268849 Cross-agency collaboration: A tularemia investigation in Virginia

Sunday, October 28, 2012

Jennifer Espiritu, MD MPH , Division of Surveillance and Investigation, Office of Epidemiology, Richmond, VA
Cynthia Sikorski, MD MPH , Threat Assessment Department, NEPMU2, Norfolk, VA
Erin Duffy, MD MPH , Occupational Medicine & Immunizations, Navy Medical Center Portsmouth, Portsmouth, VA
Margaret Tipple, MD , Division of Surveillance and Investigation, Virginia Department of Health, Richmond, VA
Background/Purpose: This study describes collaboration in the investigation of a case of pulmonary tularemia. Because Francisella tularensis can be used as biological warfare agent, this event represented a potential public health emergency. Study Design: This is an investigation of a tularemia case and associated contacts. Results/Outcomes: In September 2011, a previously healthy active-duty male in Virginia presented with a febrile respiratory illness, was admitted to a military intensive care unit for acute respiratory distress syndrome, and intubated. Further questioning of the patient's family revealed exposure to a rabbit at home one week prior to illness onset and his antibiotic coverage was broadened to include coverage for atypical pathogens. Using standard precautions, the hospital laboratory initially identified an uncommon Haemophilus species, later determined to be Francisella tularensis by the state laboratory, and the diagnosis of pulmonic tularemia was made. Patient history and information from the Federal Bureau of Investigation ruled out use of a bioweapon. Using an approach similar to the Incident Command System, civilian health departments, veterinary experts, and military medicine assets all collaborated to identify other hospital-based and community contacts, provide chemoprophylaxis as needed, and communicate with stakeholders. We recovered no rabbits for testing and identified no additional cases. The patient recovered without sequelae. Conclusions: Although only one patient was affected, this investigation demonstrates effective collaboration of various agencies during a potential public health emergency.

Learning Areas:
Environmental health sciences
Occupational health and safety
Protection of the public in relation to communicable diseases including prevention or control

Learning Objectives:
Explain the similarities between the command structure used and the Incident Command System.

Keywords: Infectious Diseases, Bioterrorism

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am an active duty Navy Preventive Medicine Officer and have participated in planning exercises for as well as real world public health emergencies. Among my scientific interests are disaster preparedness, infectious diseases, and occupational medicine.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.