Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Bioterrorism”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 181 records · Page 10Linked to original sources
PubMed2006

Antibiotic selection and resistance issues with fluoroquinolones and doxycycline against bioterrorism agents.

Bacillus anthracis (anthrax), Yersinia pestis (plague), Francisella tularensis (tularemia), Coxiella burnetti (Q fever), and Brucella sp (brucellosis) are all potential bioterrorism agents. Their known virulence, potential lethality, and ability to develop resistance to known antibiotic treatments make these pathogens particularly dangerous. We reviewed the scientific literature by searching MEDLINE databases and published abstracts from the Interscience Conference on Antimicrobial Agents and Chemotherapy and the Infectious Diseases Society of America from 1989-2005 for studies of each of these biologic agents with the specific aim of examining whether doxycycline or a fluoroquinolone should be stockpiled for mass-scale postexposure prophylaxis. An evidence-based approach was used to determine whether doxycycline or fluoroquinolones were efficacious (both in vitro and in vivo) against these biologic agents and to examine these drugs' respective susceptibility patterns and differences in cost, based on available data. Little published data are available on these pathogens, and much of the data are from studies that used older strains obtained from patient or animal sources in outbreaks decades ago. Doxycycline appears to show comparable minimum inhibitory concentrations to those of the fluoroquinolone class in most clinical and in vitro studies, perhaps with the exception of inhalation plague. Studies also suggest that development of antibiotic resistance is less likely to occur with doxycycline. Doxycycline is several-fold less expensive than most fluoroquinolones and appears to have similar efficacy in most scenarios based on clinical case studies and established Clinical and Laboratory Standards Institute (formerly known as the National Committee for Clinical Laboratory Standards) breakpoints for staphylococci. Therefore, doxycycline should be considered as a first-line antibiotic in the management of bioterrorism agents.

Anthrax↗
PubMed2002

Use of automated ambulatory-care encounter records for detection of acute illness clusters, including potential bioterrorism events.

The advent of domestic bioterrorism has emphasized the need for enhanced detection of clusters of acute illness. We describe a monitoring system operational in eastern Massachusetts, based on diagnoses obtained from electronic records of ambulatory-care encounters. Within 24 hours, ambulatory and telephone encounters recording patients with diagnoses of interest are identified and merged into major syndrome groups. Counts of new episodes of illness, rates calculated from health insurance records, and estimates of the probability of observing at least this number of new episodes are reported for syndrome surveillance. Census tracts with unusually large counts are identified by comparing observed with expected syndrome frequencies. During 1996-1999, weekly counts of new cases of lower respiratory syndrome were highly correlated with weekly hospital admissions. This system complements emergency room- and hospital-based surveillance by adding the capacity to rapidly identify clusters of illness, including potential bioterrorism events.

Acute Disease↗
PubMed2002

Bioterrorism-related anthrax: international response by the Centers for Disease Control and Prevention.

After reports of the intentional release of Bacillus anthracis in the United States, epidemiologists, laboratorians, and clinicians around the world were called upon to respond to widespread political and public concerns. To respond to inquiries from other countries regarding anthrax and bioterrorism, the Centers for Disease Control and Prevention established an international team in its Emergency Operations Center. From October 12, 2001, to January 2, 2002, this team received 130 requests from 70 countries and 2 territories. Requests originated from ministries of health, international organizations, and physicians and included subjects ranging from laboratory procedures and clinical evaluations to assessments of environmental and occupational health risks. The information and technical support provided by the international team helped allay fears, prevent unnecessary antibiotic treatment, and enhance laboratory-based surveillance for bioterrorism events worldwide.

Anthrax↗
PubMed2003

Endemic, notifiable bioterrorism-related diseases, United States, 1992-1999.

Little information is available in the United States regarding the incidence and distribution of diseases caused by critical microbiologic agents with the potential for use in acts of terrorism. We describe disease-specific, demographic, geographic, and seasonal distribution of selected bioterrorism-related conditions (anthrax, botulism, brucellosis, cholera, plague, tularemia, and viral encephalitides) reported to the National Notifiable Diseases Surveillance System in 1992 to 1999. Tularemia and brucellosis were the most frequently reported diseases. Anthrax, plague, western equine encephalitis, and eastern equine encephalitis were rare. Higher incidence rates for cholera and plague were noted in the western United States and for tularemia in the central United States. Overall, the incidence of conditions caused by these critical agents in the United States is low. Individual case reports should be considered sentinel events. For potential bioterrorism-related conditions that are endemic and have low incidence, the use of nontraditional surveillance methods and complementary data sources may enhance our ability to rapidly detect changes in disease incidence.

Adolescent↗
PubMed2003

Community reaction to bioterrorism: prospective study of simulated outbreak.

To assess community needs for public information during a bioterrorism-related crisis, we simulated an intentional Rift Valley fever outbreak in a community in the southern part of the United States. We videotaped a series of simulated print and television "news reports" over a fictional 9-day crisis period and invited various groups (e.g., first-responders and their spouses or partners, journalists) within the selected community to view the videotape and respond to questions about their reactions. All responses were given anonymously. First-responders and their spouses or partners varied in their reactions about how the crisis affected family harmony and job performance. Local journalists exhibited considerable personal fear and confusion. All groups demanded, and put more trust in, information from local sources. These findings may have implications for risk communication during bioterrorism-related outbreaks.

Adolescent↗
PubMed2005

Cost-effectiveness of defending against bioterrorism: a comparison of vaccination and antibiotic prophylaxis against anthrax.

BACKGROUND: Weaponized Bacillus anthracis is one of the few biological agents that can cause death and disease in sufficient numbers to devastate an urban setting. OBJECTIVE: To evaluate the cost-effectiveness of strategies for prophylaxis and treatment of an aerosolized B. anthracis bioterror attack. DESIGN: Decision analytic model. DATA SOURCES: We derived probabilities of anthrax exposure, vaccine and treatment characteristics, and their costs and associated clinical outcomes from the medical literature and bioterrorism-preparedness experts. TARGET POPULATION: Persons living and working in a large metropolitan U.S. city. TIME HORIZON: Patient lifetime. PERSPECTIVE: Societal. INTERVENTION: We evaluated 4 postattack strategies: no prophylaxis, vaccination alone, antibiotic prophylaxis alone, or vaccination and antibiotic prophylaxis, as well as preattack vaccination versus no vaccination. OUTCOME MEASURES: Costs, quality-adjusted life-years, life-years, and incremental cost-effectiveness. RESULTS OF BASE-CASE ANALYSIS: If an aerosolized B. anthracis bioweapon attack occurs, postexposure prophylactic vaccination and antibiotic therapy for those potentially exposed is the most effective (0.33 life-year gained per person) and least costly (355 dollars saved per person) strategy, as compared with vaccination alone. At low baseline probabilities of attack and exposure, mass previous vaccination of a metropolitan population is more costly (815 million dollars for a city of 5 million people) and not more effective than no vaccination. RESULTS OF SENSITIVITY ANALYSIS: If prophylactic antibiotics cannot be promptly distributed after exposure, previous vaccination may become cost-effective. LIMITATIONS: The probability of exposure and disease critically depends on the probability and mechanism of bioweapon release. CONCLUSIONS: In the event of an aerosolized B. anthracis bioweapon attack over an unvaccinated metropolitan U.S. population, postattack prophylactic vaccination and antibiotic therapy is the most effective and least expensive strategy.

Anthrax↗
PubMed2001

Update: Investigation of bioterrorism-related anthrax and adverse events from antimicrobial prophylaxis.

CDC and state and local public health authorities continue to investigate cases of bioterrorism-related anthrax. As of November 7, a total of 22 cases of anthrax have been identified according to the CDC surveillance case definition; 10 were confirmed inhalational anthrax cases and 12 cases (seven confirmed and five suspected) were cutaneous anthrax (Table 1). The majority of cases have occurred in persons working at postal facilities in New Jersey (NJ) and the District of Columbia (DC) in which letters contaminated with anthrax were handled or processed using high-speed sorting machines, or at media companies in New York City (NYC) or Florida (FL) where letters, either confirmed or presumed to be contaminated with anthrax, were opened or handled. The probable exposures for a case of cutaneous anthrax in NJ and a case of inhalational anthrax in NYC remain unknown. Epidemiologic investigations of these cases and surveillance to detect new cases of bioterrorism-associated anthrax continue. This report updates the investigation of these cases and describes adverse events associated with antimicrobial prophylaxis.

Anthrax↗
PubMed2001

Update: investigation of bioterrorism-related inhalational anthrax--Connecticut, 2001.

Since October 3, 2001, CDC and state and local public health authorities have been investigating cases of bioterrorism-related anthrax. As of November 28, a total of 23 cases have been identified; 11 were confirmed as inhalational anthrax, and 12 (seven confirmed and five suspected) were cutaneous. Epidemiologic investigations to identify the source of exposure to Bacillus anthracis continue for a case of inhalational anthrax in a hospital stockroom worker in New York City (NYC) and, most recently, a case of inhalational anthrax in an elderly woman in Connecticut (CT). Antimicrobial prophylaxis is continuing in persons exposed to B. anthracis, and surveillance to detect new cases of bioterrorism-related anthrax is ongoing. This report summarizes the findings of the case investigation in CT.

Aged↗
PubMedDate not supplied

[Bioterrorism: notes for an agenda in case of the unexpected].

UNLABELLED: The vulnerability of human populations to chemical, biological, radiological, and nuclear terrorism has been widely discussed but insufficiently studied. Current public health policies are not guided by solid and relevant information to design cost-effective programs for preventing or controlling this kind of incidents in the future. Governmental budgets are insufficient to respond to bioterrorist attacks. To face these threats, developing countries like Mexico should frame strategies and devise specific preventive actions that consider the transmission dynamics of potential infectious agents likely to be used in a bioterrorist attack. PROPOSALS: The international reaction to a biological attack must be supported by international agreements that ban the use of biological agents for warfare and/or defense purposes, as well as on academic and technological exchange for the prevention of bioterrorist attacks. At the national level, the recommendations in the event of a biological attack are: a) establishing a legal defense strategy against bioterrorism; b) implementing education programs as a key strategy for defense against bioterrorism; c) devising a national program of interinstitutional anti-bioterrorist coordination that includes medical emergency assistance and collection of medical forensic evidence; d) including a biological weapon registry in epidemiological surveillance systems; e) implementing a laboratory for biological material analysis related to terrorist incidents; f) devising public health information campaigns, g) assuring the supply of diagnostic testing, special protection, and emergency treatment materials; h) decentralizing alert systems for the timely detection of bioterrorist attacks; i) responding to bioterrorist actions addressed against animals and plants, and j) organizing Ethics Committees in case of urgent events derived from a biological attack. CONCLUSIONS: The proper response to sudden and unexpected events of emergent or unusual infectious diseases involved in a bioterrorist attack requires an adequate public health infrastructure. Modern technology allows the timely identification of multiple infectious agents by nucleic acid analyses and should be widely available in reference laboratories. All these measures require sufficient funding to respond to this potential threat. Resource allocation to respond to bioterrorist attacks must be consonant with their potential public health consequences.

Biological Warfare↗
PubMed2001

Bioterrorism: a renewed public health threat.

In the aftermath of the terrorist attacks of September 11, the United States is coming to terms with new and urgently felt public health and safety concerns related to the threat of bioterrorism. The recent history and the legislative agenda emerging to prevent, monitor, and respond to bioterrorism in the United States are described.

Bioterrorism↗
PubMed2002

The epidemiologic pyramid of bioterrorism.

Recent events have drawn world attention to "mythological diseases"--such as anthrax, plague and smallpox--which have been out of the spotlight for some decades. Much of our current knowledge of epidemic intervention and disease prevention was acquired over history through our experience with these diseases, such that the sudden panic over the reemergence of these historically well-known entities is perplexing. Over time, changes in the balance of the epidemiologic triangle have driven each of these disease systems towards a new equilibrium with which we are not familiar. While the pathogens may be similar, these are not the diseases of the past. These new disease systems are insufficiently described by the classic epidemiologic triangle, which lacks a dimension necessary for providing a valid model of the real-world effects of bioterror-related disease. Interactions within the classic epidemiologic triangle are now refracted through the prism of the global environment, where they are mediated, altered, and often amplified. Bioterror-associated diseases must be analyzed through the epidemiologic pyramid. The added dimension represents the global environment, which plays an integral part in the effects of the overall disease system. The classic triangle still exists, and continues to function at the base of the new model to describe actual agent transmission, but the overall disease picture should be viewed from the height of the fourth apex of the pyramid. The epidemiologic pyramid also serves as a practical model for guiding effective interventional measures.

Anthrax↗
PubMed2002

[Surveillance systems for early detection and mapping of the spread of morbidity caused by bioterrorism].

The early clinical presentations of many infectious diseases, including those initiated by bioterrorism, tend to have non-specific features such as flu-like symptoms, skin rashes, encephalitis and acute flaccid paralysis. Standard public health infectious disease surveillance systems depend on reports of specifically diagnosed diseases and thus may be relatively insensitive to the early identification of outbreaks. During the past few years, efforts have been made to improve the sensitivity of traditional systems, partly through implementation of new technologies such as electronic reporting and use of geographical information systems. In the United States, intensive efforts are being made to develop new surveillance systems for the early detection and mapping of the spread of diseases caused by bioterrorism. The development of such systems is based on the concept that surveillance for non-specific syndromes will enable earlier detection of infectious disease outbreaks compared with traditional systems. In addition, surveillance for non-specific syndromes could enable monitoring of the spread the outbreak, even before a definitive diagnosis has been made. In this paper, we describe several examples of prototype syndrome surveillance systems developed in the United States. These include the telephone hot-line system maintained by the New York City public health department, two internet based systems, LEADERS and RSVP, and an electronic reporting system, ESSENCE, operating in military facilities in the Washington DC area.

Bioterrorism↗
PubMed2002

[Biological security confronting bioterrorism].

A review is made on Biosecurity at both local and global level in relationship with Bioterrorism as a real threat and its control and prevention. The function of the network of High Security Laboratories around the world able to make immediate diagnosis, research on vaccines, fundamental and urgent epidemiological studies, conform a steady basis to control natural infections and also the possible bioterrorism attacks.

Animals↗
PubMed2002

Knowledge-based bioterrorism surveillance.

An epidemic resulting from an act of bioterrorism could be catastrophic. However, if an epidemic can be detected and characterized early on, prompt public health intervention may mitigate its impact. Current surveillance approaches do not perform well in terms of rapid epidemic detection or epidemic monitoring. One reason for this shortcoming is their failure to bring existing knowledge and data to bear on the problem in a coherent manner. Knowledge-based methods can integrate surveillance data and knowledge, and allow for careful evaluation of problem-solving methods. This paper presents an argument for knowledge-based surveillance, describes a prototype of BioSTORM, a system for real-time epidemic surveillance, and shows an initial evaluation of this system applied to a simulated epidemic from a bioterrorism attack.

Artificial Intelligence↗
PubMed2002

Psychological challenges of bioterror: containing contagion.

In this article, we have introduced the concept of shielding as a public mental health intervention. Shielding addresses the core elements of bioterrorism when we consider that bioterrorism is best understood as terrorism, i.e., psychological warefare, which merely employs biologic agents, not to kill, but to terrorize. It is, therefore, to some degree dependent upon widespread contagion. Shielding is not a panacea. It is one aspect of an overall response plan. Nevertheless, it represents a potentially useful "antidote" for the bioterrorist assault. Perhaps most significant among its putative mechanisms of action appears to be controlling contagion, both physical and psychological. In the final analysis, in the wake of a terrorist attack, physicians can physically immunize and treat those who require such attention. Engineers can reconstruct buildings and roads. But who rebuilds the essence of humanity which has been violently ripped away from those who suffered the terrorist attack? How do we reconstruct a belief in justice and safety in the wake of a mass terrorist attack? Without attention to mental health, i.e., the "psychological side of terrorism," we run the risk of rebuilding a nation without a spirit, without a vitality, without a sense of humanity.

Bioterrorism↗
PubMed2003

Bioterrorism preparedness.

The Connecticut Department of Public Health (DPH) entered into a cooperative agreement with the Centers for Disease Control and Prevention (CDC) to establish public health preparedness and a response plan for bioterrorism. With funds from the CDC and an additional grant from the Health Resources and Services Administration (HRSA), the DPH designated Hartford Hospital as one of two Centers of Excellence that will coordinate and manage a statewide system for bioterrorism preparedness. This paper reviews the progress that Hartford Hospital has made in meeting this challenge. Highlighted are the development of a Web application to use for statewide preparedness and response, and the preparation for a smallpox vaccination program at Hartford Hospital.

Bioterrorism↗
PubMed2003

Don't suffer the consequences. Prepare your office for bioterrorism response.

In a low-level bioterrorism attack without mass casualties, physician offices will stand at the front line for diagnosis and treatment. Lacking preparation, those offices can suffer some of the first casualties. Physicians and their administrators in ambulatory practices must be able to recognize and plan for a potential bioterrorism attack.

Bioterrorism↗
PubMed2003

Recognition and management of bioterrorism infections.

Recent events have demonstrated that bioterrorists have the ability to disseminate biologic agents in the United States and cause widespread social panic. Family physicians would play a key role in the initial recognition of a potential bioterrorism attack. Familiarity with the infectious agents of highest priority can expedite diagnosis and initial management, and lead to a successful public health response to such an attack. High-priority infectious agents include anthrax, smallpox, plague, tularemia, botulism, and viral hemorrhagic fever. Anthrax and smallpox must be distinguished from such common infections as influenza and varicella. Anthrax treatment is stratified into postexposure prophylaxis and treatment of confirmed cutaneous, intestinal, or inhalation anthrax. Disease prevention by vaccination and isolation of affected persons is key in preventing widespread smallpox infection. Many resources are available to physicians when a bioterrorism attack is suspected, including local public health agencies and the Centers for Disease Control and Prevention.

Anthrax↗