Monkeypox outbreak tests bioterrorism response systems

U.S. efforts to prepare for a bioterrorist attack have enabled an effective response to this month's outbreak of monkeypox in the United States, according to health officials and public health experts.

"State health departments have been actively involved in planning and preparing for the possibility of a bioterrorist event. We are now seeing that this level of preparation can also assist in unexpected, natural outbreaks," said Health and Human Services Secretary Tommy Thompson.

Health officials are investigating 54 suspected cases of monkeypox in four states. The disease is carried by rodents and is similar to smallpox but much less deadly. U.S. officials yesterday recommended the smallpox vaccine to "persons investigating monkeypox outbreaks and involved in caring for infected individuals or animals."

Monkeypox was not mistaken for smallpox, health officials said, but the similarity helped detect the disease quickly and bioterrorism was quickly ruled out.

Health workers are "trained more in clinical recognition of poxes" than they once were, said Lorna Will, an epidemiologist with the Wisconsin Department of Public Health. Wisconsin has reported 20 cases of monkeypox.

The monkeypox outbreak also tested the U.S. ability to respond to a bioterrorism incident, and the public health system performed admirably, officials said.

"Mother Nature has given us a little practice opportunity," said Shelley Hearne, executive director of Trust for America's Health, a nonpartisan public health group.

Hearne compared the monkeypox response to the confused public health reaction during the anthrax mailings of 2002 and said there has "certainly been significant improvement. That's the good news."

She cautioned, however, that the government might be focusing too heavily on a few, select biological threats. To prepare for terrorism, health officials should be prepared to face the "unexpected." The most effective preparation for an unknown biological or chemical threat is a strong public health infrastructure, according to Hearne.

Cuts in public health funding, brought on by nationwide budget shortfalls, risk "undercutting the foundation" of biological and chemical terrorism defenses, she warned.

Health officials said the outbreak was detected and reported quickly.

"Surveillance has certainly been upgraded," said Von Roebuck, a spokesman for the Centers for Disease Control and Prevention.

"I suspect we may have seen monkeypox in the past and we didn't pick it up," Hearne said.

Enhanced communication in the public health community was the most valuable improvement cited by several officials and experts.

The focus on preparing for bioterrorism "helped a lot with communication between hospitals and health departments," according to Will, the Wisconsin epidemiologist.

The CDC was able to effectively alert local health departments, said Roebuck, adding, "the information communication side has been very good, and that's huge, especially in an investigation like this."

Will, who until recently was a clinician, said that doctors now know where to go during a public health emergency.

"When we first started [improving public health infrastructure] people used to call me constantly without a clue," she said. Confused doctors did not know where to report unusual diseases or where to get information on new outbreaks. "I can tell you that as a clinician, I would not have known who to call," she said.