Chemical-Biological Terrorism and Its Impact on Children.

Chemical and biological events (including infectious disease outbreaks) may affect children disproportionately, and the threat of a chemical or biological attack remains in the United States and worldwide. Although federal programs and funding support a broad range of federal initiatives for public health preparedness and response, funding at the state and local levels has been flat or is decreasing, potentially leaving communities vulnerable. Consequently, pediatricians need to prepare and be ready to care for children in their communities before, during, and after a chemical or biological event, including during long-term recovery. Some medical countermeasures for particular chemical and biological agents have not been adequately studied or approved for children. The American Academy of Pediatrics provides resources and education on disaster preparedness and response, including information on the pediatrician's role in disasters, pediatric medical countermeasures, and mental health after an event as well as individual and family preparedness. This policy statement addresses the steps that clinicians and policy makers can take to protect children and mitigate the effects of a chemical or biological attack.

Agroterrorism targeting livestock: a review with a focus on early detection systems.

Agroterrorism targeting livestock can be described as the intentional introduction of an animal disease agent against livestock with the purpose of causing economic damage, disrupting socioeconomic stability of a country, and creating panic and distress. This type of terrorism can be alluring to terrorists because animal disease agents are easily available. This review addresses the vulnerabilities of the livestock industry to agroterrorism. However, we also show that early detection systems have recently been developed for agroterrorism and deliberate spread of animal pathogens in livestock, including an agroterrorism intelligence cycle, syndromic surveillance programs, and computer-based clinical decision support systems that can be used for early detection of notifiable animal diseases. The development of DIVA-vaccines in the past 10 to 15 years has created, in principle, an excellent response instrument to counter intentional animal disease outbreaks. These developments have made our animal agriculture less vulnerable to agroterrorism. But we cannot relax; there are still many challenges, in particular with respect to integration of first line of defense, law enforcement, and early detection systems for animal diseases.

Predicting response to reassurances and uncertainties in bioterrorism communications for urban populations in New York and California.

Recent national plans for recovery from bioterrorism acts perpetrated in densely populated urban areas acknowledge the formidable technical and social challenges of consequence management. Effective risk and crisis communication is one priority to strengthen the U.S.'s response and resilience. However, several notable risk events since September 11, 2001, have revealed vulnerabilities in risk/crisis communication strategies and infrastructure of agencies responsible for protecting civilian populations. During recovery from a significant biocontamination event, 2 goals are essential: (1) effective communication of changing risk circumstances and uncertainties related to cleanup, restoration, and reoccupancy; and (2) adequate responsiveness to emerging information needs and priorities of diverse populations in high-threat, vulnerable locations. This telephone survey study explored predictors of public reactions to uncertainty communications and reassurances from leaders related to the remediation stage of an urban-based bioterrorism incident. African American and Hispanic adults (N=320) were randomly sampled from 2 ethnically and socioeconomically diverse geographic areas in New York and California assessed as high threat, high vulnerability for terrorism and other public health emergencies. Results suggest that considerable heterogeneity exists in risk perspectives and information needs within certain sociodemographic groups; that success of risk/crisis communication during recovery is likely to be uneven; that common assumptions about public responsiveness to particular risk communications need further consideration; and that communication effectiveness depends partly on preexisting values and risk perceptions and prior trust in leaders. Needed improvements in communication strategies are possible with recognition of where individuals start as a reference point for reasoning about risk information, and comprehension of how this influences subsequent interpretation of agencies' actions and communications.

An assessment of nurses' knowledge of botulism.

OBJECTIVE: To assess nurses' knowledge of botulism, a Centers for Disease Control Category A bioterrorism agent, one case of which constitutes an emergency. DESIGN: The study utilized survey research. SAMPLE: The cluster sample included 1,414 registered nurses. MEASURE: The survey gathered demographic data and nurses' knowledge of the background, manifestation and management of botulism. RESULTS: The mean percentage of correct answers for the sample was 25.95%, with a standard deviation (SD) of ±19.89%. Only 90 (6.3%) achieved 60% or more correct. Educational preparation, experience, specialty/area of practice and whether nurses had a class in disaster medicine were also examined and although differences were noted, none of these factors accounted for a score of 60% or above. CONCLUSIONS: The results of this study indicate the need for an assessment of the current education nurses receive about botulism.

From biodefence to biosecurity: the Obama administration's strategy for countering biological threats.

The Seventh Review Conference of the Biological Weapons Convention (BWC), the first international treaty to outlaw an entire class of weapons, was held in Geneva in December 2011. On 7 December, Secretary of State Hillary Clinton became the highest-ranking US government official to address a BWC meeting. Secretary Clinton told the assembled delegation that 'we view the risk of bioweapons attack as both a serious national security challenge and a foreign policy priority'. At the same time, she warned that a large-scale disease outbreak 'could cripple an already fragile global economy'. Secretary Clinton's speech reflected a new understanding that the range of biological threats to international security has expanded from state-sponsored biological warfare programmes to include biological terrorism, dual-use research and naturally occurring infectious diseases such as pandemics. Recognizing these changes, President Barack Obama released a new national strategy for countering biological threats in 2009. This strategy represents a shift in thinking away from the George W. Bush administration's focus on biodefence, which emphasized preparing for and responding to biological weapon attacks, to the concept of biosecurity, which includes measures to prevent, prepare for and respond to naturally occurring and man-made biological threats. The Obama administration's biosecurity strategy seeks to reduce the global risk of naturally occurring and deliberate disease outbreaks through prevention, international cooperation, and maximizing synergies between health and security. The biosecurity strategy is closely aligned with the Obama administration's broader approach to foreign policy, which emphasizes the pragmatic use of smart power, multilateralism and engagement to further the national interest. This article describes the Obama administration's biosecurity strategy; highlights elements of continuity and change from the policies of the Bush administration; discusses how it fits into Obama's broader foreign policy agenda; and analyses critical issues that will have to be addressed in order to implement the strategy successfully.

Hospital disaster preparedness: mental and behavioral health interventions for infectious disease outbreaks and bioterrorism incidents.

BACKGROUND: Despite an increasing reliance on outpatient clinics and other ambulatory care facilities, traditional hospitals play a crucial role in the US healthcare system. They provide emergency services on a walk-in basis and are staffed to address issues related to triage. In an era of heightened concern over bioterrorism and a potential influenza pandemic, hospital preparedness for responding to infectious disease outbreaks is essential. During such outbreaks, mental and behavioral health problems may constitute an important part of the demand placed on hospitals. There is now sufficient clinical experience regarding such problems, and tested recommendations are available for hospitals to implement in disaster planning and practice. OBJECTIVE: This paper summarizes available literature addressing hospital preparedness for mental and behavioral health interventions in the event of an infectious disease outbreak and identifies the barriers to improvement. METHODS: A systematic literature review using the MEDLINE database was carried out. Additional articles were selected from the references of the identified sources, and Web sites of relevant agencies and organizations were searched. RESULTS: The review indicates that little literature documents recent hospital performance in or readiness for disaster mental and behavioral health interventions. The available evidence suggests a poor state of hospital readiness for providing such interventions. The problems related to financing such preparedness are likely contributors to this finding and must be overcome if improvements are to be made. CONCLUSIONS: More research is needed to categorically examine the preparedness of hospitals for mental and behavioral health interventions during times of disaster.

Nurses and emergency disasters: what is known.

Following the events of September 11, 2001, the threat of bioterrorism events has become a realistic concern for health care workers in the United States. Bioterrorism events caused by infectious agents will be challenging because nurses will need to recognize unfamiliar infections and work long hours with limited resources in stressful conditions. During a bioterrorism event caused by biologic agents, nurses will be expected to provide care to infected patients and may fear that they, or their families, could also become infected. A review of literature suggests that nurses' response to working during a bioterrorism event is not well described. The limited number of studies regarding nurses' concerns, fears, and anxieties is focused on nurses' experiences in natural disaster or war situations. Additional studies are needed to validate the appropriateness of applying findings from disaster response studies to bioterrorism events. During bioterrorism events, nurses will be expected to provide physical care and emotional and psychologic support for victims and victims' families. Realistic bioterrorism plans should incorporate strategies to support nurses and address their physical, psychologic, and emotional issues. Strategies to optimize safe working conditions and minimize psychologic trauma such as technical training regarding bioterrorism agents and debriefing opportunities should be included.

Nurses' beliefs about public health emergencies: fear of abandonment.

BACKGROUND: Since the events of September 11, 2001, subsequent anthrax mailings, world political events, and natural disasters such as Hurricane Katrina and the recent tsunami, public health emergencies including bioterrorism events are viewed as realistic possibilities. Public health emergencies would stress the current health care system. OBJECTIVE: The objective was to identify beliefs and concerns of nurses who work in hospitals designated as receiving sites during public health emergencies. METHODS: A qualitative study using focus groups with a total of 33 hospital nurses in 2003 was used. Audiotapes were analyzed, and codes, categories, and a theme were identified. RESULTS: Fear of abandonment was the overarching theme. Nurses believed that clinical settings would be chaotic, without a clear chain of command, and with some colleagues refusing to work. Limited access to personal protective equipment, risk of infection, unmanageable numbers of patients, and possibly being assaulted for their personal protective equipment resulted in the sense that they would be in unsafe clinical environments. Loss of freedom to leave the hospital and fears that hospitals would not provide treatment to nurses who become ill as a result of caring for patients contributed to the sense of abandonment. CONCLUSION: Although these nurses worked in hospitals with comprehensive public health emergency plans, they believed that they would not have readily accessible material and human resources to cope with a bioterrorism event. Readiness plans should include a systematic assessment of nurses' concerns. Health care readiness plans should incorporate focused interventions to improve safety, a sense of control, and facilitate coping in public health emergencies.

Posttraumatic stress disorder in rural primary care: improving care for mental health following bioterrorism.

CONTEXT: Recent bioterrorism attacks have highlighted the critical need for health care organizations to prepare for future threats. Yet, relatively little attention has been paid to the mental health needs of rural communities in the wake of such events. A critical aspect of bioterrorism is emphasis on generating fear and uncertainty, thereby contributing to increased needs for mental health care, particularly for posttraumatic stress disorder, which has been estimated to occur in 28% of terrorism survivors. PURPOSE: Prior experience with natural disasters suggests that first responders typically focus on immediate medical trauma or injury, leaving rural communities to struggle with the burden of unmet mental health needs both in the immediate aftermath and over the longer term. The purpose of the present article is to draw attention to the greater need to educate rural primary care providers who will be the frontline providers of mental health services following bioterrorism, given the limited availability of tertiary mental health care in rural communities. METHODS: We reviewed the literature related to bioterrorism events and mental health with an emphasis on rural communities. FINDINGS AND CONCLUSIONS: Public health agencies should work with rural primary care providers and mental health professionals to develop educational interventions focused on posttraumatic stress disorder and other mental disorders, as well as algorithms for assessment, referral, and treatment of post-event psychological disorders and somatic complaints to ensure the availability, continuity, and delivery of quality mental health care for rural residents following bioterrorism and other public health emergencies.

Hawaii veterinarians' bioterrorism preparedness needs assessment survey.

The purpose of this study was to assess the objective bioterrorism-related knowledge base and the perceived response readiness of veterinarians in Hawaii to a bioterrorism event, and also to identify variables associated with knowledge-based test performance. An anonymous survey instrument was mailed to all licensed veterinarians residing in Hawaii (N = 229) up to three times during June and July 2004, using numeric identifiers to track non-respondents. The response rate for deliverable surveys was 59% (125 of 212). Only 12% (15 of 123) of respondents reported having had prior training on bioterrorism. Forty-four percent (55 of 125) reported being able to identify a bioterrorism event in animal populations; however, only 17% (21 of 125) felt able to recognize a bioterrorism event in human populations. Only 16% (20 of 123) felt they were able to respond effectively to a bioterrorist attack. Over 90% (106 of 116) expressed their willingness to provide assistance to the state in its response to a bioterrorist event. Veterinarians scored a mean of 70% correct (5.6 out of 8 questions) on the objective knowledge-based questions. Additional bioterrorism preparedness training should be made available, both in the form of continuing educational offerings for practicing veterinarians and as a component of the curriculum in veterinary schools.

[Viruses as biological weapons]. / Biyolojik silah olarak viruslar.

The destruction made by nuclear, biological and chemical weapons used by governments and terrorist groups in the near history is posing anxiety and fear for human being. Rumour about the possible use of these agents leads to the development of serious negative effects on populations. Since there are no vaccine and therapy for most viral agents and cost of production as biological weapons is low, interest rate is rising for viruses. In this review, general characteristics, diagnosis, therapy and protective measures for viral agents such as variola virus, hemorrhagic fever viruses, encephalitis viruses, Hantaviruses and Nipah viruses, those can be used as biological weapon, have been summarized.

Concerns of Capitol Hill staff workers after bioterrorism: focus group discussions of authorities' response.

Systematic studies of mental health effects of bioterrorism on exposed populations have not been carried out. Exploratory focus groups were conducted with an exposed population to provide qualitative data and inform empirical research. Five focus groups of 28 political worker volunteers were conducted 3 months after the October 15, 2001, anthrax attack on Capitol Hill. More than 2000 transcribed focus group passages were categorized using qualitative software. The category with the most items was authorities' response (23% passages), and much of this discussion pertained to communication by authorities. The category with the fewest items was symptoms (4%). Identified issues were less within individuals and more between them and authorities. Risk communication by authorities regarding safety and medical issues was a prominent concern among Capitol Hill office staff workers regarding the anthrax incident on Capitol Hill. This suggests focus on risk communication in developing interventions, but more systematic investigation is needed.

The effect of bioterrorism messages on anxiety levels.

Public health messages sometimes use graphic language to discourage health-adverse behaviors. However, such messages could provoke adverse stress and anxiety reactions. To assess whether public health messages on bioterrorism might measurably increase stress and anxiety, we conducted a randomized controlled trial in which potent and neutral messages were randomly allocated to 116 graduate students. Pre- and post-message anxiety scores of the State-Trait Anxiety Inventory (STAI), a validated instrument, were recorded, and within- and between-group score changes compared. Reading the potent message significantly (p=.003) elevated STAI anxiety scores, while reading the neutral messages decreased scores (p<.001). The between-group difference was also statistically significant (p=.001). Potent smoking and drunk-driving cessation messages have clear benefits, but messages about bioterrorism do not. Our findings provide evidence that such messages have at least the potential of harm, so that weighing benefits and risks of such messages is warranted.

Community response to disaster: the role of the workplace.

Disasters, natural and man-made, have a considerable impact on communities. Most recently, disasters stemming from terrorist attacks have become a leading cause of concern. The importance of work in the lives of employees, coupled with the vulnerability of workplaces as potential targets of terrorist attacks, suggests that workplaces can and should play a role in planning for, and responding to, disasters. This article addresses the role of the workplace in disasters, with an emphasis on the psychological impact of such events, by drawing upon experience and literature related to workplace violence and to other traumatic events in the workplace.

Mass violence and early mental health intervention: a proposed application of best practice guidelines to chemical, biological, and radiological attacks.

Based on past episodes, there will be psychological sequelae to chemical, biological, and radiological attacks. Some of the psychological morbidity should be able to be ameliorated through planning and appropriate early intervention. Key components of early intervention are illustrated following a hypothetical scenario of a bomb and anthrax threat near the Pentagon. Many of these components, such as monitoring clear, consistent messages about health risks, are provided by physicians or politicians, not mental health providers, but have a serious impact on the mental health of the population. We hope that this scenario and the principles of response will prove useful to planners of emergency preparedness and responders in the case of an actual attack.

Predictors of help seeking among Connecticut adults after September 11, 2001.

OBJECTIVES: We conducted a population-based telephone survey in an attempt to determine correlates of formal and informal help seeking after September 11, 2001. METHODS: Between October 15 and December 31, 2001, 1774 Connecticut Behavioral Risk Factor Surveillance System respondents were asked questions directly related to their experiences of September 11. RESULTS: Multivariate logistic regression analyses showed that receipt of formal help was predicted by sleep problems, close association with a victim, reports of increased smoking or drinking, and receipt of informal help. Age, gender, reports of 1 or more problems, and formal help seeking predicted receipt of informal help. CONCLUSIONS: Public health planning and bioterrorism preparedness should include programs addressing increased smoking and drinking, sleep problems, and bereavement in the wake of disasters.

One-year health assessment of adult survivors of Bacillus anthracis infection.

CONTEXT: Little is known about potential long-term health effects of bioterrorism-related Bacillus anthracis infection. OBJECTIVE: To describe the relationship between anthrax infection and persistent somatic symptoms among adults surviving bioterrorism-related anthrax disease approximately 1 year after illness onset in 2001. DESIGN, SETTING, AND PARTICIPANTS: Cross-sectional study of 15 of 16 adult survivors from September through December 2002 using a clinical interview, a medical review-of-system questionnaire, 2 standardized self-administered questionnaires, and a review of available medical records. MAIN OUTCOME MEASURES: Health complaints summarized by the body system affected and by symptom categories; psychological distress measured by the Revised 90-Item Symptom Checklist; and health-related quality-of-life indices by the Medical Outcomes Study 36-Item Short-Form Health Survey (version 2). RESULTS: The anthrax survivors reported symptoms affecting multiple body systems, significantly greater overall psychological distress (P<.001), and significantly reduced health-related quality-of-life indices compared with US referent populations. Eight survivors (53%) had not returned to work since their infection. Comparing disease manifestations, inhalational survivors reported significantly lower overall physical health than cutaneous survivors (mean scores, 30 vs 41; P =.02). Available medical records could not explain the persisting health complaints. CONCLUSION: The anthrax survivors continued to report significant health problems and poor life adjustment 1 year after onset of bioterrorism-related anthrax disease.

Dealing with the dangers of fear: the role of risk communication.

Among the many lessons of the homeland terrorist attacks of 2001 was that fear has powerful public health implications. People chose to drive instead of flying, thereby raising their risk of injury or death. Thousands took broad-spectrum antibiotics to prevent possible anthrax infections, thereby accelerating antimicrobial resistance. Such potentially harmful actions were taken by people seeking a sense of safety because they were afraid. This essay argues for greater emphasis on risk communication to help people keep their fears in perspective. Effective communication, not only through what the government says but implicit in the actions it takes, empowers people to make wiser choices in their own lives, and to support wise choices by society in applying limited resources to maximize public and environmental health.