Laboratory Response to Anthrax Bioterrorism
In October 2001, the greater New York City Metropolitan Area was the scene of a bioterrorism attack. The scale of the public response to this attack was not foreseen and threatened to overwhelm the Bioterrorism Response Laboratory's (BTRL) ability to process and test environmental samples. In a joint effort with the Centers for Disease Control and Prevention and the cooperation of the Department of Defense, a massive effort was launched to maintain and sustain the laboratory response and return test results in a timely fashion. This effort was largely successful. The development and expansion of the facility are described, as are the special needs of a BTRL. The establishment of a Laboratory Bioterrorism Command Center and protocols for sample intake, processing, reporting, security, testing, staffing, and quality control are also described.

Laboratories across the United States have been preparing for the past 5 years for the possibility of civilian populations being the target of bioterrorism. The New York City (NYC) Department of Health (DOH) laboratory response plans for bioterrorism changed forever after October 12, 2001, with the knowledge that letters laden with Bacillus anthracis spores had been sent through the U. S. Postal Service. The original conception of the laboratory's role in bioterrorism response was not yet fully validated, nor was the need for extensive environmental testing fully appreciated or anticipated. The number of personnel with specialized training was another key factor.

The most probable scenario envisioned a sharp increase in hospital admissions caused by one of the recognized bioterrorism agents. By the time the symptoms and bioterrorism agent were diagnosed, the disease was likely to be well established within the local population. Thus, laboratory response would center primarily on human clinical sampling. The scope of required environmental sampling was not fully anticipated and was generally considered to be secondary to the original epidemiologic investigation. Such samples would predominantly consist of evidence obtained from the putative source of the exposure.

Although this was the operational scenario, the actual laboratory workload during this event was evenly divided between environmental and clinical samples. However, the amount of labor and materials associated with processing environmental samples for analysis far exceeded that of the clinical samples.