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PubMed2003

BioSTORM: a system for automated surveillance of diverse data sources.

Heightened concerns about bioterrorism are forcing changes to the traditional biosurveillance-model. Public health departments are under pressure to follow multiple, non-specific, pre-diagnostic indicators, often drawn from many data sources. As a result, there is a need for biosurveillance systems that can use a variety of analysis techniques to rapidly integrate and process multiple diverse data feeds using a variety of problem solving techniques to give timely analysis. To meet these requirements, we are developing a new system called BioSTORM (Biological Spatio-Temporal Outbreak Reasoning Module).

Bioterrorism↗
PubMed2004

Surveillance of the bioterrorist threat: a primary care response.

Threats from bioterrorism are of national and international concern. We outline a system of disease surveillance covering a selection of diseases linked to potential bioterrorist threats, based on the weekly returns service of the Royal College of General Practitioners and covering a surveillance population of 650,000 in England and Wales. Practices record working diagnoses and the episode type (distinguishing new episodes of illness from ongoing consultations) on patients' computerised medical records. These are interrogated twice weekly by using automated routines. The registered population and persons consulting for each Read code (group of codes) are counted in sex and age specific groups and the data forwarded electronically to the Research Unit, where the results are consolidated by region (North, Central, South). Weekly incidence rates between October 2001 and September 2002 were compared with the weekly average over the past seven years for 13 selected conditions. Detailed data are presented for three conditions (asthma, infections of the skin, disorders of the peripheral nervous system). For asthma increased incidence was reported in weeks 31 and 32 of 2002, predominantly in the Central region. For the other two conditions no unusual peaks of incidence were observed in any region. Operational research based on disciplined recording of morbidity in general practice can deliver timely surveillance data on bioterrorist threats.

Asthma↗
PubMed2004

EMTALA: dedicating an emergency department near you.

Congress enacted the Emergency Medical Treatment and Labor Act (EMTALA) in 1986 to prohibit patient dumping. Subsequent to its passage, however, issues concerning the application of EMTALA have vexed hospitals, patients, regulators, and courts. In an attempt to clarify these issues, the Centers for Medicare & Medicaid Services (CMS) recently promulgated new EMTALA regulations. This Article reviews the basic requirements of EMTALA and highlights the statutory definitions critical to its proper interpretation and application. The article then analyzes the impact of the new regulations, particularly in five major areas: where and when the statute applies, on-call physician requirements, hospital-owned ambulances, managed care, and bioterrorism. It concludes with a discussion of the implications of the new regulations for hospitals and their counsel.

Ambulances↗
PubMed2003

Terror and triage: prioritizing access to mass smallpox vaccination.

In response to the threat of a smallpox attack on the United States, the Centers for Disease Control and Prevention ("CDC") recommended the establishment of smallpox clinics designed to distribute a vaccine to the entire U.S. population in a ten day period. However, a number of potential obstacles raise questions about the feasibility of this plan. What is needed is a plan that applies principles of triage to smallpox vaccine distribution following a bioterrorism attack. Only in this way can those most vulnerable--the previously unvaccinated--be protected from a significantly increased risk due to delays that might arise in executing the CDC plan.

Bioterrorism↗
PubMedDate not supplied

Public health educational intervention in a family medicine residency.

Emerging infections and bioterrorism pose increasing threats to the health of our communities. To protect patients, frontline providers like family physicians must learn and use core public health skills such as disease detection, surveillance, and response activities. This paper describes a unique approach to teaching these core public health skills by incorporating residents into ongoing disease surveillance and reporting activities in coordination with the local health department. Comparison of pre- and post-intervention surveys of residents demonstrated that this intervention increased resident self-perceived competency in disease detection and surveillance, knowledge of reportable conditions, and ability to engage response activities.

Attitude of Health Personnel↗
PubMed2005

Possession, use, and transfer of select agents and toxins. Final rule.

This document establishes a final rule regarding possession, use, and transfer of select agents and toxins. The final rule implements provisions of the Public Health Security and Bioterrorism Preparedness and Response Act of 2002 and is designed to protect public health and safety. In a companion document published in this issue of the Federal Register, the United States Department of Agriculture has established corresponding final rules designed to protect animal and plant health and animal and plant products.

Animals↗
PubMed2004

[New concepts in epidemiological surveillance in French army].

Epidemiological surveillance within the French Armed Forces has had to take into account various changes in infectious diseases in recent years. The French Armed Forces are encountering new hazards, such as the spread of HIV infection, Plasmodium falciparum chemoresistance, and outbreaks of emerging diseases. Bioterrorism, industrial and occupational hazards are added concerns. For these reasons, the French Military Medical Service has introduced a new concept based on permanent epidemiological surveillance of communicable diseases. This is completed by a real-time spatial surveillance designed to detect very rapidly potential communicable diseases or new emerging diseases. This epidemiological system, based on data modeling, enhances the medical information available to staff commands before deployment to new areas.

Bioterrorism↗
PubMed2005

Ring vaccination versus mass vaccination in event of a smallpox attack.

Since vaccination is critical in responding to smallpox exposure, vaccination strategies must be evaluated during bioterrorism preparedness. Information on historical factors, smallpox characteristics, public health capabilities and hypothetical attack scenarios was used to evaluate major vaccination strategies. In event of a smallpox attack, the optimal strategy is situational, mass vaccination may be best for dense island populations such as Oahu.

Bioterrorism↗
PubMed2005

HIV legal precedent useful for microbial forensics.

The field of microbial forensics was formalized because of the need for attribution in events where a bioweapon has been used. Microbial forensics has its origins in traditional forensics, microbiology, and epidemiology. Microbial forensics can be defined as a scientific discipline dedicated to analyzing evidence for attribution purposes from a bioterrorism act, biocrime, hoax, or inadvertent microorganism/toxin release. This is a very challenging task, since there are myriad microorganisms that can pose a threat, and analytical methods need to be used reliably. The Scientific Working Group on Microbial Genetics and Forensics (SWGMGF) has addressed some quality assurance and control issues, and particularly validation criteria (focusing on preliminary validation) due to the dynamic nature of evolving investigations. Unique identification of a microorganism may never be possible. Yet, qualitative and/or quantitative assessments of the evidence can be made. One approach to provide direction on gaps in the microbial forensics effort is to perform an end-to-end retrospective analysis of past cases. As an example, the case of a gastroenterologist who was accused of second degree attempted murder of his paramour using HIV as the weapon was reviewed. The scientific evaluation involves epidemiology, molecular biology, phylogenetics, and legal deliberations.

Bioterrorism↗
PubMed2005

The statue of security: human rights and post-9/11 epidemics.

Following the attacks of September 11, 2001(9/11), there have been increasingly divisive proposals for Americans to sacrifice liberty for safety. "Health and human rights" provides a much more constructive and effective framework than fear on which to base both routine public health actions and responses to public health emergencies. This can be illustrated by the failure of bioterrorism-based government initiatives at both the state and federal levels since 9/11, as well as the worldwide response to the post-9/11 SARS epidemic. Effective public health work can only occur with a population that trusts its public health officials. 9/11 can serve as a catalyst to reform public health by adopting the health and human rights framework that can move it from a fragmented state and local activity to one that is federal and coordinated, and ultimately one that is global and based on transparency, trust, science, and respect for human rights.

Bioterrorism↗
PubMedDate not supplied

Emergency preparedness curriculum in nursing schools in the United States.

With concern about bioterrorism and inadequacies in responding to mass casualty events, health care professionals have been placed in the category of first responders. The International Nursing Coalition for Mass Casualty Education (INCMCE) was established to plan strategically to address the educational needs of the nation's nurses. This study sought to determine the types and levels of disaster preparedness curricula being delivered or in development in nursing programs at all levels. INCMCE surveyed 2,013 deans or directors of nursing schools as to curricula for emergency preparedness prior to September 11, 2001, and during the two following academic years. Initial requests were sent via email and the US postal service. Respondents were invited to answer the online survey so data could be directly entered into a database for purposes of data analysis. Responses were received from 348 schools of nursing. Curriculum plans, followed by competency lists, were selected as most helpful for teaching content in disaster preparedness. The survey results validated the general assumption that nursing programs provide limited curricula in this area. The mean number of hours of disaster preparedness content provided, approximately four hours, did not change significantly over three academic years. The study also showed that 75 percent of respondents thought that nurse faculty were inadequately prepared in the area of disaster management. The study established a baseline for future curricular growth.

Bioterrorism↗
PubMed2006

Introducing a senior course on catastrophe preparedness into the dental school curriculum.

This article describes an integrated fourth-year course in catastrophe preparedness for students at the New York University College of Dentistry (NYUCD). The curriculum is built around the competencies proposed in "Predoctoral Dental School Curriculum for Catastrophe Preparedness," published in the August 2004 Journal of Dental Education. We highlight our experience developing the program and offer suggestions to other dental schools considering adding bioterrorism studies to their curriculum.

Bioterrorism↗
PubMed2006

Early detection and surveillance for biopreparedness and emerging infectious diseases.

Biological weapons and emerging infectious diseases pose a significant risk to public health. A timely response is needed to effectively treat and contain a potential infectious disease outbreak. Detection and surveillance of biological agents needs to be sensitive and specific to allow providers to quickly and accurately identify the disease process and begin the necessary response procedures. This article addresses the importance of early detection and surveillance of both intentional and unintentional biological events. Challenges of bioterrorism and the nursing role in response are discussed. Epidemiological considerations, such as route of transmission and personal protective equipment, are presented. An overview of the major surveillance systems, including advances in computer-based technology, is provided to help health care providers become aware of current surveillance systems and clinical decision support tools designed to help diminish the impact of biological threats.

Bioterrorism↗
PubMed2006

Arming for an emergency. Hospitals may be more ready for a pandemic now than a year ago, but experts say some preparations are just lip service.

After months of work and millions of dollars awarded to state and local governments, U.S. hospitals are still less than ready to face a pandemic or bioterrorism-related emergency, according to disease experts. But it's difficult to be completely prepared for such an event, they say. "You don't know when it's going to come, where it will be, whether you'll have medicines to fight it," says Tammy Lundstrom, left.

Bioterrorism↗
PubMed2006

Focus on new antiviral drugs for AIDS and smallpox treatments.

More than 400 papers on medicinal chemistry were presented at the 231st National Meeting of the American Chemical Society in Atlanta, Georgia, U.S.A., March 26-30, 2006. A major focus was a large number of papers on new AIDS drug therapies being developed. The rapid development of HIV viral mutations is one reason expensive highly active antiretroviral therapy multidrug treatments are preferred. This increasing resistance of HIV to current drugs is spurring new drug development. In addition, concerns about bioterrorism have awakened interest in drug treatments for a viral disease once thought to be extinct, smallpox. This report will focus on these areas of research.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

Bioethics, bioweapons and the microbiologist.

The analysis of behavior of man in the field of biology is carried out through bioethics, considered the science of the survival. In the microbiology, there are numerous discoveries related with pathogenic microorganisms, including those that can be used as weapons in a biological war or in an attack considered bioterrorism. The scientist involved in microbiology can participate with his knowledge in the development and improvement of bioweapons, however from the point of view of bioethics it is not acceptable that he works in an investigation related with these topics, because the defense research can evolve in offensive one. The war is an antisurvival activity, therefore it is not acceptable. In the same way, the biological weapons composed with virus, fungi or alive bacteria, or with toxins from them, neither they are morally accepted. After the terrorist attacks with anthrax in the United States in 2001, the world scientific community in the field of microbiology should show against the use of the microorganisms like bioweapons, at the time of promoting the idea that the responsible use for the microorganisms is a moral imperative for all microbiologists around the world, since the biological weapons are a threat for the human life.

Bioethics↗
PubMed2006

[Emerging viral diseases].

Emerging and re-emerging infectious diseases have again entered the public arena in recent years. This is due to factors such as evolving lifestyles, ecological and socio-political upheavals, and recent diagnostic advances. Numerous pathogens, including viruses like West Nile, Chikungunya and Japanese encephalitis on the one hand, and hemorrhagic fever viruses like Ebola and Maburg, are particular concerns. Recently, the Corona virus responsible for SARS, which caused an epidemic sufficiently worrisome to challenge crisis management concepts, was successfully isolated. It is in this context that so-called "bird flu'", may be on the verge of causing a human pandemic. Pox and Monkeypox are "virtually emerging" viruses that have potential for use in bioterrorism. The management and treatment of these emerging infectious diseases calls for new approaches, organizations and infrastructures.

Animals↗
PubMedDate not supplied

[Venezuelan equine encephalitis: state-of-the-art].

The paper provides the currently available data on the global prevalence of Venezuelan equine encephalitis (VEE), its epidemiology, clinical picture, and specific prevention in human beings. It also discussed the problem of potential use of the causative agent of VEE as a subject of bioterrorism.

Americas↗