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PubMed2003

Bioterrorism: a new frontier for drug discovery and development.

Only a few years ago bioterrorism was considered a remote concern but today it has reached the forefront of the public imagination following recent terrorist attacks around the world. The disaster of September 11 2001, followed by anthrax letters sent via the US postal system, and now the renewed tension in the Middle East, have all brought the possibility of bioterrorism a little closer to reality. A number of biological agents could be used in a terrorist attack, including anthrax, botulinum, plague, smallpox, staphylococcal and streptococcal toxins, and the list of emerging pathogens is evolving rapidly. The serious diseases that these agents produce could cause considerable morbidity and mortality if used in a terrorist attack. This evolving threat presents the medical, public health and scientific communities with pressing challenges. The present research efforts in academia are primarily focused on the basic research on the pathogens that are considered to be bioweapons for terrorist attack. Thus, collaborative efforts between academic institutes, pharmaceutical industries and governmental agencies are warranted to translate basic research into drugs, vaccines and diagnostic tests. This review provides a brief overview of the threat from biological weapons and the current biodefense strategy to prevent and control outbreaks of diseases caused by intentional release of these bioweapons of mass destruction.

Anthrax↗
PubMedDate not supplied

[Confronting bioterrorism: Epidemiologic, clinical, and preventive aspects of smallpox].

The worldwide eradication of smallpox, a major achievement in public health, is currently threatened by the risk of bioterrorism. The debate on the destruction of the Variola virus in the two reference laboratories of the World Health Organization has dramatically switched to the preservation of the remaining virus after the September 2001 terrorist events in the U.S. along with the intentional release of Bacillus anthracis in the U.S. The risk of intentional release of Variola virus constitutes a minimal, yet possible risk. A smallpox epidemic could have a devastating impact due to its elevated morbidity and mortality that would inflict in non-immune human population, in addition to the ensuing panic and social unrest. Therefore, the development of national preparedness and response plans along with the availability of smallpox vaccine to be used in the post-exposure phase represent a fundamental part of the preventive efforts to cope with bioterrorism. Reestablishing a preventive vaccination program was recently recommended by the Advisory Committee on Immunization Practices (ACIP). However, the vaccine currently available has historically been associated with serious adverse reactions, even death. Thus, this recommendation has not been universally accepted. To counter an epidemic of smallpox, medical personnel in the frontline need to be prepared with updated smallpox information to identify, diagnose, isolate, and treat cases if a bioterrorist attack should occur. Herein we present an indepth review for health care personnel with relevant epidemiologic, clinical, and preventive information on smallpox.

Bioterrorism↗
PubMed2003

Ebola hemorrhagic fever in the era of bioterrorism.

Viral hemorrhagic fevers are among a small group of infectious diseases considered potential candidates for use as agents of bioterrorism. Ebola hemorrhagic fever, the focus of this article, has the highest mortality rate of the viral hemorrhagic fevers and has no effective treatment. It is transmitted easily to family members and health care professionals not following universal precautions. The history of this infection, its clinical presentation, and epidemiology are discussed. Attention is paid to the immunopathogenesis of the disease with a focus on pulmonary involvement. Recommendations for infection control and Ebola virus' potential as a bioterrorism agent are addressed.

Bioterrorism↗
PubMed2003

Emergency Department data for bioterrorism surveillance: electronic data availability, timeliness, sources and standards.

Emergency Department (ED) data are a key component of bioterrorism surveillance systems. Little research has been done to examine differences in ED data capture and entry across hospitals, regions and states. The purpose of this study was to describe the current state of ED data for use in bioterrorism surveillance in 2 regions of the country. We found that chief complaint (CC) data are available electronically in 54% of the North Carolina EDs surveyed, and in 100% of the Seattle area EDs. Over half of all EDs reported that CCs are recorded in free text form. Though all EDs have electronic diagnosis data, less than half report that diagnoses are coded within 24 hours of the ED visit.

Bioterrorism↗
PubMed2004

Bioterrorism preparedness--Part II. Smallpox vaccination in a hospital setting.

The threat of using smallpox as an agent for bioterrorism resulted in a directive for the creation of smallpox response teams. In Connecticut, The Commissioner of the Department of Public Health convened public health and hospital leadership to plan for the vaccination of these teams. The purpose of this paper is to provide a description of the vaccination program at Hartford Hospital, a Center of Excellence for Bioterrorism Preparedness, and to report the results of a survey of the vaccinees regarding the vaccination experience. Ninety persons were vaccinated. Six individuals experienced low-grade fever and 10 had axillary node swelling. One individual experienced significant fatigue. A total of six persons lost time from work. Four lost one day and two persons lost between four to five days of work. There was no autoinoculation, transfer inoculation, vaccinia or any other significant complication. Survey results indicate that most vaccinees felt positive about the experience.

Attitude of Health Personnel↗
PubMed2004

Bioterrorism and emerging infectious disease - antimicrobials, therapeutics and immune-modulators. SARS coronavirus.

The purpose of this meeting was to provide a forum for expert presentations and discussion about the threats of bioterrorism and emerging infectious diseases, and to address the issues relating to epidemics, prevention of infection and treatment of some of these emerging infectious diseases classified as potential agents of bioterror. Included in the talks were state-of-the-art presentations about infectious clone technology and recombinant viruses, pathogen and receptor interactions at the cellular and molecular level, genomic responses to infection, and new information on antiviral mechanisms of action. Severe acute respiratory syndrome (SARS) and progress toward understanding the epidemic was addressed, and other sessions were presented concerning immune therapy and immunopotentiation of disease, siRNA and gene silencing, host responses to pathogen infections, as well as the use of genetic engineering to circumvent and direct the immune response. Many discussions were held and data were presented about possible compounds and new drugs that may have antiviral properties, yet there were few discussions of any available new drugs. This report addresses reverse genetics of SARS virus, as well as its epidemiology, and a host of different recent approaches to developing antivirals effective against SARS, including some potential vaccine candidates. Also presented are hypotheses about the human immune response to SARS infection, as well as immune therapies against botulinum and anthrax toxins. This report also addresses antiviral approaches exploiting siRNAs, and different aspects of the host immune response to many of the different dangerous pathogens discussed at this meeting. Finally, approaches to circumventing and directing the immune response using genetic engineering will be reported.

Adjuvants, Immunologic↗
PubMed2004

Administrative detention of food for human or animal consumption under the Public Health Security and Bioterrorism Preparedness and Response Act of 2002. Final rule.

The Food and Drug Administration (FDA) is issuing a final regulation that provides procedures for the detention of an article of food, if an officer or qualified employee of FDA has credible evidence or information indicating that such article presents a threat of serious adverse health consequences or death to humans or animals ("administrative detention"). The final rule implements the Public Health Security and Bioterrorism Preparedness and Response Act of 2002 (the Bioterrorism Act), which authorizes the use of administrative detention and requires regulations establishing procedures for instituting on an expedited basis certain enforcement actions against perishable food subject to a detention order.

Animal Feed↗
PubMed2004

Perspectives of rural hospitals on bioterrorism preparedness planning.

Even the smallest, most isolated rural hospitals are now required to have bioterrorism preparedness plans. From the perspective of many rural hospitals, however, there is a disparity between Federal expectations and the realities of small hospitals operating in geographically isolated communities. As part of an effort to better understand how to close this gap, the Walsh Center for Rural Health Analysis convened a panel of representatives of rural hospitals who are responsible for bioterrorism preparedness in their hospitals. Perspectives of rural hospitals on various aspects of preparedness were discussed, in terms of workforce and training, physical capacity and supplies, communication, and coordination with other entities. All of the participants noted the tremendous progress that has been made in the past two years, but also the distance they each need to go. Some of the issues raised by the panelists included the dual benefit of efforts to increase capacity at rural hospitals, the inapplicability of many federal guidelines and directives for small hospitals because of size and less sophisticated infrastructure, the burden of geographic isolation relative to obtaining training and information, and the fragmentation of funding and directives at both the state and federal levels.

Bioterrorism↗
PubMed2004

Incorporating bioterrorism training into dental education: report of ADA-ADEA terrorism and mass casualty curriculum development workshop.

Numerous areas have been identified in which the dental profession may be called upon to assist in the event of a major terrorism attack. In order to successfully fulfill these roles, dentists and dental students must be adequately prepared. Dental schools play a vital role in this preparation. Participants in an ADA-ADEA workshop reached consensus that all dental students should be trained in a core set of competencies enabling them to respond to a significant bioterrorism attack, help contain the spread of the attack, and participate in surveillance activities as appropriate upon direction of proper authorities. Further emergency response training should be available to individuals interested in gaining additional knowledge and skills to assist in response to an attack. Participants also concluded that, where possible, training should be seamlessly implemented into the current curriculum without the addition of new courses; however, the group also recognized the possible need for alternative models at some dental schools. Challenges to implementing bioterrorism training into the dental school curriculum include regional variation, management of the basic science curriculum, and financial considerations. The development of an exportable training package will be considered and funding sources explored in moving forward with the development of a curriculum.

American Dental Association↗
PubMed2004

Establishment and maintenance of records under the Public Health Security and Bioterrorism Preparedness and Response Act of 2002. Final rule.

The Food and Drug Administration (FDA) is issuing a final regulation that requires the establishment and maintenance of records by persons who manufacture, process, pack, transport, distribute, receive, hold, or import food in the United States. Such records are to allow for the identification of the immediate previous sources and immediate subsequent recipients of food. The final rule implements the Public Health Security and Bioterrorism Preparedness and Response Act of 2002 (the Bioterrorism Act), and is necessary to help address credible threats of serious adverse health consequences or death to humans or animals. The requirement to establish and maintain records is one of several tools that will help improve FDA's ability to respond to, and further contain, threats of serious adverse health consequences or death to humans or animals from accidental or deliberate contamination of food. In the event of an outbreak of foodborne illness, such information will help FDA and other authorities determine the source and cause of the event. In addition, the information will improve FDA's ability to quickly notify the consumers and/or facilities that might be affected by the outbreak.

Animals↗
PubMed2005

The National Response Plan: a new framework for homeland security, public health, and bioterrorism response.

This Article provides a detailed overview of the new National Response Plan (NRP) with a focus on its applicability to bioterrorism and other public health emergencies. The Article highlights critical policy and legal issues left unresolved by the NRP, and offers recommendations for the resolution of those issues. The author concludes that, although the NRP is not perfect, it represents a major advance in domestic incident management and provides regular opportunities for review and revision as we learn how to best coordinate the national response to major incidents. A close working relationship between the Departments of Health and Human Services and Homeland Security should enable a unified response to bioterrorism and other public health emergencies in support of state and local efforts.

Bioterrorism↗
PubMed2005

Balancing in a crisis? Bioterrorism, public health and privacy.

Post-September 11, the government has been rapidly funding public health initiatives to bolster the Nation's ability to respond to bioterrorist attacks. While the infusion of money into the public health system is laudable, the pressure to enact legislation quickly has resulted in laws and policies that ignore privacy and civil liberties and that favor anti-bioterror initiatives over more common public health concerns. A public health agenda that ignores privacy and civil liberties will undermine public trust, leading people to not fully participate in critical public health activities. Our Nation is far more likely to succeed in preventing and responding to a potential act of bioterrorism if we embrace the principle that advancing public health and preserving individual liberties are symbiotic and inextricable.

Bioterrorism↗
PubMed2006

Estimating the usual prevalence and incidence of acute illness in the community: implications for pandemic influenza and bioterrorism preparedness.

BACKGROUND: Early clinical signs of influenza caused by a pandemic strain will presumably not differ significantly from those caused by other respiratory viruses. Similarly, early signs of diseases that may result from bioterrorism are frequently non-specific and resemble those of influenza-like illness. Since the time window for effective intervention is narrow, treatment may need to be initiated prior to a definitive diagnosis. Consequently, planning of medications, manpower and facilities should also account for those who would be treated for an unrelated acute illness. OBJECTIVES: To estimate usual patterns of acute illness in the community as a baseline for integration into pandemic influenza and bioterrorism preparedness plans. METHODS: Between 2000 and 2003 we conducted 13 telephone surveys to estimate the usual incidence and prevalence of symptoms of acute illness in the community. RESULTS: On average, 910 households were included in each of the surveys, representing about 3000 people. The compliance rates for full interviews ranged from 72.3% to 86.0%. In winter, on average, about 2% of the Israeli population (individuals) suffered each day from fever of > or = 38 degrees C, and about 0.8% during the other months. The prevalence of cough was higher, 9.2% in winter and 3% during summer. Daily incidence of fever ranged from about 0.4% per day in winter to about 0.2% in the fall. The prevalence and incidence of both fever and cough were highest for infants followed by children aged 1-5 years. CONCLUSIONS: These background morbidity estimates can be used for planning the overall treatment requirements, in addition to actual cases resulting from pandemic influenza or a bioterrorist incident.

Acute Disease↗
PubMed2006

The rule of law and bioterrorism.

Bioterrorism is multi-faceted. Its impact will extend beyond the victims, the agent used, and the perpetrator(s). The rule of law must be considered in the wake of September 11 and the fall 2001 anthrax attacks. Bioterrorism preparedness should address rule of law and social issues. Laboratory professionals must be prepared for professional, civil justice, and social impact in the event of a future major bioweapons event.

Bioterrorism↗
PubMed2000

Bioterrorism: a challenge to public health and medicine.

Only a few years ago, an attack with a biological agent would have been considered almost unthinkable. Today, however, the threat of bioterrorism is real and growing. This article will provide a brief overview of the threat of bioterrorism, the special role of public health and medicine, and some of the critical issues that need to be addressed as this nation prepares for this disturbing and potentially catastrophic threat.

Biological Warfare↗
PubMedDate not supplied

Bioterrorism as a public health threat.

The threat of bioterrorism, long ignored and denied, has heightened over the past few years. Recent events in Iraq, Japan, and Russia cast an ominous shadow. Two candidate agents are of special concern--smallpox and anthrax. The magnitude of the problems and the gravity of the scenarios associated with release of these organisms have been vividly portrayed by two epidemics of smallpox in Europe during the 1970s and by an accidental release of aerosolized anthrax from a Russian bioweapons facility in 1979. Efforts in the United States to deal with possible incidents involving bioweapons in the civilian sector have only recently begun and have made only limited progress. Only with substantial additional resources at the federal, state, and local levels can a credible and meaningful response be mounted. For longer-term solutions, the medical community must educate both the public and policy makers about bioterrorism and build a global consensus condemning its use.

Biological Warfare↗
PubMed1999

Bioterrorism alleging use of anthrax and interim guidelines for management--United States, 1998.

From October 30 through December 23, 1998, CDC received reports of a series of bioterroristic threats of anthrax exposure. Letters alleged to contain anthrax were sent to health clinics on October 30, 1998, in Indiana, Kentucky, and Tennessee. During December 17-23 in California, a letter alleged to contain anthrax was sent to a private business, and three telephone threats of anthrax contamination of ventilation systems were made to private and public buildings. All threats were hoaxes and are under investigation by the Federal Bureau of Investigation (FBI) and local law enforcement officials. The public health implications of these threats were investigated to assist in developing national public health guidelines for responding to bioterrorism. This report summarizes the findings of these investigations and provides interim guidance for public health authorities on bioterrorism related to anthrax.

Anthrax↗
PubMed1999

Targeting bioterrorism.

Concerns about bioterrorism have grown in recent years. The fear of bioterrorism is as potent as the genuine risk. In this new age of potential biological warfare, emergency medical preparedness must be on target. Physicians must be ready to alert public health authorities.

Biological Warfare↗