Bioterrorism : A public health perspective

The intentional release or threat of release of biologic agents (i.e. viruses, bacteria, fungi or their toxins) in order to cause disease or death among human population or food crops and livestock to terrorize a civilian population or manipulate the government in the present scenario of increased terrorist activity has become a real possibility. The most important step in the event of a bioterrorist attack is the identification of the event. This can be achieved by generating awareness, having high degree of suspicion and having a good surveillance system to assist quick detection.     

The Contributions of Biomedical Informatics to the Fight Against Bioterrorism

A comprehensive and timely response to current and future bioterrorist attacks requires a data acquisition, threat detection, and response infrastructure with unprecedented scope in time and space. Fortunately, biomedical informaticians have developed and implemented architectures, methodologies, and tools at the local and the regional levels that can be immediately pressed into service for the protection of our populations from these attacks. These unique contributions of the discipline of biomedical informatics are reviewed here.Current outbreaks of anthrax exposure and cases test our health care delivery and public health systems with threats of large spatial scope—the entire nation—that demand a very short temporal latency in our responses. Other potential bioterrorist attacks only increase the dimensions of this unprecedented challenge. The dimensions, however, are not unprecedented; rather, they are quite familiar to many researchers in biomedical informatics over the last 40 years. The task of comprehensive real-time monitoring on the regional and national scale has been the subject of full-fledged design and large-scale implementations led by biomedical informaticians.Nonetheless, we run the risk that the knowledge gained in the decades of informatics research will not, in the appropriate haste to safeguard the population of the United States from the threats of bioterrorism, be reflected in the national public health information infrastructure. And that may result not only in wasteful expenditures but also in ineffective measures to prevent future attacks on the health of the U.S. population. This is, therefore, a timely juncture to review some of the most germane contributions from the biomedical informatics armamentarium to the tasks at hand, particularly data acquisition, threat detection, and response.     

Public knowledge of heart attack symptoms in Beijing residents

Background Definitive treatment for heart attack is early reperfusion with either angioplasty or thrombolytic therapy, and the benefit is strictly time-dependent. Patient outcomes are improved with either therapy when initiated as soon as possible. Recognition of heart attack symptoms is logically tied to taking action to receive prompt emergency care. Inadequate knowledge of heart attack symptoms may prolong delay. The purpose of this study was to document knowledge about heart attack symptoms in Beijing residents and to identify the characteristics associated with increased knowledge of heart attack.Methods A structured survey was conducted in 18 communities in Beijing from March 1 through June 10 in 2006. Addresses and participants were selected randomly following a stratification. The survey was designed to collect knowledge of heart attack symptoms from sampled adults in each community. Results A total of 4627 respondents completed the questionnaires correctly, and 50.29% of them were female. Totally 64.15% of the respondents reported chest pain or discomfort (common symptoms) as a symptom of heart attack; 75.38% reported at least one of the following eight symptoms as a symptom of heart attack: back pain, shortness of breath, arm pain or numbness, nausea or vomiting, neck, jaw or shoulder pain, epigastric pain, sweating, weakness (less common symptoms); 20.36% correctly reported four or more heart attack symptoms, only 7.4% knew all the correct heart attack symptoms, and 28.94% knew about reperfusion therapy for heart attack; 31.7％ reported to call 120 or 999 while having a heart attack themselves; however 89.6％ reported to call 120 or 999 when someone else is suffering from a heart attack. Very old persons and those with health insurance coverage, high education level, high household income, longer living in Beijing and previous experience with heart disease had greater knowledge of heart attack symptoms.Conclusions Public knowledge of common heart attack symptoms as well as less common heart attack symptoms is deficient in Beijing residents. But their knowledge of calling emergency medical services when someone is having a heart attack is relatively adequate. Public health efforts are needed to increase the recognition of the major heart attack symptoms in both the general public and groups at high risk for an acute cardiac event, especially in socioeconomically disadvantaged subgroups, including persons with low education level, low household income, and no health insurance coverage.     

Large-scale quarantine following biological terrorism in the United States: scientific examination, logistic and legal limits, and possible consequences.

Concern for potential bioterrorist attacks causing mass casualties has increased recently. Particular attention has been paid to scenarios in which a biological agent capable of person-to-person transmission, such as smallpox, is intentionally released among civilians. Multiple public health interventions are possible to effect disease containment in this context. One disease control measure that has been regularly proposed in various settings is the imposition of large-scale or geographic quarantine on the potentially exposed population. Although large-scale quarantine has not been implemented in recent US history, it has been used on a small scale in biological hoaxes, and it has been invoked in federally sponsored bioterrorism exercises. This article reviews the scientific principles that are relevant to the likely effectiveness of quarantine, the logistic barriers to its implementation, legal issues that a large-scale quarantine raises, and possible adverse consequences that might result from quarantine action. Imposition of large-scale quarantine-compulsory sequestration of groups of possibly exposed persons or human confinement within certain geographic areas to prevent spread of contagious disease-should not be considered a primary public health strategy in most imaginable circumstances. In the majority of contexts, other less extreme public health actions are likely to be more effective and create fewer unintended adverse consequences than quarantine. Actions and areas for future research, policy development, and response planning efforts are provided.     

Anthrax as a biological weapon, 2002: updated recommendations for management

OBJECTIVE: To review and update consensus-based recommendations for medical and public health professionals following a Bacillus anthracis attack against a civilian population. PARTICIPANTS: The working group included 23 experts from academic medical centers, research organizations, and governmental, military, public health, and emergency management institutions and agencies. EVIDENCE: MEDLINE databases were searched from January 1966 to January 2002, using the Medical Subject Headings anthrax, Bacillus anthracis, biological weapon, biological terrorism, biological warfare, and biowarfare. Reference review identified work published before 1966. Participants identified unpublished sources. CONSENSUS PROCESS: The first draft synthesized the gathered information. Written comments were incorporated into subsequent drafts. The final statement incorporated all relevant evidence from the search along with consensus recommendations. CONCLUSIONS: Specific recommendations include diagnosis of anthrax infection, indications for vaccination, therapy, postexposure prophylaxis, decontamination of the environment, and suggested research. This revised consensus statement presents new information based on the analysis of the anthrax attacks of 2001, including developments in the investigation of the anthrax attacks of 2001; important symptoms, signs, and laboratory studies; new diagnostic clues that may help future recognition of this disease; current anthrax vaccine information; updated antibiotic therapeutic considerations; and judgments about environmental surveillance and decontamination.     

海口市2004—2020年突发公共卫生事件流行特征分析

目的 分析2004—2020年海口市突发公共卫生事件流行特征,为制定防控策略提供参考。方法 应用国家突发公共卫生事件监测网络,收集2004—2020年海口市突发公共卫生事件相关数据进行描述性统计分析。结果 2004—2020年海口市共报告突发公共卫生事件174起,发病5 297人,总罹患率为0.74%,罹患率呈现下降趋势（χ²_趋势=4 307.85,P<0.001）;共死亡11人,死因均为化学性中毒;时间分布呈现双峰型特征,报告高峰在3—5月和9月;74.14%的事件发生在城区;72.99%的事件发生在学校及托幼机构;传染病事件占78.16%,以呼吸道传染病为主（占73.53%）,其次是肠道传染病（占20.59%）和虫媒传染病（占5.88%）;食源性疾病占20.11%,以细菌性食源性疾病为主（占71.43%）,其次是食源性化学性中毒（占11.43%）、植物性毒素中毒（占8.57%）和未检出致病因子（占8.57%）;建筑工地罹患率较高（23.79%）;其他公共卫生事件罹患率为6.70%,高于传染病事件和食源性疾病;介入处置时间越长,罹患率越高（χ²_趋势=2 233.61,P<0.001）;报告时已有病例数>14例的罹患率较高（2.87%）;事件持续时间≤7.10 d的罹患率较高（1.21%）。结论 海口市突发公共卫生事件以传染病事件和食源性疾病为主,加强学校及托幼机构、建筑工地等场所的传染病防控和食品卫生管理,提高监测报告敏感性,及早介入处置,可减少突发公共卫生事件的发生和危害。     

Implementing Syndromic Surveillance: A Practical Guide Informed by the Early Experience

Syndromic surveillance refers to methods relying on detection of individual and population health indicators that are discernible before confirmed diagnoses are made. In particular, prior to the laboratory confirmation of an infectious disease, ill persons may exhibit behavioral patterns, symptoms, signs, or laboratory findings that can be tracked through a variety of data sources. Syndromic surveillance systems are being developed locally, regionally, and nationally. The efforts have been largely directed at facilitating the early detection of a covert bioterrorist attack, but the technology may also be useful for general public health, clinical medicine, quality improvement, patient safety, and research. This report, authored by developers and methodologists involved in the design and deployment of the first wave of syndromic surveillance systems, is intended to serve as a guide for informaticians, public health managers, and practitioners who are currently planning deployment of such systems in their regions.Bioterrorism preparedness has been the subject of concentrated national effort¹ that has intensified since the events of fall 2001.² In response to these events, the biomedical, public health, defense, and intelligence communities are developing new approaches to real-time disease surveillance in an effort to augment existing public health surveillance systems. New information infrastructure and methods to support timely detection and monitoring,^3,4,5,6,7 including the discipline of syndromic surveillance, are evolving rapidly. The term syndromic surveillance refers to methods relying on detection of clinical case features that are discernable before confirmed diagnoses are made. In particular, prior to the laboratory confirmation of an infectious disease, ill persons may exhibit behavioral patterns, symptoms, signs, or laboratory findings that can be tracked through a variety of data sources. If the attack involved anthrax, for example, a syndromic surveillance system might detect a surge in influenza-like illness, thus, providing an early warning and a tool for monitoring an ongoing crisis.Unlike traditional systems that generally utilize voluntary reports from providers to acquire data, contemporary syndromic surveillance relies on an approach in which data are continuously acquired through protocols or automated routines. The real-time nature of these syndromic systems makes them valuable for bioterrorism-related outbreak detection, monitoring, and investigation. These systems augment the capabilities of the alert frontline clinician who, athough an invaluable resource for outbreak detection, is generally better at recognizing individual cases rather than patterns of cases over time and across a region. Syndromic surveillance technology may be useful not only for bioterrorism event detection, but also for general public health, clinical medicine, quality improvement, patient safety, and research. This report, authored by developers and methodologists involved in the design and deployment of the first wave of syndromic surveillance systems, is intended to serve as a guide for informaticians, public health managers, and practitioners who may be planning deployment of such systems in their regions.     

北京某区医院的突发事件监测情况调查

目的:了解医院突发事件监测机构的设置及相关监测内容,为寻找合理的监测指标、完善医院日常监测、建立突发事件监测系统提供科学依据.方法:选取北京某区医院为研究现场,对该区所有二级和三级医院(共计15所)进行问卷调查,并回顾门/急诊量的变化及药品销售量情况.结果:53.3%的医院现行监测机构设在门/急诊,其余设在其他部门.三级医院监测资料分析周期为每周,二级医院为每月.15所医院不同程度地对就诊人员的性别、年龄、职业等11项内容实施监测.2002年和2003年的1～6月门/急诊量变化趋势以3月份为分界点,3月份之前基本一致;2003年3月份后的门/急诊量开始与2002年的曲线分离.SARS流行期间对比往年同期水平销售量增幅最大的药品依次为抗病毒类药、抗生素类药、中药、免疫制剂.结论:门急诊是医院的重点监测部门,监测项目中的人群特征不可忽视.医院门/急诊量及药品销售变化对突发事件具有警示作用,是亟待挖掘的监测指标.     

突发公共卫生事件下医疗保险统筹基金应急管理思考

通过对我国现行医疗保险统筹基金管理现状进行分析,阐述突发公共卫生事件对医疗保险统筹基金应急管理的影响,并就如何加强医疗保险统筹基金应急管理,完善医疗保险应急资金统筹渠道,建立医保专项准备金评估拨付机制等方面提出一些思路。     

Bioshock : Biotechnology and bioterrorism

In the recent past, the threat of a global bioterrorist attack has increased dramatically. In addition to the already existing microorganisms and techniques, the recent explosion in biotechnology has considerably addedto the arsenal of the bioterrorist. Molecular technologies are now available which can be used by committed bioterrorist groups to manipulate and modify microorganisms so as to make them increasingly infectious, virulent or treatment resistant for causing maximum casualties. Infectious diseases which are likely to be used as bioweapons are Anthrax, Botulism, Plague, Smallpox and Brucella. Molecular techniques like immunoassays and nucleic acid amplification are now available to detect bioattacks. This article discusses the threat of bioterrorism. It also evaluates the molecular diagnostic methods and the future of early containment of a bioterrorist attack using molecular techniques.     

突发公共卫生事件应急处理机制建立及应用效果评价

目的:探索建立适合我市特点的突发公共卫生事件应急处理机制并评价应用效果。方法:按照《濮阳市突发公共卫生事件应急预案》,建立突发公共卫生事件应急处理机制,并应用于水灾后救灾防病和暴发疫情应急处理,比较机制建立前、后传染病发病率、罹患率和二代发病率。结果:突发公共卫生事件应急处理机制的建立与应用,对救灾防病和传染病暴发疫情的控制效果显著。     

Bioshock: Biotechnology and Bioterrorism

In the recent past, the threat of a global bioterrorist attack has increased dramatically. In addition to the already existing microorganisms and techniques, the recent explosion in biotechnology has considerably added to the arsenal of the bioterrorist. Molecular technologies are now available which can be used by committed bioterrorist groups to manipulate and modify microorganisms so as to make them increasingly infectious, virulent or treatment resistant for causing maximum casualties. Infectious diseases which are likely to be used as bioweapons are Anthrax, Botulism, Plague, Smallpox and Brucella. Molecular techniques like immunoassays and nucleic acid amplification are now available to detect bioattacks. This article discusses the threat of bioterrorism. It also evaluates the molecular diagnostic methods and the future of early containment of a bioterrorist attack using molecular techniques.Key Words: Bioterrorism, Molecular techniques     

城市炭疽气溶胶恐怖事件医学处置效果评估方法

目的 构建一种炭疽气溶胶恐怖事件医学处置效果的量化评估方法。方法 首先构建炭疽暴露后医学干预的决策树模型、关键资源消耗配置模型及不同干预措施下人群状态转移模型,从而形成一个资源约束下炭疽事件医学处置效果的评估框架。然后基于离散事件仿真技术,以我国大城市遭受炭疽恐怖袭击为情景,分析评估52种干预策略对发病人数、峰值、死亡人数的影响。结果 干预效果对介入延迟时间和资源储备量2个因素均敏感。在仿真案例中,当介入延迟时间为事发后1 h时,将资源储备量从25%提高到100%可减少约59.91%的死亡人数;当介入延迟时间为事发后145时,将资源储备量从25%提高到100%只能减少约7.33%的死亡人数。干预策略对发病人数达到峰值的时间影响很小,最大值为10.52 d,最小值为9.67 d;对峰值人数影响较大,最大值为255 072人,最小值为103 943人。结论 建立了一种炭疽气溶胶恐怖事件医学处置效果的定量评估方法,在医学救援能力建设、应急策略选择方面具有一定的参考价值。     

预防医学专业学生对某起突发公共卫生事件知晓情况的分析

目的 了解预防医学专业学生对突发公共卫生事件的知晓情况,分析学生对此类事件的敏感程度,了解学生对突发公共卫生事件的关注程度和理论联系实际、分析及解决问题的能力,为教学改革提供依据.方法 对某大学预防医学专业一年级~五年级423名本科生和公共卫生与预防医学各专业104名研究生有关手足口病的知晓情况等进行匿名问卷调查,问卷满分为20分.结果 全体学生平均得分仅为6.15±3.95分,其中,研究生平均得分为8.53±3.26分,高于本科生平均得分5.56±3.89分,本科生平均得分随着年级的升高而增加.学生对问卷中疾病病原体和传染源等问题的回答正确率很低.仅有2.1%的学生对发生较多死亡的病例考虑了3个及以上的原因.从权威的专业医学网站和专业学术期刊获取疫情信息的学生仅有1.9%.结论 预防医学专业学生对本次突发公共卫生事件不能全面知晓和进行综合分析,获取信息的途径十分有限,亟需进行教学改革,更新教学理念,加强学生综合能力的培养.

Abstract：

Objective To investigate preventive medical students' awareness for emergency public health event, to understand their attention extent to this event, their ability of linking theory with practice , analyzing and solving problems and to perform the teaching reform based on the findings of this study.Methods 423 undergraduates students of grade 1 to grade S and 104 postgraduates majoring in preventive medicine from an university were investigated by questionnaire anonymously. The total score of the questionnaire was 20. Results The average score of all the participants was 6.15 ±.95, and the postgraduates ' average score was 8. 53 ±3.26, significantly higher than that (5.56±.89) of the undergraduates'(P<0.001). The average score of the latter increased with grades, P<0.001. The corrective rates for most questions were low. Among all the participants, only 2. 1 percent considered three or more causes for having more death cases, only 1.9 percent obtained the information about the disease from the authoritative and professional medical websites and academic journals. Conclusions The preventive medical students were not aware of this emergency public health event completely and were not able to analyze it comprehensively. Moreover, the approaches to acquire the information were very limited. It is urgent to reform education system, renew educational thoughts and enhance the cultivation of contact between theory and practice capabilities.     

突发公共卫生事件医疗救援预案的编制与应用

基于社会和经济迅速发展的需要以及各类突发公共卫生事件频发的现实,切实加强突发公共卫生事件紧急医疗救援准备工作是各级医疗卫生部门面临的迫切任务。本文根据近10年来本单位参与的历次突发公共卫生事件紧急医疗救援情况,同时参考国内外相关文献资料,反思了突发公共卫生事件紧急医疗救援应急预案编制和其在实际应用过程中的主要问题与困难,如预案设计和更新、与其他部门预案之间的衔接和协调、院内救治预案体系及应急专业队伍建设、应急培训演练与应急卫生评价和科研等问题,以及存在经费困难、急救专业队伍不稳定、领导重视程度不够等,并就此进行了一些思考和探索,提出了一些有益的意见和建议,以期为突发公共卫生事件紧急医疗救援准备工作提供一定的理论参考。     

从SARS的挑战谈社区健康教育的建设和完善

社区健康教育是公共卫生体系的有机组成成分,是贯彻我国卫生工作方针的重要工具．SARS的流行检验了我国公共卫生体系对紧急公共卫生事件的应对能力,也揭示出了社区健康教育的不足．讨论了如何在加大对公共卫生投入、促进社区发展的基础上,从政策、机构建设、人员培训、思想意识的转变等各个层面改善社区健康教育工作,提高社区人群的健康意识和参与行动的能力．     

Bioterrorism: a threat for which we are ill prepared

Of the weapons of mass destruction, the biological ones are the most feared and bioterrorism has become one of the most vicious threats to civilized society in recent times. Biological weapons have been sporadically used for centuries. Despite international regulations, there has been a global re-emergence of the threat of biological warfare. As many as 17 countries are suspected of either including or developing biological agents in their weapons programmes. In the past decade, a number of terrorist organizations with access to bioweapons technology have emerged. Current surveillance systems may be inadequate to detect biological attacks. The onset of illness is often delayed, thus the timing and location of such an event may be extremely difficult to identify. We are unfamiliar with most of the agents of biological warfare and are ill-equipped to handle the consequences of such an attack. In addition, there is no apparent coherent policy to handle a biological terrorist incident. Given the enormity of what is possible in the event of a biological attack, we must be prepared to detect, diagnose, epidemiologically characterize and respond appropriately to biological weapons. Of the potential biological weapons, smallpox and anthrax pose the greatest threats.     

疾病预防控制体系应急能力建设的探讨

面对未来多发的突发公共卫生事件,疾病预防控制体系如何加强应急能力的建设、保障公众身体健康与生命的安全、维护社会的和谐稳定,是当前面临的重要问题。从加强体系建设和完善应急机制两方面展开论述,探讨如何加强疾病预防控制体系应急能力建设,以期望最大限度地降低突发公共卫生事件对公众和社会造成的危害。     

遵义市2010年突发公共卫生事件流行病学分析

目的分析遵义市2010年突发公共卫生事件的流行病学特征,为突发公共卫生事件的防控提供参考依据。方法收集汇总2010年遵义市突发公共卫生事件的数据资料,应用描述性流行病学方法进行分析。结果 2010年遵义市共报告32起突发公共卫生事件,其中一般事件2起,相关信息30起;病例382例、死亡5例,罹患率2.08%、病死率1.31%;传染病疫情30起,占事件总起数的93.75%,食物中毒事件2起,占6.25%;5~9月为高发期,学校发生的突发事件占46.88%,病例占93.72%。结论夏秋季应重点加强遵义市传染病的监测、预警及控制工作,特别是学校呼吸道传染病疫情的应急管理工作。     

Smallpox in the post-eradication era

Smallpox is a recently extinct human viral infection for which herd immunity has rapidly waned. The threat of smallpox during a bioterrorist event using caches of virus outside reference repositories would lead to epidemics of great and predictable mortality. The result would be short-term societal chaos. Control of smallpox requires vaccination and quarantine, the same measures that eliminated this disease in the 1970's. Extensive coordination and planning would be needed among the healthcare infrastructure, law enforcement agencies and political leadership for effective responses to this public health threat. Despite this challenge, we must remind ourselves that smallpox transmission and vaccinia effectiveness are well understood. Strategies that successfully eradicated smallpox 25 years ago, if appropriately implemented again, would undoubtedly lead to its elimination once again.