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PubMed2003

Increasing nursing research opportunities in biodefense: National Institute of Nursing Research Science workgroup.

The threat of bioterrorism and the need for biodefense are new challenges for the scientific community. Bioterrorism already has had significant effects on the nation's health. Researchers involved in nursing research are addressing these effects and the many issues relevant to biodefense. To explore the role and potential contributions of nursing research in these arenas, the National Institute of Nursing Research (NINR) recently convened a science workgroup. The workgroup highlighted current knowledge in biodefense, suggested opportunities for nursing research, and proposed specific research topics and research training needs. The topics are integral to the strategic plan on biodefense developed by the National Institutes of Health and include biologic, behavioral, applied/translational, and health systems research. Nurse researchers can contribute particularly to biologic studies directed toward effective diagnosis, treatment, and prevention of the effects of bioterrorism and biodefense.

Bioethical Issues↗
PubMed2005

Proteomics for biodefense applications: progress and opportunities.

The increasing threat of bioterrorism and continued emergence of new infectious diseases has driven a major resurgence in biomedical research efforts to develop improved treatments, diagnostics and vaccines, as well as increase the fundamental understanding of the host immune response to infectious agents. The availability of multiple mass spectrometry platforms combined with multidimensional separation technologies and microbial genomic databases provides an unprecedented opportunity to develop these much needed resources. An overview of current proteomic strategies applied to microbes and viruses considered potential bioterrorism agents is presented. The emerging area of immunoproteomics as applied to the development of new vaccine targets is also summarized. These powerful research approaches can generate a multitude of potential new protein targets; however, translating these proteomic discoveries to useful counter-bioterrorism products will require large collaborative research efforts across multiple basic science and clinical disciplines. A translational proteomic research paradigm illustrating this approach using influenza virus as an example is discussed.

Adult↗
PubMed2002

Anthrax revisited.

BACKGROUND: Anthrax is an ancient disease affecting animals and humans. Sporadic cases of anthrax and small epidemics have been seen from time to time in different parts of the world and in Africa. However many clinicians are not very familiar with the various presentations and management of anthrax. It is relevant for the health care workers to re-familiarise themselves with all aspects of anthrax, with the impending threat of bioterrorism. OBJECTIVE: To familiarise healthcare workers on all aspects of anthrax. STUDY SELECTION: To describe epidemiology pathogenesis, clinical features, management and prevention of anthrax including measures to take when weapons grade anthrax is suspected. DATA SYNTHESIS: Three forms of the disease are recognised, cutaneous, inhalational and intestinal. Cutaneous anthrax is the most common form. Inhalation anthrax is the most severe form of anthrax. The treatment of anthrax in most cases is penicillin, however with the threat of bioterrorism, intentional releases of anthrax spores in the environment has caused much concern. Weapons grade anthrax of more virulent strain and resistant to commonly used antibiotics is possible. CONCLUSION: In view of the different clinical presentations and outcomes it is important that health care workers re-familiarise themselves with the disease and in the event of bioterrorism are able to take appropriate measures.

Africa↗
PubMed2002

Planning for biological disasters. Occupational health nurses as "first responders".

1. As a result of recent terrorist events, there is an immediate need for occupational nurses to review their disaster plans and to develop strategies to cope with bioterrorism in their workplaces. 2. The Centers for Disease Control and Prevention has identified three major categories of biological weapons. Category A, which is the highest priority category (and the focus of this article), includes smallpox, anthrax, botulism, plague, tularemia, filoviruses, and adenoviruses. Dealing with bioterrorism requires occupational health nurses to be familiar with these organisms, including their pathophysiology and methods of prevention, detection, and treatment. 3. Five principles can be used to guide responses to a biological attack. Incorporation of these principles into disaster planning will increase the effectiveness of responses to bioterrorism, if and when it occurs. Developing a plan of action before an event occurs will greatly enhance the likelihood that the repercussions of such an event are minimized.

Anthrax↗
PubMed2005

Viral vectors for use in the development of biodefense vaccines.

The heightened concerns about bioterrorism and the use of biowarfare agents have prompted substantial increased efforts towards the development of vaccines against a wide range of organisms, toxins, and viruses. An increasing variety of platforms and strategies have been analyzed for their potential as vaccines against these agents. DNA vectors, live-attenuated viruses and bacteria, recombinant proteins combined with adjuvant, and viral- or bacterial-vectored vaccines have been developed as countermeasures against many potential agents of bioterrorism or biowarfare. The use of viruses, for example adenovirus, vaccinia virus, and Venezuelan equine encephalitis virus, as vaccine vectors has enabled researchers to develop effective means for countering the threat of bioterrorism and biowarfare. An overview of the different viral vectors and the threats they counter will be discussed.

Animals↗
PubMed2003

Syndromic surveillance using automated collection of computerized discharge diagnoses.

The Syndromic Surveillance Information Collection (SSIC) system aims to facilitate early detection of bioterrorism attacks (with such agents as anthrax, brucellosis, plague, Q fever, tularemia, smallpox, viral encephalitides, hemorrhagic fever, botulism toxins, staphylococcal enterotoxin B, etc.) and early detection of naturally occurring disease outbreaks, including large foodborne disease outbreaks, emerging infections, and pandemic influenza. This is accomplished using automated data collection of visit-level discharge diagnoses from heterogeneous clinical information systems, integrating those data into a common XML (Extensible Markup Language) form, and monitoring the results to detect unusual patterns of illness in the population. The system, operational since January 2001, collects, integrates, and displays data from three emergency department and urgent care (ED/UC) departments and nine primary care clinics by automatically mining data from the information systems of those facilities. With continued development, this system will constitute the foundation of a population-based surveillance system that will facilitate targeted investigation of clinical syndromes under surveillance and allow early detection of unusual clusters of illness compatible with bioterrorism or disease outbreaks.

Bioterrorism↗
PubMed2005

Microbial forensics: the next forensic challenge.

Pathogens and toxins can be converted to bioweapons and used to commit bioterrorism and biocrime. Because of the potential and relative ease of an attack using a bioweapon, forensic science needs to be prepared to assist in the investigation to bring perpetrators to justice and to deter future attacks. A new subfield of forensics--microbial forensics--has been created, which is focused on characterization of evidence from a bioterrorism act, biocrime, hoax, or an inadvertent release. Forensic microbiological investigations are essentially the same as any other forensic investigation regarding processing. They involve crime scene(s) investigation, chain of custody practices, evidence collection, handling and preservation, evidence shipping, analysis of evidence, interpretation of results, and court presentation. In addition to collecting and analyzing traditional forensic evidence, the forensic investigation will attempt to determine the etiology and identity of the causal agent, often in a similar fashion as in an epidemiologic investigation. However, for attribution, higher-resolution characterization is needed. The tools for attribution include genetic- and nongenetic-based assays and informatics to attempt to determine the unique source of a sample or at least eliminate some sources. In addition, chemical and physical assays may help determine the process used to prepare, store, or disseminate the bioweapon. An effective microbial forensics program will require development and/or validation of all aspects of the forensic investigative process, from sample collection to interpretation of results. Quality assurance (QA) and QC practices, comparable to those used by the forensic DNA science community, are being implemented. Lastly, partnerships with other laboratories will be requisite, because many of the necessary capabilities for analysis will not reside in the traditional forensic laboratory.

Bioterrorism↗
PubMed2005

Vaccines against the category B toxins: Staphylococcal enterotoxin B, epsilon toxin and ricin.

The threat of bioterrorism worldwide has accelerated the demand for the development of therapies and vaccines against the Category B toxins: staphylococcal enterotoxin B (SEB), epsilon toxin (ETX) produced by Clostridium perfringens types B and D, and ricin, a natural product of the castor bean. The diverse and unique nature of these toxins poses a challenge to vaccinologists. While formalin-inactivated toxins can successfully induce antibody-mediated protection in animals, their usefulness in humans is limited because of potential safety concerns. For this reason, research is now aimed at developing recombinant, attenuated vaccines based on a detailed understanding of the molecular mechanisms by which these toxins function. Vaccine development is further complicated by the fact that as bioterrorism agents, SEB, ETX and ricin would most likely be disseminated as aerosols or in food/water supplies. Our understanding of the mechanisms by which these toxins cross mucosal surfaces, and importance of mucosal immunity in preventing toxin uptake is only rudimentary.

Animals↗
PubMed2005

Management of patients infected with airborne-spread diseases: an algorithm for infection control professionals.

BACKGROUND: Many US hospitals lack the capacity to house safely a surge of potentially infectious patients, increasing the risk of secondary transmission. Respiratory protection and negative-pressure rooms are needed to prevent transmission of airborne-spread diseases, but US hospitals lack available and/or properly functioning negative-pressure rooms. Creating new rooms or retrofitting existing facilities is time-consuming and expensive. METHODS: Safe methods of managing patients with airborne-spread diseases and establishing temporary negative-pressure and/or protective environments were determined by a literature review. Relevant data were analyzed and synthesized to generate a response algorithm. RESULTS: Ideal patient management and placement guidelines, including instructions for choosing respiratory protection and creating temporary negative-pressure or other protective environments, were delineated. Findings were summarized in a treatment algorithm. CONCLUSION: The threat of bioterrorism and emerging infections increases health care's need for negative-pressure and/or protective environments. The algorithm outlines appropriate response steps to decrease transmission risk until an ideal protective environment can be utilized. Using this algorithm will prepare infection control professionals to respond more effectively during a surge of potentially infectious patients following a bioterrorism attack or emerging infectious disease outbreak.

Air Microbiology↗
PubMed2006

Nurses' beliefs about public health emergencies: fear of abandonment.

BACKGROUND: Since the events of September 11, 2001, subsequent anthrax mailings, world political events, and natural disasters such as Hurricane Katrina and the recent tsunami, public health emergencies including bioterrorism events are viewed as realistic possibilities. Public health emergencies would stress the current health care system. OBJECTIVE: The objective was to identify beliefs and concerns of nurses who work in hospitals designated as receiving sites during public health emergencies. METHODS: A qualitative study using focus groups with a total of 33 hospital nurses in 2003 was used. Audiotapes were analyzed, and codes, categories, and a theme were identified. RESULTS: Fear of abandonment was the overarching theme. Nurses believed that clinical settings would be chaotic, without a clear chain of command, and with some colleagues refusing to work. Limited access to personal protective equipment, risk of infection, unmanageable numbers of patients, and possibly being assaulted for their personal protective equipment resulted in the sense that they would be in unsafe clinical environments. Loss of freedom to leave the hospital and fears that hospitals would not provide treatment to nurses who become ill as a result of caring for patients contributed to the sense of abandonment. CONCLUSION: Although these nurses worked in hospitals with comprehensive public health emergency plans, they believed that they would not have readily accessible material and human resources to cope with a bioterrorism event. Readiness plans should include a systematic assessment of nurses' concerns. Health care readiness plans should incorporate focused interventions to improve safety, a sense of control, and facilitate coping in public health emergencies.

Attitude of Health Personnel↗
PubMed2004

A call to arms-the role of the dermatologist as front line responder.

As the risk of bioterrorism becomes an increasingly significant issue in the United States and the world, dermatologists have found themselves as partners or front line participants in the effort to prepare for and respond to such a threat. In what was previously an unfamiliar part of practice for most dermatologists, bioterrorism has required that providers familiarize themselves with the pathophysiology, clinical presentation, diagnosis,and management of diseases from agents that could potentially be used.

Biological Warfare↗
PubMed2004

Genetics and attribution issues that confront the microbial forensics field.

The commission of an act of bioterrorism or biocrime is a real concern for law enforcement and society. Efforts are underway to develop a strong microbial forensic program to assist in identifying perpetrators of acts of bioterrorism and biocrimes, as well as serve as a deterrent for those who might commit such illicit acts. Genetic analyses of microbial organisms will likely be a powerful tool for attribution of criminal acts. There are some similarities to forensic human DNA analysis practices, such as: molecular biology technology, use of population databases, qualitative conclusions of test results, and the application of QA/QC practices. Differences include: database size and composition, statistical interpretation methods, and confidence/uncertainty in the outcome of an interpretation.

Bioterrorism↗
PubMed2003

Combating high-priority biological agents: What to do with drug-allergic patients and those for whom vaccination is contraindicated?

The threat of bioterrorism continues to be a very real one. Regularly, there are news stories on bioterrorism-related topics: What biologic weapons will our enemies likely use to attack the United States? How prepared is our country to successfully counter such attacks? Although these critical questions are being addressed by the leaders of our country, allergists-immunologists, too, will have to grapple with difficult questions during these uncertain and frightening times. We care for a special group of patients with various allergic and immunologic disorders. Some of our patients have immunodeficiency disorders that might preclude them from receiving life-saving vaccines. Our patients with drug allergies are fearful that should they become infected with a biologic agent, they will not be able to receive appropriate treatment. In this article we focus on the various vaccine-related and antibiotic-related adverse effects that the allergist-immunologist might see during treatment of infections caused by Category A agents. Where possible, potential management approaches are outlined.

Anti-Bacterial Agents↗
PubMed2005

To be vaccinated or not? A survey of Turkish emergency physicians regarding smallpox.

We investigated Turkish emergency physicians' opinions about the threat of smallpox, smallpox vaccination, and the treatment of patients with suspected smallpox, and sought to identify factors that affect willingness to receive smallpox vaccination. Anonymous surveys were sent by mail to university-affiliated Emergency Departments in Turkey. Ten of the 21 university-based Emergency Medicine programs participated in the study, and 125 physicians (48% of all emergency physicians in Turkey) completed the survey. The probability of a bioterror attack using smallpox within Turkish borders was viewed as none or minimal by 43.2% of participants. Only 22.4% of the participants stated that they would agree to be vaccinated. The only factor that affected the rate of participants' willingness to receive smallpox vaccination was the occurrence of a smallpox case within Turkish borders. Decisions about the treatment of patients with suspected smallpox are strongly influenced by whether or not the physician has been vaccinated against smallpox. At the time of the survey, even during the weeks leading up to and during the war in Iraq, Turkish emergency physicians' perceived risk of a bioterror attack using the smallpox virus was low. A significant number of Turkish emergency physicians were unwilling to participate in a hypothetical vaccination program. This study shows that the occurrence of a smallpox case within Turkish borders would significantly increase the willingness of emergency physicians to receive the smallpox vaccine. Decisions about treatment of patients with suspected smallpox are strongly influenced by whether or not the physician has been vaccinated against smallpox.

Adult↗
PubMed2002

Diagnostic analyses of biological agent-caused syndromes: laboratory and technical assistance.

The impact of a bioterrorism attack can be greatly reduced by collaboration among primary healthcare providers, laboratories, the veterinary community, public health officials, and emergency response personnel. Improved communication and coordination are essential to make this happen. As a first-line provider, the emergency physician must keep in mind the possibility of bioterrorism and alert the laboratory so that samples can be processed in the correct fashion. New and exciting developments in laboratory organization, communication, and diagnostic capabilities will ensure that all patients receive the best possible care.

Animal Diseases↗
PubMed2006

Discernment between deliberate and natural infectious disease outbreaks.

Public health authorities should be vigilant to the potential for outbreaks deliberately caused by biological agents (bioterrorism). Such events require a rapid response and incorporation of non-traditional partners for disease investigation and outbreak control. The astute application of infectious disease epidemiological principles can promote an enhanced index of suspicion for such events. We discuss epidemiological indicators that should be considered during outbreak investigations, and also examine their application during bioterrorism incidents, an accidental release of an agent, outbreaks of infections that were alleged to have been deliberately initiated, and a model scenario. The Grunow & Finke epidemiological assessment tool is used to examine these historical events and the model scenario. The results received from this analysis, coupled with an understanding of epidemiological clues to unnatural events, and knowledge of how to manage such events, can aid in the improved response and resolution of epidemics.

Anthrax↗
PubMed2004

A local department of public health and the geospatial data infrastructure.

Local health departments (LHD) are the most widely distributed aspect of the United States public health infrastructure. The role of LHDs has changed since the terrorist attacks of September 11, 2001, and an increased concern about bioterrorism. This concern resulted in more emphasis on disease surveillance and the need for new institutional linkages of LHDs with other entities for effective response. These changes coincide with technological changes in spatial data integration and the growth of medical informatics in public health. The integration of GIS into the daily work of an LHD holds promise of improving not only bioterrorism response capabilities, but also the management of emerging infectious diseases, such as West Nile Virus or food borne illness, as well as longstanding programs focused on nutrition and safety. Still, the impediments to using GIS at an LHD remain strong as funding decisions and a complex technology continue to challenge implementation efforts.

Bioterrorism↗