The Complete Terrorism Survival Guide
Biosafety Level 2 agents are those most commonly being sought in clinical specimens, and they include all the common agents of infectious disease, as well as HIV and several more unusual pathogens. For handling dinical specimens suspected of harboring any of these pathogens, Biosafety Level 2 precautions are sufficient. This level of safety includes the principles outlined previously plus limiting access to the laboratory during working procedures, training laboratory personnel in handling pathogenic agents, direction by competent supervisors, and performing aerosol-generating procedures in a BSC. Employers must offer hepatitis B vaccine to all employees determined to be at risk of exposure. Bacillus anthracis and Yersinia pestis, two organisms mentioned as possible bioterrorism agents, are actually listed as BSL-2 organisms. Biosafety Level 3 procedures have been recommended for the handling of material suspected of harboring viruses unlikely to be encountered in a routine clinical...
The increased expenditure for new and emerging diseases - some of it under the umbrella effort to combat bioterrorism - has provided a major impetus to establish surveillance systems in developing countries.(Koplan, 2001) Surveillance efforts, once established, can be used for varied purposes. Thus, the infrastructure established to track new diseases - such as avian influenza (influenza H5N1) - can also be used to track patterns of other infections and resistance patterns (Greene et al., 2007). In addition, antimicrobial resistance is included as a Category C (emerging infectious disease threats) priority by the United States National Institute of Health under its effort to combat new and reemerging infectious diseases. A number of efforts to track resistance, including establishing common databases - such as INSPEAR (Richet et al., 2001) and WHONET (Stelling and O'brien, 1997) - already exist and can provide the framework to expand local efforts to track resistance and improve the...
New herpesviruses continue to be discovered, whilst only HHV1 and 2 are significantly inhibited by the existing drugs. Threats of bioterroism will lead to evaluation of drugs against smallpox such as cidofovir and against viruses which cause haemorrhagic fevers such as Lassa and Ebola. Influenza has recently been added to the list of potential bioterrorist viruses.
The Army of God, a well-known underground network of domestic terrorists within the anti-choice activist groups, believes in and advocates the use of violence as an appropriate and acceptable means to end abortion. The Army of God has a manual that is basically a how-to-do-it kit for abortion clinic violence. It includes information and methods for blockading clinic entrances, butyric acid attacks, arson, bomb-making, and other illegal activities. In addition to strong antiabortion sentiments, this manual also includes antigovernment and anti-gay and anti-lesbian language. An excerpt from the Army of God Manual states that the Army of God . . . is a real Army, and God is the general and Commanderin-Chief. The soldiers, however, do not usually communicate with one another. Very few have ever met each other. And when they do, each is
When many cases of a serious disease occur, but interest tends to wane once the disease becomes rare. The public at large will then inevitably focus on the possible side-effects and complications of the vaccine preparation itself, rather than the morbidity and mortality that the disease would cause in an unprotected society. With time, the public will forget the effect that these diseases had on health and welfare, and there may be an increased tendency for doctors and health workers to grant exemption, thus reducing vaccine coverage. Some concern has been raised claiming that the discontinuation of smallpox vaccination leaves the world susceptible to reintroduction of poxviruses from unrecognised animal reservoirs. And similarly, an immuno-logically virgin global population could invite terrorist threats or the actual release of variola virus procured from illegal stocks of virus.
Abstract Viruses, particularly those that are harmful to humans, are the 'silent terrorists' of the twenty-first century. Well over four million humans die per annum as a result of viral infections alone. The scourge of influenza virus has plagued mankind throughout the ages. The fact that new viral strains emerge on a regular basis, particularly out of Asia, establishes a continual socio-economic threat to mankind. The arrival of the highly pathogenic avian influenza H5N1 heightened the threat of a potential human pandemic to the point where many countries have put in place 'preparedness plans' to defend against such an outcome. The discovery of the
Chocolate agar provides the factors, that is, hemin (X factor) and NAD (V factor), necessary for the growth of Haemophilus spp. Most strains will not grow on 5 sheep blood agar, which contains hemin but not NAD. Several bacterial species, including Staphylococcus aureus, produce NAD as a metabolic byproduct. Therefore, tiny colonies of Haemophilus spp. may be seen growing on sheep blood agar very close to colonies of bacteria that can produce V factor this phenomenon is known as satelliting (Figure 34-1). The phenomenon of satelliting has become important in this era of needing to rapidly identify potential agents of a bioterrorist attack. The protocol for ruling out Francisella or Brucella (see Chapter 65) is to first rule out Haemophilus by the lack of evidence of satelliting around S. aureus.
Of concern, two recent reports describe problems in identifying Francisella species isolated from clinical specimens.6'9 In one study, 12 microbiology employees were exposed to F. tularensis despite bioterrorism procedures being in place the organism had been isolated from blood, respiratory, and autopsy specimens and grew on chocolate agar.9 In this situation, multiple cultures were worked up on open benches without any additional personal protective equipment for what had been thought to be most consistent with a Haemophilus species. As a result of these reports, microbiologists must be aware of not only the key characteristics of this group of organisms (Box 40-1) but also the possible pitfalls in their identification (e.g., some strains grow well on sheep blood agar identification kits may incorrectly suggest an identification of Actinobacillus adinomycetemcomitans).
If I had to give the Interagency Task Force a grade after a decade of work it would be D. Why are they doing so poorly There are two major reasons and you can guess what they are. Money is number one. These agencies all compete for funding within the federal budget. Those within HHS compete for HHS monies. The goals of the Task Force require funding which has never been forthcoming in any kind of systematic or dedicated way. Yet we lose more Americans every year to antibiotic resistance than to terrorism, automobile accidents, and war. We lost 58,236 Americans in the entire Vietnam War, but we lost 63,000 per year to antibiotic resistance just in our hospitals alone That translates to over 630,000 Americans lost to resistance since the inauguration of the Task Force. Where are our funding priorities
The organisms discussed in this section require somewhat different conditions for their successful recovery from blood culture samples. Most of these organisms are infrequently isolated from blood. Therefore, it is important for the physidan to notify the laboratory of remarkable patient history, such as travel abroad, that is leading him or her to suspect these agents. In light of recent events and concerns about bioterrorism, it is also important that the laboratory be aware of organisms isolated from blood cultures that are considered potential agents for bioterrorist attacks. These bacteria indude Badllus anthrads, Francisella tularensis, Brucella spp., and Yersinia pestis. Finally, in addition to the organisms discussed below with different conditions for their successful isolation from blood, there are a number of organisms that do not grow on artifidal media and are best diagnosed by alternative methods such as serology or molecular amplification assays these organisms are...
The thud incident in October 20012 stunned the country. Although there had previously been sporadic instances of letters filled with a white powder delivered to an abortion clinic with a note indicating that the person opening the envelope had been exposed to anthrax spores, all previous letters had been hoaxes. The October 2001 outbreak resulted from intentional delivery of anthrax spores in mailed letters or packages ultimately there were 11 cases of inhalational anthrax and 11 of cutaneous disease. The unknown attacker terrorized the East Coast states of Florida, New Jersey, New York, and Connecticut as well as Washington, DC. Five individuals died. The attacks were a wake-up call for institutions everywhere to develop bioterrorism readiness plans.1 The United States government also stepped in to regulate biosecurity in laboratories and create new regulations governing security to try to prevent another incident.
The bombings at the federal building in Oklahoma City and the World Thide Center led Congress to pass the Antiterrorism and Effective Death Penalty Act of 1996. Section 511 (d) restricts the possession and use of materials capable of producing catastrophic damage in the hands of terrorists by requiring their registration. A companion law, the Uniting and Strengthening America by Providing Appropriate Tools Required to Intercept and Obstruct Terrorism (USA PATRIOT) Act of 2001 prohibits any person to knowingly possess any biologic agent, toxin or delivery system of a type or in a quantity that, under the circumstances, is not reasonably justified by prophylactic, protective, bona fide research, or other peaceful purpose. Later, the Public Health Security and Bioterrorism Preparedness and Response Act of 2002 required institutions to notify the Department of Health and Human Services (DHHS) or the United States Department of Agriculture (USDA) of the possession of specific pathogens or...
Centers for Disease Control and Prevention Biological and chemical terrorism strategic plan for preparedness and response, MMVW 49(RR-4) 1.2000. Gilchrist MJR, McKinney WP, Miller JM, et al Laboratory safety, management and diagnosis of biological agents associated with bioterrorism. In Snyder JW, coordinating editor Cumitech3X Washington DC, 2000, ASM Press. Klietmann WF, Ruoff KL Bioterrorism implications for the clinical microbiologist, Clin Microbiol Rev 14 364,2001. Morse SA Bioterrorism laboratory security, Lab Med 32 303, 2001. Sewell DL Laboratory safety practices associated with potential agents of biocrime or bioterrorism, J Clin Microbiol 41 2801,2003. Snyder JW, Weissfeld AS Laboratory detection of potential agents of bioterrorism. In Murray PR, Baron EJ, Jorgensen JE et al editors Manual of clinical microbiology, ed 8, Washington, DC, 2003, ASM Press.
There is the potential that this organism could be B. anthracis. Such an isolate could provide proof that a bioterrorist event is occurring. All plates and tubes should immediately be placed in a biological safety cabinet. Then the laboratory supervisor should be notified to contact the physician, the local epidemiologist, and the local public health department immediately. They will instruct you what action to take and how to handle the cultures. They will want you to carefully examine the Gram stain. The bacillary vegetative cells should be greater than 1 jun wide and the spores should not be wider than the vegetative cells. B. anthracis is nonmotile, whereas most other bacilli are motile. Old cultures of saprophytic Bacillus spp. tend to be nonmotile. Preparation of a fresh culture plate that is observed microscopically in a wet mount after a few hours at 35 C may be all that is needed to rule out B. anthracis. There is no danger in doing this test, because spores will not form in...
On 25 April 1953 Francis Crick and James D. Watson published their paper Molecular structure of nucleic acids in Nature (Watson and Crick, 1953), describing the double helix structure of DNA. This signalled the launch of the modern era of molecular biology and provided the foundation of our understanding of molecular medicine, transforming much of scientific research including how we approach the discovery of new drugs. On 15 April 2003, nearly 50 years after the publication in Nature, Carl B. Feldbaum of the Biotechnology Industry Organization (BIO) announced the finished version of the human genome sequence and the completion of the Human Genome Project providing an accurate map of the 3.1 billion units of DNA. At the same time, it was reported that the genome of the newly identified SARS (Severe Acute Respiratory Syndrome) virus had been sequenced in only 6 days. The Bacillus anthracis, Ames strain used in postal terrorist attacks in the United States in 2002 was reported as...
Recently, the entire genome of poliovirus was assembled from oligodeoxynucleotides as a double-stranded cDNA molecule and subsequently transcribed by RNA polymerase into infectious RNA. The experiment, reported in 2002, raised some issues of security with respect to possible bioterrorist implications of this work. In fact, the synthesis of infectious influenza virus, using preserved tissue material from the extremely virulent 1918 strain, led to an even stronger reaction. These issues highlight the increasingly sensitive nature of some aspects of modern virological research.
Inhibitors of Vaccinia Virus (Smallpox) - Smallpox has aroused considerable concern with discussion prominently focussed on its potential as an agent of bioterrorism (162167). Many inhibitors of vaccinia virus replication interfere with host cell pathways and include 11. (inosine monophosphate dehydrogenase), the cyclopentenyl nucleoside analogue neplanocin A (S-adenosylhomocysteine hydrolase) and pyrazofurin (OMP decarboxylase) (168, 169). The cytidine and 5-F cytidine analogues of neplanocin A are equally potent inhibitors of several orthopox viruses, including smallpox (170). The nucleoside phosphonate cidofovir (HPMPC), licensed in 1996 for the treatment of HCMV retinitis in HIV patients, inhibits vaccinia virus in vitro (EC5o 18 ng mL) and protects mice from a lethal vaccinia infection following a single systemic (intraperitoneal) or intranasal (aerosolized) dose (171). 5-lodo-2'-deoxyuridine, an inhibitor of vaccinia virus DNA synthesis in vitro, delays the effects of a lethal...
The main role of sentinel microbiology laboratories is to raise suspicion when a targeted agent is suspected in a human specimen. Detection and recognition of a possible bioterrorism event will depend on BOX 65-2 Targeted Critical Agents Likely to Be Used in a Bioterrorist Event*
Although smallpox virus is extinct in the wild, the recent realization that smallpox has been extensively studied as a weapon, and fears that it may be in the possession of terrorists, brings these classic studies into sharp focus. Further, other animal poxviruses such as monkey pox can infect humans, and human encroachment of tropical habitats has led to significant occurrence of this disease in tropical Africa. Another poxvirus, myxoma virus, is endemic in rabbit populations in South America, and was used in a temporarily successful attempt to control the ecological threat posed by the high rate of rabbit multiplication in Australia. While touted at the time as an example of successful biological control, numerous complications occurred with its use. Thus, this experiment is a valuable example of the benefits and problems involved with biological control.
Many of the TRAP laws clearly serve as a violation of abortion providers' rights by allowing unannounced search and seizures at times when surgery is being performed. Some of the mandated requirements include airflow and circulation requisites square-footage minimums for hallways, recovery rooms, counseling rooms, and changing rooms specific sink designs and lawn care standards. Those who continue to provide abortion services would have difficulty seeking new space due to the reluctance of landlords to rent to them. The reality is that abortion providers remain targets of arson, clinic bombings, large demonstrations, and other forms of domestic terrorism.
HIV AIDS-related bacterial infection, and diseases that may be spread as a result of bioterrorist acts. Withdrawal from antibacterial research will have a major impact on global health. A letter to the journal of the American Society for Microbiology (Appelbaum, 2003) states that, A crisis has developed and we are doing nothing about it, highlighting that Pharma companies are reducing or closing their antibacterial research and that pipelines are, practically empty. Appelbaum suggests that, unlike drugs for long-term treatments, there is a lack of funding for research into antibacterials, one of the reasons for this being the overly stringent approval criteria imposed by the Federal Drug Agency (FDA), making it practically impossible or prohibitively expensive to bring new antibacterials to market (Appelbaum, 2003).
At the time of writing this, the economics of resistance is an emerging field of research, and a number of the chapters in this volume are still in the process of development. We believe that publishing these preliminary ideas will be helpful in extending the study of the economics of resistance. Recent concerns about bioterrorism and re-emerging infections such as tuberculosis remind us of the need to give more serious thought to our arsenal of antibiotics managing those that we have efficiently and developing new ones. We hope this volume, even if it does not readily provide complete answers to such questions, provokes ideas to pursue in this growing and topical field.
Understanding the epidemiology of HIV provides an important foundation for clinicians in recognizing risk behaviors associated with clinical manifestations suggestive of HIV infection in their patients, and encouraging acceptance of HIV testing, adoption of risk-reduction strategies to prevent further transmission, and treatment to prevent opportunistic illnesses and delay disease progression. At the start of the third decade of the HIV pandemic, and following the terrorism of September 11, 2001 and the subsequent bio-terrorism, the government and the public have a heightened awareness of the crucial role of public health preparedness in assuring well-being.
And camel pox or the use of bioterrorism by mutation and selection, evade the blocking effects of a single inhibitor. Therefore, as with tuberculosis, the practical answer is to find inhibitors of a wide range of virus-specific enzymes or proteins and to use them in a patient simultaneously. This search for new drugs will be a continuing need as it is with antibacterials. Similarly, inhibitors of pandemic and epidemic influenza A viruses will need the continuing attention of antiviral chemotherapists. The human herpes viruses (HHV1-8) cause a remarkably diverse range of important diseases and will continue to remain important targets, especially VZV (varicella-zoster virus or shingles), which will reach new importance in a world population with increasing longevity. Common cold viruses and other viruses of the respiratory tract cause pathogenesis in the upper respiratory tract during all months of the year in all countries of the world and hence have economic importance. The eight or...
Rapid point-of-care diagnostics are ideal if they can be simplified, and rendered less expensive. The greatest current effort on point-of-care diagnostics has been on identifying the pathogen -rather than the antimicrobial susceptibility of the pathogen. Public investment in developing simplified point-of-care diagnostics, especially for susceptibility, is crucial The development of guidelines for the diagnosis and treatment of adult and pediatric illnesses has received considerable attention in recent years. These have been region specific to reflect the major endemic illnesses of the area - i.e., malaria endemic, HIV hyperendemic. There can be considerable variation within regions and these needs to be explored in greater depth. The most difficult regions to develop guidelines for will be the areas with the least infrastructure - where the least is known about disease endemicity Recent efforts addressed at new and emerging diseases and bioterrorism have provided an impetus for...
Following murders, terrorist attacks, wars and fatal accidents it is desirable to group together body parts from individuals when fragmentation has occurred and ultimately to identify the deceased. If the time between death and recovery of the body is short then muscle tissues provide a rich source of DNA 22 , which can be extracted using, for example, any of the Chelex , salting-out and organic extraction methods. If, however, the soft tissues are displaying an advanced state of decomposition they will not provide any DNA suitable for analysis. When the cellular structure breaks down during decomposition, enzymes that degrade DNA are released and the DNA within the cell is rapidly digested. This process is accelerated by the action of colonizing bacteria and fungi.
The obligate intracellular bacterium C. burnetii is the causal agent of Q fever in humans. The acute form of the disease can range from asymptomatic infection to atypical pneumonia, granulomatous hepatitis, or a self-limited febrile illness. The manifestations of chronic Q fever are endocarditis, hepatitis, osteomyelitis or infected aortic aneurysms (Heinzen et al. 1999). C. burnetii disseminates and replicates in a wide variety of tissues but the initial targets are the alveolar macrophages. C. burnetii can survive for long periods in natural environments as it is highly resistant to elevated temperature, desiccation, UV light and various chemical disinfectants. In general, both humans and animals become infected by inhaling contaminated aerosols. Due to its low infectious dose and high environmental resistance, the Centers for Disease Control and Prevention (CDC) consider this pathogen a Class B agent of bioterrorism (Madariaga et al. 2003).
As reported in 1998-9, infectious diseases continue to be a leading cause of death, accounting for a quarter to a third of the estimated 54 million deaths annually worldwide. Lower respiratory infections, diarrhoeal disease, tuberculosis (TB), and malaria were the leading causes of global infectious disease burden. While a decrease in diarrhoeal disease is projected for 2020, malaria is increasing and TB and HIV are growing far faster than projected (Gordon et al., 2000). For the new millennium, HIV AIDS, TB, and malaria are the leading infectious disease killers (WHO, 1999). Along with bioterrorism and homeland security, antimicrobial resistance has become one of the most important public health issues faced by the industrialised world, particularly G8 country members. Antimicrobial resistance typically develops when antibiotics are prescribed in inadequate amounts and or for a condition that does not warrant their usage, such as for viral infections. It is estimated that annual cost...
In Enterobacteriaceae, fluoroquinolone resistance is an increasing problem. Resistance is mainly caused by mutations in the gyrA gene that encodes the A subunit of DNA gyrase, but mutations in gyrB, parC and parE, encoding the B subunit of DNA gyrase and the two subunits of DNA topoisomerase IV, respectively, can also contribute. Mutations in the gyrA gene are clustered in the quinolone resistance determining region (QRDR). Several tests have been described that detect fluoroqui-nolone resistance in Salmonella and Yersinia pestis. Y. pestis has received increased interest because of its potential in biological warfare or bioterrorism.
Priate diagnosis and treatment, the organism will not be eradicated, Laboratory susceptibility testing is unreliable, leading to erroneous results. If the identification is not correct, inappropriate treatment can result. Usually the identification is confirmed by the local health department. In fact, Brucella disease is reportable and is on the list of potential bioterrorist organisms.
The culture should only be handled with biosafety level 3 precautions, the same precautions used to handle. Mycobacterium tuberculosis. However at this point, it should be sent to the state health department and the physician notified of the possible identification of P. tularerisis. Also, the local epidemiologist should be contacted immediately if you cannot rule out a bioterrorist event associated with isolation of the organism,
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