Publication of the Bureau of Epidemiology & Disease Control Service

September/October 2002, Vol. 16, No. 5

Statewide Strategy Well Under Way
For Bioterrorism Preparedness
By David Engelthaler and Powell Gammill

The anniversary of September
11th is already here, and the Arizona
Department of Health Services is
moving rapidly forward with the
development of its statewide strategy
for bioterrorism preparedness.

public health officials, first responders, and federal partners, are currently testing the system. The SIREN
system has received national attention and has become a model for
other states to follow.
Federal grants were also recently
awarded to all states to coordinate
hospital bioterrorism preparedness.
The Department has already coordinated several state-wide and regional
meetings to address the planning and
assessment needs of the hospitals in
the state. These assessments will be
used to prioritize the hospitals’ preparedness needs.

Public Health Preparedness
The Centers for Disease Control
and Prevention has provided funding
to all states, including Arizona, to
further public health preparedness
and to build a solid public health
infrastructure. The Department is
focusing on the following areas of
public health preparedness: emergency response planning; enhanced
disease surveillance; increased laboratory capabilities; secure web-based
health alert network; risk communication; and bioterrorism education
and training for healthcare providers.
Recently all county health departments were awarded grants to develop and meet these capacities as well.
Of particular note, the
Department has recently developed
the SIREN (Secure Integrated
Response Electronic Notification) system. This system is designed to share
health alerts and other sensitive information over a high-speed, highly
secure, web-based environment.
Over 100 users in the state, including

Laboratory Readiness
Staffing has been increased at the
State Public Health Laboratory to
respond to the increasing need for
public health preparedness. The
increased personnel will soon the
State Laboratory to provide seven
days per week capability for
responding to suspect bioterrorism
incidents and other potential
epidemics. Clinical laboratories
and other partners in the state will
be notified of when this expanded
coverage will start.
Real-time Polymerase Chain
Reaction (PCR) capacities and other
rapid molecular and antigen detec-

tion methods will be expanded to
cover the increasing need for swift
presumptive testing. The State
Laboratory is boosting its testing
capacity, upgrading testing methodologies and expanding environmental sampling to include improved
food-borne illness surveillance.
Throughout the state, bioterrorism laboratory personnel have conducted training in more than 30 private clinical laboratories to recognize
and safely rule out certain priority
biological agents. On-site and off-site
training will continue for all clinical
laboratories in the state.
Continued on page 8

Visit the ADHS Web site at www.hs.state.az.us
Influenza
Season
Approaching
Page 2
September/October 2002

Bacteria Leave
“Fingerprint”
Page 3

Adverse Health
Effects of Fire
Page 4

Breast Cancer
Study Update
Page 5

Antibiotic
Resistance
Campaign
Page 6

Summary Chart
of Reportable
Diseases
Page 7
Prevention Bulletin

1

Influenza Season is Rapidly Approaching
By Anne Lutz

If the 2002-2003 Arizona influenza season follows the same pattern as
last year, the first influenza case will
be detected in November and the
number of cases will peak by early
February and begin to decline by
mid-March. Projected influenza vaccine production for this year is
between 92 and 97 million doses.
The Advisory Committee on
Immunization Practices (ACIP) has
published their recommendations
for the 2002-03 flu season which
includes the optimal timing for highrisk groups and for those who are not
at risk of complications from the flu.
The special needs of young children
for the flu vaccine have also been
addressed. These guidelines can be
found at the CDC influenza website
http://www.cdc.gov/nip/flu.
It is recommended that vaccinations begin for the following groups in
October:
High Risk of Severe Illness
• 65 years old or older
• Children 6 - 23 months old
• Adults and children with a chronic
health condition
• More than 3 months pregnant
during the flu season

Can Give Flu to Those at High Risk
• Household contact or care-giver
of someone at high risk
• Health care workers
• Household contact or care-giver
of a child under 2 years old
A Child’s Very First Flu Shot
• Children 6 months to 8 years old
who are getting the first flu shot
need a booster shot one month
after the first dose of vaccine.
All other persons should be
vaccinated beginning in November.
Vaccination should continue through
December and beyond. Influenza
vaccine for the 2002-03 influenza
season is still available for purchase.
Health care providers who have not
ordered influenza vaccine should do
so as soon as possible to ensure timely receipt of vaccine. In general,
providers who ordered vaccine
directly from the manufacturers
received the vaccine earlier. Vaccine
prices have risen again from about
$5 per dose last year to $6.50 per
dose this season.
Anne Lutz is the Adult Immunization Coordinator
for the Arizona Immunization Program. She can be
reached at 602.230.5837 or alutz@hs.state.az.us.

FLU HOTLINES
Following is a listing of flu vaccine clinic hotlines that will begin in October.
• Community Information and
Referral Flu Hotline
Metro Phoenix: 602-263-8856
Outlying Areas: 800-352-3792
www.cir.org
• Southern Arizona Information and
Referral
520-881-1794
www.azinfo.org
• Basha's Healthstyles
480-895-5350
• The Mollen Clinic
602-277-3588. www.mollen.com
• Healthwaves, Inc.
480-968-1886.
www.healthwaves.com
• Maxim Health Care
1-888-436-3339
www.maximflu.com

Influenza in Arizona 1995-2001

Figure 1

Definitions
Sporadic Activity
• Influenza cases, either laboratoryAverage influenza season activity
confirmed or influenza-like illfrom 1995-2000.
ness (ILI), are reported; however,
reports of outbreaks in places
2000-2001influenza season activity.
such as schools, nursing homes,
and other institutional settings
have not been received.
Regional Activity
• Outbreaks of either laboratoryconfirmed or ILI are occurring in
geographic areas containing less
than 50% of the state’s population.
A geographic area could be a
city, county, or district.
Widespread Activity
• Outbreaks of either laboratoryconfirmed or ILI are occurring in
geographic areas representing
more than 50% of the state’s
population.
2

Prevention Bulletin

September/October 2002

Even Bacteria Leave a “Fingerprint”
Victor Waddell, Ph.D, and Graham Briggs

Foodborne illness and death
isms supplied by CDC with known
resulting from microorganisms are a
fingerprints as standards. By running a
To stop the potential
common and preventable public
known standard organism on every
health problem. It has been estimated
PFGE gel, a computerized software
spread of a foodborne
that over 80 million cases of foodprogram can standardize each gel
outbreak, it is imperative
borne and water borne illnesses
and allow comparison of fingerprints
that
the
source
of
the
occur in the United States each year
from PFGE gels from different states.
resulting in as estimated 9,000 deaths.
PulseNet's electronic database
microorganism is
Over 1,800 cases of salmonellosis,
enables
microbiologists throughout
quickly found.
shigellosis, and camphylobacteriosis
the U.S. to compare bacterial fingeroccurred in Arizona in 2001. The
print patterns with those from other
more recently recognized pathogen, E. bacterial species. The lab can help
states and to determine if there may
coli O157:H7, accounted for 30 cases determine if the cases are related by
be a common outbreak pattern. This
of illness in 2001.
looking for a common bacterial finsummer, over 19 million pounds of
To stop the potential spread of a
gerprint among the patient isolates.
ground beef was recalled from numerfoodborne outbreak, it is imperative
This information can then be used to
ous states due to E. coli O157:H7
that the source of the microorganism
connect patients to a common bactecontamination. The State Lab is comis quickly found. The State Laboratory
rial source.
paring all samples of E. coli that are
now has the ability to genetically “finBecause foodborne outbreaks
received for association with any of
gerprint” organisms using a procedure
associated with a common source
the E. coli responsible for the beef
known as Pulsed Field Gel
often occur in multiple states, the
recall. In addition, the State
Electrophoresis (PFGE). Most species
Centers for Disease Control and
Laboratory routinely compares the
of bacteria can be categorized into
Prevention (CDC) has created a labobanding patterns of Salmonella and
several sub-types by PFGE depending
ratory network called PulseNet. All
other organisms that are isolated to
on the amount of genetic variation in
50 states and the CDC participate in
statewide and national outbreaks.
that particular species and the restricthis program.
The CDC publishes standardized
tion enzyme used.
PulseNet allows standardization
protocols for all participating laboratoThe State Laboratory can perform
and coordination of laboratory results
ries. Currently, the Arizona State
PFGE with just a couple of isolated
on a multistate level when common
Laboratory has standardized protocols
colonies grown on a nutrient agar
source outbreaks occur. Images of
for E. coli, Salmonella, Listeria monoplate. By using a rare cutting restricPFGE gels can be analyzed and forcytogenes, Shigella, Clostridium pertion enzyme, the lab can cut the
warded to CDC through e-mail for
fringens, Campylobacter, and Vibrio.
entire bacterial chromosome into
comparison in a national database.
However, the State Laboratory can
twenty to thirty pieces. These pieces of Standardization of results among difalso fingerprint Enterococcus,
DNA, or bands, can then be separated ferent laboratories is accomplished
Enterobacter, Staphylococcus,
by their molecular weight using
through the use of sub-types of organStreptococcus, Pseudomonas,
agarose gel electrophoresis. The
Legionella and others upon request
difference in size of bands and
by state epidemiologists.
Figure 1
number of restriction sites allows
Bacterial “fingerprints” don’t
the lab to differentiate between
provide the finality of a human finclosely related and identical bacgerprint. While each human has a
terial sub-types from more genetiunique fingerprint, clones of bactecally divergent isolates. An identiria all have identical “fingerprints”.
cal sub-type isolated from both
Although each bacteria may not
food and persons who had conleave an actual unique fingerprint,
sumed the contaminated food can
they do leave a trail for epidemiolobe a valuable piece of evidence
gists to follow.
for epidemiologists as they investiVictor Waddell, Ph.D., is Chief of the Office of
gate an outbreak.
Microbiology at the State Lab and can be
PFGE can also be a valuable
reached at 602.542.2897 or
vwaddel@hs.state.az.us. Graham Briggs is a
analytical tool to evaluate an
Public Health Scientist with the State Lab and
increase in hospital clinical infecShows the genetic variation in E. coli O157:H7
can be reached at 602.542.6132 or
tions being caused by the same
sub-types after performing PFGE.
gbriggs@hs.state.az.us.
September/October 2002

Prevention Bulletin

3

Adverse Health Effects Associated
With The Rodeo-Chediski Fire
A public health survey
of more than 400 residents affected by the
Rodeo-Chediski fire
found widespread
stress and health
problems among both evacuees and
those who did not evacuate. The
Arizona Department of Health
Services, the federal Centers for
Disease Control and Prevention, and
the Navajo County Health
Department conducted the survey in
southern Navajo County between July
5 and July 9.
More than 40 percent of those
interviewed reported “a lot” or a “significant” amount of stress, and more
than 40 percent felt that smoke from
the fires had harmed their health.
Preliminary findings showed that:
• One-third of all respondents
reported experiencing at least one
health symptom including cough,
shortness of breath, sore throat,
chest pain, eye irritation or
increased allergies from the
smoke.

Stress levels were generally
higher in people that were
evacuated.
• Working people reported
losing approximately four
days of work because of
the fire.
• Sixty-six percent of asthmatics reported that their
symptoms were worse after
the fire.
• Asthma symptoms were
generally worse in people
that did not evacuate or
were in non-evacuated
areas.
The findings that smoke
from the fire caused respiratory
problems are consistent with
other epidemiologic studies
that have found exposure to particulate matter less than 10 microns in
size causes shortness of breath,
increases in coughs, aggravation of
asthma, decreases in lung function
and lung defense mechanisms, chronic obstructive pulmonary disease, and

By Will Humble

•

Photo courtesy of the East Valley Tribune

increased rates of hospitalization for
respiratory and cardiovascular illnesses. The concentrations of particulate
matter measured by portable monitors
established that the levels were certainly high enough to cause adverse
health effects.
Continued on page 6

Most Deaths from Fire are Preventable
During the past decade an average of 44 Arizona residents each year
died due to fire, flames, or smoke.
Most of these deaths occurred in a
residential setting. Smoke alarms, if
functional, are highly effective in preventing deaths from residential fires.
However, Arizona survey data found
that only 24.6% of adults with a residential smoke detector said they had
checked it within the past month
(Behavioral Risk Factor Survey, 1998).
Health care providers should encourage patients to install a smoke detector in each sleep area, and to test the
alarm monthly. The National Fire
Protection Association
(www.NFPA.org) urges that batteries
in battery-powered alarms be
replaced yearly, and that alarms
should be replaced every 10 years.
4

Prevention Bulletin

Figure 1

Accidental (unintentional injury) deaths from fire
and flame among Arizona residents.
Source: ADHS Vital and Health Statistics Report, 2000.

September/October 2002

Noteworthy...
“Dr. Bob” to Re-join ADHS
as State Epidemiologist
A former member of the public
health team at the Arizona
Department of Health Services
will be re-joining the staff this fall,
assuming his previous position as
Arizona’s State Epidemiologist.
Bob England, M.D., M.P.H., better known among colleagues as “Dr.
Bob” was formerly employed in the
position from 1996 to 1999, where
he was involved in a variety of public
health achievements.
“We are very lucky to have Dr.
England back at the Department,”
said Catherine Eden, Director. “His
depth of education and professional
experience will greatly assist our
efforts in dealing with the emerging
challenges facing public health,
such as bioterrorism and emerging
infectious diseases.”
As State Epidemiologist, Dr.
England’s responsibilities will include
coordinating disease control and
surveillance activities in the state,
working closely with county health
offices, and assisting the Director in
representing departmental and public
health concerns to the media,
legislature, other agencies and policy
makers. He will join the Department
in October.
Dr. England left Arizona in April
1999 for his current position as
Director of the Health Department in
Milford, Conn. His accomplishments
in Milford include the design and
management of a surveillance-based
hepatitis C intervention program for
several local health departments,
implementing a community-based
health education program with youth
peer educators, and community-wide
oral health planning.
Dr. England received his M.D.
from the University of Arizona
College of Medicine and a Master’s
in Public Health at the UCLA School
of Public Health. He holds physician
licenses in Arizona and Connecticut,
and is Board Certified in Public
Health and General Preventive
Medicine.
September/October 2002

Prior to serving as the
Department’s State Epidemiologist,
he served as Medical Director for
Preventive Medical Health Services at
the Maricopa County Department of
Public Health Services, Medical
Director for Clinica Adelante in
Surprise, Arizona, and Division
Director for the Disease Control
Division of the Pima County Health
Department.

Breast Cancer Study Update
A study called SHINE (Southwest
Hormone, Insulin, Nutrition and
Exercise) began in January to
determine if there are associations
between metabolic, genetic, and
environmental factors that may affect
the risk of developing breast cancer.
Using information supplied by the
Arizona Cancer Registry, the
University of Arizona Cancer Center
will survey approximately 1,200 randomly chosen Native American,
Hispanic, and White women diagnosed with breast cancer between
2000 and 2003. This study is being
conducted in Arizona, New Mexico,
Utah, and Colorado. (See July/August
2001 issue of Prevention Bulletin.)

As of August 1, 2002, approximately 400 physicians have given permission for their patients to be contacted for participation in this study.
Over 200 physicians have given blanket permission to contact all of their
patients. Study staff have contacted
156 patients and completed 99 surveys. The response by Arizona’s physi-

cians is greatly appreciated. Physicians
are encouraged to inform their breast
cancer patients that they may be contacted to participate in this important
study. To reach the Arizona Cancer
Registry field office, please call
Daniel Garcia at 480.947.3972. The
University of Arizona study coordinator, Tara Patton, can be reached at
520.318.7281.

Arizona Case of
Hantavirus Reported
The Arizona Department of Health
Services confirmed in June the first
case of Hantavirus Pulmonary
Syndrome (HPS) this year in Arizona
in a Maricopa County resident.
Since 1993, when hantavirus was
first identified in the southwest a total
of 35 cases of HPS have been reported
in Arizona. One case was reported in
Arizona last year.
HPS is an often deadly disease
that usually begins with flu-like symptoms, and may rapidly progress to respiratory failure when the lungs fill
with fluid. Patients usually develop
breathing difficulty approximately two
to six days after onset of symptoms.
Hantavirus is spread by the deer
mouse and other closely-related
species of wild mice, which excrete
the virus in their urine, droppings and
saliva. People can become infected by
inhaling particles of the virus that may
become airborne when rodent droppings or nests are disturbed. The virus
is not spread from person to person.
Nationwide, more than 325 cases
of HPS have been reported in 31
states since the virus was first recognized. Of these, approximately
35 percent were fatal. The disease
was first recognized during a 1993
outbreak that occurred in the Four
Corners area, affecting 53 people in
Arizona, Utah, New Mexico and
Colorado.
Hantavirus can occur wherever
the deer mouse and its close relatives
are present, which includes most rural
areas throughout the state. Other
Continued on page 8
Prevention Bulletin

5

Strike Out Antibiotic Resistance
Although some diseases
have been conquered
through major advances in
science, public health, and
technology, new infectious
diseases continue to
emerge, while others reemerge in drug-resistant
forms. The Centers for
Disease Control and
Prevention have stated that
the emergence of drug
resistance in bacteria, parasites, viruses and fungi is
swiftly reversing advances
of the previous 50 years
(www.cdc.gov/ncidod/
emergplan/3executive.htm).
Prevention and control
of drug-resistant infections
hinges upon the judicious
use of antimicrobial drugs.
In the first pitch of a public health educational
campaign, Governor Hull proclaimed September as
“Antibiotic Resistance Awareness Month”. The hit of
the campaign was an antibiotic resistance poster contest for Arizona school children that was sponsored in
part by the Arizona Diamondbacks and the Pediatric
Foundation of Arizona, Inc.
Mary-Lynn Piper, a 6th-grader from Litchfield
Elementary School, made the winning pitch with her
“Strike Out Antibiotic Resistance” poster. For a free
copy of this campaign winning poster, contact Clare
Kioski at 602.230.5927 or ckioski@hs.state.az.us.

Recommendations for appropriate
antibiotic use for health care providers:
• Only prescribe antibiotic therapy when likely to be
beneficial to the patient.
• Use an agent targeting the likely pathogens.
• Use the antibiotic for the appropriate dose and duration.
• Educate patients on the appropriate use of antibiotics and the importance of prevantative measures,
such as handwashing.

Fire – Continued from page 4

However, the long-term public
health impact from the fire may be
more insidious. Increases in substance abuse, domestic violence, and
other mental health problems are
often the consequences of stress that
follows disasters such as the RodeoChediski fire. Unfortunately, persons
in the most need of counseling and
other mental and behavioral health
services are often the least likely to
seek them out.
The Arizona Department of
Health Services has received a grant
from the Federal Emergency
Management Agency to develop
behavioral health programs and
counseling services in the affected
6

Prevention Bulletin

communities. A 24-hour
hotline, 1.800.640.2123,
is now being provided
through the Department’s
Northern Arizona mental
health contractor, the
Northern Arizona
Regional Behavioral
Health Authority. Any
of your patients who
were impacted by the
fire that you suspect
may benefit from
professional counseling
or other behavioral
health services should be
encouraged to call the
toll-free counseling hotline.

Photo courtesy of the East Valley Tribune

Will Humble is the Chief of the Office of
Environmental Health and can be reached at
602.230.5941 or whumble@hs.state.az.us.
September/October 2002

SUMMARY OF SELECTED REPORTABLE DISEASES
(January - July, 2002)1
Jan - July
2002

Jan - July
2001

5 Year Median
Jan - July

3 (1)
0
1
40 (27)
0 (0)

5 (1)
0
2
302 (120)
0 (0)

5 (3)
0
3
37 (25)
1 (0)

387
16
9
327
180

342
17
6
348
229

293
18
7
357
234

202
141
632
3
2521

254
98
1013
9
2151

463
113
*
12
*

567
207
15
20

581
112
37
13

468
118
18
33

8612
2076
112 (8)

8604
2349
87 (17)

7342
2349
103 (15)

6 (0)
599

5 (0)
437

7 (1)
485

1
0
89

1
0
95

2
0
35

1932
109
212
238
138 (127)
20

907
112
297
331
127 (106)
9

907
123
230
331
206 (106)
8

VACCINE PREVENTABLE DISEASES:
Haemophilus influenzae, serotype b invasive disease (<5 years of age)
Measles
Mumps
Pertussis (<12 years of age)
Rubella (Congenital Rubella Syndrome)
FOODBORNE DISEASES:
Campylobacteriosis
E.coli O157:H7
Listeriosis
Salmonellosis
Shigellosis
VIRAL HEPATITIDES:
Hepatitis A
Hepatitis B
Hepatitis B: non-acute2
Hepatitis C
Hepatitis C: non-acute3
INVASIVE DISEASES:
Streptococcus pneumoniae
Streptococcus Group A
Streptococcus Group B in infants <30 days of age
Meningococcal Infection
SEXUALLY TRANSMITTED DISEASES:
Chlamydia
Gonorrhea
P/S Syphilis (Congenital Syphilis)
DRUG-RESISTANT BACTERIA:
TB isolates resistant to at least INH (resistant to at least INH & Rifampin)
Vancomycin resistant Enterococci isolates
VECTOR-BORNE & ZOONOTIC DISEASES:
Hantavirus Pulmonary Syndrome
Plague
Animals with Rabies
ALSO OF INTEREST IN ARIZONA:
Coccidioidomycosis
Tuberculosis
HIV
AIDS
Lead Poisoning (<16 years of age)
Pesticide Poisoning4
1
2
*
4

Data are provisional and reflect case reports during this period except Lead Poisoning which is by date of diagnosis.
These counts reflect the year reported or tested and not the date infected.
Case counts for non-acute Hepatitis B and C are not available before 1998.
Not all reports will be confirmed as meeting the case definition for pesticide poisoning upon further investigation.

September/October 2002

Prevention Bulletin

7

❍ Change of Address/Name
❍ Delete my name from your mailing list
❍ I received more than one copy
Please include your mailing label with all requests
for changes. Fax changes to 602.230.5959

PRSRT STD
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PAID
Phoenix, AZ
Permit No. 957

Arizona Department of Health Services
Public Information Office
3815 North Black Canyon Hwy.
Phoenix, AZ 85015
602.230.5901 • Fax 602.230.5959
Jane Dee Hull, Governor
Catherine R. Eden, Ph.D., Director ADHS
Lee A. Bland, Chief, Bureau of Epidemiology
and Disease Control Services
Editorial Board
Victorio Vaz, D.V.M., Ph.D., Acting State Epidemiologist
Tim Flood, M.D.
Kathy Fredrickson, M.P.H.
Will Humble, M.P.H.
Ken Komatsu, M.P.H.
Cheryl McRill, M.D.
Wesley Press, M.S.
Emma N. Viera, M.P.H.
Managing Editor: Courtney Casillas
e-mail: ccasill@hs.state.az.us
Contributors: Graham Briggs, David Engelthaler, Tim Flood,
Powell Gammill, Will Humble, Clare Kioski,
Anne Lutz, Victor Waddell
This publication is supported by the Preventive Health and Health Services Block
Grant from the Centers for Disease Control and Prevention (CDC).
Its contents do not necessarily represent the views of the CDC.
If you need this publication in alternative format, please contact the ADHS Public
Information Office at 602.230.5901 or 1.800.367.8939 (State TDD/TTY Relay).

Hantavirus – Continued from page 5

rodents, such as roof rats, have not
been shown to pose a threat of hantavirus. It is important to take preventive measures to
avoid contracting the disease.
“The best
defense against
infection with hantavirus is to
avoid cleaning or disturbing areas
with recent rodent infestation including nests and droppings,” said Dr.
Mira Leslie, State Public Health
Veterinarian. “If you do have to clean
up droppings or nests, be sure to thoroughly disinfect the area first. Be especially cautious when entering a structure, such as a summer cabin, that has
been closed up. People who have
been exposed to rodent droppings
and who become ill with HPS-like
symptoms should seek medical care.”
For more information about
HPS, contact the ADHS Vector-Borne
& Zoonotic Disease Section at
602.230.5820.
8

Prevention Bulletin

Bioterrorism – Continued from page 1

We’ve come a long way

• A state-wide bioterrorism and
Arizona has made great gains in
epidemic training program that
the arena of public health preparedcoordinates all bioterrorism relatness, but there is still a long way to
ed training for physicians and
go. The Department’s vision of the
other health care providers
State’s bioterrorism program
These new bioterrorism initiaincludes:
tives, although borne
• A thoroughly
of unspeakable
The Centers for Disease Control
integrated
maliciousness, are
and Prevention has provided
bioterrorism
funding to all states, including
nonetheless an exciting
response system, Arizona, to further public health and vitalizing venture
preparedness and to build a solid
from the local
for public health, a
public health infrastructure.
to the federal
public service whose
levels;
role has long been
• An electronic, web-based, statemisunderstood or ignored. The
wide disease reporting system,
Department looks forward to workthat allows for highly secure
ing with health care providers across
and near real-time disease and
the state as we endeavor to achieve
outbreak surveillance;
public health preparedness.
• SIREN as the medium for
David Engelthaler is with the Department’s Office
all emergency health
of Bioterrorism and Epidemic Preparedness and
communications
Response, and can be reached at 602.230.5920 or
dengelt@hs.state.az.us. Powell Gammill is
• A laboratory system to rapidly
Manager of the Epidemic Detection and Response
analyze selected suspicious
Section at the State Lab and can be reached at
biological samples
602.542.6134 or pgammil@hs.state.az.us
September/October 2002