Role of NPHL in Responding to Bioterrorism By Anthony R. Sambol, M.S. Last fall, the CDC began a program for developing stronger public health preparedness for bioterrorism. They encouraged communities to develop or enhance public health capacities at the local and state level. Specifically, CDC funded projects for the following: a) to develop laboratory expertise for the identification of biological or chemical agents that would be involved in bioterrorist acts, b) to expand state and local laboratory capacity to identify organisms from acts of bioterrorism, c) to access planning activities among local and state health officials, d) to develop surveillance capability for detecting outbreaks of diseases that might have been caused by terrorists, and e) to improve the electronics communications network. [1] The CDC selected 43 laboratories to help rebuild the nation's public health inftastructure. The NPHL was one of the laboratories selected to provide diagnostic services regarding potential exposure of the public to infectious organisms from accidents or acts of bioterrorism. CDC Director Jeffrey P. Koplan, M.D., M.P.H., commented that "Every dollar we spend on preparing public health locally for even the possibility of a biological or chemical release among the civilian population is also a dollar that helps reinvigorate our Responding to Bioterrorism public health infrastucture. The medical expertise, laboratories, and communication network needed to counter bioterorism are the same resources that are needed to detect diseases in the community from any source, whether natural or deliberate." [1] The CDC and APHL established a laboratory response network for bioterrorism (LRNB) that designated a four-tier nationwide laboratory infrastructure. The LRNB structure is as follows: a) Level A laboratories: Most existing state and hospital laboratories are designated at this level. They will function to both "rule-out" organisms and to provide the transportation link to forward organisms to the Level B/C laboratories. Additional information regarding the CDC's role and Level A laboratory procedures can be found at the following website, www.bt.cdc.gov. b) Level B laboratories: These laboratories operate at a Biosafety Level (BSL) 2/3 and have confirmation tests available to "rule-in' or "rule-out" organisms. These tests include specialized reagents for Bacteriophage assays and Direct Fluorescent Antibody staining. In addition, these laboratories have the reference capacity and transportation function to forward organisms to the Level C/D laboratories. c) Level C laboratories: These laboratories which operate at a BSL-3, have additional confirmation tests including molecular assays, animal testing, and the reference capcity and transportation function to forward organisms to the Level D laboratory. d) Level D laboratories: This is the highest level of the LRNB where definitive identification of bioterrorist agents would take place. This facility consists of a BSL-4 laboratory located at the CDC. T h e N e b r a s k a P u b l i c HealthLaboratory has been designated as a level B/C facility. The NPHL uses a BSL-3 laboratory at UNMC for handling high risk specimens or isolates involved in accidental exposure or bioterrorist acts. When a local health officer is informed of a bioterrorist incident or threat, or suspects that cases of illness may be due to a bioterrorist incident they should proceed to a) notify their local law enforcement officers, b) notify their local FBI office, or the state FBI office at l-402-493- 8688 and, c) notify either county epidemiologists in Lincoln or Douglas County, or contact Dr. Tom Safranek at NHHS (1-402-471-0550). The LRNB has developed diagnostic protocols that can be used to either “rule-in' or "rule-out" certain biological agents that represent a threat to the public. Each of the four LRNB laboratory levels has a specified list of diagnostic tests and procedures to identify the bioterrorism agents. This list is based on the bio-safety level classification of each agent, and the capacity of each laboratory to meet the biosafety level guidelines specified by the CDC and NIH for each organism. Several different scenarios could occur