- Hospital Preparedness for Victims of Chemical or Biological Terrorism
Wetter, DC; Daniell, WE; Treser, CD
American Journal of Public Health [Am. J. Public Health], vol. 91, no. 5, pp. 710-716, May 2001
This study examined hospital preparedness for incidents involving chemical or biological weapons. By using a questionnaire survey of 224 hospital emergency departments in 4 northwestern states, we examined administrative plans, training, physical resources, and representative medication inventories. Responses were received from 186 emergency departments (83%). Fewer than 20% of respondent hospitals had plans for biological or chemical weapons incidents. About half (45%) had an indoor or outdoor decontamination unit with isolated ventilation, shower, and water containment systems, but only 12% had 1 or more self-contained breathing apparatuses or supplied air-line respirators. Only 6% had the minimum recommended physical resources for a hypothetical sarin incident. Of the hospitals providing quantitative answers about medication inventories, 64% reported sufficient ciprofloxacin or doxycycline for 50 hypothetical anthrax victims, and only 29% reported sufficient atropine for 50 hypothetical sarin victims (none had enough pralidoxime). Hospital emergency departments generally are not prepared in an organized fashion to treat victims of chemical or biological terrorism. The planned federal efforts to improve domestic preparedness will require substantial additional resources at the local level to be truly effective.
- The Poison Center Role in Biological and Chemical Terrorism
Krenzelok, EP; Allswede, MP; Mrvos, R
Veterinary and Human Toxicology [Vet. Hum. Toxicol.], vol. 42, no. 5, pp. 297-300, Oct 2000
Nuclear, biological and chemical (NBC) terrorism countermeasures are a major priority with municipalities, healthcare providers, and the federal government. Significant resources are being invested to enhance civilian domestic preparedness by conducting education at every response level in anticipation of a NBC terroristic incident. The key to a successful response, in addition to education, is integration of efforts as well as thorough communication and understanding the role that each agency would play in an actual or impending NBC incident. In anticipation of a NBC event, a regional counter-terrorism task force was established to identify resources, establish responsibilities and coordinate the response to NBC terrorism. Members of the task force included first responders, hazmat, law enforcement (local, regional, national), government officials, the health department, and the regional poison information center. Response protocols were developed and education was conducted, culminating in all members of the response task force becoming certified NBC instructors. The poison center participated actively in 3 incidents of suspected biologic and chemical terrorism: an alleged anthrax-contaminated letter sent to a women's health clinic; a possible sarin gas release in a high school; and a potential anthrax/ebola contamination incident at an international airport. All incidents were determined hoaxes. The regional response plan establishes the poison information center as a common repository for all cases in a biological or chemical incident. The poison center is one of several critical components of a regional counter-terrorism response force. It can conduct active and passive toxicosurveillance and identify sentinel events. To be responsive, the poison center staff must be knowledgeable about biological and chemical agents. The development of basic protocols and a standardized staff education program is essential. The use of the RaPiD-T (R-recognition, P-protection, D-detection, T-triage/treatment) course can provide basic staff education for responding to this important but rare consultation to the poison center.
- Anthrax: Clinical Features, Pathogenesis, and Potential Biological Warfare Threat
Current Clinical Topics in Infectious Diseases [Curr. Clin. Top. Infect. Dis.], vol. 20, pp. 335-349, 2000
Anthrax is a zoonotic disease that infects domesticated and wild animals and, secondarily, humans. Although it remains a significant disease of animals and humans in less developed parts of the world, anthrax is a very rare disease in either animals or humans in industrialized countries. The current interest in this disease is due to the heightened awareness and grave concern that Bacillus anthracis, the causative organism, might be used as a biological weapon by terrorists or in warfare. Under natural conditions, herbivores, such as cattle, sheep, horses, and goats, are the animals most commonly infected with this pathogen, although many animal species, including carnivores, are susceptible to such infection. Infection in humans occurs, under natural circumstances, by direct contact with infected animals or contaminated animal products, most often by the cutaneous route and only rarely by the respiratory or gastrointestinal routes. Anthrax is thought to have long been associated with humans and their domesticated animals. It has been suggested that the fifth and sixth plagues described in Exodus and the disease in domesticated animals and humans in Rome described by Virgil in the first century B.C. involved anthrax. The first careful clinical descriptions of anthrax in animals and humans were made only in the eighteenth century, however. Anthrax is closely associated with the origins of medical microbiology and immunology. It was the first disease for which a microbial etiology was definitively established, through the work of Robert Koch in 1877. It was also one of the first diseases for which a live bacterial vaccine was shown to be effective - in this case, by Pasteur and Greenfield.
- Growth medium for the rapid isolation and identification of anthrax
Kiel, Johnathan L; Parker, Jill E; Grubbs, Teri R; Alls, John L
PROC SPIE INT SOC OPT ENG, SOCIETY OF PHOTO-OPTICAL INSTRUMENTATION ENGINEERS, BELLINGHAM, WA, (USA), 2000, vol. 4036, pp. 92-102
Anthrax has been recognized as a highly likely biological warfare or terrorist agent. The purpose of this work was to design a culture technique to rapidly isolate and identify 'live' anthrax. In liquid or solid media form, 3AT medium (3-amino-L-tyrosine, the main ingredient) accelerated germination and growth of anthrax spores in 5 to 6 hours to a point expected at 18 to 24 hours with ordinary medium. During accelerated growth, standard definitive diagnostic tests such as sensitivity to lysis by penicillin or bacteriophage can be run. During this time, the bacteria synthesized a fluorescent and thermochemiluminescent polymer. Bacteria captured by specific antibody are, therefore, already labeled. Because living bacteria are required to generate the polymer, the test converts immunoassays for anthrax into viability assays. Furthermore, the polymer formation leads to the death of the vegetative form and non-viability of the spores produced in the medium. By altering the formulation of the medium, other microbes and even animal and human cells can be grown in it and labeled (including viruses grown in the animal or human cells).
- The threat of biological terrorism: A public health and infection control reality
Infection Control and Hospital Epidemiology [Infect. Control Hosp. Epidemiol.], vol. 21, no. 1, pp. 53-56, Jan 2000
Bioterrorism is an emerging public health and infection control threat. Potential biological agents include smallpox, anthrax, plague, tularemia, botulinum toxin, brucellosis, Q fever, viral encephalitis, hemorrhagic fever, and staphylococcal enterotoxin B. An understanding of the epidemiology, clinical manifestations, and management of the more likely candidate agents is critical to limiting morbidity and mortality from a biological event. Effective response requires an increased index of suspicion for unusual diseases or syndromes, with prompt reporting to health authorities to facilitate recognition of an outbreak and subsequent intervention. Hospital epidemiology programs will play a crucial role in this effort.
- Bacillus Spore Inactivation Methods Affect Detection Assays
Dang, JL; Heroux, K; Kearney, J; Arasteh, A; Gostomski, M; Emanuel, PA
Applied and Environmental Microbiology [Appl. Environ. Microbiol.], vol. 67, no. 8, pp. 3665-3670, Aug 2001
Detection of biological weapons is a primary concern in force protection, treaty verification, and safeguarding civilian populations against domestic terrorism. One great concern is the detection of Bacillus anthracis, the causative agent of anthrax. Assays for detection in the laboratory often employ inactivated preparations of spores or nonpathogenic simulants. This study uses several common biodetection platforms to detect B. anthracis spores that have been inactivated by two methods and compares those data to detection of spores that have not been inactivated. The data demonstrate that inactivation methods can affect the sensitivity of nucleic acid- and antibody-based assays for the detection of B. anthracis spores. These effects should be taken into consideration when comparing laboratory results to data collected and assayed during field deployment.
- Anthrax threats: A report of two incidents from Salt Lake City
Swanson, ER; Fosnocht, DE
Journal of Emergency Medicine [J. Emerg. Med.], vol. 18, no. 2, pp. 229-232, Feb 2000
The threat of anthrax as an agent of bioterrorism in the U.S. is very real, with 47 incidents of possible exposure involving 5664 persons documented by the Federal Bureau of Investigation over a 14-month period in 1998 and 1999. The highly visible and potentially devastating effects of these threats require a well-coordinated and well-organized Emergency Medical Services (EMS) and Emergency Department (ED) response to minimize panic and reduce the potential spread of an active and deadly biologic agent. This requires planning and education before the event. We describe the events of two anthrax threats in a major metropolitan area. The appropriate EMS and ED response to these threats is outlined.
- Molecular characterization of Bacillus anthracis using multiplex PCR, ERIC-PCR and RAPD
Shangkuan, Y.; Chang, Y.; Yang, J.; Lin, H.; Shaio, M.
Letters in Applied Microbiology [Lett. Appl. Microbiol.], vol. 32, no. 3, pp. 139-145, Mar 2001
Aims: To investigate the molecular characterization of Bacillus anthracis strains by multiplex PCR, enterobacterial repetitive intergenic consensus-PCR (ERIC-PCR) and random amplification of polymorphic DNA (RAPD). Methods and Results: Three primers were used to amplify the cya, cap and cereolysinAB genes in the multiplex PCR. Two distinct ERIC-PCR and RAPD fragments, which separated B. anthracis into two groups, were used as probes in Southern hybridization experiments. The probes hybridized only to the cya super(+) B. anthracis strains identified by the multiplex PCR. Nucleotide sequence analysis of the two cloned fragments showed they were from the pXO1 plasmid of B. anthracis. Conclusions: Multiplex PCR simultaneously identified isolates of the Bacillus cereus group and the B. anthracis virulence factors. ERIC-PCR and RAPD, combined with the Southern hybridization analyses, differentiated B. anthracis strains and separated them from the closely related B. cereus group bacteria. Significance and Impact of the Study: ERIC-PCR and RAPD assay could be effective in differentiating virulent from avirulent B. anthracis. Our results also show that the amplification of the large plasmids was allowed in the ERIC-PCR and RAPD assay.
- Bioterrorism: implications for the clinical microbiologist
Klietmann, WF; Ruoff, KL*
Clinical Microbiology Reviews [Clin. Microbiol. Rev.], vol. 14, no. 2, pp. 364-381, Apr 2001
The specter of bioterrorism has captured the attention of government and military officials, scientists, and the general public. Compared to other sectors of the population, clinical microbiologists are more directly impacted by concerns about bioterrorism. This review focuses on the role envisioned for clinical laboratories in response to a bioterrorist event. The microbiology and clinical aspects of the biological agents thought to be the most likely tools of bioterrorists are presented. The historical background of the problem of bioterrorism and an overview of current U.S. preparedness planning, with an emphasis on the roles of health care professionals, are also included.
- Use of Long-Range Repetitive Element Polymorphism-PCR To Differentiate Bacillus anthracis Strains
Brumlik, MJ; Szymajda, U; Zakowska, D; Liang, X; Redkar, RJ; Patra, G; Del Vecchio, VG*
Applied and Environmental Microbiology [Appl. Environ. Microbiol.], vol. 67, no. 7, pp. 3021-3028, Jul 2001
The genome of Bacillus anthracis is extremely monomorphic, and thus individual strains have often proven to be recalcitrant to differentiation at the molecular level. Long-range repetitive element polymorphism-PCR (LR REP-PCR) was used to differentiate various B. anthracis strains. A single PCR primer derived from a repetitive DNA element was able to amplify variable segments of a bacterial genome as large as 10 kb. We were able to characterize five genetically distinct groups by examining 105 B. anthracis strains of diverse geographical origins. All B. anthracis strains produced fingerprints comprising seven to eight bands, referred to as "skeleton" bands, while one to three "diagnostic" bands differentiated between B. anthracis strains. LR REP-PCR fingerprints of B. anthracis strains showed very little in common with those of other closely related species such as B. cereus, B. thuringiensis, and B. mycoides, suggesting relative heterogeneity among the non-B. anthracis strains. Fingerprints from transitional non-B. anthracis strains, which possessed the B. anthracis chromosomal marker Ba813, scarcely resembled those observed for any of the five distinct B. anthracis groups that we have identified. The LR REP-PCR method described in this report provides a simple means of differentiating B. anthracis strains.
- Utilization of the rpoB Gene as a Specific Chromosomal Marker for Real-Time PCR Detection of Bacillus anthracis
Qi, Y; Patra, G; Liang, X; Williams, LE; Rose, S; Redkar, RJ; DelVecchio, VG*
Applied and Environmental Microbiology [Appl. Environ. Microbiol.], vol. 67, no. 8, pp. 3720-3727, Aug 2001
The potential use of Bacillus anthracis as a weapon of mass destruction poses a threat to humans, domesticated animals, and wildlife and necessitates the need for a rapid and highly specific detection assay. We have developed a real-time PCR-based assay for the specific detection of B. anthracis by taking advantage of the unique nucleotide sequence of the B. anthracis rpoB gene. Variable region 1 of the rpoB gene was sequenced from 36 Bacillus strains, including 16 B. anthracis strains and 20 other related bacilli, and four nucleotides specific for B. anthracis were identified. PCR primers were selected so that two B. anthracis-specific nucleotides were at their 3' ends, whereas the remaining bases were specific to the probe region. This format permitted the PCR reactions to be performed on a LightCycler via fluorescence resonance energy transfer (FRET). The assay was found to be specific for 144 B. anthracis strains from different geographical locations and did not cross-react with other related bacilli (175 strains), with the exception of one strain. The PCR assay can be performed on isolated DNA as well as crude vegetative cell lysates in less than 1 h. Therefore, the rpoB-FRET assay could be used as a new chromosomal marker for rapid detection of B. anthracis.
- Immunoaffinity based phosphorescent sensor platform for the detection of bacterial spores
Scholl, Peter F; Bargeron, CBrent; Phillips, Terry E; Wong, Tommy; Abubaker, Sala; Groopman, John D; Strickland, Paul T; Benson, Richard C
Proceedings of SPIE - The International Society for Optical Engineering [Proc Spie Int Soc Opt Eng], vol. 3913, pp. 204-214, 2000
Consideration of emergency response plans to an attack with biological weapons such as anthrax spores has spawned renewed interest in the development of inexpensive, rapid, and sensitive field portable sensors for use by non-specialists. The conceptual feasibility of such a device is demonstrated via the immunoaffinity capture of spores of the anthrax simulant B. globigii on a column followed by their washing, elution and phosphorescent detection. Spores are generically detected via the rapid extraction of dipicolinic acid (DPA) followed by its chelation with terbium to yield a phosphorescent complex. Chemical, thermal and mechanical methods of DPA extraction were evaluated. Simple extraction in HNO sub(3) (1.8 M) released up to 5% of the spore weight as DPA within 60 seconds. Extraction in H sub(2)O (100 degree C x 10 min) liberated 7% of the spore weight as DPA. Sonication (3.5) W) with glass beads in H sub(2)O for 45 seconds released up to 4% of the spore weight as DPA. It is estimated that implementation of these techniques will permit development of a device requiring 3-5 minutes per analysis with a limit of detection on the order of 500 ng spore/mL. This approach is not intended to replace more specific methods of analysis. However, it is proposed for consideration as an inexpensive, simple and rapid means of spore detection by non-specialists in emergency situations.