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PubMed2002

Anthrax in Europe: its epidemiology, clinical characteristics, and role in bioterrorism.

In the 2001 bioterrorist attack in the United States, in which at least 22 cases of anthrax occurred, there was initial uncertainty as to whether the index case was acquired from natural sources, and many of the additional cases posed diagnostic challenges to clinicians unfamiliar with the disease. The existence in Europe of terrorist groups with demonstrated violent tendencies suggests Europe is not immune to bioterrorist attack, and the same epidemiological and clinical confusion could happen here. Bacillus anthracis is distributed widely in the soils of Europe and foci of animal disease occur, notably in southern and eastern Europe. Sporadic human cases occur in these areas, and occasional additional cases have been acquired from contaminated, imported materials or acquired in countries outside of Europe, where anthrax may be common. Depending upon the intent of a bioterrorist, illness-caused B. anthracis could take one of several clinical forms-inhalational, cutaneous or gastrointestinal-and each would pose diagnostic difficulties. Understanding the epidemiologic, pathophysiologic and bioterrorism principles of anthrax are the clinician's best means of early detection of cases.

Animals↗
PubMed2001

Preparedness and response to bioterrorism.

As we enter the 21st century the threats of biological warfare and bioterrorism (so called asymmetric threats) appear to be more real than ever before. Historical evidence suggests that biological weapons have been used, with varying degrees of success, for many centuries. Despite the international agreements to ban such weapons, namely the 1925 Geneva Protocol and the 1975 Biological and Toxin Weapons Convention, there is no effective international mechanism for challenging either the development of biological weapons or their use. Advances in technology and the rise of fundamentalist terror groups combine to present a significant threat to western democracies. A timely and definitive response to this threat will require co-operation between governments on a scale never seen before. There is a need for proper planning, good communication between various health, home office, defence and intelligence agencies and sufficient financial support for a realistic state of preparedness. The Department of Health has produced guidelines for responding to real or suspected incidents and the Public Health Laboratory Service (PHLS) has produced detailed protocols to inform the actions required by microbiologists and consultants in communicable disease control. These protocols will be published on the Department of Health and PHLS web sites.

Anthrax↗
PubMed2004

[Bioterrorism - a challenge for public health services].

Within the range of highly contagious diseases there are well-known diseases, and those caused by newly detected infectious agents (i. e. SARS) or, in the worst case, bioterror agents. Public Health Services as well as clinicians and practitioners will be confronted with a new paradigm of infectious disease control: not only the infectious agent itself, the constitution of the host or the environment will influence the spread of a disease, but also globalization, mobile societies and new communication systems. Thus, the emergence, respectively the re-emergence of such diseases demands new or better skills in management of infectious diseases. Finally, the demonstration of national and federal plans for smallpox control focuses on organisational, logistical and financial problems following the implementation of such plans.

Adult↗
PubMed2003

The anthrax team: a novel teaching approach to increase anthrax and bioterrorism awareness.

A team approach to educating staff regarding anthrax and bioterrorism awareness was implemented after the acts of terrorism that began September 11, 2001. "The Anthrax Team" developed algorithms on the basis of 5 different scenarios, an educational brochure, and a PowerPoint presentation. With use of the algorithms and PowerPoint material, the team conducted informal educational sessions to increase awareness and allay fears. On the basis of the success of this educational method, the teaching process will be applied to address staff on other biologic and chemical terrorism agents.

Algorithms↗
PubMedDate not supplied

Pediatric implications in bioterrorism part I: physiologic and psychosocial differences.

Children are physically and psychologically different from adults and require care modified to meet their needs. In the event of a bioterrorism attack, the child's stage of development can help or hinder his or her response to bioterrorist material. This Part 1 of a series of articles addresses the differences found in children and how health care providers can alter interventions to avoid causing further harm.

Adolescent↗
PubMedDate not supplied

Pediatric implications in bioterrorism part II: postexposure diagnosis and treatment.

Bioterrorism is an old tactic used in warfare. The use of fatal diseases or man-made poisons to subdue others has not been limited to wartime. Trauma personnel should be aware of commonly used agents, the signs and symptoms of their exposure, and recommended treatment. Children can be victims of terrorists' acts and need special attention because of their unique response to exposure, varying dosages of medications, and lack of active immunity.

Anthrax↗
PubMedDate not supplied

Bioterrorism and electron microscopic differentiation of poxviruses from herpesviruses: dos and don'ts.

With increased threat of terrorism, much attention is being directed toward readiness for biodefense. Smallpox virus, a deadly and much feared organism, is among possible bioterrorism agents. Herpesviruses, such as the one that causes chickenpox and shingles, produce skin lesions that may resemble those seen early in smallpox infection. Electron microscopy (EM) is a rapid and reliable method for differentiating poxviruses from herpesviruses. However, before becoming involved in the monitoring of potential smallpox cases, a laboratory must consider several issues, including expertise in virus identification, capacity for handling biohazards, and health and immune status of laboratory staff.

Bioterrorism↗
PubMedDate not supplied

Protecting the public's health in an era of bioterrorism: the Model State Emergency Health Powers Act.

During the fall of 2001, public health law scholars at the Center for Law and the Public's Health at Georgetown and Johns Hopkins Universities were asked by the Centers for Disease Control and Prevention (CDC) and a series of national partners to develop the Model State Emergency Health Powers Act (MSEHPA). The MSEHPA provides a series of modern powers for states to consider in responding to catastrophic public health emergencies, including bioterrorism events. Since December 2001, provisions based on the MSEHPA have been introduced in nearly 40 states and passed in 20. Underlying the development of the act is a long-standing debate between legal and ethical scholars and law- and policymakers as to the appropriate ways to balance individual and communal rights. The drafting challenge was to create a comprehensive model law that provides adequate powers to protect the public's health while also respecting individual and group rights. The MSEHPA empowers public health agents with broad authority and simultaneously limits the exercise of power in time, duration, and scope to accomplish communal goals of abating serious public health threats. Coercive public health powers, particularly isolation and quarantine, are exercised on a temporary basis, only so long as are reasonably necessary and only among persons who justifiably may pose a risk to others because of their contagious conditions. Individual rights to contest the coercive use of public health powers, even during an emergency, are secured.

Bioterrorism↗
PubMed2003

Public perceptions of information sources concerning bioterrorism before and after anthrax attacks: an analysis of national survey data.

This study examined data from six national surveys before and after the bioterrorist anthrax attacks in the fall of 2001. Public perceptions of information sources regarding bioterrorism were examined. The findings highlighted the importance of local television and radio and of cable and network news channels as information sources. The findings also showed the importance of national and local health officials as spokespersons in the event of bioterrorist incidents. Periodic surveys of public attitudes provide important, timely information for understanding audiences in communication planning.

Anthrax↗
PubMed2000

Implications of pandemic influenza for bioterrorism response.

The 1918-1919 influenza pandemic (Spanish flu) had catastrophic effects upon urban populations in the United States. Large numbers of frightened, critically ill people overwhelmed health care providers. Mortuaries and cemeteries were severely strained by rapid accumulation of corpses of flu victims. Understanding of the outbreak's extent and effectiveness of containment measures was obscured by the swiftness of the disease and an inadequate health reporting system. Epidemic controls such as closing public gathering places elicited both community support and resistance, and fear of contagion incited social and ethnic tensions. Review of this infamous outbreak is intended to advance discussions among health professionals and policymakers about an effective medical and public health response to bioterrorism, an infectious disease crisis of increasing likelihood. Elements of an adequate response include building capacity to care for mass casualties, providing emergency burials that respect social mores, properly characterizing the outbreak, earning public confidence in epidemic containment measures, protecting against social discrimination, and fairly allocating health resources.

Bioterrorism↗
PubMed2003

Bioterrorism web site resources for infectious disease clinicians and epidemiologists.

Finding bioterrorism-related information on the World Wide Web can be laborious. We hope to help readers find such information more easily by summarizing essential information in a consistent framework. A panel of 7 Centers for Disease Control and Prevention reviewers identified Web sites and evaluated them for sponsorship, mission, content usefulness, online ease of use, and adherence to commonly accepted quality criteria. Of >100 potential sites identified, 81 were chosen for target content of interest, and 43 were selected for inclusion. The results were classified into general purpose/portal sites; biological agent information; laboratory, infection control, epidemiology, and mental health information; and emergency contact sources, news and updates, event preparedness resources, information for first-responder settings, clinical and public education materials, and research resources. Agents covered included anthrax, smallpox, plague, botulism, tularemia, and viral hemorrhagic fever.

Anthrax↗
PubMed2003

Inhalational anthrax due to bioterrorism: would current Centers for Disease Control and Prevention guidelines have identified the 11 patients with inhalational anthrax from October through November 2001?

A panel of 10 physicians used the nominal group technique to assess the ability of the Centers for Disease Control and Prevention (CDC) interim guidelines for clinical evaluation of persons with possible inhalational anthrax (IA) to retrospectively identify the 11 patients with IA seen during the October 2001 bioterrorism outbreak. The guidelines would not have identified 10 of 11 of these patients, primarily because the guidelines were designed to address only those patients with a known history of exposure or clearly identified environmental or occupational risk. The panel suggested revisions to the guidelines, primarily consisting of broadening the criteria for evaluation to include either known exposure or environmental occupational risk, or to include clinical symptoms consistent with IA. These extensions of the guidelines retrospectively identified 8 of 11 of the patients with IA from October 2001.

Anthrax↗
PubMed2003

Serious adverse events among participants in the Centers for Disease Control and Prevention's Anthrax Vaccine and Antimicrobial Availability Program for persons at risk for bioterrorism-related inhalational anthrax.

On 20 December 2001, the Centers for Disease Control and Prevention (CDC) initiated the Anthrax Vaccine and Antibiotic Availability Program (hereafter, the "Program") under an investigational new drug application with the US Food and Drug Administration. This Program provided options for additional preventive treatment for persons at risk for inhalation anthrax as a result of recent bioterrorism attacks who had concluded or were concluding a 60-day course of antimicrobial prophylaxis. Participants were offered an additional 40 days of antibiotic therapy (with ciprofloxacin, doxycycline, or amoxicillin) or antibiotic therapy plus 3 doses of anthrax vaccine. By 11 February 2002, a total of 5420 persons had received standardized education about the Program and 1727 persons (32%) had enrolled. Twelve participants have been identified as having serious adverse events (SAEs). One SAE, which occurred in a participant with ciprofloxacin-induced allergic interstitial nephritis, was considered to be probably associated with treatment received in the Program. No SAEs were associated with anthrax vaccine. CDC will continue to monitor Program participants during the next 2 years.

Adverse Drug Reaction Reporting Systems↗
PubMed2004

Immune responses to Bacillus anthracis protective antigen in patients with bioterrorism-related cutaneous or inhalation anthrax.

Anti-protective antigen (PA) immunoglobulin (Ig) G, toxin neutralization, and PA-specific IgG memory B cell responses were studied in patients with bioterrorism-related cutaneous or inhalation anthrax and in a patient with laboratory-acquired cutaneous anthrax. Responses were determined for >1 year after the onset of symptoms. Eleven days after the onset of symptoms (15 days after likely exposure), anti-PA IgG was detected in 16 of 17 patients with confirmed or suspected clinical anthrax who were tested. Anti-PA IgG remained detectable 8-16 months after the onset of symptoms in all 6 survivors of inhalation anthrax and in 7 of 11 survivors of cutaneous anthrax who were tested. Anti-PA IgG levels and serum toxin neutralizing activity were strongly associated (R2=0.83). PA-specific IgG memory B cells were detectable in all 6 survivors of inhalation anthrax but in only 2 of 7 patients with cutaneous anthrax who were tested. Anti-PA IgG is an important diagnostic marker of anthrax, a predictor of serum anti-toxin activity, and a marker of immunological memory against anthrax.

Anthrax↗
PubMed2006

Use of sentinel laboratories by clinicians to evaluate potential bioterrorism and emerging infections.

With the persistent threat of emerging infectious diseases and bioterrorism, it has become increasingly important that clinicians be able to identify the diseases that might signal the occurrence of these unusual events. Essential to a thoughtful diagnostic approach is understanding when to initiate a public health investigation and how to appropriately use commonly performed microbiology procedures in the sentinel laboratory to evaluate potential pathogens. Although diagnostic test development is evolving rapidly, recognizing many of these pathogens continues to challenge the capabilities of most sentinel laboratories. Therefore, effective, ongoing communication and education among clinicians, infection control personnel, sentinel laboratorians, public health authorities, and Laboratory Response Network reference laboratorians is the key to preparedness.

Algorithms↗
PubMed2006

The US capitol bioterrorism anthrax exposures: clinical epidemiological and immunological characteristics.

BACKGROUND: Bioterrorism-related anthrax exposures occurred at the US Capitol in 2001. Exposed individuals received antibiotics and anthrax vaccine adsorbed immunization. METHODS: A prospective longitudinal study of 124 subjects--stratified on the basis of spore exposure, nasopharyngeal culture results, and immunization status from inside and outside an epidemiologically defined exposure zone--was performed to describe clinical outcome and immune responses after Bacillus anthracis exposure. Antibody and cell-mediated immune (CMI) responses to protective antigen (PA) and lethal factor were assayed by enzyme-linked immunosorbent assay and fluorescence-activated cell sorting. RESULTS: Antibody and CMI dose-exposure responses, albeit generally of low magnitude, were seen for unimmunized subjects from inside, within the perimeter, and outside the exposure zone and in nonexposed control subjects. Anti-PA antibody and CMI responses were detected in 94% and 86% of immunized subjects. No associations were seen between symptoms and exposure levels or immune responses. CONCLUSIONS: Anthrax spores primed cellular and possibly antibody immune responses in a dose-dependent manner and may have enhanced vaccine boost and recall responses. Immune responses were detected inside the perimeter and outside the exposure zone, which implies more-extensive spore exposure than was predicted. Despite postexposure prophylaxis with antibiotics, inhalation of B. anthracis spores resulted in stimulation of the immune system and possibly subclinical infection, and the greater the exposure, the more complete the immune response. The significance of low-level exposure should not be underestimated.

Anthrax↗
PubMed2004

School nurses as volunteers in a bioterrorism event.

Most public health departments do not have enough public health nurses to adequately respond to a bioterrorist attack or other large-scale health emergency and would need to look to volunteers to help with staffing needs in an emergency. The National Association of School Nurses supports the use of school nurses, a skilled workforce, as responders in a mass casualty event, whether it is naturally occurring or as a result of bioterrorism. This article explores the use of school nurses to supplement public health staff during an emergency. A Likert-scale survey was used to assess the preparedness and willingness of school nurses to respond to a health threat. Although school nurses are willing to respond, the findings highlight the importance of continued education on risk and personal protection.

Attitude of Health Personnel↗
PubMed2006

Bioterrorism with zoonotic disease: public health preparedness lessons from a multiagency exercise.

Responding to agricultural bioterrorism with pathogenic agents that are communicable from animals to humans (zoonotic diseases) requires effective coordination of many organizations, both inside and outside of government. Action must be simultaneously taken to address public health concerns, respond to the agricultural dimensions of the event, and carry out the necessary law enforcement investigation. As part of a project focused on examining public health preparedness in Georgia, an exercise was carried out in July 2005 examining the intentional introduction of avian influenza (H5N1) in commercial poultry operations. The attack scenario, which was written to occur during an already severe human influenza season, enabled exploration of a range of issues associated with public health preparedness for major disease outbreaks including pandemic influenza, coordination of a multiagency response operation at multiple levels of government, and effective management of interdisciplinary response activities. The exercise is described and broader policy lessons regarding preparedness planning are discussed.

Animals↗