Anthrax Events Research Articles

Spatial clustering of livestock Anthrax events associated with agro-ecological zones in Kenya, 1957\u20132017

BackgroundDeveloping disease risk maps for priority endemic and episodic diseases is becoming increasingly important for more effective disease management, particularly in resource limited countries. For endemic and easily diagnosed diseases such as anthrax, using historical data to identify hotspots and start to define ecological risk factors of its occurrence is a plausible approach. Using 666 livestock anthrax events reported in Kenya over 60 years (1957–2017), we determined the temporal and spatial patterns of the disease as a step towards identifying and characterizing anthrax hotspots in the region.MethodsData were initially aggregated by administrative unit and later analyzed by agro-ecological zones (AEZ) to reveal anthrax spatio-temporal trends and patterns. Variations in the occurrence of anthrax events were estimated by fitting Poisson generalized linear mixed-effects models to the data with AEZs and calendar months as fixed effects and sub-counties as random effects.ResultsThe country reported approximately 10 anthrax events annually, with the number increasing to as many as 50 annually by the year 2005. Spatial classification of the events in eight counties that reported the highest numbers revealed spatial clustering in certain administrative sub-counties, with 12% of the sub-counties responsible for over 30% of anthrax events, whereas 36% did not report any anthrax disease over the 60-year period. When segregated by AEZs, there was significantly greater risk of anthrax disease occurring in agro-alpine, high, and medium potential AEZs when compared to the agriculturally low potential arid and semi-arid AEZs of the country (p < 0.05). Interestingly, cattle were > 10 times more likely to be infected by B. anthracis than sheep, goats, or camels. There was lower risk of anthrax events in August (P = 0.034) and December (P = 0.061), months that follow long and short rain periods, respectively.ConclusionTaken together, these findings suggest existence of certain geographic, ecological, and demographic risk factors that promote B. anthracis persistence and trasmission in the disease hotspots.

Screening for Anthrax Postexposure Antibiotic Prophylaxis-The New York City Approach.

Individuals exposed to spores of B. anthracis must take a course of antibiotics as postexposure prophylaxis (PEP) to prevent inhalation anthrax. During an anthrax event, public health authorities are responsible for conducting dispensing operations to offer PEP to exposed individuals. Jurisdictions have developed antibiotic PEP screening algorithms to determine which antibiotic is appropriate for each individual. Variability exists with regard to screening questions and dispensing decisions based on responses to those questions. It is likely that individuals with similar profiles will receive different antibiotics based solely on the jurisdiction in which they receive their PEP. This lack of consistency among jurisdictions may lead to a loss of confidence in the public health response among the public, the healthcare community, the media, and government leaders, which could compromise the response itself. We present New York City's planning assumptions, screening algorithm, a rationale for our screening questions, and our reasons for excluding screening questions asked by other jurisdictions. We hope that our efforts may assist others in developing and refining their algorithms and associated public messaging and encourage standardization with neighboring jurisdictions where appropriate.

Forensic Approaches to Detect Possible Agents of Bioterror.

Many biological agents have been strategic pathogenic agents throughout history. Some have even changed history as a consequence of early discoveries of their use as weapons of war. Many of these bioagents can be easily isolated from the environment, and some have recently been genetically manipulated to become more pathogenic for biowarfare. However, it is difficult to determine accidental outbreaks of disease from intentional exposures. In this review, we examine how molecular tools have been used in combination with forensic research to resolve cases of unusual outbreaks and trace the source of the biocrime. New technologies are also discussed in terms of their crucial role impacting forensic science. The anthrax event of 2001 serves as an example of the real threat of bioterrorism and the employment of bioagents as weapons against a population. The Amerithrax investigation has given us lessons of the highest resolution possible with new technologies capable of distinguishing isolates at the base-pair level of sensitivity. In addition, we discuss the implications of proper sanitation to avoid waterborne diseases. The use of new methods in forensic science and health-related surveillance will be invaluable in determining the source of any new disease outbreak, and these data will allow for a quick response to any type of public health threat, whether accidental or purposely initiated.

Modeling Tool for Decision Support during Early Days of an Anthrax Event.

Health officials lack field-implementable tools for forecasting the effects that a large-scale release of Bacillus anthracis spores would have on public health and hospitals. We created a modeling tool (combining inhalational anthrax caseload projections based on initial case reports, effects of variable postexposure prophylaxis campaigns, and healthcare facility surge capacity requirements) to project hospitalizations and casualties from a newly detected inhalation anthrax event, and we examined the consequences of intervention choices. With only 3 days of case counts, the model can predict final attack sizes for simulated Sverdlovsk-like events (1979 USSR) with sufficient accuracy for decision making and confirms the value of early postexposure prophylaxis initiation. According to a baseline scenario, hospital treatment volume peaks 15 days after exposure, deaths peak earlier (day 5), and recovery peaks later (day 23). This tool gives public health, hospital, and emergency planners scenario-specific information for developing quantitative response plans for this threat.

Forensic Microbiology

The field of forensic science has obtained notoriety due, in part, to several sensational court cases, such as the murder trial of O. J. Simpson and the involuntary manslaughter conviction trial of Michael Jackson's physician, Conrad Murray, which captured national attention. In addition, although their roles are not always adequately portrayed, several modern television programs have brought to life the roles forensic scientists play in the criminal justice system. Forensic science encompasses many different areas. Most people are aware of DNA analysis, toxicology, fingerprint comparison, and ballistics, to mention a few. A newer area of forensic science is forensic microbiology. A landmark event in U.S. history, the Bacillus anthracis bioterrorism event in 2001, brought this field of science to the forefront. Forensic microbiology had been practiced before the anthrax event, and forensic microbiology involves more than just bioterror. This article discusses some of the roles that microbiology plays in forensic science.

Francisella tularensis: A Red-blooded Pathogen

Francisella tularensis: A Red-blooded Pathogen

Perspectives of PHS Funding Agencies: Session Introduction

T oday we’re going to learn about the organizations that support our science. I’m honored and grateful that to­ day’s speakers took time away from their research, their students, their offices and their patients to travel to Bethesda to be part of this meeting. This morning’s session will be about the policies and philosophy of the Public Health Service organiza­ tions that support biomedical research. I’m going to introduce all the speakers in the order in which they will speak. First we will hear from my professional home, NIH, where Dr. Sally Rockey is Deputy Director for Extramural Research. She was recently confirmed in this position after serving as Act­ ing Deputy Director—congratulations, Sally. Dr. Rockey re­ ceived her PhD in entomology from the Ohio State University in 1985. She went to work for the USDA and quickly rose through the ranks to become Deputy Administrator for the Competitive Research Grants and Awards Management Unit in the Cooperative State Research, Education, and Extension Ser­ vice, and then she became Chief Information Offi cer. It is also my pleasure to welcome Dr. Tanja Popovic, Dep­ uty Associate Director for Science at the Centers for Disease Control and Prevention (CDC), where she previously served as Associate Director for Science and as Chief Science Offi ­ cer. She joined CDC as a Fulbright fellow in 1989. Since then she has served as the Chief of the Diphtheria Reference Unit, Chief of the Epidemiological Investigations Anthrax Labora­ tory, and Co-Director of the WHO Collaborating Center for Prevention and Control of Bacterial Meningitis. She has been a WHO consultant for bacterial meningitis and diphtheria in Russia and throughout Africa. She led the CDC laboratory during the 2000 anthrax events. Dr. Popovic is the CDC Insti­ tutional Official for both human and animal research subjects. She has many more awards and credentials, too many to list. And fi nally, we will hear from Dr. David Jacobson-Kram, who received his PhD in embryology from the University of Connecticut in 1976. He served as a senior staff fellow at the National Institute on Aging, on the faculty of the George Wash­ ington University School of Medicine, and at Johns Hopkins University Oncology Center. He has also served the Environ­ mental Protection Agency as a geneticist in the Offi ce of Toxic Substances and as acting Branch Chief in their Office of Re­ search and Development. Then Dr. Jacobsen-Kram entered the private sector, serving as Director of the Genetic Toxicology Division of Microbiological Associates. Microbiological As­ sociates changed its name to BioReliance and David’s respon­ sibilities expanded to include oversight of the Mammalian Toxicology Program and the Laboratory Animal Health Pro­ gram. He also served as Vice President of the Toxicology and Laboratory Animal Health Division. Dr. Jacobson-Kram is now Associate Director of Pharmacology and Toxicology at the FDA Office of New Drugs. We’re very lucky to have David here with us today—I understand he had a tremendous fall this weekend so don’t hug him or shake his hand too vigorously.

Transport of Bacillus anthracis from the lungs to the draining lymph nodes is a rapid process facilitated by CD11c+ cells

Inhalational anthrax is established after inhaled Bacillus anthracis spores are transported to the lung associated lymph nodes. Dendritic cells (CD11c+ cells) located in the lungs are phagocytes that maintain many capabilities consistent with transport. This study investigates the role of dendritic cells as conduits of spores from the lung to the draining lymph nodes. The intratracheally spore-challenged mouse model of inhalational anthrax was utilized to investigate in vivo activities of CD11c+ cells. FITC labeled spores were delivered to the lungs of mice. Subsequently lung associated lymph nodes were isolated after infection and CD11c+ cells were found in association with the labeled spores. Further investigation of CD11c+ cells in early anthrax events was facilitated by use of the CD11c-diphtheria toxin (DT) receptor-green fluorescent protein transgenic mice in which CD11c+ cells can be transiently depleted by treatment with DT. We found that the presence of CD11c+ cells was necessary for efficient traffic of the spore to lung associated lymph nodes at early times after infection. Cultured dendritic cells were used to determine that these cells are capable of B. anthracis spore phagocytosis, and support germination and outgrowth. This data demonstrates that CD11c+ cells are likely carriers of B. anthracis spores from the point of inhalation in the lung to the lung associated lymph nodes. The cultured dendritic cell allows for spore germination and outgrowth supporting the concept that the CD11c+ cell responsible for this function can be a dendritic cell.

Human Anthrax in Turkey from 1990 to 2007

Anthrax is an endemic disease in Turkey, among other countries of the world. The potential of Bacillus anthracis as a bioterrorism agent makes anthrax an important global issue. The aim of the present study was to review human anthrax in Turkey during the last decade. Human anthrax cases recorded from 1990 to 2005 were obtained from the website of the Turkish Ministry of Health, and those recorded between 1995 and 2005 were plotted on a map of Turkey. Papers on anthrax published from Turkey between 1990 and 2007 were collected and reviewed. Most cases were recorded from the central and eastern parts of Turkey. Three of the reports appeared in international journals prior to 1990, 10 reports appeared in the 1990s, and 24 reports appeared after the anthrax events of 2001 in the United States of America. These reports included 926 cases, 426 of which could be reviewed: 413 (96.9%) cases of cutaneous anthrax, 8 (1.9%) cases of gastrointestinal anthrax, and 5 (1.2%) cases of anthrax meningitis. Of all the affected patients, 95.2% had contact with contaminated materials. All human origin isolates were sensitive to penicillin and did not produce beta-lactamase. Most of the patients (88.7%) had received penicillin G. Total mortality was 2.8%. Anthrax is an endemic disease in Turkey, and acquisition of infection is generally through contact with ill or dying animals or animal products. Sheep and cattle are generally involved. Most clinical disease in humans is cutaneous anthrax, although other clinical forms are seen and have a greater mortality. Penicillin remains the drug of choice in treating the disease. Controlling anthrax in humans depends on controlling the infection in animals.

Biological weapons

.Adequate public health preparedness for bioterrorism includes the elaboration of an agreed list of biological and chemical agents that might be used in an attack or as threats of deliberate release. In the absence of counterterrorism intelligence information, public health authorities can also base their preparedness on the agents for which the national health structures would be most vulnerable. This article aims to describe a logical method and the characteristics of the variables to be brought in a weighing process to reach a priority list for preparedness. The European Union, in the aftermath of the anthrax events of October 2001 in the United States, set up a task force of experts from multiple member states to elaborate and implement a health security programme. One of the first tasks of this task force was to come up with a list of priority threats. The model, presented here, allows Web-based updates for newly identified agents and for the changes occurring in preventive measures for agents already listed. The same model also allows the identification of priority protection action areas.

Examining the CDCynergy Event Assessment Tool: an investigation of the anthrax crisis in Boca Raton, Florida

This paper examines the dependability of the Event Assessment Tool over time. The latter is part of a CD-ROM--Emergency Risk Communication CDCynergy--distributed primarily to public information officers in the United States by the Centers for Disease Control and Prevention. The Event Assessment Tool is designed to aid emergency professionals in identifying the magnitude of a crisis event and to suggest appropriate actions to confront such a situation. Applied twice during the 2001 anthrax bioterrorism crisis in Boca Raton, Florida, the tool functioned in a binary manner by first indicating a moderate crisis level (on 4 October) and then four days later (on 8 October) a highly intense crisis, suggesting that it is time sensitive. This anthrax event provides an opportunity for crisis and disaster managers to understand the dynamic nature of crises. Rapid changes during these types of events suggest that any metric used to predict intensity must account for this variability. Additional limitations and implications of the tool are discussed.

Combining the Benefits of Decision Science and Financial Analysis in Public Health Management

State public health agencies are charged with providing and overseeing the management of basic public health services on a population-wide basis. These activities have a re-emphasized focus as a result of the events of September 11, 2001, the subsequent anthrax events, and the continuing importance placed on bioterrorism preparedness, West Nile virus, and emerging infectious diseases (eg, monkeypox, SARS). This has added to the tension that exists in budgeting and planning, given the diverse constituencies that are served in each state. State health agencies must be prepared to allocate finite resources in a more formal manner to be able to provide basic public health services on a routine basis, as well as during outbreaks. This article describes the use of an analytical approach to assist financial analysis that is used for budgeting and planning in a state health agency. The combined benefits of decision science and financial analysis are needed to adequately and appropriately plan and budget to meet the diverse needs of the populations within a state. Health and financial indicators are incorporated into a decision model, based on multicriteria decision theory, that has been employed to acquire information about counties and public health programs areas within a county, that reflect the impact of planning and budgeting efforts. This information can be used to allocate resources, to distribute funds for health care services, and to guide public health finance policy formulation and implementation.

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

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

Building Academic–Practice Partnerships

The Center for Public Health Preparedness at the Columbia University Mailman School of Public Health is part of a national network of academic centers established by the Centers for Disease Control and Prevention to strengthen links between public health practice and academe, especially for public health workforce development. Since its inception in Fall 2000, the Center has been working in partnership with the New York City Department of Health & Mental Hygiene (DOHMH) on planning and competency-based training in emergency preparedness (including bioterrorism and infectious diseases) and evaluation. Initial programs with DOHMH included development of a 3-hour orientation to basic emergency preparedness for their workforce. In the wake of 9/11 and the anthrax events, Center members gave over two dozen presentations at community forums, seminars, and clinical rounds, and over 100 press interviews, provided lay language information through community forum presentations and the School's Web site, and developed a database of volunteers for surge capacity. Subsequent programs include bioterrorism response training for clinicians and emergency medical services personnel, incident command for public health, and a study of evacuation from the World Trade Center on 9/11.

Under siege: one state's perspective of the Anthrax events of October/November 2001.

Under siege: one state's perspective of the Anthrax events of October/November 2001.

Bioterrorism preparedness and the Public Health Laboratory Network (PHLN)

The anthrax events that occurred in the USA in 2001 demonstrated that bioterrorism remains a real possibility in the modern world. Although Australia was spared the genuine anthrax events, we did experience many hoax events and massive disruption. Biological agents can cause terror not only by the real risk when one is released, but also by the social and economic disruption resulting from credible threats. Laboratory capacity is fundamental to the bioterrorist response and members of the Public Health Laboratory Network (PHLN) had a major role in the Australian white powder incidents.

Environmental Engineering and Bioterrorism?

The post-September 11 events have caused many people to reassess interests, goals, and activities. In the particular sphere of protecting against bioterrorism threats and mitigating their effects, there is a particular role for environmental engineering researchers and practitioners. A useful definition of environmental engineering is ‘‘the application of engineering principles to improve and maintain the environment for the protection of human health, for the protection of nature’s beneficial ecosystems, and for environment-related enhancement of the quality of human life’’ ~Bylaws of the American Academy of Environmental Engineers!. The autumn 2001 anthrax events have caused the threat of bioterrorism to gain increasing recognition. However, this has not been the first realized or threatened malicious use of biological agents. At least 200 such situations have occurred worldwide since 1900. The understanding of and response to a threat posed by a malicious biological release definitely involves the use of ‘‘engineering principles to improve and maintain the environment for the protection of human health.’’ Particularly, this requires skills that are in the toolbox of environmental engineers, including risk assessment ~dose-response modeling, exposure assessment!, cleanup technologies, and design of systems to reduce vulnerability. The question of ‘‘what is a safe level’’ poses questions in the context of bioterrorist events that are quite analogous to the question ‘‘how clean is clean’’ in the context of site remediation. It is entirely possible to develop dose-response relationships for pathogens that could potentially be used. From this, with the usual exposure calculations we perform ~how much air is breathed, water or food consumed, etc.!, one can arrive at an answer ~with input from decision makers as to acceptable risk!. The question of how to remediate a site where exposure occurs may involve technologies that are quite familiar ~albeit in other contexts! to environmental engineers. For example, in the remediation of the Hart Senate Office Building, the use of chlorine dioxide, which is used in drinking-water disinfection, played a significant role. We have learned particularly over the past 25 years how to design water and wastewater disinfection systems to achieve public health protection, and more recently how to apply UV to treat infectious agents in air. The development of rational standards for remediation of spaces contaminated with infectious agents is amenable to similar approaches, and environmental engineers should be central to this activity. There are interesting and complex issues with respect to the design of facilities resistant to contamination ~or spread of contamination! from malicious use of microorganisms and to the remediation of spaces in which such use has occurred. When the problem focus is on the ~indoor! air or contact surfaces with air ~e.g., HVAC ducts!, the spread of contamination and the rate at which remediation can occur ~due to penetration of any chemical agents that may be used in the gas phase! can be limited by transport through this complex environment. Lessons that have been learned in the field of indoor air pollution and industrial hygiene have direct relevance. Many of the facilities that could be targets for malicious use of microorganisms are directly within the purview of frequent environmental engineering activity. These include drinking-water systems, wastewater collection, and treatment systems. These must be looked at in detail on a site-specific basis to assess whether additional barriers ~in the form of treatment, monitoring, site modifications or security! need to be put in place to reduce vulnerability. Environmental engineers will need to work in close collaboration with colleagues in mechanical, architectural, civil, and other engineering disciplines in these tasks. Environmental engineers design systems and processes to protect against and cleanup after the release of contaminants into air, water, and land environments. These activities are equally necessary and appropriate when the contaminants are microbial and are released as a consequence of deliberate malicious activity. Vulnerability assessments of these systems to potential threats can be conducted by environmental engineers applying tools perfected in such disciplines as nuclear or mechanical engineering ~failure analysis, event-tree analysis, probabilistic safety, and reliability analysis!. Hence, there is no question that there is a link between environmental engineering and bioterrorism. As there are new challenges to the public health and the environment, our profession must rise to the occasion and show our strength in new applications. But one of the strengths, and joys, of the profession has been the historic incorporation of new skills to meet newly recognized challenges.

From the Centers for Disease Control and Prevention. Investigation of bioterrorism-related anthrax and adverse events from antimicrobial prophylaxis.

From the Centers for Disease Control and Prevention. Investigation of bioterrorism-related anthrax and adverse events from antimicrobial prophylaxis.

Anthrax events hike scientific interest

Anthrax events hike scientific interest