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Bioterrorism: a threat for which we are ill prepared.

Of the weapons of mass destruction, the biological ones are the most feared and bioterrorism has become one of the most vicious threats to civilized society in recent times. Biological weapons have been sporadically used for centuries. Despite international regulations, there has been a global re-emergence of the threat of biological warfare. As many as 17 countries are suspected of either including or developing biological agents in their weapons programmes. In the past decade, a number of terrorist organizations with access to bioweapons technology have emerged. Current surveillance systems may be inadequate to detect biological attacks. The onset of illness is often delayed, thus the timing and location of such an event may be extremely difficult to identify. We are unfamiliar with most of the agents of biological warfare and are ill-equipped to handle the consequences of such an attack. In addition, there is no apparent coherent policy to handle a biological terrorist incident. Given the enormity of what is possible in the event of a biological attack, we must be prepared to detect, diagnose, epidemiologically characterize and respond appropriately to biological weapons. Of the potential biological weapons, smallpox and anthrax pose the greatest threats.

Biological Warfare↗

Update: Investigation of bioterrorism-related anthrax and interim guidelines for exposure management and antimicrobial therapy, October 2001.

Since October 3, 2001, CDC and state and local public health authorities have been investigating cases of bioterrorism-related anthrax. This report updates previous findings, provides new information on case investigations in two additional areas, presents the susceptibility patterns of Bacillus anthracis isolates, and provides interim recommendations for managing potential threats and exposures and for treating anthrax.

Adult↗

Modeling the consequences of bioterrorism response.

Military medicine is playing important roles in preparing for the possibility of a covert biological attack on the United States. The objective of this work was to develop a spreadsheet tool that allows planners to compare the consequences of different speeds of response to a covert bioterrorist attack using the metric of preventable deaths. Our model simulates the number of patients to be treated and the number of deaths by day. It allows planners to vary their assumptions, such as the biological agent used, treatment efficacy, and speed of providing initial treatment. Responding to an attack on a city would involve many steps, such as determining the agent used, determining the time and location of the attack and the affected population, obtaining and delivering antibiotics, and providing treatment. Our model is a useful tool for planning the necessary size and timing of bioterrorism response.

Bioterrorism↗

[Bioterrorism].

Some countries explore biological agents (toxins, bacteria and viruses) as a potential threat that can be used as a weapon of mass destruction. The list of a biological and chemical weapons is still expanding. Despite military aspect of the issue, medical and civil staff must be aware that also an act of bioterrorism could happen. We must not be afraid, but we must be prepared.

Awareness↗

Are you ready for anthrax, or worse? You must revamp your bioterrorism plan.

A study has shown that EDs are unprepared to handle mass casualties of bioterrorism, and plans must be revamped. Alternate care and triage areas must be selected in advance and may include parking lots and hallways between buildings. Care for contaminated patients in areas that can be abandoned, so regular patient care areas are not disrupted. Have a system in place to decontaminate patients before they enter the ED.

Anthrax↗

Wake-up call: a bioterrorism exercise.

Operation Wake-Up Call was a simulated bioterrorism exercise conducted in Waukesha County, Wisconsin (Metropolitan Milwaukee) on November 6, 1999. The purpose of the exercise was to test and evaluate the emergency response capability of local municipal, county, state, federal, and reserve military agencies to a weapons of mass destruction terrorist act. The exercise simulated a biological agent (Bacillus anthracis spores) release, a hostage-taking event, and the management of multiple biological and conventional weapons casualties that overwhelmed local first responders' capability. The exercise involved local, county, state, and federal agencies in a joint operational environment featuring integrated command and control systems. This report describes the primary purpose, goals, and assumptions of the exercise and reports on the evaluation of Wake-Up Call by the participating agencies.

Bioterrorism↗

Don't miss smallpox/plague outbreaks: adapt strategies to track bioterrorism.

Your strategy for tracking bioterrorism should focus on early recognition of unusual disease patterns, prompt notification of public health agencies, and informing staff about additional precautions to take if an outbreak is suspected. Instead of general awareness training, have a local expert address symptoms of a specific agent, such as smallpox. Post information about tracking patterns of illness in all clinical areas. Ensure that after-hours cases aren't overlooked by having staff report suspicions by computer or telephone.

Bioterrorism↗

Our first line of defense against bioterrorism. Part 1.

Health care's response to the anthrax outbreak highlights our critical need to enlist sophisticated information technology (IT) tools in the defense against bioterrorism. Part 1 of a two-part series explains what went wrong in the most recent attack and suggests how a national IT infrastructure might help in the future.

Anthrax↗

Our first line of defense against bioterrorism part 2.

In March, Part 1 of this two-part series examined the challenges with identifying bioterrorism-specifically the anthrax outbreak. Part 2 explains what's being done to equip America's health care providers to recognize and respond to future attacks, while protecting the public.

Anthrax↗

Bioterrorism today.

Anthrax being sent through the postal service brought the risks of bioterrorism home to us all: but what dies it really mean?

Anthrax↗

Surveillance for early detection and monitoring of infectious disease outbreaks associated with bioterrorism.

The appearance of "new" infectious diseases, the reemergence of "old" infectious diseases, and the deliberate introduction of infectious diseases through bioterrorism has highlighted the need for improved and innovative infectious disease surveillance systems. Traditional current surveillance systems are generally based on the recognition of a clear increase in diagnosed cases before an outbreak can be identified. For early detection of bioterrorist-initiated outbreaks, the sensitivity and timeliness of the systems need to be improved. Systems based on syndromic surveillance are being developed using technologies such as electronic reporting and the internet. The reporting sources include community physicians, public health laboratories, emergency departments, intensive care units, district health offices, and hospital admission and discharge systems. The acid test of any system will be the ability to provide analyses and interpretations of the data that will serve the goals of the system. Such analytical methods are still in the early stages of development.

Bioterrorism↗

[Problem of bioterrorism under modern conditions].

It is practically impossible to discuss the problem of bioterrorism (BT) and to develop effective programs of decreasing the losses and expenses suffered by the society from the BT acts without evaluation of the threat and prognosis of consequences based on research and empiric data. Stained international situation following the act of terrorism (attack on the USA) on September 11, 2001, makes the scenarios of the bacterial weapon use (the causative agents of plague, smallpox, anthrax, etc.) by international terrorists most probable. In this connection studies on the analysis and prognostication of the consequences of BT, including mathematical and computer modelling, are necessary. The authors present the results of initiative studies on the analysis and prognostication of the consequences of the hypothetical act of BT with the use of the smallpox causative agent in a city with the population of about 1,000,000 inhabitants. The analytical prognostic studies on the operative analysis and prognostication of the consequences of the BT act with the use of the smallpox causative agent has demonstrated that the mathematical (computer) model of the epidemic outbreak of smallpox is an effective instrument of calculation studies. Prognostic evaluations of the consequences of the act of BT under the conditions of different reaction of public health services (time of detection, interventions) have been obtained with the use of modelling. In addition, the computer model is necessary for training health specialists to react adequately to the acts of BT with the use of different kinds of bacteriological weapons.

Bioterrorism↗

Bioterrorism--a review.

With the turn of the new millennium, a new kind of warfare has evolved--bioterrorism. After the September 11, 2001 attacks on the World Trade Center, every country in the world is now living under the shadow of an unknown yet deadly enemy--biological weapons. Every individual has suddenly become very vulnerable to this new weapon, which can strike anybody at any time without any warning. It is, therefore, important that we take a close look at this new weapon, so that we can take appropriate measures to shield ourselves from this deadly enemy.

Bacillus anthracis↗

Syndromic surveillance for bioterrorism following the attacks on the World Trade Center--New York City, 2001.

Immediately after the September 11, 2001, terrorist attacks on the World Trade Center (WTC), the New York City Department of Health and Mental Hygiene (NYCDOHMH) was concerned about the possibility of a secondary attack with a biologic agent. Because NYCDOHMH lost communications as a result of the attacks, concern arose that this disruption would affect the ability to recognize a bioterrorist event. To address this concern, NYCDOHMH quickly implemented a syndromic surveillance system in hospital emergency departments (EDs) to identify a large-scale bioterrorist event and other health conditions related to the WTC attacks. This report describes the operational and maintenance aspects of conducting syndromic surveillance for bioterrorism (BT) and demonstrates the limitations of drop-in systems that rely on manual data collection. Health departments that are establishing early warning systems for BT should consider seeking routinely collected electronic data.

Bioterrorism↗

The critical role of hospitals involved in national bioterrorism preparedness.

This article is excerpted from a speech by Homeland Security Director Ridge on April 8, 2002 at the annual meeting of the American Hospital Association. In it he spells out what is expected from hospitals in preparing for the next terror attack, with the emphasis on bioterrorism and what assistance is being and will be provided.

American Hospital Association↗