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NJPTC Public Health Emergencies: Terrorism Preparedness |
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AN EPIDEMIOLOGISTS VIEW OF BIOTERRORISM |
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Leah Zisken, MD, MS |
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Home | PDF Version
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Objectives
- To identify the conditions that call for an epidemiologic investigation.
- To recognize when a physician should report an unusual finding.
- To identify the contraindications to smallpox vaccination in the absence of the disease.
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Introduction
Eddy A. Bresnitz, MD, MS, is the state epidemiologist for the State of New Jersey, a position within the New Jersey Department of Health and Senior Service (DHSS). As state epidemiologist, he is New Jersey’s principle liaison with the federal Centers for Disease Control and Prevention (CDC). With a reorganization of the DHSS in 2006, Dr. Bresnitz became the Deputy Commissioner of the Public Health Services branch at DHSS. This branch, incorporates the Division of Health Infrastructure and Emergency Response, including the Office of Local Public Health.
Dr. Bresnitz, a medical graduate of McGill University in Montreal, Canada, served his residency in internal medicine at Montefiore Hospital and Medical Center in New York City. He is board certified by the American Board of Internal Medicine and by the American Board of Preventive Medicine. He also has a master’s degree in clinical epidemiology from the University of Pennsylvania. Dr. Bresnitz has held academic appointments at the University of Pennsylvania, MCP Hahnemann University of the Health Sciences, and, currently, serves as a professor at the UMDNJ-School of Public Health and the Robert Wood Johnson Medical School. Among his many honors are the Philip S. Brachman Award for excellence in teaching epidemiology, which was awarded by the CDC in 2002 and the NJ Outstanding Medical Educator Award in 2004.
Dr. Bresnitz reports on the work of the Division of Epidemiology, Environmental and Occupational Health and related subjects to committees of the Medical Society of New Jersey (MSNJ), including the Council of Public Health and the Bioterrorism Task Force. These updates serve to keep the membership of MSNJ informed on relevant matters in the field of public health.
New Jersey Medicine, represented by Senior Deputy Editor Leah Z. Ziskin, MD, MS, spoke with Dr. Bresnitz in his office at DHSS in 2004 and found him to be forthcoming and deeply committed to his work and to his profession.
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New Jersey Medicine What does being the state epidemiologist mean?
Eddy A. Bresnitz In many states the state epidemiologist’s responsibilities are limited to communicable-disease issues: investigation, control, and reporting. My position is broader. I am responsible for communicable-disease issues and also occupational health, environmental health, food safety, and cancer surveillance, including the cancer registry. During the four years that I have been in New Jersey, I have experienced several outbreaks of emerging infections that I could not have imagined: the West Nile virus and the anthrax outbreaks, and now the initiative of smallpox vaccinations. Obviously, we do not have any cases of smallpox, but the whole smallpox vaccination effort was tremendously time consuming.
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NJM What in your background prepared you to be a state epidemiologist?
EAB I did not specifically prepare for this position. However, I am an internist, board certified in preventive (occupational) and pulmonary medicine, with a masters degree in epidemiology. My experience as a medical school teacher and as a legal consultant in occupational health cases has taught me how to communicate with different audiences, including the media. Obtaining grant funding while I was in academia prepared me to write and manage grants in state government.
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NJM What prompts you to do an epidemiologic investigation?
EAB An epidemiologist investigates when there is more disease than one would expect in the community, when the number of cases rises above the baseline amount that is expected. Of course, diseases may vary with the time of the year, for example, respiratory infections cycle, with more cases in wintertime. Investigations can be triggered by common diseases, such as diarrhea or respiratory infections, that are occurring more frequently than anticipated. Or it might be some unusual infection that one does not expect. An example would be the West Nile virus encephalitis in 1999, when there was an unusual cluster of a few cases in a particular geographical location, the New York City area. A physician recognized that there was something unusual happening, and the two cases of encephalitis in Elmhurst Hospital prompted her to call the health department. The investigation expanded to New Jersey, and the disease spread to much of the rest of the country and now is considered endemic in the United States.
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NJM How important is it that physicians report seeing something unusual in their practice? Do you depend on that?
EAB We do not depend completely on physicians’ reporting, because we also require that laboratories and hospitals report diseases. In hospitals it is usually the infection-control professionals’ responsibility, and 95% of reports come from hospital and commercial laboratories. However, physicians are the ones who recognize that there is something unusual going on in the community. In the New Jersey anthrax outbreak, it was physicians who eventually called us. Two doctors called, each had a patient with a skin lesion that was unusual. Unfortunately, they had taken care of these patients for a couple of weeks before it was announced that the anthrax-contaminated envelopes had come through the Trenton Postal Processing and Distribution center (PDC) in Hamilton Township. It was only after it was learned that the patients could have been in contact with envelopes that had been through the PDC in Hamilton Township that the doctors wondered if their patients had anthrax. In one case, the doctor thought that the patient might have cutaneous anthrax and chose to treat it empirically, but not to report it immediately, which was unfortunate. It is possible that had that doctor reported his suspicion right away, we might have made a diagnosis earlier and closed the PDC facility sooner. This illustrates the importance of physicians’ following regulations that require that they immediately report to the state any suspected or confirmed cases of anthrax and other diseases specified in the regulations.
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