Governança de novas dimensões de segurança internacional: Doenças infecciosas emergentes / Governance of new dimensions of international security: Emerging infectious diseases

Esse estudo objetiva compreender de que forma se estrutura a governança de uma nova dimensão de segurança internacional: as doenças infecciosas emergentes (DIEs). Inicialmente, discute-se como o tema das doenças infecciosas ­ em geral ­ tem sido apresentado pela literatura acadêmica especializada como novos riscos à segurança internacional. A partir desse escrutínio, foi possível organizar as contribuições de diversos autores sobre o tema, propondo cinco abordagens diferentes da relação entre doenças infecciosas e segurança internacional. A partir disso, averígua-se a maneira mais adequada para compreender a governança das DIEs com a análise das teorias de governança nos campos das Relações Internacionais e da "saúde global". Nesse contexto, e com essas ferramentas, mapeiam-se os atores e dispositivos internacionais que caracterizam a governança das doenças infecciosas, e, posteriormente a das DIEs. Do ponto de vista metodológico, essa dissertação adota o modelo analítico de Young (1999) e Fidler (2002) para analisar a principal peça jurídica desse regime, o Regulamento Sanitário Internacional, examinando sua evolução entre versões de 1969 e 2005 em seus componentes substantivos, processuais e de implementação. Essa análise inova ao apresentar, de um ângulo original, o desenvolvimento da governança internacional das DIEs nas últimas décadas.

This study aims to understand how is developed the governance of a new dimension of international security: emerging infectious diseases (EIDs). At first, we discuss how the topic of infectious disease - in general - have been presented by the academic literature as new risk to international security. From this analysis, it was possible to organize the contributions of various authors on the subject by proposing five different approaches to the relationship between infectious diseases and international security. After that, this study investigates the most appropriate way to understand the governance of EIDs analyzing theories of governance in the fields of International Relations and "global health." In this sense, and adopting these tools, it was possible to map actors and international devices that are involved in the governance of infectious diseases, and later in the EID. Methodologically, this dissertation adopts the analytical model of Young (1999) and Fidler (2002) to analyze the centerpiece of this regime, the International Health Regulations, tracing its development between its 1969 and 2005 versions. This analysis innovates for it presents, from an original point of view, the development of international governance of EIDs in recent decades.

The Story of Serratia Marcescens: Pathologic Risk Factors in Breast Implant Surgery

Serratia marcescens (S. marcescens) emerged as an opportunist in the setting of immunodeficiency in the 1970s, when serious infections occurred in San Francisco hospitals after USA. Navy experiments had aerosolized the bacteria to study biologic warfare. We investigate the risks of S. marcescens in San Franciscans who undergo mastectomy with implant reconstruction. From 2007 to 2011, the senior author took breast capsule cultures for all patients at the time of tissue expander exchange/explant. Of the 142 women who had reconstruction, 23 had positive cultures. Only the two patients who were positive for S. marcescens developed clinical infections that required explantation. Both had postoperative chemotherapy with transient neutropenia, and both had close ties to San Francisco. Clinical signs of infection emerged for both patients months after initial surgery, despite having previously well healed incisions. Other patients were culture positive for Pseudomonas, Proteus, Enterococcus and MRSA and did not develop require explant. While the link between San Francisco and S. marcescens is controversial, a patient's geography is a simple screening tool when considering postoperative risks, especially in the immunocompromised. Closer monitoring for neutropenia during chemotherapy, and a lower threshold to administer S. marcescens targeted antibiotics may be warranted in these patients.

Bioterrorismo e a facilidade de acesso à biotecnologia e seus insumos / Bioterrorism and easy access to biotechnology and its inputs

Os fundamentalismos surgiram no Ocidente a partir de questões religiosas e posteriormente difundiram-se para outras partes do mundo tomando outras conotações, principalmente políticas. As técnicas de manipulação genética difundiram-se pelas universidades, que formam mestres e doutores com os conhecimentos básicos sobre clonagem gênica, que se tornou de domínio público. Todos os insumos para clonagem gênica podem ser adquiridos por meio de catálogos via internet. Podem-se recrutar profissionais fanáticos e com a competência para a manipulação genética de organismos patogênicos, lado perverso da biotecnologia. Os conflitos étnicos, culturais e religiosos estão associados a um cenário de contrastes entre os países ricos e carentes de matéria-prima e aqueles pobres, mas detentores de insumos básicos e energia, e atingem a sua forma mais aguda nos fundamentalismos. Grupos de fanáticos têm pleno acesso a essa biotecnologia. Estariam assim as populações civis vulneráveis aos ataques do bioterrorismo com armas biológicas geneticamente modificadas?.

Fundamentalism arose in the West based in religious matters and afterward diffused to other parts of theworld with other connotations, especially political. Genetic manipulation techniques spread to universities,which has given masters and doctors the basic knowledge on gene cloning, which has become public domain.All inputs for gene cloning may be obtained through online catalogs. Fanatic professionals may be recruited,with qualification for genetic manipulation of pathogenic organisms, the negative side of biotechnology. Eth-nic, cultural and religious conflicts are linked to a series of contrasts between countries that are rich but witha lack of raw materials and the poor countries that possess basic input and energy sources, when it reachesthe highest fundamentalist form. Fanatic groups have complete access to this biotechnology. Are civilian po-pulations in vulnerable to bioterrorist attacks involving genetically modified biological weapons?

Biological warfare, bioterrorism and biodefence.

Biological warfare is the intentional use of micro-organisms and toxins to produce disease and death in humans, livestock and crops, their attraction in war, and for use in terrorist attacks is attributed to various unique features. Biological weapons (BWs) can be disseminated by aerosol sprays, explosives or food and water contamination. Bws can strike suddenly without any warning and inflict considerable mortality and morbidity that can continue for a long period, such attacks may create high level of panic, environment contamination and extreme pressures on emergency health services. Bioterrorism is the use of bws in terrorism. Current concerns regarding the use of bws result from the increasing number of countries that are engaged in the proliferation of such weapons and their acquisition by terrorist organizations. The need of the hour is to develop biodefence by full international cooperation and to educate the likely target populations about precautions and protective measures to be taken in such attacks.

Reclassifying bioterrorism risk: Are we preparing for the proper pathogens?

Existing classifications of potential biological weapons, acknowledge only limited important parameters of biological weapon potential. Certain pathogen factors would further influence the outcome of a potential attack in context with social and political aspects of the time and space of the attack. The importance of these factors was investigated through various attack scenarios that have been developed by the authors, and an individual score for each of these factors was calculated, based on the overall effect their variation had in the scenario outcome. A new classification score for potential biological weapons was subsequently developed, one, which drastically alters the perception of risk for certain pathogens, such as filoviruses and anthrax. This frame further allows for more accurate evaluation of the bioweapon potential of agents such as avian flu. Recognition of intervening factors and proper assessment of the actual risk might augment in proper distribution of interest and funds on relevant medical research

La medicina y las guerras: una introducción / Medicine and wars: an introduction / A medicina e as guerras: uma introdução

En este y en el siguiente artículo, se presentará una sucinta evolución de la medicina moderna, una consideración antropológica sobre la guerra y la evolución de la guerra desde finales del siglo XVIII y principios del XIX hasta la actualidad...

In this and in the next article, we will be show a brief history of the evolution of modern medicine, an anthropological consideration about war and the evolution of war, starting in late 18th century and early 19th century, until our days...

Neste e no seguinte artigo, se apresentará uma sucinta evolução da medicina moderna, uma consideração antropológica sobre a guerra e a evolução da guerra desde finais do século XVIII e princípios do XIX até a atualidade...

Emergency Medical Centers Preparedness for a Biological Disaster in Korea

PURPOSE: To investigate different emergency medical centers' (EMCs) preparedness for a biological disaster in Korea. METHODS: A survey of 120 EMCs in Korea was done through questionnaire. We examined facilities, equipments and supplies, and emergency personnel training and drill. RESULTS: Ninety (75%) EMCs participated in the survey. Sixteen were from regional/specialized EMCs and 74 were from local EMCs. The median for the number of staffed beds were 680(range, 200~2200) and the median for patient visits were 73(range, 24~210) per day. Ten(11%) of the 90 participating EMCs had personal protective equipments (PPEs); 7(8%) had wet decontamination units; 11(12%) had independent ventilation systems; 15(17%) had mechanical ventilator; 9(10%) had life lines; 39(43%) had alternative care sites and none (0%) had triage tag with presence of contamination. At least one drill was conducted annually in 11(12%). When the availability of resources needed in a biological disaster between regional/specialized EMCs and local EMCs were compared, the regional/specialized EMCs had PPEs(38% vs. 5%, p<0.01), wet decontamination unit(44% vs. 0%, p<0.01), independent ventilation systems (31% vs. 8%, p<0.05), and drills (38% vs. 7%, p<0.01) more frequently than local EMCs. Approximately 70% of the respondents attributed the above passive preparedness results from a lack of budget and the notion that only the minimum preparedness is necessary for the possibility of a biological disaster. Also, half of the respondents agreed that new infectious diseases will occur with a possibility of more than 50% in the future. CONCLUSION: Our data indicated that preparedness of EMCs for a biological disaster in Korea was low. Therefore, we should develop comprehensive plans to remedy the identified deficiencies.

Microbial pathogens in ticks, rodents and a shrew in northern Gyeonggi-do near the DMZ, Korea

A total of 1,618 ticks [420 individual (adults) and pooled (larvae and nymphs) samples], 369 rodents (Apodemus arius, Rattus norvegicus, Tscherskia triton, Mus musculus, and Myodes regulus), and 34 shrews (Crocidura lasiura) that were collected in northern Gyeonggi-do near the Demilitarized Zone (DMZ) of Korea during 2004-2005, were assayed by PCR for selected zoonotic pathogens. From a total of 420 individual and pooled tick DNA samples, Anaplasma (A.) phagocytophilum (16), A. platys (16), Ehrlichia (E.) chaffeensis (63), Borrelia burgdorferi (16), and Rickettsia spp. (198) were detected using species-specific PCR assays. Out of 403 spleens from rodents and shrews, A. phagocytophilum (20), A. platys (34), E. chaffeensis (127), and Bartonella spp. (24) were detected with species-specific PCR assays. These results suggest that fevers of unknown causes in humans and animals in Korea should be evaluated for infections by these vector-borne microbial pathogens.

[Crisis management in bio terrorism]

Bioterrorism is the intentional use of harmful biological substances or germs to cause widespread illness and fear. It is one of the new intricates in health public and a threatening factor in the control of infection. Readiness and response to Bioterrorism is essential for every country in managing of crisis. Because biological destructive attacks occur in fourth episodes of time [before, beginning, during and after crisis]; the exact planning for reducing it's harmful effects in every one of episodes is critical. This is a review article with the information gathered from librarian resources, crisis management and bioterrorism articles and search in yahoo Google and CDC Web sites

O desenvolvimento biológico em conexão com a guerra / The Biological development in connection with the war

O século XX foi cenário da construção de um sistema para a operacionalização da ciência estratégica das grandes potências, chamada Big Science. Este sistema é constituído por uma vasta rede institucional integrada, o "complexo militar-industrial-acadêmico", que desenvolve pesquisas estratégicas e direciona a ciência de ponta. O objetivo deste estudo foi investigar a lógica desta construção sob a ótica do poder, fazendo um contraponto entre os desenvolvimentos tecnológicos da Física e da Biologia. Os movimentos de poder identificam algumas características que, em tese, refletem o incentivo para indução do desenvolvimento científico da modernidade, potencializado na era atômica com a fabricação de armas de destruição em massa, as armas de alta tecnologia. Nesta perspectiva, buscamos a relevância do desenvolvimento biológico de interesse político-militar, tomando por base a fabricação de três gerações de armas ao longo do século XX, com crescente posicionamento na corrida armamentista. Esta análise envolve as décadas de 1940 até 1980, na busca de demonstrar uma convergência técnico-política nas trajetórias do desenvolvimento biológico e da guerra biológica, que culminou numa conexão científico-militar no início da era biotecnológica.

The XX Century was the scenario for the construction of a system devoted to operationalizing the strategic science of the great potentials named the Big Science. This system comprehends a vast institutional and integrated network, the "military-industrial-academic complex", which carries out strategic research and guides high quality science. The objective of this study was to investigate the logics of such construction under the perspective of power, highlighting a counterpoint between the technological development of Physics and Biology. The power movement points to some characteristics, that theoretically reflect the incentive to the induction of the scientific development of modern times, potentialized during the atomic age by the manufacturing of high technology weapons. In this perspective one can search the relevance of the biological development of political-military interest in the three-generation manufacturing of weapons throughout the XX Century, and the participation in the armaments race. This historiographic analysis encompasses the decades of 1940 through 1980, in an attempt to show the ethnical-political convergence in the paths taken by the biological development and the biological war which eventually led to a scientific and military connection at the beginning of the biotechnological era.

La pandemia olvidada de 1918 / The forgotten pandemic of 1918

La pandemia de influenza del año 1918 causó más muertes que la Primera Guerra Mundial. El agente causal solo se identificó 20 años después y en la década de los 90, recién se conoció el tipo específico. El presente trabajo resume los hechos de 1918 y los esfuerzos posteriores para aclarar la causa de esta pandemia, por qué fue tan letal y si podría repetirse.

The 1918 pandemic of influenza caused more deaths than the First World War. The causal agent was isolated 20 year after the first events and in only in the 90’s the specific type was identified. The present work summarizes the 1918 facts, describes the efforts to clarify the cause of this pandemics, why it was so lethal, and if it could attack again.

Guerra e desenvolvimento biológico: o caso da biotecnologia e da genômica na segunda metade do século XX / Warfare and biological development: the case of biotechnology and genomics during the second half of the 20th Century

Desde a década de 1980, a Biotecnologia vem assumindo um papel cada vez mais importante dentro do planejamento estratégico das Grandes Potências, como elemento central para um novo tipo de arma ofensiva de destruição em massa e como paradigma para o planejamento de defesa e proteção de suas populações nacionais. Para defender esta tese, nosso estudo se orientou exatamente na história do deslocamento da Biologia para o centro do planejamento de defesa americano. Nosso objetivo foi investigar a existência de uma estreita relação entre o Desenvolvimento Biotecnológico, da ciência Genômica em particular, e a questão da guerra. Nossa hipótese é que a Biotecnologia se afirmou no campo da guerra, quando foram atingidos um ponto de condensação de fatos políticos e uma confluência de possibilidades biotécnicas que estimularam acentuadamente o interesse político-militar. A metodologia para a investigação desta conexão deu-se por dois caminhos: uma análise teórica, onde encontramos as origens e o mecanismo da Big Science desde a II Guerra Mundial, quando a Física assumiu o eixo central da ciência de ponta na era atômica, e desde a década de 1980, quando a Biologia passou a ocupar um lugar central; e uma análise historiográfica, acompanhando duas trajetórias convergentes que, para a nossa tese, formam o nervo central do Desenvolvimento Biotecnológico, da Guerra Biológica e do Projeto Genoma Humano.

Since the 1980's, biotechnology has played an increasingly predominant role in the strategic planning of the super-powers, as the central element of a new type of mass destruction weapon as well as a model for defense planning and protection of their national populations. This study aims to demonstrate the path taken by Biology towards the core of American defense planning and also to investigate the close relationship between biotechnological development, in particular that of Genome Science and war. The specific hypothesis of this study is that biotechnology took a firm stand in military affairs when a condensation point was reached encompassing political facts and a flow of biotechnological possibilities, which have increased political-military interest in biotechnological development. A historiographical analysis was the method used for investigating this connection, following the two converging roads, which, in our view, make up the central nerve of biotechnological development: biological war and the Human Genome Project.

Cutaneous reactions in nuclear, biological and chemical warfare.

Nuclear, biological and chemical warfare have in recent times been responsible for an increasing number of otherwise rare dermatoses. Many nations are now maintaining overt and clandestine stockpiles of such arsenal. With increasing terrorist threats, these agents of mass destruction pose a risk to the civilian population. Nuclear and chemical attacks manifest immediately while biological attacks manifest later. Chemical and biological attacks pose a significant risk to the attending medical personnel. The large scale of anticipated casualties in the event of such an occurrence would need the expertise of all physicians, including dermatologists, both military and civilian. Dermatologists are uniquely qualified in this respect. This article aims at presenting a review of the cutaneous manifestations in nuclear, chemical and biological warfare and their management.

Management of military medicine in new war defense

Management of military medicine service during a war faces two major kinds of weapons, conventional and unconventional.Now a days,production and application of unconventional agents and weapons of mass destruction [chemical,biological,nuclear and remote control weapons] which are called new arsenal, threaten more and more the health and life of living things and human beings every day. Super powers use these kinds of weapons for their sovereignty on other countries.The main goal of military medicine management is to maintain the health of military staff during war and peace with increasing the awareness of personnels by functional methods.The objective of this article is to emphasise roles of management of military medicine in defence during new wars. This is an original article in which the records of imposed war and the pattern of military health management in modern war counterattacks and the evidence from countries involved in these kinds of wars and crisis are mentioned and Persian and English literature were used as examples. Results show that the responsibility of military health management in modern war counterattacks is not just limited to the times of war and crisis; these issues should also be considered in the peace time as well as war and crisis in order to achieve its objectives. Preparation, providing required conditions, and acquiring information about weapons, their application and the methods to tackle them, should all be done in this phase and necessary training should be provided for military personnels and people who are in danger. Debate on using modern weapons is now of great importance since the types of weapon and their destructive effects -even if used in a limited level- have been changed. Ignoring this issue can easily affect the moral and military capabilities of ordinary people as well as military personnel and has a special importance. Although the application of these weapons may not be as widespread as before, current destructive effects of these weapons is now much greater than before. Special attention should be paid to this issue

Biological warfare--an emerging threat.

As we approach the 21st century, there is an increasing worldwide awareness and threat regarding the use of biological warfare agents both for war and terrorist attack. Biological agents include microorganisms or biological toxins that are used to produce death in humans, animals and plants. They are characterized by low visibility, high potency, substantial accessibility and relatively easy delivery. Biological warfare agents are unconventional weapons that can be delivered by unconventional means like aerosol sprays, food and water contamination, conventional explosive munitions or by covert injections. Because of their concealed delivery, easy transportation and difficult identification they are readily adaptable for terrorist operations or to gain political advantages. The detection of such attack requires recognition of the clinical syndromes associated with various biological warfare agents. Diagnosis can be made on clinical grounds and on investigations. Protective measures can be taken against biological warfare agents. These should be implemented early (if warning is received) or later (once suspicion of agent use is made). After the confirmation of diagnosis emergency medical treatment and decontamination are performed in rapid sequence. Patients are then evacuated and specific therapy is given according to the agent involved. Appropriate emergency department and hospital response could significantly limit the morbidity and mortality of biological warfare agents.

Inhibition of Lethal Toxin Expression in Bacillus anthracis Using Antisense Technology

Bacillus anthracis is the causative agent of anthrax primarily in animals and rarely in humans. B. anthracis producing 'anthrax toxin', however, could be a major agent of biological warfare. Anthrax toxin is produced from the pXO1 plasmid encoding the lethal toxin (LeTx) consisted of the protective antigen (PA) and the lethal factor (LF). In this study, we tested whether specific antisense oligonucleotide could inhibit the gene expression in B. anthracis. The antisense oligonucleotide was forced into bacterial cells either by lipofection or heat shock method. The expression of LeTx in B. anthracis was analyzed by the Western blot analysis and the MTT assay using to Raw 264.7 cells. The LeTx protein was purified and used for the production of specific antibodies. The expression of LeTx could be confirmed only in B. anthracis strains haboring pXO1 plasmid. B. anthracis treated with the antisense oligonucleotide through heat shock method markedly inhibited the production of PA. In the Western blot analysis, the expression of PA was inhibited from 25 micrometer and was completely inhibited at 50 micrometer of the antisense oligonucleotide. In the MTT assay, the cytotoxicity was reduced to 20% at 20 micrometer of the antisense oligonucleotide. Above results suggest that the antisense technology would be applied for the research on gene function in B. anthracis.

La Convención de armas biológicas: antecedentes, actualidad y perspectiva / The Conventional weapons convention: antecedents, present situation and perspectives

Se examinaron brevemente los antecedentes de la Convención de Armas Biológicas y se evaluó la actualidad y perspectivas del control internacional de este tipo de armas de destrucción masiva. El objetivo del trabajo es mantener actualizado a nuestros lectores y divulgar los enfoques desde la perspectiva de los países del sur. Se analizó la marcha y el desenlace de las negociaciones sobre el Protocolo que se negociaba para fortalecer la Convención y se muestra como los Estados Unidos bloqueó unilateralmente las negociaciones del Grupo "Ad Hoc" de los estados partes en su etapa final e hizo fracasar la Quinta Conferencia de Examen, hecho único en la historia de estas conferencias. No se vislumbra una solución inmediata al control multilateral y no discriminatorio de la Convención debido a la posición de los Estados Unidos

Bacillus anthracis: a ameaça de uma guerra bacteriológica / Bacillus anthracis: the threat of a bacteriological war

O antraz é uma doença infecciosa de elevada letalidade com grande interesse histórico. Descrita na Bíblia, foi um dos primeiros microorganismos identificados por Koch. Recentemente adquiriu grande interesse por sua potencialidade de uso em ataques de bioterrorismo. Objetivos: revisar a literatura sobre a entidade clínica denominada antraz, enfocando aspectos clínicos, microbiológicos, de diagnóstico e de tratamento, bem como formas de prevenção primária e secundária. Métodos: foi realizada uma busca em toda a base de dados do Medline até o ano 2001, usando como palavras-chave o descritor anthrax. Resultados: foram localizados cinqüenta e três artigos de revisão. Destes foram selecionados alguns artigos de interesse para elaborar este de revisão. Conclusão: a prevenção secundária (pós-exposicional) deve ser iniciada precocemente. O medicamento de escolha é a ciprofloxacina. Uma vez expostos, os indivíduos assintomáticos, além de receber a antibioticoterapia via oral, também têm que receber pelo menos as três primeiras doses de vacina de antraz. Caso tenham aparecido sinais de doença, a forma cutânea pode ser tratada oralmente, ao passo que, na doença por inalação, é essencial que sejam administradas altas doses de antibióticos parenterais e cuidados em unidade de terapia intensiva...