks.

• Experts in epidemiology are available to county health departments on a moments notice.

• Most large local health departments have skilled epidemiologists; all local health departments have the capacity to initiate an epidemiologic response.

• Pharmaceuticals are rapidly available.

• The state laboratory recognizes outbreak support as a high priority and provides services as needed during such events.

Assessment of Capacity:

Although considerable progress has been made in raising the level of response to potential bioterrorism events as well as naturally occurring cases of urgent public health importance, gaps still exist in the following areas:

• Currently the Florida Department of Health is lacking an adequate number of state and local staff to investigate and respond to a bioterrorism event or other public health emergencies. The Bureau of Epidemiology needs to develop Epidemiology Rapid Response Teams throughout the state and expand the Florida EIS Program from 6 to 12 epidemiologists. There is also a need to provide sufficient senior level epidemiologists to respond to events.

• There is a need to provide laptop computers, cell phones, and software to field staff prior to an event or outbreak.

• There is a need to further develop ongoing regional training for county health departments, to address disease surveillance, management of outbreaks, and recognition of potential bioterrorist events. A high turn over rate of staff also indicates a need to keep county health departments informed and educated about current epidemiological and bioterrorism issues. (Coordinate with focus area G)

• Training for hospitals, laboratories and other health care providers on bioterrorism preparedness and response in the state is crucial. (Coordinate with focus area G)

• Enhance capacity for emergency communications especially as it relates to public health surveillance. Develop better communication between county health departments and state headquarters.

• There is no means of sufficiently collecting data from healthcare providers or a pre-developed means of documentation of databases. The need exists for providing a system for GIS mapping and analysis of outbreak or other important event data.

• There is currently no mechanism in place for timely dissemination of educational material and other relevant technical information for healthcare providers in a bioterrorism event or other unusual disease occurrence.

• Expand Merlin to include reports from Environmental Health and other Florida agencies to detect positive lab results from agriculture, livestock, and food testing. Expand Epi-Com to include groups in the Veterinary community. Link these reports to communicable disease reporting to detect unusual events that would initiate a public health response.

Goal for Critical Capacity:

To close the gaps in the Florida Department of Health’s ability to rapidly and effectively mobilize surveillance and epidemiologic response to a potential bioterrorism event or unusual disease occurrence.

 

Strategic Approaches:

• Increase the number of properly equipped and skilled epidemiology staff whose primary responsibility is to respond to public health emergencies, outbreaks, and consultation requests from county health departments

• Improve the level and frequency of epidemiologic and surveillance communication within the state of Florida through Epi Com

• Coordinate with Focus Area G to ensure the proper surveillance and epidemiology staff in the county health departments and state offices are trained for responding to a bioterrorism event or unusual disease occurrence.

Objectives:

1. Complete the Florida Department of Health’s Bioterrorism Surveillance and Epidemiology response plan by 9/30/2002.

2. Develop a core list of qualified epidemiologists for emergency mobilization at the state health office, county health departments, and designated hospitals in each county by 10/31/2002.

3. Develop a list of communication and data entry equipment and location of resources (e.g., the national pharmaceutical stockpile) that can be mobilized to respond to a bioterrorism event or disease outbreak by 10/31/2002.

4. By November 30, 2002 provide the county health departments with additional epidemiology staff by doubling the size of the Florida EIS program from 6 to 12 officers. Each epidemiologist will have the necessary computers and software to conduct field epidemiology and surveillance.

5. Develop and train epidemiologic response teams capable of conducting field investigations, rapid needs assessment, exposure assessments, and response activities. By January 31, 2003, these teams will be trained by attending the Epi In Action course at CDC.

6. Develop a statewide on-call system that can be utilized by each county health department for 24 hour, 7 day a week communication from the community, by January 31, 2003. This will ensure that someone can be reached at all times after business hours.

7. The Florida Department of Health will launch Epi Com by March 31, 2003 to enhance statewide communication during a bioterrorism event or unusual disease occurrence. Launch of Epi Com will include a manual, training, and a plan for communication during an event.

8. Conduct and evaluate an annual bioterrorism exercise for Florida Department of Health entities including county health departments, state programs, and state laboratories by 6/30/2003.

9. Develop a plan by April 30, 2003 to coordinate response effort between field investigations and the state laboratories in the event of increased number of tests and specimens.