A proposal for the classification of biological weapons sensu lato.

Due to historical and legislation reasons, the category of bioweapons is rather poorly defined. Authors often disagree on involving or excluding agents like hormones, psychochemicals, certain plants and animals (such as weeds or pests) or synthetic organisms. Applying a wide definition apparently threatens by eroding the regime of international legislation, while narrow definitions abandon several important issues. Therefore, I propose a category of 'biological weapons sensu lato' (BWsl) that is defined here as any tool of human aggression whose acting principle is based on disciplines of biology including particularly microbiology, epidemiology, medical biology, physiology, psychology, pharmacology and ecology, but excluding those based on inorganic agents. Synthetically produced equivalents (not necessarily exact copies) and mock weapons are also included. This definition does not involve any claim to subject all these weapons to international legislation but serves a purely scholarly purpose. BWsl may be properly categorized on the base of the magnitude of the human population potentially targeted (4 levels: individuals, towns, countries, global) and the biological nature of the weapons' intended effects (4 levels: agricultural-ecological agents, and non-pathogenic, pathogenic, or lethal agents against humans).

Classification of chemical and biological warfare agent simulants by surface-enhanced Raman spectroscopy and multivariate statistical techniques.

Initial results demonstrating the ability to classify surface-enhanced Raman (SERS) spectra of chemical and biological warfare agent simulants are presented. The spectra of two endospores (B. subtilis and B. atrophaeus), two chemical agent simulants (dimethyl methylphosphonate (DMMP) and diethyl methylphosphonate (DEMP)), and two toxin simulants (ovalbumin and horseradish peroxidase) were studied on multiple substrates fabricated from colloidal gold adsorbed onto a silanized quartz surface. The use of principal component analysis (PCA) and hierarchical clustering were used to evaluate the efficacy of identifying potential threat agents from their spectra collected on a single substrate. The use of partial least squares-discriminate analysis (PLS-DA) and soft independent modeling of class analogies (SIMCA) on a compilation of data from separate substrates, fabricated under identical conditions, demonstrates both the feasibility and the limitations of this technique for the identification of known but previously unclassified spectra.

Novel technology for rapid species-specific detection of Bacillus spores.

There is an urgent need for a small, inexpensive sensor that can rapidly detect bio-warfare agents with high specificity. Bacillus anthracis, the causative agent of anthrax, would be a perilous disease-causing organism in the event of a release. Currently, most anthrax detection research is based on nucleic acid detection, immunoassays and mass spectrometry, with few detection levels reported below 10(5) spores. Here, we show the ability to distinguish Bacillus spores to a level approaching 10(3) spores, below the reported median infectious dose of B. anthracis, using pyrolysis--micromachined differential mobility spectrometry and novel pattern recognition algorithms that combine lead cluster mapping with genetic algorithms.

Histopathology and immunohistochemistry in the diagnosis of bioterrorism agents.

From October to November 2001, the inhalational and cutaneous anthrax cases that occurred in the U.S. underscored the importance of recognizing the clinical and pathological features of infectious agents that can be used in acts of terrorism. Early confirmation of bio-terrorist acts can only be performed by making organism-specific diagnosis of cases with clinical and pathologic syndromes that could be caused by possible bioterrorism weapons. Recognition and diagnosis of these cases is central to establish adequate responses. This review will examine the events that occurred during the anthrax bio-terrorist attack with specific emphasis on the role of pathology and immunohistochemistry and will describe the histopathologic features of category A bioterrorism agents (anthrax, plague, tularemia, botulism, smallpox, and viral hemorrhagic fevers).

History of chemical and biological warfare agents.

Chemical and biological warfare agents constitute a low-probability, but high-impact risk both to the military and to the civilian population. The use of hazardous materials of chemical or biological origin as weapons and for homicide has been documented since ancient times. The first use of chemicals in terms of weapons of mass destruction goes back to World War I, when on April 22, 1915 large amounts of chlorine were released by German military forces at Ypres, Belgium. Until around the 1970s of the 20th century, the awareness of the threat by chemical and biological agents had been mainly confined to the military sector. In the following time, the development of increasing range delivery systems by chemical and biological agents possessors sensitised public attention to the threat emanating from these agents. Their proliferation to the terrorists field during the 1990s with the expanding scale and globalisation of terrorist attacks suggested that these agents are becoming an increasing threat to the whole world community. The following article gives a condensed overview on the history of use and development of the more prominent chemical and biological warfare agents.

Hospital preparedness for possible nonconventional casualties: an Israeli experience.

Since 9/11, hospitals and health authorities have been preparing medical response in case of various mass terror attacks. The experience of Tel Aviv Sourasky Medical Center in treating suicide-bombing mass casualties served, in the time leading up to the war in Iraq, as a platform for launching a preparedness program for possible attacks with biological and chemical agents of mass destruction. Adapting Quarantelli's criteria on disaster mitigation to the "microinfrastructure" of the hospital, and including human behavior experts, we attempted to foster an interactive emergency management process that would deal with contingencies stemming from the potential hazards of chemical and biological (CB) weapons. The main objective of our work was to encourage an organization-wide communication network that could effectively address the contingent hazards unique to this unprecedented situation. A stratified assessment of needs, identification of unique dangers to first responders, and assignment of team-training sessions paved the way for program development. Empowerment through leadership and resilience training was introduced to emergency team leaders of all disciplines. Focal subject matters included proactive planning, problem-solving, informal horizontal and vertical communication, and coping through stress-management techniques. The outcome of this process was manifested in an "operation and people" orientation supporting a more effective and compatible emergency management. The aim of article is to describe this process and to point toward the need for a broad-spectrum view in such circumstances. Unlike military units, the civilian hospital staff at risk, expected to deal with CB casualties, requires adequate personal consideration to enable effective functioning. Issues remain to be addressed in the future. We believe that collaboration and sharing of knowledge, information, and expertise beyond the medical realm is imperative in assisting hospitals to expedite appropriate preparedness programs.

Potential use of microarray technology for rapid identification of central nervous system pathogens.

Outbreaks of central nervous system (CNS) diseases result in significant productivity and financial losses, threatening peace and wartime readiness capabilities. To meet this threat, rapid clinical diagnostic tools for detecting and identifying CNS pathogens are needed. Current tools and techniques cannot efficiently deal with CNS pathogen diversity; they cannot provide real-time identification of pathogen serogroups and strains, and they require days, sometimes weeks, for examination of tissue culture. Rapid and precise CNS pathogen diagnostics are needed to provide the opportunity for tailored therapeutic regimens and focused preventive efforts to decrease morbidity and mortality. Such diagnostics are available through genetic and genomic technologies, which have the potential for reducing the time required in serogroup or strain identification from 500+ hours for some viral cultures to less than 3 hours for all pathogens. In the near future, microarray diagnostics and future derivations of these technologies will change the paradigm used for outbreak investigations and will improve health care for all.

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.

Biological warfare from a dermatologic perspective.

Biological warfare agents have been used in this century by both organized armed forces and terrorist organizations. Beset with many problems that limit their tactical value on the battlefield, such "weapons of mass destruction" have tremendous terror appeal. Unusual presentations or clustering of diseases associated with biowarfare might alert the clinician that an attack has occurred. The clinical presentations, current recommended treatments, and preventive measures of agents such as anthrax, smallpox, plague, and the viral hemorrhagic fevers are discussed, as well as some of the issues that have been raised as authorities are considering how and when to resume smallpox vaccinations. References focus on current Internet web sites, which will provide up-to-date information and advice for allergists with immunization questions or who feel they might have encountered a patient with one of these diseases.

[Biological security confronting bioterrorism]. / Seguridad biológica frente a bioterrorismo.

A review is made on Biosecurity at both local and global level in relationship with Bioterrorism as a real threat and its control and prevention. The function of the network of High Security Laboratories around the world able to make immediate diagnosis, research on vaccines, fundamental and urgent epidemiological studies, conform a steady basis to control natural infections and also the possible bioterrorism attacks.

[The spectrum of symptoms associated with biological warfare].

BACKGROUND: There are hundreds of potential agents that could be used in biological warfare or bioterrorism: bacteria, viruses and toxins. There are no similarities between clinical presentations of organisms or toxins belonging to specific microbial families. Therefore, it is important for the physician, required to cope with an unusual disease or outbreak among his patients, to become familiar with the various symptoms that victims of biological warfare or bioterrorism may present. METHODS: To describe the six most common groups of symptoms expected in the above setting. The most common symptoms will be described as they appear in nature, because of a fortunate lack of experience with the majority of these agents in biological warfare. Hence, variations of these presentations may be possible. RESULTS: The six most common presentations reviewed are: 1) respiratory tract symptoms; 2) hemorrhagic fevers; 3) meningitis and encephalitis; 4) flaccid paralyses; 5) fever syndromes with rash; and 6) diarrheal syndromes. Additional presentations may be possible due to alterations made in these organisms or development of new agents and mixtures. A list is provided of features that may alert a physician of the possibility of biological warfare or bioterrorism. CONCLUSION: Knowledge of the principal clinical presentations of victims of biological warfare or bioterrorism is essential to all physicians. This knowledge may contribute to the early recognition of a cluster of patients, an epidemic, an unusual disease, or biological warfare; quick referral to the emergency department, leading to early microbiological diagnosis; and rapid notification of the Ministry of Health. All these, and the institution of appropriate measures, will ultimately contribute to the survival of individual patients and at-risk populations.

[The history of biological warfare].

Selected events in the history of biological weapons are highlighted to increase the physician's awareness of this crucial threat. The deliberate use of biological substances originated in antiquity and has pervaded the history of human wars throughout time until the 21th century. The history of biological warfare is difficult to assess because of a number of confounding factors. These include the difficulty in verification of allegation, the use of the threat of this weapon for propaganda purposes, the lack of microbiological or epidemiological data, and the incidence of natural occurring endemic or epidemic diseases during hostilities. Although it may be problematic to verify at times, the use of such weapons has not been limited to national armies or militia. Frustrated civilians, terrorists and even physicians have used biological substances to promote their interests. Today, the biological threat has become more serious. It's potency, cost-effectiveness, and the ability to manufacture and deploy it with little sophistication, or under the semblance of legitimate commercial endeavors, will ensure that biological weapons remain a constant threat to human health.

We are all in this together. Terrorism and the physician executive.

The threat of bioterrorism striking America is no longer a threat. It's real. Take a look at how the anthrax-laced letters and future acts of terrorism impact physician executives. Also consider some ways to prepare your physicians for a bioterrorism emergency.

Terrorist attacks: do we know how to assess the results?

On September 11, 2001, terrorists destroyed the World Trade Center (WTC) in New York City. Explosions and fires resulted in the complete collapse of the two WTC towers. The collapsing towers served as enormous point sources of gaseous and particulate air pollution, seen as huge plumes of smoke and dust. The smoke contained volatile organic compounds and fine particles and aerosols. The dust fraction contained parts of ceiling tiles, carpets, concrete, adhesives, asbestos, chromium, lead, titanium, and many other elements and materials. Whether there were unusually toxic ingredients in the plumes is largely unknown.