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Status Brief

Developmental Milestones/Developments to Date:

Current Assessment/State of the Field:




Antiterrorism and Effective Death Penalty Act of 1996, Public Law No. 104-132, 18 U.S.C. , April 24, 1996.

  1. To deter terrorism, provide justice for victims, provide for an effective death penalty, and for other purposes. Habeas Corpus reform, including filing deadlines, appeals, death penalty litigation procedures, and amendments of Federal Rules of Appellate Procedure. Justice for victims of terrorism, such as mandatory victim restitution, jurisdiction for lawsuits against terrorist states, and assistance to victims of terrorism. International terrorism prohibitions, including prohibition on international terrorist fundraising and prohibition on assistance to terrorist states, specifically financial transactions with terrorists and opposition to assistance by international financial institutions to terrorist states. Terrorist and criminal alien removal and exclusion. Removal of alien terrorists, exclusion of members and representatives of terrorist organizations, modification to asylum procedures, and criminal alien procedural improvements.Strong emphasis on nuclear, biological, and chemical weapons restrictions, especially weapons of mass destruction. Implementation of plastic explosives convention, which covers requirements of detection agents for plastic explosives, criminal sanctions and seizure and forfeiture of plastic explosives. Criminal law modifications to counter terrorism, such as increased penalty for conspiracies involving explosives and clarification of criminal jurisdiction over terrorism offenses overseas.

Law, Bioterrorism


Wadman, “Action needed to counter bioterrorism,” NATURE, v. 388, 21 aug 1997, p. 703.



Henderson, D., A., “Bioterrorism as a Public Health Threat,” Emerging Infectious Diseases, vol. 4, No. 3, July-sept 1998.

Bioterrorism, Russia, Japan, Ebola, Marburg, Hemorrhagic Fever, Smallpox, Anthrax, Germany, Yugoslavia, Vaccination, Iraq


Benjamin, Georges C. “Chemical and Biological Terrorism: Planning for the WorstPhysician Executive Volume 26 Issue 1. 80. January/February 2000.

  1. ”Chemical or biological terrorism is the use of pathogenic microbes or toxins derived from plants, animals, microbes, or chemical agents to achieve terror.” – page 80
  2. ”Chemical and biological weapons, like nuclear weapons, are categorized as weapons of mass destruction (WMD) because of the high number of potential victims that can result from their use.” – page 80
  3. ”While any chemical can be weaponized, the chemical agents traditionally of concern fall into four categories: nerve agents like sarin, which create an anticholinergic-like syndrome; vesicants like mustard gas, that cause a blistering or burn-like syndrome; cyanide, which interrupts aerobic metabolism; and riot control agents such as mace, which generally cause incapacitation.” – page 80
  4. ”Biological agents act like chemical agents but have a slower onset of action. Agents of concern include Ricin.” – page 81
  5. ”The ideal bioweapon is hard to detect from the usual microbial flora, has person-to-person spread, and is easy to aerosolize. There are two groups of organisms of public health concern: those that cause a high morbidity or a high mortality.” – page 81
  6. ”Examples of high morbidity organisms include salmonella, cholera, or E. coli. The number of highly toxic organisms is fortunately quite low and includes anthrax, smallpox, and the viruses that cause hemorrhagic fevers, plague, brucellosis, and tularemia.” – page 81
  7. “Clues that biological terrorist events have occurred include an unexplained increase in respiratory cases or deaths, or dead and dying animals. Epidemiological clues include diseases with the wrong mode of transmission, which occur in an inappropriate geographic distribution or infect a new or novel population.” – page 81
  8. “Components of a biological/chemical terrorism disaster plan: plan how to identify the threat; develop an effective public health disease surveillance system; link the public health system and the traditional medical care delivery system; develop command and control systems; determine hospital bed availability; define disease containment, isolation, and quarantine procedures; plan how to obtain extra life support equipment such as respirators; plan how to train clinical staff to identify high-risk unusual diseases; ensure non-clinical staff are trained on the management of suspicious packages and mail; identify experts; plan simple handling and transport; plan how to communicate high risk information; manage medical examiner cases; and maintain a crime scene.” – page 81
  9. “Effective disease control strategies such as case finding, decontamination, prophylaxis and vaccination, and quarantine must be defined.” – page 82

Chemical, WMD, Bioterrorism, Public Health, Military, Sarin, Japan, Ricin, E. coli, Cholera, Salmonella, Anthrax, Smallpox, Hemorrhagic Fever, Plague, Brucellosis, Tularemia, Prophylaxis, Vaccination, Quarantine


Inglesby, Thomas, V., et al, “Plague as a biological weapon: Medical and public health management,” JAMA, ma3, 2000, vol. 283, No. 17, 2281.

  1. “consensus statement 1995 microbiologist in ohio acquired plague y pestis by fraudulent means, antiterrorism drawn in response.”

Vaccination, Plague, Bioterrorism


Adamo, Beth, “Evacuating Your Home During a Terrorist Attack“, Safety. 2000.

  1. “If the order to evacuate is given, you should do so immediately and carefully follow the directions given by local authorities. If a local shelter has been established, go there.”
  2. “Wherever you’ve decided to go, the best way to get there is by car.”
  3. “Be prepared for any emergency by assembling an emergency supplies kit.”

Public Health, Emergency Response, Biosafety, Bioterrorism


Vergano, Dan, “Bioterrorism defense under fire Doctors say military plans are wrong approach”. USA TODAY. June 21, 2000.

  1. “At a recent briefing sponsored by the American Medical Association, infectious-disease specialists argued that military planners have botched the nation’s bioterrorism defenses and ignored the doctors who would form the leading lines of defense against terrorists wielding diseases to kill.”
  2. “”It’s not the military who will respond to a biological event, but biologists,” says AMA briefing speaker Michael Osterholm of the Minneapolis-based Infection Control Advisory Network, an infectious-disease consulting firm. A former state health official, he warns “it’s just a matter of time” before a bioterrorist attack occurs. He estimates an anthrax attack could cause 3 million deaths.”
  3. “Osterholm criticizes the federal government’s allocation of funds as already too military-oriented, with about $ 121 million sent to the Centers for Disease Control and Prevention to combat bioterrorism, out of about $ 10 billion in the 1999 federal counterterrorism budget”
  4. “Biological weapons pose a unique public threat. Unlike explosives or gunfire, microbes overwhelm people slowly, spreading through the populace with symptoms that can mimic more benign maladies, like the flu.”
  5. “Lab analysis, vaccines and drugs, “disease detectives,” and quarantine are all tools that can be directed toward a biological disaster by the CDC director without the involvement of any other federal agency, Lillibridge says. “We anticipate the rest of the government catching up with us.””
  6. “Instead of funding military bioterrorism response teams, he says, the government should bulk up disease surveillance efforts staffed by physicians”
  7. “”Most bioterrorism planning revolves around worst-case scenarios,” says terrorism expert Bruce Hoffman, who heads the Washington, D.C., office of RAND, a military and public policy think tank. Terrorists desire terror, he suggests, a goal achieved far more easily and cheaply with a gun or a bomb than with microbes.”

Public Health, Bioterrorism, CDC, Quarantine, Emergency Response, Military, Anthrax


Seto, Yasuo. “The Sarin Gas Attack in Japan and the Related Forensic Investigation.Organization for the Prohibition of Chemical Weapons. 14. June 2001

  1. ”Lethal nerve gas attacks in the city of Matsumoto in 1994, and in the Tokyo subway system in 1995, led to the deaths of 19 people, as well as to a large number of injuries.” – page 14
  2. ”Aum Shinrikyo was established by Shoko Asahara, and it disseminated a unique doctrine that taught that one could kill another human being who continues to commit evil deeds, and is thus destined to go to hell. After failing to win support in the 1989 general election, the cult transformed itself into a terrorist group that produced arms in toxic gases.” – page 14
  3. ”While expanding its influence in Japan, Aum also set up branch offices overseas in the United States, Germany, and Sri Lanka.” – page 14
  4. ”Two days after the Sarin incident in Tokyo, a simultaneous raid of Aum facilities was launched by 2,500 police in connection with the imprisonment of a notary public manager who had died while being detained.” – page 15
  5. ”Using established forensic toxicological techniques, it was found that during the Matsumoto incident, Sarin gas was sprayed to murder the local court judges, but nearby residents also became exposed to the toxins.” – page 16
  6. ”In the Tokyo subway Sarin incident, the cult decided to use Sarin in trains on three subway station lines, all of which stop at Kasumigaseki station near the Matsumoto Police Department. The perpetrators boarded the subway trains with plastic bags containing Sarin, and released the gas by prodding the bags open with the metal tips of umbrellas.” – pages 16, 17

Chemical, Bioterrorism, Sarin, Japan, Law Enforcement, Organizations/Groups, WMD


Khan, Ali, S., et al. “Ready or Not –Preparedness for Bioterrorism,” (CDC) NEW ENG J. MED., July 26, 2001, vol. 345, no. 4, pg. 287.

  1. glanders, rogue states, inevitable attack, public health preparedness (questions contact point for reporting).
  2. West nile virus, new york
  3. Preparedness, Policy



Netesov, Sergey V., Sandakhchiev, Lev S.The Need for Creation of the International Center in Novosibirsk, Russia for Combating Infections Diseases and Bioterrorism Threat in Asia.STATE RESEARCH CENTER OF VIROLOGY AND BIOTECHNOLOGY NOVOSIBIRSK (RUSSIA), Sep. 2001 pp 349-357.

  1. “In 1992, an International Science and Technology Center (ISTC)was established as a nonproliferation-targeted program for the Newly Independent States.” p 350
  2. “VECTOR employees have attended dozens of international conferences and workshops using ISTC Support. Hundreds of our scientists have wisited their foreign counterparts on site. It made it possible to create an atmosphere of openness and transparency at VECTOR, which is critical to science and scientists.” p 350
  3. “…with BTEP it is the study of infections representing serious public health problems such as HIV/AIDS, multi-drug-resistant tuberculosis, hepatitis, measles, etc. And these investigations are being started with establishing the international ethical standards at VECTOR in accordance with international GCP regulations. p 350
  4. “Two very perspective projects will be started soon in the field of development of fast and very sensitive PCR-microchip detection of dangerous pathogen genomes in blood and other biological samples.” p 350
  5. “Very focused are also the efforts that are being planned and implemented under U.S.A. Cooperative Threat Reduction (CTR) program that relate to upgrade the physical security and biosafety systems at the maximum biocontainment facilities at VECTOR up to the highest modern standards.” p 351
  6. “Continuous involvement of foreign scientists in work at this ”Center”would be a powerful instrument of confidence building. It is critical, therefore, that all high containment capabilities and necessary supporting facilities be incorporated into the ”Center” to alleviate concerns over possible prohibited activity.” p 351
  7. “The geographical location of the Center – near the geographical center of Russia – is very suitable for the most effective collection of natural viral and bacterial strains and diagnostic procedures for the study of specimens from Asian Russia, Central Asia FSU republics, Mongolia and other neighbor countries, if needed because Novosibirsk is the largest in the area transportation hub. this location of the proposed ”International Center” would also allow us to join international efforts to control and deter potential bioterrorists.” p 352
  8. “The Collection of Cultures of Microorganisms available in the Center comprises over 10,000 deposit entries: various viral strains, including the national collection of variola virus strains and strains of viral BSL-4 pathogens.” p 352
  9. VECTOR houses one of the two WHO Collaborating Centers (WHO Collaborating Center for orthopoxvirus diagnosis and repository for variola virus strains and DNA), supplied with all required conditions for work with human highly pathogenic viruses including variola virus.” pp 352-353
  10. “As a result of this research, the proposed ”International Center” can have one of its strategic scientific goals such as making prognosis, based on the data of global monitoring, of what new infections might emerge in the future. It should be noticed that the most of these infectious agents are considered to be possible bioterrorism agents, and therefore the proposed ICERID could develop the preventive research in anti-bioterrorism direction.” p 353
  11. “The special attention would be paid to the investigation of the unusual outbreaks of infectious diseases in the region (Asian part of Russia, Central Asian republics – members of C.I.S., possibly – another countries of the region). This investigation may be conducted using molecular epidemiology approach, which allows to determine the sero- and genotypes of infectious agents, the source of primary infection and even to help distinguishing whether it is intentional or natural outbreak … Such investigations may be made on a regular basis for a wide list of pathogens. This type of research would be extremely useful both for monitoring of the evolution and spread of infectious agents and for the investigation of possible bioterrorism cases.” pp 353-354

Russia, Bioterrorism, Biodefense, Biodetection, Lab Safety, Mongolia, Scientist, WHO, Asia


Kolata, Gina, “Debate What to Do When Findings Aid an Enemy,” NYT F1, September 25, 2001.

  1. Role of Scientists, Emotion, Regret.

Open Science, Bioterrorism


Atlas, Ronald, “Bioterrorism before and after September 11,” CRITICAL REVIEWS IN MICROBIOLOGY, 27(4):355-379 (2001.)

  1. History of bioterrorism, anthrax, 1979 Russian release from military plant pre-open science debate rhetoric.

Russia, Open Science, Bioterrorism, Anthrax


Stolberg, Sheryl, “A NATION CHALLENGED: THE HEALTH SYSTEM; Struggling to Reach a Consensus On Preparations for Bioterrorism”. The New York Times; November 5, 2001.

  1. “This year, Johns Hopkins will buy extra medicines, masks, ventilators and radios for its security force. It will retrofit a building with new air filters, to keep infectious germs from spreading. The price: $7 million. The question is, who will pay for it?”
  2. “”The federal government is going to have to give us some assistance,” Mr. Peterson said. Last week, the American Hospital Association estimated that the nation would have to spend $11.3 billion to get hospitals ready to handle a serious bioweapon attack.”
  3. “The system they have tested — the public health system — has been strained to its breaking point.”
  4. “”We have spent, in the last three years, one dollar per year per American on bioterrorism preparedness,” said Dr. Tara O’Toole, director of the Center for Civilian Biodefense Studies at Johns Hopkins University. “We are basically getting what we paid for.””
  5. “”We can achieve much better preparedness very quickly,” Mr. Kennedy said, “but it will require a major national effort and a major commitment of new resources.””
  6. “Having the will does not just mean having the money. It means training doctors and nurses and public health professionals. It will also mean a sea change in the way hospitals do business.”
  7. “To prepare for bioterrorism, hospitals must build surge capacity back in. Yet because they are reimbursed by health insurers only for patient care, hospital executives say they have no way to pay for bioterrorism preparedness. And because hospitals compete for patients, most have not engaged in regional planning for a bioterrorist attack — designating one city hospital as the burn unit, for instance, and another the infectious disease ward.”
  8. “Some bioterrorism experts, among them Dr. Frank E. Young, the former director of the Office of Emergency Preparedness at the Department of Health and Human Services, have suggested that military field hospitals could be used to help cope with an attack. Others say that is not practical.”

Public Health, Bioterrorism, Military, Vaccination, Biotechnology


Maddox, P.J., “Bioterrorism: A Renewed Public Health Threat“. Dermatology Nursing. December 1, 2001

  1. “Even though national emergency preparations since the cold war have included consideration of biological weapons, the post mortem on emergency responses to the terrorist attacks on September 11, 2001, has brought renewed concerns about bioterrorism.” (Pg. 1)
  2. “Even a single exposure could result in local outbreaks of difficult-to-diagnose disease and fatal disease outbreaks.” (Pg. 1)
  3. “Unlike weapons that use explosives or chemicals, attacks using biological weapons may occur silently and covertly and, thus, be difficult and time consuming to detect. To complicate the matter, public symptoms of biological exposure may be delayed for days or weeks.” (Pg. 1)
  4. “Once detected, a massive public exposure could overwhelm local health systems that must treat victims of an outbreak, provide care for mass casualties, and prevent further disease.” (Pg. 1)
  5. “Department of Health and Human Services (DHHS) has special responsibilities, including detecting the disease, investigating the outbreak, and providing stockpiled drugs and emergency supplies in the large amounts needed.” (Pg. 1)
  6. “The MMRS emphasizes enhancement of local planning and response capability, including hospital capacity, to care for victims of a bioterrorist incident. MMRS systems provide designated communities with structured operations, specially trained responders, special Pharmaceuticals, detection and personal protection equipment, decontamination capabilities” (Pg. 2)
  7. “The role of the National Pharmaceutical Stockpile Program is to maintain a national repository of lifesaving pharmaceuticals and medical material that will be delivered to the site of a bioterrorism disaster in order to reduce morbidity and mortality in those affected” (Pg. 3)
  8. “Through the CDC, efforts will continue to ensure that all laboratories that ship or receive specially identified biological agents axe registered and in compliance with federal requirements.” (Pg. 3)

Bioterrorism, Public Health, CDC, Emergency Response


Miriani, Allison, “Hospitals pushed to plan for bioterrorist attacksCapital Service News. Feb. 22, 2004.

  1. “Most larger hospitals have a bioterrorism plan. The bill would make sure that all hospitals, including small outstate facilities, will comply, Scott said.”
  2. “Although there are 15 million doses of the vaccine for smallpox in the United States right now, Johnson said, many side effects could even result in death from the vaccine. That is why the Department of Community Health does not advocate a mass vaccination campaign, he said.”
  3. “”We need strict airport precautions, contact isolations. We have to notify public health authorities immediately at the local level and from there the state,” he said. “We need to identify those who have had contact with the person (who was exposed).””

Public Health, Smallpox, Bioterrorism, Emergency Response


Powers, Michael and Ban, Jonathan, “Bioterrorism: Threat and Preparedness“, National Academy of Engineering. Spring 2002

  1. “Therefore, rather than planning for a narrow range of least-likely, high-consequence contingencies or focusing only on additional mailborne anthrax attacks, we must plan for a variety of future incidents–including incidents that cause mass casualties and mass disruption.”
  2. “The incidents aroused significant fear and disruptions but not mass casualties. Based on these attacks, some analysts have suggested that terrorists would not be able to orchestrate mass-casualty attacks using biological weapons. Others have considered these attacks as demonstrations of terrorists’ ability to acquire high-quality anthrax”
  3. “Rather than focusing on vulnerability to a particular organism or looking to history to determine what is to come, policy makers and scientists must recognize that the bioterrorist threat is not uni-dimensional. We must consider four key elements of the threat: the who (the actor), the what (the agent), the where (the target), and the how (the mode of attack).”
  4. “We do not know how “massive” an attack would have to be to overwhelm the response system, instill fear and panic, or cause serious political or economic fallout.”
  5. “Every dollar spent preparing for a specific agent, such as building stocks of smallpox or anthrax vaccine or purchasing antidote for botulinum toxin, is a dollar that cannot be spent on preparedness for other organisms. Given the variety of combinations among actors, agents, targets, and dissemination techniques, a public health system must be capable of rapidly and accurately detecting and assessing a large number of bioterrorism scenarios and addressing most contingencies.”
  6. “planning should be based on developing the capability of effectively and efficiently responding to a variety of bioterrorist contingencies”
  7. “We must strike a better balance between hedging our defenses against high-end, mass-casualty events and building a “system of systems” capable of addressing both a wider range of bioterrorist contingencies and natural outbreaks of infectious disease.”
  8. “In addition, accurate and timely information will be the backbone of the decision making process in times of crisis and will provide credible and consistent information to the general public to reduce panic.” *”A national surveillance system to provide an early warning of unusual outbreaks of disease, both natural and intentional, will be a critical component of our preparedness. This system will depend on an information infrastructure that includes electronic data networks connecting local public health departments and area health care providers and providing regular analyses of the data for the presence of unusual trends that could indicate a bioterrorist attack”

Public Health, Bioterrorism, WHO, Emergency Response, Smallpox, Anthrax


Mattews, Gene, “Legal Preparedness for BioterrorismEBSCO Publishing, 2002.

  1. “In fact, many emergency health laws consist of one sentence stating that the health officer in an emergency may take whatever actions he/she deems necessary” (Pg. 1)
  2. “The Draft Model State Emergency Health Powers Act, which was fashioned out of existing state laws, was designed to assist states in reviewing their emergency public health powers. The draft covers reporting of diseases cases, quarantine, vaccination, protection of civil liberties, property issues, infectious waste disposal, control of healthcare supplies, access to medical records and effective coordination with other state, local, and federal agencies.” (Pg. 1-2)
  3. “It is important to know the legal ground rules in advance of an emergency. It will be necessary to brief the public, in multiple languages, on the nature of the disease and how to respond.” (Pg. 4)
  4. “In an emergency, public health officials will be called upon to deal with a variety of hoaxes and people who are concerned but not sick.” (Pg. 4)
  5. “The smallpox vaccine is currently classified as an Investigational New Drug, a classification that raises research implications because each state maintains a separate Institutional Review Board overseeing research protocols.” (Pg. 4)
  6. “Thoughtful decisions will need to be made about closing schools, advising the public to remain at home, and delivering necessary services.” (Pg. 5)

Bioterrorism, Public Health, Emergency Response, Quarantine, CDC


Hodge, James, “Bioterrorism Law and Policy: Critical Choices in Public HealthJournal of Law, Medicine & Ethics, 2002.

  1. “However, in many states, existing legal standards for response are absent, antiquated, or insufficient. Prior to September 11, many state health departments did not address bioterrorism in their emergency response plans. Recently, public health lawyers and scholars at the Center for Law and the Public’s Health at Georgetown and Johns Hopkins Universities were asked by the Centers for Disease Control and Prevention and a series of national partners (i.e., the National Governors Association, the National Conference of State Legislatures, the Association of State and Territorial Health Officials, the National Association of City and County Health Officers, the National Association of Attorneys General, and the Turning Point Public Health Statute Modernization National Collaborative) to develop a model act for states to respond to public health emergencies.” (Pg. 1-2)
  2. “gives state and local public health authorities a modern series of powers to track, prevent, and disease threats resulting from bioterrorism or other public health emergencies. These powers include measures (e.g., isolation, quarantine, treatment, and vaccination requirements) that may temporarily compromise individual civil liberties (e.g., rights to due process, speech, assembly, travel, and privacy) to protect the public’s health. To date, thirty-two states have introduced legislative bills based on the Model Act.” (Pg. 2)
  3. “Bioterrorists may infect individuals through multiple routes: (1) intentional spread of contagious diseases through individual contact; (2) airborne dissemination of some infectious agents; or (3) contamination of water, food, controlled substances, or other widely distributed products. The equipment needed to manufacture biological weapons is easy to obtain and conceal.” (Pg. 3)
  4. “The Model Act broadly defines a “public health emergency” as: an occurrence or imminent threat of an illness or health condition that: (1) is believed to be caused by bioterrorism or the appearance of a novel or previously controlled or eradicated infectious agent or biological toxin; and (2) poses a high probability of any of the following harms: (a) a large number of deaths in the affected population; (b) a large number of incidents of serious permanent or long term disability in the affected population; or (c) widespread exposure to an infectious or toxic agent that poses a significant risk of substantial future harm to a large number of people in the affected population.” (Pg. 3-4)
  5. “First, the federal government has greater financial resources at its disposal to respond to a bioterrorism threat. Second, it may be in a better position to negotiate the price of needed vaccines, drugs, or supplies, or to suspend the patent rights of high-demand medications. These techniques were recently used by President George Bush and DHHS in negotiations with the German drug company Bayer, concerning the sale of Cipro, the antibiotic used to treat anthrax. Third, most significant bioterrorism threats will exceed the boundaries of any single state, thus requiring a national, coordinated response.” (Pg. 5)

Bioterrorism, Public Health, Emergency Response, Model Act, CDC, Anthrax


O’Toole, Tara, “Shining light on dark winterCLINICAL INFECTIOUS DISEASES, 2002:34 (april 1).

  1. Gives numbers on dark winter, but they are refuted by Meltzer et al nov/dec 2001 emerging infectious diseases vol 7, no. 6. -Dark winter exercise.



Inglesby, Thomas, V., et. al., “Anthrax as a Biological Weapon, 2002: Updated Recommendations for Management,” JAMA, May 1, 2002. vol. 287, No. 17, p. 2236.

  1. Consensus Working Group on Civian, Biodefense, Russia, Vaccination



Public Health Security and Bioterrorism Preparedness and Response Act of 2002. Public Law 107-188, 116 Stat. 647, 7 U.S.C. 8401, June 12, 2002.

  1. “The goal of the Act was ‘to improve the ability of the United States to prevent, prepare for, and respond to bioterrorism and other public health emergencies.’”
  2. Covers the following, but not limited to:
    *“National preparedness and response planning, coordinating, and reporting”
    *“Strategic National Stockpile; Development of priority countermeasures”
    *“Improving state, local, and hospital preparedness for and response to Bioterrorism and other public health emergencies”
    *“Enhancing controls on dangerous biological agents and toxins in the Department of Health and the Department of Agriculture”
    *”The protection and safety of the food and drug Supply, and the drinking water security and safety”

Law, Bioterrorism, Public Health


Johnston, D, Broad, WJ, “Anthrax in Mail was Newly Made, Investigators Say,” New York Times, June 23, 2002, pg.1.

Anthrax, Bioterrorism


Bentham, Martin, “5,000 body bags ordered in case of terrorist chemical attack Government orders 120,000 decontamination suits to be ready for distribution ‘in minutes’“. SUNDAY TELEGRAPH, December 8, 2002.

  1. “THE GOVERNMENT is buying more than 120,000 decontamination suits to protect people from a terrorist chemical or biological attack on potential targets across Britain such as Trafalgar Square.”
  2. “Thousands of decontamination showers, shelters, stretchers and other equipment are also being ordered – as well as 5,000 body bags. The equipment, which is intended to be available by the middle of next year at the latest, will be stored at 16 locations, ready to be distributed within minutes of a terrorist attack.”
  3. “Philip Ward, the managing director of Ferno UK, the country’s leading manufacturer of emergency and rescue equipment, said that his company was among those bidding for the contracts, which were for “huge” quantities that were “getting bigger by the day.”
  4. “One batch of contracts, which is about to be awarded, is for 120,000 pre-decontamination suits, to be used immediately after a chemical or biological attack. The contracts will also provide 100,000 post-decontamination suits to be worn by people after their initial treatment. Industry officials say the 20,000 difference reflects the number of deaths likely to occur.”
  5. “The treatment, said Mr Ward, would begin with each victim stripping and putting on a pre-decontamination suit. Their clothes would be placed in a separate bag for incineration. Swabs would then be provided for the victims to clean out orifices which could contain traces of the chemical, before each person passed through a shower – set up in shelters at the site of the attack – to wash off the substance. Finally, post-decontamination suits would be given to reclothe the victims.”
  6. “Other equipment required by the Government includes 50,000 decontamination shelters, 2,000 stretchers, 2,000 evacuation chairs and 5,000 body bags.He said, however, that pounds 56 million had been allocated this year to prepare for potentially catastrophic terrorist incidents. Some of the money would buy decontamination equipment, which would be held by the fire service.”
  7. Decontamination, Public Health, Bioterrorism, Emergency Response ”’Editors”’, “Terrorism. Iodine pills, just in case.” Harvard Medical School. July 2002.
  8. “People are also buying potassium iodide (KI) pills, which help protect the thyroid gland from radiation.”
  9. “Health officials worry that people who take the potassium iodide will think they’re safe and ignore evacuation orders”
  10. “If a nuclear catastrophe were to occur, the threshold for taking the pills would be lower for children and pregnant women than for other adults.”
  11. “Potassium iodide pills flood the thyroid with the stable version, lowering the uptake of the radioactive atoms, which are subsequently excreted in urine.”
  12. “One Web site,, sells 130-mg pills in packets of 14 for $9.95, but adds a hefty $6.95 shipping charge.”

Bioterrorism, Public Health, Emergency Response, Quarantine, Nuclear, Biosafety


Snyder, James, “Role of the Hospital-Based Microbiology Laboratory in Preparation for and Response to a Bioterrorism Event,” Journal of Clinical Microbiology. pg. 1-4, Vol. 41, No.1. Jan. 2003

  1. “The main role of the hospital-based clinical microbiology laboratory in support of a biothreat, biocrime, or act of bioterrorism is to “raise suspicion” when a targeted agent is suspected in a human specimen.”(Pg. 1)
  2. “These plans include the following: (i) criteria for distinguishing the type of bioterroism event; (ii) information regarding access to and utilization of the LRN, including diagnostic testing protocols; (iii) safety guidelines; (iv) communication and notification protocols…” (Pg. 1)
  3. “Therefore, risk assessment becomes the responsibility of the clinical microbiologist, infection control personnel, hospital risk management office, and infectious disease physicians.” (Pg. 3)
  4. “The laboratory, preferably the laboratory director, must establish and include in the laboratory bioterrorism response plan a notification policy that is enacted when a suspicious isolate cannot be ruled out and must be referred to the next higher level laboratory for confirmation of the organism’s identity.” (Pg. 3)

Public Health, Bioterrorism, CDC, Lab Safety, Biodetection, Biodefense, Biosafety, Biosecurity, Decontamination, Personnel Reliability


Petro, JB, Plasse, TR, et al., “Biotechnology: Impact on Biological Warfare and Biodefense,” Biosecurity and Bioterrorism: Biodefense Strategy, Practice, and Science, 1, 2003:161-168.

Bioterrorism, Biodefense, Biotechnology


Wheelis & Dando, “New technology and future developments in biological warfare,” Military Technology. May 2003, 27, 5, research library, p 52.

  1. covert programs, danger/risk in general. comment that agent can be made for which no defense is possible

Military, Bioterrorism


Editors & Staff, “Outbreaks: Laboratory electronic reporting inadequate for bioterrorist attack,” Bioterrorism Week, Page 15, October 27, 2003.

  1. “Need for backup transmission methods, validation, standards, preserving human judgment in the process, and provider and end-user involvement.”



Barbaro, Michael, “A Worst-Case Enterprise; Md. Firm Busy Making Decontamination Shelters” The Washington Post. March 13, 2003.

  1. “The doomsday shower can sanitize 800 people an hour. It boasts separate rinse stations for contaminated men and women. It can be set up by four people in less than 10 minutes. And storage is a cinch: It takes up about as much space as a typical washing machine.”
  2. “TVI Corp. of Glenn Dale says it can’t keep up with back orders for its decontamination shelters, even after doubling its workforce to about 90 last year. Sales of its shelter, which sells for around $ 88,000, nearly tripled in 2002.”
  3. “But TVI’s flagship product is the High Throughput Mass Decontamination Shelter, a car-wash-like structure for humans that has at least 50 shower nozzles threaded into its vinyl interior, a hot water pump and soap dispensers. It is designed to be attached to a fire hose and has at least three shower lanes to separate men, women and the incapacitated after an attack.”
  4. “The product is designed for particular situations. If a “dirty” nuclear bomb is detonated or a biochemical agent is released, for example, people who flee the scene before being decontaminated would risk exposing others to the danger. The shelters would be used to rapidly contain the threat.”
  5. “The decontamination shelters operate on a simple principle.“You just cream people with water,” said Thomas D. Gibson, a lieutenant with the hazardous materials team at the National Institutes of Health campus in Bethesda.”
  6. “”Decontamination is the same whether you are talking about chemical, biological or radiological agents,” said Clendenin, the Massachusetts fire official. “Soap and water is never a bad thing.””

Decontamination, Bioterrorism, Public Health, Emergency Response, Biotechnology


Goldstein, Avram, “Progress Cited on Health Threat; ‘We’re Worlds Better Prepared,’ City Official SaysThe Washington Post, April 17, 2003.

  1. “They are buying protective gear; expanding drug, food and water stockpiles; adding or enhancing decontamination facilities outside emergency rooms; and creating patient isolation rooms to help control a smallpox outbreak.”
  2. “The city has set up an elaborate incident command center that is so new it hasn’t been seen by Mayor Anthony A. Williams (D), said Feseha Woldu, acting administrator of the D.C. Emergency Health and Medical Services Administration.”
  3. “The District has expanded its epidemiology staff to eight and assigned nearly 60 city workers to bioterrorism preparedness. Meanwhile, hundreds of private doctors and nurses have volunteered to deliver health care services or to provide information to the public by phone or computer if called upon by the city.”
  4. “”We live in the No. 1 terrorist target in the world,” said Jeffrey A. Elting, medical director for bioterrorism response coordination at the D.C. Hospital Association. That stark reality has spurred much of the cooperation, he said.”
  5. “The best example is a radio system that enables all hospitals to communicate if telephone service is interrupted, allowing them to rapidly exchange information on their capacity to accept new patients and lend each other equipment and supplies. It also would let public health officials broadcast messages to hospitals regarding the dimensions and type of event. The system is tested a few times a day, when roll is called.”
  6. “The survey found that, on average, hospitals can generate their own electric power for 5.8 days. Without outside help, surveyed hospitals said, they had enough food to last 4.7 days, water for 2.5 days, and medical supplies for 7.1 days.”
  7. “At Providence Hospital, officials are buying 20 protective full-body suits, including respirators, so doctors and nurses can safely and rapidly care for people contaminated by dangerous chemicals or pathogens. They also are buying a mobile decontamination unit where patients exposed to hazardous substances can shower.”
  8. “If a smallpox outbreak occurred, Providence has 12 patient rooms and a 16-bed unit that can be isolated to keep a virus from spreading to unprotected patients and staff. The hospital also has eight portable HEPA (High Efficiency Particulate Air) filtration units that can convert a room or even a plastic tent to a temporary isolation unit.”
  9. “He said the hospital does not want to use the inflatable decontamination units they already have because they take too long to set up — 18 minutes.”
  10. “Wuerker said 12 people have been vaccinated for smallpox, including himself, and another 12 are scheduled. With that many first-line responders, he said, all 5,000 hospital workers could be vaccinated quickly to prepare for an outbreak.”
  11. “Exactly which surge facilities might be needed and when is unpredictable and depends on the exact location and nature of and attack, officials say. Instructions and guidance would be offered by public health officials through electronic and print media, they say.”

Vaccination, Decontamination, Bioterrorism, Public Health, Emergency Response, Biotechnology


Osterholm, Michael T.,”SARS: How effective is the state and local response?“, Hearing before the Permanent Subcommittee on Investigations, May 2003, pgs 14-16.

  1. “There is a critical need for our country to prepare its homeland security against human-made and Mother Nature-made biological attacks.”
  2. “There is a growing threat of emerging infections and use of biologic agents as a form of terrorism.”
  3. “Federal agencies such as the Department of Heath and Human Services, and Department of Homeland Security have been responding to such threats.”
  4. “The United States has fortunately been lucky as compared to places like Toronto, Canada, who has seen the worst of the SARS pandemic.”
  5. Their country is experiencing impacts on mortality rates, as well as economic and social impacts.”
  6. “SARS is a disease transmitted via respiratory route that has now seeded itself in a sufficient number of humans which could make elimination impossible.”
  7. “It is imperative that we coordinate the roles of Federal, State and local agencies.”
  8. “We also need to understand the capabilities of our health care delivery systems and the private sector in responding to this problem.”

Bioterrorism, Pandemic, SARS, Quarantine, Canada, Homeland Security


Pavlin, Julie,”Innovative Surveillance Methods for Rapid Detection of Disease Outbreaks and Bioterrorism: Results of an Interagency Workshop on Health Indicator SurveillanceAmerican Journal of Public Health, August 2003.

  1. “A system designed to rapidly identify an infectious disease outbreak or bioterrorism attack and provide important demographic and geographic information is lacking in most health departments nationwide.” (Pg. 1)
  2. “One of the primary goals of public health is to prevent disease in a community. To best prevent disease, knowledge of existing disease rates, risk factors, and the effectiveness of preventive measures is necessary.” (Pg. 1)
  3. “Unfortunately, most infectious disease surveillance systems are passive and rely on practitioners voluntarily reporting to the public health system” (Pg. 1)
  4. “The Department of Defense’s Global Emerging Infections System sponsored a meeting in May 2000 that focused on 3 areas: (1) identifying surveillance system needs, (2) examining existing prototype systems attempting to meet these needs, and (3) identifying the ideal features of a “system of surveillance systems” that would be more timely, sensitive, and flexible in terms of detection and response.”(Pg. 1-2)
  5. “The strengths of these systems include large populations that can be placed under surveillance; previously, it was often the case that only those meeting reportable disease conditions were followed.” (Pg. 2)
  6. “After the terrorist attacks on September 11, 2001, the Centers for Disease Control and Prevention (CDC) deployed 45 epidemic intelligence service officers to New York City to assist in a syndromic surveillance effort.” (Pg. 2)
  7. “Bringing together information from various health indicator data sets can allow public health practitioners to (1) evaluate many indicators simultaneously, (2) compare variations and identify common trends, and (3) track confounding factors and decrease false alarms. (Pg. 3)

Bioterrorism, CDC, Syndromic Surveillance, Biosurveillance


Editors, “Sentinel bioterrorism responders: Are hospital labs ready?”. MLO, August 2003.

  1. “Bioterrorism is the intentional application of microorganisms or their toxins for the purpose of causing death or disease in humans or in the animals or plants on which humans depend.”(Pg. 1)
  2. “Training is needed for laboratorians to know what specimens to collect and how to transport them.”(Pg. 1)
  3. “In May 2000, at the direction of the U.S. Congress, a mock bioterrorist event was held in Denver to test the nation’s systems. This $3-million exercise uncovered many deficiencies.” (Pg. 2)
  4. “Gradually, procedures for collection of specimens and detection of the agents in culture, when appropriate, are being posted on the ASM website at” (Pg. 2)
  5. “Generally, a leakproof package with a double liner and absorbent material to contain the specimen is sufficient. The package must be able to withstand the method of transport without damage.” (Pg. 3)
  6. “Staff can be trained specifically for the recognition of these agents. In addition, the laboratory will be able to identify other pathogens encountered on a daily basis more rapidly — but if the important tests for identification are not put into practice on a daily basis, rapid recognition will fail.” (Pg. 4)
  7. “The agents likely to be bioterrorist candidates, however, are all indolenegative.” (Pg. 4)
  8. “Do not wait for confirmatory tests to report to health department. Risk of human-to-human spread is significant.” (Pg. 5)

Bioterrorism, CDC, Emergency Response, Biosafety


Editors, “Hospitals are not prepared for terrorThe Toronto Star. January 31, 2003.

  1. “Decontamination of chemically or radiologically contaminated patients, ideally prior to entering the health-care facility, is a critical step in the delivery of care. Only 18 of 59 hospitals (30 per cent) had a decontamination area or a plan to establish one.”
  2. “The ideal system defines two areas: one where contaminated patients arrive for decontamination (the “hot” zone) and one where decontaminated patients receive care (the “cold” zone). Absence of this kind of system indicates a potentially ineffective plan. In our survey, only five emergency rooms (8 per cent) with a decontamination plan had a hot/cold system. This raises the concern that, even among hospitals with decontamination plans, the systems may not be sufficient.”
  3. “Emergency departments that have no decontamination plan must provide protective equipment so staff can function at relatively low risk. But only 41 per cent of the emergency department surveyed had protective coveralls and only 19 per cent had either gas masks”
  4. “Health regions often plan to store drugs in a central repository and deliver them when requested. This may not work in a true event”
  5. “Preparedness for chemical agents requires a readily available stock of antidotes. In this survey, we asked specifically about atropine, cyanide kits, and benzodiazepines and pralidoxime (for nerve agents). Most sites surveyed had inadequate supplies on hand. This is worrisome because, terrorism aside, these antidotes are also useful for patients with toxic ingestions”

Decontamination, Bioterrorism, Public Health, Emergency Response


Editors, “The Thomas Butler Case: Some Unreported Information and Reasons for the Department of Justice’s Prosecution,” THE SUNSHINE PROJECT, October 28, 2003,

  1. [Butler] “prompted a national bioterrorism scare”
  2. [worked in a] “large and secretive biodefense program supported by the US Army”
  3. “focus on US biodefense investigating anthrax letters in 2001, led to security concerns when vials went missing”
  4.  “need to prevent sensitive research from the public eye”
  5.  “a leak at a sensitive biodefense project isn’t just a potential health or terrorism threat. An accident could be an international liability.”

Open Science, Plague, Bioterrorism, Biodefense


Atlas, Ronald, “National Security and the LabMedical Laboratory Observer, Volume 35, Issue 9. 52. September 2003.

  1. ”The aftermath of anthrax attacks following the horrific 9/11 events increased fear that terrorists could acquire deadly pathogens from legitimate U.S. laboratories, which led to a series of laws and regulations directly impacting clinical microbiology laboratories.” – page 52
  2. ”Enhancement of clinical and public health laboratories is key to the nation’s biodefense capabilities, so the American Society for Microbiology (ASM) worked with the Centers for Disease Control and Prevention (CDC) to develop protocols for diagnostic laboratories to recognize and handle major biothreat agents.” – page 52
  3. ”Since clinical labs have been the sources of the agents used in prior acts of bioterrorism or biocrimes, (e.g., the 1989 use of salmonella by the Rajneesh cult in Dalles, OR), they must exercise appropriate oversight as to who is given access to any pathogen which can be misused to cause harm.” – page 52
  4. ”Clinical labs wishing to retain select agents as clinical specimens or reference standards must meet all of the registration requirements of the Biopreparedness Act, including imposing strict biosecurity procedures and obtaining Department of Justice clearance for all individuals with access to the select agents.” – page 52
  5. ”The CDC and USDA must maintain accurate tracking of the acquisition, transfer and possession of these select agents, and must establish safeguards and biosecurity procedures to be followed by institutions possessing select agents.” – page 52
  6. ”The FBI is responsible for conducting security risk assessments of individuals seeking access to listed agents and toxins, and individuals or entities seeking to register under the Act.” – page 52
  7. ”The Biopreparedness Act, a new regulatory burden, should have minimal impact. The greatest impact is likely to be on the labs in the western United States where plague, tularemia, and coccidioidomycoses occur.” – page 52

Public Health, Lab Security, Anthrax, Salmonella, Tularemia, Plague, CDC, Bioterrorism, Biodefense, Biosecurity


Petro, James, and David Relman. “Understanding Threats to Scientific OpennessScience, Volume 302, Issue 5652. 1898. December 12, 2003.

  1. ”The scientific community is being confronted by public concerns that freely available scientific information may be exploited by terrorists.” – page 1898
  2. ”The following brief description of some recent findings provides insight into activities of potential exploiters and emphasizes the importance of closer interaction between the scientific and security communities.” – page 1898
  3. ”Documents recovered from an Al Qaida training camp in Afghanistan in 2001 have shed light on procedures and methodologies used by Al Qaida in its efforts to establish a biological warfare (BW) program.” – page 1898
  4. ”Individuals involved in this effort apparently relied on scientific research and information obtained collegially from public and private sources.” – page 1898
  5. ”The site also contained over 20 vintage research articles and medical publications from U.K. journals of the 1950s and ‘60s that provided a method for isolating, culturing, identifying, and producing bacteria, including bacillus anthracis and clostridium botulinum.” – page 1898
  6. ”Identification of a recently constructed laboratory with equipment and supplies that could be used to produce biological agents within a few kilometers of the site where the BW-related documents were found strongly suggests that Al Qaida proceeded beyond simply reviewing ‘dual-use’ literature.” – page 1898
  7. ”With publications from nearly 50 years ago, a marginally skilled terrorist could produce a crude agent for use in a limited bioterror attack. However, using more recently published research findings and procedures, casualty rates associated with such an incident would increase dramatically.” – page 1898
  8. ”The life sciences community should take the lead in partnering with national security professionals to draft guidelines for identifying research of concern and weighing the benefits to national security against the cost to open communication of future life science discovery.” – page 1898

Public Health, Bioterrorism, Surveillance, Iraq


Editors, “Assessing The Threat of BW Terrorism”. NTI. 2004.

  1. “With the exception of the smallpox virus, most bioterrorism threat agents can be isolated from natural sources such as diseased animals, patients, or even contaminated soil in the case of anthrax spores. Nevertheless, more than 85 different strains (varieties) of anthrax bacteria have been identified in nature, and only a few of these strains are highly virulent, or capable of causing disease.”
  2. “Once terrorists acquired a “seed culture” of a virulent pathogen, they would need to cultivate the agent in laboratory glassware or a small stainless steel fermentation tank.”
  3. “The goal of weaponization is to convert the agent into a form in which it can be dispersed as an aerosol cloud of microscopic particles, ranging in size from one to five microns (thousandths of a millimeter). Only particles with these dimensions are small enough to lodge in the tiny air sacs of the victims’ lungs to cause infection.”
  4. “Anthrax spores can survive for decades in soil and for hours in an airborne aerosol. Furthermore, anthrax spores can survive environmental contaminants and potentially become re-aerosolized.”

Bioterrorism, Anthrax, Smallpox, Biosafety, Public Health


Hobbes, John,“Communicating Health Information to an Alarmed Public Facing a Threat Such as a Bioterrorist Attack”. Journal of Health Communication. 2004.

  1. “The Internet revealed much potential for effective and interactive communication in a sensitive and complex situation such as a bioterrorist attack.” (Pg. 1)
  2. “Yet, ultimately, investigation revealed that only four letters containing anthrax had been distributed through the postal system (Broad, 2002), demonstrating the ease with which a relatively small-scale bioterrorist attack could disrupt a population.” (Pg. 2)
  3. Finally, poor communication between the various healthcare workers and researchers, namely, public health officials, physicians, and field workers (both at the federal and state levels) resulted in a much slower response to the emerging risks than would be desirable.” (Pg. 3)
  4. “A key advantage the Internet has over traditional media is that the Internet provides multiple branches of information, all accessible almost simultaneously, and which the user can easily maneuver between. During the anthrax threat, the Internet also allowed for innovative communication devices such as interactive tutorials on anthrax self-care” (Pg. 5)
  5. “In the two days after the terrorist attacks, one out of four Internet users went online in addition to monitoring television and radio reports” (Pg. 5)
  6. “This is especially salient given that during the height of the bioterrorist threat many people were likely afraid to travel away from home. In some cases, when a number of cities issued warnings of potential threat, people preferred to stay at home or close to home; one survey published on September 15 found that ‘‘about 9% of Americans say that in the first two days after the terror attacks they cancelled some travel Plans”” (Pg. 5)
  7. “An advantage of this mode of communication is that it allows for more targeted information to be quickly distributed to patients from a trusted medical practitioner. However, although there is a demand from patients for e-mail communication with doctors (Deering, 2001), physicians are somewhat hesitant to adopt this practice. Through agencies such as the CDC, the government could help medical professionals by e-mailing them key messages, links to approved sites, and indicators of emerging risks.” (Pg. 6)
  8. “Search engines play a key role in organizing information for the public during a bioterrorist attack. The Internet industry in cooperation with the government should develop transparent protocols for organizing key information during emergency situations so that credible and validated sites are called up first when people search for information.” (Pg. 7)
  9. “However, there is some evidence that health information on the Internet does affect people’s management and response to health risk. The Pew Internet & American Life Project has found that 61% of those who searched online for health information—or about 43 million Americans—said that the information they found on the web improved the way they take care of themselves” (Pg. 7)
  10. “Wider use of e-mail from medical practitioners to patients could provide significant benefits in getting targeted messages on risks and suggested behavioral changes to patients, building on assumed trust between patient and physician. Finally, greater use and integration of shared electronic medical records made possible through Internet technology will provide considerable benefit in tracking emerging risks.” (Pg. 8)

Public Health, Anthrax, CDC, Bioterrorism, Biosurveillance


Kyriacou, Demetrios, “Clinical predictors of bioterrorism-related inhalational Anthrax“. Lancet 2004.

  1. “Unfortunately, clinical manifestations include a nonspecific prodrome of fever, cough, and chest discomfort that also characterizes other types of acute respiratory infections”
  2. “As a result, inhalational anthrax might not be recognized until the onset of respiratory distress and shock.”
  3. “The US Centers for Disease Control and Prevention (CDC) issued guidelines to differentiate between inhalational anthrax, community-acquired pneumonia, and influenza-like illness.”
  4. “For inhalational anthrax cases, clinical and pathological characteristics of the patients at the time of the assessment that resulted in the diagnosis of inhalational anthrax were abstracted from published accounts.”
  5. “The mortality rate was 94•4% for naturally occurring cases and 45•5% for bioterrorism-related cases.”
  6. “In particular, nausea, vomiting, pallor or cyanosis, diaphoresis, altered mental status, and raised haematocrit seemed to predict inhalational anthrax. The most accurate predictor was mediastinal widening or pleural effusion on chest radiograph. This finding was 100% sensitive (95% CI 84•6–100) for inhalational anthrax.”

Bioterrorism, Anthrax, CDC, Biodefense


Setlak, Paul, “Bioterrorism preparedness and response: Emerging role for health-system pharmacists”, American Journal of Health-System Pharmacy, 2004.

  1. “Furthermore, as pharmacists are becoming more integral in disaster relief and response, especially in the area of bioterrorism, they must be able to effectively and rapidly access the most current information about the biological agents they may encounter and the respective treatments.” (Pg. 1)
  2. “Once a pharmacist is accepted as a member of an NPRT, he or she must complete numerous Web-based training programs on emergency response, pharmaceutical caches, command operations, occupational health, and a host of other topics relating to bioterrorism and emergency response operations” (Pg. 3)
  3. “If called to serve in an emergency operation, each team will be deployed for approximately two weeks, during which time members will become temporary federal employees.” (Pg. 3)
  4. “The passage of USERRA by Congress in 1994 ensured that individuals serving in the uniformed services, including PHS and others designated by the president during war or an emergency, can return to their civilian job with the same seniority, pay, and status that they had before their service.” (Pg. 3)
  5. “The drill exposed pharmacists to the environment encountered during a pharmaceutical distribution campaign, taught them procedures for distributing mass quantities of medications, and allowed students to witness how pharmacists handle stressful situations.” (Pg. 4)
  6. “The SNS is an important deployable initial pharmaceutical stockpile for health care professionals at the state and local levels during the early stages of a bioterrorist attack.11 The Homeland Security Act of 2002 assigned responsibility for the deployment of the SNS to DHS.” (Pg. 4)
  7. “Avoiding unnecessary duplicated medications in stockpiles, repeated diagnostic steps, and similar patient paperwork can result in faster response and clinical decision-making and decrease patient fatalities.” (Pg. 7)
  8. “Treatment guidelines are available as downloadable charts for easy posting and presentation. In addition, links to federal and private sites that address bioterrorism are presented. All information is scrutinized by CDC, and great care is put into releasing correct and timely information that clinicians, especially health-system pharmacists, can use.” (Pg. 7)

Bioterrorism, Emergency Response, Pharma, CDC


Editors, “Systematic Review: Surveillance Systems for Early Detection of Bioterrorism-Related Diseases“. American College of Physicians. 2004.

  1. “the recent outbreaks of severe acute respiratory syndrome (SARS) and influenza strikingly demonstrate the continuing threat from illnesses resulting from bioterrorism and related infectious diseases. In particular, these outbreaks have highlighted that an essential component of preparations for illnesses and syndromes potentially related to bioterrorism includes the deployment of surveillance systems that can rapidly detect and monitor the course of an outbreak and thus minimize associated morbidity and mortality”(Pg 1.).
  2. “Little is known about the accuracy of surveillance systems for bioterrorism and related emerging infectious diseases, perhaps because of the diversity of potential data sources for bioterrorism surveillance data; methods for their analysis; and the uncertainty about the costs, benefits, and detection characteristics of each.”(Pg. 1)
  3. “Because most patients with bioterrorism-related diseases initially present with influenza-like illness, acute respiratory distress, gastrointestinal symptoms, febrile hemorrhagic syndromes, and febrile illnesses with either dermatologic or neurologic findings, we considered these conditions to be the bioterrorism-related syndromes.”(Pg. 2)
  4. “We identified 2 types of systems for surveillance of bioterrorism-related diseases or syndromes: those that monitor the incidence of bioterrorism-related syndromes and those that collect and transmit bioterrorism detection data from environmental or clinical samples to decision makers.”(Pg. 3)
  5. “The Interim Biological Agent Detector is used on U.S. naval ships to continuously monitor the air for a significant increase in particulate concentrations (32, 39–42). If a peak increase is detected, the instrument automatically collects an aerosol sample and alerts the ship’s damage control center so the crew can collect and screen the sample with a handheld antigen test.” (Pg. 5)
  6. “Our systematic review identified 115 existing surveillance systems, 29 of which were designed for surveillance of illnesses and syndromes associated with bioterrorism relevant pathogens. The evidence used to judge the usefulness of the reviewed systems is limited. Of the studies that evaluated systems for their intended purpose, few adhered to the CDC’s published criteria for high-quality evaluations of surveillance systems.”(Pg. 6)
  7. “Systems for bioterrorism surveillance require 3 key features: timeliness, high sensitivity and specificity, and routine analysis and presentation of the data that facilitate public health decision making.” (Pg. 6)
  8. “Systems with inadequate specificity may have frequent false alarms, which may result in costly actions by clinicians and public health officials”(Pg. 7)
  9. “Systems that collect pharmaceutical data, such as EPIFAR (198), are promising for bioterrorism surveillance. Pharmaceutical data, particularly over-the-counter medication sales data, can indicate an outbreak, although these data would probably not be specific for bioterrorism. In addition, most pharmaceutical sales are tracked electronically.” (Pg. 7)

Bioterrorism, Biosurveillance, Biodetection, Public Health, Pharma


Zilinskas, Raymond, et. al., “A Discussion Of Findings And Their Possible Implications From A Workshop On Bioterrorism Threat Assessment And Risk Management,Risk Analysis, vol. 24, No. 4, pgs. 901-909, 2004.

  1. “A quantitative bioterrorism risk assessment would need data or well-informed judgments on the intent of terrorist groups or individuals, their technical capabilities, the attributes of pathogens or toxins that might be used in a biological attack, target characteristics, and the occurrence (frequency) of various attack scenarios.”
  2. “A search of the CNS Weapons of Mass Destruction (WMD) Terrorism database…revealed that out of 383 incidents in which biological, chemical, nuclear, or radiological agents were used by criminals or terrorists during the time 1900 to the present, only 77 biological ‘events’ were perpetrated. Of these, just four post-1945 events generated more than 10 casualties.”
  3. “Bioterrorism involves the use of pathogens or toxins against human, animal, or plant populations by a terrorist group to achieve political, social, or religious aims.”
  4. “Biocriminality involves the use of pathogens or toxins by an individual or group to attack human, animal, or plant populations for reasons of greed, blackmail, revenge, or other apolitical motives.”
  5. “The likely low rate of future attacks involving pathogens also makes it very difficult to calibrate, much less validate, whatever assessment methodology might be developed.”
  6. “By putting together data derived from content analysis of the threatening statement, an assailant’s history, and interviews of persons who are or were acquainted with the assailant, sufficient information can be collected for a fairly robust assessment of the threat that assailant presents to society in general and to a particular target.”
  7. “This process (vulnerability analysis) may also be referred to as logic modeling, problem formulation, or conceptual modeling. Available information might include: pathogens or toxins that might be used to harm the target area’s population and/or contaminate its environment, methods that might be used to disperse pathogens or toxins to achieve attack objectives, and the means attackers would use to emplace mechanisms for dispersing pathogens or toxins so as to have the highest probability of harming the target population and contaminating environs.”
  8. “For a longer-term project, we suggest augmentation and enhancement of vulnerability studies through the application of quantitative risk estimation techniques, supported by use of modeling exercises.”
  9. “Risk estimation then gathers what quantitative data are available regarding the attack scenario and proceeds through four steps–hazard characterization, hazard identification, exposure assessment, and risk characterization.”

Biosurveillance, Bioterrorism


Hearne, Shelly, “Health departments remain ill-prepared to respond to public health emergenciesH&HN: Hospitals & Health Networks. February 2004.

  1. “The report, “Ready or Not? Protecting the Public’s Health in the Age of Bioterrorism,” examines 10 key indicators to assess areas of improvement and areas of ongoing vulnerability in the nation’s efforts to prepare against bioterrorism and other large scale health emergencies” (Pg. 1-2)
  2. “California, Florida, Maryland and Tennessee scored the highest, meeting seven of the 10 indicators.” (Pg. 2)
  3. “”Are we ready or not? The answer is not,” says Shelley A. Heame, executive director of TFAH.”Now is the time to get serious about developing an all-hazards approach to public health to ensure we are ready for the range of possible threats we face” (Pg. 2)
  4. “Among the major concerns raised in the report are: cuts to public health programs in nearly two-thirds of states; an impending shortage of trained professionals in the public health workforce; disagreements between state and local health agencies over resource” (Pg. 2)
  5. “The report also found that only Florida and Illinois are prepared to distribute and administer emergency vaccinations or antidotes from the national stockpile.” (Pg. 2)

Public Health, Bioterrorism, Emergency Response, Vaccination


Gluodenis, Thomas, “Homeland security and bioterrorism applicationsMedical Laboratory Observer, February 2004.

  1. “Biological weapons or bioweapons — typically, pathogenic organisms and their toxic products — constitute a particularly pernicious threat” (Pg. 1)
  2. “Unless suspicions are aroused and appropriate measures taken to sample contaminated environments, the presence of such agents is not usually confirmed until they produce symptoms in compromised individuals.” (Pg. 1)
  3. “At present, two approaches have been widely adopted for identifying organisms by characterizing their DNA; real-time polymerase chain reaction (PCR) and endpoint PCR.” (Pg. 1)
  4. “Organisms can be packaged in ways that mask their identity and produce sets of symptoms that are not sufficiently characteristic early on for rapid and” (Pg. 3)
  5. “The logical next step would be better integration of the individual operations of DNA isolation, amplification, and microfluidic-based analysis.” (Pg. 4)

Bioterrorism, Homeland Security, Biodefense, CDC


M’ikanatha, Nkuchia, et. al., “Research Letter: Use Of The Web State And Territorial Health Departments To Promote Reporting Of Infectious Disease,Journal of the American Medical Association, Vol. 291, No. 9, pgs. 1069-1070, Mar 3, 2004.

  1. “We surveyed state epidemiologists in the 57 health jurisdictions that participate in the National Notifiable Diseases Surveillance System (NNDSS). This…survey assessed the availability of an up-to-date reportable disease list on the Web and of Web-based reporting for physicians.”
  2. “Epidemiologists from 56 of the 57 jurisdictions responded to the survey. Forty-seven (84%) reported that they had current reportable disease lists on the Web, and 5 (9%) indicated they had secure Web-based capability for physician reporting.”
  3. “We also found considerable variation in Web-based information on reporting requirements for diseases potentially related to bioterrorism.”
  4. “More effective use of the Web could strengthen the partnership among clinicians and local Public Health officials that is vital for recognition of and response to disease outbreaks and bioterrorism-related events.”

Bioterrorism, Public Health, Biosurveillance


Casadevall, Arturo, and Liise-anne Pirofski, “The Weapon Potential Of A Microbe,” TRENDS IN MICROBIOLOGY, Volume 12, No. 6, June 2004.

  1.  “The weapon potential of a microbe is a function that includes such variables as its virulence, time to disease, and susceptibility of possible target populations.”

Public Health, Bioterrorism,  Anthrax


Smith, Stephen, “Bioterror Research Spurs Ideas In Medicine,” Knight Ridder Tribune Business News, pg. 1, Jul 21, 2004.

  1. “Boston-area scientists are developing a sensor capable of sounding an early alarm about acts of bioterrorism, a paperback-sized device that would be integrated into ventilation systems to detect trace amounts of Anthrax, Ricin, and other potentially lethal toxins.”
  2. “In an illustration of scientific cross-pollination becoming more common in Boston and nationally, the same technology is about to be tested as a way to diagnose disease.”
  3. “Brigham and Women’s Hospital plans to begin a study this summer of whether the sensor can pinpoint when patients are suffering from diabetes, a heart attack, a lung infection, or some other medical condition by analyzing gases in their breath.”
  4. “The device samples air drawn through heating and cooling systems.  Fine, airborne particles are broken down into their molecular building blocks, with electrical charges placed on those molecules so that they can be recognized by the detector.  Then, the charged components travel across a tiny electrical field tuned to allow only potentially threatening agents to reach the end.”
  5. “When one of the suspect molecules makes it through, the sensor compares it with molecular fingerprints of rogue agents stored in its computer.  If a match is made, an alarm sounds.”
  6. “The scientists working on the sensor said tests show it can successfully identify three harmless strains of bacteria that are cousins of anthrax.”
  7. “Stoto questioned the practicality of sensor systems, arguing that a terrorist could circumvent them.  Instead, he advocated investing in surveillance networks to swiftly identify outbreaks of unusual illness in patients by monitoring every cough, sniffle, and stomachache reported to emergency rooms and physician offices.”

Biosurveillance, Bioterrorism, Anthrax, Ricin


Janoski, Dave, “Duryea, Pa., Firm, University of Scranton Team Up In Bioterror Fight,” Knight Ridder Tribune Business News, pg. 1, Jul 29, 2004.

  1. “Schott Nexterion…produces glass slides used in genetic and biotech research…it has developed a glass/plastic composite platform that can hold up to 96 samples of suspected biological agents for testing.”
  2. “The University of Scranton’s Institute of Molecular Biology and Medicine…has been working on methods to quickly identify biological agents by analyzing their genetic material.”
  3. “By combining their research, the company and university hope to develop probes that would be able to analyze a large number of samples in the case of multiple suspected terrorist attacks using biological agents.”
  4. “‘We’re trying to develop a screening technique that would be able in hours to screen for every type of bioterror agent simultaneously.’”

Biosurveillance, Bioterrorism


Griffith, AndreaNorth Carolina Hospitals Beef Up Surveillance To Track Bioterror Events,Knight Ridder Tribune Business News, pg. 1, Aug 3, 2004.

  1. “Emergency rooms statewide will implement a new surveillance system that allows officials to track alarming trends in disease outbreaks and bioterrorism. The North Carolina Division of Public Health and the North Carolina Hospital Association are teaming up to install the system, which is designed to improve the state’s ability to recognize and react to situations such as bioterrorism and other public health emergencies.”
  2. “The surveillance system will give officials a(n) ‘every 12-hour look’ at public health.”
  3. “‘The goal is to be able to post trends in admission early in the event of a bioterrorism event.’”

Public Health, Biosurveillance, Bioterrorism


King, Warren, “Washington State Bioterror Monitoring Expands To Animals,Knight Ridder Tribune Business News, pg. 1, Aug 30, 2004.

  1. “State health officials are expanding their early warning system for a bioterrorist attack by employing the help of rabbits, squirrels, mice and other critters.”
  2. “As part of the state’s biological-warfare defense, state veterinarians recently began monitoring unusual small-animal deaths for evidence of tularemia, plague or other diseases that could be cause by lethal agents.”
  3. “Small animals likely would show symptoms and die faster than humans after being exposed to a lethal biological agent.”
  4. “In the animal reporting system, plague and tularemia are receiving special emphasis because they are considered among the highest risks for an attack and can infect both animals and humans.  Anthrax, often mentioned as a threat, also could be detected in animals, especially cattle, sheep and goats, where it occurs naturally.”
  5. “Plague, tularemia and anthrax…can be easily disseminated or transmitted person to person, can cause many deaths, and can cause panic.”
  6. “Plague is usually fatal unless treated with antibiotics within 24 hours of onset.  Typically, those who are infected experience fever, weakness and rapidly developing pneumonia.”
  7. “If inhaled, tularemia bacteria can cause abrupt fever, headache, muscle aches and potentially fatal pneumonia, if not treated quickly with antibiotics.”
  8. “The new surveillance looks for ‘die-offs’ of vulnerable animals — a group of wild animals dying quickly without apparent explanation.”
  9. “Establishing a database of information on wildlife deaths will help veterinarians to determine quickly which infections are natural and which might be from bioterrorism.”
  10. “Unusual, unexplained symptoms may indicate the introduction of a disease from abroad, such as with the monkeypox outbreak a year ago.”

Biosurveillance, Monkeypox, Bioterrorism, Plague, Anthrax, Tularemia &, “Bioterrorism; Monmouth University Developing System To Detect Disease, Terror Attacks,Medical Devices & Surgical Technology Week, pg. 39, Sep 12, 2004.

  1. “Researchers at Monmouth University are developing a computer system to quickly spot early signs of a bioterror attack or serious disease outbreak by pooling information from key medical facilities.”
  2. “Monmouth’s system will connect computer databases at New Jersey pharmacies, hospitals, nursing homes, schools and veterinary offices. It should be able to detect spike and other patterns in symptoms of emergency room patients, medicines purchased at drug stores, reasons for children missing school, even what illnesses veterinarians are treating pets for – because symptoms of some illnesses show up first in animals.”
  3. “The statewide Rapid Response Database eventually would be connected to the CDC and the World Health Organization, so that if an outbreak were detected, recommendations could be made to emergency medical workers on everything from possible antidotes to the need for quarantine.”

Biosurveillance, Bioterrorism &, “Yale University; Novel Method Estimates Time And Size Of Bioterror Attack For Real-Time Use,” Biotech Week, pg. 1008, Sep 15, 2004.

  1. “‘In the event of a bioterror attack, rapidly estimating the size and time of attack enables short-run forecasts of the number of persons who will be symptomatic and require medical care.’”
  2. “‘We present a Bayesian approach to this problem for use in real time and illustrate it with data from a simulated anthrax attack.’”

Anthrax, Biosurveillance, Bioterrorism &, “Bioterror Detection; Firm To Provide Contract Research For Homeland Security Project,” Science Letter, pg. 104, Sep 28, 2004.

  1. “Under the agreement, Accelrys will employ its proprietary technology in statistical modeling and analysis to help determine the anticipated sensitivity and selectivity of the detection tools, which will be used to monitor for the presence of bacteria, viruses and toxin-proteins.”
  2. “Northrop Grumman will be participating in the effort to develop Bioagent Autonomous Networked Detectors (BAND), which will be used to continuously monitor for bioagents in outdoor urban areas.”

Biosurveillance, Bioterrorism &, “Awards; Technology Awards With Focus On Anti-Terror Research Includes Biocheck Kit Maker,” Drug Week, pg. 53, Oct 15, 2004.

  1. “The Center’s latest solicitation releases in June specifically sought technology submissions that addressed antiterrorism applications such as force protection, port and obrder defense, and security and maritime and land logistics security.”
  2. “Another will help 20/20 GeneSystems develop a second-generation of its BioCheck hazardous substance analyzer…to extend capabilities of the BioCheck kit used by first responders to screen suspicious powders suspected of containing anthrax and other bioterror agents.”
  3. “An individual researcher received…grant to develop a rapid bioluminescent bioassay system that assesses toxicity in water and sediments. The QwikLite technology…measures toxins within 24 hours. Conventional sediment testing usually requires up to 13 days to yield results.”

Anthrax, Biosurveillance, Bioterrorism


Chyba, Christopher, Greninger, Alex, “Biotechnology and Bioterrorism: an unprecedented world,” Survival, summer 2004, pp. 143-162.

Bioterrorism, Biotechnology


Bevelacqua, Armando, “THE NEW HAZ-MAT QUESTION: WHAT ARE YOUR BIOLOGICAL CAPABILITIES?“. Pen Well Publishing Co. November 2004.

  1. “In some cases, fire response personnel used levels of protection specifically designed for chemical entry (level B and level A encapsulation), multiple alarms to handle one ounce of powder assumed to have hazardous qualities, and countless .support resources, in some places, powder found outside donut shops and funnel cake stands bad tire response personnel dressed in level A just for a cleanup.” (Pg. 1)
  2. “We must have protocols in place—actions that are followed and performed in conjunction with the public health service. A biological event is a public health response, and a health representative must be involved with the education, training, and tactical response so the system can act as one.” (Pg. 1)
  3. “A relationship must be established with the local Federal Bureau of Investigation’s weapons of mass destruction (WMD) coordinator to obtain guidance and collaboration in support of procedure and documentation” (Pg. 2)
  4. “The key issue to consider is if the environment has been identified strictly as a chemical or a potential biological. The fundamental answer comes from the air-monitoring/ detection systems within the response agency” (Pg. 3)
  5. “Joint Hazard Assessment Teams” (JHAT). JHAT teams are comprised of two haz-mat with a law enforcement representative [additional strike teams have developed into three-person teams comprised of a haz-mat person, an Explosive Ordinance Disposal (EOD). and a law enforcement crime scene officer or intelligence unit representative” (Pg. 3)

Bioterrorism, Decontamination, Public Health, Quarantine, Emergency Response


Elizabeth K. Leffel, Douglas S. Reed, “Marburg and Ebola Viruses as Aerosol Threats,” Biosecurity and Bioterrorism: Biodefense Strategy, Practice, and Science, 2004;2(3):186-191.

  1. “Although transmission during naturally occurring outbreaks is believed to occur from close personal contact with blood or other body fluids, or the failure to practice proper medical hygiene as relates to blood-borne pathogens, in the past 10 years several publications have indicated that filoviruses possess a number of properties that would make them suitable as biological weapons.”
  2. “While the possibility of aerosol exposure cannot be ruled out in some cases, it is clear that direct contact is the primary means of transmission.”
  3. “The high mortality rates, coupled with the knowledge that these viruses possess properties considered desirable in biological weapons, explains the considerable concern about their potential use.”
  4. “Without data there can be little understanding of the level of threat that filoviruses present. For example, it is not clear from the available data whether filoviruses would cause large-scale infections and deaths if disseminated by aerosol over a city without extensive preparation or modification (“weaponization”).”

Ebola, Biosecurity, Bioterrorism, Biosafety, Biodevelopment


Rose, Laura, “Chlorine Inactivation of Bacterial Bioterrorism Agents“. Applied and Environmental Microbiology. Pg. 566-568, Vol. 71, No.1

  1. “Currently, chlorination is the most common method of disinfecting drinking water in the United States. (Pg. 1)
  2. “The Bacillus anthracis spores were less susceptible to cholorine disinfection than the gram-negative organisms.” (Pg. 1)

Anthrax, Public Health, Emergency Response, Decontamination, Bioterrorism, Biosafety, Chemical


Lowell, Jennifer, “Identifying Sources of Human Exposure to PlagueJournal of Clinical Microbiology. Pg. 650-656. Vol. 43, No. 2.

  1. “Approximately 3,000 human cases occur worldwide annually, with 12 to 15 cases reported each year in the western United States”
  2. “Two of the primary objectives of routine epidemiology plague investigations are to identify the source of human exposure and to assess the exposure site for potential continuing risk.”
  3. “The use of molecular epidemiological techniques in these investigations has been particularly difficult for Y. pestis because of its apparent lack of genetic variation.”
  4. “When combined with epidemiologic information, judicious use of genetic data from nonhuman organisms is highly attractive because of the power of DNA-based analyses to identify exposure sources.”

Public Health, Pandemic, Plague, Decontamination, Biodetection, Bioterrorism, Biodefense, Biosafety


United States Government Accountability Office, “Information Technology: Federal Agencies Face Challenges In Implementing Initiatives To Improve Public Health InfrastructureGAO Report To Congressional Requestors, June 2005.

  1. “To encourage the integration of health care system response plans with public health department plans, the HHS has incorporated both Public Health preparedness and hospital performance goals into the agreements that the department uses to fund state and local public health preparedness improvements.”
  2. “In April 2004, the President established the goal that health records for most Americans should be electronic within 10 years and issued and executive order to ‘provide leadership for the development and nationwide implementation of an interoperable health information technology infrastructure to improve the quality and efficiency of health care.’”
  3. “These networks are to allow for secure and timely sharing and discussion of essential information concerning bioterrorism and other public health emergencies, as well as recommend methods for responding to such an attack or emergency.”
  4. “Two major initiatives at DHS–primarily focused on signal interpretation and biosurveillance…more work remains, particularly in surveillance and data exchange.”
  5. “The Department of Health and Human Services has primary responsibility for coordinating the nation’s response to public health emergencies, including bioterrorism.”
  6. “To improve the development of major public health IT initiatives, GAO recommends, among other actions, that the Secretary of Health and Human Services (to) (1) establish clear linkage between the initiatives and the national health care strategy and federal health architecture and (to) (2) encourage interoperability through the adoption of standards for health care data and communications.

Bioterrorism, Public Health, Biosurveillance, Homeland Security


Brookmeyer, Ron, “Editorial: Biosecurity And The Role Of Statisticians,” J.R. Statistical Society, 168, Part 2, pgs. 263-266, 2005.

  1. “Statisticians who work in Public Health are most familiar with designing and analyzing large clinical trials and epidemiological studies to answer questions.”
  2. “We must use modern statistical tools to estimate model parameters together with sensible mechanistic models for the spread of infectious diseases.”
  3. “One way to shorten the silent period is to improve disease surveillance for new outbreaks. Statisticians have been actively engaged in developing and assessing methodological approaches for rapid detection of emerging outbreaks.”
  4. “One example of an approach to speed the detection of an outbreak is Syndromic Surveillance, which refers to the collection and statistical analysis of vast quantities of public health data to detect early symptoms of a new disease.”
  5. “Syndromic surveillance offers that tantalizing possibility of an early warning of an emerging outbreak from data mining rather than waiting until public health officials have been notified of confirmed cases of disease from traditional medical care settings.”
  6. “Another approach to speed recognition of a bioterrorist attack is air monitoring systems for contaminants and pathogens in the environment.”
  7. “Biomedical research is under way to improve diagnostic test, vaccines and therapeutics for the most worrisome pathogens.”
  8. “Statisticians should be at the forefront in assisting policy makers to determine how to apportion limited resources to increase public health preparedness whether the debates involve syndromic surveillance, air monitoring systems, or vaccination programs.”

Bioterrorism, Public Health, Biosurveillance, Vaccination



  1. “In the case of a medical radiation emergency, response and recovery radiation exposure limits should be established to preserve lifesaving capabilities while taking into consideration risk to staff and facility operation.” (Pg. 13)
  2. “After removal of contaminated clothing, patients should be instructed (or assisted if necessary) to immediately shower with soap and water. Potentially harmful practices, such as bathing patients with bleach solutions, are unnecessary and should be avoided” (Pg. 17)
  3. “Patient clothing should be handled only by personnel wearing appropriate personal protective equipment, and placed in an impervious bag to prevent further environmental contamination.” (Pg. 17)
  4. “Gloves should be worn when contact with blood or body fluids is anticipated. Gloves should be removed immediately, without touching non-contaminated surfaces, as soon as the patient care task is complete.” (Pg. 17- 18)
  5. “Facial protection should be worn when performing patient care tasks likely to generate splashing or spraying of blood and body fluids onto the mucous membranes of the face.” (Pg. 18)
  6. “Disposable fluid-repelling gowns should be worn to protect skin and clothing” (Pg. 18)
  7. “Hospitals should plan for decontamination operations that will not exceed their capacity, but should also develop a contingency plan for mass decontamination when patient numbers do exceed their capacity.” (Pg 19)
  8. “Ensure large quantities of water are available for decontamination in order to dilute the agent as much as possible. Direct excess waste water to the sanitary sewer and immediately notify the POTW and/or MS4.” (PG. 21)

Decontamination, Public Health, Quarantine, Nuclear, Biosecurity, Biosafety, Biotechnology, CDC, Bioterrorism, Biodefense


Kaufman AF, Pesik NT, et al. “Syndromic Surveillance in Bioterrorist Attacks,” Emerging Infectious Diseases 11, 2005:1487-88.



Sharp, Phillip, “1918 Flu and Responsible Science“, Science, Volume 310. 7 October 2005, page 17.

  1. “The influenza pandemic of 1918 is estimated to have caused 675,000 deaths in the United States.”
  2. “We now have the sequence of the virus, perhaps permitting the development of new therapies and vaccines to protect against other such pandemic. The concern is that a terrorist group or a careless investigator could convert this new knowledge into another pandemic.”
  3. “Influenza is highly infectious, and a new strain could spread around the world in a matter of months, if not weeks. The public needs confidence that the 1918 virus will not escape from research labs.”
  4. “All of the described experiments were done in a Biosafety Level 3 laboratory, a high-containment environment recommended by the U.S. Centers for Disease Control and Prevention and the National Institute of Health on an interim basis, whose use should become a permanent requirement for such experiments.”
  5. “The dual use nature of biological information has been debated widely since September 11, 2001. In 2003, a committee of the U.S. National Academies chaired by Gerald Fink considered this issue, weighing the benefits against the risks of restricting the publication of such biological information.”
  6. “The U.S. National Science Advisory Board for Biosecurity (NSABB) was asked to consider these papers before publication and concluded that the scientific benefit of the future use of this information far outweighs the potential risk of misuse.”
  7. “Because a pandemic infection is dependent on many unknown properties, there is no certainty that the reconstructed 1918 virus is capable of causing a pandemic.”

1918 Flu, Open Science, Dual Use, Bioterrorism, NSABB, Lab Safety


Rebmann, Terri, “Defining bioterrorism preparedness for nurses: concept analysisBlackwell Publishing Ltd. Novembver 30, 2005.

  1. “Bioterrorism poses a major threat to the health of citizens around the world [Centers for Disease Control and Prevention (CDC) 2000, Miller et al. 2001]. Infectious diseases can spread rapidly through a hospital, community or around the world, making a bioterrorism attack occurring anywhere a threat to all nations.” (Pg. 1)
  2. “Nurses are the largest group of healthcare providers and, as such, are a cornerstone in bioterrorism response. Because of this, bioterrorism preparedness has become a necessity for nurses, regardless of their education level, expertise area or practice setting (Malone 1999).” (Pg. 2)
  3. “Despite this, the US National Institute of Nursing Research has asserted that bioterrorism preparedness is a necessity across nursing specialties” (Pg. 2)
  4. “All-hazards preparedness efforts focus on biological as well as chemical, nuclear and radiological events. For example, planning is required for both all-hazards and bioterrorism response plans, but knowledge of patient chemical decontamination is only needed for all-hazards preparedness because patient decontamination will probably not be required after a bioterrorism attack” (Pg. 3)
  5. “In preliminary research, Shadel et al. (2001) describe differences in bioterrorism knowledge for various professions. For example, infection control practices, triage, health education and mental health were topics identified as critical for nurses, while pathogen epidemiology and clinical diagnosis were essential for physicians” (Pg. 3)
  6. “There are four attributes of nursing bioterrorism preparedness: (a) gaining bioterrorism management knowledge that is specific to the nursing profession; (b) planning response strategies; (c) practicing response behaviors; and (d) evaluating knowledge level and response plan content. These four attributes consist of protective actions undertaken to mitigate the potential outcomes of a bioterrorism attack” (Pg. 4)
  7. “gaining bioterrorism management knowledge that is specific to the nursing profession. Topics include identifying and reporting an attack, casualty triage and management, implementing control measures and management of victims’ families (Steed et al. 2004).” (Pg, 4)
  8. “Nurses, regardless of their level of education, area of expertise or practice setting should participate in at least one educational offering and one exercise each year to meet the minimum requirements of engaging in the bioterrorism preparedness process.” (Pg. 6)
  9. “Hosting bioterrorism exercises is time-consuming and expensive; for example, most facilities in the USA conduct only one or two exercises per year, which is the minimum required by the Joint Commission on Accreditation of Healthcare Organizations standards [Joint Accreditation Commission on Hospital Organization (JACHO) 2001].” (Pg. 6)
  10. “A group of school nurses believe that bioterrorism is a conceivable threat to themselves and their community, but feel that the risk of it occurring is low. Although they want to become better prepared for a bioterrorism attack and intend to do so at some point in the future, they currently have many other responsibilities that they believe are more pressing.” (Pg. 7)

Bioterrorism, Public Health, Emergency Response, CDC


Knauss, Tim, “U.N. to Get Bioterror Agent Decontamination SystemsNTI. Dec. 13, 2005.

  1. “Two $60,000 machines capable of cleansing mail of anthrax and other biological agents were completed”
  2. “BioDefense said independent tests confirm that the system, which was created after the September 2001 al-Qaeda attacks, is capable of eliminating anthrax, smallpox, ricin, HIV, influenza, botulism and the plague”

Bioterrorism, Biodefense, Public Health, Anthrax, Smallpox, Ricin, Decontamination, al-Qaeda


Berger, Matthew, “New Advisory Panel Will Bridge Science, Intelligence To Deter Bioterrorism,” CQ Homeland Security, May 4, 2006.

  1. “The goal of the panel is to combine the resources and expertise of the intelligence community with medical and science professionals in other parts of government and the private sector.”
  2. “The new panel will assess known and emerging biological threats.”
  3. “‘While such a pandemic would be largely dealt with by those U.S. government agencies concerned with domestic and international public health issues, the (intelligence community) would be looked to for actionable medical intelligence about the spread of pandemic diseases that would not be available publicly for one reason or another.'”
  4. “The intelligence community would also need to ensure that the virus was only being spread naturally, and not by human interference.”
  5. “The intelligence community should be more focused on targeting and collection of bio-intelligence…and should shift its focus from tracking potential bioterrorism materials to tracking people with the motivation, intent and capability to become terrorists.”

Biosurveillance, Bioterrorism


Mosquera, Mary, “DHS To Develop Biosurveillance System For Pandemic,” Tech News (GCN), May 12, 2006.

  1. “The Homeland Security Department expects to award a contract in mid-summer to develop the National Biosurveillance Integration System, a critical piece of the administrations strategy yo handle a pandemic, such as the avian flu.”
  2. “The biosurveillance system will aggregate and integrate information from food, agricultural, Public Health and environmental monitoring and the intelligence community from federal and state agencies and private sources to provide an early warning system for an outbreak or possible bioterrorism attack.”
  3. “The biosurveillance system will also send back to its system partner agencies completed situational awareness in real-time streams.”
  4. “Information will come from sources such as the Centers for Disease Control and Prevention BioSense system, which reports Syndromic Surveillance from hospitals and pharmacies, and the BioWatch system, which monitors aerosols for biothreat agents in major metropolitan areas.”

Biosurveillance, Pandemic, Flu, Public Health, Bioterrorism


Olmsted, Stuart, “Patient experience with, and use of, an electronic monitoring system to assess vaccination responses.Health Expectations. June 2006.

  1. “National Research Council (NRC) report, Networking Health: Prescriptions for the Internet, highlights the potential for information technology (IT) and the Internet to revolutionize health-care delivery in the near future” (Pg. 1)
  2. “When applied to populations, electronic monitoring of many individual patients with chronic or infectious diseases can improve surveillance and management of chronic diseases, as well as reducing health-resource utilization.” (Pg. 1-2)
  3. “In public health practice, a mass vaccination program, whether for pandemic influenza or smallpox, may be strengthened and easier to administer if an electronic system were used to monitor vaccine reactions and side effects.” (Pg. 2)
  4. “Such a system can reduce the need for clinical assessments of vaccine responses, cutting travel time, work absenteeism and clinician time to assess vaccine sites. In addition, a system such as this can act as an early warning device for adverse events.” (Pg. 2)
  5. “Users also reported that the picture on the web or pocket card closely matched the appearance of their vaccine site (143/169; 85%) and that they were confident that what they reported matched their true reaction to the vaccine (147/171; 86%).” (Pg. 3)
  6. “While survey responders in this study were comfortable with a physician tracking their vaccination status via their electronic reports, and many were comfortable with having their take check determined electronically, half of the respondents were not comfortable eliminating the follow-up visit with a health-care provider.” (Pg. 6)
  7. “a similar reporting system may prove useful in public health settings in which large numbers of people will need treatment and follow-up in a short period of time, such as a mass vaccination or prophylaxis during a bioterrorism event, an influenza pandemic or another public health emergency.” (Pg. 6)

Public Health, Bioterrorism, Biosurveillance, Biodetection, Emergency Response, Vaccination


Kathleen Vogel, “Bioweapons Proliferation: Where Science Studies and Public Policy Collide,” Social Studies of Science 36/5(October 2006) 659–690.

  1. biological weapons, replication, sociology of scientific knowledge, tacit knowledge, testing

Nonproliferation, Bioterrorism


Khardori, NancyBioterrorism Preparedness:Historical Perspective and an Overview,”

  1. “The most important factors preventing a “safer world” and which are root causes of any type of terrorism include poverty and inequality,enduring state failure, war, human rights abuses, dispossession, and environmental degradation.”
  2. “The need for state, federal, and international public health law reform has come into clear focus because of bioterrorism concerns and naturally emerging infectious diseases,both with the potential of mass casualties. In the US the power to act to preserve the public’s health is constitutionally reserved primarily to the states as an exercise of their “Police Powers.”
  3. “The Public Health Security and Bioterrorism Preparedness and Response Act of 2002 was passed by the US Congress on May 23,2002 and signed into law June 12,2002. The act was designed to improve coordination of federal antibioterrorism activities, improve the health care system’s ability to respond to bioterrorism,protect the nation’s food supply and drinking water, address the shortages of specific types of health professionals, and speed up the development and production of new drugs and vaccines.”
  4. “Rapid response to rare conditions and evaluation of unusual clusters of disease hinges on effective surveillance systems. This is what led to the creation of the US Epidemic Intelligence Service which has provided training and disease detection expertise for more than 50 years.”



  1. “During a bioterrorism incident, 68.9% of hospitals would contact EMS, 68.7% percent law enforcement, 61.6% fire departments, 58.1% HAZMAT, and 42.8% all four. About 74.2% had staged mass casualty drills with EMS, 70.4% with fire departments, 67.4% with law enforcement, 43.3% with HAZMAT, and 37.0% with all four.” (Pg. 1)
  2. “Federal funding through HRSA for hospital preparedness, including mass casualty drills, has fallen from a high of $514.9 million in fiscal year 2004, to $474.2 million in FY 2006.8 But the HRSA National Bioterrorism Hospital Preparedness Program continues to encourage integration of hospitals with public safety organizations, such as fire departments, EMS, and law enforcement” (Pg. 4)
  3. “Farmer and Carlton (2006) commented that a major factor working against developing a better interface between hospitals and communities in disaster planning was cultural differences between public and private entities, with 95% of police, fire, and EMS systems being public and 95% of the medical capability being private” (Pg. 5).
  4. “The majority of hospitals involve public safety organizations in their emergency plans and drills, but some types of hospitals are more likely to do so than others. Higher hospital bed capacity was the characteristic most predictive of drilling with these organizations.” (Pg. 5)

Bioterrorism, Public Health, Emergency Response, Law Enforcement



  1. “The Spanish flu pandemic of 1918–1919 emerged killing an estimated 50 million people. Humans are still being assailed by infectious disease threats. In the past five years alone, several pathogens were seen in North America for the first time – West Nile virus, monkeypox virus, low pathogenic avian flu in commercial bird farms, mad cow disease and Severe Acute Respiratory Syndrome (SARS).” (Pg. 2)
  2. “several researchers have called for stricter controls over biotechnology experimentation that provide dual-use information and technologies, dissemination of bioinformatics data and regulation of researchers as a way to manage infectious disease risks” (Pg. 2)
  3. “Emerging diseases can be controlled but doing so requires significant funding and a coordinated effort. Implementation of strategies such as modern ‘ring containment’ where infectious disease was cordoned off by vaccinating individuals in a circle surrounding outbreak areas, and hospital quarantine under controlled conditions eradicated smallpox from the planet.” (Pg. 2)
  4. “Genetic engineering is defined as the process of manipulating the pattern of proteins in an organism by altering its existing genes. Since the genetic code is similar in all species, genes taken from one organism can function in another, allowing traits to be altered or introduced. Either new genes are added, or existing genes are changed so that they are produced by the recombinant.” (Pg. 3)
  5. “With 30,000 human gene targets, available biotechnologies, and scientific creativity just about any gene can be turned into a bioweapon target.16 The problem then becomes one of risk issue management as we try, as a society, to mitigate the risks of subverted uses of biotechnology.” (Pg. 3)
  6. “We have reached a point through science and communication technology where we can detect, track and contain most emerging diseases in real time, no longer passive victims from the assault of infectious diseases.” (Pg. 6)

Bioterrorism, Public Health, Emergency Response, Pandemic


Epstein, Gerald L., “Law Enforcement and the Prevention of Bioterrorism: Its Impact on the US Research Community,” GLOBAL NON-PROLIFERATION AND COUNTER-TERRORISM: THE IMPACT OF UNSCR 1540, Eds. Bosch, Olivia and Peter van Ham, Brookings Institution Press: 2007.

  1. Law enforcement aims to prosecute offenders, tighten security and increase preventitive measures for bioterrorism.
  2. concern over biological research use
  3. The AntiTerrorism and Effective Death Penalty Act of 1996: regualting transport of biological agents, prevent access for criminal use.
  4. imbalanced rules in science vs. law enforcement, restrictions on biological research impeding/infringing upon research creativity
  5. Tomas Foral, Thomas Butler, Steven Kurtz

Bioterrorism, Lab Safety, UNSCR 1540, Law Enforcement


Forden, Geoffrey, “How the World’s Most Underdeveloped Nations Get the World’s Most Dangerous Weapons,” Technology and Culture, 2007, pp. 92-103.

  1. “Iraqi biological weapons administrative infrastructure relied on its own mytoxin experts, who encouraged first research and then production.”
  2. “According to the Iraq Survey Group’s ”Comprehensive Report”, the Iraqis began research on the powerful nerve agent VX in 1985 with a literature search for published work on its synthesis and production.”
  3. “In 1975, the Sunday Times of London revealed that the British patent office had, a number of years earlier, approved and published the formula and method of synthesis for a whole family of organophosphate chemicals, including VX.”
  4. “A machinist can just as easily learn to operate a flow-forming machine by making a tuba horn as a rocket nuzzle; a technician can learn to control a fermenter to brew a vaccine as well as a pathogen; producing a nerve agent is not so different from producing a pesticide. As such beneficial knowledge spreads–and no one would deny a developing country the right to produce vaccines or refine its own agricultural chemicals–it will become that much easier for proliferators to find the necessary population of skilled workers already within the country.”
  5. “We still need our supply-side-oriented nonproliferation regimes to try to prevent crucial technologies from being shipped to countries that might abuse them.”

Tacit Knowledge, A.Q. Khan, Dual Use, Bioterrorism, WMD, Open Science, Vaccination, Synthetic Biology


Collett Marc S. “Impact of Synthetic Genomics on the Threat of Bioterrorism with Viral Agents. In: Working Papers for Synthetic Genomics: Risks and Benefits for Science and Society,” pp. 83-103. Garfinkel MS, Endy D, Epstein GL, Friedman RM, editors. 2007.

  1. “From a bioterrorism perspective, viruses isolated from nature are a sure bet. Their virulence and transmissibility are known. Their effect and impact can be predicted or calculated. Viruses isolated directly from diseased hosts (called “primary isolates”) demonstrate clearly the consequences of their infection. Additionally, the virus’s ability to survive, persist and spread in the environment and among susceptible hosts is generally known. Finally, pathogenic viruses isolated from diseased hosts are typically “hot” viruses; that is, primary isolates of pathogenic viruses tend to cause severe disease in their host.” P87
  2. “Most viral genome sequences deposited in databases are derived from laboratory-passaged viruses. While many sequences may be derived from low-passage viruses, and are therefore more likely to be close to their primary isolates, in some cases the passage history of the virus from which the sequence was derived is unclear, as are the biological attributes associated with that virus. Thus, there can in some cases be uncertainty regarding the biological attributes of a synthetic replica of a gene bank virus sequence.” P88
  3. “[S]ynthetic genomics technology could provide the means for the re-creation of variola virus, and therefore could affect the availability of this agent for malevolent use. Due to the large size of the poxvirus genome, however, it would be anticipated that well-established poxvirus recombination techniques would play a significant supportive or alternative role in producing an entire poxvirus genome.” p 91
  4. “Smaller genome segments of a sequence derived from variola virus may be readily incorporated into a “base” monkeypox virus, resulting in chimeric orthopoxviruses with unknown and unpredictable biological characteristics.” p 91
  5. “Because of their virulence, filoviruses are handled in high containment laboratory facilities to prevent virus release into the environment, and also to protect those working with these highly pathogenic viruses. Consequently, the number of labs in possession of these viruses is limited, as is access to these labs. However, during outbreaks, unsecured local hospitals and medical field teams collect, hold and transport numerous infectious patient specimens. Additionally, there may be covert stores of virus outside known containment laboratories. Hemorrhagic fever viruses were the subject of biowarfare research in the former Soviet Union, where weaponized Marburg virus was produced and research on Ebola was conducted. Upon the dissolution of the Soviet Union and these programs, the disposition of laboratory biological materials was not tracked.” pp 92-93
  6. “While [Australian workers] trying to improve their experimental mouse contraceptive vaccine, they engineered the expression of cytokine IL-4 from ectromelia virus, hoping that infection with this recombinant poxvirus would enhance antibody production by their vaccine. It instead resulted in severe suppression of cellular immune responses in the mice, uncontrolled virus replication, and animal death. Even mice previously immunized against normal ectromelia virus 16 or treated with the antiviral drug cidofovir17 were unable to survive ectromelia-IL-4 virus challenge.” p 95

Synthetic Biology, Bioterrorism, Smallpox, Vaccination, Ebola


Good, Linda, “Addressing Hospital Nurses’ Fear of Abandonment in a Bioterrorism EmergencySlack Incorporated, December 2007.

  1. “A study of 212 Pentagon staff members indicated that respondents who were in or near the Pentagon during the September 11, 2001, attack were more likely to have posttraumatic stress disorder and major depression than coworkers who were at other locations” (Pg. 1)
  2. “Residual post-event effects included fear of returning to the site, sleep disorders, eating problems, grief response, and a new sense of vulnerability in their place of work and community” (Pg. 2)
  3. “Nurses on night shifts felt less prepared than nurses on day shifts because education and drills were usually scheduled at times they could not attend (O’Boyle et al., 2006). A day shift drill does not simulate after-hours resource issues, including concerns about access to supplies.” (Pg. 2)
  4. “The stocks of disposable respirators, isolation gowns, and gloves are finite and would deplete quickly. Traditional standard precautions, such as frequent disposal of PPE, may not be possible, yet facilities may lack a contingency plan.” (Pg. 2)
  5. “Biological attack adds elements of evil intention and activation of deeply rooted fears, resulting in the potential of strong psychological responses (Holloway, Norwood, Fullerton, Engel, & Ursano, 1997). Nurses have reported a lack of attention to their psychosocial needs in past domestic disaster events” (Pg. 3)
  6. “Nurses anticipate that in the event of a bioterrorism disaster, they would be functioning in a chaotic environment without the presence of hospital administration or a clear chain of command (O’Boyle et al., 2006). Nurses who have actually experienced the chaos of disaster response reinforce the need for the visible, reassuring presence of leadership.” (Pg. 4)
  7. “The focus group nurses anticipated that many coworkers would fail to report to work or even quit their jobs, rather than place themselves in harm’s way. Besides an unwillingness to report for duty, an inability logistically to get to work may exist in a disaster event (Qureshi, Gershon, Gebbie, Straub, & Moore, 2005). Consequently, the nurses in the study by O’Boyle et al. believed that resulting staff shortages would place even greater pressure on those remaining…… being free to attend to family safety. Qureshi et al. (2005) found this to be the most frequently cited reason for hospital employees being unwilling to report for duty in a disaster.”(Pg. 4)

Bioterrorism, Emergency Response, Biodefense, Public Health


Snyder, Michael and Sobieski, Thomas, “Decontamination Operations in a Mass Casualty ScenarioJoint Force Quarterly. 2008.

  1. “principles of decontamination that also apply to a nuclear detonation scenario: expect a 5:1 ratio of unaffected to affected casualties, decontaminate as soon as possible, disrobing is decontamination: top to bottom, more is better, water flushing generally is the best mass decontamination method, after known exposure to a liquid agent, first responders must self-decontaminate as soon as possible to avoid serious effects” (Pg. 2)
  2. “DSCA environment require special considerations by military CBRN planners in the following areas: determining who needs to be decontaminated, multisite operations, integration of decontamination operations with other plans, disposition of runoff, disposition of personal effects, accountability, crowd control.” (Pg. 3)
  3. “It is reasonable to assume that not everyone within the evacuation zone would be contaminated. Identifying those who are “clean” would greatly reduce the resources needed and expended” (Pg. 3)
  4. “To respond to the magnitude of need, several mass decontamination sites probably would be established around the plume perimeter.” (Pg. 4)
  5. “Successful decontamination operations include planning initial medical triage and follow-on medical care, as well as providing subsequent transport, clothing, food, and shelter to all those who process through prescreening.” (Pg. 4)
  6. “Keeping large groups orderly is essential for effective mass decontamination operations. Local law enforcement would vector victims to the various mass decontamination sites established upwind of the blast and outside the projected plume path.” (Pg. 4)

Decontamination, Emergency Response, Bioterrorism, Public Health, Homeland Security, Quarantine


Dumiak, Michael, “Detecting Bioterror,” Defense Technology International – Science Watch Section, Vol. 2, No. 4, pg. 10, May 1, 2008.

  1. “While bioterror detection systems are currently deployed, early detection of a biological outbreak remains an objective rather than reality.”
  2. “The agency wants these markers to be detectable using trace amounts—less than 30 nanograms—of plasma, fluids, saliva, blood or tears, and the analysis to take no more than 90 min.”
  3. “The move is prompted by two recent research efforts: A National Institutes of Health study that used polycombinase chain reactions or PCR (i.e., cloning) to detect low levels of DNA from pathogens in clinical samples, specifically from the common yeast candida albicans in the bloodstream of rabbits. The other study, from a group doing work in Paris and Tunis, detected human herpes virus-6 DNA in the plasma of hitherto asymptomatic people with repressed disease.”
  4. “There are at least a half-dozen efforts in the U.S. that are aimed at early detection of biological outbreaks and attacks.  These are broken down into two categories: statistical or data-based syndromic biosurveillance, and biodetection, which is more immediate.”
  5. “Darpa has also employed software prototypes using rudimentary automatic translation technology to find meaningful patterns in open-information sources around the world. The technology is based on the MiTAP engine from Mitre Corp., McLean, Va., which now lives on, much modified, at Georgetown University’s Division of Integrated BioDefense.”
  6. “In 2005, Idaho Technology, Inc. of Salt Lake City, rolled out a 40-lb. device for the U.S. Air Force and Army to analyze food, environmental and clinical samples using DNA amplification.  It could reportedly identify a biological warfare agent in 40 min(utes).”

Biodetection, Bioterrorism, Syndromic Surveillance, Biosurveillance


Hsu, Spencer, “Modest Gains Against Ever-Present Bioterrorism Threat; An Attack Could Be Hard To Predict With Current Tools,The Washington Post, A Section, Pg. A10, Aug 3, 2008.

  1. “The result: modest gains, at best, toward preventing another attack similar to the one in 2001, in which anthrax bacteria killed five people and sickened 17.”
  2. “‘The potential for something to happen is much greater now than it was in 2001, simply because of developments of technology and education.’”
  3. “The government has not developed a general-use anthrax vaccine.  A new generation of sensors that would sniff out threats more quickly has been delayed.  A coordinated plan to respond to a widespread outbreak still doesn’t exist.  And the rapid increase in the number of researchers registered to work with biological agents, now 15,000 people, has come without enough oversight.”
  4. “A significant bright spot…is the dramatic improvement in government preparations to respond to threats such as smallpox, botulism (botulinum), plague and other biological agents.”
  5. “The Strategic National Stockpile, a emergency cache of critical pharmaceuticals that can be sent within 12 hours to counter outbreaks, has been greatly expanded.”
  6. “The stockpile…has 60 million treatment courses of antibiotics for anthrax and pneumonic plague.  About 300 million doses of smallpox vaccine can also be shipped.”
  7. “Officials say that the government is retooling efforts to encourage drug companies to invest in BioShield projects. and that the effort is paying off in new antitoxins for anthrax and botulism.”
  8. “All 50 states now can receive urgent disease reports around-the-clock and conduct year-round surveillance for diseases such as influenza.”
  9. “But the nation still lacks plans and an organized structure to respond to a massive disease outbreak with thousands of victims.”

Bioterrorism, Biosurveillance, Flu, Plague, Anthrax, Botulinium, Project Bioshield, Smallpox


Schmitt, Eric, “Panel Fears Use of Unconventional Weapon,” NYT, A 11, Dec. 1, 2008.

  1. “An independent commission has concluded that terrorists will most likely carry out an attack with biological, nuclear or other unconventional weapons somewhere in the world in the next five years unless the United States and its allies act urgently to prevent that.”
  2. “the Congressionally mandated panel found that with countries like Iran and North Korea pursuing nuclear weapons programs, and with the risk of poorly secured biological pathogens growing, unconventional threats are fast outpacing the defenses arrayed to confront them.”
  3. “The report is the result of a six month study by the Commission on the Prevention of Weapons of Mass Destruction Proliferation and Terrorism.”
  4. “[recommendations include] improved bioforensic capabilities, and strengthening international organizations, like the International Atomic Energy Agency, to address the nuclear threat.  It also calls for a comprehensive approach for dealing with Pakistan.”
  5. “The report calls for conducting a major review of the program to secure dangerous pathogens and tighten oversight of high-containment laboraties.”

Bioterrorism, WMD, Biosecurity, Nonproliferation, Iran, North Korea, Pakistan


Kevin Anderson, “ Vaccines for Biodefense and Emerging and Neglected Diseases,” chap. 3, Pages 33-42, 2009., Viral Biothreat Agents, (Available online 16 January 2009).

  1. The risk posed by viruses as biological threat agents is discussed primarily from a public health perspective, with the potential occurrence of significant morbidity and mortality as a result of infection via natural or intentional exposure. Parameters of risk associated with the spectrum of viruses considered as biological threat agents are discussed, to include examples of intentional use. In consideration of the threat posed by viruses, mitigating illness and preventing death are the principal goals of medical countermeasure development efforts. The existence of safe and efficacious vaccines is critical to establishing a robust posture of preparedness to address the spectrum of viral threat agents.”

Bioterrorism, Biodefense, Vaccination


Hartz, Marlena, “Scientists Develop CW Decontamination WipeNTI. March 11, 2009.

  1. “A Texas-based team has used federal funding to create a wipe that would neutralize chemical warfare materials released in a terrorist attack”
  2. “The thin sheet of carbon is included with a lotion-soaked sponge in a kit that could be distributed to U.S. military personnel and first responders. The items could be used to remove chemical agents from equipment, skin and even eyes and open wounds”

Decontamination, Bioterrorism, Public Health, Emergency Response, Military


Lee, Jeremy John et al. “Guide for mass prophylaxis of hospital employees
in preparation for a bioterrorist attack,” Am J Health-Syst Pharm—Vol 66 Mar 15, 2009, p. 570.

  1. “Health-system pharmacists should play an active role in designing and implementing an antibiotic prophylaxis plan for employees for a potential bioterrorist attack.”
  2. Anti-infective agents; Biological warfare; Disaster planning; Drugs; Guidelines

Bioterrorism, Biodefense


Shiga, David, “Report Examines Lifesaving Measures for Nuclear StrikeNTI. July 13, 2009.

  1. “Since such an explosion would obliterate most structures and people within a roughly half-mile radius, the panel concentrated on measures that planners might employ to limit deaths outside the blast zone”
  2. “The most effective way for people to protect themselves from the deadly fallout, the panel found, was to stay indoors or underground rather than try to outrun the lethal gamma rays emitted by the explosion.”
  3. “Radiation exposure generally attacks the immune system and leaves victims extremely vulnerable to infections and uncontrollable blood loss. Recent pharmaceutical advances could mitigate these potentially deadly effects, though the need at any given hospital following an attack could easily outstrip the drug supply.”

Nuclear, Emergency Response, Bioterrorism, Public Health


New York-Presbyterian Hospital/Weill Cornell Medical Center/Weill Cornell Medical College, “Early Detection And Quick Response Are Key To Defense Against Anthrax Attack,” Drug Week, pg. 94, Aug 14, 2009.

  1. “A new study finds that in order for a response to be effective, quick detection and treatment are essential, and any delay beyond three days would overwhelm hospitals with critically ill people.”
  2. “‘No matter how well-organized and prolonged a treatment program is, it must be quickly implemented. In fact, our analysis shows that time-to-treatment is roughly twice as important as the duration of the distribution program.'”
  3. “‘Crucial to rapidly implementing a treatment program is early detection, including thorough use of advanced biosurveillance technologies and live, person-to-person communication. But most important of all are multilateral diplomatic efforts to prevent bioterrorist attacks from ever happening.'”
  4. “The study predicts that a campaign initiated two days after exposure would protect as many at 87 percent of exposed individuals from illness — a rate considered successful by the CDC.”

Bioterrorism, Biosurveillance


Fitzsimmons, Emma, Graves, “Researcher Had Bacteria For Plague At His Death,NYT, A 13, Sept. 22, 2009.

  1. “researcher, Malcom Casadaban, 60 had a weakened strain of the bacteria Yersinia pestis in his blood when he died from an infection on Sept. 13, university officials said.”
  2. [He was] studying the bacteria to create a better vaccine for plague.”
  3. “As a precaution, though, the University of Chicago medical Center offered antibiotics to about 100 people who knew the researcher, including his family members, friends and colleagues.”
  4. “Plague is rare in the United States, with fewer than 15 cases reported annually, mostly in rural areas in the Southwest, according to the C.D.C.  About 1,000 to 3,000 cases of plague are reported globally each year, many in Africa.”
  5. “Dr. Casadaban had hoped to create a better vaccine for plague in part because of concerns about its possible use in bioterrorism.”
  6. “Officials are investigating whether Dr. Casadaban may have become infected through breathing, through a cut in his skin, or through his eyes or mouth.”
  7. “… required to follow safety guidelines, including wearing gloves, a lab coat and goggles and using a biosafety cabinet, a device that has a filter to clean the air in a laboratory, according to the C.D.C.”

Lab Safety, Bioterrorism, Vaccination, Plague, CDC, Biosafety


Pollack, Stefan; Jonathan Younger, “North Korea Has Stockpiles of Biological Weapons According to Report; Universal Detection Technology to Be Selected by U.S. Department of Commerce to Prepare South Korea,” MSN, October, 7, 2009.

  1. “…North Korea has the ability to launch as many as 13 kinds of viral and bacterial attacks.”

Biodefense, Bioterrorism


Hall, Mimi, “Bioterror Failings Criticized in Report,” USA Today, 1A, Oct. 21, 2009.

  1. “The Obama administration is working hard to curb nuclear threats but failing to address the more urgent and immediate threat of biological terrorism, a bipartisan commission created by Congress is reporting today.”
  2. “Disease surveillance programs fall short. The government needs to invest in rapid diagnostic tests to ‘improve the nation’s ability to treat people by providing a more timely and accurate diagnosis’ –something that can be critical to treating the victim of a biological attack.”

Biosurveillance, Bioterrorism


Nyamathi, Adeline, “Computerized Bioterrorism Education and Training for Nurses on Bioterrorism Attack Agents SLACK Incorporated. 2010.

  1. “Compared with other potential biological agents, anthrax spores are stable in the environment and the aerosolized form has a high mortality rate.” (Pg. 1)
  2. “Achieving the goal of bioterrorism preparedness is directly linked to comprehensive education and training that enables first-line responders, such as nurses, to diagnose infectious agents rapidly and assess and deal with risks appropriately to avoid widespread contamination, illness, and death. In the same way that the threat of biological attack is continuous and constantly evolving, bioterrorism education and training must take advantage of newer technologies and must be sustained and not limited to occasional seminars or a one-time symposium” (Pg. 2)
  3. “Fewer than 50% of the nurses were able to correctly differentiate anthrax from an upper respiratory infection or smallpox from chickenpox. Furthermore, nurses scored lower than physicians on all 12 of the knowledge-based questions. Of the respondents, only 20% reported having previous bioterrorism training and fewer than 15% believed that they could respond efficiently to a bioterrorism event.” (Pg. 2)
  4. “In a larger study of 651 physicians, an online program was used to train participants to diagnose and manage cases of smallpox, anthrax, botulism, and plague (Cosgrove, Perl, Song, & Sisson, 2005). Pretest/posttest scores for correct diagnosis increased from 47% to 79%, whereas scores for correct management increased from 25% to 79%. Thus, web-based, case-oriented programs were effective in educating physicians about agents of bioterrorism. (Pg. 2)
  5. “This didactic module, which was adapted for nurses, included a background on bioterrorism, encompassing a brief history of bioterrorism and the reasons why biological agents could be used as weapons and an overview of the category A bioterrorism agents, including the differential diagnosis, diagnostic methods, and treatment.” (Pg. 4)
  6. “Participants in the computerized bioterrorism education and training program were more likely to solve the cases critically without reliance on expert consultants. However, participants in the standard bioterrorism education and training program reduced the use of unnecessary diagnostic tests” (Pg. 10)

Public Health, Anthrax, Smallpox, Emergency Response, Bioterrorism, Biosecurity



  1. “Since 2001, the U.S. government has devoted considerable time and effort identifying potential vulnerabilities to biological attacks, promoting prevention strategies, and anticipating how best to respond should a large-scale biological attack ever occur.” (Pg. 2)
  2. ““The more that sophisticated capabilities, including genetic engineering and gene synthesis, spread around the globe, the greater the potential that terrorists will use them to develop biological weapons . . . . Prevention alone is not sufficient, and a robust system for public health preparedness and response is vital to the nation’s security.’” (Pg. 3)
  3. “The changes generally grant broad sweeping powers to state governors and health officials, including the power to order forced treatment and vaccination without specifying which exemptions….Such changes could increase the chances for state abuse of power and lead to confusion during a mass vaccination campaign.” (Pg. 3)
  4. “Currently, the federal government lacks authority to exert control over a state’s emergency vaccination plans, regardless of whether the plans are too lenient and severely risk the public’s health or too rigid and unnecessarily restrict individual liberty” (Pg. 4)
  5. “Maryland, the state’s attorney summoned parents of more than 1,600 children to court, giving them a choice between vaccinating their children and facing penalties of up to ten days in jail and fifty dollars a day in fines.” (Pg. 7)
  6. “Three key factors determine the percentage of the population that must be immunized in order to reach the herd immunity threshold: (1) the degree of the disease’s infectiousness; (2) the population’s vulnerability; and (3) the environmental conditions.” (Pg. 8)
  7. “The Court explained that the state had a duty to protect the welfare of the many and to refrain from subordinating their interests to those of the few.”(Pg. 12)
  8. “The Court determined that an individual’s belief qualified as a religious belief, if it was “sincere and meaningful” and it “occupied in the life of its possessor a place parallel to that filled by the God of those admittedly qualifying for the exemption.”” (Pg. 20)
  9. “The district court warned that while an individual may possess sincerely held beliefs, instead of being rooted in religious convictions, those beliefs may merely be framed in religious terms to feign compliance with the law.” (Pg. 21)
  10. “The Sherr case raises two issues. First, how much proof an individual must provide to demonstrate to the government the sincerity of the individual’s religious beliefs. Second, how public health officials in an emergency will determine quickly and fairly whether an individual meets the requisite burden of proof.” (Pg. 22)
  11. “Current state public health emergency laws inadequately address mass vaccination situations and leave wide-open the potential for the abrogation of individuals’ rights” (Pg. 29)
  12. “The model law, drafted by The Center for Law and the Public’s Health, at Georgetown and John Hopkins Universities, seeks to “grant public health powers to state and local public health authorities to ensure strong, effective, and timely planning, prevention, and response mechanisms to public health emergencies (including bioterrorism) while also respecting individual rights.” (Pg. 31)
  13. “Additionally, MSEHPA fails to address the need for a consistent and coordinated nationwide approach to mass vaccination in a multi-state emergency…..”To prevent the spread of contagious or possibly contagious disease the public health authority may isolate or quarantine . . . persons who are unable or unwilling for reasons of health, religion, or conscience to undergo vaccination.”‘ (Pg. 31)
  14. “The Public Health Emergency Medical Countermeasures Enterprise (“PHEMCE”)”  is likely the most appropriate government body to be in charge of implementing the new informed consent requirements, the medical and religious exemptions, and the right of refusal conditioned on a discretionary requirement of isolation or quarantine” (Pg. 35)

Bioterrorism, Public Health, Vaccination, Law Enforcement, CDC, Quarantine, Pandemic


Jacobson, HollyTraining Needs of Nurses in Rural TexasPublic Health Nursing, February 2010.

  1. “Federal funding for domestic biodefense increased from US$576 million in 2001 to an estimated US$5,415million in 2008, a 10-fold increase (Franco, 2008). This increase in funding has been instrumental in strengthening the preparedness infrastructure across a variety of federal, state, and local agencies.” (Pg. 1)
  2. “However, it still remains the responsibility of state and local health departments to create emergency plans that are specific to and reflect the unique characteristics of their communities” (Pg. 1)
  3. “Research suggests that nurses play an integral role in the early detection and timely management of biological agents” (Pg. 2)
  4. “response training is particularly notable in rural areas, which have unique organizational and geographic features demanding different approaches to bioterrorism preparedness training and response efforts.” (Pg. 2)
  5. “Also consistent with previous findings, nurses represented in this study have had very limited prior participation in emergency and bioterrorism preparedness and response. Considering the national interest in emergency preparedness, this result suggests that current training strategies may need to be revised.” (Pg. 5)

Bioterrorism, Emergency Response, Biodefense, CDC





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