CRISPR/Cas9 as an antiviral against Orthopoxviruses using an AAV vector

A vaccine for smallpox is no longer administered to the general public, and there is no proven, safe treatment specific to poxvirus infections, leaving people susceptible to infections by smallpox and other zoonotic Orthopoxviruses such as monkeypox. Using vaccinia virus (VACV) as a model organism for other Orthopoxviruses, CRISPR-Cas9 technology was used to target three essential genes that are conserved across the genus, including A17L, E3L, and I2L. Three individual single guide RNAs (sgRNAs) were designed per gene to facilitate redundancy in rendering the genes inactive, thereby reducing the reproduction of the virus. The efficacy of the CRISPR targets was tested by transfecting human embryonic kidney (HEK293) cells with plasmids encoding both SaCas9 and an individual sgRNA. This resulted in a reduction of VACV titer by up to 93.19% per target. Following the verification of CRISPR targets, safe and targeted delivery of the VACV CRISPR antivirals was tested using adeno-associated virus (AAV) as a packaging vector for both SaCas9 and sgRNA. Similarly, AAV delivery of the CRISPR antivirals resulted in a reduction of viral titer by up to 92.97% for an individual target. Overall, we have identified highly specific CRISPR targets that significantly reduce VACV titer as well as an appropriate vector for delivering these CRISPR antiviral components to host cells in vitro.

The Role of Brincidofovir in Preparation for a Potential Smallpox Outbreak

Smallpox (variola) virus is considered a Category A bioterrorism agent due to its ability to spread rapidly and the high morbidity and mortality rates associated with infection. Current recommendations recognize the importance of oral antivirals and call for having at least two smallpox antivirals with different mechanisms of action available in the event of a smallpox outbreak. Multiple antivirals are recommended due in large part to the propensity of viruses to become resistant to antiviral therapy, especially monotherapy. Advances in synthetic biology heighten concerns that a bioterror attack with variola would utilize engineered resistance to antivirals and potentially vaccines. Brincidofovir, an oral antiviral in late stage development, has proven effective against orthopoxviruses in vitro and in vivo, has a different mechanism of action from tecovirimat (the only oral smallpox antiviral currently in the US Strategic National Stockpile), and has a resistance profile that reduces concerns in the scenario of a bioterror attack using genetically engineered smallpox. Given the devastating potential of smallpox as a bioweapon, preparation of a multi-pronged defense that accounts for the most obvious bioengineering possibilities is strategically imperative.

Clinical management of potential bioterrorism-related conditions

The agents most likely to be used in bioterrorism attacks are reviewed, along with the clinical syndromes they produce and their treatment.

[The epidemic of smallpox in Guangdong Province and its prevention and treatment in the Republican period]

During the Republican period, the smallpox broke out in high frequency almost annually in Guangdong. In response to infectious diseases, the Guangdong government established the Health Administration and institutions for infectious disease's prevention and treatment, and prepared smallpox vaccine by themselves. In order to grasp the situation of the epidemic, related institutions collected epidemic data weekly, monthly, and annually with the statistics reported regularly. Meanwhile, infectious disease hospital was established for smallpox patients. Harbor quarantine put smallpox as a key target of inspection. With the joint effort of the government and social organizations, massive "vaccination campaigns" was organized to promote vaccination, in which children, students and young people were the main subjects for inoculations. Prevention knowledge and anti-epidemic concept towards smallpox have been actively publicized and improved by media.

[Treatment and remedies against smallpox outbreaks in Ferrara in the late nineteenth century]

Health interventions against smallpox during the two epidemics in the second half of the 19th century are outlined. The 1871 hospital health report and the medical report on smallpox patients treated at the hospital and poorhouse of Ferrara between January 1891 and January 1892, drawn up by Alessandro Bennati, provide both interesting data and insights into the treatments and remedies of the time. The treatment of this illness was - and indeed could be - nothing other than symptomatic, there being no real means to halt the spread of the disease. Rather, other remedies were found by alleviating pain and regaining energy during the various stages of the disease. A close relationship between vaccination and the incidence and gravity of the illness is underlined. When the practice of vaccination started to be widely employed at the end of the century, there were almost no cases of death due to smallpox. The pharmacopoeias of the time, Antonio Campana's Farmacopea ferrarese in particular, proved an essential guide in the analysis of each document.

Development of a multi--electrode electrical stimulation device to improve chronic wound healing

A new device has been developed for the application of Electrical Stimulation to improve healing of chronic wounds. The device enables the creation of a composite electrode hence matching the electrode(s) to the size and shape of the wound. Up to 49 electrodes in an array can be combined, delivering High Voltage Pulsed Current (HVPC) in the range 60-120 Hz with a pulse duration range from 90-110 mus and the possibility of treating the patient with direct current instead of HVPC. In addition, the software can import the measurements from the ImpediMap device, analysing the electrical impedance of the tissues involved. A test on healthy volunteers did not prove a statistically significant rise in skin temperature, TcPO2 or impedance due to the stimulation, even though a slight reddening of the stimulated site was observed.

Osteomyelitis variolosa: a report of two cases

We present 2 patients with osteomyelitis variolosa in both elbow joints--sequelae of smallpox. The condyles were elongated and the central portions of the distal humeri were absorbed and the elbow joints were unstable. One of the patients sustained a closed fracture of the distal humerus. The fracture united uneventfully following stabilisation and bone grafting. At the 13-year follow-up, the patient had satisfactory elbow function.

Unraveling the structure of the variola topoisomerase IB-DNA complex: a possible new twist on smallpox therapy

Smallpox is a serious and highly contagious disease that is caused by the variola virus. It is one of the most severe infectious human diseases known, with mortality rates as high as 30%. A successful worldwide vaccination program led to the eradication of smallpox in 1980. However, the high transmission rate of variola virus, coupled with the deadly nature of smallpox, makes this virus a potentially devastating weapon for bioterrorism. Currently, there is no specific treatment for smallpox. However, a recent article on the structure of a variola topoisomerase IB-DNA complex provides an intriguing starting point for the rational design of drugs with potential activity against smallpox.

Public health and bioterrorism: renewed threat of anthrax and smallpox

Bioterrorism is one of the main public health categorical domains. According to sociological analytics, in postmodern society terrorism is one of the real threats of the 21st century. While rare, the use of biological weapons has a long history. Recently, anthrax has been evaluated as one of the most dangerous biological weapons. Naturally occurring anthrax in humans is a disease acquired from contact with anthrax-infected animals or anthrax-contaminated animal products. Usually anthrax infection occurs in humans by three major routes: inhalational, cutaneous, and gastrointestinal. Inhalational anthrax is expected to account for most serious morbidity and most mortality. The clinical presentation of inhalation anthrax has been described as a two-stage illness. Many factors contribute to the pathogenesis of Bacillus anthracis. Antibiotics, anthrax globulin, corticosteroids, mechanical ventilation, vaccine are possible tools of therapy. Smallpox existed in two forms: variola major, which accounted for most morbidity and mortality, and a milder form, variola minor. Smallpox spreads from person to person primarily by droplet nuclei or aerosols expelled from the oropharynx of infected persons and by direct contact. In the event of limited outbreak with few cases, patients should be admitted to the hospital and confined to rooms that are under negative pressure and equipped with high-efficiency particulate air filtration. In larger outbreaks, home isolation and care should be the objective for most patients. Progress in detection, suitable vaccines, postexposure prophylaxis, infection control, and decontamination might be serious tools in fight against the most powerful biological weapon. To assure that the public health and healthcare system can respond to emergencies, the government should direct resources to strengthen the emergency-response system, create medication stockpiles, and improve the public health infrastructure.

Knowledge about the initial presentation of smallpox among emergency physicians in Washington, DC

OBJECTIVES

To assess the current knowledge of full-time emergency physicians in Washington, DC, regarding the initial diagnosis of smallpox and the initial care of the patient with smallpox.

METHODS

A written true/false test was prepared based on information accessed from the current Centers for Disease Control and Prevention (CDC) Web site on smallpox. The 20-question test was administered to full-time emergency physicians practicing emergency medicine in all seven adult civilian hospitals in Washington, DC.

RESULTS

The overall response rate was 81% (52 of the 64 eligible full-time emergency physicians). The average score was 59% correct. The facts most likely to be known were 1) that the symptoms of smallpox begin with a two- to four-day prodrome of fever and myalgia (before the appearance of any rash), 2) that no antiviral treatment is of more proven value than vaccination of contacts, and 3) that a person with smallpox may be contagious before any rash appears (average, 90% correct). The facts least likely to be known were 1) that when dealing with a known case of smallpox, fit-tested N95 masks are not needed by treating personnel if they have been vaccinated; 2) that the rash of smallpox begins with 24-48 hours of flat, erythematous macules (not papules or vesicles); and 3) that very typically the rash of smallpox begins in the mouth (average, 22% correct).

CONCLUSIONS

Some facts from the current CDC Web site on smallpox are known by a large majority of full-time emergency physicians in Washington, DC, whereas questions based on other facts were answered incorrectly by a majority of the physicians tested.

Pediatricians knowledge, views, and perspectives on smallpox and smallpox vaccine

Increasing concerns regarding smallpox as a biologic weapon have led to massive production of vaccinia vaccine and targeted vaccination campaigns. A regional mail survey was conducted among pediatricians to assess their knowledge and perceptions on smallpox and smallpox vaccine. Fifty-nine percent of the responders were unable to differentiate chickenpox from smallpox, and the majority would not accept vaccination in the absence of an outbreak and would not recommend smallpox vaccine to their patients. Even in previously vaccinated pediatricians, willingness to receive smallpox vaccine is poor and vaccination campaigns in the absence of a smallpox outbreak may not be successful.

"Lo! The poor Indian!" colonial responses to the 1862-63 smallpox epidemic in British Columbia and Vancouver Island

The smallpox epidemic that swept through the colonies of Vancouver Island and British Columbia in 1862-63 was particularly devastating to the First Nations of the region. Colonists responded to the developments with a mixture of pity, revulsion, a smug sense of inevitability, and, above all, an overriding concern for their own self-interest. The colonial population may not have consciously attempted to devastate the First Nations populations, but their frequently negative attitudes towards them ensured that actions to prevent this occurrence were sporadic, poorly planned, counterproductive, or simply minimal.

[Bioterrorism]

Biological terrorism is intentionally to use infectious substances for developing diseases or death in animals or humans, leading to disaster and panic in our community. Bioterrorism-associated diseases are mostly rare or eradicated infectious diseases, and recently, we do not have experience to make a clinical and laboratory diagnosis. In particular, these infectious diseases have incubation periods from infection to development of the disease. The staff working at public health institutions, including legal medicine, must be involved in as a first responder when bioterrorism would happen. The preparedness in general against bioterrorism and the bioterrorism-related diseases, such as anthrax, smallpox, viral hemorrhagic fever, tularemia, and botulinum toxin, important for us are described. Both medical knowledge of bioterrorism and the preparedness with training under simulation should be required in advance.

Ability of Physicians to Diagnose and Manage Illness Due to Category A Bioterrorism Agents

BACKGROUND

Early recognition of a terrorist attack with biologic agents will rely on physician diagnosis. Physicians' ability to diagnose and care for patients presenting after a bioterror event is unknown. The role of online case-based didactics to measure and improve knowledge in the diagnosis and treatment of these patients is unknown.

METHODS

A multicenter online educational intervention was completed by 631 physicians at 30 internal medicine residency programs in 16 states and Washington, DC, between July 1, 2003, and June 10, 2004. Participants completed a pretest, assessing ability to diagnose and manage potential cases of smallpox, anthrax, botulism, and plague. A didactic module reviewing diagnosis and management of these diseases was then completed, followed by a posttest. Pretest performance measured baseline knowledge. Posttest performance compared with pretest performance measured effectiveness of the educational intervention. Results were compared based on year of training and geographic location of the residency program.

RESULTS

Correct diagnoses of diseases due to bioterrorism agents were as follows: smallpox, 50.7%; anthrax, 70.5%; botulism, 49.6%; and plague, 16.3% (average, 46.8%). Correct diagnosis averaged 79.0% after completing the didactic module (P<.001). Correct management of smallpox was 14.6%; anthrax, 17.0%; botulism, 60.2%; and plague, 9.7% (average, 25.4%). Correct management averaged 79.1% after completing the didactic module (P<.001). Performance did not differ based on year of training (P = .54) or geographic location (P = .64). Attending physicians performed better than residents (P<.001).

CONCLUSIONS

Physician diagnosis and management of diseases caused by bioterrorism agents is poor. An online didactic module may improve diagnosis and management of diseases caused by these agents.

The medical practice of the sexed body: women, men and disease in Britain , circa 1600-1740

Although it has been widely argued that pre-Enlightenment western medicine ascribed to a one-sex (male) model of the body, this theory has never been evaluated in terms of medical practice. This article seeks to determine the usefulness of such a model for early modern Britain, circa 1600-1740, by examining how medical practitioners responded to three common illnesses that afflicted both male and female patients: venereal disease, smallpox, and malaria. It concludes that, despite a number of similarities, medical treatment of such illnesses was marked by important differences which were based upon the sex of the patient. Due to its unique physiological functions (vaginal discharge, menstruation, pregnancy, and lactation), the female body was considered by practitioners to be capable of manifesting, transmitting, and responding to disease and treatment in ways that the male body could not. This awareness provided practitioners with additional reasons to monitor, and alter, medical treatment in their female patients. In fact, the different constitutions of men and women meant that the patient body was much more complex than the theory of a one-sex model suggests. Furthermore, differences in medical treatment were influenced by age, a variable which was inexorably linked to physiological changes in the 'sexed' body.

Hospital preparedness and management of patients affected by viral haemorrhagic fever or smallpox at the Lazzaro Spallanzani Institute, Italy

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.

[Smallpox--in the past or not?]

Smallpox is a potentially deadly illness caused by the variola virus, an orthopoxvirus. Severe illness followed by blister-like body rash is the sign of smallpox. Smallpox symptoms develop about 12 days after exposure. V. variole can spread very readily by aerosol, which may lead to explosive epidemics. For centuries, smallpox has been a worldwide cause of death, killing about 30% of the infected people. In 1972, the epidemic of smallpox in ex-Yugoslavia was the largest postwar smallpox epidemic in Europe. The total number of the affected was 175, out of whom 35 with fatal outcome, accounting for 20% of mortality. However, after a decade-long vaccination effort, the last natural case of smallpox occurred in 1977. The only way to prevent smallpox epidemic is by vaccination and patients' isolation. The possibility of future bioterrorism attacks, which may cause a new outbreak of smallpox and return variola, is very serious. World population is not immune, because of lack of vaccination. In 1980, the World Health Organization (WHO) declared the disease fully eradicated.

Bichat guidelines for the clinical management of smallpox and bioterrorism-related smallpox

Smallpox is a viral infection caused by the variola virus. It was declared eradicated worldwide by the Word Health Organization in 1980 following a smallpox eradication campaign. Smallpox is seen as one of the viruses most likely to be used as a biological weapon. The variola virus exists legitimately in only two laboratories in the world. Any new case of smallpox would have to be the result of human accidental or deliberate release. The aerosol infectivity, high mortality, and stability of the variola virus make it a potential and dangerous threat in biological warfare. Early detection and diagnosis are important to limit the spread of the disease. Patients with smallpox must be isolated and managed, if possible, in a negative-pressure room until death or until all scabs have been shed. There is no established antiviral treatment for smallpox. The most effective prevention is vaccination before exposure.

Biological agents with potential for misuse: a historical perspective and defensive measures

Biological and chemical agents capable of producing serious illness or mortality have been used in biowarfare from ancient times. Use of these agents has progressed from crude forms in early and middle ages, when snakes and infected cadavers were used as weapons in battles, to sophisticated preparations for use during and after the second World War. Cults and terrorist organizations have attempted the use of biological agents with an aim to immobilize populations or cause serious harm. The reasons for interest in these agents by individuals and organizations include relative ease of acquisition, potential for causing mass casualty or panic, modest financing requirement, availability of technology, and relative ease of delivery. The Centers for Disease Control and Prevention has classified Critical Biological Agents into three major categories. This classification was based on several criteria, which include severity of impact on human health, potential for delivery in a weapon, capacity to cause panic and special needs for development, and stockpiling of medication. Agents that could cause the greatest harm following deliberate use were placed in category A. Category B included agents capable of producing serious harm and significant mortality but of lower magnitude than category A agents. Category C included emerging pathogens that could be developed for mass dispersion in future and their potential as a major health threat. A brief description of the category A bioagents is included and the pathophysiology of two particularly prominent agents, namely anthrax and smallpox, is discussed in detail. The potential danger from biological agents and their ever increasing threat to human populations have created a need for developing technologies for their early detection, for developing treatment strategies, and for refinement of procedures to ensure survival of affected individuals so as to attain the ultimate goal of eliminating the threat from intentional use of these agents. International treaties limiting development and proliferation of weapons and continuing development of defense strategies and safe guards against agents of concern are important elements of plans for eliminating this threat.

Triage of a febrile patient with a rash: a comparison of chickenpox, monkeypox, and smallpox

The immediate and correct recognition of an infectious exanthema can be aided with a focused history and minor assessment. False alarms can consume health care resources and create unnecessary anxiety. Clinicians can use specific references to not only help with educating staff, but to ensure a more accurate diagnosis and trigger notification of appropriate infectious disease protocols. The authors recommend that al emergency departments have a process in place to immediately isolate suspicious cases until a more thorough medial workup can be performed.

Molecular diagnostic techniques for use in response to bioterrorism

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.

Bioterrorism. Clinical recognition and primary management

The recent anthrax attacks in the United States have demonstrated the reality of bioterrorist threats as well as the need for preparedness and planning to mount a successful response to such events. Medical practitioners have a key role in responding to bioterrorist activity because they can contribute to the timely recognition of an event and to the mitigation of morbidity resulting from a bioterrorist attack. The medical community needs to become familiar with how to recognize and manage diseases produced by the biologic agents that might be used by terrorists. This review summarizes the microbiological and clinical aspects of the agents of anthrax, smallpox, plague, and tularemia, which are all considered likely bioterrorist weapons.

[Small pox--infection, therapy and anaesthesiological management (part 1)]

Smallpox is an acute contagious and sometimes fatal infectious disease. It is caused by the variola-virus. Smallpox is characterized by a typical disease form with a progressive distinctive skin rash, especially at face, arms and legs. Smallpox has a fatality rate of about 30 % and the therapy of infected patients is only symptomatically. As prevention the WHO initiated worldwide vaccination programs in the year 1967. The last naturally occurring case of smallpox in the world was in Somalia in 1977. Since then the only known cases of smallpox happened from an outbreak in Birmingham, England caused by a laboratory accident in the year of 1979. On May the 8 th 1980 the disease was declared as eliminated from the world by the WHO (WHO-Resolution 33.33). A natural occurrence of the variola-virus seems to be not given. Nevertheless the virus exists for research in two laboratories, the American Centers of Disease Control and Prevention in Atlanta, Georgia and in the Russian Research Center for Virology and Biotechnics in Kolzowo, Sibiria. Threatening infections with smallpox or other microorganisms, used as bioweapons, get a new dimension through global terrorism. The variola-virus represents an optimal candidate for bioweapons. It is easy to replicate, it is highly contagious and the transmission over aerosol or direct contact from man to man is easy to handle. After the disease was eliminated from the world, routine vaccination among general public was stopped. Therefore younger people don't possess any vaccination protection. Older formerly vaccinated people probably have only a non-sufficient protection. Because of the smallpox elimination a lot of physicians have no experience with this disease. An outbreak of this smallpox isn't only controlled by new vaccination. In our times we need adapted prevention-standards, pox-alarm plans and quarantine standards.

Recognition and management of bioterrorism infections

Recent events have demonstrated that bioterrorists have the ability to disseminate biologic agents in the United States and cause widespread social panic. Family physicians would play a key role in the initial recognition of a potential bioterrorism attack. Familiarity with the infectious agents of highest priority can expedite diagnosis and initial management, and lead to a successful public health response to such an attack. High-priority infectious agents include anthrax, smallpox, plague, tularemia, botulism, and viral hemorrhagic fever. Anthrax and smallpox must be distinguished from such common infections as influenza and varicella. Anthrax treatment is stratified into postexposure prophylaxis and treatment of confirmed cutaneous, intestinal, or inhalation anthrax. Disease prevention by vaccination and isolation of affected persons is key in preventing widespread smallpox infection. Many resources are available to physicians when a bioterrorism attack is suspected, including local public health agencies and the Centers for Disease Control and Prevention.

Anticipating smallpox as a bioterrorist weapon

The treat of bioterrorism means it is important to be able to diagnose smallpox. The responsibility for the initial recognition of cases lies with clinicians, and early diagnosis is the key to the successful control of an outbreak. Unless rapidly contained, a bioterrorist release of smallpox would constitute not just a national but a global threat to health. This brief review sets smallpox in its modern context as an infection potentially spread by bioterrorists and recommends sources of information from the twentieth century that will assist clinicians in diagnosing the disease.

Biological weapons preparedness: the role of physicians

The real risk posed by biological weapons was demonstrated with the distribution of anthrax spores via the USA postal service in 2001. This review outlines the central roles of physicians in optimizing biopreparedness in Australia, including maintaining awareness of the risk, promptly recognizing an event, notifying appropriate authorities upon suspicion of an event, and instituting appropriate management. Management aspects covered include appropriate diagnostic tests, infection control procedures, and empirical therapy of agents considered possible biological weapons. The critical role of physicians as public health advocates working to prevent the use of biological weapons is also outlined.

Smallpox

With recent events, the threat of bioterrorism has become a reality. In late 2001, multiple cases of cutaneous and inhalation anthrax were spread through the US mail. On the front line were dermatologists who diagnosed the first cases of cutaneous anthrax in New York City. Since then, physicians who are unsure if they are facing a new form of bioterrorism frequently have consulted dermatologists to evaluate rashes. Because most biological weapons (anthrax, tularemia, plague, smallpox) can have cutaneous manifestations, dermatologists will continue to have an important role in evaluating these potential threats.

Therapeutic options for diseases due to potential viral agents of bioterrorism

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.

Bioterriorism: from threat to reality

The fears and predictions of attacks with biological weapons, which were increasing at the close of the twentieth century, were transformed into reality not long after September 11, 2001, when several anthrax-laden letters were sent through the U.S. postal system. The attack challenged our medical preparedness and scientific understanding of the epidemiology of biothreat agents. It is fortunate that this was not a massive aerosol release that could have exposed hundreds of thousands. Rapid diagnoses and medical treatments limited casualties and increased survival rates, but tragically some individuals died of inhalational anthrax. Even as physicians tested new treatment regimes and scientists employed new ways of detecting anthrax and decontaminating the mail, new predictions were made for potentially even more devastating attacks with anthrax, smallpox, plague, tularemia, botulism, or hemorrhagic fever viruses. Fear gripped the nation. Law enforcement sought to find the villain(s) who sent the anthrax letters and to deter future bioterrorist attacks. The biomedical community began to seek new ways of protecting against such future threats of bioterrorism.

[The variola virus as a biological weapon]

In view of the threat of use of the variola virus as a biological weapon, the interest of medical and other public in this causative agent that was eradicated in the wild at the end of the 1970s has increased. The paper gives an outline of the current knowledge on biological properties of the variola virus, and on the epidemiology, pathogenesis, clinical picture and prophylaxis of the disease caused by this virus. Descriptions of two sudden smallpox epidemics (Germany in 1970 and former Yugoslavia in 1972) could illustrate the potential of the smallpox virus as a biological weapon in bioterrorism and biological warfare. In fact, this virus can spread very readily through aerosol, which may lead to explosive epidemics. Not having been immunised, our population aged less than 25 years totally lacks the immunity. Older individuals are likely to have a low residual specific immunity to the agent. The only way to prevent a smallpox epidemic is by vaccination and patient isolation. A rapid smallpox diagnostics and prompt vaccination of all contacts is of utmost importance in stopping the outbreak.

Defending against viruses in biowarfare. How to respond to smallpox, encephalitides, hemorrhagic fevers

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.

Biological agents as weapons 1: smallpox and botulism

1. Early recognition by clinicians of illnesses suggesting a biological attack is integral to the public health response. 2. The four biological agents of most concern are smallpox virus, botulinum toxin, and anthrax and plague bacteria. 3. Smallpox is distinguishable from chickenpox by the prominent prodromal period and lesions that develop at the same pace and, on any part of the body, appear identical to each other, evolve slowly and are peripherally distributed. 4. The degree of protection conferred by smallpox vaccination given 20 or more years ago is unknown. 5. Foodborne and inhalational botulism could result from deliberate release of toxin. 6. Botulism presents with cranial nerve palsies and descending paralysis in a patient with normal conscious state and no fever.

Biological and chemical agents: a brief synopsis

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.

Bioterrorism's invisible threats: heightened awareness will help nurses identify real and suspected bioterrorism

Ready your nursing staff for potential bioterrorism with this review of the symptoms and treatment of anthrax, smallpox, plague, tularemia, and botulism.