Bioterrorism as a public health threat

Emerging Diseases of Avian Wildlife

Climate change and the interaction with humans and domestic species influences disease in avian wildlife. This article provides updated information on emerging disease conditions such as the spread of an Asian tick, Haemaphysalis longicornis, and its associated diseases among migratory birds in the eastern United States; lymphoproliferative disease virus in wild turkeys in the United States; and salmonellosis, particularly among passerines, which has zoonotic potential. In addition, it includes updated information on West Nile virus, Wellfleet Bay virus, and avian influenza and is intended to serve as a complement to the current veterinary literature for veterinarians treating avian wildlife species.

Defining the Synthetic Biology Supply Chain

Several recent articles have described risks posed by synthetic biology and spurred vigorous discussion in the scientific, commercial, and government communities about how to best detect, prevent, regulate, and respond to these risks. The Pacific Northwest National Laboratory's (PNNL) deep experience working with dual-use technologies for the nuclear industry has shown that analysis of supply chains can reveal security vulnerabilities and ways to mitigate security risk without hindering beneficial research and commerce. In this article, a team of experts in synthetic biology, data analytics, and national security describe the overall supply chain surrounding synthetic biology to illustrate new insights about the effectiveness of current regulations, the possible need for different screening approaches, and new technical solutions that could help identify or mitigate risks in the synthetic biology supply chain.

Classifying infectious disease outbreaks to improve timeliness and efficiency of response

Following the intentional dissemination of B.anthracis through the U.S. Postal Service in 2001, use of the term "naturally occurring" to classify some infectious disease outbreaks has become more evident. However, this term is neither a scientific nor an epidemiologic classification that is helpful in describing either the source or the mode of transmission in outbreaks. In this paper, the authors provide examples of how and when the public health community has recognized potentially flawed or misleading taxonomy in the past and taken steps to improve the taxonomy's accuracy and usefulness. We also offer examples of alternative terms for classifying outbreaks since inaccurate descriptions of outbreaks could potentially lead to a flawed or incomplete set of underlying assumptions about the outbreak's causal factors. This, in turn, could lead to implementing a flawed or incomplete intervention or response strategy which could extend the duration of the outbreak, resulting in avoidable morbidity and mortality.

Discernment between deliberate and natural infectious disease outbreaks

Public health authorities should be vigilant to the potential for outbreaks deliberately caused by biological agents (bioterrorism). Such events require a rapid response and incorporation of non-traditional partners for disease investigation and outbreak control. The astute application of infectious disease epidemiological principles can promote an enhanced index of suspicion for such events. We discuss epidemiological indicators that should be considered during outbreak investigations, and also examine their application during bioterrorism incidents, an accidental release of an agent, outbreaks of infections that were alleged to have been deliberately initiated, and a model scenario. The Grunow & Finke epidemiological assessment tool is used to examine these historical events and the model scenario. The results received from this analysis, coupled with an understanding of epidemiological clues to unnatural events, and knowledge of how to manage such events, can aid in the improved response and resolution of epidemics.

Availability and perceived effectiveness of public health activities in the nation's most populous communities

OBJECTIVES

We examined the availability and perceived effectiveness of 20 basic public health activities in the communities where most Americans reside.

METHODS

A self-administered questionnaire was mailed to the 497 directors of US local health departments serving at least 100 000 residents.

RESULTS

On average, two thirds of the 20 public health activities were performed in the local jurisdictions surveyed, and the perceived effectiveness rating averaged 35% of the maximum possible. In multivariate models, availability of public health activities varied significantly according to population size, socioeconomic measures, local health department spending, and presence of local boards of health.

CONCLUSIONS

Local public health capacity varies widely across the nation's most populous communities, highlighting the need for targeted improvement efforts.

Guidelines for preclerkship bioterrorism curricula

PURPOSE

To develop medical school curriculum guidelines related to bioterrorism to ensure that future medical graduates are armed with the critical knowledge, skills, and attitudes to face this emerging threat.

METHOD

An Internet-based Delphi survey was performed in 2002 under the auspices of the Association of Medical School Microbiology and Immunology Chairs involving 64 medical educators in microbiology, immunology, and infectious diseases representing 54 U.S. medical schools. A 12-member bioterrorism expert reference panel participated in the final phase of the survey.

RESULTS

Study participants identified the top educational objectives for the following bioterrorism-related curriculum categories: general issues, biodefense, public health, infection control, infectious diseases, and toxins.

CONCLUSION

The study focused on preparedness training through the development of curricular guidelines in predominantly preclerkship medical education by identifying basic science and clinical laboratory aspects of putative biologic weapons organisms and toxins, clinical manifestations of bioterrorist attacks, treatment strategies, epidemiology, and prophylaxis.

The role of an advanced practice public health nurse in bioterrorism preparedness

The 2001 anthrax events have vividly illustrated that terrorism involving the release of a biological agent is a major public health emergency requiring an immediate and well-coordinated response. If healthcare professionals and emergency responders are to be prepared to manage such attacks, unprecedented cooperative efforts at the national, state, and local levels are necessary. To aid such efforts, advanced practice public health nurses (PHNs) must exercise their ability to collaborate with a variety of disciplines and communities. Using the Los Angeles County Public Health Nursing Practice Model, advanced practice PHNs can be trained to deal effectively with acts of bioterrorism. This model defines the practice of public health nursing as working on a population-based level to create conditions under which healthy people can live within healthy communities. This article will discuss the threat of bioterrorism and describe how the Public Health Nursing Practice Model can be applied to assist advanced practice PHNs in the development of a public health plan for preparedness and response to bioterrorism. Six specific interventions that enable advanced practice PHNs to affect populations at the community and systems level will be discussed along with the implications of bioterrorism for advanced practice public health nursing.

Bioterrorism in 2001 - How ready are we?

On January 30, 2001, the federal Immigration Department's headquarters in Ottawa were evacuated and shut down following a bioterrorism scare, which turned out to be a hoax. The building reopened 48 h later, after it was determined that the substance found was not anthrax (1). In the same week, a similar hoax forced the evacuation of an Ontario provincial government building in Toronto (1).

The threat of biological terrorism: a public health and infection control reality

Bioterrorism is an emerging public health and infection control threat. Potential biological agents include smallpox, anthrax, plague, tularemia, botulinum toxin, brucellosis, Q fever, viral encephalitis, hemorrhagic fever, and staphylococcal enterotoxin B. An understanding of the epidemiology, clinical manifestations, and management of the more likely candidate agents is critical to limiting morbidity and mortality from a biological event. Effective response requires an increased index of suspicion for unusual diseases or syndromes, with prompt reporting to health authorities to facilitate recognition of an outbreak and subsequent intervention. Hospital epidemiology programs will play a crucial role in this effort.