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PubMed2002

The power to act: two model state statutes.

Enabling statutes for state and local public health agencies set forth their powers and duties and provide the legal basis for their work. Obsolescence, inconsistency, and inadequacy may render some public health laws ineffective or even counterproductive. Reforming state public health law can improve the legal infrastructure that supports public health systems in responding to bioterrorism and other public health threats. Two legal tools available to assist the process of establishing a strong legal foundation for public health practice are the Model State Emergency Health Powers Act, developed in 2001 by the Center for Law and the Public's Health, and the Model State Public Health Act, currently under development by the Turning Point Public Health Statute Modernization National Collaborative. These model acts can serve as guides for assessing current state public health law, and they provide example statutory language for use by those working to update their laws. That strong state public health law and model public health acts serve as resources for law reform is recognized by local health officials and state legislators as well as by state public health officials. Lessons learned from recent experiences with crafting and introducing legislation based on the Model State Emergency Health Powers Act can prove useful in the future to those working on public health law reform efforts in their states.

Bioterrorism↗
PubMed2002

The future of public health preparedness.

This redacted version of a speech by former United States Senator Sam Nunn, Chairman of the Nuclear Threat Initiative, points out that although there are concerns about global issues involving security and weapons of mass destruction and bioterrorism, it was not until September 11, 2001, that these issues (and new, unforeseen ones) were getting the funding and attention they deserved. In the event of a biological attack, millions of lives may depend on how quickly we diagnose the effects, report the findings, disseminate information to the healthcare communities and to state and local governments, and bring forth a fast and an effective response at the local, state, and federal levels. Public health must become an indispensable pillar of our national security framework. As we develop a national strategy to respond to these challenges, we must think in the broader context of causes as well as symptoms. To provide context for the next 25 years, Senator Nunn provided an overview of the "Seven Revolutions" for change identified by the Center for Strategic and International Studies (CSIS) with which he is also associated. Finally, he discusses major security challenges facing the United States.

Bioterrorism↗
PubMed2002

[Cutaneous palpebral anthrax].

The interest for anthrax is permanent because of its difficult diagnosis, its severe prognosis, and the possibility of its dissemination during biological war and bioterrorism. Cutaneous anthrax is an infectious disease caused by Bacillus anthracis. Palpebral localizations are rare, raising problems of differential diagnosis. The case of a 21-year-old male with palpebral anthrax is presented. The diagnosis was established by the progression of the palpebral lesions (serohemorrhagic vesicle, black necrotic eschar), extended palpebral edema, and positive epidemiological data. During the onset period, the differential diagnosis was difficult because of uncharacteristic symptoms, negative bacteriological tests (previous antibiotic treatment), and the absence of epidemiological data. Treatment with G penicillin led to the patient's cure.

Adult↗
PubMedDate not supplied

[Use of the bioluminescent method for the determination of bacterial adenosinetriphosphate (ATP-metry) in microbiology].

The attention of a wide circle of specialists has recently been attracted by different methods for rapid determination of pathogenic microorganisms in biological specimens, environmental objects and foodstuffs, as well as in cases of possible acts of bioterrorism. In this respect the bioluminescent method for determination of adenosine triphosphate (ATP) contained in microbial cells is of interest. The method is based on the interaction ATP, luciferase and luciferin, accompanied by giving off energy in the form of light emission. When compared with routine methods, the use of this method considerably reduces the duration of the analysis, and its high sensitivity is comparable with that of the polymerase chain reaction. In this review the data on the prospects of the practical use of the bioluminescent method of ATP-metry are presented.

Adenosine Triphosphate↗
PubMed2002

The National Pharmaceutical Stockpile Program: an overview and perspective for the Pacific Islands.

The National Pharmaceutical Stockpile (NSP) program was created as a national resource and is an essential response component of the Centers for Disease Control and Prevention's (CDC's) larger Bioterrorism Preparedness and Response Initiative. The role of the NPS program is to maintain a national repository of life-saving pharmaceuticals and medical supplies that can be delivered to communities in the event of a biological or chemical terrorist attack or an event involving mass casualties. The NPS is to be a re-supply and backup mechanism to state and local emergency response. Before a decision is made to deploy NPS assets, CDC will collaborate with local, state, and federal officials to determine the nature and extent of the event. Once the federal decision to deploy NPS assets is made, CDC's NPS program will arrange for delivery of assets to reach the affected area within 12 hours.

Bioterrorism↗
PubMed2003

Smallpox: a review of clinical disease and vaccination.

The clinical course of smallpox infection and the current and future roles of vaccination and strategies for controlling smallpox outbreaks are reviewed. Close personal contact is required for transmission of variola, the DNA virus that causes smallpox. Following an incubation period, infected persons have prodromal symptoms that include high fever, back pain, malaise, and prostration. The eruptive stage is characterized by maculopapular rash that progresses to papules, then vesicles, and then pustules and scab lesions. The mortality rate for smallpox is approximately 30%. Patients having a fever and rash may be confused with having chickenpox. The most effective method for preventing smallpox epidemic progression is vaccination. Until recently, only 15 million doses of smallpox vaccine--manufactured 20 years ago--were available in the United States. The vaccine is a live vaccinia virus preparation administered by scarification with a bifurcated needle. The immune response is protective against orthopoxviruses, including variola. Vaccination is associated with moderate to severe complications, such as generalized vaccinia, eczema vaccinatum, progressive vaccinia, and postvaccinial encephalitis. Efforts for vaccine production are now focused on a live cell-culture-derived vaccinia virus vaccine. Although smallpox was eradicated in 1980, it remains a potential agent for bioterrorism. As a category A biological weapon, its potential to devastate populations causes concern among those in the public health community who have been actively developing plants to deal with smallpox and other potential agents of biological warfare. The only proven effective strategy against smallpox is vaccination.

Bioterrorism↗
PubMed2002

Anthrax 2001--lessons learned by public health laboratories.

OBJECTIVE: To share lessons learned by one local public health department during the anthrax outbreak and associated public hysteria during the autumn of 2001. DATA SOURCES: Current literature and personal experience. CONCLUSIONS: Previous planning for a possible bioterrorism event is essential. Management of the communication and testing process is essential for the protection of the public.

Anthrax↗
PubMed2003

An ounce of prevention is a ton of work: mass antibiotic prophylaxis for anthrax, New York City, 2001.

Protocols for mass antibiotic prophylaxis against anthrax were under development in New York City beginning in early 1999. This groundwork allowed the city's Department of Health to rapidly respond in 2001 to six situations in which cases were identified or anthrax spores were found. The key aspects of planning and lessons learned from each of these mass prophylaxis operations are reviewed. Antibiotic distribution was facilitated by limiting medical histories to issues relevant to prescribing prophylactic antibiotic therapy, formatting medical records to facilitate rapid decision making, and separating each component activity into discrete work stations. Successful implementation of mass prophylaxis operations was characterized by clarity of mission and eligibility criteria, well-defined lines of authority and responsibilities, effective communication, collaboration among city agencies (including law enforcement), and coordination of staffing and supplies. This model can be adapted for future planning needs including possible attacks with other bioterrorism agents, such as smallpox.

Anthrax↗
PubMed2003

Anthrax-protective effects of yeast beta 1,3 glucans.

CONTEXT: The recent events increasing the threat of bioterrorism have prompted a widespread search for defenses against this peril. OBJECTIVE: To evaluate the anthrax-protective effect of beta1,3-glucan immune modulators (PGG-glucan and WGP beta glucan) in an experimental animal model. DESIGN: Beta1,3-glucan immune modulators were administered by subcutaneous injection to Balb/c mice 2 days prior to anthrax challenge. WGP beta glucan was administered by daily oral gavage for 7 days prior to challenge, or in drinking water for 10 days postchallenge with a lethal dose of Bacillus anthracis spores. Survival, survival time, and microbial bioburden relative to an infected, untreated control group were assessed. RESULTS: A single injected dose of PGG-glucan or WGP beta glucan immune modulators given 2 days before challenge significantly: (a) increased the survival rate of infected mice (2.5-fold), (b) diminished the bacterial load in the lungs of infected mice (4-8-fold), and (c) increased the proportion of bacteria-free animals 10 days after challenge (2-fold). In mice prophylactically administered oral WGP beta glucan for 1 week prior to infection, survival increased from 50% to 100%; therapeutic administration of oral WGP beta glucan for 10 days postinfection increased survival from 30% up to 90% in treatment groups. CONCLUSIONS: These results demonstrate the potential for beta1,3-glucan immune modulators to provide a significant degree of protection against anthrax, a potential biological warfare (BW) agent in a mouse model of anthrax infection. Further studies are needed to optimize protection, evaluate activity in combination with other treatment options, demonstrate activity in a validated primate model of infection, and determine if protection is effective against other potential BW agents.

Adjuvants, Immunologic↗
PubMed2003

Skin reaction following immunization with smallpox vaccine: a personal perspective.

Concerns about the possibility of bioterrorism or unconventional weaponry using the variola virus have emerged following the events of September 11, 2001. Immunization of emergency personnel in Israel against smallpox started in September 2002. This case report describes the skin reaction following immunization with vaccinia virus. Physicians should be aware of the variations at the site of the inoculation.

Bioterrorism↗
PubMed2003

Phage therapy: a reappraisal of bacteriophages as antibiotics.

The concept of phage therapy to treat bacterial infections was born with the discovery of the bacteriophage almost a century ago. After a chequered history, its current renaissance is fueled by the dangerous appearance of antibiotic-resistant bacteria on a global scale. As a mark of this renewed interest, the unanswered problems of phage therapy are now being addressed, especially for human use. Phage therapy in the agricultural, food-processing and fishery industries is already being successfully applied, and this review, whilst being aware of the potential drawbacks, emphasizes the need for further carefully controlled empirical data on its efficacy and safety in treating human and animal disease, especially in view of its numerous advantages over antibiotics. Finally the potential of phage therapy against bioterrorism and the emergence of second generation phage antibacterials based on phage-derived single-protein lysis systems are addressed.

Animals↗
PubMed2003

Brucellosis.

Brucellosis is an old disease, revisited because of its past use in biological warfare programs and its potential use in bioterrorism. Early recognition and management of this systemic disease in its acute or chronic form is vital to current antibioterrorism defense programs. This article focuses on the causative organism, as well as the clinical presentation, diagnosis, and therapeutic challenges of Brucellosis.

Anti-Infective Agents↗
PubMed2003

Coccidioides immitis as a potential bioweapon.

Coccidioides immitis is a fungus endemic to the soil of areas of the southwestern United States, northern Mexico, and scattered areas of Central and South America. Natural infection occurs by inhalation of airborne arthroconidia. C. immitis could be used as a weapon of bioterror or biowarfare with aerosol delivery. Its use for this purpose would, however, present a number of obstacles and its effect would be uncertain and most probably limited.

Bioterrorism↗
PubMed2003

[The Alkhurma virus (family Flaviviridae, genus Flavivirus): an emerging pathogen responsible for hemorrhage fever in the Middle East].

To date tick-borne flaviviruses causing hemorrhagic fevers in humans have been isolated in Siberia (Omsk hemorrhagic fever virus), India (Kyasanur Forest disease virus), and Saudi Arabia (Akhurma virus). Because of their potential use as biological weapons for bioterrorism, these 3 viruses require level 4 biosafety handling facilities and have been listed as hypervirulent pathogens by the Center for Disease Control and Prevention. Alkhurma virus was isolated in 1995 from patients with hemorrhagic fever in Saudi Arabia. Current evidence suggests that transmission to humans can occur either transcutaneously either by contamination of a skin wound with the blood of an infected vertebrate or bites of an infected tick or orally by drinking unpasteurized contaminated milk. To date a total of 24 symptomatic human cases have been recorded with a mortality rate at 25% (6/24). Pauci-symptomatic or asymptomatic cases are likely but epidemiologic data are currently unavailable. The complete coding sequence of the prototype strain of Alkhurma virus was determined and published in 2001 based on international research project involving investigators from France, Great Britain, and Saudi Arabia. Phylogenetic studies demonstrate that closest known relative of Alkhurma virus is Kyasanur Forest disease virus and that both viruses share a common ancestor. Genetic analysis of several human strains sequentially isolated over a 5-year period showed a very low diversity. This finding has important potential implications for diagnosis and vaccination.

Animals↗
PubMed2003

Glandular tularemia in a Native American child.

This case report details the clinical manifestation and course of glandular tularemia, an uncommon but significant cause of cervical lymphadenopathy in children. We discuss the unique attributes of this disease along with appropriate steps that lead to early identification of the organism and effective treatment. The potential use of the organism as a bioterrorism agent is another interesting aspect of this entity.

Bioterrorism↗
PubMed2003

Creating a health care agenda for the Department of Homeland Security.

The challenge before us at DHS--to optimize use of our resources to create an effective health response to terrorist incidents--is formidable. After spending several weeks in Baghdad and seeing all the problems that arise in establishing a new government, I found myself thinking, "This is going to take years." Then, when I returned to the United States, Surgeon General Vice Adam. Richard Carmona, MD, MPH, almost immediately assigned me to the new Department of Homeland Security, adding that the problems it faced were probably worse than those in Baghdad. "That is impossible," I thought. "There's no way this could present a greater logistical, organizational, cultural, and administrative challenge than establishing a new government in a country with no democratic tradition in its 5,000-year history!" Within two days of my appointment to the new department, however, I recognized the accuracy of the surgeon general's statement. We will, however, work diligently toward our goals. During the next couple of years, a major DHS priority will be state and local preparedness, which includes rapid identification of epidemics, improved training, the establishment of liaisons with other first responders such as fire, rescue, law enforcement, and emergency medical services teams, and implementing state-of-the-art communication, disease alert, and reporting systems. Table 2 constitutes a checklist for bioterrorism preparedness, from a public health perspective. Local response and coordination with federal authorities and the issues inherent in these efforts are discussed in depth in the presentations that begin on the following page of this publication.

Bioterrorism↗
PubMedDate not supplied

Biological, chemical and radiological terrorism.

After completing this overview of terrorism, readers should be able to: Describe the early signs and symptoms of a covert terrorist attack. Discuss the radiographic signs of exposure to bioterrorism agents. List likely chemical, biological and radiological agents of terrorism. Categorize biological agents of terror by their Centers for Disease Control (CDC) threat level. Explain the relevance of syndromic surveillance in terrorism preparedness.

Bioterrorism↗
PubMed2003

An analytic framework fo space-time aberrancy detection in public health surveillance data.

Public health surveillance is changing in response to concerns about bioterrorism, which have increased the pressure for early detection of epidemics. Rapid detection necessitates following multiple non-specific indicators and accounting for spatial structure. No single analytic method can meet all of these requirements for all data sources and all surveillance goals. Analytic methods must be selected and configured to meet a surveillance goal, but there are no uniform criteria to guide the selection and configuration process. In this paper, we describe work towards the development of an analytic framework for space-time aberrancy detection in public health surveillance data. The framework decomposes surveillance analysis into sub-tasks and identifies knowledge that can facilitate selection of methods to accomplish sub-tasks.

Bioterrorism↗