Respiratory medical societies and the threat of bioterrorism.
Respiratory medical societies throughout the world have an important role in helping governments to develop public policy to counter the threat of bioterrorism.
Biological Warfare↗
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Inhalational anthrax after bioterrorism exposure: spectrum of imaging findings in two surviving patients.
The radiographic and computed tomographic (CT) findings in two patients with documented inhalational anthrax resulting from bioterrorism exposure are presented. Chest radiographs demonstrated mediastinal widening, adenopathy, pleural effusions, and air-space disease. Chest CT images revealed enlarged hyperattenuating mediastinal and hilar lymph nodes and edema of mediastinal fat. Chest CT findings are helpful for making the initial diagnosis. To the authors' knowledge, the spectrum and follow-up of CT findings have not been previously described.
Anthrax↗
Bioterrorism, public health, and human rights.
It is unnecessary and counterproductive to sacrifice basic human rights to respond to bioterrorism. Constructive public health legislation, which must be federal, cannot be carefully drafted under panic conditions. When it is, like the "model act," it will predictably rely on broad, arbitrary state authority exercised without public accountability. Public health should resist reverting to its nineteenth-century practices of forced examination and quarantine, which will simply encourage people to avoid physicians, hospitals, and public health practitioners they now trust and actively seek out in emergencies. Upholding human rights is essential to public trust and is ultimately our best defense against the threat of terrorism in the twenty-first century.
Bioterrorism↗
Bioterrorism, public health, and the law.
The controversy over the Model State Emergency Health Powers Act has underscored the enduring tension in public health between guarding the common welfare and respecting individual liberty. The current version of the act, crafted in response to extensive public commentary, attempts to strike a balance between these values but has failed to allay the concerns of many civil libertarians and privacy advocates. Although the debates over the model act have been triggered by the threat of bioterrorism, they illustrate broader philosophical differences, with profound implications for all realms of public health policy.
Bioterrorism↗
Leveraging the nation's anti-bioterrorism investments: foundation efforts to ensure a revitalized public health system.
The emerging potential threats of bioterrorism combined with critical existing epidemics facing the United States call for immediate and urgent attention to the U.S. public health system. The foundation world is helping to answer that call and is sounding the alarm that our health defenses must be able to do "double duty" to protect us from the full spectrum of modern health threats. This Special Report presents a selective sample of recent and ongoing grant activities designed to revitalize and modernize the public health infrastructure, which is vital to protecting the nation's health and ensuring its safety.
Bioterrorism↗
Bioterrorism and catastrophe response: a quick-reference guide to resources.
BACKGROUND: Dentists' responses to catastrophe have been redefined by bioterrorism. Informed response requires accurate information about agents and diseases that have the potential to be used as weapons. METHODS: The authors reviewed information about the most probable bioterrorist weapons (those from the Center for Disease Control and Prevention's Category A) from the World Wide Web and print journals and distilled it into a resource list that is current, relevant to dentistry and noncommercial. The Web sites cited include those sponsored by federal agencies, academic institutions and professional organizations. The articles cited include those published in English within the last six years in refereed journals that are available in most higher education institutions. RESULTS: The authors present the information in a table that provides a quick-reference guide to resources describing agents and diseases with the greatest potential for use as weapons: anthrax, botulism, plague, smallpox, tularemia and viral hemorrhagic fevers. This article presents Web site and journal citations for background and patient-oriented information (fact sheets), signs and symptoms, and prophylactic measures and treatment for each of the agents and diseases. The table facilitates quick access to this information, especially in an emergency. This article also points out guidelines for response should a suspected attack occur. CONCLUSIONS: Armed with information about biological weapons, dentists can provide faster diagnosis, inform their patients about risks, prophylaxis or treatment and rethink their own role in terrorism response. CLINICAL IMPLICATIONS: Fast, accurate diagnosis limits the spread of exceptionally contagious diseases. Providing accurate information to patients minimizes misinformation and the associated public fear and panic that, unchecked, could overwhelm health care systems.
Anthrax↗
[Smallpox, vaccine prevention and the bioterrorism threat].
With the international threat of bioterrorism, smallpox is again a matter of intense debate. The authors review this disease and raise considerations on the exploitation of the etiologic agent as a biological weapon. Also bring to discussion the available efforts to produce and develop vaccines against the disease.
Biological Warfare↗
Innovative surveillance methods for rapid detection of disease outbreaks and bioterrorism: results of an interagency workshop on health indicator surveillance.
A system designed to rapidly identify an infectious disease outbreak or bioterrorism attack and provide important demographic and geographic information is lacking in most health departments nationwide. The Department of Defense Global Emerging Infections System sponsored a meeting and workshop in May 2000 in which participants discussed prototype systems and developed recommendations for new surveillance systems. The authors provide a summary of the group's findings, including expectations and recommendations for new surveillance systems. The consensus of the group was that a nationally led effort in developing health indicator surveillance methods is needed to promote effective, innovative systems.
Bioterrorism↗
Ethical challenges in preparing for bioterrorism: barriers within the health care system.
Preparedness for bioterrorism poses significant ethical challenges. Although public health ethics and preparedness have received attention recently, health care ethics must also be considered. In epidemics, the health care system assists public health in 3 tasks: detection, containment, and treatment. Detection might fail if all patients do not have access to care, or if physicians do not understand their obligation to report infectious diseases to public health authorities. Containment might fail if physicians view themselves only as advocates for individual patients, ignoring their social obligations as health professionals. Treatment might fail if physicians do not accept their professional duty to treat patients during epidemics. Each of these potential ethical barriers to preparedness must be addressed by physicians and society.
Bioterrorism↗
Bioterrorism preparedness and response in European public health institutes.
The terrorist attacks on 11 September 2001 and the deliberate release of anthrax in the United States had consequences for public health not only there, but also in Europe. Europe's public health systems had to manage numerous postal materials possibly contaminated with anthrax. Our survey aimed to document the response of European public health institutes to recent bioterrorist events to identify the gaps that need to be addressed; 18 institutes from 16 countries participated in this Euroroundup. Bioterrorist threats in Europe were hoaxes only, and should be considered as a "preparedness exercise" from which three lessons can be drawn. Firstly, because of inadequate preparedness planning and funding arrangements, Europe was not ready in October 2001 to respond to bioterrorism. Secondly, although European institutes reacted quickly and adapted their priorities to a new type of threat, they need adequate and sustained support from national governments to maintain their overall capacity. Thirdly, the recent crisis demonstrated the need for increased investment in epidemiology training programmes and the establishment of a technical coordination unit for international surveillance and outbreak response in the European Union.
Bioterrorism↗
First case of bioterrorism-related inhalational anthrax in the United States, Palm Beach County, Florida, 2001.
On October 4, 2001, we confirmed the first bioterrorism-related anthrax case identified in the United States in a resident of Palm Beach County, Florida. Epidemiologic investigation indicated that exposure occurred at the workplace through intentionally contaminated mail. One additional case of inhalational anthrax was identified from the index patient's workplace. Among 1,076 nasal cultures performed to assess exposure, Bacillus anthracis was isolated from a co-worker later confirmed as being infected, as well as from an asymptomatic mail-handler in the same workplace. Environmental cultures for B. anthracis showed contamination at the workplace and six county postal facilities. Environmental and nasal swab cultures were useful epidemiologic tools that helped direct the investigation towards the infection source and transmission vehicle. We identified 1,114 persons at risk and offered antimicrobial prophylaxis.
Anthrax↗
First case of bioterrorism-related inhalational anthrax, Florida, 2001: North Carolina investigation.
The index case of inhalational anthrax in October 2001 was in a man who lived and worked in Florida. However, during the 3 days before illness onset, the patient had traveled through North Carolina, raising the possibility that exposure to Bacillus anthracis spores could have occurred there. The rapid response in North Carolina included surveillance among hospital intensive-care units, microbiology laboratories, medical examiners, and veterinarians, and site investigations at locations visited by the index patient to identify the naturally occurring or bioterrorism-related source of his exposure.
Anthrax↗
Molecular subtyping of Bacillus anthracis and the 2001 bioterrorism-associated anthrax outbreak, United States.
Molecular subtyping of Bacillus anthracis played an important role in differentiating and identifying strains during the 2001 bioterrorism-associated outbreak. Because B. anthracis has a low level of genetic variability, only a few subtyping methods, with varying reliability, exist. We initially used multiple-locus variable-number tandem repeat analysis (MLVA) to subtype 135 B. anthracis isolates associated with the outbreak. All isolates were determined to be of genotype 62, the same as the Ames strain used in laboratories. We sequenced the protective antigen gene (pagA) from 42 representative outbreak isolates and determined they all had a pagA sequence indistinguishable from the Ames strain (PA genotype I). MLVA and pagA sequencing were also used on DNA from clinical specimens, making subtyping B. anthracis possible without an isolate. Use of high-resolution molecular subtyping determined that all outbreak isolates were indistinguishable by the methods used and probably originated from a single source. In addition, subtyping rapidly identified laboratory contaminants and nonoutbreak-related isolates.
Anthrax↗
Fear of bioterrorism and implications for public health preparedness.
After the human anthrax cases and exposures in 2001, the Illinois Department of Public Health received an increasing number of environmental and human samples (1,496 environmental submissions, all negative for Bacillus anthracis). These data demonstrate increased volume of submissions to a public health laboratory resulting from fear of bioterrorism.
Anthrax↗
Isolated case of bioterrorism-related inhalational anthrax, New York City, 2001.
On October 31, 2001, in New York City, a 61-year-old female hospital employee who had acquired inhalational anthrax died after a 6-day illness. To determine sources of exposure and identify additional persons at risk, the New York City Department of Health, Centers for Disease Control and Prevention, and law enforcement authorities conducted an extensive investigation, which included interviewing contacts, examining personal effects, summarizing patient's use of mass transit, conducting active case finding and surveillance near her residence and at her workplace, and collecting samples from co-workers and the environment. We cultured all specimens for Bacillus anthracis. We found no additional cases of cutaneous or inhalational anthrax. The route of exposure remains unknown. All environmental samples were negative for B. anthracis. This first case of inhalational anthrax during the 2001 outbreak with no apparent direct link to contaminated mail emphasizes the need for close coordination between public health and law enforcement agencies during bioterrorism-related investigations.
Anthrax↗
Automated laboratory reporting of infectious diseases in a climate of bioterrorism.
While newly available electronic transmission methods can increase timeliness and completeness of infectious disease reports, limitations of this technology may unintentionally compromise detection of, and response to, bioterrorism and other outbreaks. We reviewed implementation experiences for five electronic laboratory systems and identified problems with data transmission, sensitivity, specificity, and user interpretation. The results suggest a need for backup transmission methods, validation, standards, preserving human judgment in the process, and provider and end-user involvement. As illustrated, challenges encountered in deployment of existing electronic laboratory reporting systems could guide further refinement and advances in infectious disease surveillance.
Bioterrorism↗
Estimating time and size of bioterror attack.
In the event of a bioterror attack, rapidly estimating the size and time of attack enables short-run forecasts of the number of persons who will be symptomatic and require medical care. We present a Bayesian approach to this problem for use in real time and illustrate it with data from a simulated anthrax attack. The method is simple enough to be implemented in a spreadsheet.
Anthrax↗
Development of a risk-priority score for category A bioterrorism agents as an aid for public health policy.
In developing public health policy and planning for a bioterrorist attack or vaccination of military personnel, the most common method for assigning priority is using the probability of attack with a particular agent as the single criterion. Using this approach, smallpox is often dismissed as an unlikely threat. We aimed to develop an evidence-based, systematic, multifactorial method for prioritizing the level of risk of each category A bioterrorism agent. Using 10 criterion, anthrax scored the highest, followed by smallpox. Tularemia was the lowest scoring agent. We suggest that such a system would be useful for developing public policy, stockpiling of vaccines and therapeutics, vaccination of military personnel, and planning for public health responses to a bioterrorist attack.
Anthrax↗