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Fryk JJ, Tong S, Marshall C, Rajkhowa A, Buising K, MacIsaac C, Walsham N, Thevarajan I. Knowledge, attitudes and practices of healthcare workers within an Australian tertiary hospital to managing high-consequence infectious diseases. Infect Dis Health 2021; 26:95-103. [PMID: 33189598 PMCID: PMC7657000 DOI: 10.1016/j.idh.2020.10.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 10/08/2020] [Accepted: 10/20/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Adequate preparation and support for healthcare workers (HCWs) managing high-consequence infectious diseases (HCIDs) is critical to the overall clinical management of HCIDs. Qualitative studies examining how well prepared and supported HCWs feel are lacking despite their key role. This study investigated how prepared and supported front-line HCWs at an Australian tertiary hospital felt about managing HCIDs such as viral haemorrhagic fever (VHF). METHODS A qualitative research approach was used to undertake interviews with 45 Royal Melbourne Hospital medical and nursing staff from emergency, intensive care and infectious diseases. Interview questions captured data on HCWs' role, familiarity with using protocols, psychological attributes and training for scenarios related to VHF patient management. Interviews were recorded and transcribed. Categorical responses were analysed quantitatively and open-ended responses were analysed thematically. RESULTS Ninety-eight percent of participants indicated feeling capable of undertaking their role in managing VHF patients; 77% felt supported through personnel/resources. However, 69% indicated barriers to managing these patients effectively; and 68% felt anxious at the prospect of managing VHF patients. Themes emerging from participants' observations included concerns about training frequency, miscommunication, difficulty with uncertainty, feeling underprepared, and fear of transmitting infection to others. CONCLUSION Although the majority of HCWs feel confident about their ability to care for VHF patients, they also have a moderately-high degree of anxiety. Perceptions of interviewed staff have fed into recommendations to increase HCW preparedness and reduce anxiety, which include investigating support services, and exploring training options that create multi-departmental groups of highly specialised medical officers and nurses.
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Affiliation(s)
- Jesse J Fryk
- Victorian Infectious Disease Service, The Royal Melbourne Hospital, Parkville, Australia; The Peter Doherty Institute for Infection and Immunity, University of Melbourne, Parkville, Australia; School of Population and Global Health, University of Melbourne, Parkville, Australia
| | - Steven Tong
- Victorian Infectious Disease Service, The Royal Melbourne Hospital, Parkville, Australia; The Peter Doherty Institute for Infection and Immunity, University of Melbourne, Parkville, Australia
| | - Caroline Marshall
- Victorian Infectious Disease Service, The Royal Melbourne Hospital, Parkville, Australia; The Peter Doherty Institute for Infection and Immunity, University of Melbourne, Parkville, Australia; Infection Prevention and Surveillance Service, The Royal Melbourne Hospital, Parkville, Australia
| | - Arjun Rajkhowa
- National Centre for Antimicrobial Stewardship, Department of Medicine and Radiology, University of Melbourne, Parkville, Australia; Department of Medicine and Radiology, The University of Melbourne, Parkville, Australia
| | - Kirsty Buising
- Victorian Infectious Disease Service, The Royal Melbourne Hospital, Parkville, Australia; The Peter Doherty Institute for Infection and Immunity, University of Melbourne, Parkville, Australia; National Centre for Antimicrobial Stewardship, Department of Medicine and Radiology, University of Melbourne, Parkville, Australia; Department of Medicine and Radiology, The University of Melbourne, Parkville, Australia
| | - Christopher MacIsaac
- Intensive Care Unit, The Royal Melbourne Hospital, Parkville, Australia; Department of Medicine and Radiology, The University of Melbourne, Parkville, Australia
| | - Nicola Walsham
- Emergency Department, The Royal Melbourne Hospital, Parkville, Australia
| | - Irani Thevarajan
- Victorian Infectious Disease Service, The Royal Melbourne Hospital, Parkville, Australia; The Peter Doherty Institute for Infection and Immunity, University of Melbourne, Parkville, Australia.
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Kumosani TA, Al-Malki AL, Razvi SS, Balgoon MJ, Kaleem M, Huwait EA, Alghamdi MA, Yaghmoor SS, Abualnaja KO, Barbour EK, AL-Madani KA, AlToukhi MH, Kumosani AT, Moselhy SS. Hemorrhagic fever in Saudi Arabia: challenge to public health, effective management and future considerations. Afr Health Sci 2020; 20:1153-1163. [PMID: 33402960 PMCID: PMC7751520 DOI: 10.4314/ahs.v20i3.17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background Viral hemorrhagic fevers (VHF) refers to a group of febrile illnesses caused by different viruses that result in high mortality in animals and humans. Many risk factors like increased human-animal interactions, climate change, increased mobility of people and limited diagnostic facility have contributed to the rapid spread of VHF. Materials The history of VHFs in the Saudi Arabian Peninsula has been documented since the 19th century, in which many outbreaks have been reported from the southwestern region of Saudi Arabia. Despite presence of regional network of experts and technical organizations, which expedite support and respond during outbreaks, there are some more challenges that need to be addressed immediately. Gaps in funding, exhaustive and inclusive response plans and improved surveillance systems are some areas of concern in the region which can be dealt productively. This review primarily focusses on the hemorrhagic fevers that are caused by three most common viruses namely, the Alkhurma hemorrhagic fever virus, Rift valley fever virus, and Dengue fever virus. Conclusion In summary, effective vector control, health education, possible use of vaccine and concerted synchronized efforts between different government organizations and private research institutions will help in planning effective outbreak-prevention and response strategies in future.
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Affiliation(s)
- Taha A Kumosani
- Department of Biochemistry, Faculty of Science, King Abdulaziz University, Jeddah, Saudi Arabia
- Experimental Biochemistry Unit, King Fahd Medical Research Center, King Abdulaziz University, Jeddah, Saudi Arabia
- Production of Bioproducts for Industrial Applications Research Group, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Abdulrahman L Al-Malki
- Department of Biochemistry, Faculty of Science, King Abdulaziz University, Jeddah, Saudi Arabia
- Experimental Biochemistry Unit, King Fahd Medical Research Center, King Abdulaziz University, Jeddah, Saudi Arabia
- Bioactive Natural Products Research Group, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Syed S Razvi
- Department of Biochemistry, Faculty of Science, King Abdulaziz University, Jeddah, Saudi Arabia
- Math and Science Department, Community College of Qatar
| | - Maha J Balgoon
- Department of Biochemistry, Faculty of Science, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Mohammed Kaleem
- Department of Biochemistry, Faculty of Science, King Abdulaziz University, Jeddah, Saudi Arabia
- Bioactive Natural Products Research Group, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Etimad A Huwait
- Department of Biochemistry, Faculty of Science, King Abdulaziz University, Jeddah, Saudi Arabia
- Production of Bioproducts for Industrial Applications Research Group, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Maryam A Alghamdi
- Department of Biochemistry, Faculty of Science, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Soonham S Yaghmoor
- Experimental Biochemistry Unit, King Fahd Medical Research Center, King Abdulaziz University, Jeddah, Saudi Arabia
- Production of Bioproducts for Industrial Applications Research Group, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Khalid O Abualnaja
- Department of Biochemistry, Faculty of Science, King Abdulaziz University, Jeddah, Saudi Arabia
- Bioactive Natural Products Research Group, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Elie K Barbour
- Department of Biochemistry, Faculty of Science, King Abdulaziz University, Jeddah, Saudi Arabia
- Experimental Biochemistry Unit, King Fahd Medical Research Center, King Abdulaziz University, Jeddah, Saudi Arabia
- Director of R and D Departement, Opticon Hygiene Consulting, Oechsli7,8807 Freienbach, Switzerland
| | - Khalid A AL-Madani
- Consultant in Clinical Nutrition, Member of the Boardof ILSI Middel East, Member of the Board of Saudi Society for Food and Nutrition. Advance Clinics, Jeddah, Saudi Arabia
| | - Majdi H AlToukhi
- General Supervisor Health and Environmental Department and Consultant, Public Health and Infectious Diseases
| | - Afnan T Kumosani
- Department of pathology and Laboratory Medicine, Blood Bank Transfusion medicine, King Abdulaziz Medical City, Jeddah, National Guards, Jeddah, 21423
| | - Said S Moselhy
- Biochemistry Department, Faculty of Science, Ain shams University, Cairo, Egypt
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Nicol ED, Mepham S, Naylor J, Mollan I, Adam M, d'Arcy J, Gillen P, Vincent E, Mollan B, Mulvaney D, Green A, Jacobs M. Aeromedical Transfer of Patients with Viral Hemorrhagic Fever. Emerg Infect Dis 2019; 25:5-14. [PMID: 30431424 PMCID: PMC6302577 DOI: 10.3201/eid2501.180662] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
For >40 years, the British Royal Air Force has maintained an aeromedical evacuation facility, the Deployable Air Isolator Team (DAIT), to transport patients with possible or confirmed highly infectious diseases to the United Kingdom. Since 2012, the DAIT, a joint Department of Health and Ministry of Defence asset, has successfully transferred 1 case-patient with Crimean-Congo hemorrhagic fever, 5 case-patients with Ebola virus disease, and 5 case-patients with high-risk Ebola virus exposure. Currently, no UK-published guidelines exist on how to transfer such patients. Here we describe the DAIT procedures from collection at point of illness or exposure to delivery into a dedicated specialist center. We provide illustrations of the challenges faced and, where appropriate, the enhancements made to the process over time.
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Green A. WHO investigates mysterious outbreak in South Sudan. Lancet 2016; 387:2589. [PMID: 27353810 DOI: 10.1016/s0140-6736(16)30890-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Abstract
Viral haemorrhagic fevers (VHFs) are currently at the forefront of the world's attention due to the recent Zaire ebola virus epidemic in West Africa. This epidemic has highlighted the frailty of the world's public health response mechanisms and demonstrated the potential risks to nations around the world of imported cases of epidemic diseases. While imported cases in children are less likely, the potential for such a scenario remains. It is therefore essential that paediatricians are aware of and prepared for potential imported cases of tropical diseases, VHFs being of particular importance due to their propensity to cause nosocomial spread. Examining the four families of viruses--Filoviridae, Arenaviridae, Bunyaviridae and Flaviviridae--we describe the different types of VHFs, with emphasis on differentiation from other diseases through detailed history-taking, their presentation and management from a paediatric perspective.
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Affiliation(s)
| | - Surjo De
- Imported Fever Service, Public Health England, Porton Down, Wiltshire, UK
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Reducing mortality from emerging diseases. Wkly Epidemiol Rec 2015; 90:121-3. [PMID: 25816447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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Affiliation(s)
- Tom E Fletcher
- Liverpool School of Tropical Medicine, Liverpool L3 5QA, UK
| | - Timothy J G Brooks
- Rare and Imported Pathogens Laboratory, Public Health England, Porton Down, Salisbury, UK
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8
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Chen ZH, Qin XC, Song R, Shen Y, Chen XP, Wang W, Zhao YX, Zhang JS, He JR, Li MH, Zhao XH, Liu DW, Fu XK, Tian D, Li XW, Xu J, Plyusnin A, Holmes EC, Zhang YZ. Co-circulation of multiple hemorrhagic fever diseases with distinct clinical characteristics in Dandong, China. PLoS One 2014; 9:e89896. [PMID: 24587107 PMCID: PMC3937409 DOI: 10.1371/journal.pone.0089896] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2013] [Accepted: 01/29/2014] [Indexed: 12/14/2022] Open
Abstract
Hemorrhagic fevers (HF) caused by viruses and bacteria are a major public health problem in China and characterized by variable clinical manifestations, such that it is often difficult to achieve accurate diagnosis and treatment. The causes of HF in 85 patients admitted to Dandong hospital, China, between 2011–2012 were determined by serological and PCR tests. Of these, 34 patients were diagnosed with Huaiyangshan hemorrhagic fever (HYSHF), 34 with Hemorrhagic Fever with Renal Syndrome (HFRS), one with murine typhus, and one with scrub typhus. Etiologic agents could not be determined in the 15 remaining patients. Phylogenetic analyses of recovered bacterial and viral sequences revealed that the causative infectious agents were closely related to those described in other geographical regions. As these diseases have no distinctive clinical features in their early stage, only 13 patients were initially accurately diagnosed. The distinctive clinical features of HFRS and HYSHF developed during disease progression. Enlarged lymph nodes, cough, sputum, and diarrhea were more common in HYSHF patients, while more HFRS cases presented with headache, sore throat, oliguria, percussion pain kidney area, and petechiae. Additionally, HYSHF patients displayed significantly lower levels of white blood cells (WBC), higher levels of creations kinase (CK) and alanine aminotransferase (ALT), while HFRS patients presented with an elevation of blood urea nitrogen (BUN) and creatinine (CREA). These clinical features will assist in the accurate diagnosis of both HYSHF and HFRS. Overall, our data reveal the complexity of pathogens causing HFs in a single Chinese hospital, and highlight the need for accurate early diagnosis and a better understanding of their distinctive clinical features.
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Affiliation(s)
- Zhi-Hai Chen
- Department of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Xin-Cheng Qin
- State Key Laboratory for Infectious Disease Prevention and Control, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Department of Zoonoses, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Rui Song
- Department of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Yi Shen
- Department of Infectious Diseases, Dandong Infectious Hospital, Dandong, Liaoning Province, China
| | - Xiao-Ping Chen
- State Key Laboratory for Infectious Disease Prevention and Control, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Department of Zoonoses, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Wen Wang
- State Key Laboratory for Infectious Disease Prevention and Control, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Department of Zoonoses, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yong-Xiang Zhao
- Department of Infectious Diseases, Dandong Infectious Hospital, Dandong, Liaoning Province, China
| | - Jing-Shan Zhang
- State Key Laboratory for Infectious Disease Prevention and Control, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Department of Zoonoses, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Jin-Rong He
- State Key Laboratory for Infectious Disease Prevention and Control, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Department of Zoonoses, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Ming-Hui Li
- State Key Laboratory for Infectious Disease Prevention and Control, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Department of Zoonoses, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Xue-Hua Zhao
- Department of Infectious Diseases, Dandong Infectious Hospital, Dandong, Liaoning Province, China
| | - De-Wei Liu
- Department of Infectious Diseases, Dandong Infectious Hospital, Dandong, Liaoning Province, China
| | - Xiao-Kang Fu
- Department of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Di Tian
- Department of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Xing-Wang Li
- Department of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Jianguo Xu
- State Key Laboratory for Infectious Disease Prevention and Control, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Department of Zoonoses, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Alexander Plyusnin
- State Key Laboratory for Infectious Disease Prevention and Control, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Department of Zoonoses, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
- Department of Virology, Haartman Institute, University of Helsinki, Finland
| | - Edward C. Holmes
- Marie Bashir Institute for Infectious Diseases and Biosecurity, School of Biological Sciences and Sydney Medical School, The University of Sydney, Sydney, Australia
| | - Yong-Zhen Zhang
- State Key Laboratory for Infectious Disease Prevention and Control, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Department of Zoonoses, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
- * E-mail:
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Abstract
Access to critical care is rapidly growing in areas of the world where it was previously nonexistent and where infectious diseases often comprise the largest disease burden. Additionally, with crowding, mass migrations, and air travel, infectious diseases previously geographically confined are quickly spread across the planet, often in shorter time frames than disease incubation periods. Hence, critical care practitioners must be familiar with infectious diseases previously confined to the developing world. This article reviews selected tropical diseases that are seen in diverse locales and often require critical care services.
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Affiliation(s)
- Srinivas Murthy
- Department of Critical Care Medicine, Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, Ontario M5G 1X8, Canada.
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Kotturi MF, Botten J, Sidney J, Bui HH, Giancola L, Maybeno M, Babin J, Oseroff C, Pasquetto V, Greenbaum JA, Peters B, Ting J, Do D, Vang L, Alexander J, Grey H, Buchmeier MJ, Sette A. A multivalent and cross-protective vaccine strategy against arenaviruses associated with human disease. PLoS Pathog 2009; 5:e1000695. [PMID: 20019801 PMCID: PMC2787016 DOI: 10.1371/journal.ppat.1000695] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2009] [Accepted: 11/17/2009] [Indexed: 01/06/2023] Open
Abstract
Arenaviruses are the causative pathogens of severe hemorrhagic fever and aseptic meningitis in humans, for which no licensed vaccines are currently available. Pathogen heterogeneity within the Arenaviridae family poses a significant challenge for vaccine development. The main hypothesis we tested in the present study was whether it is possible to design a universal vaccine strategy capable of inducing simultaneous HLA-restricted CD8+ T cell responses against 7 pathogenic arenaviruses (including the lymphocytic choriomeningitis, Lassa, Guanarito, Junin, Machupo, Sabia, and Whitewater Arroyo viruses), either through the identification of widely conserved epitopes, or by the identification of a collection of epitopes derived from multiple arenavirus species. By inoculating HLA transgenic mice with a panel of recombinant vaccinia viruses (rVACVs) expressing the different arenavirus proteins, we identified 10 HLA-A02 and 10 HLA-A03-restricted epitopes that are naturally processed in human antigen-presenting cells. For some of these epitopes we were able to demonstrate cross-reactive CD8+ T cell responses, further increasing the coverage afforded by the epitope set against each different arenavirus species. Importantly, we showed that immunization of HLA transgenic mice with an epitope cocktail generated simultaneous CD8+ T cell responses against all 7 arenaviruses, and protected mice against challenge with rVACVs expressing either Old or New World arenavirus glycoproteins. In conclusion, the set of identified epitopes allows broad, non-ethnically biased coverage of all 7 viral species targeted by our studies. Arenaviruses cause significant morbidity and mortality worldwide and are also regarded as a potential bioterrorist threat. CD8+ T cells restricted by class I MHC molecules clearly play a protective role in murine models of arenavirus infection, yet little is known about the epitopes recognized in the context of human class I MHC (HLA). Here, we defined 20 CD8+ T cell epitopes restricted by HLA class I molecules, derived from 7 different species of arenaviruses associated with human disease. To accomplish this task, we utilized epitope predictions, in vitro HLA binding assays, and HLA transgenic mice inoculated with recombinant vaccinia viruses (rVACV) expressing arenavirus antigens. Because our analysis targeted two of the most common HLA types worldwide, we project that the CD8+ T cell epitope set provides broad coverage against diverse ethnic groups within the human population. Furthermore, we show that immunization with a cocktail of these epitopes protects HLA transgenic mice from challenge with rVACV expressing antigens from different arenavirus species. Our findings suggest that a cell-mediated vaccine strategy might be able to protect against infection mediated by multiple arenavirus species.
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Affiliation(s)
- Maya F. Kotturi
- Division of Vaccine Discovery, La Jolla Institute for Allergy and Immunology, La Jolla, California, United States of America
| | - Jason Botten
- Vermont Center for Immunology and Infectious Diseases, The University of Vermont College of Medicine, Burlington, Vermont, United States of America
| | - John Sidney
- Division of Vaccine Discovery, La Jolla Institute for Allergy and Immunology, La Jolla, California, United States of America
| | - Huynh-Hoa Bui
- Division of Vaccine Discovery, La Jolla Institute for Allergy and Immunology, La Jolla, California, United States of America
| | - Lori Giancola
- Division of Vaccine Discovery, La Jolla Institute for Allergy and Immunology, La Jolla, California, United States of America
| | - Matt Maybeno
- Division of Vaccine Discovery, La Jolla Institute for Allergy and Immunology, La Jolla, California, United States of America
| | - Josie Babin
- Division of Vaccine Discovery, La Jolla Institute for Allergy and Immunology, La Jolla, California, United States of America
| | - Carla Oseroff
- Division of Vaccine Discovery, La Jolla Institute for Allergy and Immunology, La Jolla, California, United States of America
| | - Valerie Pasquetto
- Division of Vaccine Discovery, La Jolla Institute for Allergy and Immunology, La Jolla, California, United States of America
| | - Jason A. Greenbaum
- Division of Vaccine Discovery, La Jolla Institute for Allergy and Immunology, La Jolla, California, United States of America
| | - Bjoern Peters
- Division of Vaccine Discovery, La Jolla Institute for Allergy and Immunology, La Jolla, California, United States of America
| | - Joey Ting
- Departments of Molecular Biology and Biochemistry and Community and Environmental Medicine, University of California, Irvine, California, United States of America
| | - Danh Do
- Vermont Center for Immunology and Infectious Diseases, The University of Vermont College of Medicine, Burlington, Vermont, United States of America
| | - Lo Vang
- Pharmexa-Epimmune, San Diego, California, United States of America
| | - Jeff Alexander
- Pharmexa-Epimmune, San Diego, California, United States of America
| | - Howard Grey
- Division of Vaccine Discovery, La Jolla Institute for Allergy and Immunology, La Jolla, California, United States of America
| | - Michael J. Buchmeier
- Departments of Molecular Biology and Biochemistry and Community and Environmental Medicine, University of California, Irvine, California, United States of America
| | - Alessandro Sette
- Division of Vaccine Discovery, La Jolla Institute for Allergy and Immunology, La Jolla, California, United States of America
- * E-mail:
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Carod-Artal FJ. [Strokes caused by infection in the tropics]. Rev Neurol 2007; 44:755-63. [PMID: 17583870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
INTRODUCTION Almost three out of every four people in the world who suffer a fatal stroke live in developing countries. A number of different tropical diseases may appear in Europe in the coming years as a consequence of the demographic change that is being brought about by migratory flows. We review the main infectious causes of strokes in the tropics. DEVELOPMENT There are estimated to be 500 million cases of malaria every year. Cerebral malaria can cause cerebral oedema, diffuse or focal compromise of the subcortical white matter and cortical, cerebellar and pontine infarctions. Chagas disease is an independent risk factor for stroke in South America. At least 20 million people have the chronic form of Chagas disease. The main prognostic factors for Chagas-related stroke are the presence of apical aneurysms, arrhythmia and heart failure. Vascular complications of neurocysticercosis include transient ischemic attacks, ischemic strokes due to angiitis and intracranial haemorrhages. The frequency of cerebral infarction associated with neurocysticercosis varies between 2% and 12%. Gnathostomiasis is a cause of subarachnoid haemorrhage in south-east Asia. Other less common causes of stroke are viral haemorrhagic fevers due to arenavirus and flavivirus. CONCLUSIONS Several diseases that are endemic in the tropics can be responsible for up to 10% of the cases of strokes in adults.
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Affiliation(s)
- F J Carod-Artal
- Servicio de Neurología, Hospital Sarah, Red Sarah de Hospitales de Rehabilitación, Brasilia DF, Brasil.
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12
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Abstract
Viral exanthems are a common problem in tropical regions, particularly affecting children. Most exanthems are transient and harmless, but some are potentially very dangerous. Pregnant women and malnourished or immunocompromised infants carry the greatest risk of adverse outcome. In this article, parvovirus B19; dengue and yellow fever; West Nile, Barmah Forest, Marburg, and Ebola viruses, and human herpesviruses; asymmetric periflexural exanthema of childhood; measles; rubella; enteroviruses; Lassa fever; and South American hemorrhagic fevers will be discussed.
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Abstract
This article describes infectious diseases that are of special importance to intensivists. The emphasis on epidemiology notwithstanding, it also addresses clinical, diagnostic, and treatment issues related to each infection described. The discussion avoids terrorism-related aspects of these infections, because they were very well covered in the October 2005 issue of the Critical Care Clinics.
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Affiliation(s)
- Raul E Istúriz
- Department of Medicine, Infectious Diseases, Centro Médico de Caracas, Av. El Estanque, San Bernardino, Caracas 1011, Venezuela.
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Borisevich IV, Markin VA, Firsova IV, Evseev AA, Khamitov RA, Maksimov VA. [Hemorrhagic (Marburg, Ebola, Lassa, and Bolivian) fevers: epidemiology, clinical pictures, and treatment]. Vopr Virusol 2006; 51:8-16. [PMID: 17087059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
The evaluation of the biological and epidemiological properties of Ebola, Marburg, Lassa, and Machupo viruses suggests that they are of social importance for health care authorities. The studies have created prerequisites to the development of reliable biosafety means against these pathogens. Particular emphasis is laid on the methods for infection diagnosis and on the studies to design specific protective agents--immunoglobulins and inactivated vaccines.
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Abstract
The viral haemorrhagic fevers are a group of diseases that share many clinical features. Ebola, Marburg and Lassa are diseases that cause a relatively small number of deaths globally, but pose special risks to medical staff due to the ease of transmission, and can have a profound impact to the communities they affect. This article gives a brief overview of diseases caused by the Ebola, Marburg and Lassa viruses. It gives some practical advice to the clinician on the diagnosis and management of these diseases.
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Abstract
This article reviews the epidemiology, pathophysiology, and clinical management of patients with suspected or confirmed viral hemorrhagic fever infection. The focus is on clinical management based on case series from naturally occuring outbreaks of viral hemorrhagic fever infection as well as imported cases of viral hemorrhagic fever encountered in industrialized nations. The potential risk of bioterrorism involving these agents is discussed as well as emergency department and critical care management of isolated cases or larger outbreaks. Important aspects of management, including recognition of infected patients, isolation and decontamination procedures, as well as available vaccines and therapies are emphasized.
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Affiliation(s)
- David C Pigott
- Department of Emergency Medicine, The University of Alabama at Birmingham, 619 South 19th Street, Birmingham, AL 35249-7013, USA.
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Ippolito G, Nicastri E, Capobianchi M, Di Caro A, Petrosillo N, Puro V. Hospital preparedness and management of patients affected by viral haemorrhagic fever or smallpox at the Lazzaro Spallanzani Institute, Italy. Euro Surveill 2005; 10:36-9. [PMID: 15827373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023] Open
Abstract
The US cases of anthrax in 2001 and the recent severe acute respiratory syndrome outbreak have heightened the need for preparedness and response to naturally emerging and re-emerging infections or deliberately released biological agents. This report describes the response model of the Istituto Nazionale per le Malattie Infettive Lazzaro Spallanzani (INMI), Rome, Italy for managing patients suspected of or affected by smallpox or viral haemorrhagic fever (VHF) either in the context of an intentional release or natural occurrence. The INMI is Italy's leading hospital in its preparedness and response plan to bioterrorism-related infectious agents. All single and double rooms of INMI are equipped with negative air pressure, sealed doors, high efficiency particulate air (HEPA) filters and a fully-equipped anteroom; moreover, a dedicated high isolation unit with a laboratory next door for the initial diagnostic assays is available for admission of sporadic patients requiring high isolation. For patient transportation, two fully equipped ambulances and two stretcher isolators with a negative pressure section are available. Biomolecular and traditional diagnostic assays are currently performed in the biosafety level 3/4 (BSL 3/4) laboratories. Continuing education and training of hospital staff, consistent application of infection control practices, and availability of adequate personnel protective equipment are additional resources implemented for the care of highly infectious patients and to maintain the readiness of an appropriately trained workforce to handle large scale outbreaks.
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Affiliation(s)
- G Ippolito
- Istituto Nazionale per le Malattie Infettive Lazzaro Spallanzani, Rome, Italy
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Bossi P, Tegnell A, Baka A, Van Loock F, Hendriks J, Werner A, Maidhof H, Gouvras G. Bichat guidelines for the clinical management of haemorrhagic fever viruses and bioterrorism-related haemorrhagic fever viruses. Euro Surveill 2004; 9:E11-2. [PMID: 15677844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023] Open
Abstract
Haemorrhagic fever viruses (HFVs) are a diverse group of viruses that cause a clinical disease associated with fever and bleeding disorder. HFVs that are associated with a potential biological threat are Ebola and Marburg viruses (Filoviridae), Lassa fever and New World arenaviruses (Machupo, Junin, Guanarito and Sabia viruses) (Arenaviridae), Rift Valley fever (Bunyaviridae) and yellow fever, Omsk haemorrhagic fever, and Kyanasur Forest disease (Flaviviridae). In terms of biological warfare concerning dengue, Crimean-Congo haemorrhagic fever and Hantaviruses, there is not sufficient knowledge to include them as a major biological threat. Dengue virus is the only one of these that cannot be transmitted via aerosol. Crimean-Congo haemorrhagic fever and the agents of haemorrhagic fever with renal syndrome appear difficult to weaponise. Ribavirin is recommended for the treatment and the prophylaxis of the arenaviruses and the bunyaviruses, but is not effective for the other families. All patients must be isolated and receive intensive supportive therapy.
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Affiliation(s)
- Philippe Bossi
- Task Force on Biological and Chemical Agent Threats, Public Health Directorate, European Commission, Luxembourg.
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19
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Abstract
The use of micro-organisms as agents of biological warfare is considered inevitable for several reasons, including ease of production and dispersion, delayed onset of symptoms, ability to cause high rates of morbidity and mortality and difficulty in diagnosis. Therefore, the clinical presentation and pathogenesis of the organisms posing the highest threat (variola major, Bacillus anthracis, Yersinia pestis, Clostridium botulinum toxin, Francisella tularensis, filoviruses, arenaviruses and Brucella species), as well as the available diagnostic techniques and treatments for such infections, will be reviewed in this article. Due to the necessity of rapid identification and diagnosis, molecular techniques have been the ongoing focus of current research. Consequently, the molecular diagnostic techniques that have recently been developed for the diseases associated with these agents will be emphasized.
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Affiliation(s)
- Marcia A Firmani
- Department of Clinical Laboratory Sciences, Louisiana State University Health Sciences Center, 1900 Gravier Street, New Orleans, LA 70112-2223, USA.
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Abstract
BACKGROUND Dentists' responses to catastrophe have been redefined by bioterrorism. Informed response requires accurate information about agents and diseases that have the potential to be used as weapons. METHODS The authors reviewed information about the most probable bioterrorist weapons (those from the Center for Disease Control and Prevention's Category A) from the World Wide Web and print journals and distilled it into a resource list that is current, relevant to dentistry and noncommercial. The Web sites cited include those sponsored by federal agencies, academic institutions and professional organizations. The articles cited include those published in English within the last six years in refereed journals that are available in most higher education institutions. RESULTS The authors present the information in a table that provides a quick-reference guide to resources describing agents and diseases with the greatest potential for use as weapons: anthrax, botulism, plague, smallpox, tularemia and viral hemorrhagic fevers. This article presents Web site and journal citations for background and patient-oriented information (fact sheets), signs and symptoms, and prophylactic measures and treatment for each of the agents and diseases. The table facilitates quick access to this information, especially in an emergency. This article also points out guidelines for response should a suspected attack occur. CONCLUSIONS Armed with information about biological weapons, dentists can provide faster diagnosis, inform their patients about risks, prophylaxis or treatment and rethink their own role in terrorism response. CLINICAL IMPLICATIONS Fast, accurate diagnosis limits the spread of exceptionally contagious diseases. Providing accurate information to patients minimizes misinformation and the associated public fear and panic that, unchecked, could overwhelm health care systems.
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Affiliation(s)
- Susan Z Han
- Harvard School of Dental Medicine, Boston, USA
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Affiliation(s)
- T Debord
- Service des maladies infectieuses et tropicales, hôpital militaire Bégin, Saint-Mandé, France
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Sata T, Shimazaki K, Sato Y, Kurata T. [Viral hemorrhagic fever]. Nihon Rinsho 2003; 61 Suppl 2:281-7. [PMID: 12722229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/20/2023]
Affiliation(s)
- Tetsutaro Sata
- Department of Pathology, National Institute of Infectious Diseases
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Visser LG, Schippers EF, van den Broek PJ, Swaan CM. [How to treat a patient with indications for an infectious viral hemorrhagic fever]. Ned Tijdschr Geneeskd 2003; 147:221-2. [PMID: 12645357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
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24
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Bronze MS, Greenfield RA. Therapeutic options for diseases due to potential viral agents of bioterrorism. Curr Opin Investig Drugs 2003; 4:172-8. [PMID: 12669378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
The etiologic agents of smallpox and viral hemorrhagic fever have emerged as potential agents of bioterrorism due to their virulence, potential for human to human dissemination and limited strategies for treatment and prevention. Cidofovir has shown significant promise in animal models, and limited case reports in humans are encouraging. Ribavirin is the treatment of choice for certain hemorrhagic fever viral infections, but has no current application to Ebola and Marburg infections. Current vaccine strategies for smallpox are effective, but carry significant risk for complications. Licensed vaccines for hemorrhagic fever viruses are limited to yellow fever, but animal studies are promising. Genomic analysis of the viral pathogen and the animal model response to infection may provide valuable information enabling the development of novel treatment and prevention strategies. Current knowledge of these strategies is reviewed.
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Affiliation(s)
- Michael S Bronze
- Department of Medicine, University of Oklahoma Health Sciences Center, Williams Pavilion, Room WP2080, 920 Stanton Young Blvd, Oklahoma City, OK 73190, USA.
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Bronze MS, Voskuhl GW, Machado LJ, Greenfield RA. The potential role of viral pathogens as agents of bioterrorism. J Okla State Med Assoc 2003; 96:29-33. [PMID: 12632851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Affiliation(s)
- Michael S Bronze
- Department of Medicine, University of Oklahoma Health Sciences Center, Room WP2080, 920 Stanton Young Blvd, Oklahoma City, OK 73190, USA.
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26
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Zieliński A, Rosińska M, Gut W. [Viral hemorrhagic fevers--epidemiology and clinical picture]. Przegl Epidemiol 2003; 57:639-54. [PMID: 15029840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
The article presents current knowledge about viral hemorrhagic fevers (VHF), their epidemiology, etiological factors, pathogenesis, symptoms and clinical management. Since none of the diseases appear endemically in Poland, special attention was given to spatial distribution of VHF for the purpose to facilitate undertaking clinical suspicions on the basis of the patient's recent travels. Determining the etiological agent should lead to selection of appropriate management options.
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Abstract
The term viral hemorrhagic fever refers to an acute systemic illness with a propensity for bleeding and shock. The viral hemorrhagic fevers endemic in the Americas include yellow fever, dengue hemorrhagic fever, the South American hemorrhagic fevers, hantavirus pulmonary syndrome, and hemorrhagic fever with renal syndrome. Because these diseases are primarily zoonotic, the distribution of any given virus is generally restricted by the distribution of its natural reservoir or arthropod vector. A high index of suspicion, detailed investigation of the travel and exposure history of the patient, and a basic understanding of the incubation periods and distributions of the various reservoirs of hemorrhagic fever viruses are imperative, as are prompt notification and laboratory confirmation. Clinical management is largely supportive, with a special emphasis on safe nursing practices to prevent nosocomial transmission.
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Affiliation(s)
- Daniel G Bausch
- Special Pathogens Branch, MS G-14, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30333, USA.
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28
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Visser LG, Schippers EF, Swaan CM, van den Broek PJ. [How to treat a patient with indications for an infectious viral hemorrhagic fever]. Ned Tijdschr Geneeskd 2002; 146:2183-8. [PMID: 12467160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/27/2023]
Abstract
Lassa, Ebola, Marburg and Crimean-Congo haemorrhagic fever viruses are the most important causes of viral haemorrhagic fever which is transmitted from person to person through contact with blood or excreta. A non-specific fever may be the initial symptom of viral haemorrhagic fever. By means of carefully noting where the patient has travelled, possible exposure to ill persons, vectors or an animal reservoir, and the incubation period (< or = 21 days versus longer), it is possible to estimate the risk of infection with one of these viruses. Using this approach it is possible to diagnose high-risk patients in good time and to take appropriate measures.
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Affiliation(s)
- L G Visser
- Leids Universitair Medisch Centrum, afd. Infectieziekten, Postbus 9600, 2300 RC Leiden
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Straight TM, Lazarus AA, Decker CF. Defending against viruses in biowarfare. How to respond to smallpox, encephalitides, hemorrhagic fevers. Postgrad Med 2002; 112:75-6, 79-80, 85-6. [PMID: 12198755 DOI: 10.3810/pgm.2002.08.1276] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The threat of bioterrorism with use of viruses is increasing. Smallpox, encephalitis, and hemorrhagic fevers are the most likely diseases to result from viral deployment. It is critical that all healthcare professionals become familiar with the clinical presentation, diagnosis, management, and prevention of these diseases. Awareness and preparedness are instrumental in reducing viral transmission and improving survival of the victims.
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Affiliation(s)
- Timothy M Straight
- Department of Medicine, Infectious Disease Service, Walter Reed Army Medical Center, 6800 Georgia Ave, Washington, DC 20317, USA.
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31
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Abstract
Although once considered unlikely, bioterrorism is now a reality in the United States since the anthrax cases began appearing in the fall of 2001. Intelligence sources indicate there are many countries and terrorist organizations that either possess biological weapons or are attempting to procure them. In the future it is likely that we will experience additional acts of bioterrorism. The CDC category A agents represent our greatest challenge because they have the potential to cause grave harm to the medical and public health systems of a given population. Thus, it is imperative that plans be developed now to deal with the consequences of an intentional release of any one or more of these pathogens.
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Affiliation(s)
- Robert G Darling
- Operational Medicine Division, US Army Medical Research Institute of Infectious Diseases (USAMRIID), 1425 Porter Street, ATTN: MCMR-UIM-O, Fort Detrick, MD 21702-5011, USA.
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32
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Steinhauer R. Bioterrorism. RN 2002; 65:48-54; quiz 55. [PMID: 11961869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
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Abstract
The objective of this article is to provide a concise overview of the most likely biological and chemical agents that could be used as biochemical weapons. The diagnosis, pathology, prevention, decontamination, treatment, and disposition of these biological and chemical agents are presented in a tabular format for quick reference purposes. The information provided outlines the bare essentials needed to deal with any emergency or catastrophic event involving these agents.
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Affiliation(s)
- Mark Rosenbloom
- Northwestern University School of Medicine, Chicago, IL, USA
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34
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Drugs and vaccines against biological weapons. Conn Med 2001; 65:719-20. [PMID: 11797482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
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35
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Drugs and vaccines for biological weapons. Med Lett Drugs Ther 2001; 43:87-9. [PMID: 11606896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
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36
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Armignacco O, Lauria FN, Puro V, Macrì G, Petrecchia A, Ippolito G. The model of response to viral haemorrhagic fevers of the National Institute for Infectious Diseases "Lazzaro Spallanzani". J BIOL REG HOMEOS AG 2001; 15:314-21. [PMID: 11693443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
Viral haemorrhagic fevers (VHF) are severe and life-threatening diseases caused by a range of viruses. However, only four agents of VHF are known to be readily capable of person-to-person spread: Lassa virus, Crimean/Congo haemorrhagic fever virus, Ebola and Marburg viruses. Diseases caused by these viruses are endemic only in few areas in the world, most notably Africa and some rural parts of the Middle East and Eastern Europe. Nonetheless, the increasing volume of international travel presents a greater likelihood for the importation of these infections or of suspected cases in non endemic countries. Four conditions can lead to the importation and to the subsequent recognition of VHF within Europe: 1) patients arriving as a result of a planned medical evacuation; 2) persons who became sick on route to their destination; 3) persons discovered ill when entering a country, for example during routine clinical examination at the airport; 4) persons becoming sick after their arrival. Public health implications and the risk of secondary spread of pathogens in the above reported circumstances are very different. Similarly, preparedness and response should vary. This paper summarizes the present knowledge on the four VHF capable of person-to-person spread, describes the high isolation area constructed at the Italian National Institute for Infectious Diseases Lazzaro Spallanzani in Rome to respond to the occurrence of VHF. A brief overview of procedures and equipment adopted is provided.
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Affiliation(s)
- O Armignacco
- National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS, Rome, Italy
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Affiliation(s)
- R J Bellamy
- Department of Infectious Diseases, University Hospital of Wales, Cardiff, UK.
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38
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Abstract
Hantaviruses and arenaviruses are naturally occurring viruses of rodents. Four South American hemorrhagic fevers caused by arenaviruses have emerged in the last 5 decades. All have similar clinical manifestations, with a case-fatality rate as high as 15% to 30%. Hantavirus infections have been increasingly recognized in South America since the description in 1993 of Hantavirus pulmonary syndrome. Given the diversity of rodent species in the region, it can be foreseen that many other viruses will be discovered, and some of them will be causing human illnesses of high public health impact.
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Affiliation(s)
- D A Enria
- Instituto Nacional de Enfermedades Virales Humanas Dr. Julio I. Maiztegui, Administración Nacional de Laboratories e Institutos de Salud (ANLIS), Pergamino, Argentina.
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40
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Abstract
The recently revised Japanese Law on Infectious Diseases designates pest, Lassa, Marburg, Ebola and Crimean-Congo hemorrhagic diseases should be treated in an MBSL-level ward and that it should be constructed in each prefecture. However, pest can be treated with several antibiotics easily in an ordinary infectious disease ward. Lassa, Marburg and Ebola virus diseases are endemic in tropical Africa and only Lassa fever was imported into Japan in 1987. The probability of its importation to each prefecture is calculated on an assumption that a Lassa fever patient may be imported into Japan once in 10 years. Its incidence was calculated in comparison with the incidence of imported malaria from the African continent. Its probability P is calculated as follows. Corrected number of imported malaria patients from the African continent per year for each prefecture CN is divided by 445. 445 is the number of imported malaria patients from the African continent in ten years. Finally 445/CN is the number of years needed for each prefecture to import one case of Lassa fever. The results indicate that it takes 37 years for Metropolitan Tokyo where the largest number of malaria patients are imported annually. Other prefectures need more than 100 to 10,000 years, with an average of 1,017 years, for importation of one patient of Lassa fever. It is concluded that construction of an MBSL-level ward in each prefecture is unnecessary. The reports that the above mentioned viral hemorrhagic diseases can be treated safely in the ordinary infectious disease ward should be carefully reviewed.
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Abstract
Military personnel are frequently deployed to distant locations around the world under conditions of great stress, which involve potential exposure to hazardous viruses that are not commonly seen in the developed world. This article will provide an overview of two clinical presentations of viral infections of potential military significance: hemorrhagic fever and poxvirus infections. The three viral hemorrhagic fever viruses described--dengue, hemorrhagic fever with renal syndrome, and Congo-Crimean hemorrhagic fever--represent the diversity of potential hemorrhagic fever viruses that military forces may be exposed. Human poxvirus infections are currently uncommon but knowledge of these agents, will again become important should a terrorist threat of the use of smallpox become real and widespread use of vaccinia be considered to protect the military force.
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Affiliation(s)
- D L Mayers
- Viral and Rickettsial Disease Program, Naval Medical Research Institute, Bethesda, Maryland, USA
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de Manzione N, Salas RA, Paredes H, Godoy O, Rojas L, Araoz F, Fulhorst CF, Ksiazek TG, Mills JN, Ellis BA, Peters CJ, Tesh RB. Venezuelan hemorrhagic fever: clinical and epidemiological studies of 165 cases. Clin Infect Dis 1998; 26:308-13. [PMID: 9502447 DOI: 10.1086/516299] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Epidemiological and clinical data are presented on 165 cases of Venezuelan hemorrhagic fever (VHF), a newly emerging viral zoonosis caused by Guanarito virus (of the family Arenaviridae). The disease is endemic in a relatively circumscribed area of central Venezuela. Since its first recognition in 1989, the incidence of VHF has peaked each year between November and January, during the period of major agricultural activity in the region of endemicity. The majority of cases have involved male agricultural workers. Principal symptoms among the patients with VHF included fever, malaise, headache, arthralgia, sore throat, vomiting, abdominal pain, diarrhea, convulsions, and a variety of hemorrhagic manifestations. The majority of patients also had leukopenia and thrombocytopenia. The overall fatality rate among the 165 cases was 33.3%, despite hospitalization and vigorous supportive care.
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Affiliation(s)
- N de Manzione
- Regional Research Unit, Portuguesa State Division of Health, Guanare, Venezuela
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Abstract
Sensationalised accounts of wards of dying patients have fueled intense public fascination with filoviruses and highlighted the global threat of emerging and re-emerging infectious diseases. Filoviruses are the prototypical emerging pathogens: they cause a haemorrhagic disease of high case-fatality associated with explosive outbreaks due to person-to-person transmission, have no known treatment, occur unpredictably, and have an unknown reservoir. In truth, since their initial discovery in 1967, only a handful of filoviral outbreaks have occurred, mostly in remote locations. However, the documented occurrence of secondary cases in locations far from endemic areas validates the concern that filoviruses have the potential to cause unprecedented outbreaks in the future.
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Affiliation(s)
- A S Khan
- Special Pathogens Branch, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA
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44
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Management and control of viral haemorrhagic fevers. Commun Dis Rep CDR Wkly 1997; 7:57, 60. [PMID: 9048449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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45
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Ignat'ev GM, Kashentseva EA, Kaliberov SA, Prozorovskiĭ NS. [Experimental study of the effect of the drug desferal and serum against tumor necrosis factor on the course of the infectious process in arenaviral hemorrhagic fever]. Antibiot Khimioter 1996; 41:30-4. [PMID: 8929116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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46
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Yong BH. Critical care aspects of dengue haemorrhagic fever/dengue shock syndrome. Malays J Pathol 1993; 15:35-9. [PMID: 8277788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Affiliation(s)
- B H Yong
- Department of Anaesthesiology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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48
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Lum LC. Management of dengue haemorrhagic fever/dengue shock syndrome. Malays J Pathol 1993; 15:29-33. [PMID: 8277786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Affiliation(s)
- L C Lum
- Department of Paediatrics, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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49
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50
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Management of patients with suspected viral hemorrhagic fever. MMWR Suppl 1988; 37:1-16. [PMID: 3126390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
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