Anthrax: Public health response plan for Australia

Response Actions

Page last updated: 05 December 2012

4. Response Actions


Immediate response
Response codes and associated actions
Key stakeholders
Roles and Responsibilities
Media response to an outbreak of anthrax infection in Australia

Immediate response

If a credible threat or confirmed anthrax release, the appropriate response code will be declared by the Australian Government Chief Medical Officer (CMO), through the Australian Health Protection Principal Committee (AHPPC) and the DoHA National Incident Room will be activated. Times of operation, contact phone and fax numbers, 1800 public information numbers, email addresses and details of operational procedures will be promulgated to CDNA Jurisdictional Executive Group (CDNA-JEG) and PHLN by the Secretariat. Teleconferences will be called at the discretion of the CMO, as chair of AHPPC, or CDNA/PHLN chairs. Media liaison on the incident will be established through the National Emergency Media Response Network (NEMRN), coordinated through DoHA.

Aerosol release or suspicious substance incidents

In the event of a suspected aerosol release of anthrax spores, or the threat of a release, the police should be advised immediately by telephone. The release zone should be regarded as a crime scene, and advice sought from police. Environmental samples should be taken by emergency services personnel at the direction of public health authorities and/or police, as outlined in Appendix 5. Detailed instructions are contained within the National Counter-Terrorism Committee Suspicious Substances/Packages Assessment Guidelines, September 2011. Environmental samples and clinical specimens taken from those exposed should be regarded as potential forensic material, and appropriate chain-of-custody procedures put in place.

First responders and any members of the public who have possibly been exposed should be offered post-exposure prophylaxis (PEP) where indicated, as outlined in Section 5. PEP should be discontinued only if the incident is confirmed as a hoax.

A decision as to whether PEP will be offered, and to which groups, will be taken by the State/Territory health authority, in consultation with emergency services authorities. Consideration will be given to the nature of the release, credibility of threat, accessibility of the exposed zone to the community and other groups (e.g. shopping centres, office buildings or open air sporting venues). An extensive contact tracing exercise may be necessary to identify all exposed persons. Names and contact details of all exposed persons should be taken by the local health authority for follow-up purposes.

Environmental clean-up and disinfection will be undertaken as outlined in Appendix 9.

Food-borne release

If food-borne release of anthrax is suspected, or cases of gastrointestinal anthrax are diagnosed, the State/Territory health authority and police should be advised immediately. Details of the incident or outbreak should be forwarded to the chairs of AHPPC and CDNA, who may request an urgent meeting of the AHPPC/CDNA-JEG by teleconference, and the chair of Food Standards Australia New Zealand (FSANZ), who may activate the National Food Incident Response Protocol. Where indicated, States/Territories should make urgent inquiries as to the incidence and aetiology of recent cases of gastrointestinal disturbance presenting to emergency departments of hospitals in their jurisdictions.

Where a foodstuff is implicated in the outbreak, urgent consideration should be given to implementing a nationwide recall of the food, using the usual FSANZ procedures. The recall should be given the widest possible publicity by FSANZ, and through media releases and interviews/media conferences coordinated by the NEMRN. The World Health Organization (WHO) will also be advised promptly by the Australian Government.

If the implicated food has been exported to foreign countries, the operational response to the recall will be coordinated through the Australian Quarantine and Inspection Service (AQIS). The countries involved should be advised of the recall as a matter of urgency, through the Australian Government Department of Foreign Affairs and Trade (DFAT), on advice from FSANZ. If the implicated food has been otherwise exported (e.g. in meals provided to passengers on international airlines or cargo or cruise ships) the Australian Government will urgently advise WHO and the countries served by those airlines and vessels of the food recall, together with relevant epidemiological information, such as the dates on which the food may have been consumed.
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PEP, where indicated (see section 5), should be offered to persons who have eaten implicated foods, and discontinued only if the foodstuff is confirmed as not contaminated with B.anthracis.

Covert release

If a covert release of anthrax is suspected—e.g. one or more cases of anthrax without an obvious occupational or other epidemiological link are identified—all State/Territory health authorities should be contacted through the CDNA Secretariat, and an urgent teleconference convened to determine whether other cases may have occurred, with data collated and coordinated by the Australian Government through the AHPPC/CDNA Secretariat or the National Incident Room, as appropriate.

Where appropriate, information will be provided to the public on the status of the incident and protective measures which should be taken, through media releases, media conferences and interviews with the CMO, CHOs and their delegates. Appropriate technical information will also be provided to professional groups such as the Royal Australian College of General Practitioners, police and emergency services agencies. Extensive use will be made of the Australian Government and State health authorities’ web sites, and all communications activities will be coordinated at the Australian Government level through the NEMRN.

DoHA’s Health Issues Media Unit will work closely with the Public Affairs Unit of the Australian Government Attorney-General’s Department which, under current National Security Public Information Guidelines, must approve all communications activities.

If a patient with anthrax has an overseas travel history which coincides with the incubation period for the disease, both the country from which the patient came and WHO will immediately be advised of the case by the Australian Government, to enable appropriate epidemiological studies and contact tracing to be undertaken. Border protection agencies (AQIS, DFAT, DIAC) and the Australian Government Department of Transport and Regional Services (DoTARS) will also be notified to enable additional controls to be implemented.

Response codes and associated actions

Response Code 0: No credible threat

Intelligence organisations advise there is no credible threat of a deliberate release of anthrax spores in Australia.

Jurisdictional actions
  • Review laboratory capability, including test availability and validation, staff training, and surge capacity.
  • Consider a list of high-risk laboratory personnel who may be appropriate for vaccination if available.
  • Develop and implement bioterrorism (BT) training programs for health-care workers and emergency workers who would be called upon to respond to an incident.
  • Develop and maintain plans for receipt of activated components of the National Medical Stockpile (NMS).
  • Develop and maintain plans and logistical support for rapid distribution of antibiotics, vaccine and PPE as required.

Australian Government actions
  • Regularly assess the inventory of key antibiotics in Australia e.g. doxycycline, ciprofloxacin, amoxycillin.
  • If a vaccine is available, regularly assess the inventory, expiry dates and location of stocks of anthrax vaccine in Australia.
  • Develop and maintain plans and logistical support for rapid deployment of antibiotics and vaccine as required.
  • Develop databases for registration of exposed or symptomatic patients, clinical presentation of patients, PEP or therapy administered and adverse reactions to these, and mortality/recovery.
  • Prepare content for educational materials with the Communicable Diseases Network Australia (CDNA).
  • Review and update frequently asked question (FAQ) sheets for the public on the signs, symptoms, treatment, and preventive measures including personal hygiene measures, for anthrax.
  • Develop the logistics for distribution of FAQ sheets (e.g. hard copy by mail, email, web sites, and newspaper advertisements). Do not distribute at this stage.
  • Prepare content for posters with CDNA for hospitals and doctors’ surgeries concerning procedures for decontamination of clothing if a patient presents without prior decontamination. Do not distribute at this stage.
  • Prepare summary information on case detection, diagnostic testing, clinical management, and infection control for hospitals and doctors’ surgeries. Don’t distribute at this stage.
  • Build relationships with key media personnel (see Section 4).

Response Code 1: Credible threat of release

Intelligence authorities advise that there is a credible threat of release of anthrax spores in Australia e.g. release of anthrax overseas and intelligence of threat in Australia, or overt threat from a credible terrorist group or individual. No cases of human anthrax in Australia. Actions as per Response Code 0, plus the following:

Jurisdictional actionstop of page
  • If a vaccine is available, consider vaccination of the ‘code 1’ list of high-risk laboratory personnel. On the basis of intelligence reports, decisions are to be taken as to whether to offer vaccination to the entire code 1 list, or only those in a particular geographical location, or to defer all vaccination.
  • Participate in teleconferences of the AHPPC, CDNA Jurisdictional Executive Group (CDNA-JEG) and Public Health Laboratories Network (PHLN).
  • Activate logistical support for receipt of components of the NMS.
  • Activate logistical support for rapid distribution of antibiotics and vaccines.
  • Activate logistical support for surveillance and contact tracing.

Australian Government actions
  • The Department of Health and Ageing (DoHA) will establish an Australian Government Interdepartmental Committee to deal with national policy and implementation issues.
  • DoHA will convene teleconferences of the AHPPC, CDNA-JEG and PHLN.
  • DoHA will assess the adequacy of antibiotic stocks, and obtain additional supplies if necessary. Deploy supplies of the stockpile as required to strategic locations as identified by State/Territory health authorities.
  • If a vaccine is available, DoHA will assess the adequacy of vaccine stocks, and obtain additional supplies if necessary.
  • Review and update posters for hospitals and doctors’ surgeries on procedures for decontamination of clothing if a patient presents without prior decontamination.
  • Review and update the summary information on case detection, diagnostic testing, clinical management, and infection control for hospitals and doctors’ surgeries.
  • DoHA’s Health Issues Media Unit (HIMU), in conjunction with the Australian Government Chief Medical Officer and the media units of relevant national security agencies, to take a lead role in explaining to the media the nature of the heightened threat and the response required. Such communications will be approved by the Public Affairs Unit of the Australian Government Attorney-General’s Department according to the current arrangements for clearance under the National Security Public Information Guidelines. These communications will include strong messages about any specific measures that may need to be taken by the general public. The HIMU will also convey relevant information to state and territory health authority media units via regular teleconferences or other means as appropriate.
  • DoHA will notify the Attorney-General’s Department Crisis Coordination Centre (CCC) of actions taken and provide any other information relevant to the elevated threat.

Response Code 2: Release imminent

Intelligence agencies advise that the release of anthrax spores in Australia is imminent. Actions as per Response Code 1, plus the following:

Jurisdictional actions
  • PHLN member laboratories notify clinical laboratories.
  • Clinical and reference laboratories review their ability to respond if a release occurs.

Australian Government actions
  • Public health laboratories and reference laboratories to be notified by DoHA through ABLN and PHLN member laboratories. Private laboratories are covered through PHLN private laboratory representatives.
  • CDNA and PHLN report to AHPPC.
  • DoHA to convene an Australian Government Interdepartmental Committee.
  • Distribute posters and infection control guidelines for health-care facilities to hospitals, doctors in private practice (including dermatologists, gastroenterologists and infectious diseases physicians) and postal facilities.
  • It is likely in this scenario that the Australian Government’s Special Incident Task Force (SITF) will be convened. DoHA is a member of that task force and will ensure open dialogue with the SITF about actions being taken by health authorities.

Response Code 3: Overt release or suspected covert release

Overt release of B. anthracis in Australia is identified by State/Territory health authorities, or covert release is suspected because, either:
  • one or more cases of human anthrax without plausible exposure history are identified, and AHPPC considers there is adequate suspicion of possible covert release or
  • intelligence agencies advise that such an event has occurred.
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Actions as per Response Codes 1 and 2, plus the following:

Jurisdictional actions
  • Reference laboratories implement staff rosters to deal with B. anthracis identification and additional workload.
  • States and Territories to initiate logging of data on exposed or symptomatic patients, clinical presentation of patients, nature of PEP or therapy administered and adverse reactions to these, mortality/recovery. Particular attention to be paid to adverse reactions in pregnant women and children in respect of off-label indications.
  • DoHA in coordination with States/Territories will distribute FAQ sheets for the public concerning signs, symptoms, treatment, preventive measures for anthrax, as required. Distribution by mail, email, web sites, newspaper advertisements.
  • State health authorities notify the local police and DoHA of new cases of anthrax where criminal activity is suspected.
  • Liaison with police and security agencies on new suspected or confirmed anthrax cases, by telephone in the first instance, followed up with details in hard copy.

Australian Government actions
  • DoHA activates the National Incident Room (NIR) within the department.
  • National data to be collated by the Australian Government.
  • Liaise and share relevant data with the Australian Government Department of Agriculture, Fisheries and Forestry (DAFF).
  • DoHA’s Health Issues Media Unit to activate the National Emergency Media Response Network (NEMRN), establish a national communications centre and invoke the national media response plan
  • Participate in SITF.
  • A suspected covert release of anthrax may constitute an act of terrorism against Australia. In this case, the National Counter-Terrorist Plan (NCTP) may be activated. The NCTP outlines responsibilities, authorities and the mechanisms to prevent or, if they occur, manage acts of terrorism and their consequences within Australia. The ramifications of any terrorist attack will necessitate high-level decision making in the Australian Government and the States and Territories.
  • The response will need to take into account public anxiety and any international dimensions. The scale of the situation may also dictate special cooperative responses. Throughout the response, the primary goals are minimising loss of life, preventing further attacks, and recovery.
  • Report to the World Health Organisation (WHO).

Response Code 4: Multiple releases of anthrax spores

This situation is to apply when two or more releases of anthrax spores in Australia have been confirmed, or a single release has been confirmed and intelligence agencies advise that a second release is imminent. The decision to go to Code 4 will rest with DoHA’s Secretary, Deputy Secretary or Chief Medical Officer on advice from relevant intelligence agencies. Actions

as per Response Code 3, plus the following:

Jurisdictional actions
  • Manage surge capacity in health-care system.
  • Report on the response and any requirements in CDNA and PHLN teleconferences.
  • CDNA nominated representative informs Australian Health Protection Principal Committee (AHPPC) of status.

Australian Government actions
  • Assist jurisdictions with coordination of medical response from other jurisdictions through AHPPC and EMA.
  • Arrange international assistance if required.
  • Extend more widely education of the public through distribution of FAQs and media advertisements.

Key stakeholders

Clear roles, responsibilities and lines of communication, both within the States and Territories concerned, and between the States and Territories and the Australian Government, are required to implement an effective response to an anthrax release.
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In essence, the state and territory health authorities are responsible for disease control. The role of DoHA will include overseeing the national health response, including maintenance of the National Medical Stockpile and (in conjunction with the Attorney-General’s Public Affairs Unit) coordination of the national news media response.

The response to an anthrax threat may differ between jurisdictions according to lead authority arrangements and the requirements of the State concerned. The roles and responsibilities of the Australian and State/Territory governments are set out below. Response plans should be complementary to the following Australian Government plans, coordinated from the National Incident Room, the health aspects of which are:
  1. National Health Emergency Response Arrangements
  2. Domestic Response Plan for Chemical Biological and Radiological Incidents of National Consequence (Health CBRN-INC Plan)
  3. Australian Government Disaster Response Plan (COMDISPLAN)
  4. Australian Government Overseas Disaster Assistance Plan (AUSASSISTPLAN)
  5. Australian Veterinary Emergency Plan (AUSVETPLAN)
  6. National Counter-Terrorism Plan (NCTP)
  7. National Counter-Terrorism Handbook and
  8. National Security Public Information Guidelines
  9. Guidance on the national coordination arrangements for responding to the deliberate use of chemical biological and radiological materials

DAFF coordinates AUSVETPLAN, the national plan for dealing with exotic animal disease emergencies. DoHA has no operational responsibilities under this plan, but may provide assistance to the States and Territories under COMDISPLAN in support of AUSVETPLAN operations.

When the incident involves livestock or other animals, the State or Territory department of agriculture, primary industries or other relevant animal health authority will respond operationally according to the national AUSVETPLAN Disease Strategy for Anthrax. The Australian Chief Veterinary Officer (CVO) will also be notified of the event and national arrangements made to ensure effective management of the disease both nationally and internationally. This may involve convening the Consultative Committee on Emergency Animal Diseases (CCEAD), which will coordinate a national veterinary response to the incident.

The Australian Government Attorney-General’s Department and the Crisis Coordination Centre coordinates the plans mentioned at points f, g, and h above. DoHA has operational, national coordination and media management roles in all these plans.

Roles and Responsibilities

State and territory roles and responsibilities

While each state and territory needs to determine governance structures, the guidelines advise the following model, and the States and Territories should decide on levels of authority and clarify roles and responsibilities in an anthrax event.
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State and territory plans for response to an anthrax event should give consideration to:
  • hoax assessment and identification of suspicious unidentified substances
  • developing protocols for reporting to, and requesting assistance from, DoHA
  • incident-site management planning, including defining the area of contamination, determining who has been exposed, evacuation of people at risk, containing the agent, collecting evidence and samples, sealing and/or decontamination of the affected area, and confirmation that the area is safe after decontamination
  • data collection and data transfer for national collation
  • operational plans for hospitals including surge capacity
  • decontamination plans
  • promulgation of infection-control requirements in health-care facilities and the community
  • laboratory management and surge capacity
  • processes for requesting vaccine and antibiotics from the Australian Government
  • the State or Territory’s own stock of antibiotics
  • logistical arrangements for the receipt and rapid distribution of vaccine and antibiotics
  • media liaison
  • developing databases including:
    • PEP or therapy administered and adverse reactions to these,
    • clinical presentation of patients.
    • mortality/recovery register(s) of exposed or symptomatic patients

State and territory departments of agriculture are responsible for the response to animal health aspects of an incident.

Australian Government roles and responsibilities

The Australian Government Department of Health and Ageing will provide overall national coordination of the health response, liaise with the international community, give logistic support to States and Territories, activate the National Incident Room, and provide leadership in the coordination of national emergency media management arrangements.

Australia is signatory to the International Health Regulations (IHR) which requires notification to WHO of the release of chemical, biological or radiological agents with the potential to cause widespread injury, illness or death. DoHA is the nationally competent authority responsible for notification of WHO under the IHR.

In a large-scale emergency involving anthrax cases, it is likely that the Australian Government will form an IDC or taskforce to coordinate the work of Australian Government departments and agencies. The lead agency of the IDC or taskforce will be determined at the time of the emergency.

DoHA maintains a stockpile of antidotes, antibiotics, vaccines and treatments to be mobilised to aid in the management of a chemical or biological incident. The department, in close collaboration with state and territory Chief Health Officers or their delegates, will direct the distribution of elements of the stockpile.

The Australian Defence Force maintains the Special Operations Engineering Regiment, which may be deployed to assess and respond to CBRN incidents. The circumstances of a terrorist event will determine whether or not security agencies will declare it a national terrorist situation.

If a national terrorist situation is declared, overall responsibility for policy and broad strategy transfers to the Australian Government, in close consultation with relevant States or Territories. This may involve determining overall policy objectives, setting priorities between policy objectives where resources are inadequate, pre-positioning resources, international liaison and determining public communication messages. The Australian Government’s role does not include operational management and deployment of emergency services. The Commissioners of Police, including the Commissioner of the Australian Federal Police (AFP), will determine the command and resourcing of the national police response. In other respects the management arrangements in a national terrorist situation will replicate those in other terrorist situations.
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Specific response and management of an anthrax event at the Australian Government level will include:
  • consultation to refine these guidelines with state and territory representatives
  • assistance to States and Territories in coordinating the response, maintenance of pharmaceutical stock levels, and delivery to each state and territory according to the criteria outlined at each code level
  • assistance to states and territories in provision of training materials
  • communication of the national status of an event to the media and general public and to the international community through the World Health Organization
  • development of databases including:
    • stock levels and deployment of vaccine and antibiotics
    • adverse reactions to vaccine
    • exposed cases and PEP.

Media response to an outbreak of anthrax infection in Australia

Background

An anthrax outbreak in Australia, either naturally occurring or from a deliberate release, would generate significant media interest. Good communication during such an event is crucial to reduce public anxiety and improve the effectiveness of emergency service responders and health-care workers. The public should understand that a plan is being followed, and be given explanations for the various actions being undertaken. One of the primary communication objectives is to instil and maintain public confidence by providing the public with information that addresses their questions, fears and concerns.

In a deliberate anthrax release, media arrangements and public statements would be coordinated as specified in the National Counter-Terrorism Committee National Counter-Terrorism Plan 2008.

DoHA’s Health Issues Media Unit (HIMU) would play a leading role in the national coordination of health-related media responses to an anthrax outbreak. Coordination arrangements are specified within the National Health Security Agreement. Plans include the activation of the National Emergency Media Response Network (NEMRN) and close liaison with state and territory governments, health departments and allied organisations that would have a role during such an event.

The HIMU also provides media services to the Australian Government’s Chief Medical Officer who would be a key national spokesperson during an anthrax outbreak.

The HIMU is also a key member of national security media arrangements undertaken by the Australian Government Attorney-General’s Department Public Affairs Unit. The HIMU will work closely with this unit, which will approve all communications activities according to current arrangements for clearance under the National Security Public Information Guidelines.

Objectives

In an anthrax outbreak, the DoHA communications strategy will seek to:
  • provide national leadership and guidance to state and territory health and other relevant media teams/officers during the incident
  • ensure the smooth and rapid distribution of accurate information to the Australian and overseas media, relevant agencies and organisations, and the Australian public
  • ensure that public confidence is maintained in the Australian Government’s system to respond to the incident.

Communications activities according to response codes

Response Code 0
At Code 0, it is important to start to build relationships with key media personnel who can be used to convey information to the public should an event occur. The task is to increase the range and type of anthrax material available to the public, health-care providers, policy makers and the media.

Communications should outline how the public-health system will respond, the roles and responsibilities of the different sectors involved and reasonable expectations regarding the scope and effects of public-health actions. Pre-prepared media responses directed to those groups might be useful. DoHA’s Health Issues Media Unit has undertaken such work, in conjunction with national security agencies and the media advisers of state and territory health departments.

Response Code 1
HIMU, in conjunction with the Chief Medical Officer and relevant national security agencies, will take the lead role in explaining to the media the nature of the heightened threat and the response required. This communication will include strong messages about specific measures that may need to be taken by the general public. Continue and update Code 0 communication activities.
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Response Code 2
DoHA will activate a dedicated anthrax web site and a national telephone inquiry line. HIMU will collaborate closely with CDNA and media advisers in state and territory health departments, particularly in the State or Territory where the threat is imminent. HIMU will also work closely with national security agencies and will activate the National Emergency Media Response Network to coordinate a national public response, including media conferences and public statements.

Response Codes 3 and 4
The full resources of HIMU will be deployed to handle media management, and the NEMRN activated at its highest level of response. The national media plan for a response to a chemical, biological or radiological incident in Australia will be invoked, involving national security agencies and State/Territory governments.

DoHA will establish a national communication centre, staffed by media advisers from DoHA and seconded media officers, and will probably operate 24 hours a day and 7 days a week. An advisory team will be appointed, consisting of medical officers familiar with anthrax response plans and epidemiologists from the DoHA Surveillance and Epidemiology Section. The national communication centre will respond to inquiries from the media, public and health-care providers.top of page