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PubMed2002

Bioterrorism preparedness for local health departments.

Bioterrorism preparedness has not traditionally been an everyday concern of local public health departments. The likely first responders to a biological bioterrorism event will be local public health personnel. The events of September 11, 2001, and the anthrax crisis that followed tested the capabilities of the public health system and demonstrated its fragility. Little federal funding has trickled down to local health departments, and they have not been included in planning or training for bioterrorism preparedness. Now local health departments must develop detailed bioterrorism response plans. Effective plans will involve internal assessment of strengths and weaknesses and strategizing with other local community agencies. Our health department is a suburban county agency that serves a population of over 250,000. We have started this self-assessment and planning process. This bioterrorism guide has provided some structure for us and may be helpful for other local health departments as they begin this process.

Bioterrorism↗
PubMed2003

Vaccine development for potential bioterrorism agents.

Vaccines are considered to be one of the most effective ways of combating disease caused by bioterrorism agents. Such vaccines must be able to provide protection against pathogens which might enter the body by a number of routes, including the respiratory tract. They should also be able to induce protective immunity rapidly and would ideally be given non-invasively. There are few vaccines which currently meet these requirements. In part, this reflects the low level of research on many bioterrorism agents over the past few decades. Little is known about basic mechanisms of pathogenicity of many of these agents. However, by their very nature these agents cause serious disease, and must be handled in high containment laboratories. This requirement also limits the speed and ease with which research on these pathogens can now take place. Against this background, research on vaccines against potential bioterrorism agents is likely to proceed along two lines. Firstly because the genome sequences of most of the principal bioterrorism agents have either been completed or are close to completion, there is likely to be reliance on the exploitation of this information to devise improved vaccines. A number of groups are working on methodologies to identify vaccine antigens directly from genome sequences. Secondly, there will be a need to formulate such vaccines appropriately for the rapid induction of protective immunity after non-invasive delivery. The prospects for the development of a new generation of bioterrorism vaccines which exploit these technologies are reviewed in this manuscript.

Bioterrorism↗
PubMed2003

Detecting bioterror attacks by screening blood donors: a best-case analysis.

To assess whether screening blood donors could provide early warning of a bioterror attack, we combined stochastic models of blood donation and the workings of blood tests with an epidemic model to derive the probability distribution of the time to detect an attack under assumptions favorable to blood donor screening. Comparing the attack detection delay to the incubation times of the most feared bioterror agents shows that even under such optimistic conditions, victims of a bioterror attack would likely exhibit symptoms before the attack was detected through blood donor screening. For example, an attack infecting 100 persons with a noncontagious agent such as Bacillus anthracis would only have a 26% chance of being detected within 25 days; yet, at an assumed additional charge of $10 per test, donor screening would cost $139 million per year. Furthermore, even if screening tests were 99.99% specific, 1,390 false-positive results would occur each year. Therefore, screening blood donors for bioterror agents should not be used to detect a bioterror attack.

Anthrax↗
PubMed2005

[Bioterrorism].

Biological terrorism is intentionally to use infectious substances for developing diseases or death in animals or humans, leading to disaster and panic in our community. Bioterrorism-associated diseases are mostly rare or eradicated infectious diseases, and recently, we do not have experience to make a clinical and laboratory diagnosis. In particular, these infectious diseases have incubation periods from infection to development of the disease. The staff working at public health institutions, including legal medicine, must be involved in as a first responder when bioterrorism would happen. The preparedness in general against bioterrorism and the bioterrorism-related diseases, such as anthrax, smallpox, viral hemorrhagic fever, tularemia, and botulinum toxin, important for us are described. Both medical knowledge of bioterrorism and the preparedness with training under simulation should be required in advance.

Animals↗
PubMed2003

Bioterrorism and the nervous system.

Recent events of war, terrorist attacks, and mail-borne anthrax exposure have produced increasing awareness of potential bioterrorism attacks in the United States and other parts of the world. Physicians and healthcare personnel play a key role in identifying potential bioterrorist attacks. Early recognition and preparedness for bioterrorism-associated illnesses is especially important for neurologists because most bioterrorism agents can directly or indirectly affect the nervous system. This article reviews the neurologic manifestations, diagnosis, and treatments of syndromes caused by potential bioterrorism agents, as well as the potential side effects of vaccines against some of these agents.

Anthrax↗
PubMed2005

Occupational physician perceptions of bioterrorism.

The rationale for most preparedness training of healthcare professionals is based on the assumption that most persons infected following a biological incident will present first to emergency departments of acute care facilities or to ambulatory settings such as private physician offices, and such incidences would be recognized, appropriately treated, and reported to the local health departments. However, an alternative first point of contact is industry, a location where workers gather and disperse on a regular and documented basis, and require healthcare. In industry there are health professionals responsible for the health, safety and on-site well-being of the workforce and surrounding community; these professionals are in a position for early recognition, surveillance, and isolation. Targeted education must be provided to these health professionals. To address perceptions of risk and preferred educational delivery methods for bioterrorism and emerging infections-related materials, a survey of occupational physicians was performed during the spring of 2001. Within the 2 months following the September 11 terrorist attack and subsequent anthrax bioterrorism event, and before release of any results from the first survey, a follow-up mail survey was initiated in November 2001. Response rate to the pre- and post-September 11 survey were 58% (n = 56) and 33% (n = 33), respectively. No significant demographic differences were observed between the respondents of the pre- and post-surveys. Perceptions of likelihood of another bioterrorism event increased between surveys, as would be expected; however, a tendency to believe that it would not happen locally persisted. Even though over 90% of the physicians had received immediate training following September 11, additional training/education needs were demonstrated. Although training and education modules can be designed without information based on the population that can be on the receiving end, it rarely accomplishes its goal. Results from this survey can serve as a base for designing various levels of targeted training and educational material specific to the perceived need, method of obtaining information and the format considered to be most conducive for learning. Potential consequences from lack of bioterrorism preparedness due to low perception of need and threat awareness need to be addressed.

Adult↗
PubMed2002

Preparing for bioterrorism at the state level: report of an informal survey.

Members of 18 states' departments of mental health were interviewed about their plans for managing the psychosocial impacts of a bioterrorism event. Questions were developed from recommendations of an international conference on planning for bioterrorism ("Planning for bioterrorism," 2000). Information derived from the survey highlights the need for, and the importance of, mental health consultation to the state's planning process. Familiarity with the unique psychological and behavioral consequences of a bioterrorism event in contrast to natural disasters is essential. Realistic training scenarios that incorporate likely psychosocial impacts and appropriate mental health response must be developed.

Bioterrorism↗
PubMedDate not supplied

The role of an advanced practice public health nurse in bioterrorism preparedness.

The 2001 anthrax events have vividly illustrated that terrorism involving the release of a biological agent is a major public health emergency requiring an immediate and well-coordinated response. If healthcare professionals and emergency responders are to be prepared to manage such attacks, unprecedented cooperative efforts at the national, state, and local levels are necessary. To aid such efforts, advanced practice public health nurses (PHNs) must exercise their ability to collaborate with a variety of disciplines and communities. Using the Los Angeles County Public Health Nursing Practice Model, advanced practice PHNs can be trained to deal effectively with acts of bioterrorism. This model defines the practice of public health nursing as working on a population-based level to create conditions under which healthy people can live within healthy communities. This article will discuss the threat of bioterrorism and describe how the Public Health Nursing Practice Model can be applied to assist advanced practice PHNs in the development of a public health plan for preparedness and response to bioterrorism. Six specific interventions that enable advanced practice PHNs to affect populations at the community and systems level will be discussed along with the implications of bioterrorism for advanced practice public health nursing.

Bioterrorism↗
PubMed2005

Funding agendas: has bioterror defense been over-prioritized?

Post-9/11, concern about bioterrorism has transformed public health from unappreciated to a central component of national security. Within the War on Terror, bioterrorism preparedness has taken a back seat only to direct military action in terms of funding. Domestically, homelessness, joblessness, crime, education, and race relations are just a few of a litany of pressing issues requiring government attention. Even within the biomedical sciences and healthcare, issues surrounding the fact that more than 40 million Americans lack health insurance, the rising cost of prescription medications, and the use of government funds for research using embryonic stem cells remain unresolved. Should we prioritize a hypothetical threat (bioterrorism), or existing conditions that have implications for identifiable individuals? Even more fundamentally, should we prioritize research aimed at defense from bioterrorism (or even terrorism in general) when there are so many pressing social problems that affect the U.S. population?

Biomedical Research↗
PubMed2004

The HIPAA privacy rule and bioterrorism planning, prevention, and response.

Effective bioterrorism planning, prevention, and response require information sharing between various entities, ranging from public health authorities and health-care workers to national security and law enforcement officials. While the source of much information exchanged may be nonidentifiable, many entities legitimately need access to personally identifiable health information (or "protected health information" [PHI]) in planning for and responding to a bioterrorism event. The HIPAA Privacy Rule allows for essential exchanges of health data during a public health emergency while protecting against unnecessary disclosures of PHI. In the event of a bioterrorist attack, the Privacy Rule allows covered entities to disclose PHI without individual authorization in the following instances: (1) for treatment by health-care providers, (2) to avert a serious threat to health or safety, (3) to public health authorities for public health purposes, (4) to protect national security, (5) to law enforcement under certain conditions, and (6) for judicial or administrative proceedings. Despite these favorable disclosure provisions, some privacy challenges remain. The flow of PHI may be slowed by misunderstandings of the Privacy Rule's accounting requirement. In addition, in a bioterrorism scenario, nontraditional entities may find themselves acting as health-care providers, triggering Privacy Rule provisions. Finally, the potential for de facto disclosures of individuals' disease or exposure status increases where conspicuous treatment methods, isolation, or quarantine are implemented without additional measures to protect privacy. Understanding the Privacy Rule's impact on bioterrorism planning and response ensures that various entities can conduct their activities with needed information while still protecting individual privacy.

Bioterrorism↗
PubMed2006

Reducing mortality from anthrax bioterrorism: strategies for stockpiling and dispensing medical and pharmaceutical supplies.

A critical question in planning a response to bioterrorism is how antibiotics and medical supplies should be stockpiled and dispensed. The objective of this work was to evaluate the costs and benefits of alternative strategies for maintaining and dispensing local and regional inventories of antibiotics and medical supplies for responses to anthrax bioterrorism. We modeled the regional and local supply chain for antibiotics and medical supplies as well as local dispensing capacity. We found that mortality was highly dependent on the local dispensing capacity, the number of individuals requiring prophylaxis, adherence to prophylactic antibiotics, and delays in attack detection. For an attack exposing 250,000 people and requiring the prophylaxis of 5 million people, expected mortality fell from 243,000 to 145,000 as the dispensing capacity increased from 14,000 to 420,000 individuals per day. At low dispensing capacities (<14,000 individuals per day), nearly all exposed individuals died, regardless of the rate of adherence to prophylaxis, delays in attack detection, or availability of local inventories. No benefit was achieved by doubling local inventories at low dispensing capacities; however, at higher dispensing capacities, the cost-effectiveness of doubling local inventories fell from 100,000 US dollars to 20,000 US dollars/life year gained as the annual probability of an attack increased from 0.0002 to 0.001. We conclude that because of the reportedly rapid availability of regional inventories, the critical determinant of mortality following anthrax bioterrorism is local dispensing capacity. Bioterrorism preparedness efforts directed at improving local dispensing capacity are required before benefits can be reaped from enhancing local inventories.

Anthrax↗
PubMed2006

Physician assistants and bioterrorism preparedness.

Despite the resources dedicated since 2001 to training health providers in emergency and bioterrorism preparedness and response, the literature on the participation of physician assistants (PAs) is very limited. The purpose of this pilot study was to explore the training level and experiences of PAs in the diagnosis and treatment of chemical, biological, radiological, nuclear, and explosive agents that could be used in a bioterrorism attack. The study population consisted of licensed PAs in 37 northern Texas counties. Data were collected through mailed and web-based surveys. Response rate was 36%. More than half of the respondents (58.6%) had not participated in bioterrorism preparedness and response training. Results also indicated that the level of training has not increased since September 11, 2001. However, most respondents were receptive to the idea of participating in both preparedness training and response efforts. It is recommended that state agencies increase training opportunities for PAs in bioterrorism preparedness and response.

Adult↗
PubMed2005

Bioterrorism and smallpox: policies, practices, and implications for social work.

Terrorist acts and the fear of terrorism have become a part of everyday life in the early 21st century. Among the threats most feared is bioterrorism, including the intentional release of smallpox. With the invasion of Iraq and toppling of the Saddam Hussein regime, acute bioterrorism fears have abated; however, an ongoing threat remains.This article addresses the need for knowledge and rational policies in dealing with potential bioterrorism attacks. It presents information on four of the most likely bioterrorism agents: smallpox, anthrax, botulism, and plague. It illustrates the importance of accurate knowledge and rational decision making in addressing the threat of terrorism through the intentional release of biological weapons such as smallpox. Finally, it provides information essential for social workers to make informed practice decisions, to educate clients and the public, and to advocate for sound public policy.

Anthrax↗
PubMed2005

Public health department training of emergency medical technicians for bioterrorism and public health emergencies: results of a national assessment.

HYPOTHESIS: The public health system has a specialized body of knowledge and expertise in bioterrorism and public health emergency management that can assist in the development and delivery of continuing medical education programs to meet the needs of emergency medical service providers. METHODS: A nationally representative sample of the basic and paramedic emergency medical service providers in the United States was surveyed to assess whether they had received training in weapons of mass destruction, bioterrorism, chemical terrorism, radiological terrorism, and/or public health emergencies, and how the training was provided. RESULTS: Local health departments provided little in the way of training in biologic, chemical, or radiological terrorism to responders (7.4%-14.9%). State health departments provided even less training (6.3%-17.3%) on all topics to emergency medical services providers. Training that was provided by the health department in bioterrorism and public health emergency response was associated with responder comfort in responding to a bioterrorism event (OR = 2.74, 95% CI = 2.68, 2.81). CONCLUSIONS: Local and state public health agencies should work with the emergency medical services systems to develop and deliver training with an all-hazards approach to disasters and other public health emergencies.

Bioterrorism↗
PubMed2004

Emotional and behavioral consequences of bioterrorism: planning a public health response.

Millions of dollars have been spent improving the public health system's bioterrorism response capabilities. Yet relatively little attention has been paid to precisely how the public will respond to bioterrorism and how emotional and behavioral responses might complicate an otherwise successful response. This article synthesizes the available evidence about the likely emotional and behavioral consequences of bioterrorism to suggest what decision makers can do now to improve that response. It examines the emotional and behavioral impact of previous "bioterrorism-like" events and summarizes interviews with experts who have responded to such events or conducted research on the effects of community-wide disasters. The article concludes by reflecting on the evidence and experts' perspectives to suggest actions to be taken now and future policy and research priorities.

Bioterrorism↗
PubMedDate not supplied

Modeling the public health response to bioterrorism: using discrete event simulation to design antibiotic distribution centers.

BACKGROUND: Post-exposure prophylaxis is a critical component of the public health response to bioterrorism. Computer simulation modeling may assist in designing antibiotic distribution centers for this task. METHODS: The authors used discrete event simulation modeling to determine staffing levels for entry screening, triage, medical evaluation, and drug dispensing stations in a hypothetical antibiotic distribution center operating in low, medium, and high disease prevalence bioterrorism response scenarios. Patient arrival rates and processing times were based on prior mass prophylaxis campaigns. Multiple sensitivity analyses examined the relationship between average staff utilization rate (UR) (i.e., percentage of time occupied in patient contact) and capacity of the model to handle surge arrivals. RESULTS: Distribution center operation required from 93 staff for the low-prevalence scenario to 111 staff for the high-prevalence scenario to process approximately 1000 people per hour within the baseline model assumptions. Excess capacity to process surge arrivals approximated (1-UR) for triage staffing. CONCLUSIONS: Discrete event simulation modeling is a useful tool in developing the public health infrastructure for bioterrorism response. Live exercises to validate the assumptions and outcomes presented here may improve preparedness to respond to bioterrorism.

Anti-Bacterial Agents↗
PubMed2004

Multi-pathogens sequence containing plasmids as positive controls for universal detection of potential agents of bioterrorism.

BACKGROUND: The limited circulation of many of the agents that are likely to be used in a bioterrorism attack precludes the ready availability of positive controls. This means that only specialized laboratories can screen for the presence of these agents by nucleic amplification assays. Calibrated controls are also necessary for quantitative measurements. Primers and probes to be used in both conventional and real-time PCR assays were designed for the detection of agents likely to be used by a bioterrorist. Three plasmids, each of which contains 4 to 6 specific sequences from agents on the CDC Category A and B list (excluding RNA viruses) were constructed. Two plasmids incorporate the sequences of Category A and B agents, respectively. The third plasmid incorporates sequences from Variola major and organisms that cause rash-like illnesses that may be clinically confused with smallpox. An "exogenic sequence", introducing a NotI restriction site was incorporated in the native sequences of the bioterrorism agents inserted in plasmids. The designed molecular system for detection of bioterrorism agents was tested on each of these agents (except Monkeypox virus, Smallpox virus and 2 Burkholderia species for which no native DNA was available) and a collection of 50 isolates of C. burnetii using constructed plasmids as positive controls. RESULTS: Designed primers and probes allowed molecular detection, in either single or multiplex assays, of agent-specific targets with analytical sensitivities of between 1 and 100 DNA copies. The plasmids could be used as positive controls. False-positive results due to contamination by the positive control were easily detected by sequencing and eliminated by digestion with NotI. CONCLUSION: Plasmid A and B can be used as positive controls in molecular assays for the detection of bioterrorism agents in clinical specimens or environmental samples. Plasmid C can be used as a positive control in differentiation of vesicular rashes. It is also possible to avoid or to ensure immediate detection of false positive results due to contamination by positive controls using these plasmids. These plasmids and the corresponding primers and probes are immediately available for all clinical microbiology laboratories provided they have molecular amplification equipment.

Bacteria↗
PubMed2005

Online bioterrorism continuing medical education: development and preliminary testing.

OBJECTIVE: Education to achieve awareness and competency in responding to incidents of bioterrorism is important for health care professionals, especially emergency physicians and nurses, who are likely first points of medical contact. The authors describe the development of a computer-based approach to initial education, incorporating a screensaver to promote awareness and a Web-based approach to provide initial content competency in the areas of smallpox and anthrax. METHODS: Screensavers were developed and tested on emergency department rotating senior medical students and internal medicine interns. Conceptually, screensavers were designed as "billboards" for attracting attention to the educational domain. Five rotating images sequenced at five-second intervals incorporated a teaser question and an interactive toolbar. An interactive toolbar was linked to a Web site that provided content on smallpox and anthrax for hospital-based specialties (emergency physicians and nurses, infection control practitioners, pathologists, and radiologists). The content included both summary and comprehensive content as well as free continuing education credits in an online, specialty-specific, case-scenario format with remediation pop-up boxes. RESULTS: Formal testing indicated that the screensaver and Web site combination deployed on computers in the emergency department and the events of the fall of 2001 significantly increased the percentage of correct responses to five standardized bioterrorism questions. Formal evaluation with a randomized trial and long-term follow-up is ongoing. CONCLUSIONS: Screensavers and Web sites can be used to increase awareness of bioterrorism. Web-based education may provide an effective means of education for bioterrorism.

Awareness↗