Developmental Milestones/Developments to Date:
Current Assessment/State of the Field:
Brennan, Richard et al. “Chemical Warfare Agents: Emergency Medical and Emergency Public Health Issues.” Annals of Emergency Medicine, Volume 34 Issue 2. 191. August 1999
- ”Although it is prudent not to overstate the risk posed by chemical warfare agents (CWA), the proliferation of chemical, biological, and nuclear weapons (weapons of mass destruction [WMD]) was recently recognized by the US Congress as the most serious threat to national security.” – page 191
- “Risks to civilian populations include terrorism, military stockpiles, military use, and industrial accidents involving chemicals used as CWAs.”
- “To ensure that American cities and communities are appropriately prepared for a terrorist attack with a chemical, biological, or nuclear weapon, Congress passed The Defense Against Weapons of Mass Destruction Act of 1996 (WMD Act).” – page 192
- ”CWAs are broadly classified as nerve agents, vesicants, pulmonary agents, and cyanides (formerly bloody agents).” – page 194
- ”Their clinical effects, and their comparative advantages as weapons, vary according to their physiochemical characteristics, toxicity, and primary site of action.” – page 194
- ”Relevant issues in disaster preparedness for an incident involving a CWA include education and training of emergency personnel, disaster planning, public education, deployment of specialized teams, and stockpiling of appropriate antidotes.” – page 195
- ”The federal response to terrorism consists of 2 components: crisis management and consequence management. The lead federal agency for crisis management is the FBI and the lead federal agency for consequence management is FEMA.” – page 198
- ”Recent trends in terrorism, the production and transport of industrial chemicals, and the aging of the military stockpile have increased the risk that civilians may be exposed to CWAs.” – page 202
- “Principles of emergency response and medical treatment include levels of response, command and control, personal protective equipment, assessment, demarcation of the contaminated area, agent detection and identification, triage, decontamination, preparedness of the emergency department, protecting the public, medical treatment and antidotes, poison control centers, and surveillance.
Chemical, WMD, Public Health, Military, Japan, Sarin, CWC, Chemical Surveillance
Adamo, Beth, “Evacuating Your Home During a Terrorist Attack“, Safety. 2000.
- “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.”
- “Wherever you’ve decided to go, the best way to get there is by car.”
- “Be prepared for any emergency by assembling an emergency supplies kit.”
Public Health, Emergency Response, Biosafety, Bioterrorism
Benjamin, Georges C. “Chemical and Biological Terrorism: Planning for the Worst” Physician Executive Volume 26 Issue 1. 80. January/February 2000.
- 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
- ”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 *
- ”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
- ”Biological agents act like chemical agents but have a slower onset of action. Agents of concern include Ricin.” – page 81
- ”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
- ”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
- “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
- “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
- ”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
Vergano, Dan, “Bioterrorism defense under fire Doctors say military plans are wrong approach”. USA TODAY. June 21, 2000.
- “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.”
- “”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.”
- “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”
- “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.”
- “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.””
- “Instead of funding military bioterrorism response teams, he says, the government should bulk up disease surveillance efforts staffed by physicians”
- “”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
Higham, Steve, “Chernobyl Challenge”. International Construction. August 2001.
- “Within six months, Russian and Ukrainian teams had contained the damaged reactor under a makeshift ‘tomb’. This helped plug to plug immediate radioactive leakage, but will not outlive the danger posed by its contents.”
- “Parts of Chernobyl’s interior have not been seen since the day of the accident—even by remote-controlled cameras. In experimental explorations, robots carrying such cameras had their electronic components destroyed instantly by the high levels of ambient radiation.”
Nuclear, Public Health, Quarantine
Stolberg, Sheryl, “A NATION CHALLENGED: THE HEALTH SYSTEM; Struggling to Reach a Consensus On Preparations for Bioterrorism”. The New York Times; November 5, 2001.
- “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?”
- “”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.”
- “The system they have tested — the public health system — has been strained to its breaking point.”
- “”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.””
- “”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.””
- “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.”
- “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.”
- “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
- “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)
- “Even a single exposure could result in local outbreaks of difficult-to-diagnose disease and fatal disease outbreaks.” (Pg. 1)
- “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)
- “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)
- “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)
- “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)
- “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)
- “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 attacks” Capital Service News. Feb. 22, 2004.
- “Most larger hospitals have a bioterrorism plan. The bill would make sure that all hospitals, including small outstate facilities, will comply, Scott said.”
- “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.”
- “”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
- 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.”
- “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”
- “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).”
- “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.”
“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.”
- “planning should be based on developing the capability of effectively and efficiently responding to a variety of bioterrorist contingencies”
- “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.”
- “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
Editors, “Terrorism. Iodine pills, just in case.” Harvard Medical School. July 2002.
- “People are also buying potassium iodide (KI) pills, which help protect the thyroid gland from radiation.”
- “Health officials worry that people who take the potassium iodide will think they’re safe and ignore evacuation orders”
- “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.”
- “Potassium iodide pills flood the thyroid with the stable version, lowering the uptake of the radioactive atoms, which are subsequently excreted in urine.”
- “One Web site, www.nukepills.com, 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
Mattews, Gene, “Legal Preparedness for Bioterrorism” EBSCO Publishing, 2002.
- “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)
- “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)
- “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)
- “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)
- “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)
- “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 Health” Journal of Law, Medicine & Ethics, 2002.
- “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)
- “…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)
- “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)
- “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)
- “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
Glass, Thomas A. and Monica Schoch-Spana, “Bioterrorism and the People: How To Vaccinate a City against Panic,” Clinical Infectious Diseases, 34:217-23 (Jan 15, 2002)
- [Glass and Schoch-Spana propose a five point model for community participation in response bioterror attacks, especially epidemics]: 1. “treat the public as a capable ally,” 2. “enlist civic organizations,” 3. “anticipate the need for home-based patient care and infection control,” 4. “invest in public outreach and communication strategies,” and 5. “ensure that planning reflects the values and priorities of affected populations.”
- The public has generally been discounted as an effective means of defense against bioterrorism; this attitude is not based on experience, as the authors claims “natural and technological disasters and disease outbreaks indicate a pattern of generally effective and adaptive collective actions.”
- “Collective behavior changes over time and in relation to external events. This suggests that, in times of disaster, panic may be ‘iatrogenic’: that is, the actions of emergency managers may determine the extent and duration of he panic, to the extent that it exists.”
Emergency Response, Public Health, Prophylaxis, Anthrax, Ethics
Roffey, R.; Lantorp, K.; Tegnell, A.; Elgh, F. “Biological Weapons and Bioterrorism Preparedness: Importance of Public-Health Awareness and International Cooperation” Clinical Microbiology and Infection, Volume 8 Number 8, 2002
- “In Sweden, every county (population approximately 400 000) has an infectious disease clinic with containment facilities. In order to treat patients with highly contagious serious infectious diseases, Sweden has a special containment unit at the university hospitals in Linko¨ping and Stockholm. Sweden also has a special field epidemiologic group that can be called upon to investigate outbreaks of disease of different types, on both a national and an international level.” p525
- “The Swedish Defence Research Agency Division of NBC Defense analyzes the international developments
and threats concerning biological weapons and bioterrorism. The research is, among other things, focused on the development of methods and technology for detection/identification of and protection against biological warfare agents. The Swedish Defense Research Agency cooperates with the Swedish Institute for Infectious Disease Control with regard to identification of specific biological warfare agents.” p525
- “There is a themselves, temptation for these scientists to immigrate to countries that want to acquire biological weapons. In order to meet this threat, several initiatives have been taken by the world community. An example of this the Department of Defense Cooperative Threat Reduction Program (DOD CTR) in the USA, as well as other US agencies. Economic support is also given through the International Science and Technology Center (ISTC) in Moscow and the Science and Technology Center Ukraine (STCU) in Kiev, which are financed by the USA, the European Union (EU), Japan, and others.” p526
- “In Sweden, the Ministry for Foreign Affairs has supported research cooperation between the Swedish Defense Research Agency (FOI), the Swedish Institute for Disease Control (SMI) and the Scientific Research Institute Vector in Novosibirsk, Russia in the areas of biosafety and diagnostics.” p526
Public Health, Sweden, Biosafety, Russia
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.
- “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.”
- “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.”
- “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.”
- “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.”
- “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.”
- “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.”
Decontamination, Public Health, Bioterrorism, Emergency Response
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
- “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)
- “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)
- “Therefore, risk assessment becomes the responsibility of the clinical microbiologist, infection control personnel, hospital risk management office, and infectious disease physicians.” (Pg. 3)
- “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
Lombardo, Joseph, S., “The ESSENCE II Disease Surveillance Test Bed for the National Capital Area,” Johns Hopkins Technical Digest, pp. 327-334, Vol. 24, No. 4, 2003. http://www.jhuapl.edu/techdigest/td2404/Lombardo.pdf
- “The Electronic Surveillance System for the Early Notification of Community-based Epidemics, version two (ESSENCE II), is being developed through a collaboration between the DoD Global Emerging Infections System and APL [Applied Physics Laboratory]. ESSENCE II uses nontraditional health indicators in syndromic groupings coupled with advanced analytical techniques in an advanced information technology environment.” p. 327
- “The contamination and closure of major medical centers, even if only temporary, could have an impact on the health of the populations they serve. To mitigate the consequences of such an event, an effective public health campaign must be launched early in the course of the outbreak.” p. 327
- “Disease surveillance began in Europe in the 14th century as a means of controlling disease within communities. IN the United States, disease reporting began in 1741 when Rhode Island passed an act requiring tavern keepers to report patrons with contagious diseases.” p. 327
- “ESSENCE II has been a tool for health department epidemiologists to support the early recognition of abnormal disease patterns within the NCA [National Capital Area].” p. 334.
- “ESSENCE I is a worldwide military syndromic surveillance system operated by the DoD Global Emerging infections System (DoD-GEIS). ESSENCE II relies solely on the acquisition and processing of existing data from various sources. It is also unique in that it is the only known system to integrate both military and civilian health indicators.” p. 328
- “ESSENCE II is being developed as a test bed for the National Capital Area (NCA). As such it permits the implementation and evaluation of novel surveillance concepts.” p. 328
- “ESSENCE II modules implement the following: Policies to ensure the privacy of personal health care information. Policies governing the exchange of information among other surveillance systems, Data achieve …detection of abnormalities in the indicator data, [controls for] special events or environmental conditions that warrant changes in detection parameters …identify false positives … current or historical trends, Visualization of user interfaces, Processes for injecting simulated data for training and measuring the performance of ESSENCE II detectors and indicators.” p 328
- “The data needed to effectively use and operate ESSENCE II fall into three distinct categories: sensitive health care information, publically available information, and products of external surveillance.” p. 329
- [Data collected includes:] “chief-complaint data from hospital emergency rooms; International Classification of Disease, 9th Revision, Clinical Modification (ICD-9-CM) codes used for billing patient visits for private practice groups; over-the-counter (OTC) sales of pharmaceuticals that can be used for sefl-medication; nurse hotline calls; school absentee records; etc.”
- “We have grouped these data streams into the ”sensitive heath care” category because they may acquired and used only in conformance with privacy laws, corporate policies, memoranda of agreements, etc.” p. 329
- “ESSENCE II data achieve is partitioned into three parts: public domain information, sensitive health care data, and data that are subject to the policies agreed upon by the providers and users of the data.” p. 330
- “The traditional gold standard is a confirmed laboratory result, but this data source may not provide the timeliness needed to respond to a widespread outbreak caused by a covert attack with a weaponized disease.” p. 330
- “One problem with the removal of all personal identifiers on nontraditional clinical data is that a single case of illness could show up in several of the data streams used for surveillance.” p 330
- “In addition, the processes implemented must fit into the business rules and privacy policies of the organizations supplying the data.” p. 331
- “Most data available to ESSENCE II can be resolved down to only the patient zip code.” p. 331
- “A basic function of ESSENCE II is to deliver alerts and surveillance information to civilian public health authorities in the NCA.” p. 332
- “Separate user names and passwords are provided so that ESSENCE II can recognize each authorized user and give only the data the user is authorized to view. …a director of epidemiology would have access to all the information within his or her jurisdiction as well as the shared information from the surrounding jurisdictions.” p. 332
Biosurveillance, Public Health, Military
Barbaro, Michael, “A Worst-Case Enterprise; Md. Firm Busy Making Decontamination Shelters” The Washington Post. March 13, 2003.
- “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.”
- “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.”
- “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.”
- “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.”
- “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.”
- “”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
Stellman, Jeanne, et al., “The Extent and Patterns of Usage of Agent Orange and Other Herbicides in Vietnam.” Nature, Vol. 422, 681. April 17, 2003.
- ”Herbicides including Agent Orange were sprayed by the United States forces for military purposes during the Vietnam War (1961-1971) at a rate more than an order of magnitude greater than for similar domestic weed control.” – page 681
- ”Herbicide mixtures, nicknamed by the colored identification band painted on their 208-liter barrels, were used by the United States and Republic of Vietnam forces to defoliate forests and mangroves, to clear perimeters of military installations, and to destroy “unfriendly” crops as a tactic for decreasing enemy food supplies. The best known mixture was Agent Orange” – page 681
- ”Agent White was less satisfactory than Agent Orange because several weeks were required for defoliation to begin. Agent Blue was the agent of choice for crop destruction by desiccation throughout the entire war.” – page 682
- ”Although Agent Purple is, indeed, likely to have been more highly contaminated with tetrachlorodibenzo-p-dioxin (TCDD), it is also likely that the mean TCDD levels in Agent Orange were far higher for much of the herbicide use.” – page 684
- ”Large numbers of Vietnamese civilians appear to have been directly exposed to herbicidal agents, some of which were sprayed at levels at least an order of magnitude greater than for similar US domestic purposes. Other analyses being carried out by us show large numbers of American troops also to have been directly exposed or to have served in recently sprayed areas.” – page 686
- ”NAS-1974, a comprehensive study carried out by The National Academy of Science, found the HERBS file, a chronological record which contained flight path coordinates of Air Force spraying missions, to be a powerful tool for studying exposure to herbicides.” – page 686
Military, Public Health, Chemical, Food Supply, WMD
Goldstein, Avram, “Progress Cited on Health Threat; ‘We’re Worlds Better Prepared,’ City Official Says” The Washington Post, April 17, 2003.
- “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.”
- “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.”
- “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.”
- “”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.”
- “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.”
- “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.”
- “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.”
- “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.”
- “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.”
- “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.”
- “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
Editors, “Hospitals are not prepared for terror” The Toronto Star. January 31, 2003.
- “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.”
- “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.”
- “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”
- “Health regions often plan to store drugs in a central repository and deliver them when requested. This may not work in a true event”
- “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
Atlas, Ronald, “National Security and the Lab” Medical Laboratory Observer, Volume 35, Issue 9. 52. September 2003.
- ”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
- ”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
- ”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
- ”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
- ”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
- ”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
- ”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 Openness” Science, Volume 302, Issue 5652. 1898. December 12, 2003.
- ”The scientific community is being confronted by public concerns that freely available scientific information may be exploited by terrorists.” – page 1898
- ”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
- ”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
- ”Individuals involved in this effort apparently relied on scientific research and information obtained collegially from public and private sources.” – page 1898
- ”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
- ”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
- ”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
- ”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, “Assesing The Threat of BW Terrorism”. NTI. 2004. http://www.nti.org/h_learnmore/bwtutorial/chapter04_01.html
- “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.”
- “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.”
- “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.”
- “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.
- “The Internet revealed much potential for effective and interactive communication in a sensitive and complex situation such as a bioterrorist attack.” (Pg. 1)
- “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)
- 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)
- “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)
- “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)
- “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)
- “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)
- “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)
- “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)
- “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
Editors, “Systematic Review: Surveillance Systems for Early Detection of Bioterrorism-Related Diseases“. American College of Physicians. 2004.
- “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.).
- “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)
- “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)
- “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)
- “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)
- “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)
- “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)
- “Systems with inadequate specificity may have frequent false alarms, which may result in costly actions by clinicians and public health officials”(Pg. 7)
- “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
Lecchire, Gary, and Michael A. Wermuth, et al., “Triage for Civil Support: Using Military Medical Assets to Respond to Terrorist Attacks“, TRIAGE, “Legal and Other Barriers to Military Support to Civil Authorities“, 2004.
- “State governments and their political subdivisions have primary responsibility for coping with emergencies, including terrorist events.”
- Military support for civil authorities, 4 categories allowed: ‘civil disturbance/insurrections, counterdrug operations, disaster relief, counterterrorism/weapons of mass destruction.’
- “Under the Stafford Act, a presidential declaration of a major disaster or an emergency triggers federal assistance. The type of federal assistance available depends on whether the situation is considered a disaster or an emergency.”
- “In the event of a catastrophic event, particularly when a deadly biological agent is implicated, officials, including military personnel, may need to restrict the civil liberties of Americans, especially freedom of movement, to prevent mass chaos and mitigate public health threats.”
Stafford Act, Public Health, Emergency Response, Posse Comitatus Act, Law Enforcement, Military
Hearne, Shelly, “Health departments remain ill-prepared to respond to public health emergencies” H&HN: Hospitals & Health Networks. February 2004.
- “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)
- “California, Florida, Maryland and Tennessee scored the highest, meeting seven of the 10 indicators.” (Pg. 2)
- “”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)
- “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)
- “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
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.
- “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.”
- “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.”
- “We also found considerable variation in Web-based information on reporting requirements for diseases potentially related to bioterrorism.”
- “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.
- “The weapon potential of a microbe is a function that includes such variables as its virulence, time to disease, and suceptibility of possible target populations.”
Public Health, Bioterrorism, Anthrax
Griffith, Andrea “North Carolina Hospitals Beef Up Surveillance To Track Bioterror Events,” Knight Ridder Tribune Business News, pg. 1, Aug 3, 2004.
- “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.”
- “The surveillance system will give officials a(n) ‘every 12-hour look’ at public health.”
- “‘The goal is to be able to post trends in admission early in the event of a bioterrorism event.’”
Public Health, Biosurveillance, Bioterrorism
Bevelacqua, Armando, “THE NEW HAZ-MAT QUESTION: WHAT ARE YOUR BIOLOGICAL CAPABILITIES?“. Pen Well Publishing Co. November 2004.
- “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)
- “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)
- “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)
- “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)
- “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
Edward Despott, Mario J. Cachia, “A Case of Accidental Ricin Poisoning,” Malta Medical Journal 2004;16(4):39-41
- “Ricin is one of the most potent naturally occurring toxins known to man.”
- “With a LD50 of 3 g/kg body weight (aerosol and parenteral) and 30 g/kg body weight (ingestion)”
- “Ricin belongs to a class of proteins known as ribosomal inactivating proteins (RIPs). As their name suggests, these proteins interfere with the function of ribosomes, halt protein synthesis and thus induce cellular death.”
- “These worries have led to intensive awareness campaigns and research into the development of vaccines of antiricin and methods of rapid serological diagnosis by EIA.”
- “In this case the diagnosis was made using the clear evidence provided but in other scenarios where suspicion is strong but other corroborative evidence is lacking, the toxin can be detected by Enzyme Immuno Assay (EIA), as ricin is very immunogenic.”
Ricin, Biodetection, Vaccination, Public Health
Lowell, Jennifer, “Identifying Sources of Human Exposure to Plague” Journal of Clinical Microbiology. Pg. 650-656. Vol. 43, No. 2.
- “Approximately 3,000 human cases occur worldwide annually, with 12 to 15 cases reported each year in the western United States”
- “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.”
- “The use of molecular epidemiological techniques in these investigations has been particularly difficult for Y. pestis because of its apparent lack of genetic variation.”
- “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
Rose, Laura, “Chlorine Inactivation of Bacterial Bioterrorism Agents” Applied and Environmental Microbiology. Pg. 566-568, Vol. 71, No.1
- “Currently, chlorination is the most common method of disinfecting drinking water in the United States. (Pg. 1)
- “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
Enhorn v Sweden (2005) 41 EHRR 30 (56529/00)
- “In 1994 it was discovered that the applicant, a homosexual, was infected with the HIV virus and that he had transmitted it to a young man. A medical officer issued instructions to the applicant designed to prevent him from spreading the disease. In February 1995, finding that he had failed to comply with those instructions, the Court ordered that he be kept in compulsory isolation in a hospital for up to three months. Thereafter, orders to prolong his detention were issued every six months until December 2001. Since the applicant absconded several times, his actual deprivation of liberty lasted almost one-and-a-half years.”
- “The applicant complained that the compulsory isolation orders and his involuntary placement in hospital had deprived him of his liberty in violation of Art.5(1) of the Convention”
- “Held, unanimously that there had been a violation of Art.5(1);”
- “The compulsory isolation orders and the applicant’s involuntary placement in hospital constituted a “deprivation of liberty” within the meaning of Art.5(1).”
- “Since the purpose of the applicant’s detention was to prevent him from spreading the HIV infection, Art.5(1)(e) was applicable.”
- “The expressions “lawful” and “in accordance with a procedure prescribed by law” stated the obligation to conform to the substantive and procedural rules of national law. It was particularly important to comply with the principle of legal certainty. The conditions for deprivation of liberty had to be clearly defined and the law had to be foreseeable in its application. Furthermore, a deprivation of liberty had to be free from arbitrariness, necessary in the circumstances and in accordance with the principle of proportionality.”
- “The applicant’s detention had a basis in Swedish law. In the light of the relevant statutory provisions, the national courts considered that he had not voluntarily complied with the measures needed to prevent the virus from spreading; that there was reasonable cause to suspect that, if released, he would fail to comply with the instructions issued by the medical officer; and that such non-compliance would entail a risk of the infection spreading.”
- “The essential criteria when assessing the lawfulness of detention “for the prevention of the spreading of infectious diseases” were whether the spreading of the disease would have been dangerous for public health or safety, and whether detention of the person infected was the last resort in order to prevent the spreading of the disease, because less severe measures had been considered and had been found to be insufficient to safeguard the public interest. When these criteria were no longer fulfilled, the basis for the deprivation of liberty ceased to exist.”
- “Since the HIV virus was dangerous for public health and safety, the first criterion was fulfilled.”
- “As to whether the applicant’s detention had been the last resort in order to prevent the virus spreading, the Government had not provided any examples of less severe measures which might have been considered but which had been found to be insufficient to safeguard the public interest.”
- “Despite being at large for most of the period from February 16, 1995 until December 12, 2001, there was no indication that during this time the applicant had transmitted the HIV virus to anybody, or that he had had sexual intercourse without first informing his partner about his infection, or that had not used a condom, or indeed that he had had any sexual relationship at all. Although he had infected the young man with whom he had first had sexual contact in 1990, this had only been discovered in 1994 after he had become aware of his own infection. There was no indication that he had transmitted the virus deliberately or through gross neglect.”
- “The applicant’s compulsory isolation had not been a last resort in order to prevent him from spreading the HIV virus. Moreover, by extending the order for his compulsory isolation over almost seven years, with the result that he had been involuntarily detained in hospital for almost one-and-a-half years, the authorities had not struck a fair balance between the need to ensure that the HIV virus did not spread and the applicant’s right to liberty. Accordingly, there had been a violation of Art.5(1)”
Detention, Law, Sweden, Public Health, Europe
United States Government Accountability Office, “Information Technology: Federal Agencies Face Challenges In Implementing Initiatives To Improve Public Health Infrastructure” GAO Report To Congressional Requestors, June 2005.
- “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.”
- “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.'”
- “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.”
- “Two major initiatives at DHS–primarily focused on signal interpretation and biosurveillance…more work remains, particularly in surveillance and data exchange.”
- “The Department of Health and Human Services has primary responsibility for coordinating the nation’s response to public health emergencies, including bioterrorism.”
- “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.
Biosurveillance, Bioterrorism, Public Health
International Health Regulations, WHO, 2005, 2nd Edition. http://whqlibdoc.who.int/publications/2008/9789241580410_eng.pdf
- to provide support to developing countries and countries with economies in transition if
they so request in the building, strengthening and maintenance of the public health capacities
required under the International Health Regulations (2005)
- to collaborate with States Parties to the extent possible in the mobilization of financial
resources to provide support to developing countries in building, strengthening and maintaining
the capacities required under the International Health Regulations (2005)
- The Director-General shall select the members of the Review Committee on the basis of the
principles of equitable geographical representation, gender balance, a balance of experts from
developed and developing countries, representation of a diversity of scientific opinion, approaches and
practical experience in various parts of the world, and an appropriate interdisciplinary balance.
Public Health, Developing Countries, WHO
Editors, “PATIENT DECONTAMINATION RECOMMENDATIONS FOR HOSPITALS” EMSA. July 2005.
- “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)
- “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)
- “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)
- “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)
- “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)
- “Disposable fluid-repelling gowns should be worn to protect skin and clothing” (Pg. 18)
- “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)
- “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
Brookmeyer, Ron, “Editorial: Biosecurity And The Role Of Statisticians,” J.R. Statistical Society, 168, Part 2, pgs. 263-266, 2005.
- “Statisticians who work in Public Health are most familiar with designing and analyzing large clinical trials and epidemiological studies to answer questions.”
- “We must use modern statistical tools to estimate model parameters together with sensible mechanistic models for the spread of infectious diseases.”
- “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.”
- “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.”
- “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.”
- “Another approach to speed recognition of a bioterrorist attack is air monitoring systems for contaminants and pathogens in the environment.”
- “Biomedical research is under way to improve diagnostic test, vaccines and therapeutics for the most worrisome pathogens.”
- “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, Biosurveillance, Public Health, Vaccination
Rebmann, Terri, “Defining bioterrorism preparedness for nurses: concept analysis” Blackwell Publishing Ltd. Novembver 30, 2005.
- “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)
- “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)
- “Despite this, the US National Institute of Nursing Research has asserted that bioterrorism preparedness is a necessity across nursing specialties” (Pg. 2)
- “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)
- “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)
- “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)
- “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)
- “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)
- “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)
- “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 Systems” NTI. Dec. 13, 2005.
- “Two $60,000 machines capable of cleansing mail of anthrax and other biological agents were completed”
- “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, UN
Olowokure, B. et al., “Global Surveillance for Chemical Incidents of International Public Health Concern” Bulletin of the World Health Organization, 7 pages. December 2005.
- “This report describes the frequency, nature and geographical location of acute chemical incidents of potential international concern from August 2002 to December 2003” – page 928
- “In December 2001, an expert consultation convened by WHO identified strengthening national and global chemical incident preparedness and response as a priority” – page 928
- “The international community, through the World Health Assembly, has recognized the need to strengthen surveillance for chemical incidents. There are three main reasons for doing this.” – page 928
- “First, the continuing rapid growth and globalization of the chemicals industry means that chemical incidents will continue to be a problem.” – page 928
- “Second, chemical incidents may have an impact beyond their original location, in some cases crossing national borders.” – page 928
- “Third, there is concern regarding the deliberate use of chemicals for terrorist purposes, engendered by events such as the use of sarin on the Tokyo underground system and reports of the threatened use of ricin” – page 928
- “On a daily basis, information from a range of informal and formal sources was reviewed to identify acute chemical incidents and outbreaks of disease of unknown etiology that might be of chemical origin.” – page 929
- “The principal informal sources were the Global Public Health Intelligence Network (GPHIN), ProMED-Mail, and Hazard Intelligence (HInt)… all three had international scope” – page 929
- “Formal information sources included reports from national authorities, WHO offices, WHO Collaborating Centres and other United Nations agencies. ChemiNet and the communicable disease outbreak verification teams were additional sources, the latter particularly for diseases of unknown etiology that might be linked with chemicals.” – page 929
- “Each identified event was assessed against International Health Regulations (IHR) criteria … by the chemical alert and response team. If an event was deemed to be of potential international importance, WHO regional and country offices were contacted to obtain additional information, including official verification of the event…. Once verified, and depending on the nature of the event, a decision was taken about the need for a response.” – page 931
- “Such a response might include laboratory support (e.g. identification of a laboratory to carry out analyses, arranging supply of an analytical standard), on-site epidemiological assistance (e.g. assistance with investigation, control measures) or the provision of technical information.” – page 931
- “From 1 August 2002 to 31 December 2003, 779 chemical events were evaluated and 35 (4.5%) events of potential or actual international public health importance were identified in 26 countries” – page 931
- “…most chemical events tend to be localized, in contrast to communicable diseases, which are readily spread around the world by human or animal carriers.” – page 932
WHO, Chemical, Chemical Surveillance, Public Health, Emergency Response
Mosquera, Mary, “DHS To Develop Biosurveillance System For Pandemic,” Tech News (GCN), May 12, 2006.
- “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.”
- “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.”
- “The biosurveillance system will also send back to its system partner agencies completed situational awareness in real-time streams.”
- “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.
- “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)
- “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)
- “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)
- “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)
- “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)
- “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)
- “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
Baker, Michael & David Fidler, “Global Public Health Surveillance Under New International Health Regulations,” Emerging Infectious Diseases, Vol. 12, No. 7, pgs. 1058-1065, July 2006.
- “IHR (International Health Regulations) 2005 identifies health-related events that each country that agrees to be bound by the regulations must report to WHO.”
- “These events include any unexpected or unusual public health events regardless of its origin or source.”
- “IHR 2005 also requires state parties …to inform WHO of public health risks identified outside their territories that may cause international disease spread, as manifested by exported or imported human cases, vectors that may carry infection or contamination, or contaminated goods.”
- “IHR 2005 defines a ‘public health emergency of international concern’ (PHEIC) as ‘an extraordinary event’ which is determined by the WHO.”
- “IHR 2005 contains a ‘decision instrument’ that helps state parties identify whether a health-related event may constitute a PHEIC and therefore requires formal notification to WHO.”
- “IHR 2005 includes a list of diseases for which a single case may constitute a PHEIC and must be reported to WHO immediately. This list consists of smallpox, poliomyelitis, human influenza (flu) caused by new subtypes, and severe acute respiratory syndrome (SARS).”
- “IHR 2005 also encourages state parties to consult with WHO over events that do not meet the criteria for formal notification but may still be of public health relevance.”
- “IHR 2005’s surveillance strategy, especially the decision instrument, has been specifically designed to make IHR 2005 directly applicable to emerging infectious disease events, which are usually unexpected and often threaten to spread internationally.”
- “IHR 2005’s purpose is to prevent, protect against, control, and facilitate public health responses to the international spread of disease.”
- “IHR 2005 makes surveillance central to guiding effective public health action against cross-border disease threats.”
- “Surveillance needs to be sufficiently sensitive to detect infectious agents that have not yet resulted in large numbers of diagnosed cases.”
- “One approach to this challenge is [[Syndromic Surveillance]], but such surveillance has not been effective in detecting emerging infectious diseases early.”
Biosurveillance, Flu, Anthrax, Polio, SARS, Smallpox, Public Health
Niska, Richard, “HOSPITAL COLLABORATION WITH PUBLIC SAFETYORGANIZATIONS ON BIOTERRORISM RESPONSE” Prehospital Emergency Care, 2007.
- “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)
- “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)
- “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).
- “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
Tyshenko, Michael, “MANAGEMENT OF NATURAL AND BIOTERRORISM INDUCED PANDEMICS” Bioethics, 2007.
- “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)
- “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)
- “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)
- “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)
- “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)
- “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
Capua, Ilaria, Marangon, Stefano, “Control and prevention of avian influenza in an evolving scenario,” Vaccine 25 (2007) 5645–5652.
- Continuing outbreaks of highly pathogenic avian influenza (HPAI) across Eurasia and in Africa, caused by a type A influenza virus of the H5N1 subtype appear out of control and represent a serious risk for animal and public health worldwide. It is known that biosecurity represents the first line of defence against AI, although in certain circumstances strict hygienic measures appear to be inapplicable for social and economic conditions. The option of using vaccination against AI viruses of the H5 and H7 subtypes, has made its way in recent times—primarily as a tool to maximise the outcome of a series of control measures in countries that are currently infected, but also as a means of reducing the risk of introduction in areas at high risk of infection
Vaccination, Control, Poultry, Africa, Public Health, Avian Flu
Good, Linda, “Addressing Hospital Nurses’ Fear of Abandonment in a Bioterrorism Emergency” Slack Incorporated, December 2007.
- “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)
- “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)
- “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)
- “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)
- “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)
- “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)
- “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
Bradbery, Sally, “Ricin and Abrin“, Medicine 2007;35: 576-577.
- “Ricin is a globular glycoprotein derived from the beans of the castor oil plant ‘Ricinus communis.’”
- “By inhalation or injection, the lethal dose is about 5–10 μg/kg but it is approximately one thousand-fold less toxic by ingestion”
- “Many of the features seen in poisoning can be explained by ricin- induced endothelial cell damage, which leads to fluid and protein leakage and tissue oedema, causing so-called ‘vascular leak syndrome’.”
Ricin, Public Health, Biodetection
Editors, “Disaster Planning for Schools” Journal of the American Academy of Pediatrics. 2008. http://pediatrics.aappublications.org/content/122/4/895.full.pdf+html. Last Checked October 4, 2012.
- “Schools that are well prepared for an individual emergency involving a student or staff member are more likely to be prepared for complex events such as community disasters. Individual emergencies are covered in a separate policy statement from the American Academy of Pediatrics (AAP).”
- “There are 55 million US children enrolled in kindergarten through 12th grade, attending 17 000 public school districts and 29 000 private schools. Children spend a large part of their time in school, so whether a large-scale crisis occurs during school hours, before or after school, or off the school campus, the school district plays an important role in the unfolding of events.”
- “The guidelines are intended to give schools, school districts, and communities the critical concepts and components of good crisis planning, stimulate thinking about the crisis-preparedness process, and provide examples of promising practices. These guidelines focus on 4 stages of planning: mitigation and prevention; preparedness; response; and recovery. These school-focused guidelines are also designed to complement and integrate with the complex system of emergency preparedness in the greater community locally, regionally, and nationally.”
- “In a 2004 survey of more than 2100 superintendents, most (86.3%) reported having a disaster-response plan, but fewer (57.2%) had a plan for prevention. Most (95.6%) had an evacuation plan, but almost one third (30%) had never conducted an evacuation drill. Almost one quarter (22.1%) had no disaster plan provisions for children with special health care needs, and one quarter reported having no plans for postdisaster counseling. Almost half (42.8%) had never met with local emergency medical services (EMS) ofﬁcials to discuss emergency planning.”
- “School facilities are often designated as disaster evacuation shelter sites. These venues provide shelter for many who have lost their homes as a result of disaster and also provide an opportunity for school ofﬁcials to assess family and child needs. Likewise, disaster recovery centers operated by FEMA are set up in heavily affected communities to support the reestablishment of infrastructure and the provision of food, supplies, health care, and human services. It is recommended that school district ofﬁcials, including mental health professionals, be present in all disaster recovery centers to disseminate information and provide guidance for parents seeking support for their children.”
- “Each community has idiosyncratic elements that predispose it to possible crises such as tornadoes, earthquakes, hurricanes, toxic chemical hazards, radiation, and community violence. Pediatricians should have an ofﬁce-based disaster plan that reﬂects these hazards and not only be prepared to treat the medical outcomes of these crises but also be aware of the school district’s attempts to prepare for these unique disaster issues.”
Emergency Response, Homeland Security, Public Health
Snyder, Michael and Sobieski, Thomas, “Decontamination Operations in a Mass Casualty Scenario” Joint Force Quarterly. 2008.
- “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)
- “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)
- “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)
- “To respond to the magnitude of need, several mass decontamination sites probably would be established around the plume perimeter.” (Pg. 4)
- “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)
- “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
Harris, Gardiner, “For F.D.A., a Major Backlog Overseas,” NYT, A15, Jan 29, 2008.
- “FDA is so overwhelmed by a flood of imports that it is incapable of protecting the public from unsafe drugs, medical devices, and food.”
- “Few checks of plants that make food and drugs sent to the US”
- backlog of inspections, GAO, FDA
Fowler, Daniel, “ACLU, HHS Debate Pandemic Preparedness Strategies,” CQ Homeland Security, January 14, 2008,
- Avian Flu
- leaning toward law enforcement and national security
- George Annas/Wendy K. Mariner/Wendy E. Parme
- civil liberties
Hsu, Spencer, “Costly Weapon-Detection Plans Are In Disarray, Investigators Say,” The Washington Post, A-Section, Pg. A15, July 16, 2008.
- “Bush administration initiatives to defend the nation against a smuggled nuclear bomb or a biological outbreak or attack remain poorly coordinated, costing billions of tax dollars while basic goals and policies remain incomplete.”
- “Separately, a five-year-old program to detect the airborne release of biological warfare agents such as anthrax, plague and smallpox in more than 30 major U.S. cities still lacks basic technical data to help medical officials determine how to respond to an alert triggered by the sensors.”
Public Health, Biosurveillance, Anthrax, Plague, Smallpox
Poltzer, Patrice, “Tuberculosis: A New Pandemic?“, CNN, November 17, 2008. http://www.cnn.com/2008/HEALTH/11/17/tb.pandemic/index.html
- “TB mutating into dangerous new strains for which there is no known cure”
- XDR-TB = a drug-resistant TB, incurable, could lead to a pandemic, airborne disease,
- 40,000 new cases of XDR-TB each year – WHO
- disease primarily affects developing nations
- TB is curable but if drugs not administered or used, disease can mutate into strands like XDR
- strong link between TB and poverty
Developing Countries, Public Health, Vaccination, Pandemic, Tuberculosis
Roni Caryn Rabin, “Preparing for a Bioterror Attack, Assisted Suicide on TV and Bird Flu in Hong Kong,” December 10, 2008. NYT http://www.nytimes.com/2008/12/10/health/10rounds.html?_r=1&ref=health Last Checked, March 27, 2013.
- “States Cut Funding to Combat Disease Outbreaks The economy is jeopardizing the nation’s ability to handle public health emergencies and bioterror attacks, as both the federal government and states cut funding for programs to combat disease outbreaks and natural disasters, USA Today reports.”
- “Meanwhile Georgia, home to the Centers for Disease Control and Prevention, barely got a passing grade in a new report assessing its readiness to distribute stockpiled medicine and vaccines should a terror attack occur or pandemic break out, The Atlanta Journal Constitution reports. The stockpile is controlled by the C.D.C. and Georgia is one of 10 states that turned around a failing grade in the assessment last year.”
- “Hong Kong is reporting another outbreak of avian influenza, or bird flu, among chickens at one of the city’s largest poultry farms. Officials are concerned because the chickens were vaccinated against the virus. The city is culling birds and shutting down the local poultry industry for 21 days, Time Magazine reports.”
Emergency Response, Public Health, CDC
Gerald J. Fitzgerald “Chemical Warfare and Medical Response During World War I,” American Journal of Public Health 2008;98(4):611-625.
- “The first large-scale use of a traditional weapon of mass destruction (chemical, biological, or nuclear) involved the successful deployment of chemical weapons during World War I (1914–1918).” P.611
- “Defined today as “man- made, supertoxic chemicals that can be dispersed as a gas, vapor, liquid, aerosol (a suspension of microscopic droplets), or adsorbed onto a fine talcum-like powder to create ‘dusty’ agents,” chemical weapons remain a viable public health threat for civilians and soldiers across the globe.” P.612
- “On August 31, 1917, the Gas Defense Service (later known as the Gas Defense Division) was formally organized within the Army Medical Department under the auspices of the Office of the Surgeon General to carry out gas mask research and manufacture.” P.616
- “Between the 1918 armistice and 1933, several international conferences were held to try to limit or abolish chemical weapons; these included the Washington Conference (1921–1922), the Geneva Conference (1923–1925), and the World Disarmament Conference (1933).” P.621
- “At present, the United States maintains a large and sophisticated arsenal of chemical and nerve agents for tactical and strategic use.” P.622
”’Verweij, Marcel”’, “Health Inequities In Times Of A Pandemic”, PUBLIC HEALTH ETHICS, Volume 2, Issue 3, pgs 207-209, 2009.
* people in low-income countries may have no access to vaccination despite being more vulnerable to the significant negative effects of H1N1
* “Australia, Canada, and the Netherlands expect to have sufficient vaccines to immunise the whole population”
*[[Ethics]], [[Developing Countries]], [[Pandemic]], [[Vaccination]], [[Flu]]
”’Adams, Vincanne, Le, Phuoc V., Erwin, Kathleen”’, “Public health works: Blood donation in urban [[China]],” Social Science & Medicine 68 (2009) 410–418,
*Recent shifts in the global health infrastructure warrant consideration of the value and effectiveness of national public health campaigns. These shifts include the globalization of pharmaceutical research, the rise of NGO-funded health interventions, and the rise of biosecurity models of international health. We argue that although these trends have arisen as worthwhile responses to actual health needs, it is important to remember the key role that public health campaigns can play in the promotion of national health, especially in developing nations…. , we argue that there is an important role for strong national public health programs. We also identify the key factors that enabled China’s response to this bourgeoning epidemic to be, in the end, largely successful.” [[Developing Countries]]
”S v H.S.E.” (2009) IEHC 106 (11th February 2009) Judgement of ”’Edwards J”’
*“The patient (was) alleged to be detained unlawfully at the Mercy University Hospital, an institution operated by the (H.S.E), in purported pursuance of an order made by (the H.S.E.) pursuant to s. 38 of the Health Act, 1947…which provides for the detention and isolation of a person suffering from an infectious disease who is a probable source of infection.”
*“the patient’s detention, although initially unlawful, became lawful once she was delivered into the custody of the staff at the Mercy University Hospital who were directly authorised by the s. 38 order to isolate her there in a specialised negatively pressurised room.”
*“The key criterion is the need to ensure “effective” isolation. The section expressly provides that the power may only be invoked in cases where the patient cannot be effectively isolated in their own home. It is implicit in the section that the legislature intended that the power should be invoked sparingly and that it should not be resorted to save where absolutely necessary. It is difficult to conceive of any circumstances where it would be necessary to invoke the power save in the case of patient non co-operation with a proposed regime of isolation. Even in a case where a patient’s home is physically, or otherwise, unsuitable to provide effective isolation, it would be unnecessary to invoke the s. 38 power of detention in the case of a co-operative patient. He or she could simply be admitted to, and isolated within, a hospital or other suitable place on a voluntary basis.”
*“The power created by section 38 supports an important public interest objective, namely, it assists in safeguarding against the spread of particular infectious diseases amongst the general population by facilitating, where necessary, the compulsory effective isolation of a person who is suffering from such a disease.”
*“While it might be desirable that the section should contain more specific safeguards towards the defence and vindication of a detainee’s personal rights, the absence of such safeguards does not, of itself, render the section unconstitutional. A detainee may have recourse at any time to the High Court within the context of Article 40.4.2˚ of the Constitution for the purpose of seeking an inquiry into the lawfulness of his or her detention.”
*“The combination of (i) such safeguards as already exist within the section, (ii) the presumption that the section will be operated constitutionally, and (iii) the existence of a readily accessible remedy for the person affected if it is not in fact operated constitutionally, provides an adequate level of protection for the personal rights of detainees. I therefore dismiss the claim of constitutional invalidity.”
*[[Detention]], [[Quarantine]], [[Law]], [[Ireland]], [[Public Health]], [[Europe]]
”’Sferopolous, Rodi”’, “A Review of Chemical Warfare Agent (CWA) Detector Technologies and Commercial-Off-the-Shelf Items.” Defense Science and Technology Organization. March 2009
* ”An ideal detector can be described as one that can detect both Chemical Warfare Agents (CWA) and Toxic Industrial Chemicals (TIC) selectively within an acceptable time; sensitive enough to detect agent concentrations at or below levels which post a health risk, and not be affected by other factors in the environment. As yet, the ‘ideal’ detector is not a commercial reality.” – Executive Summary
* ”Whilst Chemical Agents (CA) can cause serious injury or death, it is the method and accuracy of their delivery that determines the severity of the damage.” – page 2
* ”TICs are another class of CA that are less deadly than conventional CWAs, but pose a greater threat because they are more easily accessible in large quantities and are widely used in the manufacturing or primary material processing (mining and refining) industries.” – page 6
* ”Most detectors are designed to respond only when a threat is directly imminent and therefore tend to ‘detect to respond’ or ‘detect to react’ rather than ‘detect to warn.’” – page 10
* ”Individual Personal Equipment (IPE) is still utilized as the main form of protection against a chemical weapons attack as it has been proven to provide effective protection for an individual whilst the agent is neutralized or eliminated.” – page 10
* ”With increasing threats of terrorism, the roles of CA detectors are also increasing in civil emergency responses.” – page 10
* ”At present, the most challenging aspect for detection and identification of CAs is the differentiation of the agent of interest from another chemicals already present in the environment.” – page 11
* ”Environmental conditions, such as temperature, humidity, wind, dust and contamination concentration in the air, can affect the performance of a detector. It is crucial that during the selection process it is determined if a detector is able to operate effectively in the intended environment.” – page 14
* ”Ion Mobility Spectroscopy (IMS) based detectors are the most commonly deployed detectors for chemical monitoring by the military.” – page 16
* ”Existing IMS-based field detectors include Chemical Agent Monitor (CAM), Advanced Portable chemical Agent Detector (APD 2000), Multi-IMS, Rapid Alarm and Identification Device-Monitor (RAID-M), IMS-2000, GID-3 also known as Automatic Chemical Agent Detection Alarm (ACADA), SABRE 4000, and the Lightweight Chemical Detector (LCD).” – page 20
* ”Flame Photometry Detectors (FPD) are deployed in military forces and civil agencies worldwide, however they are more commonly found integrated with a gas chromatograph (GC) in the laboratory. To date, GC-FPD has been one of the most useful methods in determining the CWA concentrations in samples sent to a laboratory for confirmation analysis.” – page 32
* ”Existing FPD based field detectors include the French AP2C monitor, the updated AP4C version, and MINICAMS.” – page 34
* ”For field applications, Infra-Red (IR) Spectroscopy based detectors are used to determine whether a sample contains targeted chemicals rather than being used to identify them.” – page 38
* ”Existing IR based detectors include the M21 detector, Joint Service Lightweight Standoff Chemical Agent Detector (JSLSCAD), MIRAN SapphIRE Portable Ambient Air Analyzer, AN/KAS-1 and AN/KAS-1A Chemical Warfare Directional Detectors, TravelIR HCI, HazMat ID, and the IlluminatIR.” – page 43
* ”Raman Spectroscopy is a light scattering technique based upon the knowledge that when radiation passes through a transparent medium, any chemical species present will scatter a portion of the radiation bean in different directions.” – page 52
* ”Existing Raman spectroscopy based field detectors include the FirstDefender and the FirstDefender XL.” – page 54
* ”Surface Acoustic Waves (SAW) sensors operate by detecting changes in the properties of acoustic waves as they travel at ultrasonic frequencies in piezoelectric materials.” – page 57
* ”Existing SAW based field detectors include the HAZMATCAD, ChemSentry 150C, CW Sentry Plus, SAW MINICAD mk II, and the Joint Chemical Agent Detector (JCAD).” – page 59
* ”Colorimetric detection is a wet chemistry technique formulated to indicate the presence of a CA by a chemical reaction that causes a color change when agents come into contact with certain solutions or substrates.” – page 65
* ”Photo Ionization Detectors (PID) are typically used in first responder scenarios to give preliminary information about a variety of chemicals as they can detect vapors given off by certain inorganic compounds that other detectors may not. They only provide suggestive, not definitive, information about whether a site has been compromised.” – page 75
* ”Existing PID field detectors include MiniRAE 2000, MiniRAE 3000, ppbRAE, ppbRAE 3000, ppbRAE Plus, MultiRAE Plus, ToxiRAE Plus, and the TVA 1000B Toxic Vapor Analyzer.”- page 77
* ”Flame Ionization detectors are general-purpose and non-selective, therefore they respond to any molecule containing carbon-hydrogen bonds.” – page 86
* ”Existing FID field detectors include the Photovac MicroFID Handheld FID.” – page 87
* ”Current detection capability is somewhat limited, as such there is a need for further research into the development of technologies which are aimed at building improved detectors to accurately provide advanced warning of a CA release.” – page 89
* [[Chemical]], [[Military]], [[Chemical Surveillance]], [[Public Health]], [[Emergency Response]], [[WMD]]
”’Hartz, Marlena”’, “Scientists Develop CW Decontamination Wipe” NTI. March 11, 2009.
*“A Texas-based team has used federal funding to create a wipe that would neutralize chemical warfare materials released in a terrorist attack”
*“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]]
”’Ryerson-Cruz, Geraldine”’, “As Flu Pandemic Declared, Leaders Must Focus On Poor Countries To Avert Bleaker Picture”, WORLDVISION.ORG, June 11, 2009. http://www.worldvision.org/content.nsf/about/20090611-flu-pandemic
* Africa and Central America
* “With limited access to health services, extreme poverty, high malnutrition rates, and the slower-burning pandemics of HIV and AIDS, tuberculosis, and malaria already stretching society’s coping mechanisms, the poor are more at risk than the general population,” said Stefan Germann, World Vision International’s Geneva-based director for global health partnerships.
*[[Developing Countries]], [[Pandemic]], [[Flu]]
”’Shiga, David”’, “Report Examines Lifesaving Measures for Nuclear Strike”. NTI. July 13, 2009.
*“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”
*“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.”
*“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]]
”’Yamada, Tadataka”’, “Poverty, Wealth, and Access to Pandemic Influenza Vaccines”, THE NEW ENGLAND JOURNAL OF MEDICINE. September 17, 2009. Volume 361, Number 12, pgs. 1129-1131., http://content.nejm.org/cgi/content/full/NEJMp0906972?query=TOC
*do developing countries have the manufacturing capacity, cost, and delivery systems and resources available to get vaccines?
*only a few countries in the world have plants for manufacturing influenza vaccine and 3 companies account for most of the world’s manufacturing capacity: GlaxoKlineSmith, Sanofi-Aventis, and Novartis.
* problem- “much if not most of the manufacturing capacity is already spoken for through purchasing contracts held by many of the world’s wealthy countries.”
* steps to ensure global community has vaccinations: identify strategies and mechanisms to make vaccines more accessible
* [[Developing Countries]], [[Pandemic]], [[Vaccination]], [[Flu]], [[Ethics]]
“Swine Flu Pandemic Will Reveal 21st Century’s Poverty Pandemic”, GLOBAL HEALTH POLICY AT NYU-WAGNER, Sept 27, 2009. http://globalhealthpolicynyu.wordpress.com/2009/09/27/swine-flu-pandemic-will-reveal-21st-century%E2%80%99s-poverty-pandemic/
* historically influenza not an “equal opportunity” disease
* “people with coexisting conditions are more susceptible to poor health outcomes” and “most developng countries have high incidence of malnourished children and adults with many coexisting medical conditions.”
* socioeconomic factors- “poor resources for clean water and sanitation, no health care system or inadequate resources to seek medical attention”
* [[Ethics]], [[ Flu]], [[Pandemic]], [[Vaccination]], [[Developing Countries]]
”’Editors.”’ “The Future of CFATS.” Professional Safety, Volume 54 Issue 10. 18. October 2009.
*”The Chemical Facility Anti-Terrorist Standard (CFATS) is up for renewal in October 2009 and Congress is working to renew the standard.” – page 18
*”The regulation requires affected businesses to identify chemicals within their facility that are listed by Department of Homeland Security as potentially dangerous to national security in certain doses or situations, and create a security plan focused on keeping these chemicals from being used by terrorists.” – page 18
*”Under CFATS, a company must register and submit a Top-Screen assessment to determine whether it is a high risk facility.” – page 18
*”If DHS determines that it is a high risk facility, the company must then submit a security vulnerability assessment (SVA) using the agency’s online assessment tool to analyze a series of scenarios designed to elicit vulnerability and off-site consequence information.” – page 18
*”Determining whether a facility deserves to be classified in a particular tier is based primarily on the properties of the chemicals listed in DHS’s Appendix A, which lists 322 chemicals of interest, as well as other site-specific factors reported in the Top-Screen and SVA.” – page 18
*”Because DHS’s current authority to regulate through CFATS sunsets in October 209, the House Committee on Homeland Security is reviewing and attempting to enhance the current legislation by incorporating new stipulations.” – page 18
*[[Chemicals]], [[Homeland Security]], [[Public Health]]
”’Moss, Michael”’, “Companies Strike Deal on testing for E. COli,” NYT, A23, Oct. 8, 2009.
*”Costco said Wednesday that they had struck a new accord on testing for the pathogen E. Coli.”
*”some of the largest slaughterhouses have resisted the added scrutiny for fear that one grinder’s discovery of E. coli will lead to expanded recalls of beef sent to other grinders.”
*”‘The U.S.D.A. is supposed ti be protecting public health and at the same time be promotig agricultural products, and my view is that those two things don’t mix,’ said Representative Rosa DeLauro.”
[[E. coli]], [[Oversight]], [[Public Health]]
”’Suk, Jonathan, et.al”’, “Wealth, Inequality, and Tuberculosis Elimination in Europe”, EMERGING INFECTIOUS DISEASES, Volume 15, No. 11, November 2009.
* Europe- wealth inequality directly related to TB
* “decline of TB incidence in Europe preceded the advent of anti-TB drugs and coincided with rapid improvement of quality of life”
* “the current financial crisis could exacerbate the conditions of existing vulnerable groups as well as create new ones”
* [[Tuberculosis]], [[Europe]], [[Pandemic]]
”’Harris, Gardiner”’, “E. Coli Kills 2 And Sickens Many Others; Focus on Beef,” NYT, A12, Nov. 3, 2009.
*”The New hampshire resident who died of it contracted hemolytic uremic syndrome, a disease that attacks red blood cells and can cause kidney failure. The New Yorker who died was an adult from Albany County who had several underlying health problems.”
*”Donna Rosenbaum, executive director of Safe Tables Our Priority, a food safety organization said … ‘contamination problems are not found by any checks on the products by companies. They’re found when people get sick, and that’s a failure in the system.”
*[[E. coli]], [[Oversight]], [[Public Health]]
”’Moss, Michael”’, “E. Coli Outbreak Traced to Company That Halted Testing of Ground beef,” NYT, A14, Nov. 13, 2009.
*”it was linked to an outbreak that has killed two people and sickened an estimated 500 others.”
*”E. Coli outbreaks in ground beef, which have now reached 18 since 2007, that the beef trimmings commonly used to make ground beef are more susceptable to contamination because the pathogen thrives in cattle feces that can get smeared on the surfaces of whole cuts of meat.”
*”But while slaughterhouses seek ti limit such contamination, and conduct their own testing for the pathogen, they have resisted independent testing by grinders for fear that it would cause expanded recalls.”
*”The United States Department of Agriculture, which banned the deadly E. Coli strain known as 0157:H7 in 1994, has encouraged — but does not require — meat companies to test their products for the pathogen. In the absence of such a rule, meat companies have adopted varied practices.”
*[[E. coli]], [[U.S. Dept. of Agriculture]], [[Oversight]], [[Public Health]]
”’Sasaki, Asami, et al”’., “Evidence-based Tool for Triggering School Closures during Infl uenza Outbreaks, Japan,”
Emerging Infectious Diseases , Vol. 15, No. 11, November 2009.
* ”Using empirical data on absentee rates of elementary school students in Japan, we developed a simple and practical algorithm for determining the optimal timing of school closures for control of infl uenza outbreaks.”
*”Infl uenza pandemic preparedness and seasonal infl uenza control programs have focused on vaccine development and antiviral drugs, which are only partially effective and not always available to all persons at risk (1–3). Nonpharmaceutical interventions, such as social distancing, represent additional key tools for mitigating the impact of outbreaks.”
*”Because children are a major factor in the transmission of infl uenza within communities and among households, school closure may be a valuable social distancing method (4,5).”
*” We evaluated the optimal infl uenza-related absentee rate for predicting outbreaks of infl uenza.”
*” Our analysis suggests that a single-day at a threshold infl uenza-related absentee rate of 5%, double-days >4%, or triple-days >3% are optimal levels for alerting school administrators to consider school closure. The double- and triple-day scenarios performed similarly, and gave better results than the singleday. Thus, the double-day scenario might be the preferred early warning trigger.”
*” We used the Youden index for calculating optimal thresholds (7). The Youden index = (sensitivity) + (specificity) – 1. A perfect test result would have a Youden index of 1. For the single-day scenario, the optimal threshold was 5%, with a sensitivity of 0.77 and specifi city of 0.73.”
*[[Flu]], [[Public Health]], [[Prophylaxis]], [[Biosurveillance]], [[Japan]]
== 2010 ==
”’Nyamathi, Adeline”’, “Computerized Bioterrorism Education and Training for Nurses on Bioterrorism Attack Agents” SLACK Incorporated. 2010.
*“Compared with other potential biological agents, anthrax spores are stable in the environment and the aerosolized form has a high mortality rate.” (Pg. 1)
*“ 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)
*“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)
*“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)
*“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)
*“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]]
”’Davis, Sara”’, “BALANCING PUBLIC HEALTH AND INDIVIDUAL CHOICE: A PROPOSAL FOR A FEDERAL EMERGENCY VACCINATION LAW”. Health Matrix: Journal of Law Medicine, January 1, 2010.
*“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)
*““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)
*“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)
*“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)
*“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)
*“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)
*“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)
*“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)
*“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)
*“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)
*“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)
*“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)
*“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)
*“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]]
”’Beam, Elizabeth”’. “The Nebraska Experience in Biocontainment Patient Care”. Public Health Nursing Vol. 27 No. 2, April 2010.
*“The Centers for Disease Control (CDC) set health protection goals and objectives that address preparation for these emerging health threats in the current era of international travel (2007)” (Pg. 1) .
*“Public health nurses in local health departments may receive the first call regarding a potential case of avian influenza, monkeypox, or viral hemorrhagic fever. In some cases, caring for the index patient and their direct contacts in the diagnosing hospital is the most logical approach.” (Pg. 1)
*“Early access to a biocontainment patient care unit (BPCU) for isolation during a bioterrorism or a public health emergency event along with appropriate use of epidemiological and therapeutic interventions in the community may dramatically impact the size and severity of a disease outbreak” (Pg. 1-2)
*“The collaboration of many organizations in Nebraska led to the development of a BPCU for the care of patients with potentially dangerous, highly infectious illnesses.” (Pg. 2)
*“Plans are most effective when routinely practiced. Under the direction of the lead registered nurse, NBU personnel drill on a quarterly basis to test the adequacy of policies and procedures, learn new equipment as it is introduced, and test various care processes.” (Pg. 2)
*“Community education is required for an isolation unit to be successful in achieving its public health mission. The NBU personnel provide education and training focused on communication and decision making in a situation requiring isolation of a potentially dangerous emerging infectious disease.” (Pg. 3)
*“Some examples of unique policies to the NBU include: Transporting a patient to the biocontainment unit from the emergency department; Transporting a patient to the biocontainment unit from another patient care area within the Nebraska Medical Center; Obtaining and processing laboratory specimens; Laundry and biohazard waste removal from the biocontainment unit; Contingency plan for hospital surge capacity; Removal of patient remains.” (Pg. 3)
*“Beyond moving a patient inside the hospital, vehicle transport for those who require intense isolation continues to be a concern among local, state, and federal organizations charged with this responsibility.” (Pg. 4)
*“The continued success of the NBU has been a function of several key factors. These factors include three major areas: strong leadership, an engaged professional team, and successful collaborations.” (Pg. 4)
*“The role of the lead registered Beam et al.: Nebraska Biocontainment Patient Care 143 nurse includes managing day-to-day operations and guiding routine monthly meetings and quarterly procedural drills.” (Pg. 4-5)
*“A BPCU would allow health care workers to maintain their personal safety while providing care to a patient with a hazardous infection. The personnel who work in this specialized care unit could also become a resource for a larger public health emergency.” (Pg. 5)
*[[Public Health]], [[Bioterrorism]], [[Emergency Response]], [[Biosafety]], [[CDC]], [[Quarantine]]
”’Editors”’, “Bioterrorism Decontamination Could Cost Trillions, Report Warns” NTI. April 13, 2010.
*“The United States might need to spend trillions of dollars to decontaminate the site of a major biological attack”
*“The federal government has not assigned clear-cut cleanup research and execution duties to the federal entities that would be most involved in dealing with the aftermath of a biological strike”
*“The paper urges the Homeland Security Department to designate clearer decontamination duties to each federal agency, and it presses lawmakers to increase spending on biological-weapon cleanup studies and personnel”
*[[Bioterrorism]], [[Public Health]], [[Decontamination]], [[Quarantine]], [[Emergency Response]]
”’Bouri, Nidhi & Franco, Crystal”’, “Environmental Decontamination Following a Large-Scale Bioterrorism Attack: Federal Progress and Remaining Gaps,” Biosecurity and Bioterrorism: Biodefense Strategy, Practice, and Science, Volume 8, Number 2, 2010. April 7, 2010.
*”The process of environmental decontamination is a key step in a successful response to a large-scale attack involving a biological agent. Costs for the decontamination response following the 2001 anthrax attacks were estimated in the hundreds of millions of dollars, and some facilities could not be reopened for more than 2 years.”
*”However, a large-scale biological attack would likely result in an even greater amount of contamination, more areas that need to be cleaned and made safe, and a much greater cost to the American public.”
*”The Select Biological Agents (biological organisms of particular concern) can be categorized along a continuum of decontamination difficulty, ranging from not problematic to very problematic, with a range of difficulty in between. Factors influencing the difficulty of decontamination for a particular agent following a biological attack would include both the natural stability of the agent in the environment and added man-made stability through weaponization.”
*”Bacillus anthracis, the causative agent of anthrax, is considered to be the most problematic agent of concern. Anthrax is both a threat to human health and extremely hardy in the environment. Thus, anthrax requires extensive environmental decontamination following a release.”
*”The main purpose of this analysis is to identify the gaps in decontamination policy and technical practice at the federal level, including safety standards, that must be addressed in order to facilitate a successful response to a large-scale attack involving a biological agent.”
*”The U.S. intelligence community, including the Central Intelligence Agency (CIA), the Defense Intelligence Agency (DIA), the Department of State, the National Intelligence Council, and the Defense Science Board, has assessed the threat of an attack on the U.S. using biological weapons, and they have determined that the threat of a biological attack on the U.S. is current and real.14 Yet, as noted by the Com- mission on the Prevention of Weapons of Mass Destruction Proliferation and Terrorism (the Commission) in their World at Risk report released in December 2008, the U.S. remains vulnerable and unprepared to deal with such an attack.”
*”Decontamination is the process of removing or inactivating a hazardous substance (in this case, a biological agent) from contaminated environments or surfaces, including skin, clothing, buildings, air, and water, in order to prevent adverse health events from occurring. Remediation fol- lowing an attack with a biological weapon will involve a number of different phases of response, including: Sampling, Testing, and Analysis; Containment and Mitigation; Decontamination, Confirmatory Sampling, and Testing”
*”Although efforts are underway and advancements have been made in the field of biological agent decontamination, there are a number of high-level policy and scientific questions that have not yet been resolved. These gaps will be major stumbling blocks to a successful decontamination response following a large bioterrorism attack. Gaps include challenges in leadership, research coordination, funding, and decontamination response.”
*”Numerous federal agencies have responsibility for portions of the decontamination response to a bioterrorism attack. Yet, federal plans do not sufficiently delineate decontamination leadership roles and responsibilities.”
*”Currently, the U.S. lacks a coordinated and sustained federal research program in biological decontamination.”
*”The federal government does not have the human resources to carry out a decontamination response on its own, even for a small biological event.”
*”The nation must be ready to effectively and efficiently respond to and recover from a large-scale bioterrorism attack, and the federal government must take steps now to ensure that the U.S. has the technical and operational capabilities necessary to re- cover after an attack.”
*“The DOD Chemical and Biological Defense Program (CBDP) strives to develop capabilities for decontamination research and response ‘‘that enable the quick restoration of combat power, maintain/recover essential functions that are free from the effects of CBRN hazards, and facilitate the return to pre-incident operational capability””(Pg. 3)
*“Investment now in biological decontamination research to improve technologies and methods has the potential to save the country tens of billions of dollars in clean-up costs for the next event” (Pg. 5)
*“The risks of secondary aerosolization are important to understand, because they will greatly affect decontamination methods and standards, as well as policy decisions surrounding evacuation, transportation, and population movement” (Pg. 6)
*“The federal government does not have the human resources to carry out a decontamination response on its own, even for a small biological event” (Pg. 7)
*[[Decontamination]], [[Anthrax]], [[Biodefense]], [[Biosafety]], [[Bioterrorism]], [[Emergency Response]], [[Public Health]], [[Biosecurity]], [[Quarantine]],
”’Editors,”’ “Detection of ”Enterobacteriaceae” Isolates Carrying Metallo-Beta-Lactamase — United States, 2010,” MMWR Morbidity and Mortality Weekly Report, Vol. 59, No. 24, CDC, Published June 25,2010.
*”Current CDC infection control guidance for carbapenem-resistant ”Enterobacteriaceae” also is appropriate for NDM-1–producing isolates (5). This includes recognizing carbapenem-resistant ”Enterobacteriaceae” when cultured from clinical specimens, placing patients colonized or infected with these isolates in contact precautions, and in some circumstances, conducting point prevalence surveys or active-surveillance testing among other high-risk patients. Laboratory identification of the carbapenemresistance mechanism is not necessary to guide treatment or infection control practices but should instead be used for surveillance and epidemiologic purposes.”
*“Current CDC infection control guidance for carbapenem-resistant Enterobacteriaceae also is appropriate for NDM-1–producing isolates.”
*“Carbapenem resistance and carbapenemase production conferred by blaNDM-1 is detected reliably with phenotypic testing methods currently recommended by the Clinical and Laboratory Standards Institute (3), including disk diffusion testing and the modified Hodge test.”
*”Clinicians should be aware of the possibility of NDM-1–producing ”Enterobacteriaceae” in patients who have received medical care in India and Pakistan, and should specifically inquire about this risk factor when carbapenem-resistant ”Enterobacteriaceae” are identified. CDC asks that carbapenem-resistant isolates from patients who have received medical care within 6 months in India or Pakistan be forwarded through state public health laboratories to CDC for further characterization. Infection control interventions aimed at preventing transmission, as outlined in current guidance (5), should be implemented when NDM-1–producing isolates are identified, even in areas where other carbapenem-resistance mechanisms are common among ”Enterobacteriaceae”.
*[[NDM-1]], [[Public Health]], [[CDC]]
”’Associated Press,”’ “NDM-1, Superbug Gene, Could Spread Worldwide, Doctors Warn,” September 6, 2010
*”People traveling to India for medical procedures have brought back to Britain a new gene that allows any bacteria to become a superbug, and scientists are warning this type of drug resistance could soon appear worldwide.”
*”Though already widespread in India, the new superbug gene is being increasingly spotted in Britain and elsewhere. Experts warn the booming medical tourism industries in India and Pakistan could fuel a surge in antibiotic resistance, as patients import dangerous bugs to their home countries.”
*”The superbug gene, which can be swapped between different bacteria to make them resistant to most drugs, has so far been identified in 37 people who returned to the U.K. after undergoing surgery in India or Pakistan.”
*”The resistant gene has also been detected in Australia, Canada, the U.S., the Netherlands and Sweden.”
*”The gene alters bacteria, making them resistant to nearly all known antibiotics.”
[[NDM-1]], [[Public Health]]
”’Associated Press,”’ “Austria reports 2 cases of superbug gene,” September 6, 2010 [http://www.google.com/hostednews/ap/article/ALeqM5iJg9vxJttMtWFhClPLSt6Ay8zHHQD9HRNRR80 2]
*”The ministry says experts at the medical university in the southern city of Graz detected the gene, known as NDM-1, in two people, both of whom are believed to have been infected in hospitals abroad.”
[[NDM-1]], [[Public Health]]
”’Editors”’, “Planned Malaysian Biolab Raises Security Concerns,” Global Security Newswire [http://gsn.nti.org/gsn/nw_20100908_8991.php] September 8, 2010. Last checked September 10, 2010.
*”Plans to construct a high-security biological research laboratory in Malaysia have caused some worry over possible proliferation of highly lethal disease materials, ProPublica reported yesterday.”
*”Maryland-based Emergent BioSolutions and Ninebio Sdn Bhd., which is funded by the Malaysian Health Ministry, in 2008 announced a joint plan to construct a large complex at an industrial site not far from Kuala Lumpur for ‘vaccine development and manufacturing.'”
*”Emergent is the producer of the only U.S.-licensed anthrax vaccine. The Emergent-Ninebio venture intends to manufacture halal-compliant vaccines for the international Muslim market. The complex is currently slated to begin work in 2013, according to an Emergent release.”
*”The two firms intend to construct a ‘biocontainment R&D facility that includes BSL … 3 and 4 laboratories,’ According to online architectural plans for the 52,000-square-foot complex.”
*”Biosafety Level 4 laboratories perform countermeasure research on diseases for which there are no known cures, such as the Ebola and Marburg viruses. There are fewer than 40 such facilities in the world and none in Malaysia. The nation has three BSL-3 laboratories, which handle potentially deadly pathogens like anthrax and plague.”
*”U.S. Assistant Secretary of State Vann Van Diepen said during a House panel hearing in March that a critical aspect of today’s biological weapon fears is ‘the growing biotechnology capacity in areas of the world with a terrorist presence.'”
*”Malaysia’s history with terrorism includes the 2002 bomb attack by Malaysian-based extremists from Jemaah Islamiyah that killed 202 people at a popular nightclub in Bali, Indonesia. Kuala Lumpur served as the ‘primary operational launchpad’ for al-Qaeda senior operatives planning the Sept. 11 attacks, according to the FBI. The Malaysian capital was also a key hub in the nuclear technology smuggling ring operated by Pakistani nuclear scientist Abdul Qadeer Khan (see GSN, March 14, 2005).”
*”Security specialists argue that having a U.S. firm such as Emergent involved in Malaysia’s growing biotechnology industry would give Washington some degree of clout and authority over international biodefense work.”
*”Malaysian authorities want the high-tech laboratories to respond to local epidemics of diseases such as SARS and Japanese encephalitis in addition to advancing research on cures for biological materials that could be used in acts of terrorism.”
*”Kuala Lumpur has started to develop new biological security regulations that would meet U.S. standards. It has received assistance in the effort from the U.S. Energy Department’s Sandia National Laboratories, ProPublica reported.”
*”…and monitoring of biological manufacturing installations under the Biological Weapons Convention. The United States and Russia, however, are against site inspections and the likelihood of more effective oversight controls being put into effect is not known.”
*”‘We currently do not have [BSL-4] labs in Malaysia but we would be happy to collaborate with the government of Malaysia on biosurveillance, safety and security in the future,’ a Defense Department spokesman said (Coen/Nadler, ProPublica, Sept. 7).”
*[[BSL]], [[Malaysia]], [[Vaccination]], [[Nonproliferation]], [[Bioterrorism]], [[Public Health]], [[Military]], [[State Department]]
”’Shino Yuasa,”’ “Japan confirms its first case of new superbug gene,” AP September 7, 2010 [http://news.yahoo.com/s/ap/20100907/ap_on_sc/as_japan_superbug]
*”Japan has confirmed the nation’s first case of a new gene in bacteria that allows the microorganisms to become drug-resistant superbugs, detected in a man who had medical treatment in India, a Health Ministry official said Tuesday.”
*”The WHO says NDM-1 requires monitoring and further study. With effective measures, countries have successfully battled multi-drug resistant microorganisms in the past.”
*”It recommends that governments focus their efforts in four areas: surveillance, rational antibiotic use, legislation to stop sales of antibiotics without prescription, and rigorous infection prevention measures such as hand-washing in hospitals.”
*”Researchers say since many Americans and Europeans travel to India and Pakistan for elective procedures like cosmetic surgery, it was likely the superbug gene would spread worldwide.”
*”President of Indian Association of Medical Microbiology Dr Abhay Chaudhary, said, “Drug-resistant bacteria are not new. Whenever we use a particular antibiotic, bacteria will always try to develop resistance to it. This is a natural phenomena.””
*””The potential of NDM-1 to be a worldwide public health problem is great, and coordinated international surveillance is needed,” said a widely publicised report in the Lancet in August, which pinpointed India as the country of origin.”
*[[NDM-1]], [[Public Health]], [[WHO]]
”’Kumarasamy K., Toleman M. et,al.,”’ “Emergence of a new antibiotic resistance mechanism in India, Pakistan, and the UK: a molecular, biological and epidemiological study,” The Lancet Infectious Diseases, Vol 10(9),Pg 597-602, doi:10.1016/S1473-3099(10)70143-2, Published August 2010, Last checked September 17, 2010.
*”Enterobacteriaceae with NDM-1 carbapenemases are highly resistant to many antibiotic classes and potentially herald the end of treatment with β-lactams, fluoroquinolones, and aminoglycosides-the main antibiotic classes for the treatment of Gram-negative infections.”
*”Most isolate remained susceptible to colistin and tigecyline.”
*”Nevertheless, NDM-1-positive K ”pneumoniae” isolates from Haryana were clonal, suggesting that some strains could potentially cause outbreaks. Most ”bla”NDM-1 positive plasmids were readily transferable and prone to rearrangement, losing or (more rarely) gaining DNA on transfer.”
*”This transmissibility and plasticity implies an alarming potential to spread and diversify among bacterial populations.”
*”This scenario is of great concern because there are few anti-Gram negative antibiotics in the pharmaceutical pipeline and none that are active against NDM-1 producers. Even more disturbing is that most of the Indian isolates from Chennai and Haryana were from community-acquired infections, suggesting that ”bla”NDM-1 is widespread in the environment.”
*”Several of the UK source patients had undergone elective, including cosmetic, surgery while visiting India pr Pakistan. India also provides cosmetic surgery for other Europeans and Americans, and ”bla”NDM-1 will likely spread worldwide.”
*”The potential for wider international spread of producers and for NDM-1 encoding plasmids to become endemic worldwide, are clear and frigthening.”
*[[NDM-1]], [[Public Health]]
”’Leung, Gabriel M. and Nicoll, Angus”’. “Reflections on Pandemic (H1N1) 2009 and the International Response”. PLoS Medicine 7.10 October 2010.[http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.1000346]Last checked Feb. 21, 2011
* “The pandemic virus was detected and isolated reasonably early, although too late for any attempt at containment.”
* “…late clinical presentation and delayed initiation of antiviral treatment have been implicated with more severe complications worldwide, indicating gaps in identifying and treating patients before disease severity increases.”
* “Clear communication of public health messages will remain a particular challenge and not confusing what could happen (and should be prepared for) with what is most likely to happen.”
* “One challenge faced initially in this pandemic was for timely collection and sharing of clinical data to inform optimal management of critically ill patients worldwide.”
* “Greater access to antiviral and influenza vaccines worldwide is an ongoing challenge.”
*[[Pandemic]], [[Flu]], [[Vaccination]], [[Emergency Response]], [[Public Health]]
”’Matishak, Martin”’, “Homeland Security Says Radiation Detector Decision Coming Within Year” NTI. Oct. 1st, 2010.
*“The detection office was established by presidential directive in 2005 to coordinate federal efforts to protect the United States against nuclear terrorists and designated to be the lead agency in domestic nuclear detection.”
*“It has also deployed 1,500 radiation portal monitors and 3,000 hand-held detectors to the nation’s borders to support Customs and Border Protection and set up 6,500 detectors with the Coast Guard, he said”
*“The new machines were designed to not only detect radiation but identify the nature of its source. Proponents claimed the devices, each expected to cost approximately $822,000, would eliminate time-consuming secondary inspections to determine whether a material was in fact dangerous.”
*“Congressional auditors in June said a comprehensive strategic plan against nuclear terrorism could involve installing radiation detection equipment at all U.S. border crossings and ports of entry; addressing vulnerabilities and risks; identifying the mix of detection equipment that would be at various entry points and when those devices would be deployed”
*[[Nuclear]], [[Public Health]], [[Biodetection]], [[Biotechnology]], [[Bioterrorism]]
”’Editors”’ “New detector tests for illegal drugs, superbugs in minutes” Homeland Security Newswire, October 2 2010.
*”A new method of detecting illegal drugs and super bugs will be used in a government-backed handheld device that analyses saliva. The Vantix portable reader will be able to test for chemical substances or bacteria such as MRSA in human or animal saliva within minutes”
*”Things like feces, urine and saliva are dreadful samples to work with; even in ground up animal feed where we’re detecting illegal use of antibiotics.”
[[NDM-1]], [[Public Health]]
”’Jeffery Bigongiari,”’ “FDA gives grants to fight tuberculosis”, Last accessed October 18, 2010. [http://vaccinenewsdaily.com/news/216702-fda-gives-grants-to-fight-tuberculosis 2]
*”The U.S. Food and Drug Administration on October 4 announced that it has awarded nearly $3 million to fund research that will support the diagnosis, treatment and prevention of tuberculosis.”
*”TB remains a major public health threat and continues to rise in prevalence globally. The FDA said that help is needed to shorten therapy and to treat drug resistant forms of the disease.”
*”The six projects and their research teams that FDA will grant funding to include Aeras Global TB Vaccine Foundation’s discovery of biological and immunological biomarkers for TB vaccines and the Global Alliance for TB Drug Development frozen trials for developing a repository of clinical trial specimens.”
*[[Tuberculosis]], [[Public Health]]
”’Editors,”’ “Sea floor organisms offer response to bioterrorism” Homeland Security Newswire October 7, 2010 [http://homelandsecuritynewswire.com/sea-floor-organisms-offer-response-bioterrorism] Last accessed October 21, 2010.
*”The U.S. Defense Threat Reduction Agency recently signed a $29.5 million contract with San Diego-based Trius Therapeutics and the Scripps Institute of Oceanography to search for new antibiotics at the bottom of the ocean that could be used to fight bioterrorism.”
*”Ted Purlain, citing a SignOnSanDiego.com report, writes that over the next four years, the two organizations expect to find treatments for the bubonic plague, Yersinia pestis, and other bacterial infections that could be utilized by terror groups for an attack on the United States.”
*”Researchers at the Scripps Institute for Oceanography have spent much of the last fifteen years scouring the seas for useful microorganisms and have built a library of more than 15,000 strains of bacteria, yeast and fungi that are kept on ice at their laboratories.”
*”Trius will use its Focused Antisense Screening Technology to evaluate dozens of potential treatment candidates every week. The process will measure how effectively a molecule can act against specific proteins that are known to be critical in the functions of specific pathogens.”
*”The scientists hope to find bacteria that precisely target a pathogen’s means of attack. If they are too toxic, they can cause unwanted side effects.“It’s quite easy to find compounds that are generally toxic,” Stein told SignOnSanDiego.com. “The challenge is detecting which ones of those are inhibiting the cell because they are highly specific and potent.””
*”The military has recently increased its efforts to find new treatments for the effects of biological weapons as more infections have become drug resistant and the pipeline for new antibiotics has begun to dry up.”
*”Currently, there are two compounds undergoing Phase II clinical trials that were found at the bottom of the ocean floor.”
*[[Biodefense]], [[Public Health]]
”’Editors”’, ‘U.S. Awards Contract For Radiation Treatment Work’. GSN. Sept. 7, 2010.
*“Funding from the department’s Biomedical Advanced Research and Development Authority is to be used to develop a medical treatment which uses myeloid progenitor cells, which can develop into any type of blood cell. The medication, CLT-008, is intended to foster the growth of and assist the body’s progenitor cells, according to an agency release.”
*“The Biomedical Advanced Research and Development Authority also approved millions of dollars in new funding for additional work on a treatment for plague and tularemia — two disease agents classified as potential bioterrorism threats, according to a press release.”
*“The antibiotic could be used against tularemia and plague infections as well as more common illnesses such as pneumonia that are growing increasingly resistant to antibiotics.”
*“”This new antibiotic is part of our push against antibiotic resistance for certain bacterial infections, and at the same time could provide a new treatment for plague and tularemia biothreats””
*[[Bioterrorism]], [[Biosafety]], [[Public Health]], [[Emergency Response]], [[Pharma]], [[Drug Resistance]], [[Biodevelopment]], [[Biotechnology]], [[Quarantine]]
”’Sternberg Steve,”’ “Drug-resistant ‘superbugs’ hit 35 states, spread worldwide” USA Today Published September 17, 2010, Last accessed October 27, 2010 [http://www.usatoday.com/yourlife/health/medical/2010-09-17-1Asuperbug17_ST_N.htm]
*”Bacteria that are able to survive every modern antibiotic are cropping up in many U.S. hospitals and are spreading outside the USA, public health officials say.”
*”The bugs, reported by hospitals in more than 35 states, typically strike the critically ill and are fatal in 30% to 60% of cases. Israeli doctors are battling an outbreak in Tel Aviv that has been traced to a patient from northern New Jersey, says Neil Fishman, director of infection control and epidemiology at the University of Pennsylvania and president of the Society of Healthcare Epidemiologists.”
*”The bacteria are equipped with a gene that enables them to produce an enzyme that disables antibiotics. The enzyme is called Klebsiella pneumoniae carbapenamase, or KPC. It disables carbapenam antibiotics, last-ditch treatments for infections that don’t respond to other drugs.”
*”Carbapenam-resistant germs are diagnosed mostly in hospital patients and are not spreading in the community. They’re far more common nationwide than bacteria carrying a gene called NDM-1 that made headlines this week, Fishman says.”
*”Although KPCs are most common in New York and New Jersey, Srinivasan says, “they’ve now been reported in more than half of the states.” A decade ago, only 1% of Klebsiella pneumoniae bacteria reported to CDC by hospitals were carbapenam-resistant. Today, resistance has spread to more than 8% of these bacteria. No one knows precisely how many people have KPC infections because cases aren’t routinely reported to the CDC.”
*”One of the only drugs that combats these bugs is polymixin, which was all but abandoned years ago because it is so toxic to the kidneys, Fishman says. As a result, he says, prevention is crucial.”
*”In March 2009, the CDC gave hospitals new guidelines for prevention. Among other things, doctors treating any patient diagnosed with carbapenam-resistant infections are advised to wear gowns and gloves to protect themselves and make sure they don’t infect other patients.”
*[[KPC]], [[NDM-1]], [[Public Health]]
”’Graham Judith,”’ “Drug-resistant bacterium raises alarms in Chicago” Chicago Tribune Last accessed October 27, 2010. [http://www.chicagotribune.com/health/ct-met-superbug-20101022,0,6867309.story]
*”A dangerous, often deadly bacterium resistant to the most powerful antibiotics known to medicine is spreading in Chicago hospitals and nursing homes, prompting an effort to mobilize a regionwide response.”
*”Earlier this year, 37 health facilities in Chicago reported an average of 10 KPC cases each, up from an average of four cases in 2009 in 26 facilities, according to a new study presented Friday at the annual meeting of the Infectious Diseases Society of America.”
*”They’re part of a class of organisms known as Gram-negative bacteria, whose best-known member is Escherichia coli, or E. coli.”
*”Over the last decade, Gram-negative bacteria have begun to evolve resistance to drugs once commonly used to fight them as well as to the drugs called carbapenems — medications of last resort that are used to treat infections that don’t respond to other interventions.”
*”Another drug-resistant Gram-negative bacterium originating in India made headlines around the world in September when disease trackers noted its emergence in Europe and the U.S. That organism carries a carbapenem-disabling gene known as NDM-1, which experts worry might be transferred to other pathogens and hasten drug resistance.”
*”An outbreak of KPC in Rio de Janeiro this year claimed 18 lives. The epicenter for infections in the U.S. is New York.”
*[[KPC]], [[NDM-1]], [[Public Health]]
”’Pollack Andrew,”’ “Antibiotics Research Subsidies Weighed by U.S.” New York Times Last accessed November 11, 2010. [http://www.nytimes.com/2010/11/06/health/policy/06germ.html?_r=3&adxnnl=1&partner=rss&emc=rss&adxnnlx=1289228400-5qfTrKyKaYxNo7j2bms15g]
*”Worried about an impending public health crisis, government officials are considering offering financial incentives to the pharmaceutical industry, like tax breaks and patent extensions, to spur the development of vitally needed antibiotics.”
*”While the proposals are still nascent, they have taken on more urgency as bacteria steadily become resistant to virtually all existing drugs at the same time that a considerable number of pharmaceutical giants have abandoned this field in search of more lucrative medicines.”
*”The number of new antibiotics in development is “distressingly low,” Dr. Margaret A. Hamburg, commissioner of the Food and Drug Administration, said at a news conference last month. The world’s weakening arsenal against “superbugs” has prompted scientists to warn that everyday infections could again become a major cause of death just as they were before the advent of penicillin around 1940.”
*”For example, scientists have become alarmed by the spread from India of a newly discovered mutation called NDM-1, which renders certain germs like E. coli invulnerable to nearly all modern antibiotics. About 100,000 Americans a year are killed by infections acquired in hospitals, many resistant to multiple antibiotics. Methicillin-resistant staphylococcus aureus, or MRSA, the best known superbug, now kills more Americans each year than AIDS.”
*”Besides tax breaks and extra protection from competition, other ideas policy makers are considering include additional federal funding of research and guaranteed purchases by the government of new antibiotics. Measures like these are already used to encourage the development of drugs for rare diseases, through the Orphan Drug Act, and for illnesses like malaria that primarily afflict poor countries.”
*”The Obama administration is also taking some steps. The federal agency that oversees development of treatments for bioterrorism agents like anthrax is broadening its scope to encompass more common infections. In August, the agency, known as the Biomedical Advanced Research and Development Authority, awarded its first such “multi-use” contract, giving an initial $27 million to a company called Achaogen to develop an antibiotic that could be used for plague and tularemia as well as antibiotic-resistant infections.”
*”The Department of Health and Human Services is considering creating an independent fund that would invest in small bio-defense companies. Antibiotic-resistant germs would be one priority, according to a report that the department issued in August.”
*”The European Union is also working on a plan, based on proposals from the London School of Economics. A year ago, the United States and the European Union formed a task force on antibiotic resistance.”
*”Ramanan Laxminarayan, who directs the Extending the Cure project on antibiotic resistance at Resources for the Future, a policy organization, said the government should focus on conserving the effectiveness of existing antibiotics. That could be done by preventing unnecessary use in people and farm animals and requiring better infection control measures in hospitals.”
*”Only five of the 13 biggest pharmaceutical companies still try to discover new antibiotics, said Dr. David M. Shlaes, a consultant to the industry and the author of a new book “Antibiotics: The Perfect Storm.””
*”One reason is that antibiotics are typically taken for a week or two and usually cure the patient. While that makes them cost-effective for the health system, it also makes them less lucrative to drug companies than medicines for diseases like cancer or diabetes, which might be taken for months, or even for life, because they do not cure the patient.”
*”Another factor is that new antibiotics are likely to be used only sparingly at first, to stave off the emergence of resistance. While that might be medically appropriate, it reduces the ability of a drug company to recoup its investment, said Dr. Barry I. Eisenstein, a senior vice president at the antibiotic maker Cubist Pharmaceuticals. Another factor discouraging investment, some experts say, is that the F.D.A. recently made it harder for new antibacterial drugs to win approval.”
*[[NDM-1]], [[Public Health]], [[Prophylaxis]], [[Pharma]]
”’Low, Donald E. and McGeer, Allison.”’, “Pandemic (H1N1) 2009: Assessing the Response.” Canadian Medical Association Journal, November 2010. [http://www.docstoc.com/docs/70230222/Pandemic-%28H1N1%29-2009-assessing-the-response]
* “Research published by Viboud and colleagues suggests that the first waves of the 2009 pandemic may have been more severe than is widely perceived.”
* “…the estimate number of years of life lost was 25% greater than duing a usual influenza season.”
* “The vaccine could not be made quickly enough to protect Canadians from the second wave, the complexity of delivering vaccine was badly underestimated, and attempts to deliver rapid public education about vaccination with an adjuvant vaccine failed.”
* “…uncertainty and limited communication about vaccine supply hampered local and provincial coordination of delivery.”
* “Last year’s events clearly show that our current methods of vaccine production are too slow for an adequate response to a pandemic.”
*[[Flu]], [[Vaccination]], [[Pandemic]], [[Emergency Response]], [[Biosecurity]], [[Public Health]], [[Adjuvant]]
”’Kron, Josh,”’ “Uganda Seen as a Front Line in Bioterrorism.” NYT A8, November 11, 2010.
* Uganda Virus Research Institute
* “need to tighten the security of vulnerable public health laboratories in East Africa” – Andrew C. Weber, Asst. to Secretary of Defense for Nuclear and Chemical and Biological Defense Programs.
* “preventing terrorist acquisition of dangerous pathogens, the seed material for biological bioweapons, is a security imperative.”
* Shabab insurgent group – “attention on East Africa as a fronteir in American security interests.”
* warm, wet environment fuels biothreats of anthrax, marburg, and ebola.
* anthrax- killed hundred of hippos in recent years
* marburg- tourist died after contracting disease at a natl park
* ebola- outbreak 2007- killed over 20 people
* relaxed security and poor funding/financing creates a security risk.
* [[Biodefense]], [[Anthrax]], [[Bioterrorism]], [[Lab Safety]], [[Ebola]], [[Marburg]], [[Biosafety]], [[Africa]]
”’Editors,”’ “India, US join hands to set up global disease detection centre” The Economic Times, November 8, 2010, Last accessed November 26, 2010 [http://economictimes.indiatimes.com/news/news-by-industry/healthcare/biotech/healthcare/India-US-join-hands-to-set-up-global-disease-detection-centre/articleshow/6888740.cms]
*”The US and India today signed a memorandum of understanding for establishment and operation of global disease detection centre here.”
*”The agreement would facilitate development of human resources, both in epidemiology and laboratory, enable sharing best practices for detection and response to emerging infections, wherever required.”
*”It would also facilitate advanced training in the field of epidemiology and surveillance for emerging infectious diseases, international health and mentoring of public health professionals.”
*”Building laboratory capacity in India for diagnosis of emerging infectious diseases using well characterised reference materials and advanced technology transfer are the other aims of the MoU.”
*[[Public Health]], [[NDM-1]]
”’Glazier K.,”’ “Cargill: E. coli cattle vaccine promising,” Denver Post, November 16, 2010, Last accessed November 26, 2010 [http://www.denverpost.com/business/ci_16623151#ixzz15TA1ycgW]
*”International food marketer Cargill announced Monday the initial results of a trial for the new vaccine, a test involving 85,000 cattle at the company’s Fort Morgan beef-processing facility.”
*”Schaefer said Cargill was awaiting results from other researchers across the nation but that the company had plans to conduct a second trial next summer at a Midwest processing plant. The cattle had no negative reaction to the vaccine, Schaefer said.”
*”He said the vaccinated Fort Morgan animals showed positive immune system response and low levels of the strain of E. coli bacteria that can sicken and kill human beings if consumed. But Schaefer said nonvaccinated cattle at Fort Morgan also showed low levels of E. coli. A variety of factors influence E. coli levels in cattle, Schaefer said, including weather, living conditions and vaccine dosage.”
*”Minnesota-based pharmaceutical company Epitopix developed the vaccine used in the trial. It received initial testing approval from the Food and Drug Administration and the U.S. Department of Agriculture in February 2009.”
*[[Vaccination]], [[Public Health]], [[E. coli]]
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“We should not be complacent about our population-based public health response to the first influenza pandemic of the 21st century.” . 2011.
“Officials Warn Swine Flu Outbreak in Britain May Spread to Rest of Europe,” 7 January 2011.
[[Europe]], [[Pandemic]], [[Pharma]], [[Flu]], [[Vaccination]], [[Public Health]], [[WHO]]
“Response of W.H.O. to Swine Flu Is Criticized,” March 10, 2011,
*[[WHO]], [[Flu]], [[Pandemic]], [[Public Health]], [[Vaccination]], [[Pharma]], [[Ethics]], [[Misconduct]]
“Report of the Review Committee on the Functioning of the International Health Regulations (2005) and on Pandemic Influenza A (H1N1) 2009”. March 7, 2011.
[[WHO]], [[Public Health]], [[Flu]], [[Pandemic]]
“Decontamination After Radiation Exposure: Simpler Than You May Think” March 17, 2011.
*[[Nuclear]], [[Bioterrorism]], [[Public Health]], [[Decontamination]]
“Vaccinia Virus Infections in Martial Arts Gym, Maryland, USA, 2008,”. 2011 Apr.,
*[[Vaccination]], [[Smallpox]], [[Contact Tracing]], [[Public Health]]
“Tools for Tracking Antibiotic Resistance”,. May 2011.
*[[Public Health]], [[Bioterrorism]], [[Drug Resistance]], [[E. coli]], [[NDM-1]]
“Moffitt Cancer Center researchers use new tool to counter multiple myeloma drug resistance”. Sept. 9, 2011.
*[[Drug Resistance]], [[Public Health]]
‘“MRSA in U.S. Becoming Resistant to Over the Counter Ointment,” September 14, 2011
*[[Drug Resistance]], [[Public Health]]
“Resistant TB Spreading In Europe At Alarming Rate, WHO, September 15, 2011
*[[Tuberculosis]], [[Drug Resistance]], [[Public Health]], [[WHO]]
“Fact Sheet: Global Health Security” The White House. Sept. 22, 2011.
[[Public Health]], [[Bioterrorism]], [[Biodefense]], [[Biosecurity]], [[Developing Countries]], [[Executive Order]], [[Pandemic]], [[Emergency Response]]
“Experts Offer Measures to Save Lives After Nuclear Explosion”. September 28, 2011.
*[[Biosecurity]], [[Nuclear]], [[Public Health]], [[Al-Qaeda]], [[Emergency Response]], [[Pandemic]], [[Biodetection]]
“U.S. Supplies Jordan With Radiation Sensor Trucks” , Oct. 6th, 2011.
[[Nuclear]], [[Bioterrorism]], [[Biotechnology]], [[Public Health]]
“U.N. Should Address Chemical Weapons Disposal Deadline Busting: Iran” Oct. 6th, 2011.
*[[Russia]], [[Bioterrorism]], [[Nuclear]], [[Public Health]]
“U.S. Better Prepared for Bioterror, Experts Say,” 14 October 2011,
*[[Bioterrorism]], [[Biosurveillance]], [[Public Health]]
“First Case of Dengue Fever Reported in Palm Beach County,” October 13, 2011,
*[[Dengue]], [[Drug Resistance]], [[Public Health]]
“Fukushima Cleanup to Cost Minimum of $13B” Oct. 21, 2011
*[[Nuclear]], [[Decontamination]], [[Public Health]], [[Russia]]
“Debate Flares Over Testing Anthrax Vaccine on Children”, Oct. 25, 2011
*[[Anthrax]], [[Public Health]], [[Bioterrorism]], [[Biotechnology]]
“Wave of Mysterious E. Coli Outbreaks Hits U.S.,” October 28, 2011
*[[E. coli]], [[Public Health]]
“Terminator-like robot will help Army test anti-chemical clothing” Oct. 31, 2011
*[[Chemical]], [[Biotechnology]], [[Biosafety]], [[Military]], [[Emergency Response]], [[Nuclear]], [[Public Health]]
“Boosting “Natural Killer” Cells May Counteract Anthrax” Wednesday, Nov. 2, 2011
*[[Anthrax]],[[Public Health]], [[Vaccination]], [[Synthetic Biology]], [[Decontamination]], [[Bioterrorism]], [[Biodefense]]
“U.S. Acknowledges Possible Threats to Pakistani Nukes”. Nov. 8th, 2011.
*[[Public Health]], [[Military]], [[Chemical]], [[Nuclear]], [[Biosafety]], [[Biodefense]]
“Survey to compile detailed radiation map in Fukushima begins”. Nov. 8th 2011.
*[[Chemical]], [[Decontamination]], [[Public Health]], [[Nuclear]], [[Biodetection]], [[Biosafety]], [[Biodefense]], [[Biosecurity]]
“Challenges in the Use of Anthrax Vaccine Absorbed (AVA) in the Pediatric Population as a Component of Post-Exposure Prophylaxis (PEP),” October 2011
*[[Anthrax]], [[Vaccination]], [[Public Health]]
“Georgia Bioterror Suspects to Appear in Court,” November 9, 2011
[[Ricin]], [[Public Health]], [[Drug Resistance]], [[Law Enforcement]]
“Militia Members Plead Innocence on Bioterror Charges,” November 10, 2011.
*[[Ricin]], [[Public Health]], [[Drug Resistance]]. [[Law Enforcement]]
“Drug resistance growing among TB patients,”, November 15, 2011
*[[Tuberculosis]], [[India]], [[Drug Resistance]], [[Vaccination]], [[Public Health]]
“Georgia Militia Members to Seek Bail Release,” , November 16, 2011.
*[[Ricin]], [[Drug Resistance]], [[Law Enforcement]], [[Public Health]]
“Egyptian military using ‘more dangerous’ teargas on Tahrir Square protesters”, 23 November 2011,
* [[Chemical]], [[Africa]], [[Military]], [[Public Health]]
“US fears Dutch research could be biological weapon”. November 2011.
*[[Bioterrorism]], [[Public Health]], [[Flu]], [[Japan]], [[Pandemic]], [[Biosafety]]
“Saudi may join nuclear arms race: ex-spy chief”,. Dec. 5th 2011.
*[[Nuclear]], [[Biosecurity]], [[Bioterrorism]], [[Biodefense]], [[Biosafety]], [[Public Health]]
“North Korea making missile able to hit U.S.”, Dec 5th, 2011.
*[[Nuclear]], [[Biosecurity]], [[Biodefense]], [[Bioterrorism]], [[Biotechnology]], [[Emergency Response]], [[Military]], [[Public Health]], [[CWC]], [[Russia]], [[North Korea]], [[Homeland Security]], [[Biodetection]]
“France admits lapses after breach of nuke reactor security” Dec. 6th,2011.
[[Biosecurity]], [[Biodefense]], [[Public Health]], [[Law Enforcement]]
“Timeliness of contact tracing among flight passengers for influenza A/H1N1 2009, December 28, 2011.
[[Contact Tracing]], [[Flu]], [[Public Health]], [[Netherlands]]
“Thompson seeks health care for veterans; DOD tested chemical weapons on servicemen during 60s and 70s”, 24 February 2012,.
[[Public Health]], [[Chemical]], [[Military]]
“Army called after chemical drum ruptured”, 29 February 2012, MSN.CO.NZ,
*[[Chemical]], [[Public Health]], [[Military]]
“Vets feel abandoned after secret drug experiments”, 1 March 2012,
*[[Chemical]], [[Public Health]], [[Military]]
“Amateurs Are New Fear in Creating Mutant Virus”, March 5, 2012,
*[[Public Health]], [[Lab Safety]], [[Open Science]]
“UI researchers develop effective, less costly way to remove contaminants”, 18 March 2012
*[[Chemical]], [[Public Health]], [[Decontamination]]
“Alert over sale of deadly Jequirity bracelets containing terrorism toxin”, 22 March 2012,
*[[Chemical]], [[Public Health]], [[U.K.]]
“Does the beauty of the Withlacoochee State Forest behold danger?”, 9 April 2012,
*[[Chemical]], [[Public Health]]
“Rapid Pathogen Screening secures Homeland Security deal”, 3 May 2012,
*[[Biodetection]], [[Biotechnology]], [[Public Health]], [[Flu]], [[Chemical Surveillance]]
“Agroterrorism: Threats to America’s Economy and Food Supply,”
*[[Agriculture]], [[al-Qaeda]], [[Food Supply]], [[Sabotage]], [[Public Health]]
“Schools Unprepared for Pandemics”, September 21, 2012.
[[Emergency Response]], [[Pandemic]], [[Public Health]]
“How to Tell If FEMA is Doing a Good Job, or a Lousy One.” October 30, 2012.
[[Emergency Response]], [[Public Health]]
“Federal Support to New York for the Response to Hurricane Sandy” November 15, 2012.
[[Emergency Response]], [[Public Health]]
“Americans Depend on a Strong CDC.” November 27, 2012, Politico.
[[Emergency Response]], [[CDC]], [[Public Health]]
, “Experts differ on HHS select-agent proposal for H5N1,” December 26, 2012,
[[Biosecurity]], [[Open Science]], [[Flu]], [[Biosafety]], [[Pharma]], [[Lab Safety]], [[Public Health]]
== 2013 ==
“NIH approves bio lab at BU”, January 2, 2013
*[[Lab Safety]], [[Public Health]]
“Transmission Studies Resume for Avian Flu,”, January 23, 2013
*[[Scientific Self-Governance]], [[Dual Use]], [[Flu]], [[Biosafety]], [[Biosecurity]], [[WHO]], [[Open Science]], [[Oversight]], [[Public Health]], [[Canada]], [[Risk]], [[BSL]], [[Pandemic]]
, “NIH panel supports stronger safeguards for H5N1 research,” January 25, 2013
*[[Oversight]], [[Biosafety]], [[BSL]], [[Law]], [[Flu]], [[Public Health]], [[Scientific Self-Governance]]
“Bioterrorism Preparedness – The Forgotten Patient Population.” February 5, 2013
[[Emergency Response]], [[Public Health]], [[Pandemic]]
“New SARS-like Virus Shows Person-to-person Transmission”, February 13, 2013.
*[[WHO]], [[Public Health]]
‘”U.S. Announces More New Rules for Potentially Risky Research”, February 21, 2013.
*[[Lab Safety]], [[Public Health]], [[Lab Security]]
Post-Fukushima, Arguments for Nuclear Safety Bog Down. February 26, 2013.
[[Nuclear]], [[Public Health]], [[Japan]]
Rebuilding Public Health in Haiti, February 26, 2013.
[[Public Health]], [[CDC]], [[Emergency Response]]
“Energy Department says budget cuts could delay cleanup at highest-risk nuclear sites,”
*[[Nuclear]], [[Public Health]], [[Executive]]
“Most Nations Still Lack Required Disease Outbreak Response Capacity.” February 28, 2013.
[[Public Health]], [[Biosurveillance]], [[Emergency Response]]
“Deadly Bacteria That Resist Strongest Drugs Are Spreading” March 5, 2013.
[[Drug Resistance]], [[CDC]], [[Public Health]]
“Saudi Arabian death marks 15th novel coronavirus case”, March 12, 2013.
*[[Biodetection]], [[Public Health]], [[Biosurveillance]]
“Understanding the New Coronavirus: Receptor Discovered”, March 15, 2013.
*[[Biodetection]], [[Public Health]]
“Novel coronavirus lab studies hint at wide tissue susceptibility”, March 27, 2013,
, Be Prepared- The Boston Marathon and Mass Casualty Events. May 1, 2013.
[[Emergency Response]], [[Public Health]]
“The War on Superbugs” January 2014.
*[[Drug Resistance]], [[Public Health]]
“One-year Surveillance of the Chemical and Microbial Quality of Drinking Water Shuttled to the Eolian Islands” January 17, 2014.
*[[Chemical]], [[Public Health]], [[Surveillance]], [[Chemical Surveillance]], [[Biochemical Surveillance]]
”’Gamo, Francisco-Javier.”’ “Antimalarial Drug Resistance: New Treatment Options for Plasmodium.” Drug Discovery Today: Technologies, Volume 11. 81. March 2014.
*”Millions of lives are threatened by the continued development of resistance in the malaria parasite which is overcoming the effectiveness of current antimalarial treatments.” – page 81
*”Malaria is an infectious disease caused by protozoa of the genus plasmodium and is transmitted by infected female anopheles mosquitoes.” – page 81
*”More than 219 million cases and around 660,000 deaths are the alarming data provided by the World Health Organization in the last World Malaria Report.” – page 81
*”Current antimalarial therapy is built upon only a few different chemotypes: atovaquone, sulfadioxine-pyrimethamine combination, chloroquine, primaquine, mefloquine, and artemisinin.” – page 81
*”The main strategies to advance the development of new treatments for malaria have been based on (a) target based screening, through the assessment and validation of new antimicrobial targets as well as seeking for new chemical diversity to interfere with already validated targets or processes, and (b) whole cell screening using large chemical libraries” – page 84
*”It may be necessary to combine different chemical entities with a variety of therapeutic profiles as part of a single treatment to assure effectiveness against intra-erythrocytic stages, thus relieving clinical symptoms, to block parasite transmission, and to reduce the potential for the emergence of resistance.” – page 87
*”New antimalarial treatments should display novel mechanisms of action with efficacy against already existing multi-drug resistant strains.” – page 87
*[[Drug Resistance]], [[Public Health]], [[WHO]], [[Chemical]]
‘ “A Need for New Generation Antibiotics against MRSA Resistant Bacteria” March 2014
*[[Drug Resistance]], [[Public Health]]
“Biological Warfare, Bioterrorism, and Biocrime” June 2014.
*[[Military]], [[Public Health]], [[WMD]], [[Chemical]], [[BWC]], [[Bioterrorism]], [[Anthrax]], [[Ricin]], [[Drug Resistance]], [[CDC]]
“Negative Impact of Laws Regarding Biosecurity and Bioterrorism on Real Diseases
*[[Military]], [[Public Health]], [[Anthrax]], [[Bioterrorism]], [[CDC]]
“Understanding Drug Resistance in Malaria Parasites: Basic Science for Public Health.” July 2014.
*[[Drug Resistance]], [[Public Health]], [[WHO]], [[Military]], [[China]], [[Developing Countries]], [[Africa]]
“Epidemiological and Clinical Characteristics and Management of Oropharyngeal Tularemia Outbreak.”. 2015
*[[Tularemia]], [[Public Health]], [[Zoonotic]]
“The Impact of Acute Brucellosis on Mean Platelet Volume and Red Blood Cell Distribution.” 1. February 2015.
*[[Brucellosis]], [[Public Health]], [[Developing Countries]], [[Zoonotic]]
“Fighting Microbial Drug Resistance: A Primer on the Role of Evolutionary Biology in Public Health.”. March 2015
*[[Public Health]], [[Drug Resistance]]
“Biopreparedness in the Age of Genetically Engineered Pathogens and Open Access Science: An Urgent Need for a Paradigm Shift” September 2015.
*[[Public Health]], [[Bioterrorism]], [[Chemical]]
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