"During May 20-23, 2000, local, state, and federal officials, and the staff of three hospitals in metropolitan Denver, participated in a bioterrorism exercise called Operation Topoff. As a simulated bioterrorist attack unfolded, participants learned that a Yersinia pestis aerosol had been covertly released 3 days earlier at the city's center for the performing arts, leading to >2,000 cases of pneumonic plague, many deaths, and hundreds of secondary cases. The exercise provided an opportunity to practice working with an infectious agent and to address issues related to antimicrobial prophylaxis and infection control that would also be applicable to smallpox or pandemic influenza. In Colorado, where plague is endemic, we are familiar with the public health management of single plague cases, but the magnitude of the simulated epidemic and the fact that infection was spreading from person to person after a short (2- to 3-day) incubation period quickly overwhelmed the available resources. The challenge to our surveillance system was not in detecting the outbreak but rather in maintaining surveillance at each of the 22 acute-care hospitals in metropolitan Denver. Our hospital surveillance system usually relies on reporting by infection control practitioners, but during the exercise these practitioners had many additional responsibilities. In a true bioterrorist attack, emergency response teams of state or local health department employees should be set up and sent to each hospital to monitor cases and provide information to a central command center."
Centers for Disease Control: http://www.cdc.gov/
Emerging Infectious Diseases (November-December 2000), v.6, no.6, p. 652-653