Bioterror and public health infrastructure: a response to commentators.
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The authors present a quantitative risk analysis approach to estimating infection risk due to airborne pathogens exhibiting relatively large infectious dose values. The method is applied to hypothetical scenarios involving airborne spores of Bacillus anthracis. The method combines the estimated parameters for exposure intensity, the pathogen dose-response relationship, and respirator penetration values (if respiratory protection is used). Because knowledge of the true parameter values will be uncertain, an uncertainty analysis is an essential part of the process. Given a specified value for acceptable infection risk, the method permits choosing a respirator that sufficiently reduces exposure to meet the acceptable risk criterion. A strength of the risk analysis approach is its transparency, in that the model structure and data inputs are explicitly identified. Further, risk analysis informs the expert judgment that must typically be applied in selecting respiratory protection against airborne pathogens.
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BACKGROUND: Bacterial pathogens and their products are potential agents of biological terrorism and biological warfare. These agents can be deployed through simple aerosol delivery systems and thereby cause widespread disease and death. METHODS: This report is a review of bacterial species that have been employed for development of biological terrorism, relying on a system for classification of their threat developed by the Centers for Disease Control. RESULTS: Physicians must understand how to recognize early signs and symptoms caused by bacterial agents. Clinical findings often seen on presentation are emphasized along with a summary of therapeutic approaches. CONCLUSIONS: Initiation of immediate therapy and supportive care provides the best chance for survival from these potentially lethal and devastating infections. A high index of suspicion must be maintained, especially in the setting of a sudden influx of cases with what are often relatively nonspecific symptoms.
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