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PubMed2005

Administrative issues related to infectious disease research in the age of bioterrorism.

The recent unprecedented growth in infectious disease research funding and infrastructure has resulted in part from an outgrowth of concern about newly emerging and re-emerging diseases and the progressive development of antibiotic-resistant pathogens. However, the most compelling impetus is the suspected and demonstrated capability and will of unknown individuals, groups, or states to use biological agents and/or toxins as weapons. Although the actual number of known victims and fatalities from bioterrorism in the United States has been miniscule compared with many other daily hazards, biological agents have the potential to cause human mass casualties, severely damage segments of our economy or agricultural infrastructure, poison or compromise our food or water supply, and, perhaps most damaging, disrupt our society physically and psychologically. The significant institutional commitment necessary to participate in infectious disease research is described, with a focus on programs that involve research with pathogens thought to have potential for use by bioterrorists. Administrative considerations are described, and include obtaining necessary research funding to offset high operating costs; complying with "select agent" regulations, security screening of employees; building or renovating a biocontainment facility; finding skilled professional and technical manpower; providing adequate physical security in a threat environment; conducting targeted training; overcoming potential internal and external dissent; developing and/or providing sufficient occupational health and safety programs; achieving and maintaining compliance standards in a fluid regulatory environment; mitigating potentially hazardous working conditions; understanding personal and institutional liability; and reassuring and dealing with a concerned, skeptical, or even hostile public.

Animals↗
PubMed2001

Emerging illness and bioterrorism: implications for public health.

Biological weapons have the potential to inflict deliberate, potentially devastating epidemics of infectious disease on populations. The science and technology exist to create deliberate outbreaks of human disease, as well as disease among plants and animals, crops, and livestock. A new awareness among policymakers of the link between public health and national security requires the attention of public health professionals. The issues posed by biological weapons are likely to challenge the political assumptions of many progressive public health professionals and will demand new coalitions. The prospect of bioterrorism may offer new opportunities for improving the public health infrastructure and its capabilities.

Bioterrorism↗
PubMed2002

Viral agents as biological weapons and agents of bioterrorism.

Multiple viral agents have been classified by the CDC as potential weapons of mass destruction or agents for biologic terrorism. Agents such as smallpox, viral hemorrhagic fever viruses, agents of viral encephalitis, and others are of concern because they are highly infectious and relatively easy to produce. Although dispersion might be difficult, the risk is magnified by the fact that large populations are susceptible to these agents and only limited treatment and vaccination strategies exist. Although the risk of large-scale bioterrorism using viral agents is small, public health programs and health care providers must be prepared for this potentially devastating impact on public health.

Arenaviridae Infections↗
PubMed2005

A short medical school course on responding to bioterrorism and other disasters.

The events of 9/11 highlighted the limitations of the United States health care system in responding to large-scale public health emergencies. The key for an effective response to any mass casualty event is preparedness; thus, the education of medical students has become a priority. The Association of American Medical Colleges (AAMC) recommended that the nation's medical schools should thoroughly educate students about the public health and emergency services systems to ensure coordinated responses to weapons of mass destruction or other public health threats. In response, The Texas A&M University System Health Science Center College of Medicine, partnering with the Defense Institute for Medical Operations (DIMO), developed a one-week block of required (but not graded) instruction, the "Leadership Course in Disaster Response," first given in 2003-04 to 72 second-year students and taught by six military experts from DIMO. The course goal is to (1) educate students on resources available for regional disaster response; (2) define principles of resource management in disaster response; (3) identify specific agents associated with bioterrorism; and (4) understand the psychosocial aspects of disasters. The course was well received, and the 2004-05 session was improved, based on student and faculty feedback. The authors describe the details of the course (specifically, how the course was tailored to fit the AAMC guidelines), changes in students' knowledge and attitudes, and how the course was improved.

Adult↗
PubMed2003

Inhalational anthrax and bioterrorism.

Until recently, inhalational anthrax was considered an infectious disease curiosity for medical specialists and veterinarians. This attitude abruptly changed following the intentional release of Bacillus anthracis spores via the US Postal Service in October 2001. Because of its rarity, few physicians were familiar with its clinical manifestations, treatment and prophylaxis. In this report, we try to fill this informational gap by reviewing these issues based on additional data culled from this recent bioterrorism-related epidemic. Moreover, we have purposely emphasized its clinical manifestations, searching for common findings that may alert the physician to suspect and rapidly diagnose this infection. To improve survival rates, prompt diagnosis of inhalational anthrax is crucial, since even a brief delay in therapy of this fulminating infection almost uniformly results in death.

Anthrax↗
PubMed2005

Assessing bioterrorism and disaster preparedness training needs for school nurses.

Meeting the complex needs of a school system and all its members in the event of a bioterrorism (BT) disaster demands a competent workforce. School nurses are in position to be key contributors to planning for and responding to potential BT and disaster events. As part of a state preparedness leadership institute, the BT and disaster preparedness needs of school nurses in a three-county area were assessed and the nurses' preferred method to meet those needs was determined. Using competencies derived from publications by the Centers for Disease Control and Prevention and National Association of School Nurses, a survey was created and mailed to school nurses (N = 125) in public and private k-12 schools. Eighty surveys were returned (64% response rate). Responses were analyzed according to BT and emergency preparedness competencies and skills required for the phases of emergency management: mitigation, preparedness, response, and recovery. Low confidence in preparedness capabilities across almost all categories was reported. High training need was identified across almost all competencies, with 63 percent to 70 percent requesting additional education related to emergency response, infectious disease, hazardous materials, and diagnostic criteria. Although two-thirds report having Internet access in their school office, traditional classroom instruction was overwhelmingly preferred (74%) for training.

Attitude of Health Personnel↗
PubMed2005

Development of an on-line bioterrorism preparedness course.

To reach a large audience of public health workers and others interested in learning more about bioterrorism and emergency preparedness, an on-line, Web-based, certificated course entitled "Terrorism, Preparedness and Public Health: An Introduction" was planned, developed, and implemented. Interactivity and other user-friendly devices helped it gain acceptance. To date (May 2005), more than 6,000 people from all 50 states and some foreign countries have registered for the course, and about 2,400 have passed an exam for a certificate of completion. We believe the success of this course is related to the strength and accuracy of the content and its historical perspective; to the quality of the technical development, including multiple levels of interactivity, ease of use, and a printed completion certificate; and to the use of real case studies and the lack of dramatic overstatement.

Attitude of Health Personnel↗
PubMedDate not supplied

From bioterrorism exercise to real-life public health crisis: lessons for emergency hotline operations.

Although public health agencies routinely operate hotlines to communicate key messages to the public, they are rarely evaluated to improve hotline management. Since its creation in 2003, the New Jersey Department of Health & Senior Services' Emergency Communications Center has confronted two large-scale incidents that have tested its capabilities in this area. The influenza vaccine shortage of 2004 and the April 2005 TOPOFF 3 full-scale bioterrorism exercise provided both real-life and simulated crisis situations from which to derive general insights into the strengths and weaknesses of hotline administration. This article identifies problems in the areas of staff and message management by analyzing call volume data and the qualitative observations of group feedback sessions and semistructured interviews with hotline staff. It also makes recommendations based on lessons learned to improve future hotline operations in public health emergencies.

Bioterrorism↗
PubMed2002

Bioterrorism vs. health security--crafting a plan of preparedness.

Bioterrorism, once a subject of fantasy and speculation, has become all too real in a world turned upside down by the September 11, 2001. series of events. An essential, but as yet unanswered, question has become a crucial topic for discussion on the nightly news and in living rooms across the United States: How much of a terrorist threat do we face, and what must be done to control its potential for mass destruction? This article seeks to both answer this question and explore proper plans of preparedness for the eventuality of the unthinkable.

Anthrax↗
PubMed2004

Management guidelines for laboratory exposures to agents of bioterrorism.

Over the past several years, funding for biodefense research has increased dramatically, leading to the possibility of increased laboratory-acquired infections with potential bioterrorism agents. The Special Immunizations Program at United States Army Medical Research Institute of Infectious Diseases reviewed its policy and management of potential occupational exposures (1989-2002) to assess guidelines for determining the risk of exposure and disease and to determine criteria for initiating postexposure prophylaxis (PEP). Initiating antibiotic PEP was based primarily on exposure risk but was also influenced by vaccination status and agent virulence. PEP was given to nearly all moderate- and high-risk bacterial exposures, regardless of vaccination status, to most unvaccinated and subsets of vaccinated minimal-risk exposures, but generally not to negligible-risk exposures. Algorithms for evaluating and managing potential exposures are presented to provide guidance to other agencies as they begin to work with these agents.

Antibiotic Prophylaxis↗
PubMed2004

Experience in the medical management of potential laboratory exposures to agents of bioterrorism on the basis of risk assessment at the United States Army Medical Research Institute of Infectious Diseases (USAMRIID).

Experience in managing laboratory exposures to potential agents of bioterrorism is limited. The United States Army Medical Research Institute of Infectious Diseases reviewed laboratory exposures involving these agents (1989 to 2002) to assess the effectiveness of medical management. The evaluation of 234 persons (78% vaccinated) for exposure to 289 infectious agents revealed 5 confirmed infections (glanders, Q fever, vaccinia, chikungunya, and Venezuelan equine encephalitis). Postexposure antibiotic prophylaxis was given for most moderate- or high-risk bacterial exposures (41/46; 89%); most unvaccinated minimal-risk (7/10; 70%), and subsets of vaccinated minimal-risk exposures (18/53; 34%) but generally not negligible-risk exposures (6/38; 16%). Vaccine "breakthroughs" were not unexpected (enzootic Venezuelan equine encephalitis, localized vaccinia) or presented with mild symptoms (Q fever). A multifaceted policy of personal protective measures, vaccination, early assessment, and postexposure antibiotic prophylaxis was effective in minimizing morbidity and mortality in at-risk laboratory workers.

Alphavirus Infections↗
PubMed2005

Concerns of Capitol Hill staff workers after bioterrorism: focus group discussions of authorities' response.

Systematic studies of mental health effects of bioterrorism on exposed populations have not been carried out. Exploratory focus groups were conducted with an exposed population to provide qualitative data and inform empirical research. Five focus groups of 28 political worker volunteers were conducted 3 months after the October 15, 2001, anthrax attack on Capitol Hill. More than 2000 transcribed focus group passages were categorized using qualitative software. The category with the most items was authorities' response (23% passages), and much of this discussion pertained to communication by authorities. The category with the fewest items was symptoms (4%). Identified issues were less within individuals and more between them and authorities. Risk communication by authorities regarding safety and medical issues was a prominent concern among Capitol Hill office staff workers regarding the anthrax incident on Capitol Hill. This suggests focus on risk communication in developing interventions, but more systematic investigation is needed.

Anthrax↗
PubMed2006

PTSD and substance use: unrecognized sequelae of bioterrorism in primary care providers.

BACKGROUND: Psychological casualties following public health emergencies are likely to significantly outnumber physical casualties. However, postevent psychological disorders may be underrecognized by primary care providers (PCPs). METHODS: Rural PCPs in northern and central Florida were interviewed using a series of open-ended questions to assess knowledge of likely mental disorders, their risk factors, and preferred treatment options following such events (n=21). RESULTS: PTSD was identified by 14% and substance abuse by 10% of the sample. Physicians were significantly more likely to identify posttraumatic stress disorder (PTSD) as an expected postevent psychological disorder than nonphysician providers. PCPs were significantly more likely to endorse counseling (86%) than medications (43%) as a preferred treatment option. CONCLUSIONS: Our findings support the need for increased education and training regarding the mental health consequences of bioterrorism in rural PCPs, particularly for nursing-level and other nonphysician providers. Improvements in knowledge may enhance preparedness for such emergencies.

Adult↗
PubMed2003

Simulation modeling of anthrax spore dispersion in a bioterrorism incident.

Recent events have increased awareness of the risk posed by terrorist attacks. Bacillus anthracis has resurfaced in the 21st century as a deadly agent of bioterrorism because of its potential for causing massive civilian casualties. This analysis presents the results of a computer simulation of the dispersion of anthrax spores in a typical 50-story, high-rise building after an intentional release during a bioterrorist incident. The model simulates aerosol dispersion in the case of intensive, small-scale convection, which equalizes the concentration of anthrax spores over the building volume. The model can be used to predict the time interval required for spore dispersion throughout a building after a terrorist attack in a high-rise building. The analysis reveals that an aerosol release of even a relatively small volume of anthrax spores during a terrorist incident has the potential to quickly distribute concentrations that are infectious throughout the building.

Aerosols↗
PubMed2005

Nucleic acid test screening of blood donors for orthopoxviruses can potentially prevent dispersion of viral agents in case of bioterrorism.

BACKGROUND: Microbiologic agents such as variola virus (VAR) are very attractive for terrorism. As a result of international collaboration under the WHO eradication campaign, smallpox was declared eradicated in 1980. Therefore, the immunization programs were discontinued worldwide. Because most people are now immunologically naive, VAR is considered to be a potential threat agent or bioterrorist weapon. Real-time polymerase chain reaction (PCR) followed by melting analysis was developed for fast and safe analysis and allows differentiation of VAR from other orthopoxviruses (OPVs) like vaccinia or camelpox virus. STUDY DESIGN AND METHODS: A RealArt Orthopox LC PCR kit (Artus GmbH) was used to amplify OPV sequences from blood donor samples. A total of 31,500 blood donor samples were tested in minipools of up to 96 samples. To evaluate the sensitivity of the assay, routine donor minipools (90 +/- 6 samples per pool) were spiked with vaccinia virus used as positive control. RESULTS: Specificity was 100 percent because none of 31,500 blood donors was positive for the presence OPV. The detection limit of the assay was 10.6 copies per PCR procedure. Therefore, a sensitivity of 1590 copies per mL was calculated. Overall, 0.28 percent of test results had to be considered invalid owing to negative internal controls. CONCLUSION: The RealArt Orthopox LC PCR kit enables reliable detection of OPV DNA in viremic blood donor samples, even at the beginning of the disease when patients present minor clinical symptoms, and could be implemented in our routine screening procedure immediately. Thus, the assay could potentially help to prevent dispersion of viral agents by blood transfusion in case of bioterrorism.

Bioterrorism↗
PubMed2003

Public health. Building microbial forensics as a response to bioterrorism.

Combating bioterrorism is a challenge to all of us. To be proactive, the U.S. Government has formalized the discipline of "microbial forensics" to deter and attribute perpetrators of such acts. This Policy Forum describes the foundations of the microbial forensics program: the creation of a national bioforensics laboratory, a partnership laboratory network, and a peer-consensus scientific working group and the promulgation of quality assurance guidelines.

Advisory Committees↗
PubMed2004

Bioterrorism and smallpox planning: information and voluntary vaccination.

Although smallpox was declared eradicated in 1980, there are fears that stocks of the virus manufactured for military purposes by the Soviet Union may have fallen into the hands of "rogue nations" or terrorists. Worries about bioterrorism have thus sparked debate about whether or not the smallpox vaccine, which can be dangerous, should be offered to the general public. Meaningful public debate on this issue requires expert information about the likelihood that the virus will in fact be used as a weapon. Informed voluntary individual decision making, about whether to get vaccinated if vaccine is made available to the public, would similarly require appreciation of the likelihood of attack. Public deliberation and private deliberation thus both require briefing by the intelligence community.

Bioterrorism↗
PubMed2003

Bioterrorism: preparing for the unthinkable.

Terrorism is not a new concept but our need to prepare for the effects of bioterrorism has achieved a particular urgency. The use of biological agents provides a new set of challenges to professional caregivers, emergency personnel and Governments. These agents are generally not readily identified through the senses, have delayed effects and have the power to generate fear and panic. They are also intended to demonstrate that Governments and other organisations are not able to protect their citizens and members. What evidence there is suggests bioterrorist incidents have the potential to create higher levels of psychopathology than physical injury. Therefore, the authorities must identify and rehearse suitable methods of psychoprophylaxis and intervention.

Anthrax↗