The second element of smallpox preparedness, rapid public health response, is defined in Annex A of the Guidance (CDC, 2003b) as “disease surveillance for rash illnesses and laboratory analysis to rapidly detect a single case of smallpox and any subsequent cases.” Building capacity for rapid response requires strengthening communication and information networks, training and education of public health, health care and other relevant personnel, and the review of legal authority and public health law.
Communication and information networks needed for rapid public health response require many components, including connectivity among levels of the public health infrastructure (agencies and laboratories), a system for rapid reporting by practicing clinicians, a means for rapid notification of all relevant parties in the event a case of smallpox is confirmed, and a way to notify and mobilize all response team members. An additional aspect of communication that should not be overlooked is the provision of timely, clear, and accurate information to the media and public.
Because clinicians might well be the first to identify a potential smallpox case, training and education are needed to enable health care providers in all settings to assess and report rash illnesses. All clinicians, including primary care providers, infectious disease practitioners, emergency physicians, and those in other health care settings need to be familiar with the precautions to be taken and parties to be notified and consulted (local and state public health agency, CDC). At the public health agency level, public health response team members require regularly updated training and education about their agency’s plans, about their roles, and about the knowledge and skills needed to rapidly identify and respond to suspected or confirmed smallpox cases.
Many aspects of public health surveillance and information systems and channels that operate both within and among states rely on public health law, which defines types of authority during public health emergencies (quarantine, evacuation, etc.) (Fraser and Fisher, 2001). Although the variation in public health statutes across states is understandable and to some extent inevitable, the Turning Point Public Health Statute Modernization Collaborative has been working to achieve a level of consistency and uniformity through a draft Model State Public Health Act (IOM, 2002; Turning Point Public Health Statute Modernizing Collaborative, 2003). Following this and other resources, states could review the requirements of legal authority that will be needed to meet all contingencies in the event of smallpox attack or other public health threats and facilitate any changes needed to ensure effective response.