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How real is the threat of bioterrorism? Experts may disagree on the likelihood of use, but the possibility cannot be totally dismissed. Complacent ignorance of a low-probability, high-cost risk is dangerous and can result in devastating global consequences. This is a US government work. There are no restrictions on its use.
It is important to understand that the issues surrounding bioterrorism and all weapons of mass destruction are complex. In an effort to enhance response to such events, EMS should handle all incidents from the perspective of an all-hazards approach. Prevention, preparation, response and recovery are essential to the safe mitigation of all incidents. Organizations must be prepared. Plan now for a safer tomorrow. Your personnel and communities depend on you.
Florida hospitals are benefiting in practical ways from a system originally designed to detect bioterrorism attacks. The system is proving useful in alerting emergency staff to naturally occurring infections early enough to take proactive action. The system is available to any interested ED. EDs can use the system to identify common maladies such as influenza in time to prepare for a community outbreak. Any ED in a large populated area may find the system useful.
Smallpox has been considered a disease of historical interest. However, given the 2001 terrorist events in the U.S. with intentional release of spores of Bacillus anthracis, and the current political worldwide agenda, the risk of bioterrorism has become a global public health concern. The risk of an intentional release of Variola virus as a biological weapon mandates a critical review of the historical impact of the disease in our country and the possible risk of its intentional reemergence. Smallpox was introduced into susceptible Indian populations in the Americas in the 16th century, contributing to the collapse of the Aztec Empire. Francisco Xavier Balmis start a vaccination campaign in the New World, and his efforts are considered the first eradication campaign of vaccine preventable diseases. Due to his efforts, smallpox was eliminated in Mexico in 1951. In the posteradication era, there is small but finite risk of intentional release of Variola virus. In response to this risk, Mexico has developed a comprehensive National preparedness plan. The impact of a new epidemic of smallpox will be considered a catastrophic event from both a historical and public health perspectives.
The events of 9/11 have raised awareness that certain scientific research in the public domain may aid terrorists in their quest to develop biological weapons, and there is a legitimate cause for concern in rare cases. Proposed executive branch responses are consistent in their approach to the problem: restrain the offending research by restricting public access to it in some form or another. This paper examines some of the history of the United States (U.S.) government's restrictions on scientific communication and the protection that the First Amendment affords scientists against such restrictions. It focuses in particular on biological science, which has in recent years come under increased scrutiny due to fears of "bioterrorism." It concludes that science needs to be vigilant against government encroachment, but also needs to become the first line of defense in preventing dissemination of potentially dangerous research data. Should the exercise of prior restraint against biological research become necessary, the guidelines developed at the 2002 Monterey workshop provide a useful framework for determining what biological research might cause "direct, immediate, and irreparable" harm to national security under the New York Times Co. v. United States precedent.
The September 11, 2001 terrorist attacks on the World Trade Center and continued conflict in Middle Eastern countries has provoked a strong interest in issues of national security. On December 13, 2002 the Bush Administration announced its smallpox vaccination policy, the first nationwide "proactive" measure to address the threat of bioterrorism. The Program has received mixed reactions as a result of partisan issues, tensions in public health policy and federal and state jurisdiction, conflicting scientific views, and different risk assessments. The slow pace of the program, the difficulties surrounding its implementation, and the debates regarding its validity serves as a "case study" to demonstrate current short-comings in federal and state anti-terrorist and public health policies. The focus will be on the states' public health laws and emergency preparedness plans through an analysis of the proposed Model State Emergency Preparedness Act. Updating current public health laws combined with increased funding of scientific research and the foresight to act "proactively" will reach far beyond improving national security. These efforts serve the dual purpose of deterring future terrorist attacks while greatly improving responses to a number of other health emergencies and disasters.
Following a bioterror event, hospitals may be overwhelmed by an influx of patients. An Agency for Healthcare Research and Quality tool includes 30 different attributes by which to compare and rank facilities. The tool was made available to representatives at Olympics venues in Athens, Greece.
Accordingly to HIRSA, 35,000 health professionals need to be trained in recognition and acute field treatment of victims of bioterrorism within year 2004 alone The Department of Defense anticipates even larger numbers. Training of very large number of healthcare workers is particularly daunting in the context of "just-in-time" education. The paper presents utilization of simulation-based distance training as a particularly useful tool in rapid development of readiness in a large population of widely distributed medical and lay personnel facing imminent threat of a chem/bioterrorism incident.
The National Bioterrorism Syndromic Surveillance Demonstration Program identifies new cases of illness from electronic ambulatory patient records. Its goals are to use data from health plans and practice groups to detect localized outbreaks and to facilitate rapid public health follow-up. Data are extracted nightly on patient encounters occurring during the previous 24 hours. Visits or calls with diagnostic codes corresponding to syndromes of interest are counted; repeat encounters are excluded. Daily counts of syndromes by zip code are sent to a central data repository, where they are statistically analyzed for unusual clustering by using a model-adjusted SaTScan approach. The results and raw data are displayed on a restricted website. Patient-level information stays at the originating health-care organization unless required by public health authorities. If a cluster surpasses a threshold of statistical aberration chosen by the corresponding public health department, an electronic alert can be sent to that department. The health department might then call a clinical responder, who has electronic access to records of cases contributing to clusters. The system is flexible, allowing for changes in participating organizations, syndrome definitions, and alert thresholds. It is transparent to clinicians and has been accepted by the health-care organizations that provide the data. The system's data are usable by local and national health agencies. Its software is compatible with commonly used systems and software and is mostly open-source. Ongoing activities include evaluating the system's ability to detect naturally occurring outbreaks and simulated terrorism events, automating and testing alerts and response capability, and evaluating alternative data sources.
Disaster leads to severe disruptions of the coping capacities of the community. Terrorism, and in particular bioterrorism, has tremendous impact on the community that is affected Cultural groups present unique issues that need to be appreciated for the effective integration of disaster mental health services with public health. The following paper identifies unique issues and challenges of cultural groups in disaster. It highlights issues such as language, cultural interpretation and expression of grief, and help-seeking behavior, as well as inherent cultural resources that can promote resilience. The implications of these cultural issues are illustrated in a potential bioterrorist event, addressing the areas of surge capacity, mass quarantine, and risk communication. Next steps are identified in promoting greater cultural competency in the integration of disaster mental health and public health, thus building greater community resilience.
OBJECTIVES: This study examined the content of hospital terrorism preparedness emergency response plans; whether those plans had been updated since September 11, 2001; collaboration of hospitals with outside organizations; clinician training in the management of biological, chemical, explosive, and nuclear exposures; drills on the response plans; and equipment and bed capacity. METHODS: The National Hospital Ambulatory Medical Care Survey (NHAMCS) is an annual survey of a probability sample of approximately 500 non-Federal general and short-stay hospitals in the United States. A Bioterrorism and Mass Casualty Supplement was included in the 2003 survey and provided the data for this analysis. RESULTS: Almost all hospitals have plans for responding to natural disasters (97.3 percent). Most have plans for responding to chemical (85.5 percent), biological (84.8 percent), nuclear or radiological (77.2 percent), and explosive incidents (76.9 percent). About three-quarters of hospitals were integrated into community-wide disaster plans (76.4 percent), and 75.9 percent specifically reported a cooperative planning process with other local health care facilities. Despite these plans, only 46.1 percent reported written memoranda of understanding with these facilities to accept inpatients during a declared disaster. Hospitals varied widely in their plans for re-arranging schedules and space in the event of a disaster. Training for hospital incident command and smallpox, anthrax, chemical, and radiological exposures was ahead of training for other infectious diseases. The percentage of hospitals training their staff in any exposure varied from 92.1 percent for nurses to 49.2 percent for medical residents. Drills for natural disasters occurred more often than those for chemical, biological, explosive, nuclear, and epidemic incidents. More hospitals staged drills for biological attacks than for severe epidemics. Despite explosions being the most common form of terrorism, drills for these were staged by only one-fifth of hospitals. Hospitals collaborated on drills most often with emergency medical services, fire departments, and law enforcement agencies.
From September 2001 through April 2004, the United States Postal Service (USPS) dealt, for the first time, with bioterrorism resulting in employee deaths and the closure of a large mail processing plant in Washington, D.C. The Employee Assistance Program (EAP) partnered with the USPS throughout this tumultuous time to meet the multiple and evolving behavioral health needs of the employees and facilitate the employees' emotional preparedness for their return to work at the closed facility. This paper discusses the reactions manifested by the employees during this extended period, as well as the EAP activities in the recovery process.
Millions of dollars have been spent improving the bioterrorism surveillance capabilities of the public health system. Yet relatively little attention has been paid to the benefits that such expenditures yield. To assess the impact of an aerosol release of Bacillus anthracis, this article collects the available evidence on the potential benefits of environmental detection relative to the costs of a bioterrorist attack like the one in 2001, which occurred in the absence of any such detection. The cost-benefit model shows that biological surveillance that reduces time to treatment to 48 hours yields economic benefits that range from $1.11 billion to $50.74 billion depending on the nature of the release and the value of statistical life one assigns. The author collected annual costs of the current biological surveillance system, BioWatch, for the cost-benefit analysis. The costs of BioWatch are justified when the probability of a biological threat exceeds 1.26 percent.
The September 11, 2001 terrorist attacks in the U.S.A. demonstrated our vulnerability to terrorist raids. Furthermore, in the same year inhalational anthrax cases in humans caused by the intentional [corrected] release of Bacillus anthracis spores via the U.S.A. postal system inflicted a lot of panic and terror over the civilian population. The succeeding terrorist events scattered in several other countries are continuous reminders of our frailness [corrected] and of the risk that terrorists attempts in the future may be implemented by means of deliberate evil release of biological agents. These events may be perpetrated by either the release of an infectious agent or any of its products in order to spread death or sickness in humans, animals, or plants with the obnoxius purpose of scaring governments and societies for the profit of particular ideological causes. In the current article, we present a review of the main bioterrorism agents, as well as a historical and clinical aspects and their significance for public health preparedness and response.
Along with smallpox, inhalation anthrax and pneumonic plague are among the diseases most likely to be spread by biowarfare, either from a rogue nation or terrorist group. Neither anthrax nor plague has been seen by many pulmonary (or any other) physicians in the United States. This article summarizes these two diseases as pulmonary manifestations of bioterrorism and discusses the possibility of avian influenza as a potential respiratory pathogen in biowarfare. It is hoped that phyisicians will need to know this information only as an academic exercise and not because of a clinical circumstance.
Yersinia pestis is the causative agent of plague, an enzootic vectorborne disease usually infecting rodents (rats) and fleas. Humans can become infected after being bitten by fleas that have fed on infected rodents. In humans, the disease usually occurs in the form of bubonic plague. In rare cases, the infection spreads to the lungs via the bloodstream and causes secondary pneumonic plague. Person-to-person transmission has been described for pneumonic plague but is rare in primary bubonic plague. Bubonic plague can usually be treated successfully with antibiotics; however, pneumonic plague develops rapidly and carries a high fatality rate despite immediate treatment with antibiotics. Plague is also recognized as a potential agent of bioterrorism. It has been used, or considered for use, as a biologic weapon on several occasions. It is important for the medical community to be familiar with the epidemiology, diagnosis, and symptoms of plague so it can deliver an appropriate and calm response should the unthinkable happen.
Anthrax, a potentially fatal infection, is a virulent and highly contagious disease. It is caused by a gram-positive, toxigenic, spore-forming bacillus: Bacillus anthracis. For centuries, anthrax has caused disease in animals and, although uncommonly, in humans throughout the world. Descriptions of this naturally occurring disease begin in antiquity. Anthrax is primarily a disease of herbivores, which are infected by ingestion of spores from the soil. With the advent of modern microbiology, Pasteur developed the first successful anthrax vaccine in 1881. The incidence of the disease has continually decreased since the late 19th century, and animal vaccination programs drastically reduced the animal mortality from the disease. However, anthrax spores continue to be documented in soil samples from throughout the world. Research on anthrax as a biological weapon began more than 80 years ago, and today at least 17 nations are believed to have offensive biological weapons programs that include anthrax. Recent events in the USA have shown how society is affected by both hoax and real threats of anthrax bioweapons. This fourth article in the series on weapons of biowarfare/bioterrorism summarizes the historical background of anthrax as well as clinical and laboratory information useful for bioterrorism preparedness.
There is a growing concern in the public health community over the potential for domestic biological and chemical acts of terrorism. These types of events do not respect city limits, county lines, or other geopolitical borders and pose a unique challenge for local health departments that have a critical role in detecting, preparing for, and responding to such events. Because direct support for most public health service, including bioterrorism preparedness, occurs primarily at the local level, this is the logical starting point for all planning activities.