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PubMed2003

Bioterrorism--a new challenge for public health.

The opening years of the new millennium have presented a new and worrisome possibility to the public, including travellers: the threat of deadly infectious diseases from biological agents being deliberately released. The possibility of bioterrorism had always seemed remote but the recent anthrax attacks by mail have made this threat of immediate relevance. The deliberate use of Bacillus anthracis with the intent to harm civilian populations has raised public health concerns about potential exposure to intentionally released Variola virus and other biological agents. There is an urgent need for countries to examine their preparedness to respond to biological weapons attacks. Given the emotional shock of even an alleged threat of a biological release, it will be wise for governments to consider how to address such dangers as an integral part of the national response to other threats to public health and well being. Physicians and other health professionals, including those providing guidance to international and domestic travellers, need to have a clear understanding of the possible agents and the appropriate therapy or prophylaxis. This paper attempts to give a perspective on the threat of bioterrorism, the consequences of its use, the likely biological agents that may be used, and the clinical presentation and management of diseases caused by some agents most likely to be used.

Bioterrorism↗
PubMed2001

Towards an internet civil defence against bioterrorism.

Approaches towards the public-health prevention of bioterrorism are too little, and too late. New information-based approaches could yield better homeland protection. An internet civil defence is presented where millions of eyes could help to identify suspected cases of bioterrorism, with the internet used to report, confirm, and prevent outbreaks.

Bioterrorism↗
PubMed2002

[Medical control of bioterrorism].

Against the recently accrued risk of bioterrorism, the Biotox plan has been set up in order to take in charge any person that could be facing a potential terrorist contamination. It has to take into consideration the components of bioterrorism, i.e. the incubation period, the function of bacterial or viral agents, the variable number of concerned people, the difficulty of alert launching, and the diagnosis of the responsible agent. This plan relies on hospitals comprising departments of infectious diseases. Those are specifically in charge of informing, organising, and coordinating the reception of people having been in contact or infected by infectious agents, in order to isolate and treat them properly. The recent experience has allowed to test this plan, to precise and correct some of its features.

Bacterial Infections↗
PubMedDate not supplied

Aum Shinrikyo and the Japanese law on bioterrorism.

Before the sarin incidents in Tokyo and Matsumoto, the Aum Shinrikyo (now Aleph) had tried to conduct bioterrorism with botulinum toxin and Bacillus anthracis. Followers of the Aum could not overcome technical difficulties inherent in developing biological weapons, and the perpetrators had not been prosecuted for their failed attempts of bioterrorism. But the Aum's biological attack revealed several shortcomings in the Japanese law that regulated biological weapons. Since the missile experiment of North Korea conducted in 1998, the Japanese government has come to consider the threat posed by biological weapons more seriously. In 2001, after the 11 September 2001 terrorist attacks and the series of anthrax letter scares in the United States of America, the Japanese government established its Five Basic Principles for Chemical and Biological Weapons Terrorism and several measures were taken at the central and local levels. Activities of the Aum have been monitored by the Public Security Investigation Agency and the National Police Agency under the Anti-Aum Law since 2000.

Bioterrorism↗
PubMed2003

Meeting the challenge of bioterrorism: lessons learned from West Nile virus and anthrax.

Hospital emergency departments (EDs) and ambulatory clinics may be the first to recognize illness related to a bioterrorist event. Every health-care institution must develop a weapons-of-mass- destruction (WMD) preparedness plan as part of its all-hazards disaster planning. As part of an all-hazards disaster plan, WMD preparedness should use the incident-command model to insure the required chain of command for effectively coordinating activities between hospital departments and external agencies. Preparedness for bioterrorism poses unique challenges. In the event of a biological attack, the hospital infection control staff and administration must already have in place the means to communicate with local and state public health agencies, the Centers for Disease Control and Prevention (CDC), local law-enforcement agencies, and the Federal Bureau of Investigation (FBI). Local and regional planners must consider how to coordinate the responses of emergency medical services (EMS), police, and fire departments with healthcare providers and the news media. Most hospitals are ill equipped to deal with a catastrophic event caused by WMD. The burden of responding to such events will fall initially on ED physicians and staff members. The severity of such an incident might be mitigated with careful planning, training and education. The responses of one hospital network to the outbreak of West Nile virus and, more recently, to the threat of anthrax, are presented as guides for bioterrorism preparedness.

Anthrax↗
PubMed2002

Bioterrorism: relevance to allergy and immunology in clinical practice.

It has become clear in recent months that the threat of bioterrorism is very real. All physicians need to be aware of the presenting signs and symptoms of the most likely agents. Allergists and immunologists care for a unique population of patients with several alterations of their immune system that might change the expected course of illnesses from biologic terror agents. In this review, we discuss specific bioterrorism agents, focusing on their presentation, pathogenesis, and immunology. In addition, we describe how these illnesses might differ in the population of patients followed by allergists and immunologists.

Adult↗
PubMed2003

Syndromic analysis of computerized emergency department patients' chief complaints: an opportunity for bioterrorism and influenza surveillance.

STUDY OBJECTIVE: Emergency department computerized triage logs might be useful for automated ED surveillance and potentially for early identification of bioterrorism events. We describe a Web-based surveillance program and its feasibility for surveillance. METHODS: A Web-based surveillance program that receives computerized chief complaint data daily from a large academic urban teaching hospital and performs syndromic analysis on these data was developed. On the basis of preset limits, the Web-based surveillance program sends an alert e-mail message when the syndromic analysis reveals an increase in the number of patients in predefined symptom groups. The feasibility of this system was tested by using historical data during an influenza outbreak (December 1999 to January 2000) and applying the anthrax symptom group. RESULTS: The Web-based surveillance program identified the influenza outbreak in the first week. CONCLUSION: Computerized triage logs might be a feasible method for bioterrorism and influenza surveillance. The Web-based nature of the surveillance program creates the opportunity for other hospitals to contribute data, potentially resulting in an automated network of ED computerized triage log surveillance.

Academic Medical Centers↗
PubMed2005

Bacteria as potential tools in bioterrorism, with an emphasis on bacterial toxins.

The threat of bioterrorism remains a reality worldwide and, although of low probability, an attack would be a high-consequence event. Microbes are available to individuals with appropriate contacts and even many low-grade bacterial pathogens can severely affect health. Toxins provide bacteria with a system of defence that is often detrimental to humans and their versatility makes them potential tools of bioterrorism. It should be remembered that the aim of terrorism is not always to kill but rather to strike fear into peoples lives. Therefore, agents such as botulinum and cholera toxin could be used, which may not cause significant mortality but would cause widespread panic and potentially high morbidity. Importantly, no state can ever be fully prepared for a response and it is probable that no state ever could be. It is for this reason that biological agents are so attractive as weapons.

Antigens, Bacterial↗
PubMedDate not supplied

Bioterrorism in the United States: a balanced assessment of risk and response.

There are many definitions of terrorism and numerous examples of the use of explosives and small arms, especially against civilians and with the objective of instilling fear. Although chemical and biological agents have only rarely been used by terrorists, there has recently been much concern about the threat of bioterrorism and the role of future health personnel in counteracting it. Rational setting of priorities requires the balance of risks against benefits in prevention and preparedness. Adverse effects of preparedness include inappropriate warnings, diversion of resources from other public health measures, both in the United States and overseas and constraints on civil rights. It is argued that the US should counteract the threat of bioterrorism by dealing with its root causes and by strengthening civil rights, international arms control and international law rather than by a self-defeating 'war on terrorism'.

Bioterrorism↗
PubMed2003

Optimistic bias and perceptions of bioterrorism in Michigan corporate spokespersons, fall 2001.

The notion that individuals believe that they are more likely than others to experience positive events and avoid negative ones is a well-documented phenomenon in the combined literatures of social psychology and health communication. The current study focuses on Michigan corporate spokespersons' perceptions of their company's risk and potential for optimistic bias. Beginning on September 10, 2001, and continuing through October 2001, telephone surveys were conducted by a professional survey research firm to assess spokespersons' awareness of and preparedness for a bioterrorism attack at their corporation, as well as to ascertain perceived self-risk relative to that of other, similar corporations. The results offer evidence of a robust optimistic bias, and provide an unusually timely snapshot of levels of corporate awareness of bioterrorism during a critical period of time in which the U.S. experienced its first anthrax attack.

Bioterrorism↗
PubMed2001

Lessons from the West Nile viral encephalitis outbreak in New York City, 1999: implications for bioterrorism preparedness.

The involvement and expertise of infectious disease physicians, microbiologists, and public health practitioners are essential to the early detection and management of epidemics--both those that are naturally occurring, such as the 1999 outbreak of West Nile virus (WN virus) in New York City, and those that might follow covert acts of bioterrorism. The experience with the WN virus outbreak offers practical lessons in outbreak detection, laboratory diagnosis, investigation, and response that might usefully influence planning for future infectious disease outbreaks. Many of the strategies used to detect and respond to the WN virus outbreak resemble those that would be required to confront other serious infectious disease threats, such as pandemic influenza or bioterrorism. We provide an overview of the critical elements needed to manage a large-scale, fast-moving infectious disease outbreak, and we suggest ways that the existing public health capacity might be strengthened to ensure an effective response to both natural and intentional disease outbreaks.

Animals↗
PubMed2004

Screening for inhalational anthrax due to bioterrorism: evaluating proposed screening protocols.

Eleven known cases of bioterrorism-related inhalational anthrax (IA) were treated in the United States during 2001. We retrospectively compared 2 methods that have been proposed to screen for IA. The 2 screening protocols for IA were applied to the emergency department charts of patients who presented with possible signs or symptoms of IA at Inova Fairfax Hospital (Falls Church, Virginia) from 20 October 2001 through 3 November 2001. The Mayer criteria would have screened 4 patients (0.4%; 95% CI, 0.1%-0.9%) and generated charges of 1900 dollars. If 29 patients (2.6%; 95% CI, 1.7%-3.7%) with >or=5 symptoms (but without fever and tachycardia) were screened, charges were 13,325 dollars. The Hupert criteria would have screened 273 patients (24%; 95% CI, 22%-27%) and generated charges of 126,025 dollars. In this outbreak of bioterrorism-related IA, applying the Mayer criteria would have identified both patients with IA and would have generated fewer charges than applying the Hupert criteria.

Adult↗
PubMed2005

No evidence of a mild form of inhalational Bacillus anthracis infection during a bioterrorism-related inhalational anthrax outbreak in Washington, D.C., in 2001.

BACKGROUND: The mail-related dispersal of Bacillus anthracis spores in the Washington, D.C., area during October 2001 resulted in 5 confirmed cases of inhalational anthrax. We identified an additional 144 ill persons who were potentially exposed to aerosolized spores and whose symptoms were compatible with early inhalational anthrax but whose clinical course and nonserologic laboratory evaluation revealed no evidence for B. anthracis infection. We hypothesized that early antibiotic use could have decreased the sensitivity of diagnostic tests or that bioterrorism-related inhalational anthrax may include mild disease. METHODS: Eligible patients included those with illness compatible with early inhalational anthrax who had potential exposure to B. anthracis. Patient serum samples were tested for immunoglobulin G (IgG) antibody against B. anthracis protective antigen (PA) using a sensitive enzyme-linked immunosorbant assay (sensitivity, 97.6%). RESULTS: Of the 144 eligible patients, 66 (46%) had convalescent-phase serum samples available for testing; 29 (44%) worked in an area considered to pose a high risk of exposure to B. anthracis spores. Of the 37 patients who worked in areas that did not meet the definition of high-risk exposure, 23 (62%) worked in United States postal or other government facilities in which exposure was plausible but not documented. None of the 66 patients with convalescent-phase serum samples showed evidence of an anti-PA IgG serologic response to B. anthracis. CONCLUSIONS: These data suggest that a mild form of inhalational anthrax did not occur and that surveillance for moderate or severe illness was adequate to identify all inhalational anthrax cases resulting from the Washington, D.C., bioterrorism-related anthrax exposures.

Adult↗
PubMed2005

Communicating the risks of bioterrorism and other emergencies in a diverse society: a case study of special populations in North Dakota.

In the event that terrorists use air, water, or food to deliver destructive agents to civilian populations, some groups and populations may be disproportionately at risk and have unique communications needs. Bioterrorism represents an even greater national public health threat if the nation's preparedness and readiness plans do not address the needs and perspectives of, for example, low-income residents, racially and ethnically diverse communities, and other "special populations". The objective of this study was to develop communications strategies to reach special populations in North Dakota before, during, and after a bioterrorism attack or other crisis. To achieve the study objectives, the investigators used telephone interviews and telephone focus groups with organizations that represented special populations. Areas of inquiry included attitudes and concerns about crises, sources of information used and those identified as most credible, methods to reach people during a crisis event, and awareness of and attitudes about the agencies and organizations that affect risk communications.

Aged↗
PubMed2006

Are community health centers prepared for bioterrorism?

Community health centers (CHCs) are essential in the delivery of primary care services to underserved populations. Given the critical function of CHCs, surprisingly little is known about their role in preparing for or responding to acts of terrorism. This survey-based study examines the state of CHCs in terrorism preparedness and assesses their training needs. Of the administrators who responded to the survey, 87% indicated that their centers had an emergency response or disaster plan. Of those, 78% indicated they had updated their plans within the past year. Among those who had a written plan, 41% addressed bioterrorism preparedness, 38% had contingencies for a mass influx of patients, and 3% indicated that their plans addressed increasing operational capacity. Additionally, while 48% reported having assessed the education and training needs of their professional staff in the area of disease surveillance and reporting, only 24% had assessed these needs in relation to bioterrorism. Our findings suggest that CHCs have made great strides in preparing for some emergencies but that preparedness does not yet extend to specifically include terrorism events. Policy and practice recommendations are included to more fully develop CHCs as a resource.

Bioterrorism↗
PubMedDate not supplied

Epidemiologic clues to bioterrorism.

Public health investigators have successfully carried out epidemiologic investigations of outbreaks of disease for many years. By far the majority of these outbreaks have occurred naturally. With the recent illnesses resulting from deliberate dissemination of B. anthracis on an unsuspecting population, public health investigation of diseases must now include consideration of bioterrorism as a potential cause of outbreaks of disease. The features of naturally occurring outbreaks have a certain amount of predictability in terms of consistency with previous occurrences, or at least biological plausibility. However, with a deliberately introduced outbreak or infection among a population, this predictability is minimized. In this paper, the authors propose some epidemiologic clues that highlight features of outbreaks that may be suggestive of bioterrorism. They also describe briefly the general process of involvement of agencies at various levels of government, public health and non-public health, depending on the extent of an outbreak or level of suspicion.

Anthrax↗
PubMed2003

Bioterrorism: are we prepared?

Bioterrorism information including the role for professional health providers is increasing daily. Because this subject creates a variety of personal feelings and is very new information, many nurses ignore opportunities to educate themselves thinking, "It will never happen to me."Every American, especially healthcare personnel, must be knowledgeable and up-to-date about prevention and intervention strategies as well as their responsibilities. This article outlines the current concerns, approaches, and roles of home care nurses in bioterrorism.

Bioterrorism↗
PubMed2005

Bioterrorism: Preparing for the impossible or the improbable.

OBJECTIVE: To review the current literature surrounding the history of bioterrorism, the relative risk of a bioterrorist attack, methods of surveillance for biological agents, identification and management of various biological agent casualties, as well as the role of the intensivist in managing a bioterrorist attack. METHODS: Internet and Medline search (from 1966 to 2004) for articles relating to bioterrorism, biological agents, biological warfare, hospital preparedness, disaster management, and intensive care. CONCLUSIONS: There are few instances of a successful large-scale biological weapons attack in history. Weaponization of biological agents for aerosol dispersal is difficult and has often proved to be the rate-limiting step for a successful attack. Although a successful biological attack is currently unlikely, it is still feasible. More importantly, the threat of one is likely to cause much panic in the public, while a successful attack would overburden the current healthcare infrastructure. Intensivists will need to have specific knowledge of identifying and managing casualties from various biological agents. In addition, they will need to play an integral part in the preparedness of their institutions and communities for managing a bioterrorist event.

Biological Warfare↗