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PubMed2002

Dentistry's response to bioterrorism: a report of a consensus workshop.

BACKGROUND AND OVERVIEW: The possibility of a significant bioterrorist attack on the civilian population of the United States has become a focus of local, state and national attention since the fall of 2001. An appropriate role for dentistry in the response to a massive bioterrorist attack has not yet been established, even though dentistry's role in other disasters has been developed and proven to be effective. To develop a consensus on a potential role for dentistry in dealing with bioterrorism, experts in bioterrorism issues and representatives of key organizations that could play a role in dentistry's response met at the American Dental Association's Workshop on the Role of Dentistry in Bioterrorism in June. CONCLUSIONS: In the event of a bioterrorist attack, dentists may be called on to fulfill several functions: education, risk communication, diagnosis, surveillance and notification, treatment, distribution of medications, decontamination, sample collection and forensic dentistry. Local dental societies should develop a plan for the dental response to potential bioterrorist attacks that can be integrated into each community's mass disaster response plan. Educational programs for dentists should be developed to prepare them for providing services they may be recruited to perform in an emergency. PRACTICE IMPLICATIONS: Dentistry has assets in personnel and facilities that can be of great value in responding to a major bioterrorist attack on the United States.

American Dental Association↗
PubMed2003

Bioterrorism: pivotal clinical issues. Consensus review of the Society of Infectious Diseases Pharmacists.

OBJECTIVES: To discuss specific facts regarding use as a bioweapon, epidemiology, microbiology, clinical manifestations, diagnosis, antimicrobial therapy, immunization, and isolation precautions for five most likely agents of bioterrorism; to review and provide recommendations for health care clinicians on the management of these bioterrorism agents; and to share information on the pharmacist's role in preparedness and response. PARTICIPANTS: The manuscript was drafted by the three authors, reviewed by a group of selected members of the Society of Infectious Diseases Pharmacists, and approved by its Board of Directors. EVIDENCE: The primary focus was to review and summarize recent and key articles on bioterrorism. Preference was given to peer-reviewed journal information and government-sponsored journals, such as the MMWR, Morbidity and Mortality Weekly Report. CONSENSUS PROCESS: Written comments were requested from each reviewer. Comments were incorporated into the final draft. CONCLUSION: Pharmacists play an integral role in disaster preparedness and response and should be involved in planning committees. As drug information specialists, pharmacists can assist other health care providers and emergency personnel, as well as provide counseling to calm, comfort, and empower the public.

Adult↗
PubMed2004

The pitfalls of bioterrorism preparedness: the anthrax and smallpox experiences.

Bioterrorism preparedness programs have contributed to death, illness, and waste of public health resources without evidence of benefit. Several deaths and many serious illnesses have resulted from the smallpox vaccination program; yet there is no clear evidence that a threat of smallpox exposure ever existed. The anthrax spores released in 2001 have been linked to secret US military laboratories-the resultant illnesses and deaths might not have occurred if those laboratories were not in operation. The present expansion of bioterrorism preparedness programs will continue to squander health resources, increase the dangers of accidental or purposeful release of dangerous pathogens, and further undermine efforts to enforce international treaties to ban biological and chemical weapons. The public health community should acknowledge the substantial harm that bioterrorism preparedness has already caused and develop mechanisms to increase our public health resources and to allocate them to address the world's real health needs.

Anthrax↗
PubMed2004

Legal and public policy responses of states to bioterrorism.

In late 2001, during the aftermath of the anthrax letter attacks, model legislation was proposed to relevant state agencies to update their states' public health laws to meet the threat of bioterrorism. This legislation was the Model State Emergency Health Powers Act. A concern underlying this and related efforts to address future bioterrorism threats was the perceived inadequacy of state laws to respond effectively when such threats occur. We evaluated how 4 states--Utah, Maine, South Dakota, and Indiana--addressed this concern in the context of the model legislation. The conclusion is that the model legislation generally served as an important catalyst for state action in the field of bioterrorism preparation.

Anthrax↗
PubMed2002

Call-tracking data and the public health response to bioterrorism-related anthrax.

After public notification of confirmed cases of bioterrorism-related anthrax, the Centers for Disease Control and Prevention's Emergency Operations Center responded to 11,063 bioterrorism-related telephone calls from October 8 to November 11, 2001. Most calls were inquiries from the public about anthrax vaccines (58.4%), requests for general information on bioterrorism prevention (14.8%), and use of personal protective equipment (12.0%); 882 telephone calls (8.0%) were referred to the state liaison team for follow-up investigation. Of these, 226 (25.6%) included reports of either illness clinically confirmed to be compatible with anthrax or direct exposure to an environment known to be contaminated with Bacillus anthracis. The remaining 656 (74.4%) included no confirmed illness but reported exposures to "suspicious" packages or substances or the receipt of mail through a contaminated facility. Emergency response staff must handle high call volumes following suspected or actual bioterrorist attacks. Standardized health communication protocols that address contact with unknown substances, handling of suspicious mail, and clinical evaluation of suspected cases would allow more efficient follow-up investigations of clinically compatible cases in high-risk groups.

Anthrax↗
PubMed2002

Laboratory response to anthrax bioterrorism, New York City, 2001.

In October 2001, the greater New York City Metropolitan Area was the scene of a bioterrorism attack. The scale of the public response to this attack was not foreseen and threatened to overwhelm the Bioterrorism Response Laboratory's (BTRL) ability to process and test environmental samples. In a joint effort with the Centers for Disease Control and Prevention and the cooperation of the Department of Defense, a massive effort was launched to maintain and sustain the laboratory response and return test results in a timely fashion. This effort was largely successful. The development and expansion of the facility are described, as are the special needs of a BTRL. The establishment of a Laboratory Bioterrorism Command Center and protocols for sample intake, processing, reporting, security, testing, staffing, and and quality control are also described.

Algorithms↗
PubMed2004

Evaluating detection and diagnostic decision support systems for bioterrorism response.

We evaluated the usefulness of detection systems and diagnostic decision support systems for bioterrorism response. We performed a systematic review by searching relevant databases (e.g., MEDLINE) and Web sites for reports of detection systems and diagnostic decision support systems that could be used during bioterrorism responses. We reviewed over 24,000 citations and identified 55 detection systems and 23 diagnostic decision support systems. Only 35 systems have been evaluated: 4 reported both sensitivity and specificity, 13 were compared to a reference standard, and 31 were evaluated for their timeliness. Most evaluations of detection systems and some evaluations of diagnostic systems for bioterrorism responses are critically deficient. Because false-positive and false-negative rates are unknown for most systems, decision making on the basis of these systems is seriously compromised. We describe a framework for the design of future evaluations of such systems.

Bioterrorism↗
PubMed2004

Integrating bioterrorism education into nursing school curricula.

Due to the events of September 11, 2001 and the bioterrorism-related anthrax episodes, the United States has escalated efforts to better prepare the nation for terrorist attacks. Early recognition and management of a biological attack are largely dependent on the clinical expertise of frontline health care personnel. Nurses are recognized as an integral part of this team. Schools of nursing should integrate bioterrorism education into their curricula to address this growing frontier of health care management. This article outlines the necessary components of bioterrorism education for nurses, reviews examples of available resources to facilitate its inclusion, and suggests ways to integrate this material into nursing curricula.

Anthrax↗
PubMed2002

Confronting bioterrorism: physicians on the front line.

The events surrounding September 11, 2001, and its aftermath have compelled the public health and medical community to face the hitherto unfamiliar reality of bioterrorism. Physicians and public health personnel are frontline soldiers in this new form of warfare. This article provides a general overview of the pathophysiology, clinical presentation, diagnosis, and management of patients infected with the 6 highest priority agents that could potentially be used in bioterrorism. The diseases discussed include anthrax, smallpox, tularemia, plague, botulism, and viral hemorrhagic fevers. Despite the unpredictable nature of bioterrorism, disaster preparedness and knowledge of essential diagnostic and epidemiological principles can contribute substantially toward combating this new threat.

Anthrax↗
PubMed2002

The microbiology laboratory's role in response to bioterrorism.

CONTEXT: Bioterrorism has existed since before the 14th century; however, the specter of such an attack is much greater today than ever before. Technical expertise in microbiology and molecular testing, combined with the rapidity of worldwide air travel, has ensured that no geographic area would be untouched in a widespread attack. Clinical microbiology laboratories will play a pivotal role in the detection of attacks involving weapons of mass destruction. OBJECTIVE: To identify and discuss the microorganisms most likely to be used as agents of bioterrorism. DATA SOURCES: Data were obtained from literature searches from 1997 through June 2001 using the subject headings of bioterrorism, biological weapons, biological warfare, anthrax, brucellosis, tularemia, smallpox, plague, and botulism. In addition, information was obtained from publications of the Center for Civilian Studies, Johns Hopkins University, the Centers for Disease Control and Prevention, American Society for Microbiology, and the United States Army Medical Research Institute of Infectious Diseases. DATA EXTRACTION AND SYNTHESIS: Findings obtained from these studies and publications were analyzed for the most likely microorganisms that would be involved in a bioterrorist attack and the most efficient means by which they could be identified. In all instances, the guidelines from the Centers for Disease Control and Prevention for Level A laboratories were observed. CONCLUSIONS: The most likely microorganisms to be utilized as biological weapons include Bacillus anthracis (anthrax), Brucella species (brucellosis), Clostridium botulinum (botulism), Francisella tularensis (tularemia), Yersinia pestis (plague), and variola major (smallpox). While knowledge of the potential of these microorganisms is critical, clinical microbiologists and medical technologists possess the basic tools to rule out the suspected pathogens or to refer these isolates to public health laboratories for identification and susceptibility testing.

Bacillus anthracis↗
PubMed2000

[Bioterrorism--a public and health threat].

In recent years the fear of bioterrorism, of secret modernization and dissemination of biological weapons is increasing. Facts detected recently in Iran, Japan and the former Soviet Union provide evidence that there are countries and dissident groups which have access to modern technology of cultivation of dangerous pathogens as well as motivation for their use in acts of terrorism or war. The menace of biological terrorism is nowadays, as compared with the past, much greater. The most feared candidates as regards production of biological weapons are the pathogens of smallpox, anthrax and plague. The author discusses the serious character of possible events associated with terrorist dissemination of these pathogens. It is much esier to produce and use biological weapons than to create effective systems of defence against them. The menace of bioterrorism and bioweapons must not be exaggerated nor underestimated. The possible terrorist use of bioweapons is real. At present even the most advanced industrial countries cannot quarantee effective protection of their populations. Fortunately they are however aware of their present vulnerability. Our society is not equipped to cope with bioterrorism. Preparation and reinforcement of the health services, in particular of sections specialized in the control of infectious diseases is an effective step to divert the sequelae and suffering associated with terrorist use of biological agents. It is essential to be prepared. This calls for time and funds which unfortunately are not plentiful.

Anthrax↗
PubMed2000

A Swedish/European view of bioterrorism.

Bioterrorism includes possible use of Weapons of Mass Destruction (WMD), preferably biological agents, by non-state terrorist groups as well as criminal clusters. The threat from terrorists to utilize biological agents to achieve goals is not new, but the threshold to realize the threats seems to be lower than previously expected. It can be argued that as targets for bioterrorism Sweden and Europe are less likely than is the U.S. However, with the collapse of the former Soviet Union heavy mafia-based groups have emerged in Russia with the intent to obtain and trade material and utilities for the creation of WMD. Such activities are reaching far beyond the borders and can thus be found in Sweden as well as the other countries of Europe. This together with the fact that groups of different shades of political opinion can come in open conflict in the most unexpected countries of Europe have given bioterrorism a face in Sweden, as well as in the rest of Europe.

Animals↗
PubMed2001

Update: Investigation of bioterrorism-related anthrax and interim guidelines for clinical evaluation of persons with possible anthrax.

Since October 3, 2001, CDC and state and local public health authorities have been investigating cases of bioterrorism-related anthrax. This report updates findings as of October 31, and includes interim guidelines for the clinical evaluation of persons with possible anthrax. A total of 21 cases (16 confirmed and five suspected) of bioterrorism-related anthrax have been reported among persons who worked in the District of Columbia, Florida, New Jersey, and New York City (Figure 1). Until the source of these intentional exposures is eliminated, clinicians and laboratorians should be alert for clinical evidence of Bacillus anthracis infection. Epidemiologic investigation of these cases and surveillance to detect new cases of bioterrorism-associated anthrax continues.

Adult↗
PubMed2002

[Bioterrorism].

The terror attacks of the September 11, 2001 in the U.S.A followed by the proliferation of anthrax using mail in some US cities and abroad, demonstrated the complex, devastating and harmful nature of terror activity. The use of weapons of mass destruction (WMD) in terrorist activities is a reality as is the use of biological weapons (BW) in bioterrorism. Cyberterrorism is another form of non-conventional terrorism. The health care system throughout all its different components and layers--public health, primary care, hospitals, first responders etc., must be prepared. The complete network must have a comprehensive contingency plan for any possible BW scenario. The health care system must cope successfully with the challenge of early diagnosis of extraordinary illness or outbreak of disease, having the ability to define any bioterror event and to conduct appropriate risk assessments. It is of great importance to prepare in advance a comprehensive coordinated plan with all other governmental ministries and agencies. In order to succeed it is crucial that the top decision makers--the Prime Minister and government members and top ranking officials at the Ministry of Health, be committed, and continuously proactive in the complicated and lengthy process of preparing the health care system for a bioterrorism event.

Bioterrorism↗
PubMedDate not supplied

After 9/11: priority focus areas for bioterrorism preparedness in hospitals.

Following the terrorist attacks of September 11, 2001, bioterrorism preparedness was a priority in hospitals, but it did not remain a priority. As a result, hospitals are still unprepared to deal with the effects of a bioterrorist attack. The government has provided initial funding to state and local governments for bioterrorism preparedness; however, much of this money has yet to reach hospitals. With the inadequate funding available to hospitals, four initial measures must be focused on. These focus areas are community involvement, hospital staff education, information technology and disease surveillance improvement, and additional equipment and staff acquisition. Hospitals should also make bioterrorism-preparedness planning a regional effort.

Bioterrorism↗
PubMed2005

Registration of food facilities under the Public Health Security and Bioterrorism Preparedness and Response Act of 2002. Final rule.

The Food and Drug Administration (FDA) is issuing a final regulation that confirms the interim final rule entitled "Registration of Food Facilities Under the Public Health Security and Bioterrorism Preparedness and Response Act of 2002" (68 FR 58894, October 10, 2003 (interim final rule) as corrected by a technical amendment (69 FR 29428, May 24, 2004), and responds to comments submitted in response to the request for comments in the interim final rule. This final rule affirms the interim final rule's requirement that domestic and foreign facilities that manufacture/process, pack, or hold food for human or animal consumption in the United States be registered with FDA by December 12, 2003. The interim final rule implemented the Public Health Security and Bioterrorism Preparedness and Response Act of 2002 (the Bioterrorism Act), which requires domestic and foreign facilities to be registered with FDA by December 12, 2003. This final rule does not make any changes to the regulatory requirements established by the interim final rule.

Bioterrorism↗
PubMed2003

The critical role of pathology in the investigation of bioterrorism-related cutaneous anthrax.

Cutaneous anthrax is a rare zoonotic disease in the United States. The clinical diagnosis traditionally has been established by conventional microbiological methods, such as culture and gram staining. However, these methods often yield negative results when patients have received antibiotics. During the bioterrorism event of 2001, we applied two novel immunohistochemical assays that can detect Bacillus anthracis antigens in skin biopsy samples even after prolonged antibiotic treatment. These assays provided a highly sensitive and specific method for the diagnosis of cutaneous anthrax, and were critical in the early and rapid diagnosis of 8 of 11 cases of cutaneous anthrax during the outbreak investigation. Skin biopsies were obtained from 10 of these 11 cases, and histopathological findings included various degrees of ulceration, hemorrhage, edema, coagulative necrosis, perivascular inflammation, and vasculitis. Serology was also an important investigation tool, but the results required several weeks because of the need to test paired serum specimens. Other tests, including culture, special stains, and polymerase chain reaction assay, were less valuable in the diagnosis and epidemiological investigation of these cutaneous anthrax cases. This report underscores the critical role of pathology in investigating potential bioterrorism events and in guiding epidemiological studies, a role that was clearly demonstrated in 2001 when B. anthracis spores were intentionally released through the United States postal system.

Adult↗
PubMed2006

Bioterrorism: management of major biological agents.

Bioterrorism is defined by the intentional or threatened of microorganisms or toxins derived from living organisms to cause death or diseases in humans, animals or plants on which we depend. The other major point is to generate fear in the population. More than 180 pathogens have been reported to be potential agents for bioterrorism. The following is an overview of several agents that could be involved in a biological attack.

Anthrax↗