Government’s Response to Tularemia Concerns Some
WASHINGTON, Oct. 13 — A highly-suspect air sample in Washington was held for four days at the end of September before government officials determined it contained fragments of microbes causing a rare but treatable form of pneumonia and notified state and local public health officials.
While the bacteria that causes the disease, Tularemia, is considered a potential biological terror weapon, the sample did not meet the standards required to set off an immediate alert, or was not “BioWatch positive,” as one Department of Homeland Security official put it.
The Tularemia incident has raised the question of when the government should notify state and local public health officials of potential bioterrorism attacks, especially if the material in question is in low concentrations and tests show it appears probable but unconfirmed.
DNA fragments of Francisella tularensis – a naturally-occurring bacteria, but one that is also considered a potential weapon of bioterrorism along with Anthrax and Smallpox – were found in the air in very low concentrations in the areas of the National Mall, Lincoln Memorial, Judiciary Square and Fort McNair on Sept.24, according to published reports. About 250 people from Maine were in Washington that day attending an antiwar protest. Another 140 veterans from Maine also were in the area visiting the World War II Memorial.
City officials were not notified of the alert for four days, a fact that has drawn criticism from some in Congress.
“There should have been a much more rapid notification of the CDC by the Department of Homeland Security [and] in turn the CDC should have quickly notified the local health authorities,” said Sen. Susan Collins (R-Maine), who chairs the Homeland Security and Governmental Affairs Committee.
“Just imagine if there had been a biological release and the sensors had picked it up and we had lost five days in potentially identifying and providing early treatment to victims, that would be a terrible situation,” she said.
Rep. Tom Davis (R-Va.), chairman of the Committee on Governmental Reform, wrote letters to the Department of Homeland Security and the Centers for Disease Control and Prevention in early October to find out why public health officials in D.C., Maryland and Virginia were not notified sooner.
“If the bacteria detected can cause a flu-like illness and if symptoms can begin to appear one day after exposure it appears that notification of the appropriate state and local officials was delayed too long,” he wrote.
Dr. Jeffrey Stiefel, who directs BioWatch – a $60 million early warning, environmental monitoring program overseen by the Department of Homeland Security – disagreed. An initial test of the air samples at a local lab on Sunday, Sept. 25 was not a confirmed a “BioWatch positive,” he said.
“You’ve got to think of the greater good on this one,” he said. “If you come out and say that this is what it is and you’re wrong and the entire public health response network stands up then you now.have that community losing faith and potentially nation-wide losing faith in the system.”
Collins disagreed. “I supported the decision by New York officials to heighten security on the subway systems in response to what appeared to be credible evidence of a specific threat targeting the New York subway system,” she said. “Now it turned out that nothing happened but I think it is better to be on the safe side.”
BioWatch is a system of air collectors in 30 cities nationwide which monitors the air for six undisclosed substances, except in Washington where monitors check for eight substances, Stiefel said. No cities in Maine have BioWatch collectors.
“It didn’t meet our standards because .there are a certain number of markers that have to show up every single time and we weren’t getting that, but we were getting some of that which we’ve never seen before,” Stiefel said.
The Department of Homeland Security and CDC are both currently working on responses to Davis’ letter, officials from those offices said. Rep. Davis could not be reached for comment.
“Now is there a chance that you can miss something? Maybe,” Stiefel acknowledged. “But the fact is that if this had been . a true bioterrorist attack when they had used a lot of agent, it would have hit all of our markers.and we would have known by Sunday.” He added: “The system worked and it worked better than one would have thought.”
A “very astute” lab worker encouraged a repeat test on Wednesday, after which the lab contacted the CDC for more sophisticated testing, even though they are not required to do so, Stiefel said. The CDC confirmed fragments were of Francisella Tularensis, a bacteria commonly found in soil and water in certain southern and southwestern parts of the country like Arizona, New Mexico and parts of Texas.
The bacteria, which causes Tularemia, commonly known as “Rabbit Fever,” is not contagious from person to person. Rather it is transmitted to people from animals or insects. The symptoms are usually like those of a cold or flu, but in rare instances – or if collected in a powder and sprayed in the air, as would be in a case of bioterrorism – a person can breathe it and get pneumonia which is generally treatable, but not always immediately recognizable to doctors, according to infectious disease specialists.
Congressman Davis also questioned BioWatch’s operating procedures.
If it had been a true “BioWatch positive,” notification would have gone out immediately, Stiefel said. Also the response given to something that is not a confirmed “BioWatch positive” differs depending on the organism. “One would think that if we had seen a similar signal and it said smallpox it would have gone up the chain real, real fast,” Stiefel said.
A nationwide alert went out to state and local public health departments on Friday, Sept. 30, six days after BioWatch labs first detected that Tularemia microbes might have been in the air.
As of last week, no cases of Tularemia had been documented, according to CDC, but officials there wanted state and local public health officials to be on alert for it.
“I’ve not heard anything to say that it was intentional but I think we do need to understand the source,” said Von Roebuck, a CDC spokesman.
Sen. Collins said that the Department of Homeland Security had recently contacted her office to tell her that it was a false positive. But when asked if this was a terrorist attack, Stiefel said “there’s no way that anybody can know. There’s not enough data.”
Stiefel said the current theory is that it was environmental. In 2003 in Houston, Texas there was a similar incident where an air sample showed fragments of the Tularemia bacteria after winds stirred up dust, according to Penny Hitchcock, senior associate of the Center for Biosecurity at the University of Pittsburgh Medical Center.
Maine State Health Officer Dr. Dora Mills received the alert Friday, Sept. 30.
“I was just sort of scratching my head,” she said, adding that the alert provided little information about the level of risk involved. “I had to read it twice to wonder what they were trying to get us to do.”
Mills said she forwarded the alert to Maine infectious disease specialists, but did not track down the Mainers who had been in Washington for the march. Left to their own devices – and the media – to grapple with exposure to a potential bioterrorist agent, the protesters were not sure how to react.
“Everything that we’ve read really [is] so preliminary,” said Merry Segal, a Bowdoin college sophomore who attended the antiwar march and helped organize buses for the event. “It’s something that we’ll follow but.we’re not doing anything at this point in response to it other than making other folks aware.”
“As we do more and more sampling of the environment we’re going to.detect organisms that are in the soil and that we didn’t know could be aerosolized and collected in a device like this so there’s a learning curve,” said Hitchcock.
“It’s a microbe that’s carried by rodents and other animals like rabbits,” said Dr. Mills. “It just would seem to me like of course you’re going to find it if you go looking for it on a grassy park.”
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