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PubMedDate not supplied

Demystifying bioterrorism: misinformation and misperceptions.

The true threat of bioterrorism remains mysterious and elusive to the common citizen. It principally has become the dominion of a few "experts", many of whom have limited apparent expertise, who have failed to effectively communicate the risks and realities to society, and have instead created an air of uncertainty surrounding the topic. Unlike the great classic deceptions of modern life (e.g., "the check is in the mail"), the misinformation and misperceptions associated with bioterrorism can be dangerous and are not merely humorous. Indeed, it is possible to grasp the facts as well as fallacies associated with bioterrorism, and, as a result, demystify this nightmare scenario and prepare for the "unthinkable".

Bioterrorism↗
PubMed2001

What we need to know about bioterrorism preparedness: results from focus groups conducted at APIC 2000.

Infection control practitioners (ICPs) are important partners in enhancing the US public health infrastructure, both as essential recipients of continuing education and as instructors responsible for providing this education. Focus groups were conducted at APIC 2000, the annual meeting for the Association for Professionals in Infection Control and Epidemiology, Inc, to determine the ICPs' priorities for educational opportunities in bioterrorism preparedness and the preferred methods of education delivery. Focus group participants affirmed the need to provide education in sessions of less than 60 minutes, with use of a variety of technologies and methods of presentation such as video, Internet, and paper-based self-learning texts. The participants' comments suggested a lack of awareness by employees in health care institutions about the potential threat of bioterrorism in the United States and a deficiency in knowledge about the potential consequences of an attack. The focus group participants believed this lack of awareness also leads to unwillingness by their administrators to allocate funds for planning and education. Since it appears that ICPs will be looking for direction and expertise from the local health departments in their communities, the first subset of professionals to target for bioterrorism education and preparedness should probably be the public health professionals.

Adult↗
PubMed2002

Bioterrorism preparedness: a survey of Nebraska health care institutions.

In March 2001, a 6-question survey was mailed to all hospitals and long-term care facilities in Nebraska to assess preparedness for bioterrorism. Only half of the respondents at that time believed that bioterrorism was something their community was likely to experience. We found that most facilities (98%) believed that they were unprepared for a bioterrorism event, and many did not know whom to contact in the event of such an emergency. We concluded from the results of the survey that the greatest needs to facilitate preparation were policies and procedures, identification of contacts, medications, protective equipment, laboratory support, and communication.

Bioterrorism↗
PubMed2006

Uncertainty in predictions of disease spread and public health responses to bioterrorism and emerging diseases.

Concerns over bioterrorism and emerging diseases have led to the widespread use of epidemic models for evaluating public health strategies. Partly because epidemic models often capture the dynamics of prior epidemics remarkably well, little attention has been paid to how uncertainty in parameter estimates might affect model predictions. To understand such effects, we used Bayesian statistics to rigorously estimate the uncertainty in the parameters of an epidemic model, focusing on smallpox bioterrorism. We then used a vaccination model to translate the uncertainty in the model parameters into uncertainty in which of two vaccination strategies would provide a better response to bioterrorism, mass vaccination, or vaccination of social contacts, so-called "trace vaccination." Our results show that the uncertainty in the model parameters is remarkably high and that this uncertainty has important implications for vaccination strategies. For example, under one plausible scenario, the most likely outcome is that mass vaccination would save approximately 100,000 more lives than trace vaccination. Because of the high uncertainty in the parameters, however, there is also a substantial probability that mass vaccination would save 200,000 or more lives than trace vaccination. In addition to providing the best response to the most likely outcome, mass vaccination thus has the advantage of preventing outcomes that are only slightly less likely but that are substantially more horrific. Rigorous estimates of uncertainty thus can reveal hidden advantages of public health strategies, suggesting that formal uncertainty estimation should play a key role in planning for epidemics.

Bayes Theorem↗
PubMed2002

Bioterrorism: an overview.

Bioterrorism has reached the forefront of the public imagination following recent events across the world. The disaster of 11 September 2001, followed by anthrax letters sent via the US postal system and now renewed tension over Iraq have all brought the possibility of bioterrorism closer. A number of biological agents could be used in a terrorist attack, including anthrax, plague, smallpox and botulinum toxin. The serious diseases that these agents produce have been brought under control in the developed world; however, a lack of protective immunity against such diseases could cause considerable morbidity and mortality if used in a terrorist attack. This essay provides a background to bioterrorism, discusses many of the current points of interest and gives an update to the economic consequences of such an attack.

Bioterrorism↗
PubMed2004

Health system preparedness for bioterrorism: bringing the tabletop to the hospital.

OBJECTIVE: To evaluate the acceptance and usefulness of a hospital-based tabletop bioterrorism exercise. DESIGN: A descriptive study of responses to a smallpox scenario delivered as a tabletop exercise in three modules. SETTING: A large, multi-institutional urban health system. PARTICIPANTS: Healthcare workers representing 16 hospital departments. RESULTS: Thirty-nine (78%) of 50 invited employees from 4 hospitals participated. Key responses highlighted the importance of pre-event planning in intra-departmental communication, identification of resources for the dependents of healthcare workers, clarification of the chain of command within the hospital, establishment of a link to key governmental agencies, and advanced identification of negative pressure rooms for cohorting large numbers of patients. Almost one-fourth of the participants described their hospital department as poorly prepared for a bioterrorism event of moderate size. At the conclusion of the tabletop, 79% of the participants stated that the exercise had increased their knowledge of preplanning activities. Seventy-nine percent of all participants, 94% of physicians and nurses, and 95% of participants from non-university hospitals ranked the exercise as extremely or very useful. The exercise was completed in 3 1/2 hours and its total direct cost (excluding lost time from work) was 225 dollars (U.S.). CONCLUSIONS: Tabletop exercises are a feasible, well-accepted modality for hospital bioterrorism preparedness training. Hospital employees, including physicians and nurses, rank this method as highly useful for guiding preplanning activities. Infection control staff and hospital epidemiologists should play a lead role in hospital preparedness activities. Further assessment of the optimal duration, type, and frequency of tabletop exercises is needed.

Bioterrorism↗
PubMed2001

Citywide pharmaceutical preparation for bioterrorism.

One community's efforts to become pharmaceutically prepared for an attack with biological agents is described. In response to recent bioterrorist activities, including a local scare in 1999 involving anthrax, the pharmacy department at Deaconess Medical Center in Spokane, Washington, was asked to develop a plan for bioterrorism preparedness. A literature search was conducted, and resources, such as the Centers for Disease Control and Prevention, were contacted. For each biological agent, information was compiled about symptom onset, treatment, postexposure prophylaxis, patient isolation precautions, and the availability of antidotes at local hospitals. A procedure was developed for obtaining antidotes that might not be available or stocked in sufficient quantities. After being reviewed by appropriate authorities, the information was presented to area hospitals and trauma centers, drug wholesalers, hospital risk-management personnel, and emergency management personnel. In May 2000 dozens of emergency and medical personnel attended a day-long program on domestic preparedness. Citywide cooperation was obtained on how to respond to a mass exposure to a bioterrorism agent. The job of a pharmacist during a bioterrorism strike is to rapidly disseminate antidotes and information, provide dosage and vaccination schedules for both treatment and prophylaxis, and counsel patients. Medical facilities in Spokane have cooperated to make the community more prepared for a bioterrorist attack.

Antidotes↗
PubMedDate not supplied

The application of ultraviolet germicidal irradiation to control transmission of airborne disease: bioterrorism countermeasure.

Bioterrorism is an area of increasing public health concern. The intent of this article is to review the air cleansing technologies available to protect building occupants from the intentional release of bioterror agents into congregate spaces (such as offices, schools, auditoriums, and transportation centers), as well as through outside air intakes and by way of recirculation air ducts. Current available technologies include increased ventilation, filtration, and ultraviolet germicidal irradiation (UVGI) UVGI is a common tool in laboratories and health care facilities, but is not familiar to the public, or to some heating, ventilation, and air conditioning engineers. Interest in UVGI is increasing as concern about a possible malicious release of bioterror agents mounts. Recent applications of UVGI have focused on control of tuberculosis transmission, but a wide range of airborne respiratory pathogens are susceptible to deactivation by UVGI. In this article, the authors provide an overview of air disinfection technologies, and an in-depth analysis of UVGI-its history, applications, and effectiveness.

Air Microbiology↗
PubMed2004

Guidelines for preclerkship bioterrorism curricula.

PURPOSE: To develop medical school curriculum guidelines related to bioterrorism to ensure that future medical graduates are armed with the critical knowledge, skills, and attitudes to face this emerging threat. METHOD: An Internet-based Delphi survey was performed in 2002 under the auspices of the Association of Medical School Microbiology and Immunology Chairs involving 64 medical educators in microbiology, immunology, and infectious diseases representing 54 U.S. medical schools. A 12-member bioterrorism expert reference panel participated in the final phase of the survey. RESULTS: Study participants identified the top educational objectives for the following bioterrorism-related curriculum categories: general issues, biodefense, public health, infection control, infectious diseases, and toxins. CONCLUSION: The study focused on preparedness training through the development of curricular guidelines in predominantly preclerkship medical education by identifying basic science and clinical laboratory aspects of putative biologic weapons organisms and toxins, clinical manifestations of bioterrorist attacks, treatment strategies, epidemiology, and prophylaxis.

Allergy and Immunology↗
PubMedDate not supplied

Public health response to bioterrorism with Bacillus anthracis: coordinating public health laboratory, communication, and law enforcement.

In October 2001, public health departments across the United States were part of an intensive response to a bioterrorism event using anthrax spores delivered by mail. It is useful to examine this experience as an unscripted exercise of bioterrorism response capacity, more realistic than scenarios of planned exercises. The event particularly challenged public health laboratory and communications capacity, but it also tested surveillance and training capacity. The bioterrorism response demonstrated the importance of strong partnerships between the public health laboratory and emergency response agencies as well as medical providers and the usefulness of open, flexible communication strategies.

Anthrax↗
PubMedDate not supplied

Local collaborations: development and implementation of Boston's bioterrorism surveillance system.

The Boston Public Health Commission developed and implemented an active surveillance system for bioterrorism and other infectious disease emergencies. A bioterrorism Surveillance Task Force was formed with representatives from local emergency medicine, infection control, infectious diseases, public health, and emergency medical services. These local agencies worked together to develop a reliable, easy to use electronic surveillance system. Collaboration at the local level and building on existing relationships is a key component of this system. Effective follow-up systems and technology back-up plans are essential. Improved communication networks and increased bioterrorism education for clinicians and the general public have also been achieved.

Bioterrorism↗
PubMed2004

The potential of next-generation microbiological diagnostics to improve bioterrorism detection speed.

Emerging, rapid, multivalent, microbial diagnostic technologies can produce results in hours, as contrasted to the standard methods that require at least the better part of a week. Used in bioterrorism surveillance in medical settings, the new biodetectors could significantly reduce the time between a covert attack and its detection. By how much is determined by the intensity of sampling. If used to screen all patients reporting flu-like symptoms to their doctors, this basic level of "front-line" sampling would reduce life-threatening medical floundering and missteps and give responders 3-5 days of warning that they otherwise would not have had. Being miniaturized and amenable to mass production, these devices could reduce the cost of screening to a fraction of current costs and so it is tempting to imagine their use in more intensive bioterrorism screening programs aimed at the apparently healthy population, programs that could detect a covert attack even before the victims felt ill. This article examines the tradeoffs between surveillance effort and probability of detection for such programs. Dual-use deployment, where the biodetector provides some medically useful information in addition to bioterrorism surveillance, is discussed.

Bioterrorism↗
PubMedDate not supplied

Emergency preparedness and bioterrorism response: development of an educational program for public health personnel.

Public health departments are under increasing pressure to provide emergency preparedness and bioterrorism response education to public health personnel. The challenge that health departments face is to provide cost-efficient, timely education to a large number of multidisciplinary personnel. This article describes an innovative strategy for providing this education to public health personnel using the health department's intranet system. The intranet system provided confidential information specific to the staff role and allowed for concurrent access to the program by multiple individuals at different service sites. Knowledge acquisition was tested through short multiple-choice questions that followed the specific information modules. The intranet system faced a number of challenges during the pilot-testing phase, primarily related to changes in the role of the public health nurse and limitations in funding and public health staff to maintain and monitor the bioterrorism response program and the intranet system. The design of the program may prove useful for other public health organizations when a need exists for quick delivery of information to a large number of personnel. It may especially be useful in providing basic emergency preparedness and bioterrorism education to new personnel in health departments.

Attitude of Health Personnel↗
PubMed2001

Bioterrorism: implications for the clinical microbiologist.

The specter of bioterrorism has captured the attention of government and military officials, scientists, and the general public. Compared to other sectors of the population, clinical microbiologists are more directly impacted by concerns about bioterrorism. This review focuses on the role envisioned for clinical laboratories in response to a bioterrorist event. The microbiology and clinical aspects of the biological agents thought to be the most likely tools of bioterrorists are presented. The historical background of the problem of bioterrorism and an overview of current U.S. preparedness planning, with an emphasis on the roles of health care professionals, are also included.

Bacteria↗
PubMedDate not supplied

A model curriculum for public health bioterrorism education.

Beginning with the spring semester of 2001, a course designed to prepare future public health leaders for potential bioterrorism events has been offered by the University of Connecticut Graduate Program in Public Health. Entitled "The Public Health Response to Bioterrorism," this popular course was one of the few developed by academic programs in the United States prior to the attack of September 11, 2001. The course utilizes innovative teaching methods and presentations by distinguished guest speakers to educate public health personnel, public health and medical students, and physicians and nurses about the complex issues involved in the public health response to bioterrorism. The instructional methods and curriculum can serve as prototypes for similar efforts.

Bioterrorism↗
PubMedDate not supplied

Biological and chemical bioterrorism agents.

Bioterrorism of a chemical or biological nature poses a potential public health threat to our nation at a time when the health care infrastructure is challenged. This article reviews the history of bioterrorism research, some potential biological and chemical agents, and concludes with a review of the five functions that should be addressed in a bioterrorism response plan. The offending biological or chemical agent is reviewed with the clinical presentation and methods of treatment and prevention.

Adult↗
PubMed2005

Patients' request for and emergency physicians' prescription of antimicrobial prophylaxis for anthrax during the 2001 bioterrorism-related outbreak.

BACKGROUND: Inappropriate use of antibiotics by individuals worried about biological agent exposures during bioterrorism events is an important public health concern. However, little is documented about the extent to which individuals with self-identified risk of anthrax exposure approached physicians for antimicrobial prophylaxis during the 2001 bioterrorism attacks in the United States. METHODS: We conducted a telephone survey of randomly selected members of the Pennsylvania Chapter of the American College of Emergency Physicians to assess patients' request for and emergency physicians' prescription of antimicrobial agents during the 2001 anthrax attacks. RESULTS: Ninety-seven physicians completed the survey. Sixty-four (66%) respondents had received requests from patients for anthrax prophylaxis; 16 (25%) of these physicians prescribed antibiotics to a total of 23 patients. Ten physicians prescribed ciprofloxacin while 8 physicians prescribed doxycycline. CONCLUSION: During the 2001 bioterrorist attacks, the majority of the emergency physicians we surveyed encountered patients who requested anthrax prophylaxis. Public fears may lead to a high demand for antibiotic prophylaxis during bioterrorism events. Elucidation of the relationship between public health response to outbreaks and outcomes would yield insights to ease burden on frontline clinicians and guide strategies to control inappropriate antibiotic allocation during bioterrorist events.

Anthrax↗
PubMedDate not supplied

Ready and willing? Physicians' sense of preparedness for bioterrorism.

Little is known about contemporary physicians' sense of preparedness for bioterrorism, willingness to treat patients despite personal risk, or belief in the professional duty to treat during epidemics. In a recent national survey few physicians reported that they or their practice are "well prepared" for bioterrorism. Still, most respondents reported that they would continue to care for patients in the event of an outbreak of "an unknown but potentially deadly illness," although only a narrow majority reported believing in a professional duty to treat patients in epidemics. Preparing physicians for bioterrorism should entail providing practical knowledge, preventive steps to minimize risk, and reinforcement of the profession's ethical duty to treat.

Adult↗