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PubMed2001

Preparing for expected bioterrorism attacks.

The threat of bioterrorism in the United States is increasing. Health professionals, especially "front-line" practitioners, must be able to recognize the potential for major impacts from a bioterrorism event. Although an effective attack could produce numbers of casualties equivalent to those resulting from a nuclear weapon, an unannounced attack would be unlikely to be recognized immediately. Health workers may be the first to recognize an attack. However, only limited assistance is available to aid local community medical organizations in planning for bioterrorism. Military medical personnel have had more experience in planning for terrorist activities than many of their civilian colleagues. Their experience may be invaluable to local civilian treatment facilities in developing practical plans to meet the unique aspects of bioterrorism. In addition to considering agent-specific medical problems and requirements, it is particularly important for plans to address command and control, communication, and coordination if the resultant response is to be effective.

Biological Warfare↗

PubMed2000

Bioterrorism: challenges and opportunities for local health departments.

The emerging threat of bioterrorism will significantly impact local health departments. If a bioterrorism attack occurs, local medical and public health personnel will have the primary role of recognition and response. Federal assistance and training to deal with bioterrorism have been directed to 120 of our largest cities. Despite progress, much needs to be done. The public health approach to bioterrorism must begin with the development of local and state plans developed by public health, emergency response, and law enforcement communities, which must work together closely if an epidemic is to be detected in a timely manner.

Biological Warfare↗

PubMed2001

Citywide pharmaceutical preparation for bioterrorism.

One community's efforts to become pharmaceutically prepared for an attack with biological agents is described. In response to recent bioterrorist activities, including a local scare in 1999 involving anthrax, the pharmacy department at Deaconess Medical Center in Spokane, Washington, was asked to develop a plan for bioterrorism preparedness. A literature search was conducted, and resources, such as the Centers for Disease Control and Prevention, were contacted. For each biological agent, information was compiled about symptom onset, treatment, postexposure prophylaxis, patient isolation precautions, and the availability of antidotes at local hospitals. A procedure was developed for obtaining antidotes that might not be available or stocked in sufficient quantities. After being reviewed by appropriate authorities, the information was presented to area hospitals and trauma centers, drug wholesalers, hospital risk-management personnel, and emergency management personnel. In May 2000 dozens of emergency and medical personnel attended a day-long program on domestic preparedness. Citywide cooperation was obtained on how to respond to a mass exposure to a bioterrorism agent. The job of a pharmacist during a bioterrorism strike is to rapidly disseminate antidotes and information, provide dosage and vaccination schedules for both treatment and prophylaxis, and counsel patients. Medical facilities in Spokane have cooperated to make the community more prepared for a bioterrorist attack.

Antidotes↗

PubMed2001

Bioterrorism: implications for the clinical microbiologist.

The specter of bioterrorism has captured the attention of government and military officials, scientists, and the general public. Compared to other sectors of the population, clinical microbiologists are more directly impacted by concerns about bioterrorism. This review focuses on the role envisioned for clinical laboratories in response to a bioterrorist event. The microbiology and clinical aspects of the biological agents thought to be the most likely tools of bioterrorists are presented. The historical background of the problem of bioterrorism and an overview of current U.S. preparedness planning, with an emphasis on the roles of health care professionals, are also included.

Bacteria↗

PubMed2000

[Bioterrorism--a public and health threat].

In recent years the fear of bioterrorism, of secret modernization and dissemination of biological weapons is increasing. Facts detected recently in Iran, Japan and the former Soviet Union provide evidence that there are countries and dissident groups which have access to modern technology of cultivation of dangerous pathogens as well as motivation for their use in acts of terrorism or war. The menace of biological terrorism is nowadays, as compared with the past, much greater. The most feared candidates as regards production of biological weapons are the pathogens of smallpox, anthrax and plague. The author discusses the serious character of possible events associated with terrorist dissemination of these pathogens. It is much esier to produce and use biological weapons than to create effective systems of defence against them. The menace of bioterrorism and bioweapons must not be exaggerated nor underestimated. The possible terrorist use of bioweapons is real. At present even the most advanced industrial countries cannot quarantee effective protection of their populations. Fortunately they are however aware of their present vulnerability. Our society is not equipped to cope with bioterrorism. Preparation and reinforcement of the health services, in particular of sections specialized in the control of infectious diseases is an effective step to divert the sequelae and suffering associated with terrorist use of biological agents. It is essential to be prepared. This calls for time and funds which unfortunately are not plentiful.

Anthrax↗

PubMed2000

A Swedish/European view of bioterrorism.

Bioterrorism includes possible use of Weapons of Mass Destruction (WMD), preferably biological agents, by non-state terrorist groups as well as criminal clusters. The threat from terrorists to utilize biological agents to achieve goals is not new, but the threshold to realize the threats seems to be lower than previously expected. It can be argued that as targets for bioterrorism Sweden and Europe are less likely than is the U.S. However, with the collapse of the former Soviet Union heavy mafia-based groups have emerged in Russia with the intent to obtain and trade material and utilities for the creation of WMD. Such activities are reaching far beyond the borders and can thus be found in Sweden as well as the other countries of Europe. This together with the fact that groups of different shades of political opinion can come in open conflict in the most unexpected countries of Europe have given bioterrorism a face in Sweden, as well as in the rest of Europe.

Animals↗

PubMed2001

Update: Investigation of bioterrorism-related anthrax and interim guidelines for clinical evaluation of persons with possible anthrax.

Since October 3, 2001, CDC and state and local public health authorities have been investigating cases of bioterrorism-related anthrax. This report updates findings as of October 31, and includes interim guidelines for the clinical evaluation of persons with possible anthrax. A total of 21 cases (16 confirmed and five suspected) of bioterrorism-related anthrax have been reported among persons who worked in the District of Columbia, Florida, New Jersey, and New York City (Figure 1). Until the source of these intentional exposures is eliminated, clinicians and laboratorians should be alert for clinical evidence of Bacillus anthracis infection. Epidemiologic investigation of these cases and surveillance to detect new cases of bioterrorism-associated anthrax continues.

Adult↗

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↗

PubMed2000

Bioterrorism: a challenge to public health and medicine.

Only a few years ago, an attack with a biological agent would have been considered almost unthinkable. Today, however, the threat of bioterrorism is real and growing. This article will provide a brief overview of the threat of bioterrorism, the special role of public health and medicine, and some of the critical issues that need to be addressed as this nation prepares for this disturbing and potentially catastrophic threat.

Biological Warfare↗

PubMedDate not supplied

Bioterrorism as a public health threat.

The threat of bioterrorism, long ignored and denied, has heightened over the past few years. Recent events in Iraq, Japan, and Russia cast an ominous shadow. Two candidate agents are of special concern--smallpox and anthrax. The magnitude of the problems and the gravity of the scenarios associated with release of these organisms have been vividly portrayed by two epidemics of smallpox in Europe during the 1970s and by an accidental release of aerosolized anthrax from a Russian bioweapons facility in 1979. Efforts in the United States to deal with possible incidents involving bioweapons in the civilian sector have only recently begun and have made only limited progress. Only with substantial additional resources at the federal, state, and local levels can a credible and meaningful response be mounted. For longer-term solutions, the medical community must educate both the public and policy makers about bioterrorism and build a global consensus condemning its use.

Biological Warfare↗

PubMed1999

Bioterrorism alleging use of anthrax and interim guidelines for management--United States, 1998.

From October 30 through December 23, 1998, CDC received reports of a series of bioterroristic threats of anthrax exposure. Letters alleged to contain anthrax were sent to health clinics on October 30, 1998, in Indiana, Kentucky, and Tennessee. During December 17-23 in California, a letter alleged to contain anthrax was sent to a private business, and three telephone threats of anthrax contamination of ventilation systems were made to private and public buildings. All threats were hoaxes and are under investigation by the Federal Bureau of Investigation (FBI) and local law enforcement officials. The public health implications of these threats were investigated to assist in developing national public health guidelines for responding to bioterrorism. This report summarizes the findings of these investigations and provides interim guidance for public health authorities on bioterrorism related to anthrax.

Anthrax↗

PubMed1999

Targeting bioterrorism.

Concerns about bioterrorism have grown in recent years. The fear of bioterrorism is as potent as the genuine risk. In this new age of potential biological warfare, emergency medical preparedness must be on target. Physicians must be ready to alert public health authorities.

Biological Warfare↗

PubMed2000

Medical response to bioterrorism: are we prepared?

The 1995 bombing of the Federal Building in Oklahoma City made terrorism a shocking reality for all Oklahomans. The fact that such an event could happen here, far from foreign political and ethnic conflicts and from large coastal cities, made us realize that no one is immune from the terrorist threat. But as horrific as that event and other terrorist incidents have been, the present threat of the use of infectious agents in acts of terrorism has the potential to cause far greater human death and suffering than any previously used terrorist weapon. Although health care professionals have not historically participated in terrorist planning and response activities, the addition of infectious agents to the terrorists' arsenal makes medical and public health professionals critical players in these efforts. Indeed, physicians have the ability to first recognize and report such an event and thereby diminish the impact. To meet the bioterrorism responsibility, physicians must be knowledgeable of this type of threat. In this article we present an overview of bioterrorism and review the organisms most likely to be used in a terrorist event.

Biological Warfare↗

PubMed2000

Bioterrorism and the importance of the public health laboratory.

Biological terrorism is a threat to the United States that public health laboratories cannot afford to ignore. With the ability to recognize unusual strains of organisms, or an increase in test requests or isolation of specific organisms, the public health laboratory can detect the beginning of an outbreak. The laboratory can also facilitate appropriate response measures with rapid diagnostic testing and by determining antibiotic resistance patterns. Public health laboratory personnel need to assess their capabilities, improve them where indicated, and know where to turn for assistance. As improvements in bioterrorism detection occur in the civilian sector, military laboratories must integrate with local, state, and federal health department systems. Laboratories are essential components in surveillance, recognition, and response for both bioterrorism and naturally occurring disease outbreaks.

Biological Warfare↗

PubMed2001

Preparedness and response to bioterrorism.

As we enter the 21st century the threats of biological warfare and bioterrorism (so called asymmetric threats) appear to be more real than ever before. Historical evidence suggests that biological weapons have been used, with varying degrees of success, for many centuries. Despite the international agreements to ban such weapons, namely the 1925 Geneva Protocol and the 1975 Biological and Toxin Weapons Convention, there is no effective international mechanism for challenging either the development of biological weapons or their use. Advances in technology and the rise of fundamentalist terror groups combine to present a significant threat to western democracies. A timely and definitive response to this threat will require co-operation between governments on a scale never seen before. There is a need for proper planning, good communication between various health, home office, defence and intelligence agencies and sufficient financial support for a realistic state of preparedness. The Department of Health has produced guidelines for responding to real or suspected incidents and the Public Health Laboratory Service (PHLS) has produced detailed protocols to inform the actions required by microbiologists and consultants in communicable disease control. These protocols will be published on the Department of Health and PHLS web sites.

Anthrax↗

PubMedDate not supplied

Pediatric implications in bioterrorism part I: physiologic and psychosocial differences.

Children are physically and psychologically different from adults and require care modified to meet their needs. In the event of a bioterrorism attack, the child's stage of development can help or hinder his or her response to bioterrorist material. This Part 1 of a series of articles addresses the differences found in children and how health care providers can alter interventions to avoid causing further harm.

Adolescent↗

PubMedDate not supplied

Pediatric implications in bioterrorism part II: postexposure diagnosis and treatment.

Bioterrorism is an old tactic used in warfare. The use of fatal diseases or man-made poisons to subdue others has not been limited to wartime. Trauma personnel should be aware of commonly used agents, the signs and symptoms of their exposure, and recommended treatment. Children can be victims of terrorists' acts and need special attention because of their unique response to exposure, varying dosages of medications, and lack of active immunity.

Anthrax↗

PubMed2000

Implications of pandemic influenza for bioterrorism response.

The 1918-1919 influenza pandemic (Spanish flu) had catastrophic effects upon urban populations in the United States. Large numbers of frightened, critically ill people overwhelmed health care providers. Mortuaries and cemeteries were severely strained by rapid accumulation of corpses of flu victims. Understanding of the outbreak's extent and effectiveness of containment measures was obscured by the swiftness of the disease and an inadequate health reporting system. Epidemic controls such as closing public gathering places elicited both community support and resistance, and fear of contagion incited social and ethnic tensions. Review of this infamous outbreak is intended to advance discussions among health professionals and policymakers about an effective medical and public health response to bioterrorism, an infectious disease crisis of increasing likelihood. Elements of an adequate response include building capacity to care for mass casualties, providing emergency burials that respect social mores, properly characterizing the outbreak, earning public confidence in epidemic containment measures, protecting against social discrimination, and fairly allocating health resources.

Bioterrorism↗