West Nile Virus: Preliminary Information on Lessons Learned
(Correspondence, 06/23/2000, GAO/HEHS-00-142R).

Pursuant to a congressional request, GAO reviewed the lessons learned
from the 1999 outbreak of West Nile Virus in New York City and
surrounding areas.

GAO noted that: (1) officials involved in the West Nile events indicated
that the communications helped update involved parties as the
investigation unfolded; (2) however, some key officials indicated that
they believed this means of sharing information was time-consuming and
inefficient and that alternatives for communicating detailed information
were needed so they could use their expertise and skills to conduct the
investigation; (3) assessments of the West Nile events and many
officials said that the events highlighted the need for better
integration and communication between animal/wildlife health communities
and public health; (4) since the initial outbreak, the Centers for
Disease Control and Prevention, state wildlife veterinarians, and an
expanding group of federal and other agencies are using deaths in crows
as sentinel events to define the geographic distribution of mosquitoes
and birds infected with West Nile virus; (5) during the West Nile
investigation, the six New York City Health Department staff who
normally track over 50 reportable infectious diseases in the city worked
long hours seven days a week to contact relevant officials at 70
hospitals to identify potential cases, interview patients and families,
track cases, and ensure laboratory samples were shipped to appropriate
parties; (6) officials indicated that the availability of even the small
number of trained staff in New York City was critical to the quick
response to the initial outbreak; (7) a frequent theme of discussions
and assessments has been the adequacy of laboratory infrastructure at
the state and federal levels for performing timely and thorough
laboratory analyses; (8) officials pointed out that there are only two
federal laboratories capable of handling those infectious agents
considered of most concern; (9) further, most laboratories are not
equipped to identify diseases that are rarely seen; (10) according to
officials, laboratory capacity for performing the tests needed to
identify the West Nile virus and to diagnose which people had the virus
was consumed quickly by this relatively small outbreak; (11) while the
West Nile virus outbreak is thought to have been a naturally-occurring
event and officials interviewed indicated that the investigation did not
find otherwise, at one point there was speculation in media reports that
the outbreak might have had an unnatural (bioterrorist) origin; and (12)
if it is determined that the outbreak is the result of a bioterrorist
incident or threat, then additional organizations would need to become
involved to carry out a criminal investigation.

--------------------------- Indexing Terms -----------------------------

 REPORTNUM:  HEHS-00-142R
     TITLE:  West Nile Virus: Preliminary Information on Lessons
	     Learned
      DATE:  06/23/2000
   SUBJECT:  Disease detection or diagnosis
	     Biomedical research
	     Interagency relations
	     Laboratories
	     Infectious diseases
	     Emergency preparedness
IDENTIFIER:  New York (NY)

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GAO/HEHS-00-142R

1 GAO/ HEHS- 00- 142R West Nile Virus

United States General Accounting Office Washington, DC 20548

Health, Education, and Human Services Division

B- 285709 June 23, 2000 The Honorable Daniel Patrick Moynihan The Honorable
Charles E. Schumer United States Senate

The Honorable Gary L. Ackerman The Honorable Joseph Crowley The Honorable
Eliot L. Engel The Honorable Vito J. Fossella The Honorable Carolyn B.
Maloney The Honorable Jerrold L. Nadler The Honorable Major R. Owens The
Honorable Charles B. Rangel The Honorable Jose E. Serrano The Honorable
Edolphus Towns The Honorable Anthony D. Weiner House of Representatives

Subject: West Nile Virus: Preliminary Information on Lessons Learned At your
request we are performing a review of the lessons learned from the 1999
outbreak of West Nile virus in New York City and surrounding areas, for
bioterrorism preparedness and related public health policies. This letter,
as requested by your office, provides information on our progress to date
and our preliminary findings.

We are currently completing fieldwork for this assignment, including
interviews with and documentation gathering from key officials and agencies
involved in the identification of and response to the outbreak last fall.
These parties include: the infectious disease physician in northern Queens
who first reported the unusual illnesses; city and state health department
and emergency preparedness officials who responded to the report; Centers
for Disease Control and Prevention (CDC) epidemiological, emergency
preparedness and other officials involved in the outbreak; federal, state,
and academic laboratories contributing to the identification of the virus
including the laboratories of the Department of Agriculture, the Department
of the Army, and the University of California, Irvine; wildlife and zoo
officials who tracked the virus's impact on birds, and others. Our work is
designed to provide information on

2 GAO/ HEHS- 00- 142R West Nile Virus

3 GAO/ HEHS- 00- 142R West Nile Virus

ï¿½ Communication between public health agencies and other organizations with
relevant information, such as animal health experts. Livestock animals and
wildlife are often considered sentinels, providing an early warning device
for diseases that could harm people. Assessments of the West Nile events and
many officials we interviewed said that the events highlighted the need for
better integration and communication between animal/ wildlife health
communities and public health. Since the initial outbreak, CDC, state
wildlife veterinarians, and an expanding group of federal and other agencies
are using deaths in crows as sentinel events to define the current
geographic distribution of mosquitoes and birds infected with West Nile
virus.

ï¿½ The adequacy of epidemiological capacity and local level disease
surveillance systems. The outbreak was initially identified because an
astute physician reported two unusual cases of illness to the City Health
Department, and active surveillance in New York City confirmed 62 human
cases of the disease. Physicians are required to report encephalitis cases
to the Health Department; however, the West Nile investigation confirmed
that such reporting often did not occur. During the West Nile investigation,
the six New York City Health Department staff who normally track over 50
reportable infectious diseases in the city- along with several others
detailed to assist from other divisions and agencies- worked long hours
seven days a week to contact relevant officials at 70 hospitals to identify
potential cases, interview patients and families, track cases, and ensure
laboratory samples were shipped to appropriate parties, among other duties.
Officials indicated that the availability of even the small number of
trained staff in New York City was critical to the quick response to the
initial outbreak. Such capacity at the local level is thought to be lacking
in many other locations.

ï¿½ The adequacy of laboratory capacity- especially “surge
capacity” to allow a quick response to an unexpected crisis. A
frequent theme of discussions and assessments has been the adequacy of
laboratory infrastructure at the state and federal levels for performing
timely and thorough laboratory analyses. Officials pointed out that there
are only two federal laboratories capable of handling those infectious
agents considered of most concern. Further, most laboratories, including
veterinary laboratories, are not equipped to identify diseases that are
rarely seen. Inadequate “surge capacity,” the ability to deal
with a sudden increase in needed testing, was another cited concern.
According to officials we spoke with, laboratory capacity for performing the
tests needed to identify the West Nile virus and to diagnose which people
had the virus was consumed quickly by this relatively small outbreak.

ï¿½ Potential problems in distinguishing between a naturally occurring
biological outbreak and one that is intentionally caused. While the West
Nile virus outbreak is thought to have been a naturally- occurring event and
officials interviewed indicated that the investigation did not find
otherwise, at one point there was speculation in media reports that the
outbreak might have had an unnatural (bioterrorist) origin. Because of this,
experts indicate that this episode does illustrate the potential problems in
distinguishing natural disease from an intentional attack. The source of the
disease (whether natural or intentional) would not change the process to
diagnose and treat patients. However, if local health officials are informed
of a bioterrorist incident or threat, or if a health department or CDC
investigation determines that an event is likely a bioterrorist one, then
additional organizations would need to become involved to carry out a
criminal investigation. Current recommended protocols are to notify the
Federal Bureau of

4 GAO/ HEHS- 00- 142R West Nile Virus Investigation and law enforcement
officials, who would also seek to determine whether

terrorists had targeted additional locations for release of the disease. We
will be providing a final report of our findings in early September 2000,
including more detailed information and agency comments. As agreed, unless
you publicly announce the contents of this letter earlier, we plan no
further distribution of it until 3 days from the date of this letter. At
that time, we will send copies to the Honorable Jeffrey P. Koplan, Director
of CDC, the Honorable Dan Glickman, Secretary of Agriculture, and other
interested parties. We will make copies available to others upon request. If
you or your staffs have any questions, please contact me at (202) 512- 7119.
Other major contributors to this letter included Linda Bade, Marcia Crosse,
Katherine Iritani, Anita Kay, and Deborah Miller.

Janet Heinrich Associate Director, Health Financing and

Public Health Issues (201062)
*** End of document. ***