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PubMed2005

Adenovirus-based genetic vaccines for biodefense.

The robust host responses elicited against transgenes encoded by (E1-)(E3-) adenovirus (Ad) gene transfer vectors can be used to develop Ad-based vectors as platform technologies for vaccines against potential bioterror pathogens. This review focuses on pathogens of major concern as bioterror agents and why Ad vectors are ideal as anti-bioterror vaccine platforms, providing examples from our laboratories of using Ad vectors as vaccines against potential bioterror pathogens and how Ad vectors can be developed to enhance vaccine efficacy in the bioterror war.

AIDS Vaccines↗

PubMed2002

Public health nursing practice: aftermath of September 11, 2001.

America's experience on September 11, 2001, forms the backdrop of this review of the public health nursing role in bioterrorism preparedness. The risks and challenges to the public health infrastructure are reviewed in order to place bioterrorism preparedness in a public health context. A review of the literature provides background material on the extent to which public health has evolved in planning for a bioterrorism event. The skills and competencies that will prepare public health nurses in their planning for and response to threats of bioterrorism are addressed. Anthrax is used as an example to illustrate how public health nursing can assist in a bioterrorism response.

Anthrax↗

PubMed2003

Terrorism: a public health threat with a trauma system response.

BACKGROUND: The threat of mass casualties and widespread infectious disease caused by terrorism is now a challenge for our government and public health system. Funds have been granted to the states by the Centers for Disease Control and Prevention and the Health Resources and Services Administration to establish bioterrorism preparedness and response capabilities. METHODS: Hartford Hospital has been designated as a Center of Excellence for Bioterrorism Preparedness by the Commissioner of the Connecticut Department of Public Health. The Center of Excellence has implemented strategies to prepare for a possible bioterrorist attack. A unique model that combines epidemiology and traumatology is being used to guide the preparedness activities. Although the focus of the grant from the Connecticut Department of Public Health is bioterrorism, the application of the model can apply to preparation for all terrorist events. RESULTS: Implementation of strategies indicates that bioterrorism preparedness is well underway. Similar initiatives should be achievable by other trauma systems throughout the country. CONCLUSION: A Center of Excellence for Bioterrorism Preparedness in Connecticut is successfully modifying a trauma system to meet the challenge of a new public health threat, terrorism.

Centers for Disease Control and Prevention, U.S.↗

PubMed2001

Psychological effects of biological warfare.

We compare and contrast psychological and behavioral reactions to bioterrorism with responses to the use of traditional and chemical weapons by terrorists. We discuss the characteristics of biological agents that make them potent agents of terror. We suggest strategies for preparation and response to bioterrorism. We reviewed the literature on psychological, behavioral, and social responses to terrorism, natural disasters, and infectious disease outbreaks. The first psychiatric intervention is to ensure good medical care for illness. Initial psychosocial interventions also include effective and accurate risk communication, management of misattribution of somatic symptoms, and the creation of a recovery environment that restores effective social roles and returns people to their usual sources of social support. Bioterrorism presents special challenges for our society. Domestic bioterrorism preparedness and response plans should reflect realistic consideration of psychological, behavioral, and societal reactions to this novel weapon.

Behavior↗

PubMed2002

[Detection and identification of a biological attack].

It is difficult to detect bioterrorism attacks and to identify the castoff biological agent. The principal enigmas are the wide variety of the clinical symptoms associated with various biological agents and the fact that the attack is likely to be a covert event. The first and major indication of a bioterrorism attack could be the presence of affected patients. It is, however, extremely important to detect and identify an attack using a biological agent as early as possible. Therefore, it is crucial to be alert to such possibilities and to maintain high levels of suspicion. The aim of this article is to list all the clues, which will help us highlight the suspicion that a disease or clinical symptoms are the result of a bioterrorism attack and not a "natural" outbreak. These clues involve the recognition of a wide range of clinical patterns pertinent to biological agent attacks on the individual victim and the overall integrated epidemiological picture. Further signs also include the identification of the roots of transmission, the contagious patterns of bioterrorism agents and possible unusual findings in laboratory tests and in animals.

Bioterrorism↗

PubMed2002

[The spectrum of symptoms associated with biological warfare].

BACKGROUND: There are hundreds of potential agents that could be used in biological warfare or bioterrorism: bacteria, viruses and toxins. There are no similarities between clinical presentations of organisms or toxins belonging to specific microbial families. Therefore, it is important for the physician, required to cope with an unusual disease or outbreak among his patients, to become familiar with the various symptoms that victims of biological warfare or bioterrorism may present. METHODS: To describe the six most common groups of symptoms expected in the above setting. The most common symptoms will be described as they appear in nature, because of a fortunate lack of experience with the majority of these agents in biological warfare. Hence, variations of these presentations may be possible. RESULTS: The six most common presentations reviewed are: 1) respiratory tract symptoms; 2) hemorrhagic fevers; 3) meningitis and encephalitis; 4) flaccid paralyses; 5) fever syndromes with rash; and 6) diarrheal syndromes. Additional presentations may be possible due to alterations made in these organisms or development of new agents and mixtures. A list is provided of features that may alert a physician of the possibility of biological warfare or bioterrorism. CONCLUSION: Knowledge of the principal clinical presentations of victims of biological warfare or bioterrorism is essential to all physicians. This knowledge may contribute to the early recognition of a cluster of patients, an epidemic, an unusual disease, or biological warfare; quick referral to the emergency department, leading to early microbiological diagnosis; and rapid notification of the Ministry of Health. All these, and the institution of appropriate measures, will ultimately contribute to the survival of individual patients and at-risk populations.

Biological Warfare↗

PubMed2003

Planning against biological terrorism: lessons from outbreak investigations.

We examined outbreak investigations conducted around the world from 1988 to 1999 by the Centers for Disease Control and Prevention's Epidemic Intelligence Service. In 44 (4.0%) of 1,099 investigations, identified causative agents had bioterrorism potential. In six investigations, intentional use of infectious agents was considered. Healthcare providers reported 270 (24.6%) outbreaks and infection control practitioners reported 129 (11.7%); together they reported 399 (36.3%) of the outbreaks. Health departments reported 335 (30.5%) outbreaks. For six outbreaks in which bioterrorism or intentional contamination was possible, reporting was delayed for up to 26 days. We confirmed that the most critical component for bioterrorism outbreak detection and reporting is the frontline healthcare profession and the local health departments. Bioterrorism preparedness should emphasize education and support of this frontline as well as methods to shorten the time between outbreak and reporting.

Bioterrorism↗

PubMed2004

One-year health assessment of adult survivors of Bacillus anthracis infection.

CONTEXT: Little is known about potential long-term health effects of bioterrorism-related Bacillus anthracis infection. OBJECTIVE: To describe the relationship between anthrax infection and persistent somatic symptoms among adults surviving bioterrorism-related anthrax disease approximately 1 year after illness onset in 2001. DESIGN, SETTING, AND PARTICIPANTS: Cross-sectional study of 15 of 16 adult survivors from September through December 2002 using a clinical interview, a medical review-of-system questionnaire, 2 standardized self-administered questionnaires, and a review of available medical records. MAIN OUTCOME MEASURES: Health complaints summarized by the body system affected and by symptom categories; psychological distress measured by the Revised 90-Item Symptom Checklist; and health-related quality-of-life indices by the Medical Outcomes Study 36-Item Short-Form Health Survey (version 2). RESULTS: The anthrax survivors reported symptoms affecting multiple body systems, significantly greater overall psychological distress (P<.001), and significantly reduced health-related quality-of-life indices compared with US referent populations. Eight survivors (53%) had not returned to work since their infection. Comparing disease manifestations, inhalational survivors reported significantly lower overall physical health than cutaneous survivors (mean scores, 30 vs 41; P =.02). Available medical records could not explain the persisting health complaints. CONCLUSION: The anthrax survivors continued to report significant health problems and poor life adjustment 1 year after onset of bioterrorism-related anthrax disease.

Absenteeism↗

PubMed2006

Lessons learned from clinical anthrax drills: evaluation of knowledge and preparedness for a bioterrorist threat in Israeli emergency departments.

STUDY OBJECTIVE: Emergency department (ED) physicians and nurses are considered critical sentinels of a bioterrorist attack. We designed a special hospital drill to test EDs' response to inhalational anthrax and assess the level of preparedness for anthrax bioterrorism. We hypothesized that the occurrence of such a drill in an ED would improve the knowledge of its physicians, even those who had not actually participated in the drill. METHODS: We conducted 23 drills at all Israeli general hospitals' EDs. An actor entered the walk-in triage area, simulating a febrile patient with lower respiratory complaints. A chest radiograph with mediastinal widening, as can be seen in early anthrax disease, was planted in the hospital's imaging results system. Patients were instructed to give additional epidemiologic clues, such as having a few friends with a similar syndrome. Either before or after the drills, we distributed multiple choice tests about diagnosis and management of anthrax to the 115 senior emergency physicians at these hospitals. RESULTS: In 91% of EDs, a decision to admit the patient was made. Sixty-one percent included anthrax in the differential diagnosis and activated the appropriate protocols. Only 43% contacted all relevant officials. Average score on the anthrax tests was 58 (of 100). Physicians who were tested before the drill (in their institution) achieved a mean score of 54.5, whereas those who were tested after their ED had been exercised achieved a mean score of 59.3. CONCLUSION: A national framework of drills on bioterrorism can help estimate and potentially augment national preparedness for bioterrorist threats. It is not, on its own, an effective educational tool. More emphasis should be given to formal accredited continuing medical education programs on bioterrorism, especially for emergency physicians and ED nurses, who will be in the front line of a bioterrorist attack.

Anthrax↗

PubMed2004

Vaccines for the prevention of diseases caused by potential bioweapons.

The development of vaccines and implementation of vaccination programs are among the most important medical contributions to humanity. To date, vaccination has reduced morbidity and mortality from infectious diseases more than any other specific medical intervention. The intentional use of bioweapons against civilians (bioterrorism), recently highlighted by events around the world, has fueled interest in the development of vaccines for potential microbial agents of bioterror. This review discusses the microbial agents that are considered to pose the greatest risk to the public, the diseases associated with them, and the vaccines that are available for their prevention. The paucity of such vaccines and uncertainty regarding mechanisms of vaccine efficacy and the microbial antigens that elicit protection underscore the need for continued study of host-microbe interaction and the immune response to potential agents of bioterror for the development of new vaccines and immune-based therapies to combat their potential to harm the public.

Biological Warfare↗

PubMed2004

Vaccines against biologic agents: uses and developments.

Although the Geneva protocol that prohibits the use of chemical and biologic weapons was ratified in 1925, many countries failed to accept this protocol: others stipulated retaliation, and some, like the United States, did not ratify the protocol for decades. This delay allowed the continued development of chemical and biologic agents. Members of the health care community are responsible for determining the best way to protect society from the potentially devastating effects of these biologic agents. Ideally,these diseases would be prevented from ever developing into systemic illnesses. In the past, vaccination has been a successful means of eradicating disease. Vaccines remain a hopeful therapy for the future, but time is short,and there are many obstacles.Information regarding bioterrorism agents and their treatments comes mainly from dated data or from in vitro or animal studies that may not apply to human treatment and disease. Additionally, the current threat of bioterrorism does not allow enough time for accurate, well-designed,controlled studies in humans before the release of investigational vaccines. Furthermore, some human studies would not be safe or ethical. Finally,many members of society suffer from illnesses that would put them at high risk to receive prophylactic vaccination. It is therefore naive to believe that vaccines would be the ultimate protection from these agents. In addition to vaccine development, there must be concurrent investigations into disease management and treatment. Even in instances in which vaccination is known to be an effective means of disease protection. biologic agents may be presented in a manner that renders vaccines ineffective. Virulent strains of organisms may be used, more than one organism may be used in tandem to increase virulence, and strains may be selected for antibiotic and vaccine resistance. Genetically engineered strains may use virulence factors other than those targeted in vaccines, and high concentrations of organisms may overcome vaccine protection. Finally,exposure may not be immediately noted until it is too late to vaccinate, as was the case with anthrax. Even in a case, such as smallpox, in which postexposure vaccination is possible, patients will still develop disease, and the health care system may be overwhelmed. The United States government has been defensively planning and researching the use of vaccines and chemoprophylaxis against any potential biologic agents since at least 1953, and resources are still lacking. There are inadequate stockpiles of vaccine to protect the entire population. The pharmaceutical industry also lacks a means of mass producing vaccines ina short timeframe. There is no policy in place for the use of vaccines that are yet unlicensed and experimental but may be the only therapy in the event ofa terrorist attack. Investigations into these solutions have been instituted only after the September 11, 2001, attacks heightened the awareness of terrorism. Although vaccination is an effective means of prophylaxis and a means of terminating epidemics or treating active disease, there is also resistance from the general public. In some instances there is a lack of acceptance of vaccines, or the risk of side effects is too great. In other cases, a questionable benefit does not justify the expense of mass vaccination. Because of this uncertainty, mass vaccination is deemed an impractical solution to the threat of bioterrorism. Extending vaccination with most vaccines to include all members of society who may be first responders in the event of an attack should be considered. In all instances, the benefit-to-risk must be weighed ratio when deciding how and when to offer preemptive prophylaxis to protect society from a real but unknown threat.

Anthrax Vaccines↗

PubMed2003

An overview of terrorism and its impact on biomedical research facilities.

Since the '9/11' and anthrax-contaminated-letter events of 2001, American society has given the term "bioterrorism" much attention. The author clarifies the definitions associated with bioterrorism and terrorism, provides an historical perspective regarding bioweapons, defines and characterizes the types of agents used as bioweapons, reviews pertinent bioterrorism legislation, and concludes by assessing the impact of these elements on biomedical research facilities.

Animal Welfare↗

PubMed2005

Genetic analysis and attribution of microbial forensics evidence.

Because of the availability of pathogenic microorganisms and the relatively low cost of preparing and disseminating bioweapons, there is a continuing threat of biocrime and bioterrorism. Thus, enhanced capabilities are needed that enable the full and robust forensic exploitation and interpretation of microbial evidence from acts of bioterrorism or biocrimes. To respond to the need, greater resources and efforts are being applied to the burgeoning field of microbial forensics. Microbial forensics focuses on the characterization, analysis and interpretation of evidence for attributional purposes from a bioterrorism act, biocrime, hoax or inadvertent agent release. To enhance attribution capabilities, a major component of microbial forensics is the analysis of nucleic acids to associate or eliminate putative samples. The degree that attribution can be addressed depends on the context of the case, the available knowledge of the genetics, phylogeny, and ecology of the target microorganism, and technologies applied. The types of genetic markers and features that can impact statistical inferences of microbial forensic evidence include: single nucleotide polymorphisms, repetitive sequences, insertions and deletions, mobile elements, pathogenicity islands, virulence and resistance genes, house keeping genes, structural genes, whole genome sequences, asexual and sexual reproduction, horizontal gene transfer, conjugation, transduction, lysogeny, gene conversion, recombination, gene duplication, rearrangements, and mutational hotspots. Nucleic acid based typing technologies include: PCR, real-time PCR, MLST, MLVA, whole genome sequencing, and microarrays.

Bacterial Typing Techniques↗

PubMedDate not supplied

New developments in health and medical preparedness related to the threat of terrorism.

Since 1999, and particularly the tragic events of September 11, 2001, the federal government has sought to prepare against the threat of bioterrorism by developing a comprehensive national "preparedness and response" program that encompasses state and local health agencies. In fiscal year 1999, approximately $150 million was made available through the Department of Health and Human Services (DHHS) to develop bioterrorism preparedness and response infrastructure in public health departments. Emergency medical services (EMS) funding was not specifically considered in this DHHS program, primarily because EMS is usually funded through traditional first-responder programs in other departments of the U.S. government. This approach may be effective in addressing some EMS needs, but it is insufficient for enhancing the emergency medical infrastructure throughout this country or for linking emergency public health and emergency medical prehospital initiatives. The role of EMS is shifting. As EMS in the future will be expected to be more comprehensive and encompass the urgent aspects of public health preparedness and response, more resources must be applied to the medical control units of EMS systems so that they may provide the most benefit to the public health and medical system. Emergency medical systems and their leadership are poised to play a critical role in national preparedness against bioterrorism. Preparedness funding within the health sector will continue to expand markedly in the near future. However, a well-developed strategy will be necessary to sustain the best linkage between EMS, hospital preparedness, and public health preparedness at the local, state, and federal levels.

Bioterrorism↗

PubMed2006

Universal influenza vaccination: the time to act is now.

Annual influenza epidemics create a significant public health burden each year in the United States. That influenza continues to pose a public health threat despite being largely preventable through vaccination is indicative of continuing weaknesses in the U.S.'s public health system. Moreover, the burden of annual influenza epidemics and the fragility and instability of the capacity to respond to them underscore the U.S.'s ongoing vulnerability to pandemic influenza and highlights gaps in bioterrorism preparedness and response efforts. This article examines the burden of annual influenza epidemics in the U.S., efforts to combat that burden with vaccination, shortcomings of influenza vaccination efforts, and how those shortcomings exemplify weaknesses in pandemic influenza and bioterrorism preparedness efforts. We make the case for establishing an annual universal influenza vaccination program to assure access to influenza vaccination to anyone who can safely receive vaccination and desires it. Such a program could greatly reduce the annual burden of influenza while advancing and maintaining U.S. pandemic influenza and bioterrorism preparedness and response efforts.

Bioterrorism↗

PubMed2004

Real-time syndrome surveillance in Ontario, Canada: the potential use of emergency departments and Telehealth.

OBJECTIVE: The purpose of this paper is to review new bioterrorist and emerging infectious threats to public health in Ontario, Canada, and to propose a means of integrating a telephone-based health information service and emergency department triage with a first-line real-time, 24-h a day syndrome surveillance system. This automated system could be beneficial in detecting a bioterrorist threat as well as in detecting and monitoring disease outbreaks such as influenza, Norwalk, West Nile virus, Escherichia coli 0157 or severe acute respiratory syndrome. METHOD: The Medline PubMed database was searched for articles relating to bioterrorism and syndromic surveillance from 1997 onwards. The websites of the Ontario Ministry of Health and Long-Term Care, Ontario Ministry of Public Safety and Security, Centers for Disease Control and Canadian Population and Public Health Branch of Health Canada were searched for articles relating to bioterrorism and syndromic surveillance. Interviews were conducted with key informants from Telehealth staff, the public health services of Ontario and the Centers for Disease Control and Prevention, Atlanta, GA, USA. RESULTS: Real-time syndrome surveillance is a new means of detecting disease outbreaks or possibly acts of bioterrorism at the first contact with the healthcare system. It has been used successfully to detect influenza outbreaks at an early stage. The system that is proposed would be a province-wide integrated early warning system for both bioterrorist events and emerging infections. It would use clusters of symptoms tied to temporal, demographic and spatial data to increase sensitivity and specificity. CONCLUSION: Real-time syndrome surveillance is an evolving science. Emergency departments and Telehealth in Ontario lend themselves as first contacts to the healthcare system as excellent opportunities to perform syndrome surveillance. They offer the opportunity properly to identify at-risk patients for emerging infections by including contact and travel data into the symptom complex. This could identify at-risk patients early and lead to appropriate public health measures. The benefit of using Telehealth in Ontario is the provincial accessibility of Telehealth and the extensive data collected on one computerized system. Emergency departments should also have a uniform computerized triage data collection system to facilitate surveillance.

Bioterrorism↗

PubMed2006

Terrorism preparedness: Web-based resource management and the TOPOFF 3 exercise.

BACKGROUND: The bombings of London on July 7, 2005 highlight the need for continued vigilance and readiness to respond to terrorist attacks. Trauma centers need to be at the core of preparedness activities. The State of Connecticut has taken a lead in preparedness and was selected as a site for the US Department of Homeland Security's Top Officials Three Exercise (TOPOFF 3), the largest and most extensive antiterrorism drill ever conducted. METHODS: All 32 acute care hospitals in Connecticut took part in the drill. The simulated attacks were designed to test all aspects of emergency preparedness including the ability of hospitals to treat large numbers of victims and effectively monitor and implement mechanisms for surge capacity. In Connecticut, TOPOFF 3 tested the Bioterrorism Preparedness Web Application that was designed to be the primary communication and resource management tool during a terrorist event or public health emergency. This paper describes: 1) the impetus for the State of Connecticut Department of Public Health's Bioterrorism Preparedness Web Application; 2) the strategies used to ensure its readiness and appropriate utilization during a public health emergency; and 3) its use for communication and resource management by the Department of Public Health and the acute care hospitals during TOPOFF 3. RESULTS: The Bioterrorism Preparedness Web Application was successfully implemented and used during TOPOFF 3 to assess surge capacity and other resources. CONCLUSIONS: Careful development and implementation of the Web application, or any communication system, as well as training and regular practice are required to ensure effective use during a public health emergency.

Bioterrorism↗

PubMed2005

Identifying sources of human exposure to plague.

Yersinia pestis, the etiologic agent of plague, has shaped the course of human history, killing millions of people in three major pandemics. This bacterium is still endemic in parts of Asia, Africa, and the Americas, where it poses a natural disease threat to human populations. Y. pestis has also recently received attention as a possible bioterrorism agent. Thus, rapid methods to distinguish between bioterrorism and naturally occurring plague infections are of major importance. Our study is the first to demonstrate that variable-number tandem repeats (VNTRs) in the Y. pestis genome can link human case isolates to those obtained from suspected environmental sources of infection. We demonstrate the valuable utility of VNTR markers in epidemiological investigations of naturally occurring plague and the forensic analysis of possible bioterrorism events.

Animals↗