The smallpox vaccine: An update for oral health care professionals

BACKGROUND: A heightened awareness of the potential for bioterrorist attacks in the United States has led to the expansion of the nation's supply of smallpox vaccine and the institution of procedures to distribute this vaccine in the unlikely event of a release of this potentially deadly agent. METHODS: The authors conducted a review of the relevant smallpox literature through a MEDLINE search. They also reviewed the Web site of the Centers for Disease Control and Prevention and numerous other Web sites. RESULTS: The authors considered for inclusion more than 100 articles discussing smallpox, the smallpox vaccine and the role of the dental professional in a bioterrorist attack. CONCLUSIONS: Dentists may detect the initial signs of a smallpox infection, provide information concerning the disease to the public and potentially assist in the administration of smallpox vaccine. CLINICAL IMPLICATIONS: Should an intentional release of smallpox occur, the dental professional may play an important role in its treatment and prevention.     

Smallpox Vaccination: A National Survey of Emergency Health Care Providers

Concerns about bioterrorism have prompted a national voluntary smallpox (SP) vaccination program in the United States. Although emergency health care providers are among the first targeted for vaccination, little is known about how these providers view the risks and benefits of SP vaccination. OBJECTIVES: To assess the willingness of emergency health care personnel to receive pre-event SP vaccination prior to the start of the national program. METHODS: The authors conducted a national cross-sectional, anonymous survey of 1,701 emergency physicians, nurses, and mid-level practitioners working full time in 13 adult and pediatric academic emergency departments in large U.S. cities in November and December 2002. The main outcome measure was willingness to be vaccinated against SP. Secondary outcomes included the prevalence of self-reported contraindications, and reasons for and against vaccination. RESULTS: 732 emergency health care providers returned questionnaires (response rate 43%). Overall, 73% (95% CI = 66% to 80%) were willing to receive pre-event SP vaccination. 18% (95% CI = 14% to 23%) reported contraindications to vaccination, and 50% (95% CI = 39% to 61%) of these providers were willing to receive pre-event SP vaccination. Self-protection (72%) was the most common reason cited for desiring vaccination against SP; concern about vaccine-related adverse events (54%) was the most common reason cited for not wanting immunization. CONCLUSIONS: Most emergency health care providers express a willingness to receive pre-event SP immunization; self-protection is a principal motivating reason. A subset of health care providers, however, may place themselves at increased risk by desiring vaccination despite contraindications.     

An overview of biosecurity in Australia

Threats of natural and deliberate biological agent release are very real and are of serious concern within Australia and internationally, having the potential to substantially impact human, plant and animal health as well as agriculture, trade relations, infrastructure and the economy. Biosecurity programmes and policies are essential for counteracting these threats and enabling a nation to effectively prevent and/or respond to the natural, accidental and deliberate release of a biological agent. The major biosecurity focus in Australia is the protection against invasive animal, plant and insect species; however, more recently, the threat of microbiological agents has become a priority for Australia’s national security. Australia’s biosecurity capabilities are maintained through a coordinated effort, involving national, state and local government and non-government agencies. Communication and collaboration between all parties, at both a national and international level, is the key to an effective response. The threat from biological agents is a very real concern and Australia must maintain its preparedness in order to ensure its capacity to respond to biological threats. This review provides a contemporary overview of biosecurity in Australia and the role of forensic science in the investigation of biosecurity incidents.     

基于社会接触网络的大规模人群天花传播并行仿真

天花生物恐怖是世界各国面临的重大潜在威胁.本文利用并行仿真的技术手段,研究天花在大规模城市人群中的传播规律并对环形接种和大规模疫苗接种这两种主要的天花疫苗接种策略进行有效性分析,结果表明环形接种措施能够有效控制天花疫情的扩散,在天花疫苗储备不足的情况下可以优先考虑采用该措施.     

Biological warfare,bioterrorism, and biocrime

Biological weapons achieve their intended target effects through the infectivity of disease-causing infectious agents. The ability to use biological agents in warfare is prohibited by the Biological and Toxin Weapon Convention. Bioterrorism is defined as the deliberate release of viruses, bacteria or other agents used to cause illness or death in people, but also in animals or plants. It is aimed at creating casualties, terror, societal disruption, or economic loss, inspired by ideological, religious or political beliefs. The success of bioterroristic attempts is defined by the measure of societal disruption and panic, and not necessarily by the sheer number of casualties. Thus, making only a few individuals ill by the use of crude methods may be sufficient, as long as it creates the impact that is aimed for. The assessment of bioterrorism threats and motives have been described before. Biocrime implies the use of a biological agent to kill or make ill a single individual or small group of individuals, motivated by revenge or the desire for monetary gain by extortion, rather than by political, ideological, religious or other beliefs. The likelihood of a successful bioterrorist attack is not very large, given the technical difficulties and constraints. However, even if the number of casualties is likely to be limited, the impact of a bioterrorist attack can still be high. Measures aimed at enhancing diagnostic and therapeutic capabilities and capacities alongside training and education will improve the ability of society to combat ‘regular’ infectious diseases outbreaks, as well as mitigating the effects of bioterrorist attacks.     

反生物恐怖袭击医学救援中人员洗消装置的生物学效果观察

目的测试研制的反生物恐怖袭击医学救援中人员洗消装置的现场洗消生物学效果。方法以大肠杆菌和枯草杆菌为指示剂涂于分别着普通衣物和防化服的受试对象标定的检测区,试验组通过洗消装置喷淋洗消,5 min后对试验组和未洗消的对照组的检测区采样,培养计数菌落数,计算落数平均杀灭对数值(KLV)。结果用含1 000mg/L有效氯浓度的三氯异氰脲酸剂洗消剂喷淋洗消,着普通衣物组的大肠杆菌和枯草杆菌KLV为4.26(t=26.359,P<0.001)和4.03(t=21.053,P<0.001),着防化服组两菌KLV分别为5.12(t=24.178,P<0.001)和4.64(t=23.398,P<0.001)。结论现场测试KLV均大于3,采用装置喷淋洗消达到洗消的生物学效果。     

重大生物事件复杂系统分析及其综合应急框架研究

在深入研究重大生物事件（生物袭击、生物恐怖、重大传染病）应急防控的一些典型研究成果的基础上,基于系统学思想分析了重大生物事件演化过程开放性、复杂性、高维性、不确定性及涌现性的整体特性,对系统结构和功能进行分析;提出了应对重大生物事件的＂应急准备—监测预警—灾害评估—救援处置—恢复重建＂的综合框架,明确各阶段任务面临的主要风险与需求,以及需要研究的核心科学问题,为建立重大生物灾害事件的综合防控体系奠定理论基础。     

Surveillance of Infectious Disease Occurrences in the Community: An Analysis of Symptom Presentation in the Emergency Department

OBJECTIVES: To determine the effectiveness of a simulated emergency department (ED)-based surveillance system to detect infectious disease (ID) occurrences in the community. METHODS: Medical records of patients presenting to an urban ED between January 1, 1999, and December 31, 2000, were retrospectively reviewed for ICD-9 codes related to ID symptomatology. ICD-9 codes, categorized into viral, gastrointestinal, skin, fever, central nervous system (CNS), or pulmonary symptom clusters, were correlated with reportable infectious diseases identified by the local health department (HD). These reportable infectious diseases are designated class A diseases (CADs) by the Ohio Department of Health. Cross-correlation functions (CCFs) tested the temporal relationship between ED symptom presentation and HD identification of CADs. The 95% confidence interval for lack of trend correlation was 0.0 +/- 0.074; thus CCFs > 0.074 were considered significant for trend correlation. Further cross-correlation analysis was performed after chronic and non-community-acquirable infectious diseases were removed from the HD database as a model for bioterrorism surveillance. RESULTS: Fifteen thousand five hundred sixty-nine ED patients and 6,489 HD patients were identified. Six thousand two hundred eight occurrences of true CADs were identified. Only 87 (1.33%) HD cases were processed on weekends. During the study period, increased ED symptom presentation preceded increased HD identification of respective CADs by 24 hours for all symptom clusters combined (CCF = 0.112), gastrointestinal symptoms (CCF = 0.084), pulmonary symptoms (CCF = 0.110), and CNS symptoms (CCF = 0.125). The bioterrorism surveillance model revealed increased ED symptom presentation continued to precede increased HD identification of the respective CADs by 24 hours for all symptom clusters combined (CCF = 0.080), pulmonary symptoms (CCF = 0.100), and CNS symptoms (CCF = 0.120). CONCLUSIONS: Surveillance of ED symptom presentation has the potential to identify clinically important ID occurrences in the community 24 hours prior to HD identification. Lack of weekend HD data collection suggests that the ED is a more appropriate setting for real-time ID surveillance.     

Effectiveness of a Mobile Short-Message-Service–Based Disease Outbreak Alert System in Kenya

We conducted a randomized, controlled trial to test the effectiveness of a text-messaging system used for notification of disease outbreaks in Kenya. Health facilities that used the system had more timely notifications than those that did not (19.2% vs. 2.6%), indicating that technology can enhance disease surveillance in resource-limited settings.     

Efficacy of an Educational Web Site for Educating Physicians about Bioterrorism

OBJECTIVES: To determine whether a Web-based educational intervention improves emergency physicians' knowledge about bioterrorism and to survey physicians' knowledge and sources of information on bioterrorism. METHODS: Prospective randomized controlled trial using pre- and postintervention testing in hospitals. Participants were general and pediatric emergency medicine attending physicians, fellows, and fourth-year emergency medicine residents. All participants completed a pretest and attended a lecture on bioterrorism. Participants were then randomized to the Web intervention group that received continuous access to a bioterrorism educational Web site with weekly exposure to case scenarios of diseases due to biological agents, or the control group. Participants were retested after one and six months and surveyed to identify their sources of information and assess their knowledge. RESULTS: Sixty-three physicians completed the pretest. There was no difference in mean +/- standard deviation (SD) pretest scores between Web intervention (45% +/- 10%) and control (44% +/- 10%) groups (mean difference: 1.9%; 95% confidence interval [CI] = -6.7% to 2.9%). There was no significant difference between pre- and posttest scores among groups at one month (Web intervention 48% +/- 10% vs. control 45% +/- 10%; mean difference: 3.3%; 95% CI = -8.5% to 2.0%) and six months (Web intervention 51% +/- 8% vs. control 47% +/- 9%; mean difference: 3.8%; 95% CI = -8.8% to 1.2%). More than 60% of physicians cited media reports as their primary source of information on bioterrorism and believed that their knowledge of bioterrorism was limited after one month. CONCLUSIONS: Providing physicians information on bioterrorism through simulated cases and continuous access to an educational Web site does not increase knowledge of bioterrorism. Physicians are more likely to use media reports for their primary source of information.