Bioterrorism Event Research Articles

Terbium Phenanthroline Complex as a Luminescent Probe for the Detection of Anthrax Biomarker: Dipicolinic acid.

Dipicolinic acid (DPA) is a prominent biomarker for Anthrax disease. Bacillus anthracis bacterial endospores is composed of DPA as the significant component, which on over inhalation can cause severe health issues. Such contagious and life-threatening pathogens can be employed as bioweapons or biothreat agents for spreading bioterrorism which is a major risk for national security and public health concerns. Hence, effective detection or a surveillance system is essential for preventing the growth of bioterrorism events. Herein, we have developed a Terbium - 1,10 Phenanthroline (Tb-Phen) based lanthanide luminescence complex with bright green fluorescence. On addition of DPA, the green fluorescence is turn-off at a linear range from 0.6 to 4.762 mM. In this effect, 5D4- 7F5 transition caused by 1,10-phenanthroline to Tb3+ at 544nm is restricted due to energy transfer quenching and Inner Filter Effect (IFE). The developed probe shows good sensitivity towards the detection of DPA with other coexisting biomolecules and ions with a low Limit of Detection (LOD) of 5.029 µM. The practical feasibility was evaluated in paper strip assay and extended in real samples such as human serum and tap water with satisfactory recovery percentage. Thereby, probe finds promising application in sensing of anthrax spore biomarker (DPA) and biothreat agents.

Evaluation of water treatments on surfaces to inhibit bacterial spore resuspension

AbstractThe impact of water and the wet–dry cycle was examined as a potential mitigation solution to pathogenic bacterial spore transport and inhalation risk via resuspension of spores from surfaces due to human activities. In this study, a fine mist of water was distributed onto a hydrophilic surface to represent conditions during a dew cycle or fog. Resuspension experiments were conducted on clean and dusty surfaces while they were wet and after drying. These resuspension results were directly compared to surfaces that had not been subjected to any surface water treatment to determine an absolute resuspension rate reduction ratio that could be treated as independent of resuspension technique. A minimum of a 3‐log reduction in resuspension was observed for dusty wet coupons and a maximum reduction of 4‐logs was observed after the clean coupons had dried. Water treatments have been demonstrated to inhibit spore resuspension under certain laboratory conditions while under an air‐generated shear stress similar in magnitude to shear forces generated by human interaction. This research has demonstrated that treating surfaces with water to inhibit spore resuspension could be a valuable tool in exposure minimization and remediation after a bioterrorism event.

Possible Bioterrorism by North Korea and South Korea's Preparedness.

This paper reviews the elements and infection mechanisms of bioterrorism, assess North Korea's capability for biological warfare, and propose strategies for South Korea to counter potential bioterrorist threats from the North. The four critical elements of bioterrorism include the biological agent, the weaponization of the agent, the delivery system, and the impact of weather conditions on the attack. The infection routes for biological agents in bioterrorism include inhalation, ingestion, dermal exposure, and injection. The potential agents under development could include anthrax, smallpox, plague, and botulinum toxin, which might be deployed using missiles, artillery shells, or through covert operations. Proximity to North Korea significantly increases vulnerability to biological attacks. Possible methods include contaminating water supplies, food sources, or densely populated areas. Anthrax, smallpox, plague, and botulinum toxin could theoretically be delivered using packages attached to balloons. Minimizing the impact of a bioterrorism event requires strategy that includes four key actions: detection, decision-making, distribution, and dispensation. By integrating these steps, authorities can effectively manage and mitigate the effects of a bioterrorism event. Civilian doctors play a role in the early detection, diagnosis, treatment, and management of biological agents. Educating medical professionals is crucial for preparing against potential biological warfare or bioterrorism threats.

Human Anthrax: Update of the Diagnosis and Treatment.

Anthrax is one of the most important zoonotic diseases which primarily infects herbivores and occasionally humans. The etiological agent is Bacillus anthracis which is a Gram-positive, aerobic, spore-forming, nonmotile, rod-shaped bacillus. The spores are resistant to environmental conditions and remain viable for a long time in contaminated soil, which is the main reservoir for wild and domestic mammals. Infections still occur in low-income countries where they cause suffering and economic hardship. Humans are infected by contact with ill or dead animals, contaminated animal products, directly exposed to the spores in the environment or spores released as a consequence of a bioterrorist event. Three classical clinical forms of the disease, cutaneous, gastrointestinal and inhalation, are seen, all of which can potentially lead to sepsis or meningitis. A new clinical form in drug users has been described recently and named "injectional anthrax" with high mortality (>33%). The symptoms of anthrax in the early stage mimics many diseases and as a consequence it is important to confirm the diagnosis using a bacterial culture or a molecular test. With regards to treatment, human isolates are generally susceptible to most antibiotics with penicillin G and amoxicillin as the first choice, and ciprofloxacin and doxycycline serving as alternatives. A combination of one or more antibiotics is suggested in systemic anthrax. Controlling anthrax in humans depends primarily on effective control of the disease in animals. Spore vaccines are used in veterinary service, and an acellular vaccine is available for humans but its use is limited.

The PRISMA 2020 Statement: A System Review of Hospital Preparedness for Bioterrorism Events

Hospitals are an important part of a nation's response to bioterrorism events. At present, research in this field is still in the initial stage. The number of related studies is small, the research direction is relatively concentrated, and a comprehensive analysis and standard evaluation system are lacking. This literature survey was conducted using PRISMA methodology. Collective information was gathered from PubMed, Web of Science, Scopus, and available grey literature sourced through Google and relevant websites. The studies were screened according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) flowchart. Analysis and summary of the extracted data was performed according to the World Health Organization (WHO) Rapid Hospital Readiness Checklist (2020). Twenty-three articles were selected for review, data extraction, and data analysis. Referring to the WHO rapid hospital readiness checklist, six main indicator categories were determined, including emergency management, medical service capacity, surge capacity, laboratories, regional coordination, and logistical support, and fifty-two subcategories were finally identified. The study summarizes and analyzes the relevant literature on hospital disaster preparedness and extracts relevant capability elements, providing a reference for the preparation of hospitals against bioterrorism events and a basis for the design and development of hospital preparedness assessment indicators.

Disaster Response-A Global Concern: Are You Prepared to Care for Victims of Chemical, Biological, Radiological, and Nuclear Attacks?

The threat of bioterrorism is increasing in lethality and numbers of events globally. Weapons of mass destruction include devices of chemical, biological, radiological, and nuclear origin and are often selected by terrorists because they are capable of causing widespread destruction, harm, and panic. Emergency personnel are often first to recognize and report potential terrorist activities. It is essential that emergency personnel maintain a high index of suspicion for symptom patterns that correspond with effects of bioterrorism agents. Health care providers must have a solid understanding of personal protective equipment for specific categories of bioterrorism agents to protect themselves and others while providing care to victims in the emergency department. A clear understanding of disaster protocols, established communication systems, reporting requirements, and available resources to aid in patient management following a bioterrorism event is crucial for optimal, safe, quality care to be administered.

Evaluation of a Frozen Micro-Agar Plates of MAPt Antibiotic Susceptibility Test for Enhanced Bioterror Preparedness.

There is an urgent need for rapid antibiotic susceptibility tests to improve clinical treatment and to support antibiotic stewardship, especially concerning the emergence of multi-drug-resistant bacteria. Nowadays this need is even more profound due to progress in synthetic biology procedures that may facilitate the malicious preparation of engineered antibiotic-resistant pathogens. We recently described a novel, rapid, simple, specific, and sensitive method named a Micro-Agar-PCR-test (MAPt) and showed its performance on clinical as well as environmental samples. The method does not require any isolation or purification steps and is applicable to a wide range of bacterial concentrations, thus allowing a short time to respond within a bioterror event (5–7 h for B. anthracis, 10–12 h for Y. pestis, and 16 h for F. tularensis). Ready-to-use reagents for this assay may add a level of preparedness. We examined the option of freezing pre-prepared MAPt agar plates and thawing them upon need. Our results show that adequate minimal inhibitory concentration (MIC) values are obtained with the use of thawed 6- and 12-month frozen agar plates. The ability to store MAPt micro-agar plates at −70 °C for a year, together with all other reagents required for MAPt, holds a great advantage for bioterror preparedness.

NBACC's Scientific Research and Operational Posture During the 2020-2021 COVID-19 Pandemic.

The National Biodefense Analysis and Countermeasures Center (NBACC) is a national resource established to understand the scientific basis of the risk posed by biological threats, and to analyze evidentiary material from bioterror or biocrime events. Like many other U.S. research institutions, the emergence of the SARS-CoV-2 virus, and rapid development of the COVID-19 pandemic allowed only a few short weeks of preparations before infectious disease controls could be implemented. Due to the nature of its mission, the NBACC must be available on a 24/7 readiness posture to support bioforensic casework from the Federal Bureau of Investigation (FBI). It also serves to provide the Department of Homeland Security (DHS) with key scientific data to assess the hazard from biological agents, especially in this instance to inform the national response to COVID-19. These factors caused the operational tempo to significantly increase. To accomplish our mission during a national emergency, laboratory staffing levels needed to be maintained at prepandemic levels. As a result, the Battelle National Biodefense Institute (BNBI) leadership took significant actions to prevent COVID-19 exposure and transmission within the workforce. These multiple actions included engineering changes to the facility, stockpiling of personal protective equipment and consumable products, educating the staff on the signs and symptoms of COVID-19, reducing the population of the nonlaboratory staff, and the completion of a comprehensive risk assessment to quantify the risk of COVID-19 infection for all NBACC staff. These early actions, used in tandem, were successful in maintaining a healthy and stable workforce so that BNBI's research objectives could be met.

Bioterrorism: An analysis of biological agents used in terrorist events.

BackgroundThe Covid19 pandemic has reignited debates and discussions around healthcare systems' biosecurity vulnerabilities and cast a spotlight on the potential weaponization of biological agents. Terrorist and violent extremist groups have already attempted to incite the intentional spread of Covid19 and to use it as an improvised form of a biological weapon. This study aims to provide an epidemiological description of all terrorism-related attacks using biological agents sustained between 1970 and 2019.MethodsData collection was performed using a retrospective database search through the Global Terrorism Database (GTD). The GTD was searched using the internal database search functions for all events using biological weapons between January 1, 1970 - December 31, 2019.Results33 terrorist attacks involving biological agents were recorded between 1970 and 2019, registering 9 deaths and 806 injuries. 21 events occurred in the United States, 3 in Kenya, 2 each in both the United Kingdom and Pakistan and a single event in Japan, Columbia, Israel, Russia and Tunisia.ConclusionThe reported use of biological agents as a terrorist weapon is extremely rare and accounts for 0.02% of all historic terrorist attacks. Despite its apparent rarity, however, bioterrorism has the ability to inflict mass injuries unmatched by conventional weapons. Anthrax has been the most commonly used in previous bioterrorism events with the vast majority of reported attacks occurring in the United States by a single suspected perpetrator. Counter-Terrorism Medicine (CTM) and Disaster Medicine (DM) specialists need to be proactive in delivering ongoing educational sessions on biological events to first responder communities, and anticipate emerging novel biotechnology threats.

Beating the Bio-Terror Threat with Rapid Antimicrobial Susceptibility Testing.

A bioterror event using an infectious bacterium may lead to catastrophic outcomes involving morbidity and mortality as well as social and psychological stress. Moreover, a bioterror event using an antibiotic resistance engineered bacterial agent may raise additional concerns. Thus, preparedness is essential to preclude and control the dissemination of the bacterial agent as well as to appropriately and promptly treat potentially exposed individuals or patients. Rates of morbidity, death, and social anxiety can be drastically reduced if the rapid delivery of antimicrobial agents for post-exposure prophylaxis and treatment is initiated as soon as possible. Availability of rapid antibiotic susceptibility tests that may provide key recommendations to targeted antibiotic treatment is mandatory, yet, such tests are only at the development stage. In this review, we describe the recently published rapid antibiotic susceptibility tests implemented on bioterror bacterial agents and discuss their assimilation in clinical and environmental samples.

Clinical Guidelines for Diagnosis and Treatment of Botulism, 2021.

SummaryBotulism is a rare, neurotoxin-mediated, life-threatening disease characterized by flaccid descending paralysis that begins with cranial nerve palsies and might progress to extremity weakness and respiratory failure. Botulinum neurotoxin, which inhibits acetylcholine release at the neuromuscular junction, is produced by the anaerobic, gram-positive bacterium Clostridium botulinum and, rarely, by related species (C. baratii and C. butyricum). Exposure to the neurotoxin occurs through ingestion of toxin (foodborne botulism), bacterial colonization of a wound (wound botulism) or the intestines (infant botulism and adult intestinal colonization botulism), and high-concentration cosmetic or therapeutic injections of toxin (iatrogenic botulism). In addition, concerns have been raised about the possibility of a bioterrorism event involving toxin exposure through intentional contamination of food or drink or through aerosolization. Neurologic symptoms are similar regardless of exposure route. Treatment involves supportive care, intubation and mechanical ventilation when necessary, and administration of botulinum antitoxin. Certain neurological diseases (e.g., myasthenia gravis and Guillain-Barré syndrome) have signs and symptoms that overlap with botulism. Before the publication of these guidelines, no comprehensive clinical care guidelines existed for treating botulism. These evidence-based guidelines provide health care providers with recommended best practices for diagnosing, monitoring, and treating single cases or outbreaks of foodborne, wound, and inhalational botulism and were developed after a multiyear process involving several systematic reviews and expert input.

Knowledge and preparedness of healthcare providers towards bioterrorism

BackgroundSeveral emergent circumstances require healthcare providers to recognize the unusual and dangerous and pathogenic agents. An in-depth literature review showed that studies about bioterrorism preparedness amongst healthcare providers are lacking. Therefore, this study aimed to investigate the knowledge and preparedness level of first emergency respondents towards bioterrorism events.MethodsThis study has a cross-sectional design and was carried out at the Emergency departments and poison control centers/clinical laboratories three in major tertiary care hospitals in Riyadh, Saudi Arabia. The subjects were randomly selected to complete the self-administered questionnaire to collect study outcomes.ResultsA total of 1030 participants were included in the final data analysis. The mean knowledge score in the basic concepts of bioterrorism and introductory clinical presentations of bioterrorism-related agents was 4.92 ± 1.86 out of 12 points.Moreover, the findings showed a mean knowledge score of 22.80 ± 3.92 out of 38 in the bioterrorism preparedness and governing policies and procedures. Respondents who received previous training in bioterrorism preparedness had a significantly higher number of perceived benefits than those not sure and without prior training (z = − 2.67, p = 0.008) and (z = − 4.4, p < 0.0001), respectively. About 79.4% of participants did not have previous training in bioterrorism preparedness, but 68.7% expressed willingness in the institution’s response and control to assist in a bioterrorist attack incident.ConclusionAlthough healthcare professionals have reported their desire to help in bioterrorism events, they need to enhance their knowledge of bioterrorism preparedness.

Strategy for the Enrichment of Protein Biomarkers from Diverse Bacterial Select Agents.

Some pathogenic bacteria can be potentially used for nefarious applications in the event of bioterrorism or biowarfare. Accurate identification of biological agent from clinical and diverse environmental matrices is of paramount importance for implementation of medical countermeasures and biothreat mitigation. A novel methodology is reported here for the development of a novel enrichment strategy for the generally conserved abundant bacterial proteins for an accurate downstream species identification using tandem MS analysis in biothreat scenario. Conserved regions in the common bacterial protein markers were analyzed using bioinformatic tools and stitched for a possible generic immuno-capture for an intended downstream MS/MS analysis. Phylogenetic analysis of selected proteins was carried out and synthetic constructs were generated for the expression of conserved stitched regions of 60 kDa chaperonin GroEL. Hyper-immune serum was raised against recombinant synthetic GroEL protein. The conserved regions of common bacterial proteins were stitched for a possible generic immuno-capture and subsequent specific identification by tandem MS using variable regions of the molecule. Phylogenetic analysis of selected proteins was carried out and synthetic constructs were generated for the expression of conserved stitched regions of GroEL. In a proof-of-concept study, hyper-immune serum raised against recombinant synthetic GroEL protein exhibited reactivity with ~60 KDa proteins from the cell lysates of three bacterial species tested. The envisaged methodology can lead to the development of a novel enrichment strategy for the abundant bacterial proteins from complex environmental matrices for the downstream species identification with increased sensitivity and substantially reduce the time-to-result.

Factors Influencing Health Care Workers' Willingness to Respond to Duty during Infectious Disease Outbreaks and Bioterrorist Events: An Integrative Review.

Infectious disease emergencies are increasingly becoming part of the health care delivery landscape, having implications to not only individuals and the public, but also on those expected to respond to these emergencies. Health care workers (HCWs) are perhaps the most important asset in an infectious disease emergency, yet these individuals have their own barriers and facilitators to them being willing or able to respond. The purpose of this review was to identify factors affecting HCW willingness to respond (WTR) to duty during infectious disease outbreaks and/or bioterrorist events. An integrative literature review methodology was utilized to conduct a structured search of the literature including CINAHL, Medline, Embase, and PubMed databases using key terms and phrases. PRISMA guidelines were used to report the search outcomes and all eligible literature was screened with those included in the final review collated and appraised using a quality assessment tool. A total of 149 papers were identified from the database search. Forty papers were relevant following screening, which highlighted facilitators of WTR to include: availability of personal protective equipment (PPE)/vaccine, level of training, professional ethics, family and personal safety, and worker support systems. A number of barriers were reported to prevent WTR for HCWs, such as: concern and perceived risk, interpersonal factors, job-level factors, and outbreak characteristics. By comprehensively identifying the facilitators and barriers to HCWs' WTR during infectious disease outbreaks and/or bioterrorist events, strategies can be identified and implemented to improve WTR and thus improve HCW and public safety.

Decontamination of Bacillus anthracis Spores at Subzero Temperatures by Complete Submersion.

Introduction: Bacillus anthracis, the etiological agent of anthrax, produces long-lived spores, which are resistant to heat, cold, pH, desiccation, and chemical agents. The spores maintain their ability to produce viable bacteria even after decades, and when inhaled can cause fatal disease in over half of the clinical cases. Owing to these characteristics, anthrax has been repeatedly selected for both bioweapon and bioterrorism use. In the event of a bioterrorism attack, surfaces in the vicinity of the attack will be contaminated, and recovering from such an event requires rapid and effective decontamination. Previous decontamination method development has focused mainly on temperatures >0°C, and have shown poor efficacy at subzero temperatures. Methods: In this study, we demonstrate the use of calcium chloride (CaCl2) as a freezing point depression agent for pH-adjusted sodium hypochlorite (NaOCl) for the effective and rapid decontamination of B. anthracis Sterne strain spores at subzero temperatures. Results: We show the complete decontamination of 106 B. anthracis Sterne strain spores at temperatures as low as -20°C within 2.5 min by submersion in solution containing 25% (w/v) CaCl2, 0.50% NaOCl, and 0.40% (v/v) acetic acid. We also demonstrate significant reduction in number of spores at -28°C. Conclusions: The results show promise for rapidly decontaminating equipment and materials used in the response to bioterrorism events using readily available consumer chemicals. Future study should examine the efficacy of these results on complex surfaces.

Ebola Virus in West Africa as National Security Threat to the United States of America

This study sought to explain the reasons the United States (US) makes the Ebola virus became pandemic in West Africa as a priority of US national security. This research is shows that the US lowered its troops to 3,000 troops to Liberia. In addition, countries in the West African region in particular Guinea, Sierra Leone and Liberia as countries affected by the Ebola geopolitically located in the Sahel region highly vulnerable to conflict likely to be used by terrorist groups. Through linkages framework of national security and foreign policy, this study will explain the reasons behind the US decision in making the Ebola virus as a national security priority. By using literature and data analysis, this research concluded that the US has Ebola as a national security priority for the United States wants to prevent the use of Ebola virus for bioterrorism events. This is confirmed by the adoption of the US strategy of selective engagement through the use of the countries in West Africa as an instrument for anticipating such bioterrorism.

Plague and Pregnancy: Why Special Considerations Are Needed.

Pregnant women are an important at-risk population to consider during public health emergencies. These women, like nonpregnant adults, may be faced with the risk of acquiring life-threatening infections during outbreaks or bioterrorism (BT) events and, in some cases, can experience increased severity of infection and higher morbidity compared with nonpregnant adults. Yersinia pestis, the bacterium that causes plague, is a highly pathogenic organism. There are 4 million births annually in the United States, and thus the unique needs of pregnant women and their infants should be considered in pre-event planning for a plague outbreak or BT event.

Knowledge and Preparedness of Healthcare Providers Towards Bioterrorism

Introduction: Several emergent circumstances require healthcare providers to be able to recognize the dangerous and uncommon pathogenic agents. An in-depth literature review showed that studies about bioterrorism preparedness amongst healthcare providers from the Middle East, including Saudi Arabia, are lacking. Therefore, we conducted this study to investigate the knowledge and preparedness level of first emergency respondents towards bioterrorism events, which are the emergency department (ED) healthcare providers and the poison control center/clinical laboratory staff. Methods: A cross-sectional study was conducted between at the Emergency departments and poison control centers/clinical laboratories three in major tertiary care hospitals in Riyadh city, Saudi Arabia. The subjects were randomly selected to complete the self-administered questionnaire to collect study outcomes. Results: A total of 1030 participants were included in the final data analysis. The majority were nurses, 516 (50.1%) and doctors 351 (34.1%), and females 550 (53.6%). Overall, the findings revealed a mean knowledge score of 4.92 ± 1.86 out of 12 in the basic concepts of bioterrorism and basic clinical presentations of bioterrorism-related agents. Moreover, the findings showed a mean knowledge score of 22.80 ± 3.92 out of 38 in the bioterrorism preparedness and governing policies and procedures. Respondents who received previous training in bioterrorism preparedness had a significantly higher number of perceived benefits than those not sure and without prior training (z = -2.67, p = 0.008) and (z = - 4.4, p < 0.0001), respectively. About 79.4% of participants did not have previous training in bioterrorism preparedness, but 68.7% expressed willingness in the institution's response and control to assist in the event of a bioterrorist attack. Conclusion: Although healthcare professionals have reported their willingness to assist in bioterrorism events, they need to enhance their knowledge towards bioterrorism preparedness. Funding Statement: The study was funded by King Fahad Medical City, Riyadh, Saudi Arabia. Declaration of Interests: Authors have no conflict of interests. Ethics Approval Statement: The study was reviewed and approved by the institutional review boards at the study site. Participants’ completion of the questionnaire implied their consent to take part in the study.

Antivirals in medical biodefense.

The viruses historically implicated or currently considered as candidates for misuse in bioterrorist events are poxviruses, filoviruses, bunyaviruses, orthomyxoviruses, paramyxoviruses and a number of arboviruses causing encephalitis, including alpha- and flaviviruses. All these viruses are of concern for public health services when they occur in natural outbreaks or emerge in unvaccinated populations. Recent events and intelligence reports point to a growing risk of dangerous biological agents being used for nefarious purposes. Public health responses effective in natural outbreaks of infectious disease may not be sufficient to deal with the severe consequences of a deliberate release of such agents. One important aspect of countermeasures against viral biothreat agents are the antiviral treatment options available for use in post-exposure prophylaxis. These issues were adressed by the organizers of the 16th Medical Biodefense Conference, held in Munich in 2018, in a special session on the development of drugs to treat infections with viruses currently perceived as a threat to societies or associated with a potential for misuse as biothreat agents. This review will outline the state-of-the-art methods in antivirals research discussed and provide an overview of antiviral compounds in the pipeline that are already approved for use or still under development.

Coordination, Communication, and Clade X: Challenges and Lessons Learned from Health Emergency Exercise After-Action Reports and How They Can Help Guide Future Efforts to Improve Information Sharing

Abstract Clade X is only the latest in a series of high profile health emergency preparedness exercises intended to better equip government officials and responders at different levels of government and in different sectors for the challenges they are likely to face during a pandemic or bioterrorism event. A key issue in regard to emergency preparedness response is information sharing. This study examines previous literature on the importance of information sharing to emergency response, particularly in regard to public health emergencies. A content and correspondence analysis of data collected from exercise after-action reports is then conducted to examine the prominence of information sharing as a theme in those reports. The relationship between information sharing and other themes is also considered. Specific passages regarding information sharing are examined to consider how the theme is discussed in the context of the report. The findings of the analyses above are then compared to a recent tabletop exercise conducted by the Nuclear Threat Initiative regarding a biological attack. The comparison of this recent exercise to previous exercises is used to highlight key policy considerations. Recommendations are provided regarding how policy makers could help to address these considerations prior to a real world emergency. While technology is consistently evolving to improve the means by which we can share information, issues of coordination, including between the public health and health care sectors, continue to remain an obstacle.