Bioterrorism Preparedness Research Articles

Promoting Information Sharing for Multijurisdictional Public Health Emergency Preparedness

The objective was to assess the planning needs of emergency management and public health professionals to provide a flexible and comprehensive planning tool. This study first assessed the needs of emergency management and public health professionals via an online survey. On the basis of results of the assessment, pertinent information was collected and organized into an online resource tool. The assessment was designed to address the needs of local, state, and federal government administrators working in emergency management and public health. The online tool was designed for use by any entity that functions to promote public health in the event of an emergency. Sixty-four participants completed the assessment survey. Seven states were represented. Most participants were senior-level administrators or management-level employees and were employed in public health, emergency, or bioterrorism preparedness, or in emergency medical services. Needs assessment for preparedness tools. The results of the survey identified a need for increased access to information (especially concerning liability issues and authority to enter into agreements) and high levels of interest in the availability of an online planning tool. The majority (80.7%) of respondents indicated an ability to locate and quantify resources within their own jurisdiction but only about half (42.9%) could do the same for resources outside of their jurisdiction. Finally, 71.9% reported having no assessment tool to measure emergency capacity and limitations. Planning for cross-border and multijurisdictional emergencies depends on access to pertinent information and the feasibility of attaining such information. The creation of a comprehensive guide to multijurisdictional collaborations, with its self-assessment checklists, can easily provide such information to emergency. In addition, information sharing and increased collaboration can lead to increased utilization of emergency preparedness best practices.

Recent Advances in the Prevention of Bioterrorism Attacks

Since the September 2001 attacks on the World Trade Center and other locations in the United States, a primary concern for the global community has been to heighten homeland security and thereby prevent terrorist attacks. Additional attacks following the tragedy in 2001 across the world included mailed envelopes containing viable Bacillus anthracis or Anthrax spores that caused 5 deaths in the US. As a countermeasure to bioterrorism attacks, the US implemented the “Public Health Security and Bioterrorism Preparedness and Response Act� in 2002. This was recently strengthened by the passing of the “Food Safety Modernization Act� of 2010. Both laws are intended to provide resources to oversight agencies for tighter regulation and control of food entering and being distributed in the US. It raises the question to what degree a nation can prepare for a potential bioterrorism attack on the food supply. The Centers for Disease Control and Prevention (CDC) have identified several biotoxins that could be used for dispersion. Many of these agents are listed in categories A (including anthrax, botulism, smallpox, and the plague) and B (including strains of Salmonella and Escherichia, Cholera, and Ricin) of the CDC list of potential bioterrorism agents that can be dispersed with relative ease and result in high morbidity and mortality rates. A major concern is the preparedness of public health authorities and the timeliness of the response and recognition of an actual incident. A recent risk analysis of the response to a bioterrorism incident involving Salmonella or Escherichia bacteria concluded that it would take between 3-5 days and at least 2 confirmed cases to detect and contain the source.

Dental Professionals’ Knowledge and Perceived Need for Education in Bioterrorism Preparedness

Dental professionals should be well prepared to provide care during bioterrorist events. In this study, we assessed the knowledge, opinions about playing various roles during a bioterrorist event, and perceived need for education of dental professionals (dentists and dental hygienists) from one region (Oregon) that had been exposed to bioterrorism and from another region (New England) not exposed. This cross-sectional study used an eighteen-item pretested, self-administered questionnaire distributed at the 2005 Oregon Dental Conference (n=156) and 2005 Yankee Dental Conference (n=297). Dental professionals' knowledge and perceived need for education on bioterrorist preparedness were quantified by multivariate linear and logistic modeling. More than 90 percent of the dental professionals were willing to provide care during bioterrorist events. Perceived knowledge was high; however, actual knowledge was low. Dental professionals who wanted to attend a continuing education course and who thought dental professionals should play more roles during a bioterrorist attack had higher actual knowledge. Willingness to provide care was not supported by adequate knowledge. No significant differences between New England and Oregon dental professionals were observed in terms of actual knowledge or perceived need for bioterrorism education. Integrating training and education into the predoctoral dental and dental hygiene curricula and developing continuing education courses would improve knowledge and better prepare dental professionals to effectively perform American Dental Association-recommended roles during any future bioterrorism events.

Effects of the USA PATRIOT Act and the 2002 Bioterrorism Preparedness Act on select agent research in the United States

A bibliometric analysis of the Bacillus anthracis and Ebola virus archival literature was conducted to determine whether negative consequences of the Uniting and Strengthening America by Providing Appropriate Tools Required to Intercept and Obstruct Terrorism" (USA PATRIOT) Act and the 2002 Bioterrorism Preparedness Act on US select agent research could be discerned. Indicators of the health of the field, such as number of papers published per year, number of researchers authoring papers, and influx rate of new authors, indicated an overall stimulus to the field after 2002. As measured by interorganizational coauthorships, both B. anthracis and Ebola virus research networks expanded after 2002 in terms of the number of organizations and the degree of collaboration. Coauthorship between US and non US scientists also grew for Ebola virus but contracted for the subset of B. anthracis research that did not involve possession of viable, virulent bacteria. Some non-US institutions were dropped, and collaborations with others intensified. Contrary to expectations, research did not become centralized around a few gatekeeper institutions. Two negative effects were detected. There was an increased turnover rate of authors in the select agent community that was not observed in the control organism (Klebsiella pneumoniae) research community. However, the most striking effect observed was not associated with individual authors or institutions; it was a loss of efficiency, with an approximate 2- to 5-fold increase in the cost of doing select agent research as measured by the number of research papers published per millions of US research dollars awarded.

Computerized Bioterrorism Education and Training for Nurses on Bioterrorism Attack Agents

Biological agents have the ability to cause large-scale mass casualties. For this reason, their likely use in future terrorist attacks is a concern for national security. Recent studies show that nurses are ill prepared to deal with agents used in biological warfare. Achieving a goal for bioterrorism preparedness is directly linked to comprehensive education and training that enables first-line responders such as nurses to diagnose infectious agents rapidly. The study evaluated participants' responses to biological agents using a computerized bioterrorism education and training program versus a standard bioterrorism education and training program. Both programs improved participants' ability to complete and solve case studies involving the identification of specific biological agents. Participants in the computerized bioterrorism education and training program were more likely to solve the cases critically without reliance on expert consultants. However, participants in the standard bioterrorism education and training program reduced the use of unnecessary diagnostic tests.

Incorporating Bioterrorism Content in the Nursing Curriculum: A Creative Approach

The community health faculty has developed a creative and comprehensive approach with community agencies to present bioterrorism content that could be useful to community health faculty in other schools of nursing. Since September 11, 2001, the United States has recognized that the threat of bioterrorism is real. Nurses are recognized by the American Association of Colleges of Nursing as key players in disaster response efforts. However, bioterrorism knowledge among nurses and nursing students has been reported to be low, and textbooks do not include comprehensive information about bioterrorism preparedness. Our college of nursing has collaborated with the U.S. Public Health Department to design a creative educational experience for community health students on bioterrorism and disaster preparedness. Content areas include the National Stockpile, the Planned Response to Pandemic Influenza provided by the U.S. Public Health Department, recognition and treatment of biological threats, and the care of patients with smallpox.

Bioterrorism Knowledge and Educational Participation of Nurses in Missouri

Nurses are integral to bioterrorism preparedness, but nurses' bioterrorism preparedness knowledge has not been evaluated well. Missouri Nurses Association members (1,528) were studied in the summer of 2006 to assess their bioterrorism knowledge and the perceived benefits of education as well as barriers to education. The response rate was 31%. Most respondents (60%, n = 284) received no bioterrorism education. Nurses who were nurse practitioners (t = -2.42, p < .05), were male (t = -2.99, p < .01), or were on a planning committee (t = -1.96, p = .05) had received more education than other nurses. The most commonly cited barrier to education (46.6%, n = 221) was not knowing where to obtain training. One third of respondents (31.2%) reported no interest in receiving bioterrorism education in the future. Nurses' average score on the knowledge test was 73%. The most commonly missed questions pertained to infection control and decontamination procedures. Bioterrorism preparedness training should be offered through continuing education and nursing school curricula.

Providence Health and Services San Fernando Valley Service Area: A Case Study in Los Angeles County's Emergency Medical Services Agency's Bioterrorism Preparedness Program

Providence Health and Services San Fernando Valley Service Area: A Case Study in Los Angeles County's Emergency Medical Services Agency's Bioterrorism Preparedness Program

Does Federal Assistance to Health Departments for Bioterrorism Preparedness Improve Local Public Health Activity? An Empirical Evaluation Using the 2005 NACCHO Profile of Local Health Departments

Does Federal Assistance to Health Departments for Bioterrorism Preparedness Improve Local Public Health Activity? An Empirical Evaluation Using the 2005 NACCHO Profile of Local Health Departments

"Bioterrorism"- Knowledge, Attitude and Practice Among Faculty Members of Dental Schools of Uttar Pradesh, India

Objective : The purpose of this study was to assess Bioterrorism knowledge, attitude and practice among dentists serving as faculty members in dental schools situated in Uttar Pradesh. Design and Setting: Five among 28 Dental Schools in Uttar Pradesh (U.P) were randomly selected. The knowledge and attitude towards Bioterrorism was assessed by mailing a closed ended structured questionnaire with 24 questions which was pre-tested among 10 dentists of the same institution. Chi Square Test was employed for statistical analysis. Main outcome measures: Knowledge, Attitude and Practice about Bioterrorism among dental school faculty members. Results: Out of 150 questionnaire delivered, 115 returned (response rate = 76.6%). Only 7% of the survey respondents reported having Bioterrorism preparedness training. About 40% agreed that they could recognize oral manifestation of Bioterrorism agents. A high percentage (85.2%) was interested in participating in Bioterrorism response training. Conclusions: A low prevalence of prior training coupled with high degree of willingness to provide assistance in response to Bioterrorism suggests that a high priority should be established for providing dentists with the knowledge and training necessary to respond effectively in such an event.

Research on Preparedness for Bioterrorism - Associated Events in Japan: Smallpox Vaccine Preparedness

The 2001 anthrax attack in the United States made the deliberate release of biological agents a real issue and forced many countries to improve their bioterrorism preparedness. Smallpox is a threat that requires international preparedness because it spreads from human to human and would be expected to have a high level of lethality. In 2001, Japan restarted the production and stockpiling of a medical countermeasure, the smallpox vaccine LC16m8, which is a cell-cultured, live attenuated smallpox vaccine that was developed in the 1970s in Japan. The Smallpox Vaccine Research Group has continuously worked to characterize LC16m8 genetically, demonstrate the efficacy and safety of the LC16m8 vaccine, reduce the cost of stockpiling through shelf-life extension via the presentation of evidence of its stability in long-term storage, and maintain the quality of the stockpiled vaccine that is available in case of emergency. Maintaining the stockpile and production capacity of “orphan” medical countermeasures has contributed to national security and also to global health. This paper reviews smallpox vaccine preparedness and the surrounding policy issues in Japan as a typical and classic case of biopreparedness research activities and discusses achievements, problems, and future directions.

OR Forum—Homeland Security: From Mathematical Models to Policy Implementation: The 2008 Philip McCord Morse Lecture

This paper is the archival record of the INFORMS Philip McCord Morse Lecture delivered in 2008. It describes the author's research on four topics in homeland security and public health: preparedness and response to a bioterror anthrax attack, preparedness and response to a bioterror attack on the food supply, routes of transmission and infection control for pandemic influenza, and biometrics (e.g., fingerprint matching) to prevent terrorists from entering the country. The paper focuses on the modeling, policy recommendations, and implementation of these recommendations. The author draws lessons about policy implementation from these examples and from examples from his other homeland security work with colleagues, including a bioterror smallpox attack, preventing nuclear weapons from entering the country on a shipping container, preventing nuclear weapons from entering a city, and preventing terrorists from crossing the border between the United States and Mexico.

Anthrax: Real Threat or Useful Scare Tactic?

In the years following the attacks of September 11, both the United States Government and the general public have become increasingly aware of the threat of terrorism and its many forms. Not only do we fear "weapons of mass destruction" such as nuclear missiles, but also microscopic spores such as anthrax which has opened up a whole new world of "bioterrorism." On June 12, 2002, President George W. Bush signed the Public Health Security and Bioterrorism Preparedness and Response Act in response to the "Amerithrax" attacks in late 2001. However, the risk of biological warfare use is not well understood, and bioterrorism is a threat without precedent. The extremely low incidence of real biological events in the early 21st century contrasts with the outburst of political rhetoric and mass-media coverage surrounding the subject. Thus, the question arises whether bioterrorism is a real threat or merely a useful scare tactic. Research shows that anthrax is both a real threat—on account of its contagiousness, durable spore structure, complex lethal toxin, and demonstrated use as a weapon of biological warfare—and a useful scare tactic as the bacterium has become a public obsession and the subject of countless hoaxes. America and its allies must confront the reality of bioterrorism by organizing defenses for possible attacks and by further investigating the nature and properties of anthrax and other pathogenic agents—after all, knowing your enemy is the best strategy in any type of warfare.

Modeling Bioterrorism and Disaster Preparedness: SMDM's Recommendations for Design and Reporting

Modeling Bioterrorism and Disaster Preparedness: SMDM's Recommendations for Design and Reporting

National Survey of Laboratory Response Network Sentinel Laboratory Preparedness

The Laboratory Response Network (LRN) is the United States' laboratory system for detecting, confirming, and reporting potential bioterrorism agents. The first tier-sentinel laboratories-is composed principally of hospital-based laboratories and is tasked with ruling out potential biological threat agents in clinical specimens or the identification of suspicious specimens for further testing in higher tiers of the LRN system. The aim of the present study was to broadly describe preparedness of the first tier of the hospital LRN, the sentinel laboratories, with a specific focus on training, personnel, and communications. A semistructured cross-sectional survey of US sentinel laboratories was designed and conducted. Hospitals with greater than 250 beds and an emergency department were considered eligible for inclusion. A geographically weighted sample of 201 hospitals was selected for inclusion. The survey was administered by telephone to the microbiology managers (or designees) at the selected hospitals. The survey contained questions related to drill frequency, proficiency survey participation, personnel training, personnel responsibilities, procedures for biological threat response, and overall confidence in preparedness. Overall, 179 hospitals (89.1%) identified themselves as sentinel laboratories and participated in the survey; 11.7% reported that they had had an emergency alert within the last 2 years. Although rates of internal drills were low (20.7%), participation in some form of bioterrorism proficiency evaluation was high (79.9%). In all, 83.8% of laboratories reported that they had personnel designated to coordinate response to acts of bioterrorism. More than 73% of respondents indicated that they had sufficient personnel, equipment, and training to respond to a biological terrorism event. By multivariate analysis, sentinel laboratories were 3.4 times more likely to feel confident that they had sufficient personnel, equipment, and training to respond to a biological terrorism event if they had designated personnel for bioterrorism roles. This pilot study of sentinel laboratory bioterrorism preparedness demonstrated that hospital laboratory personnel, training, and communication preparedness were not universal, despite designation as sentinel laboratories. A need for unified monitoring of sentinel laboratories exists, and efforts should be made to develop standardized metrics for sentinel laboratory preparedness.

The Impact of Federal Bioterrorism Funding Programs on Local Health Department Preparedness Activities

Using the 2005 National Association of County and City Health Officers Profile of Local Health Departments data set, bivariate probit and Heckman selection models were used to test the hypothesis that the level of federal funding received for bioterrorism preparedness is related to the preparedness activities undertaken by local health departments. Overall budget, leadership, and crisis experience are found to be the most important determinants of local preparedness activity, but Centers for Disease Control and Prevention preparedness funding plays a mediating role by building capacity through the hiring of one key leadership position, the emergency preparedness coordinator. Additional research is needed to determine the potential impact of these funds on other aspects of the local public health system, such as the scope of services delivered, to determine secondary effects of the program.

Early Warning Infectious Disease Surveillance

The Early Warning Infectious Disease Surveillance program (EWIDS) is part of the Cooperative Agreement on Public Health Preparedness and Response for Bioterrorism administered by the Centers for Disease Control and Prevention (CDC). The purpose of EWIDS is to develop and implement a program to collaborate with states or provinces across international borders, to provide rapid and effective laboratory confirmation, and to expand surveillance capabilities. Prior to September 11, 2001, funds were not allocated to states for improving cross-border epidemiologic and laboratory surveillance activities that would increase cross-border preparedness. States were required through the Cooperative Agreement to self-report data twice a year in progress reports to the Division of State and Local Readiness Management Information System (MIS). An analysis of self-reported activities was conducted to determine the activities that states most frequently chose to implement based on existing public health infrastructure along the U.S. borders, since analysis of preparedness activities on the border has not previously been conducted. This article discusses how states chose to address expanding infrastructure capacity with the EWIDS supplemental funding, the challenges that have prevented U.S. border states from addressing all suggested activities, and the importance of sustained funding for the investment of continued capacity building and collaboration with international partners.

Interdisciplinary Approach to All-Hazards Preparedness

The Center for Bioterrorism and All-Hazards Preparedness (CBAP) at Nova Southeastern University College of Osteopathic Medicine is part of the National Education Strategy Team supported by the Assistant Secretary for Preparedness and Response. It developed and implemented an extensive interdisciplinary community-focused, all-hazards preparedness program as a template for use nationally. CBAP provides discipline-customized education and training experiences in emergency and disaster preparedness using multiple formats. In addition to addressing competencies that all responders must have, the CBAP National Education Strategy Team has special emphasis areas in personal planning, vulnerable and hard-to-reach populations, the employment of "cells" in the community, evidence-based evaluation including a unique casualty objective-structured clinical examination, use of student and faculty and Medical Reserve Corps volunteers, all-hazards preparedness aimed at school children, and programs addressing campus violence. CBAP emphasizes that all-hazards preparedness is an academic discipline that necessitates those trained have periodic updates to maintain their currency.

Critical Challenges Ahead in Bioterrorism Preparedness Training for Clinicians

A survey was distributed to determine physicians' confidence levels in recognizing potential Category-A bioterrorism disease threats (e.g., smallpox, anthrax), preferred means of obtaining continuing medical education (CME) credits, and their knowledge of the Connecticut Department of Public Health's (DPH) disease reporting requirements. Surveys were mailed to all physicians in the three-hospital Yale New Haven Health (YNHH) System (2,174) from January to March 2004; there were 820 respondents for a 37.7% response rate. A total of 71% of physicians indicated that they were "not confident" that they could recognize five of the infectious agents named; they had higher confidence rates for smallpox (48.8%). Infectious diseases and emergency medicine physicians had the highest rates of confidence. Seventy-eight percent of physicians indicated conferences and lectures as their preferred CME learning modality. Nearly 72% of physicians reported a low familiarity with the DPH reporting requirements. The results highlighted the breadth of perceived weaknesses among clinicians from disease recognition to reporting incidents, which signifies the need for greater training in these areas. As clinicians themselves emphasized their lack of skills and knowledge in this area, there should be a rapid development and dissemination of problem-based learning CME courses in bioterrorism preparedness.

Bioterrorism

There is a paucity of literature in the United States regarding preparedness for a bioterrorist attack on children. The main objective of this study was to assess the self-reported level of bioterrorism preparedness of pediatricians practicing in Michigan. We conducted a survey that was mailed to 1000 pediatricians practicing in Michigan from July through December 2006. Survey questions were designed to evaluate the overall level of preparedness, as defined by the American Academy of Pediatrics, in dealing with a possible biological event and to describe key demographic variables. Of the 590 pediatricians who responded (59%), a majority (80%) were general pediatricians, whereas 20% were pediatric subspecialists. Sixty percent of responders believe terrorism is a threat, with biological agents (52%; 95% confidence interval (CI), 48.00-56.12) as the most likely cause of an event. Half of the pediatricians who responded had a workplace disaster plan, but only 12% feel their preparedness for a biological attack/event was good. Sixty-six percent (392/590) were not currently Pediatric Advanced Life Support certified, 38% (95% CI,34.63-42.51) have never attended a lecture based on bioterrorism, 85% (95% CI, 82.00-87.78) have never participated in a bioterrorism training exercise, and 89% (95% CI, 87.00-91.95) do not provide disaster-oriented anticipatory guidance to their patients. Seventy-six percent (95% CI, 73.10-79.98) of all responders indicated their desire for more bioterrorism training, with 42% preferring diagnostic algorithms and 37% (95% CI, 32.79-40.59) preferring a prepared lecture on video format. Surveyed pediatricians in Michigan consider bioterrorism a significant threat but are overwhelmingly underprepared to deal with an event. There is a perceived need for a coordinated educational program to improve level of preparedness.