Evaluation of Sponge Wipe Surface Sampling for Collection of Potential Surrogates for Non-spore-forming Bioterrorism Agents.

AIM: Evaluate the efficacy of sponge wipe sampling at recovering potential bacterial surrogates for Category A and B non-spore-forming bacterial bioterrorism agents from hard nonporous surfaces. METHODS: A literature survey identified seven nonpathogenic bacteria as potential surrogates for selected Category A and B non-spore-forming bacterial agents. Small (2- by 4-cm) and large (35.6- by 35.6-cm) coupons made from either stainless steel, plastic, or glass, were inoculated and utilized to assess persistence, and surface sampling efficiency, respectively. Three commercially available premoistened sponge wipes (3M™, Sani-Stick®, and Solar-Cult®) were evaluated. RESULTS: Mean recoveries from persistence testing indicated that three microorganisms (Yersinia ruckeri, Escherichia coli, and Serratia marcescens) demonstrated sufficient persistence across all tested material types. Sampling of large inoculated (≥ 107 CFU per sample) coupons resulted in mean recoveries ranging from 6.6 to 3.4 Log10 CFU per sample. Mean recoveries for the Solar-Cult®, 3M™ sponge wipes, and Sani-Sticks® across all test organisms and all material types were ≥ 5.7, ≥ 3.7, and ≥ 3.4 Log10 CFU per sample, respectively. Mean recoveries for glass, stainless steel, and ABS plastic across all test organisms and all sponge types were ≥ 3.8, ≥ 3.7, and ≥ 3.4 Log10 CFU per sample, respectively. CONCLUSIONS: Recovery results suggest that sponge wipe sampling can effectively be used to recover non-spore-forming bacterial cells from hard, nonporous surfaces such as stainless steel, ABS plastic, and glass.

A systematic approach to microbial forensics.

The coronavirus disease 2019 pandemic accelerated developments in biotechnology that underpin infection science. These advances present an opportunity to refresh the microbial forensic toolkit. Integration of novel analytical techniques with established forensic methods will speed up acquisition of evidence and better support lines of enquiry. A critical part of any such investigation is demonstration of a robust causal relationship and attribution of responsibility for an incident. In the wider context of a formal investigation into agency, motivation and intent, the quick and efficient assembly of microbiological evidence sets the tone and tempo of the entire investigation. Integration of established and novel analytical techniques from infection science into a systematic approach to microbial forensics will therefore ensure that major perspectives are correctly used to frame and shape the evidence into a clear narrative, while recognizing that forensic hypothesis generation, testing and refinement comprise an iterative process. Development of multidisciplinary training exercises that use this approach will enable translation into practice and efficient implementation when the need arises.

[Understanding public health nurses' experience, knowledge, and perception of bioterrorism training in Japan].

Objectives　Bioterrorism is a disease in which the attacks can be covert and latent, take time to manifest, and, when discovered, can result in large outbreaks. When detected, they can become large-scale outbreaks. Therefore, preparedness is essential for early detection and response for damage mitigation. Although public health nurses (PHNs) of public health centers are responsible for detecting and dealing with bioterrorism, their preparation status is not clear. Therefore, this study aimed to elucidate the status of training experience, knowledge, and awareness of bioterrorism among PHNs working in public health centers' infectious disease control departments in Japan's metropolitan areas.Methods　This was a cross-sectional, descriptive study. The participants were PHNs in the infectious disease control departments of 88 public health centers in Tokyo and its three neighboring prefectures. This are densely populated metropolitan areas with many mass gathering events and a high probability of bioterrorism. An anonymous, self-administered questionnaire survey was conducted by mail in 2019. Two PHNs per location were surveyed regarding their attributes, training experience, knowledge, and perceptions.Results　We received 71 responses (40.3%). A total of 10 (14.1%) PHNs reported having experience with bioterrorism training in the workplace. Regarding the knowledge of the four infectious diseases with a high probability of bioterrorism, more than 95% of the respondents answered they had heard of them. However, few were aware of related treatments or terrorist responses. Although survey respondents were aware of the seriousness of bioterrorism and the effectiveness of preparedness, they did not have sufficient opportunity or time to have training. They tended to be less confident in their response and were willing to have training.Conclusion　PHNs who responded to this survey do not have sufficient training experience, knowledge, opportunities, and time for bioterrorism training, and establishing a training system to improve bioterrorism preparedness is a challenge. It will be necessary for PHN students to learn about the existence of bioterrorism. Further, PHNs in public health centers need to be trained at least once using online services, including brushing up on information as needed. Based on the lessons learned from the coronavirus disease 2019 pandemic, health centers will formulate a Health Crisis Management Plan. This will be effective in fiscal 2024, and we believe that it is essential that preparedness against bioterrorism be a part of this plan.

Effects of a mobile-based bioterrorism response program among clinical nurses: A quasi-experimental study.

BACKGROUND: To respond to unstable international security and the outbreak of new infectious diseases, clinical nurses should be equipped with bioterrorism response competencies. OBJECTIVES: This study developed a mobile-based bioterrorism response program for clinical nurses and examined its effectiveness on their knowledge of bioterrorism, attitude toward bioterrorism response, and bioterrorism response competencies. DESIGN: A quasi-experimental study design was used. SETTING: General or tertiary general hospitals in South Korea were considered. PARTICIPANTS: Participants were 45 clinical nurses (23 in the experimental group and 22 in the control). METHODS: The mobile-based bioterrorism response program was conducted over three weeks in 10 sessions (total of 300 min). The knowledge of bioterrorism, attitude toward bioterrorism response, and bioterrorism response competencies were compared between two groups using paired t-test, and Wilcoxon signed ranks test. Satisfaction with the program was measured in the experimental group. RESULTS: Upon completion of the mobile-based bioterrorism response program, the experimental group showed significant increases in knowledge of bioterrorism, attitude toward bioterrorism response, and bioterrorism response competencies. CONCLUSIONS: The mobile-based bioterrorism response program is expected to contribute to better preparedness for bioterrorism response systems in clinical practice. In addition, this program is expected to be of valuable use in bioterrorism education for nursing students as well as other healthcare professionals involved in bioterrorism response.

Pattern of bioterrorism in ancient times: lessons to be learned from the microbial and toxicological aspects.

The current research aimed to analyze the history of bioterrorism in antiquity and to adapt the data to modern medical knowledge. To this end, a thorough evaluation of the literature related to the ancient history of bioterrorism and modern data was done using the Web of Sciences, Science Direct, Scopus, PubMed, and Google Scholar. Results showed that knowledge of bioterrorism has existed since antiquity in different civilizations. Biological and toxicological agents were used as an instrument of legal execution, as a warfare tool in battles, or to eliminate political rivals across nations. Ancient people researched bioterrorism to apply it against enemies and at the same time provide countermeasures in favor of themselves and allies. Despite the existence of the principles of bioterrorism since ancient times, adaptation of the data to modern research can assist in planning countermeasure efforts, preventive actions, and treatments in the framework of modern counterterrorism medicine.

Bioterrorismo y armas biológicas: caracterización y respuesta frente a las amenazas actuales / Bioterrorism and biological weapons: characterization and response to current threats

El uso de agentes biológicos con fines terroristas constituye una amenaza singular. Aunque poco probable, su materialización puede ser difícilmente evitable en el futuro. Este artículo revisa el fenómeno del bioterrorismo, examinando los posibles riesgos y vulnerabilidades, los mecanismos de respuesta y las nuevas amenazas para la bioseguridad. (AU)

The use of biological agents for terrorist purposes is a unique threat. Although unlikely, it may be difficult to prevent in the future. This article provides an overview of the phenomenon of bioterrorism, examining potential risks and vulnerabilities, response mechanisms and emerging threats to biosecurity. (AU)

Knowledge, attitudes, and practices associated with bioterrorism preparedness in healthcare workers: a systematic review.

Introduction: Bioterrorism is an important issue in the field of biosecurity, and effectively dealing with bioterrorism has become an urgent task worldwide. Healthcare workers are considered bioterrorism first responders, who shoulder essential responsibilities and must be equipped to deal with bioterrorism. This study aims to extract and summarize the main research components of the bioterrorism knowledge, attitude, and practice dimensions among healthcare workers. Method: This study utilized a systematic review research design based on the PRISMA 2020 guidelines. A literature search was conducted in the PubMed, Web of Science, and Scopus databases for peer-reviewed literature, and the Mixed Methods Appraisal Tool (MMAT) version 2018 was used to assess the quality of the literature. Result: A total of 16 studies were included in the final selection. Through the analysis and summary of the included studies, three main aspects and 14 subaspects of the knowledge dimension, three main aspects and 10 subaspects of the attitude dimension, and two main aspects and six subaspects of the practice dimension were extracted. Conclusion: This study conducted a literature review on bioterrorism knowledge, attitudes, and practices for healthcare workers based on the PRISMA 2020 guidelines. The findings can guide improvements in health literacy and provide beneficial information to professional organizations that need to respond effectively to bioterrorism.

Dental Students' Perceptions Regarding Bioterrorism; a Cross-Sectional Study.

Introduction: During the COVID-19 outbreak, dental professionals have demonstrated their importance in combating mass casualty incidents. This study aimed to understand dental students' perceptions of their potential roles in a bioterrorism attack. Methods: This cross-sectional study used a self-administered anonymous questionnaire, which was sent to all dental students and interns at King Abdulaziz University, Saudi Arabia. Bivariate and multiple linear regression analyses were conducted to assess dental students' willingness to provide care during a bioterrorism attack, knowledge regarding bioterrorism and total number of roles a dentist should play during an attack. Results: This study included 472 dental students and interns. The mean knowledge score regarding bioterrorism was 3.3 ± 1.9 out of 5. A large majority of the respondents (83.8%) were willing to provide care during a bioterrorism attack. Students with a cumulative grade point average (GPA) of 4.5-5 were more likely to indicate that a dental professional should take on more roles during a bioterrorism attack than those with a GPA of 2.5-2.99. Fourth- and fifth-year dental students had lower knowledge scores regarding bioterrorism than dental interns (B: -0.71; SE: 0.30; 95% CI: -1.3--0.1 and B: -0.68; SE: 0.30; 95% CI: -1.3- -0.1, respectively). Conclusion: Despite the fact that dental curricula do not cover topics related to bioterrorism, most students would be willing to provide care under bioterrorism conditions. There is wide agreement among the students regarding the need to add bioterrorism-related educations to dental curricula.

United States' regulatory approved pharmacotherapies for nuclear reactor explosions and anthrax-associated bioterrorism.

INTRODUCTION: Nuclear reactor incidents and bioterrorism outbreaks are concerning public health disasters. Little is known about US Food and Drug Administration (FDA)-approved agents that can mitigate consequences of these events. We review FDA data supporting regulatory approvals of these agents. AREAS COVERED: We reviewed pharmaceutical products approved to treat Hematopoietic Acute Radiation Syndrome (H-ARS) and to treat or prevent pulmonary infections following Bacillus anthracis (anthrax) exposure. Four drugs were approved for H-ARS: granulocyte-colony stimulating factor (G-CSF), granulocyte/macrophage colony stimulating factor, pegylated G-CSF, and romiplostim. For bioterrorism-associated anthrax, the FDA approved five antibiotics (doxycycline, penicillin-G, levofloxacin, moxifloxacin, and ciprofloxacin), two monoclonal antibodies (obiltoxaximab and raxibacumab), one polyclonal antitoxin (Anthrax Immune Globulin Intravenous) and two vaccines (Anthrax Vaccine Adsorbed and Anthrax Vaccine Adsorbed with an adjuvant). A national stockpile system ensures that communities have ready access to these agents. Our literature search was based on data included in drugs@FDA (2001-2023). EXPERT OPINION: Two potential mass public health disasters are aerosolized anthrax dissemination and radiological incidents. Five agents authorized for anthrax emergencies only have FDA approval for this indication, five antibiotics have FDA approvals as antibiotics for common infections and for bacillus anthrax, and four agents have regulatory approvals for supportive care for cancer and for radiological incidents.

Epidemiology of Pathogens Listed as Potential Bioterrorism Agents, the Netherlands, 2009‒2019.

We provide incidences (cases/10 million persons) in the Netherlands during 2009-2019 for pathogens listed as potential bioterrorism agents. We included pathogens from the highest categories of the European Medicines Agency or the US Centers for Disease Control and Prevention. Notifiable diseases and recently published data were used to calculate the average annual incidence. Coxiella burnetii had the highest incidence because of a Q fever epidemic during 2007-2010. Incidence then decreased to 10.8 cases/. Pathogens with an incidence >1 were Brucella spp. (2.5 cases), Francisella tularensis (1.3 cases), and Burkholderia pseudomallei (1.1 cases). Pathogens with an incidence <1 were hemorrhagic fever viruses (0.3 cases), Clostridium botulinum (0.2 cases), and Bacillus anthracis (0.1 cases). Variola major and Yersinia pestis were absent. The generally low incidences make it unlikely that ill-meaning persons can isolate these pathogens from natural sources in the Netherlands. However, the pathogens are stored in laboratories, underscoring the need for biosecurity measures.

Review of Restricted Experiment Requests, Division of Select Agents and Toxins, US Centers for Disease Control and Prevention, 2014-2021.

The US Centers for Disease Control and Prevention Division of Select Agents and Toxins (DSAT) regulates laboratories that possess, use, or transfer select agents and toxins within United States as part of the Federal Select Agent Program. DSAT also mitigates biosafety risks through the review of "restricted experiments," which under the select agent regulations are experiments that pose heightened biosafety risks. In a previous study, we evaluated restricted experimental requests submitted to DSAT for review between 2006 and 2013. The purpose of this study is to provide an updated analysis of requests to conduct potential restricted experiments submitted to DSAT between 2014 and 2021. This article describes the trends and characteristics of the data associated with restricted experimental requests involving select agents and toxins that have an impact on public health and safety (US Department of Health and Human Services agents only) or both public health and safety and animal health or products (overlap agents). From January 2014 to December 2021, DSAT received 113 requests to conduct potential restricted experiments; however, 82% (n=93) of those requests were determined not to meet the regulatory definition of a restricted experiment. Of the 20 requests that met the definition of a restricted experiment, 8 were denied because the experiments had the potential to compromise disease control in humans. DSAT continues to encourage entities to practice due diligence and request a review of research that could potentially meet the regulatory definition of a restricted experiment out of an abundance of caution to protect public health and safety and prevent any potential compliance action.

Benchtop DNA synthesis raises alarms.

Report calls for safeguards against misuse for bioterror.

Triage Algorithms for Mass-Casualty Bioterrorism: A Systematic Review.

OBJECTIVES: To understand existing triage algorithms, propose improvement measures through comparison to better deal with mass-casualty incidents caused by bioterrorism. STUDY DESIGN: Systematic review. METHODS: Medline, Scopus and Web of Science were searched up to January 2022. The studies investigating triage algorithms for mass-casualty bioterrorism. Quality assessment was performed using the International Narrative Systematic Assessment tool. Data extractions were performed by four reviewers. RESULTS: Of the 475 titles identified in the search, 10 studies were included. There were four studies on triage algorithms for most bioterrorism events, four studies on triage algorithms for anthrax and two studies on triage algorithms for mental or psychosocial problems caused by bioterrorism events. We introduced and compared 10 triage algorithms used for different bioterrorism situations. CONCLUSION: For triage algorithms for most bioterrorism events, it is necessary to determine the time and place of the attack as soon as possible, control the number of exposed and potentially exposed people, prevent infection and determine the type of biological agents used. Research on the effects of decontamination on bioterrorism attacks needs to continue. For anthrax triage, future research should improve the distinction between inhalational anthrax symptoms and common disease symptoms and improve the efficiency of triage measures. More attention should be paid to triage algorithms for mental or psychosocial problems caused by bioterrorism events.

A clinical approach to an unidentified aerosolized bioterrorism agent: a narrative review for emergency providers.

The current heightened international political climate is accompanied by increased risk of chemical or biological agent weaponization. Historical accounts of biochemical warfare are extensive, and considering the recent use of such agents for targeted attacks, clinicians need to recognize and manage these cases. However, agent properties such as the color, odor, ability to be aerosolized, and long incubation period can introduce difficulties in the diagnostic and management approach. We searched PubMed and Scopus for a colorless, odorless, aerosolized substance with an incubation period of at least 4 hours. Data from articles were summarized and reported by agent. Based on data from the available literature, we included agents such as nerve agents, ricin, botulinum toxin, anthrax, tularemia, and psittacosis in this review. We also highlighted potential chemical and biological agents that could be weaponized and the optimal strategies for the diagnosis and treatment of patients exposed to an unknown aerosolized biological or chemical bioterrorism agent.

Blind spots in biodefense.

In October, the Biden administration released its National Biodefense Strategy (NBS-22), the first update since the COVID-19 pandemic began. Although the document notes that one of the lessons of the pandemic is that threats originating anywhere are threats everywhere, it frames threats as largely external to the United States. NBS-22 focuses primarily on bioterrorism and laboratory accidents, neglecting threats posed by routine practices of animal use and production inside the United States. NBS-22 references zoonotic disease but assures readers that no new legal authorities or institutional innovations are needed. Although the US is not alone in failing to confront these risks, its failure to comprehensively address them echoes across the globe.

Predictors of bioterrorism preparedness among clinical nurses: A cross-sectional study.

BACKGROUND: Bioterrorism is terrorism that causes death, injury, or illness by the intentional release of viruses, bacteria, fungi, or toxins. Bioterrorism cannot be prevented; therefore, having the ability to recognize and respond to the consequences of infection caused by biological agents is imperative. This study aimed to examine the level of bioterrorism preparedness and identify the influencing factors of bioterrorism preparedness among nurses, who are early responders to bioterrorism. METHODS: This study had a predictive correlational study design. It surveyed 245 clinical nurses currently working in general hospitals. We used a structured questionnaire consisting of items about general characteristics, knowledge about bioterrorism, awareness of bioterrorism risk, perception of institutional bioterrorism preparedness, attitude toward bioterrorism, and bioterrorism preparedness. The collected data were analyzed using descriptive statistics and by performing a t-test, chi-square test, analysis of variance, post-hoc test, correlational analysis, and regression analysis. RESULTS: Bioterrorism preparedness was significantly positively correlated with the perception of institutional and frontline bioterrorism preparedness and attitude toward bioterrorism. It was also significantly influenced by sex, undergraduate bioterrorism education, employee bioterrorism education, perception of governmental bioterrorism preparedness, and attitude toward bioterrorism. The greatest predictors of bioterrorism preparedness were attitude toward bioterrorism, perception of institutional bioterrorism preparedness, and undergraduate bioterrorism education, which explained 39 % of the variance of bioterrorism preparedness. CONCLUSION: This study found that clinical nurses' awareness and attitude toward bioterrorism are important factors in their bioterrorism preparedness and that attention to and education about bioterrorism are crucial to enhance clinical nurses' bioterrorism preparedness. Continued research is needed to establish a bioterrorism response system and relevant educational programs.

Bioterrorismo

The use of biological agents in TERRORISM. This includes the malevolent use of BACTERIA; VIRUSES; or other BIOLOGICAL TOXINS against people, ANIMALS; or PLANTS.

Uso de agentes biológicos en el TERRORISMO. Incluye el uso malévolo de BACTERIAS, VIRUS y otras TOXINAS BIOLÓGICAS contra personas, ANIMALES o PLANTAS.

Uso de agentes biológicos em TERRORISMO. Isto abrange o uso maléfico de BACTÉRIAS, VÍRUS ou outras TOXINAS BIOLÓGICAS contra pessoas, ANIMAIS ou PLANTAS.

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.

Systematic Review of Hospital Treatment Outcomes for Naturally Acquired and Bioterrorism-Related Anthrax, 1880-2018.

BACKGROUND: Bacillus anthracis can cause anthrax and is a potential bioterrorism agent. The 2014 Centers for Disease Control and Prevention recommendations for medical countermeasures against anthrax were based on in vitro data and expert opinion. However, a century of previously uncompiled observational human data that often includes treatment and outcomes is available in the literature for analysis. METHODS: We reviewed treatment outcomes for patients hospitalized with anthrax. We stratified patients by meningitis status, route of infection, and systemic criteria, then analyzed survival by treatment type, including antimicrobials, antitoxin/antiserum, and steroids. Using logistic regression, we calculated odds ratios and 95% confidence intervals to compare survival between treatments. We also calculated hospital length of stay. Finally, we evaluated antimicrobial postexposure prophylaxis (PEPAbx) using data from a 1970 Russian-language article. RESULTS: We identified 965 anthrax patients reported from 1880 through 2018. After exclusions, 605 remained: 430 adults, 145 children, and 30 missing age. Survival was low for untreated patients and meningitis patients, regardless of treatment. Most patients with localized cutaneous or nonmeningitis systemic anthrax survived with 1 or more antimicrobials; patients with inhalation anthrax without meningitis fared better with at least 2. Bactericidal antimicrobials were effective for systemic anthrax; addition of a protein synthesis inhibitor(s) (PSI) to a bactericidal antimicrobial(s) did not improve survival. Likewise, addition of antitoxin/antiserum to antimicrobials did not improve survival. Mannitol improved survival for meningitis patients, but steroids did not. PEPAbx reduced risk of anthrax following exposure to B. anthracis. CONCLUSIONS: Combination therapy appeared to be superior to monotherapy for inhalation anthrax without meningitis. For anthrax meningitis, neither monotherapy nor combination therapy were particularly effective; however, numbers were small. For localized cutaneous anthrax, monotherapy was sufficient. For B. anthracis exposures, PEPAbx was effective.