Health authorities try to minimize disease risk

Air, water, soil samples taken from New York

Terrorism Strikes America


As rescue workers and cleanup crews dig through the rubble of the World Trade Center and the Pentagon, health authorities face a new challenge - minimizing the risk of disease.

The combination of dust, debris and shards of razor-sharp metal poses a risk of tetanus for victims still alive in the ruins and for emergency workers combing through the debris, say officials.

The U.S. Department of Health and Human Services, or HHS, also is determining whether so many corpses within the wreckage of the New York City complex might be a risk to relief workers or to the public. Experts disagree on whether the remains create a risk of diseases such as cholera or hepatitis.

Almost 5,000 people are known to be missing at the New York City site; about 200 are estimated to be dead at the Pentagon.

The Centers for Disease Control and Prevention and HHS wouldn't comment about specific public health concerns, but the CDC is taking samples of air, water and soil in New York.

Dr. David Cone, an associate professor of emergency medicine at Yale University School of Medicine in New Haven, Conn., says that rescue workers generally wear gloves, masks and protective eyewear such as goggles.

"We get some training on how to protect yourself, but it is basically to make sure that your gloves don't have holes in them, and keep a mask on," he says.

"You can't wear anything particularly protective," Cone adds, because bulky clothing or gear would interfere with the job at hand. "Regular firefighting clothes aren't meant to provide good protection from biohazards anyway."

He says medical personnel receive tetanus shots on a regular basis, and receive hepatitis B immunizations. In his experience, rescue workers don't receive special medical screening after a rescue and cleanup operation.

Cone says that a risk of communicable diseases could arise because of the large numbers of bodies trapped in the rubble, but that little can be done to protect rescue workers or the public.

"They ran into this a little bit in Oklahoma City, just because of how long it took to get everybody out," says Cone. "There's not a whole lot you can do."

However, Colleen Terriff, an assistant professor of pharmacy practice at Washington State University in Spokane, doubts that the risk of diseases like cholera or typhoid is significant, because the pathogens are unlikely to contaminate the local drinking water supply.

"The rescue workers are taking every precaution," says Terriff, who prepared a city contingency plan for a bioterrorism attack after an anthrax scare in Spokane.

But she says that some concern exists for blood-borne diseases such as hepatitis B and C and HIV. "This is a different scenario because [relief workers] might be reaching into an area and easily get cut from the metal," says Terriff. "If there was a victim that was bleeding in the area, there's always those concerns."

Still, she says that those risks, while real, are of minimal concern.

In a news conference Wednesday, HHS Secretary Tommy G. Thompson outlined the department's emergency medical response to the attacks in New York and at the Pentagon.

According to Thompson, about 270 people from the CDC's Disaster Mortuary Operational Response Teams were making sure bodies were removed from the site and transported to makeshift morgues as quickly as possible.

On the day of the attacks, Thompson authorized the first emergency use of the National Pharmaceutical Stockpile, releasing one of the eight "12-Hour Push Packages" stored around the country. Each package consists of truckloads of drugs, intravenous equipment, bandages and other supplies needed to respond to a mass casualty situation.

At the same time, he said, 50,000 doses of tetanus vaccine had been shipped to the New York City Public Health Department in Manhattan. Swiftwater, N.J.-based Aventis Pasteur donated the vaccine doses, along with another 3,000 sent to New Jersey Public Health Department.

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