Researchers find weaknesses in Arkansas public health system

01/28/04

CHICAGO Several obstacles in the public health system of Arkansas were encountered during the 2001-2002 outbreak of pertussis (whooping cough), emphasizing a need for better testing procedures, organization and communication, and underscoring the vulnerability of the public health system in the event of a bioterrorist attack, according to an article in the February issue of The Archives of Pediatrics & Adolescent Medicine, one of the JAMA/Archives journals.

Since September 11, 2001, America's public health system has been examined to assess the nation's preparedness for bioterrorist events, according to the article. This assessment has led to questions about the ability of the public health system to deal with non-terrorist events as well, especially in light of cuts in public health budgets.

J. Gary Wheeler, M.D., from the University of Arkansas for Medical Sciences, Little Rock, and colleagues examined whether vulnerabilities in the public health infrastructure existed during the 2001-2002 Arkansas pertussis outbreak that occurred shortly after the September 11, 2001 terrorist attacks.

The researchers interviewed key personnel involved in the outbreak, including physicians, infectious disease specialists, epidemiologists, nurses, laboratory staff and administrators, and reviewed state health department data. They found the following issues impeded effective diagnosis of pertussis during the outbreak: nonspecific clinical diagnosis, unreliable testing methods, excessive numbers of samples, unavailability of chemicals/kits needed for testing samples, inadequate transport system (causing delays between taking samples and testing), and inadequate laboratory personnel and equipment. Treating pertussis was problematic because of feared adverse effects of drugs and uncertainty about how well new drugs would work. The researchers also identified problems with communications, staffing and public cooperation. However, the epidemic was successfully managed, and no deaths were reported.

"Despite many identified barriers to effective public health management, Arkansas tolerated its worst epidemic of pertussis in many years," the researchers write. "However, were the state to experience an outbreak of a more pathogenic agent, introduced either naturally or of bioterrorist origin, these vulnerabilities could become critical. Natural outbreaks serve as excellent experiences on which to recognize and correct barriers to public health management."

Source: Eurekalert & others

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