How to vaccinate 30,000 people in three days: realities of outbreak management.

Abstract

Michael T. Osterholm, PhD, MPHa How do we begin to look at our level of bioterrorism preparedness? I will address this issue as part of a "collective experience." There are no textbooks or even book chapters that describe this problem. There is no way to define it. I congratulate the New York City Department of Health for their work with West Nile virus. It brings back memories of when, in 1982,1 was in charge of a program to spray malathion in 287 Minnesota cities located over 45,000 square miles because of an outbreak of western encephalitis. In addition, our group worked up the single largest food-borne outbreak in this country, with 240,000 cases of salmonellosis from contaminated ice cream. My discussion focuses on a Neisseria meningitidis, serogroup C, outbreak and our response, which involved a large community-based immunization program. However, not one of these prior experiences gives us the answer to the question I just asked, although they do offer a common vision of what the future might be, a vision that, I might add, concerns me because we have not really absorbed its meaning at the local, state, and federal levels.