In October of 2001, staff members of U. S. Senators Daschle and Leahy contracted a respiratory infection that turned out to be anthrax, which was caused by letters deliberately contaminated with Bacillus anthracis received in their offices. Bacillus anthracis was one of the first bacteria discovered, named by Robert Koch in 1875. It is a relatively large rod-shaped gram negative bacterium, which forms spores under certain conditions, and this characteristic was taken advantage of to contaminate the letters (CDC 2001, MMWR 50). By November, eleven cases of inhalational anthrax were ultimately identified, including that of a ninety-four year old woman in Oxford, Connecticut. Epidemiological and laboratory investigations mounted by the Connecticut State Department of Public Health established that the source of anthrax that she died from was identical to that released in the original letters, and that she had become infected from her mail. This in turn had become contaminated from the bulk mail sorting machines in a Connecticut mail distribution facility (Griffith, 2001).
Biological terrorism was quickly recognized as a public health issue, as it affects the health and well-being of the community and requires a coordinated response. It was also recognized that there was a threat of chemical terrorism, that is, the deliberate introduction of chemical poisons into a populated area, perhaps by the blowing up of a chemical storage facility. Radiation terrorism, or the explosion of a small radioactive device (a “dirty bomb”) which could contaminate an inhabited area with radiation, was another possible threat. Many policies and procedures that had been developed in response to bioterrorism were found to apply to chemical and radiological terrorism as well. Additionally, preparation for and response to natural disasters such as hurricanes, floods and power outages were similar to those required for terrorist activities. This suggested a coordinated approach to emergency planning (CDC, LRN website).
The CDC established the Laboratory Response Network (LRN) in 1999, in accordance with Presidential Decision Directive #39 dealing with anti-terrorism measures. It generated a lot more interest after 2001, for obvious reasons. The LRN is a nationally integrated network of laboratories that can respond quickly to acts of biological or chemical terrorism in terms of testing and reporting of results. On the biological side, the LRN classifies laboratories into sentinel laboratories, which provide early detection of a potential bioterrorism incident, reference laboratories which can perform confirmatory testing and national laboratories which provide more specialized functions like bioforensics and handling of highly infectious agents like smallpox. On the chemical side, Level 3 laboratories have the capability to collect and transport blood and urine sampled from the first forty victims of a chemical terrorism attack (chemical terrorism typically affects many people at once). Level 2 and Level 1 laboratories perform the actual testing of chemical terrorism agents. The LRN is associated with veterinary and agricultural laboratories also, and is now beginning to include laboratories that perform radiological testing (CDC, LRN website).
In response to the Connecticut anthrax event, the State Department of Public Health Laboratory created the Bioterrorism Response Action Team, known as the “BRATs”. These were group of scientists who made themselves available to perform identification and confirmatory tests of suspected anthrax specimens from postal workers and others who may have been exposed. During the crisis in the fall of 2001, they performed over 1,300 tests on throat and nose swabs, and have been available ever since to deal with “white powder incidents,” i.e. situations where a powder that could be weaponized anthrax spores has been discovered and transported to the state laboratory for analysis. Many of these incidents turn out to be hoaxes, but they are a federal crime nonetheless. Additionally, automated detectors installed at the major mail sorting facilities in Connecticut sample the air regularly and test for the presence of DNA matching that of anthrax. When one of these devices “scores a hit,” it is forwarded to the state laboratory for confirmation (Griffith, 2001)
The Greenwich Department of Health Laboratory is a member of the Laboratory Response Network. On the biological side, it is a sentinel laboratory, and is capable of performing primary inoculations, gram stains and presumptive identification of select agents, which are bacteria considered especially suitable for bioterrorism use. Federal law strictly controls possession of cultures of “select agents”, which means that none of these bacteria are kept in the laboratory. Select agents include: Bacillus anthracis (anthrax); Yersinia pestis (plague); Francisella tularensis (tularemia) and Brucells sp. (brucellosis) (CDC, BT Response Guide). Staff from the laboratory attend workshops and conferences provided by the BRATs that provide training in the identification of these bacteria, and they also participate in proficiency testing to practice their identification skills. The laboratory is a Level 3 lab for chemical terrorism testing. Laboratory staff have been trained in the proper way to obtain, package and ship clinical specimens to reference laboratories for testing to determine biological or chemical agents. Funded by a state grant, a scientist associated with Yale University has developed a bioassay to determine clinical exposure to radiation, and all the LRN laboratories in Connecticut (including Greenwich) have received training and participate in proficiency testing programs in this area also. Finally, the director of the laboratory participates in the Laboratory Preparedness Advisory Committee meeting, convened monthly at the state laboratory in Hartford and bringing together representatives of all aspects of emergency response: laboratorians, hospitals, state police, FBI, toxicologists, and food scientists. Greenwich represents the point of view of local health departments and particularly their laboratories in these discussions (Terrorism Readiness Plan, 2008).