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Public health threats are events
or disasters that can affect you and your community. Examples of public health
Public health threats can affect air quality, cause
shortages of safe water and food, and cut off electricity, gas, telephone, and
other services. You and your family members may be separated.
Disasters are hard to predict and usually are out of your control. But
you can take steps to help keep yourself and your family safe.
Here are some things you can
do to help prepare for a disaster:
Following these steps can help you be better prepared for
any type of public health threat.
There are many
things in our environment that can be harmful. Chemicals, fumes, viruses,
bacteria, and low-level radiation are just a few of them. When these substances
are released in large quantities or get out of control, they can become urgent
public health threats. Guidelines for how to prepare for and avoid a problem
often depend on how the substance is spread.
In general, a health
threat may spread through a community:
Call your local health department for information about
health threats in your area.
Chemicals are the most likely
source of air contamination. An accident at a plant or factory or a train wreck
might release large amounts of a hazardous chemical into the air, for instance.
A terrorist attack could involve the deliberate release of a toxic chemical or
In a bioterror attack, bacteria or viruses causing diseases
tularemia could be released in an aerosol form. Anyone
who inhaled the substance could be affected.
Although air itself
does not become radioactive, the release of radiation into the environment can
create radioactive dust and dirt (fallout) that can make the air unsafe. A
"dirty bomb" could work in this manner, causing a relatively minor explosion
but doing its real damage by releasing radioactive materials into the
You cannot do much in advance to
protect yourself from a hazardous substance released into the air. If there
hasn't been an obvious explosion or a known terrorist attack, the air could
become contaminated without anyone knowing it until people or animals start to
As with other potential emergencies, it makes
sense to have a disaster kit with water, food, first aid items, tools, and
other essentials. Concern over terrorist threats has prompted some people to
consider adding the following items to their supplies:
Vaccines for anthrax and smallpox are available for
certain high-risk groups but are not recommended for the general public at this
time. In 2007, the U.S. Food and Drug Administration (FDA) approved the first
vaccine for humans against bird flu (avian influenza). Immunization is not currently recommended for the public.
The vaccine will be kept in the U.S. government stockpile.1 For more information, see Bioterrorism and Vaccinations.
If a hazardous substance is released into
Chemicals, heavy metals
like lead and mercury, and living organisms such as bacteria and viruses can
all be threats to a safe water supply. These substances can also contaminate
Unintentional contamination of water as a result of chemical
leaks or spills, natural disasters, and other causes has been a much bigger
problem than deliberate contamination. Likewise, accidental food contamination
by botulinum toxin (the agent that causes
E. coli, and other harmful
organisms during the storage or preparation of food is much more likely than
intentional food poisoning.
Intentional poisoning of food and
water has occurred, though. The use of food and water to expose people to
biological or chemical weapons is also possible. Terrorists could release
living organisms such as the bacteria that cause
tularemia or botulism into the water or food supply.
Hazardous chemicals could be deliberately released in liquid or solid form.
Radioactive materials could be released into the water.
With the exception of a known
accident (such as a chemical spill into the water supply) or an announced
terrorist or criminal incident, you probably would not know that you had
consumed contaminated water or food unless you developed symptoms. To reduce
your risk of consuming contaminated food or water and to be better prepared for
public health emergencies affecting the water supply:
If there is an emergency affecting the water
Some bacteria, viruses, and other biological agents can be spread from
person to person or from animals or insects to people. The ease of
international travel has made many of these health threats more difficult to
contain. Recent health threats such as SARS (severe acute respiratory
West Nile virus, and monkeypox have made people more
aware of how easily disease can spread not only within a community but from one
community to the next.
With some exceptions such as
pneumonic plague, which are contagious diseases, most
biological agents that could be used as bioterror weapons are not spread from
person to person.
The U.S. Centers for Disease Control and
Prevention (CDC) and the World Health Organization (WHO) have current, reliable
information on communicable diseases and health concerns throughout the world.
For updates on specific health emergencies, visit their websites:
To reduce your chances of being
infected with or spreading a contagious disease:
Also see the Bioterrorism and Vaccinations section of
this topic. A vaccine for smallpox is available for certain high-risk groups
but is not recommended for the general public at this time.
The U.S. Centers for
Disease Control and Prevention (CDC) has developed plans on how to respond to
bioterrorism threats. Certain diseases have been identified as posing the
greatest threat. These diseases are:
Although the CDC is addressing all of these potential
threats, vaccines are available only for anthrax and smallpox. Currently these
vaccines are not recommended for the general public. But the CDC has advised
special vaccinations for people at high risk for exposure to anthrax or
smallpox, such as certain health care workers or military personnel. For more
A little organization can go a
long way towards helping you feel ready to handle the unexpected. Having an
emergency plan and an emergency supplies kit for your household can help you
and your family be better prepared for any kind of disaster.
Putting together an
emergency plan is easy:
You may have other things that you want to include,
especially if you have children in school or if anyone in your household has
special needs. Review your plan yearly, and make sure that phone numbers,
email addresses, and other items are still current.
essentials of an emergency kit are the same no matter what the situation:
food and water, first aid supplies and medicines, blankets and clothing,
special-needs items (such as baby formula), and certain tools and household
items, including a battery-powered radio, a flashlight, and extra
batteries. You can also use a radio or flashlight that is powered by a hand crank and so does not need batteries.
Visit the American Red Cross's website at
www.redcross.org for a checklist to use as you gather supplies. Store
everything in one place, preferably a cool, dark location. Consider putting
together a smaller version of your emergency kit that you could take if you had
to leave home or
shelter in place.
After you've assembled
your emergency supplies, remember to check and replace them
It is hard
to prepare for a terrorist attack because no one knows what form it might take
or when or where it may occur. But being prepared for general
emergencies—including fires, natural disasters, power failures, fresh-water
shortages, and similar events—makes sense and will help to reassure you and
The following agencies provide extensive information
about disaster planning and terrorism:
In any disaster situation,
transportation and communication may be interrupted, and medical services
may be overwhelmed. You may need to evaluate or treat minor or major injuries
or provide first aid, because medical care may not be immediately available.
You may feel more confident when an emergency happens if you know what to do
ahead of time and have resources at hand. The following topics discuss
emergencies that can occur in a disaster situation:
Emergency procedures you may want to know include:
natural disaster, industrial accident, or terrorist attack can cause a lot of
situations that lead to injury or illness. In some cases your home may need to
be evacuated or may be damaged. A disaster may interrupt water supplies, food
supplies, sewer and trash services, and heat and electricity. You may be
exposed to the elements or have less-than-adequate shelter for a period of
time. The following topics can help you avoid or cope with injuries related to
food safety, sanitation, and exposure:
Dealing With Emergencies provides more information
about how to cope with injuries that can occur during or right after a
You may feel overwhelmed after
an accident, natural disaster, or terrorist attack. Some people who witness a
traumatic event that seemed life-threatening develop a stress reaction known as
acute stress disorder, which can last up to a month
after the event.
Symptoms include feeling numb, reliving the
event through disturbing memories or dreams, and avoiding anything that may be
a reminder of the event. Symptoms are so intense that they disrupt daily
activities like going to work and interacting with other people.
If the symptoms last more than a month or don't develop until more than a
month after the event, you may have
post-traumatic stress disorder (PTSD). Even if you
were not injured or in danger, you can still get acute stress disorder or PTSD
if you felt physically threatened or witnessed violence. For more information,
see the topic
Post-Traumatic Stress Disorder (PTSD).
People who have experienced or witnessed a traumatic event often need
help from health professionals who are specially trained. If symptoms are
severe enough to disrupt your daily life or do not improve after 2 weeks, talk
with a doctor.
If you lost a loved one or friend in a disaster or
accident (or even a pet, your home, or important possessions), you will need
time to cope with feelings of grief and loss. For more information, see the
Grief and Grieving.
Traumatic events can
also cause feelings of depression that may need treatment. For more
information, see the topic
This Web site is intended to help people living in the
United States of America prepare for and respond to public health emergencies.
You can report an emergency, find information on the top emergency resources,
and learn practical tips such as how to assemble an emergency supply kit.
This Web site also has information on bioterrorism, chemical and
radiation emergencies, mass casualties, natural disasters and severe weather,
and recent outbreaks and incidents.
This Web site of the U.S. Department of Health and Human
Services offers resources on how to plan, prepare, and respond to natural and
man-made disasters. The site has resources for people who have experienced
traumatic events, whether they are survivors, friends and relatives of those
who are hurt or who have died, or rescue workers.
The World Health Organization (WHO) is an agency of the
United Nations. It has about 200 member states. WHO promotes technical
cooperation among nations on health issues, carries out programs to control and
eliminate disease, and strives to improve the quality of human life.
The Web site has information on many health topics, including health and
disease related to travel.
U.S. Food and Drug Administration (2007). FDA approves
first U.S. vaccine for humans against the avian influenza virus H5N1.
FDA News. Available online:
Other Works Consulted
Tochner ZA, Glatstein E (2012). Radiation terrorism. In DL Longo et al., eds., Harrison's Principles of Internal Medicine, 18th ed., vol. 1, pp. 1788–1796. New York: McGraw-Hill.
American Academy of Pediatrics (2006, reaffirmed 2011).
Chemical-biological terrorism and its impact on children. Pediatrics, 118(3): 1267–1278.
American Red Cross (accessed January 2013). Terrorism. Available online: http://www.redcross.org/prepare/disaster/terrorism.
Centers for Disease Control and Prevention (2012).
Emergency Preparedness and Response. Available online:
Centers for Disease Control and Prevention (2012).
Severe acute respiratory syndrome (SARS). Available
Cieslak TJ, et al. (2008). Disaster preparedness and
response. In RB Wallace et al., eds., Wallace/Maxcy-Rosenau-Last Public Health and Preventive Medicine, 15th ed., pp. 1285–1294. New York: McGraw-Hill.
Federal Emergency Management Agency (2004).
Food and Water in an Emergency. Available online:
Federal Emergency Management Agency (2012).
Are You Ready? A In-Depth Guide to Citizen Preparedness.
Hurst CG, et al. (2012). Chemical terrorism. In DL Longo et al., eds., Harrison's Principles of Internal Medicine, 18th ed., vol. 1, pp. 1779–1787. New York: McGraw-Hill.
Lane HC, Fauci AS (2012). Microbial bioterrorism. In DL Longo et al., eds., Harrison's Principles of Internal Medicine, 18th ed., vol. 1, pp. 1768–1778. New York: McGraw-Hill.
U.S. Department of Homeland Security (2010).
Be informed. Available online:
April 16, 2013
E. Gregory Thompson, MD - Internal Medicine
& Christine Hahn, MD - Epidemiology
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