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PubMed2005

The evolving field of biodefence: therapeutic developments and diagnostics.

The threat of bioterrorism and the potential use of biological weapons against both military and civilian populations has become a major concern for governments around the world. For example, in 2001 anthrax-tainted letters resulted in several deaths, caused widespread public panic and exerted a heavy economic toll. If such a small-scale act of bioterrorism could have such a huge impact, then the effects of a large-scale attack would be catastrophic. This review covers recent progress in developing therapeutic countermeasures against, and diagnostics for, such agents.

Anti-Bacterial Agents↗
PubMed2002

Laboratory diagnosis and biosafety issues of biological warfare agents.

Bioterrorism events have been rare until recently. Many clinical laboratories may not be familiar with handling specimens from a possible bioterrorism attack. Therefore, they should be aware of their own responsibilities and limitations in the handling and treatment of such specimens, and what to do if they are requested to process clinical samples. The Centers for Disease Control and Prevention has developed the Laboratory Response Network to provide an organized response system for the detection and diagnosis of biological warfare agents based on laboratory testing abilities and facilities. There are potentially many biological warfare agents, but probably a limited number of agents would be encountered in case of an attack, and their identification and laboratory safety will be discussed.

Biological Warfare↗
PubMed2002

Research opportunities in biodefense for the National Institute of Nursing Research.

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 recently convened a science work group. The work group 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.

Bioterrorism↗
PubMedDate not supplied

Dark Winter and the spring of 1972: deflecting the social lessons of smallpox.

This article examines how the master status of bioterrorism has distracted professional and political attention from the social lessons of smallpox. I illustrate this by comparing an influential bioterrorism simulation known as Dark Winter with the social history surrounding the Yugoslavian smallpox epidemic of 1972. Dark Winter's epidemiological premises were largely based upon what was learned from the Yugoslavian outbreak. Yet, although this epidemic was non-deliberate, the exercise did not attend to the social conditions within which it developed. Most notably, it did not consider that this epidemic was mainly borne by marginalized communities of Kosovan Albanians and that difficulties in controlling it were linked to the relative lack of pre-existing public health infrastructure among these people; instead, the Dark Winter exercise mainly focused upon the proximate determinants of violence and its immediate management. This distraction from the social dynamics of infectious diseases has major implications for the prevention and management of future outbreaks, regardless of whether or not they are deliberately initiated.

Bioterrorism↗
PubMed2005

Clostridium botulinum: a bug with beauty and weapon.

Clostridium botulinum, a Gram-positive, anaerobic spore-forming bacteria, is distinguished by its significant clinical applications as well as its potential to be used as bioterror agent. Growing cells secrete botulinum neurotoxin (BoNT), the most poisonous of all known poisons. While BoNT is the causative agent of deadly neuroparalytic botulism, it also serves as a remarkably effective treatment for involuntary muscle disorders such as blepharospasm, strabismus, hemifacial spasm, certain types of spasticity in children, and other ailments. BoNT is also used in cosmetology for the treatment of glabellar lines, and is well-known as the active component of the anti-aging medications Botox and Dysport. In addition, recent reports show that botulinum neurotoxin can be used as a tool for pharmaceutical drug delivery. However, BoNT remains the deadliest of all toxins, and is viewed by biodefense researchers as a possible agent of bioterrorism (BT). Among seven serotypes, C. botulinum type A is responsible for the highest mortality rate in botulism, and thus has the greatest potential to act as biological weapon. Genome sequencing of C. botulinum type A Hall strain (ATCC 3502) is now complete, and has shown the genome size to be 3.89 Mb with a G+C content of approximately 28.2%. The bacterium harbors a 16.3 kb plasmid with a 26.8% G+C content--slightly lower than that of the chromosome. Most of the virulence factors in C. botulinum are chromosomally encoded; bioinformatic analysis of the genome sequence has shown that the plasmid does not harbor toxin genes or genes for related virulence factors. Interestingly, the plasmid does harbor genes essential to replication, including dnaE, which encodes the alpha subunit of DNA polymerase III which has close similarity with its counterpart in C. perfringens strain 13. The plasmid also contains similar genes to those that encode the ABC-type multidrug transport ATPase, and permease. The presence of ABC-type multidrug transport ATPase, and permease suggests putative involvement of efflux pumps in bacteriocin production, modification, and export in C. botulinum. The C. botulinum plasmid additionally harbors genes for LambdaBa04 prophage and site-specific recombinase that are similar to those found in the Ames strain of Bacillus anthracis; these genes and their products may play a role in genomic rearrangement. Completion of genome sequencing for C. botulinum will provide an opportunity to design genomic and proteomic-based systems for detecting different serotypes of C. botulinum strains in the environment. The completed sequence may also facilitate identification of potential virulence factors and drug targets, as well as help characterize neurotoxin-complexing proteins, their polycistronic expression, and phylogenetic relationships between different serotypes.

Antibodies, Bacterial↗
PubMedDate not supplied

Which bio-weapons might be used by terrorists against the United Kingdom?

The properties of potential biological weapon agents for bioterrorism include a consistent effect at low dosage and short incubation period in a population of low immunity, being difficult to treat, able to be produced in bulk, stable in storage and readily disseminated. Possible agents include smallpox, haemorrhagic fever viruses, anthrax, tularaemia and plague. The example of Severe Acute Respiratory Syndrome (SARS) demonstrates the possible consequences of an act of bioterrorism, but also the necessary global response. There is scepticism about the practicability of surveillance schemes and the global elimination of biological weapons though the Biological and Toxin Weapons Convention remains urgent.

Bioterrorism↗
PubMed2001

A plague on your city: observations from TOPOFF.

The United States Congress directed the Department of Justice to conduct an exercise engaging key personnel in the management of mock chemical, biological, or cyberterrorist attacks. The resulting exercise was called "TOPOFF," named for its engagement of top officials of the United States government. This article offers a number of medical and public health observations and lessons discovered during the bioterrorism component of the exercise. The TOPOFF exercise illuminated problematic issues of leadership and decision-making; the difficulties of prioritization and distribution of scarce resources; the crisis that contagious epidemics would cause in health care facilities; and the critical need to formulate sound principles of disease containment. These lessons should provoke consideration of future directions for bioterrorism planning and preparedness at all levels of government and among the many communities and practitioners with responsibilities for national security and public health.

Bioterrorism↗
PubMed2002

Management of anthrax.

From 3 October 2001 through 16 November 2001, in the United States, there were 18 confirmed cases of inhalational and cutaneous anthrax, an additional 4 suspected cases of cutaneous anthrax, and 5 deaths due to inhalational anthrax. Although the number of cases was relatively small, this experience brought bioterrorism and its potential to sharp focus as thousands of people began receiving prophylactic antibiotics after possible exposure to anthrax spores. These events have resulted in a substantial impact on the health care system, including the rewriting of pneumonia guidelines, new emphasis on identification of microbial etiology, substantial infusion of funds for bioterrorism-related research, and a sudden mandate for regional disaster and public health planning. This article provides clinicians with clinically relevant information about the diagnosis and management of anthrax.

Anthrax↗
PubMed2003

Age distribution for T cell reactivity to vaccinia virus in a healthy population.

The potential for bioterrorism involving smallpox has led to a debate about the durability of protective immunity against smallpox from vaccination. By assessing the T cell reactivity to vaccinia virus in a healthy population, we show that subjects who were vaccinated within the past 3 decades and who have a visible vaccination scar had remarkable T cell reactivity. However, person who were vaccinated within the past 3 decades but who do not have a scar and those who were vaccinated >4 decades ago had responses as low as those in unvaccinated subjects. Thus, we estimate that the significant T cell memory response to vaccinia virus from successful vaccination may persist for only 20-30 years. Furthermore, we found the vaccinia-specific cellular immunity could be easily assessed by determination of the frequencies of vaccinia-specific CD69 expression on T cell subsets. These data may help in the development of public health strategies to counter bioterrorism threats associated with smallpox.

Adolescent↗
PubMed2004

Strategic dilemmas of biosecurity in the European Union.

Systems for societal/homeland security in both Europe and the United States are in flux to adjust to 21st century threats, such as terrorism, the proliferation of weapons of mass destruction, regional conflicts, state failures, and organized crime. It is important that reforms take place on both sides of the Atlantic that recognize the interdependence of Europe and the United States. Security, including biosecurity, for Europe is strongly connected to security in the U.S. Diseases transcend borders, and their consequences can be the same, irrespective of where the outbreak occurs or whether it is a natural occurrence or an act of bioterrorism. This article examines the political and strategic dilemmas and complexities that would confront the European Union (EU) in the event of a bioterrorism attack or a naturally occurring outbreak. Although several initiatives have been taken by the 15 member states and within the EU Commission, the EU is not institutionally prepared for transnational, rapidly moving diseases that could cause grave consequences in Europe and other regions, including the U.S. The prime responsibility for protecting European citizens against outbreaks rests with each member state. However, with intertwined and open European societies, the consequences would likely spill across borders. The EU Commission would have to become involved because such aspects as the internal market and freedom of movement would be affected. Responsibility, but not authority, would be pushed to the top. A coordinated EU response to such crises depends on European political leadership.

Bioterrorism↗
PubMed2004

Will public health's response to terrorism be fair? Racial/ethnic variations in perceived fairness during a bioterrorist event.

OBJECTIVES: Public health departments' effectiveness during catastrophic bioterrorism will require trust on the part of diverse communities. This study describes variations in perceptions that the public health system will respond fairly to one's needs in a bioterrorist event, regardless of race/ethnicity, income, or other characteristics. METHODS: Using the Los Angeles County Health Survey, a random-digit, population-based, telephone survey, we conducted multivariate logistic regression of race/ethnicity on perceived fairness, adjusting for demographic factors and perceived neighborhood safety. We performed similar analyses stratified by race/ethnicity subgroup. RESULTS: Overall, 72.7% of respondents perceived that the public health system will respond fairly in a bioterrorist event. African Americans (AA) and Asian/Pacific Islanders (API) reported the lowest perceived fairness (AA 63.0%, API 68.2%, Latino 73.1%, White 76.6%, p = 0.005 for group differences). Adjusting for demographic factors and neighborhood safety, African Americans had lower perceived fairness compared to whites (adjusted odds ratio, aOR 0.45; 95% confidence intervals, CI 0.26-0.79; p < 0.005). Other factors associated with lower perceived fairness included Asian-language compared to English-language interview (aOR 0.29; 95% CI 0.11-0.76; p < 0.05) and lower compared to higher neighborhood safety (aOR 0.48; 95% CI 0.31-0.74; p < 0.005). Among African Americans, participants aged 18-29 years were less likely to report perceived fairness (aOR 0.06; 95% CI 0.01-0.59) compared to participants older than 60 years of age. Among Asian/Pacific Islanders, Asian-language interview (aOR 0.07; 95% CI 0.01-0.48) and lower perceived neighborhood safety (aOR 0.01; 95% CI <0.01-0.13) were associated with perceived fairness. CONCLUSIONS: To strengthen bioterrorism preparedness, public health officials must continue to improve perceived fairness among African American and Asian/Pacific Islander communities.

Adult↗
PubMed2005

E3LSI research: an essential element of biodefense.

The threat of bioterrorism has prompted the U.S. to undertake a vast biodefense initiative, including funding biodefense-related scientific research at unprecedented levels. Unfortunately, the many ethical, economic, environmental, legal, and social implications (E(3)LSI) of biodefense research and activities are not yet receiving the attention they warrant. Previously, in laudable demonstrations of foresight and responsibility, the federal government has funded research into the E(3)LSI of other recent scientific endeavors--namely, the Human Genome Project and the nanotechnology research program--through directed appropriations from their respective research budgets. This article advocates and proposes a model for a portion of biodefense funding to be similarly set aside for an E(3)LSI research program to complement biodefense research, to ensure that bioterror preparedness does not give rise to harmful or otherwise undesirable unintended consequences.

Bioterrorism↗
PubMed2005

Confidence in crisis? Understanding trust in government and public attitudes toward mandatory state health powers.

In response to the possibility of a bioterror attack using smallpox, many states have updated and revised their current public health laws in line with the Model Act, which would effectively give states the right to invoke mandatory state health powers, such as quarantine or vaccine. Previous studies have supported the importance of allying with the public in creating and implementing effective bioterror response policies. Historical case studies and recent research suggest that when the public is not supportive of government health policies, they may be less willing to comply. In this study we analyze a recent survey to determine the effects of a set of variables, including aspects of trust in government that have been found in previous studies to influence public opposition to compulsory government health policies, on opinions about compulsory vaccination and quarantine.

Adolescent↗
PubMed2004

A generalized linear mixed models approach for detecting incident clusters of disease in small areas, with an application to biological terrorism.

Since the intentional dissemination of anthrax through the US postal system in the fall of 2001, there has been increased interest in surveillance for detection of biological terrorism. More generally, this could be described as the detection of incident disease clusters. In addition, the advent of affordable and quick geocoding allows for surveillance on a finer spatial scale than has been possible in the past. Surveillance for incident clusters of disease in both time and space is a relatively undeveloped arena of statistical methodology. Surveillance for bioterrorism detection, in particular, raises unique issues with methodological relevance. For example, the bioterrorism agents of greatest concern cause initial symptoms that may be difficult to distinguish from those of naturally occurring disease. In this paper, the authors propose a general approach to evaluating whether observed counts in relatively small areas are larger than would be expected on the basis of a history of naturally occurring disease. They implement the approach using generalized linear mixed models. The approach is illustrated using data on health-care visits (1996-1999) from a large Massachusetts managed care organization/multispecialty practice group in the context of syndromic surveillance for anthrax. The authors argue that there is great value in using the geographic data.

Bioterrorism↗
PubMed2004

Preevent vaccination against smallpox: a survey of pediatric emergency health care providers.

BACKGROUND: In January 2003, smallpox vaccinations were offered to health care workers to create hospital-based teams prepared to care for patients with smallpox as part of national bioterrorism preparedness activities. METHODS: An anonymous survey of pediatric emergency health care workers was conducted in November and December 2002. Two mailings were sent to physicians, nurses and ancillary staff at five academic pediatric emergency departments in major US cities. We assessed the willingness to receive preevent smallpox vaccine. In addition we measured the prevalence of vaccine contraindications, perceived likelihoods of a local smallpox outbreak or a vaccine-related adverse event and reasons for or against wanting to receive the vaccine. RESULTS: Overall 72% of respondents were willing to receive the smallpox vaccine. Individuals who were willing to receive the smallpox vaccine, compared with those not willing, believed a local outbreak was more likely to occur (odds ratio, 1.29; 95% confidence interval, 1.16 to 1.44). One-fifth of respondents reported a contraindication to smallpox vaccine; however, more than half indicated they would still be willing to receive vaccine. Individuals who perceived themselves at high risk for vaccine-related adverse events were less willing to receive the preevent smallpox vaccine. Self-protection was the most common reason cited for wanting to receive the vaccine. CONCLUSIONS: A majority of pediatric healthcare workers were willing to receive preevent smallpox vaccine before the onset of Phase I of the CDC Smallpox Vaccination Program. A greater understanding of the knowledge, attitudes and beliefs of pediatric health care workers toward preevent smallpox vaccination will assist in the development of future bioterrorism preparedness programs.

Attitude of Health Personnel↗
PubMedDate not supplied

Building academic-practice partnerships: the Center for Public Health Preparedness at the Columbia University Mailman School of Public Health, before and after 9/11.

The Center for Public Health Preparedness at the Columbia University Mailman School of Public Health is part of a national network of academic centers established by the Centers for Disease Control and Prevention to strengthen links between public health practice and academe, especially for public health workforce development. Since its inception in Fall 2000, the Center has been working in partnership with the New York City Department of Health & Mental Hygiene (DOHMH) on planning and competency-based training in emergency preparedness (including bioterrorism and infectious diseases) and evaluation. Initial programs with DOHMH included development of a 3-hour orientation to basic emergency preparedness for their workforce. In the wake of 9/11 and the anthrax events, Center members gave over two dozen presentations at community forums, seminars, and clinical rounds, and over 100 press interviews, provided lay language information through community forum presentations and the School's Web site, and developed a database of volunteers for surge capacity. Subsequent programs include bioterrorism response training for clinicians and emergency medical services personnel, incident command for public health, and a study of evacuation from the World Trade Center on 9/11.

Bioterrorism↗
PubMed2005

Competency-based preparedness training for public health practitioners.

The bioterrorism preparedness training needs of the public health workforce have been described in several studies, assessments, and surveys. To meet these needs, the North Carolina Center for Public Health Preparedness (NCCPHP) and the Public Health Leadership Program (PHLP) at the University of North Carolina School of Public Health developed a new distance learning course, Introduction to Public Health Preparedness for Disasters and Emergencies. After a review of assessment data to identify training needs, we conducted a literature review of methodology and concluded that a distance learning course would be the best approach. The course curriculum is based on the Bioterrorism and Emergency Readiness Competencies for All Public Health Workers. This paper describes the course development process and methods used to make this course an effective training tool.

Bioterrorism↗
PubMed2002

Emergency department security: a call for reassessment.

Numerous articles tell of the security breaches hospital emergency rooms face on a daily basis. The recent events of September 11 th have further complicated these breaches, and have shed new light on previously ignored issues surrounding bioterrorism. In previous disaster scenarios there has been a "script" to follow; however bioterrorism follows no script and presents a host of new security issues. Successful delineation of the characteristics of bioterrorist weapons is only the first step in dealing with such a scenario, and will set into motion a series of events seen only on small levels in the past.

Biological Warfare↗