Modeling the public health system response to a terrorist event in the food supply.

We have developed a simulation model to quantify and characterize the response of the public health system and the impact of public health advisories in the event of an intentional contamination of the food supply. The model has three components: (1) definition of individual exposure over time and the outcomes of exposure, (2) definition of the geographical dispersal of exposures, and (3) response of the public health authorities to symptomatic individuals. The model explicitly considers the variation in the multiple interrelated facets of the response system, including differences among individuals' responses to exposure, variation between health care providers, and the subsequent processing of samples and confirmation of cases. To illustrate use of the model, case studies with Escherichia coli O157:H7 and Salmonella spp. in three categories of food vehicle were compared. The level of detail required to run the public health component of the model is not trivial. While some data may not be available for hazards of particular interest in potential bioterrorism events, the application of expert judgment permits comparisons between different agents, different system reactions, and other assumptions within the system. The model provides the capacity to study the impact of system changes, to compare scenarios and to quantify the benefits of improvement in terms of averted exposures and risk reduction, and constitutes a significant aid to understanding and managing these threats. Essentially, the model provides an explicit valuation of time saved in the identification and intervention in terrorist events in the food supply.