Public Health

From Security Commons
Jump to: navigation, search

Contents

Return to Index Page

Status Brief

History/Origins:


Developmental Milestones/Developments to Date:


Current Assessment/State of the Field:


Problems/Challenges:


Proposals: .

2000

Adamo, Beth, "Evacuating Your Home During a Terrorist Attack", Safety. 2000. [1]

  • “If the order to evacuate is given, you should do so immediately and carefully follow the directions given by local authorities. If a local shelter has been established, go there.”
  • “Wherever you've decided to go, the best way to get there is by car.”
  • “Be prepared for any emergency by assembling an emergency supplies kit.”
  • Public Health, Emergency Response, Biosafety, Bioterrorism


Vergano, Dan, “Bioterrorism defense under fire Doctors say military plans are wrong approach”. USA TODAY. June 21, 2000.

  • “At a recent briefing sponsored by the American Medical Association, infectious-disease specialists argued that military planners have botched the nation's bioterrorism defenses and ignored the doctors who would form the leading lines of defense against terrorists wielding diseases to kill.”
  • “"It's not the military who will respond to a biological event, but biologists," says AMA briefing speaker Michael Osterholm of the Minneapolis-based Infection Control Advisory Network, an infectious-disease consulting firm. A former state health official, he warns "it's just a matter of time" before a bioterrorist attack occurs. He estimates an anthrax attack could cause 3 million deaths.”
  • “Osterholm criticizes the federal government's allocation of funds as already too military-oriented, with about $ 121 million sent to the Centers for Disease Control and Prevention to combat bioterrorism, out of about $ 10 billion in the 1999 federal counterterrorism budget”
  • “Biological weapons pose a unique public threat. Unlike explosives or gunfire, microbes overwhelm people slowly, spreading through the populace with symptoms that can mimic more benign maladies, like the flu.”
  • “Lab analysis, vaccines and drugs, "disease detectives," and quarantine are all tools that can be directed toward a biological disaster by the CDC director without the involvement of any other federal agency, Lillibridge says. "We anticipate the rest of the government catching up with us."”
  • “Instead of funding military bioterrorism response teams, he says, the government should bulk up disease surveillance efforts staffed by physicians”
  • “"Most bioterrorism planning revolves around worst-case scenarios," says terrorism expert Bruce Hoffman, who heads the Washington, D.C., office of RAND, a military and public policy think tank. Terrorists desire terror, he suggests, a goal achieved far more easily and cheaply with a gun or a bomb than with microbes.”
  • Public Health, Bioterrorism, CDC, Quarantine, Emergency Response, Military, Anthrax

2001

Higham, Steve, “Chernobyl Challenge”. International Construction. August 2001.

  • “Within six months, Russian and Ukrainian teams had contained the damaged reactor under a makeshift ‘tomb’. This helped plug to plug immediate radioactive leakage, but will not outlive the danger posed by its contents.”
  • “Parts of Chernobyl’s interior have not been seen since the day of the accident—even by remote-controlled cameras. In experimental explorations, robots carrying such cameras had their electronic components destroyed instantly by the high levels of ambient radiation.”

Nuclear, Public Health, Quarantine


Stolberg, Sheryl, “A NATION CHALLENGED: THE HEALTH SYSTEM; Struggling to Reach a Consensus On Preparations for Bioterrorism”. The New York Times; November 5, 2001.

  • “This year, Johns Hopkins will buy extra medicines, masks, ventilators and radios for its security force. It will retrofit a building with new air filters, to keep infectious germs from spreading. The price: $7 million. The question is, who will pay for it?”
  • “"The federal government is going to have to give us some assistance," Mr. Peterson said. Last week, the American Hospital Association estimated that the nation would have to spend $11.3 billion to get hospitals ready to handle a serious bioweapon attack.”
  • “The system they have tested -- the public health system -- has been strained to its breaking point.”
  • “"We have spent, in the last three years, one dollar per year per American on bioterrorism preparedness," said Dr. Tara O'Toole, director of the Center for Civilian Biodefense Studies at Johns Hopkins University. "We are basically getting what we paid for."”
  • “"We can achieve much better preparedness very quickly," Mr. Kennedy said, "but it will require a major national effort and a major commitment of new resources."”
  • “Having the will does not just mean having the money. It means training doctors and nurses and public health professionals. It will also mean a sea change in the way hospitals do business.”
  • “To prepare for bioterrorism, hospitals must build surge capacity back in. Yet because they are reimbursed by health insurers only for patient care, hospital executives say they have no way to pay for bioterrorism preparedness. And because hospitals compete for patients, most have not engaged in regional planning for a bioterrorist attack -- designating one city hospital as the burn unit, for instance, and another the infectious disease ward.”
  • “Some bioterrorism experts, among them Dr. Frank E. Young, the former director of the Office of Emergency Preparedness at the Department of Health and Human Services, have suggested that military field hospitals could be used to help cope with an attack. Others say that is not practical.”
  • Public Health, Bioterrorism, Military, Vaccination, Biotechnology



Maddox, P.J., "Bioterrorism: A Renewed Public Health Threat". Dermatology Nursing. December 1, 2001 [2]

  • “Even though national emergency preparations since the cold war have included consideration of biological weapons, the post mortem on emergency responses to the terrorist attacks on September 11, 2001, has brought renewed concerns about bioterrorism.” (Pg. 1)
  • “Even a single exposure could result in local outbreaks of difficult-to-diagnose disease and fatal disease outbreaks.” (Pg. 1)
  • “Unlike weapons that use explosives or chemicals, attacks using biological weapons may occur silently and covertly and, thus, be difficult and time consuming to detect. To complicate the matter, public symptoms of biological exposure may be delayed for days or weeks.” (Pg. 1)
  • “Once detected, a massive public exposure could overwhelm local health systems that must treat victims of an outbreak, provide care for mass casualties, and prevent further disease.” (Pg. 1)
  • “Department of Health and Human Services (DHHS) has special responsibilities, including detecting the disease, investigating the outbreak, and providing stockpiled drugs and emergency supplies in the large amounts needed.” (Pg. 1)
  • “The MMRS emphasizes enhancement of local planning and response capability, including hospital capacity, to care for victims of a bioterrorist incident. MMRS systems provide designated communities with structured operations, specially trained responders, special Pharmaceuticals, detection and personal protection equipment, decontamination capabilities” (Pg. 2)
  • “The role of the National Pharmaceutical Stockpile Program is to maintain a national repository of lifesaving pharmaceuticals and medical material that will be delivered to the site of a bioterrorism disaster in order to reduce morbidity and mortality in those affected” (Pg. 3)
  • “Through the CDC, efforts will continue to ensure that all laboratories that ship or receive specially identified biological agents axe registered and in compliance with federal requirements.” (Pg. 3)
  • Bioterrorism, Public Health, CDC, Emergency Response

2002

Miriani, Allison, "Hospitals pushed to plan for bioterrorist attacks" Capital Service News. Feb. 22, 2004. [3]

  • “Most larger hospitals have a bioterrorism plan. The bill would make sure that all hospitals, including small outstate facilities, will comply, Scott said.”
  • “Although there are 15 million doses of the vaccine for smallpox in the United States right now, Johnson said, many side effects could even result in death from the vaccine. That is why the Department of Community Health does not advocate a mass vaccination campaign, he said.”
  • “"We need strict airport precautions, contact isolations. We have to notify public health authorities immediately at the local level and from there the state," he said. "We need to identify those who have had contact with the person (who was exposed)."”
  • Public Health, Smallpox, Bioterrorism, Emergency Response


Powers, Michael and Ban, Jonathan, "Bioterrorism: Threat and Preparedness", National Academy of Engineering. Spring 2002 [4]

  • “Therefore, rather than planning for a narrow range of least-likely, high-consequence contingencies or focusing only on additional mailborne anthrax attacks, we must plan for a variety of future incidents--including incidents that cause mass casualties and mass disruption.”
  • “The incidents aroused significant fear and disruptions but not mass casualties. Based on these attacks, some analysts have suggested that terrorists would not be able to orchestrate mass-casualty attacks using biological weapons. Others have considered these attacks as demonstrations of terrorists’ ability to acquire high-quality anthrax”
  • “Rather than focusing on vulnerability to a particular organism or looking to history to determine what is to come, policy makers and scientists must recognize that the bioterrorist threat is not uni-dimensional. We must consider four key elements of the threat: the who (the actor), the what (the agent), the where (the target), and the how (the mode of attack).”
  • “We do not know how "massive" an attack would have to be to overwhelm the response system, instill fear and panic, or cause serious political or economic fallout.”
  • “Every dollar spent preparing for a specific agent, such as building stocks of smallpox or anthrax vaccine or purchasing antidote for botulinum toxin, is a dollar that cannot be spent on preparedness for other organisms. Given the variety of combinations among actors, agents, targets, and dissemination techniques, a public health system must be capable of rapidly and accurately detecting and assessing a large number of bioterrorism scenarios and addressing most contingencies.”
  • “planning should be based on developing the capability of effectively and efficiently responding to a variety of bioterrorist contingencies”
  • “We must strike a better balance between hedging our defenses against high-end, mass-casualty events and building a "system of systems" capable of addressing both a wider range of bioterrorist contingencies and natural outbreaks of infectious disease.”
  • “In addition, accurate and timely information will be the backbone of the decision making process in times of crisis and will provide credible and consistent information to the general public to reduce panic.”
  • "A national surveillance system to provide an early warning of unusual outbreaks of disease, both natural and intentional, will be a critical component of our preparedness. This system will depend on an information infrastructure that includes electronic data networks connecting local public health departments and area health care providers and providing regular analyses of the data for the presence of unusual trends that could indicate a bioterrorist attack"
  • Public Health, Bioterrorism, WHO, Emergency Response, Smallpox, Anthrax


Editors, "Terrorism. Iodine pills, just in case." Harvard Medical School. July 2002.

  • “People are also buying potassium iodide (KI) pills, which help protect the thyroid gland from radiation.”
  • “Health officials worry that people who take the potassium iodide will think they’re safe and ignore evacuation orders”
  • “If a nuclear catastrophe were to occur, the threshold for taking the pills would be lower for children and pregnant women than for other adults.”
  • “Potassium iodide pills flood the thyroid with the stable version, lowering the uptake of the radioactive atoms, which are subsequently excreted in urine.”
  • “One Web site, www.nukepills.com, sells 130-mg pills in packets of 14 for $9.95, but adds a hefty $6.95 shipping charge.”
  • Bioterrorism, Public Health, Emergency Response, Quarantine, Nuclear, Biosafety


Mattews, Gene, "Legal Preparedness for Bioterrorism" EBSCO Publishing, 2002. [5]

  • “In fact, many emergency health laws consist of one sentence stating that the health officer in an emergency may take whatever actions he/she deems necessary” (Pg. 1)
  • “The Draft Model State Emergency Health Powers Act, which was fashioned out of existing state laws, was designed to assist states in reviewing their emergency public health powers. The draft covers reporting of diseases cases, quarantine, vaccination, protection of civil liberties, property issues, infectious waste disposal, control of healthcare supplies, access to medical records and effective coordination with other state, local, and federal agencies.” (Pg. 1-2)
  • “It is important to know the legal ground rules in advance of an emergency. It will be necessary to brief the public, in multiple languages, on the nature of the disease and how to respond.” (Pg. 4)
  • “In an emergency, public health officials will be called upon to deal with a variety of hoaxes and people who are concerned but not sick.” (Pg. 4)
  • “The smallpox vaccine is currently classified as an Investigational New Drug, a classification that raises research implications because each state maintains a separate Institutional Review Board overseeing research protocols.” (Pg. 4)
  • “Thoughtful decisions will need to be made about closing schools, advising the public to remain at home, and delivering necessary services.” (Pg. 5)
  • Bioterrorism, Public Health, Emergency Response, Quarantine, CDC


Hodge, James, "Bioterrorism Law and Policy: Critical Choices in Public Health" Journal of Law, Medicine & Ethics, 2002. [6]

  • “However, in many states, existing legal standards for response are absent, antiquated, or insufficient. Prior to September 11, many state health departments did not address bioterrorism in their emergency response plans.'^ Recently, public health lawyers and scholars at the Center for Law and the Public's Health at Georgetown and Johns Hopkins Universities were asked by the Centers for Disease Control and Prevention and a series of national partners (i.e., the National Governors Association, the National Conference of State Legislatures, the Association of State and Territorial Health Officials, the National Association of City and County Health Officers, the National Association of Attorneys General, and the Turning Point Public Health Statute Modernization National Collaborative) to develop a model act for states to respond to public health emergencies.” (Pg. 1-2)
  • “gives state and local public health authorities a modern series of powers to track, prevent, and disease threats resulting from bioterrorism or other public health emergencies. These powers include measures (e.g., isolation, quarantine, treatment, and vaccination requirements) that may temporarily compromise individual civil liberties (e.g., rights to due process, speech, assembly, travel, and privacy) to protect the public's health. To date, thirty-two states have introduced legislative bills based on the Model Act." (Pg. 2)
  • “Bioterrorists may infect individuals through multiple routes: (1) intentional spread of contagious diseases through individual contact; (2) airborne dissemination of some infectious agents; or (3) contamination of water, food, controlled substances, or other widely distributed products. The equipment needed to manufacture biological weapons is easy to obtain and conceal.” (Pg. 3)
  • “The Model Act broadly defines a "public health emergency" as: an occurrence or imminent threat of an illness or health condition that: (1) is believed to be caused by bioterrorism or the appearance of a novel or previously controlled or eradicated infectious agent or biological toxin; and (2) poses a high probability of any of the following harms: (a) a large number of deaths in the affected population; (b) a large number of incidents of serious permanent or long term disability in the affected population; or (c) widespread exposure to an infectious or toxic agent that poses a significant risk of substantial future harm to a large number of people in the affected population.” (Pg. 3-4)
  • “First, the federal government has greater financial resources at its disposal to respond to a bioterrorism threat. Second, it may be in a better position to negotiate the price of needed vaccines, drugs, or supplies, or to suspend the patent rights of high-demand medications. These techniques were recently used by President George Bush and DHHS in negotiations with the German drug company Bayer, concerning the sale of Cipro, the antibiotic used to treat anthrax. Third, most significant bioterrorism threats will exceed the boundaries of any single state, thus requiring a national, coordinated response.” (Pg. 5)
  • Bioterrorism, Public Health, Emergency Response, Model Act, CDC, Anthrax



Glass, Thomas A. and Monica Schoch-Spana, "Bioterrorism and the People: How To Vaccinate a City against Panic," Clinical Infectious Diseases, 34:217-23 (Jan 15, 2002)

  • Glass and Schoch-Spana propose a five point model for community participation in response bioterror attacks, especially epidemics: 1. "treat the public as a capable ally," 2. "enlist civic organizations," 3. "anticipate the need for home-based patient care and infection control," 4. "invest in public outreach and communication strategies," and 5. "ensure that planning reflects the values and priorities of affected populations."
  • The public has generally been discounted as an effective means of defense against bioterrorism; this attitude is not based on experience, as the authors claims "natural and technological disasters and disease outbreaks indicate a pattern of generally effective and adaptive collective actions."
  • "Collective behavior changes over time and in relation to external events. This suggests that, in times of disaster, panic may be 'iatrogenic': that is, the actions of emergency managers may determine the extent and duration of he panic, to the extent that it exists."
  • Emergency Response, Public Health, Prophylaxis, Anthrax, Ethics


Roffey, R.; Lantorp, K.; Tegnell, A.; Elgh, F. “Biological Weapons and Bioterrorism Preparedness: Importance of Public-Health Awareness and International Cooperation” Clinical Microbiology and Infection, Volume 8 Number 8, 2002

  • “In Sweden, every county (population approximately 400 000) has an infectious disease clinic with containment facilities. In order to treat patients with highly contagious serious infectious diseases, Sweden has a special containment unit at the university hospitals in Linko¨ping and Stockholm. Sweden also has a special field epidemiologic group that can be called upon to investigate outbreaks of disease of different types, on both a national and an international level.” p525
  • “The Swedish Defence Research Agency Division of NBC Defense analyzes the international developments

and threats concerning biological weapons and bioterrorism. The research is, among other things, focused on the development of methods and technology for detection/identification of and protection against biological warfare agents. The Swedish Defense Research Agency cooperates with the Swedish Institute for Infectious Disease Control with regard to identification of specific biological warfare agents.” p525

  • “There is a themselves, temptation for these scientists to immigrate to countries that want to acquire biological weapons. In order to meet this threat, several initiatives have been taken by the world community. An example of this the Department of Defense Cooperative Threat Reduction Program (DOD CTR) in the USA, as well as other US agencies. Economic support is also given through the International Science and Technology Center (ISTC) in Moscow and the Science and Technology Center Ukraine (STCU) in Kiev, which are financed by the USA, the European Union (EU), Japan, and others.” p526
  • “In Sweden, the Ministry for Foreign Affairs has supported research cooperation between the Swedish Defense Research Agency (FOI), the Swedish Institute for Disease Control (SMI) and the Scientific Research Institute Vector in Novosibirsk, Russia in the areas of biosafety and diagnostics.” p526
  • Public Health, Sweden, Russia


Bentham, Martin, "5,000 body bags ordered in case of terrorist chemical attack Government orders 120,000 decontamination suits to be ready for distribution 'in minutes'". SUNDAY TELEGRAPH, December 8, 2002. [7]

  • “THE GOVERNMENT is buying more than 120,000 decontamination suits to protect people from a terrorist chemical or biological attack on potential targets across Britain such as Trafalgar Square.”
  • “Thousands of decontamination showers, shelters, stretchers and other equipment are also being ordered - as well as 5,000 body bags. The equipment, which is intended to be available by the middle of next year at the latest, will be stored at 16 locations, ready to be distributed within minutes of a terrorist attack.”
  • “Philip Ward, the managing director of Ferno UK, the country's leading manufacturer of emergency and rescue equipment, said that his company was among those bidding for the contracts, which were for "huge" quantities that were "getting bigger by the day.”
  • “One batch of contracts, which is about to be awarded, is for 120,000 pre-decontamination suits, to be used immediately after a chemical or biological attack. The contracts will also provide 100,000 post-decontamination suits to be worn by people after their initial treatment. Industry officials say the 20,000 difference reflects the number of deaths likely to occur.”
  • “The treatment, said Mr Ward, would begin with each victim stripping and putting on a pre-decontamination suit. Their clothes would be placed in a separate bag for incineration. Swabs would then be provided for the victims to clean out orifices which could contain traces of the chemical, before each person passed through a shower - set up in shelters at the site of the attack - to wash off the substance. Finally, post-decontamination suits would be given to reclothe the victims.”
  • “Other equipment required by the Government includes 50,000 decontamination shelters, 2,000 stretchers, 2,000 evacuation chairs and 5,000 body bags.He said, however, that pounds 56 million had been allocated this year to prepare for potentially catastrophic terrorist incidents. Some of the money would buy decontamination equipment, which would be held by the fire service.”
  • Decontamination, Public Health, Bioterrorism, Emergency Response

2003

Snyder, James, "Role of the Hospital-Based Microbiology Laboratory in Preparation for and Response to a Bioterrorism Event" Journal of Clinical Microbiology. pg. 1-4, Vol. 41, No.1. Jan. 2003

  • "The main role of the hospital-based clinical microbiology laboratory in support of a biothreat, biocrime, or act of bioterrorism is to "raise suspicion" when a targeted agent is suspected in a human specimen."(Pg. 1)
  • "These plans include the following: (i) criteria for distinguishing the type of bioterroism event; (ii) information regarding access to and utilization of the LRN, including diagnostic testing protocols; (iii) safety guidelines; (iv) communication and notification protocols..." (Pg. 1)
  • "Therefore, risk assessment becomes the responsibility of the clinical microbiologist, infection control personnel, hospital risk management office, and infectious disease physicians." (Pg. 3)
  • "The laboratory, preferably the laboratory director, must establish and include in the laboratory bioterrorism response plan a notification policy that is enacted when a suspicious isolate cannot be ruled out and must be referred to the next higher level laboratory for confirmation of the organism's identity." (Pg. 3)
  • Public Health, Bioterrorism, CDC, Lab Safety, Biodetection, Biodefense, Biosafety, Biosecurity, Decontamination, Personnel Reliability


Lombardo, Joseph, S., "The ESSENCE II Disease Surveillance Test Bed for the National Capital Area," Johns Hopkins Technical Digest, pp. 327-334, Vol. 24, No. 4, 2003. [8]

  • "The Electronic Surveillance System for the Early Notification of Community-based Epidemics, version two (ESSENCE II), is being developed through a collaboration between the DoD Global Emerging Infections System and APL [Applied Physics Laboratory]. ESSENCE II uses nontraditional health indicators in syndromic groupings coupled with advanced analytical techniques in an advanced information technology environment." p. 327
  • "The contamination and closure of major medical centers, even if only temporary, could have an impact on the health of the populations they serve. To mitigate the consequences of such an event, an effective public health campaign must be launched early in the course of the outbreak." p. 327
  • "Disease surveillance began in Europe in the 14th century as a means of controlling disease within communities. IN the United States, disease reporting began in 1741 when Rhode Island passed an act requiring tavern keepers to report patrons with contagious diseases." p. 327
  • "ESSENCE II has been a tool for health department epidemiologists to support the early recognition of abnormal disease patterns within the NCA [National Capital Area]." p. 334.
  • " ESSENCE I is a worldwide military syndromic surveillance system operated by the DoD Global Emerging infections System (DoD-GEIS). ESSENCE II relies solely on the acquisition and processing of existing data from various sources. It is also unique in that it is the only known system to integrate both military and civilian health indicators." p. 328
  • "ESSENCE II is being developed as a test bed for the National Capital Area (NCA). As such it permits the implementation and evaluation of novel surveillance concepts." p. 328
  • "ESSENCE II modules implement the following: Policies to ensure the privacy of personal health care information. Policies governing the exchange of information among other surveillance systems, Data achieve …detection of abnormalities in the indicator data, [controls for] special events or environmental conditions that warrant changes in detection parameters ...identify false positives ... current or historical trends, Visualization of user interfaces, Processes for injecting simulated data for training and measuring the performance of ESSENCE II detectors and indicators." p 328
  • "The data needed to effectively use and operate ESSENCE II fall into three distinct categories: sensitive health care information, publically available information, and products of external surveillance." p. 329
  • [Data collected includes:] "chief-complaint data from hospital emergency rooms; International Classification of Disease, 9th Revision, Clinical Modification (ICD-9-CM) codes used for billing patient visits for private practice groups; over-the-counter (OTC) sales of pharmaceuticals that can be used for sefl-medication; nurse hotline calls; school absentee records; etc."
  • "We have grouped these data streams into the sensitive heath care category because they may acquired and used only in conformance with privacy laws, corporate policies, memoranda of agreements, etc." p. 329
  • "ESSENCE II data achieve is partitioned into three parts: public domain information, sensitive health care data, and data that are subject to the policies agreed upon by the providers and users of the data." p. 330
  • "The traditional gold standard is a confirmed laboratory result, but this data source may not provide the timeliness needed to respond to a widespread outbreak caused by a covert attack with a weaponized disease." p. 330
  • "One problem with the removal of all personal identifiers on nontraditional clinical data is that a single case of illness could show up in several of the data streams used for surveillance." p 330
  • "In addition, the processes implemented must fit into the business rules and privacy policies of the organizations supplying the data." p. 331
  • "Most data available to ESSENCE II can be resolved down to only the patient zip code." p. 331
  • "A basic function of ESSENCE II is to deliver alerts and surveillance information to civilian public health authorities in the NCA." p. 332
  • "Separate user names and passwords are provided so that ESSENCE II can recognize each authorized user and give only the data the user is authorized to view. ...a director of epidemiology would have access to all the information within his or her jurisdiction as well as the shared information from the surrounding jurisdictions." p. 332
  • Biosurveillance, Public Health, Military


Barbaro, Michael, "A Worst-Case Enterprise; Md. Firm Busy Making Decontamination Shelters". The Washington Post. March 13, 2003.

  • “The doomsday shower can sanitize 800 people an hour. It boasts separate rinse stations for contaminated men and women. It can be set up by four people in less than 10 minutes. And storage is a cinch: It takes up about as much space as a typical washing machine.”
  • “TVI Corp. of Glenn Dale says it can't keep up with back orders for its decontamination shelters, even after doubling its workforce to about 90 last year. Sales of its shelter, which sells for around $ 88,000, nearly tripled in 2002.”
  • “But TVI's flagship product is the High Throughput Mass Decontamination Shelter, a car-wash-like structure for humans that has at least 50 shower nozzles threaded into its vinyl interior, a hot water pump and soap dispensers. It is designed to be attached to a fire hose and has at least three shower lanes to separate men, women and the incapacitated after an attack.”
  • “The product is designed for particular situations. If a "dirty" nuclear bomb is detonated or a biochemical agent is released, for example, people who flee the scene before being decontaminated would risk exposing others to the danger. The shelters would be used to rapidly contain the threat.”
  • “The decontamination shelters operate on a simple principle.“You just cream people with water," said Thomas D. Gibson, a lieutenant with the hazardous materials team at the National Institutes of Health campus in Bethesda.”
  • “"Decontamination is the same whether you are talking about chemical, biological or radiological agents," said Clendenin, the Massachusetts fire official. "Soap and water is never a bad thing."”
  • Decontamination, Bioterrorism, Public Health, Emergency Response, Biotechnology



Goldstein, Avram, “Progress Cited on Health Threat; 'We're Worlds Better Prepared,' City Official Says”. The Washington Post, April 17, 2003.

  • “They are buying protective gear; expanding drug, food and water stockpiles; adding or enhancing decontamination facilities outside emergency rooms; and creating patient isolation rooms to help control a smallpox outbreak.”
  • “The city has set up an elaborate incident command center that is so new it hasn't been seen by Mayor Anthony A. Williams (D), said Feseha Woldu, acting administrator of the D.C. Emergency Health and Medical Services Administration.”
  • “The District has expanded its epidemiology staff to eight and assigned nearly 60 city workers to bioterrorism preparedness. Meanwhile, hundreds of private doctors and nurses have volunteered to deliver health care services or to provide information to the public by phone or computer if called upon by the city.”
  • “"We live in the No. 1 terrorist target in the world," said Jeffrey A. Elting, medical director for bioterrorism response coordination at the D.C. Hospital Association. That stark reality has spurred much of the cooperation, he said.”
  • “The best example is a radio system that enables all hospitals to communicate if telephone service is interrupted, allowing them to rapidly exchange information on their capacity to accept new patients and lend each other equipment and supplies. It also would let public health officials broadcast messages to hospitals regarding the dimensions and type of event. The system is tested a few times a day, when roll is called.”
  • “The survey found that, on average, hospitals can generate their own electric power for 5.8 days. Without outside help, surveyed hospitals said, they had enough food to last 4.7 days, water for 2.5 days, and medical supplies for 7.1 days.”
  • “At Providence Hospital, officials are buying 20 protective full-body suits, including respirators, so doctors and nurses can safely and rapidly care for people contaminated by dangerous chemicals or pathogens. They also are buying a mobile decontamination unit where patients exposed to hazardous substances can shower.”
  • “If a smallpox outbreak occurred, Providence has 12 patient rooms and a 16-bed unit that can be isolated to keep a virus from spreading to unprotected patients and staff. The hospital also has eight portable HEPA (High Efficiency Particulate Air) filtration units that can convert a room or even a plastic tent to a temporary isolation unit.”
  • “He said the hospital does not want to use the inflatable decontamination units they already have because they take too long to set up -- 18 minutes.”
  • “Wuerker said 12 people have been vaccinated for smallpox, including himself, and another 12 are scheduled. With that many first-line responders, he said, all 5,000 hospital workers could be vaccinated quickly to prepare for an outbreak.”
  • “Exactly which surge facilities might be needed and when is unpredictable and depends on the exact location and nature of and attack, officials say. Instructions and guidance would be offered by public health officials through electronic and print media, they say.”
  • "Sibley Memorial Hospital has 16 negative-pressure rooms and a small decontamination shower that is being renovated. Like other hospitals, Sibley has zoned ventilation systems that can quickly shut down if outside air is tainted."
  • "Washington Hospital Center, the region's largest medical facility, has 32 negative-pressure isolation rooms -- which don't allow air with contagious germs to flow into other areas -- and is planning more, said Christopher Wuerker, chairman of the emergency preparedness committee."
  • Public Health, Bioterrorism, Emergency Response, Vaccination, Biotechnology, Decontamination



Editors, "Hospitals are not prepared for terror". The Toronto Star. January 31, 2003.

  • “Decontamination of chemically or radiologically contaminated patients, ideally prior to entering the health-care facility, is a critical step in the delivery of care. Only 18 of 59 hospitals (30 per cent) had a decontamination area or a plan to establish one.”
  • “The ideal system defines two areas: one where contaminated patients arrive for decontamination (the "hot" zone) and one where decontaminated patients receive care (the "cold" zone). Absence of this kind of system indicates a potentially ineffective plan. In our survey, only five emergency rooms (8 per cent) with a decontamination plan had a hot/cold system. This raises the concern that, even among hospitals with decontamination plans, the systems may not be sufficient.”
  • “Emergency departments that have no decontamination plan must provide protective equipment so staff can function at relatively low risk. But only 41 per cent of the emergency department surveyed had protective coveralls and only 19 per cent had either gas masks”
  • “Health regions often plan to store drugs in a central repository and deliver them when requested. This may not work in a true event”
  • “Preparedness for chemical agents requires a readily available stock of antidotes. In this survey, we asked specifically about atropine, cyanide kits, and benzodiazepines and pralidoxime (for nerve agents). Most sites surveyed had inadequate supplies on hand. This is worrisome because, terrorism aside, these antidotes are also useful for patients with toxic ingestions”
  • Decontamination, Bioterrorism, Public Health, Emergency Response

2004

Editors, “Assesing The Threat of BW Terrorism”. NTI. 2004. [9]

  • “With the exception of the smallpox virus, most bioterrorism threat agents can be isolated from natural sources such as diseased animals, patients, or even contaminated soil in the case of anthrax spores. Nevertheless, more than 85 different strains (varieties) of anthrax bacteria have been identified in nature, and only a few of these strains are highly virulent, or capable of causing disease.”
  • “Once terrorists acquired a "seed culture" of a virulent pathogen, they would need to cultivate the agent in laboratory glassware or a small stainless steel fermentation tank.”
  • “The goal of weaponization is to convert the agent into a form in which it can be dispersed as an aerosol cloud of microscopic particles, ranging in size from one to five microns (thousandths of a millimeter). Only particles with these dimensions are small enough to lodge in the tiny air sacs of the victims' lungs to cause infection.”
  • “Anthrax spores can survive for decades in soil and for hours in an airborne aerosol. Furthermore, anthrax spores can survive environmental contaminants and potentially become re-aerosolized.”
  • Bioterrorism, Anthrax, Smallpox, Biosafety, Public Health


Hobbes, John,“Communicating Health Information to an Alarmed Public Facing a Threat Such as a Bioterrorist Attack”. Journal of Health Communication. 2004.

  • “The Internet revealed much potential for effective and interactive communication in a sensitive and complex situation such as a bioterrorist attack.” (Pg. 1)
  • “Yet, ultimately, investigation revealed that only four letters containing anthrax had been distributed through the postal system (Broad, 2002), demonstrating the ease with which a relatively small-scale bioterrorist attack could disrupt a population.” (Pg. 2)
  • Finally, poor communication between the various healthcare workers and researchers, namely, public health officials, physicians, and field workers (both at the federal and state levels) resulted in a much slower response to the emerging risks than would be desirable.” (Pg. 3)
  • “A key advantage the Internet has over traditional media is that the Internet provides multiple branches of information, all accessible almost simultaneously, and which the user can easily maneuver between. During the anthrax threat, the Internet also allowed for innovative communication devices such as interactive tutorials on anthrax self-care” (Pg. 5)
  • “In the two days after the terrorist attacks, one out of four Internet users went online in addition to monitoring television and radio reports” (Pg. 5)
  • “This is especially salient given that during the height of the bioterrorist threat many people were likely afraid to travel away from home. In some cases, when a number of cities issued warnings of potential threat, people preferred to stay at home or close to home; one survey published on September 15 found that ‘‘about 9% of Americans say that in the first two days after the terror attacks they cancelled some travel Plans”” (Pg. 5)
  • “An advantage of this mode of communication is that it allows for more targeted information to be quickly distributed to patients from a trusted medical practitioner. However, although there is a demand from patients for e-mail communication with doctors (Deering, 2001), physicians are somewhat hesitant to adopt this practice. Through agencies such as the CDC, the government could help medical professionals by e-mailing them key messages, links to approved sites, and indicators of emerging risks.” (Pg. 6)
  • “Search engines play a key role in organizing information for the public during a bioterrorist attack. The Internet industry in cooperation with the government should develop transparent protocols for organizing key information during emergency situations so that credible and validated sites are called up first when people search for information.” (Pg. 7)
  • “However, there is some evidence that health information on the Internet does affect people’s management and response to health risk. The Pew Internet & American Life Project has found that 61% of those who searched online for health information—or about 43 million Americans—said that the information they found on the web improved the way they take care of themselves” (Pg. 7)
  • “Wider use of e-mail from medical practitioners to patients could provide significant benefits in getting targeted messages on risks and suggested behavioral changes to patients, building on assumed trust between patient and physician. Finally, greater use and integration of shared electronic medical records made possible through Internet technology will provide considerable benefit in tracking emerging risks.” (Pg. 8)
  • Public Health, Anthrax, CDC, Bioterrorism, Biosurveillance



Editors, "Systematic Review: Surveillance Systems for Early Detection of Bioterrorism-Related Diseases". American College of Physicians. 2004. [10]

  • “the recent outbreaks of severe acute respiratory syndrome (SARS) and influenza strikingly demonstrate the continuing threat from illnesses resulting from bioterrorism and related infectious diseases. In particular, these outbreaks have highlighted that an essential component of preparations for illnesses and syndromes potentially related to bioterrorism includes the deployment of surveillance systems that can rapidly detect and monitor the course of an outbreak and thus minimize associated morbidity and mortality”(Pg 1.).
  • “Little is known about the accuracy of surveillance systems for bioterrorism and related emerging infectious diseases, perhaps because of the diversity of potential data sources for bioterrorism surveillance data; methods for their analysis; and the uncertainty about the costs, benefits, and detection characteristics of each."(Pg. 1)
  • “Because most patients with bioterrorism-related diseases initially present with influenza-like illness, acute respiratory distress, gastrointestinal symptoms, febrile hemorrhagic syndromes, and febrile illnesses with either dermatologic or neurologic findings, we considered these conditions to be the bioterrorism-related syndromes.”(Pg. 2)
  • “We identified 2 types of systems for surveillance of bioterrorism-related diseases or syndromes: those that monitor the incidence of bioterrorism-related syndromes and those that collect and transmit bioterrorism detection data from environmental or clinical samples to decision makers.”(Pg. 3)
  • “The Interim Biological Agent Detector is used on U.S. naval ships to continuously monitor the air for a significant increase in particulate concentrations (32, 39–42). If a peak increase is detected, the instrument automatically collects an aerosol sample and alerts the ship’s damage control center so the crew can collect and screen the sample with a handheld antigen test.” (Pg. 5)
  • “Our systematic review identified 115 existing surveillance systems, 29 of which were designed for surveillance of illnesses and syndromes associated with bioterrorism relevant pathogens. The evidence used to judge the usefulness of the reviewed systems is limited. Of the studies that evaluated systems for their intended purpose, few adhered to the CDC’s published criteria for high-quality evaluations of surveillance systems.”(Pg. 6)
  • “Systems for bioterrorism surveillance require 3 key features: timeliness, high sensitivity and specificity, and routine analysis and presentation of the data that facilitate public health decision making.” (Pg. 6)
  • “Systems with inadequate specificity may have frequent false alarms, which may result in costly actions by clinicians and public health officials”(Pg. 7)
  • “Systems that collect pharmaceutical data, such as EPIFAR (198), are promising for bioterrorism surveillance. Pharmaceutical data, particularly over-the-counter medication sales data, can indicate an outbreak, although these data would probably not be specific for bioterrorism. In addition, most pharmaceutical sales are tracked electronically.” (Pg. 7)
  • Bioterrorism, Biosurveillance, Biodetection, Public Health, Pharma


Lecchire, Gary, and Michael A. Wermuth, et al., "Triage for Civil Support: Using Military Medical Assets to Respond to Terrorist Attacks", TRIAGE, "Legal and Other Barriers to Military Support to Civil Authorities", 2004.

  • "State governments and their political subdivisions have primary responsibility for coping with emergencies, including terrorist events."
  • Military support for civil authorities, 4 categories allowed: 'civil disturbance/insurrections, counterdrug operations, disaster relief, counterterrorism/weapons of mass destruction.'
  • "Under the Stafford Act, a presidential declaration of a major disaster or an emergency triggers federal assistance. The type of federal assistance available depends on whether the situation is considered a disaster or an emergency."
  • "In the event of a catastrophic event, particularly when a deadly biological agent is implicated, officials, including military personnel, may need to restrict the civil liberties of Americans, especially freedom of movement, to prevent mass chaos and mitigate public health threats."
  • Posse Comitatus Act, Stafford Act, Military, Emergency Response, Law Enforcement


Hearne, Shelly, “Health departments remain ill-prepared to respond to public health emergencies” H&HN: Hospitals & Health Networks. February 2004. [11]

  • “The report, "Ready or Not? Protecting the Public's Health in the Age of Bioterrorism," examines 10 key indicators to assess areas of improvement and areas of ongoing vulnerability in the nation's efforts to prepare against bioterrorism and other large scale health emergencies” (Pg. 1-2)
  • “California, Florida, Maryland and Tennessee scored the highest, meeting seven of the 10 indicators.” (Pg. 2)
  • “"Are we ready or not? The answer is not," says Shelley A. Heame, executive director of TFAH."Now is the time to get serious about developing an all-hazards approach to public health to ensure we are ready for the range of possible threats we face” (Pg. 2)
  • “Among the major concerns raised in the report are: cuts to public health programs in nearly two-thirds of states; an impending shortage of trained professionals in the public health workforce; disagreements between state and local health agencies over resource” (Pg. 2)
  • “The report also found that only Florida and Illinois are prepared to distribute and administer emergency vaccinations or antidotes from the national stockpile.” (Pg. 2)
  • Public Health, Bioterrorism, Emergency Response, Vaccination


M'ikanatha, Nkuchia, et. al., "Research Letter: Use Of The Web State And Territorial Health Departments To Promote Reporting Of Infectious Disease," Journal of the American Medical Association, Vol. 291, No. 9, pgs. 1069-1070, Mar 3, 2004.

  • "We surveyed state epidemiologists in the 57 health jurisdictions that participate in the National Notifiable Diseases Surveillance System (NNDSS). This...survey assessed the availability of an up-to-date reportable disease list on the Web and of Web-based reporting for physicians."
  • "Epidemiologists from 56 of the 57 jurisdictions responded to the survey. Forty-seven (84%) reported that they had current reportable disease lists on the Web, and 5 (9%) indicated they had secure Web-based capability for physician reporting."
  • "We also found considerable variation in Web-based information on reporting requirements for diseases potentially related to bioterrorism."
  • "More effective use of the Web could strengthen the partnership among clinicians and local Public Health officials that is vital for recognition of and response to disease outbreaks and bioterrorism-related events."
  • Biosurveillance


Casadevall, Arturo, and Liise-anne Pirofski, "The Weapon Potential Of A Microbe," TRENDS IN MICROBIOLOGY, Volume 12, No. 6, June 2004.

  • microbes as potential biological weapons, (ex. Anthrax scare of 2001)
  • "The weapon potential of a microbe is a function that includes such variables as its virulence, time to disease, and suceptibility of possible target populations."
  • Anthrax, Bioterrorism, microbes as weapons


Griffith, Andrea, "North Carolina Hospitals Beef Up Surveillance To Track Bioterror Events," Knight Ridder Tribune Business News, pg. 1, Aug 3, 2004.

  • "Emergency rooms statewide will implement a new surveillance system that allows officials to track alarming trends in disease outbreaks and bioterrorism. The North Carolina Division of Public Health and the North Carolina Hospital Association are teaming up to install the system, which is designed to improve the state's ability to recognize and react to situations such as bioterrorism and other public health emergencies."
  • "The surveillance system will give officials a(n) 'every 12-hour look' at public health."
  • "'The goal is to be able to post trends in admission early in the event of a bioterrorism event.'"
  • Biosurveillance


Bevelacqua, Armando, "THE NEW HAZ-MAT QUESTION: WHAT ARE YOUR BIOLOGICAL CAPABILITIES?". Pen Well Publishing Co. November 2004.

  • “In some cases, fire response personnel used levels of protection specifically designed for chemical entry (level B and level A encapsulation), multiple alarms to handle one ounce of powder assumed to have hazardous qualities, and countless .support resources, in some places, powder found outside donut shops and funnel cake stands bad tire response personnel dressed in level A just for a cleanup.” (Pg. 1)
  • “We must have protocols in place—actions that are followed and performed in conjunction with the public health service. A biological event is a public health response, and a health representative must be involved with the education, training, and tactical response so the system can act as one.” (Pg. 1)
  • “A relationship must be established with the local Federal Bureau of Investigation's weapons of mass destruction (WMD) coordinator to obtain guidance and collaboration in support of procedure and documentation” (Pg. 2)
  • “The key issue to consider is if the environment has been identified strictly as a chemical or a potential biological. The fundamental answer comes from the air-monitoring/ detection systems within the response agency” (Pg. 3)
  • “Joint Hazard Assessment Teams" (JHAT). JHAT teams are comprised of two haz-mat with a law enforcement representative [additional strike teams have developed into three-person teams comprised of a haz-mat person, an Explosive Ordinance Disposal (EOD). and a law enforcement crime scene officer or intelligence unit representative]” (Pg. 3)
  • Bioterrorism, Decontamination, Public Health, Quarantine, Emergency Response

2005

Lowell, Jennifer, "Identifying Sources of Human Exposure to Plague". Journal of Clinical Microbiology. Pg. 650-656. Vol. 43, No. 2.

  • "Approximately 3,000 human cases occur worldwide annually, with 12 to 15 cases reported each year in the western United States"
  • "Two of the primary objectives of routine epidemiology plague investigations are to identify the source of human exposure and to assess the exposure site for potential continuing risk."
  • "The use of molecular epidemiological techniques in these investigations has been particularly difficult for Y. pestis because of its apparent lack of genetic variation."
  • "When combined with epidemiologic information, judicious use of genetic data from nonhuman organisms is highly attractive because of the power of DNA-based analyses to identify exposure sources."
  • Public Health, Pandemic, Plague, Decontamination, Biodetection, Bioterrorism, Biodefense, Biosafety


Rose, Laura, "Chlorine Inactivation of Bacterial Bioterrorism Agents". Applied and Environmental Microbiology. Pg. 566-568, Vol. 71, No.1

Enhorn v Sweden (2005) 41 EHRR 30 (56529/00)

  • “In 1994 it was discovered that the applicant, a homosexual, was infected with the HIV virus and that he had transmitted it to a young man. A medical officer issued instructions to the applicant designed to prevent him from spreading the disease. In February 1995, finding that he had failed to comply with those instructions, the Court ordered that he be kept in compulsory isolation in a hospital for up to three months. Thereafter, orders to prolong his detention were issued every six months until December 2001. Since the applicant absconded several times, his actual deprivation of liberty lasted almost one-and-a-half years.”
  • “The applicant complained that the compulsory isolation orders and his involuntary placement in hospital had deprived him of his liberty in violation of Art.5(1) of the Convention”
  • “Held, unanimously that there had been a violation of Art.5(1);”
  • “The compulsory isolation orders and the applicant's involuntary placement in hospital constituted a “deprivation of liberty” within the meaning of Art.5(1).”
  • “Since the purpose of the applicant's detention was to prevent him from spreading the HIV infection, Art.5(1)(e) was applicable.”
  • “The expressions “lawful” and “in accordance with a procedure prescribed by law” stated the obligation to conform to the substantive and procedural rules of national law. It was particularly important to comply with the principle of legal certainty. The conditions for deprivation of liberty had to be clearly defined and the law had to be foreseeable in its application. Furthermore, a deprivation of liberty had to be free from arbitrariness, necessary in the circumstances and in accordance with the principle of proportionality.”
  • “The applicant's detention had a basis in Swedish law. In the light of the relevant statutory provisions, the national courts considered that he had not voluntarily complied with the measures needed to prevent the virus from spreading; that there was reasonable cause to suspect that, if released, he would fail to comply with the instructions issued by the medical officer; and that such non-compliance would entail a risk of the infection spreading.”
  • “The essential criteria when assessing the lawfulness of detention “for the prevention of the spreading of infectious diseases” were whether the spreading of the disease would have been dangerous for public health or safety, and whether detention of the person infected was the last resort in order to prevent the spreading of the disease, because less severe measures had been considered and had been found to be insufficient to safeguard the public interest. When these criteria were no longer fulfilled, the basis for the deprivation of liberty ceased to exist.”
  • “Since the HIV virus was dangerous for public health and safety, the first criterion was fulfilled.”
  • “As to whether the applicant's detention had been the last resort in order to prevent the virus spreading, the Government had not provided any examples of less severe measures which might have been considered but which had been found to be insufficient to safeguard the public interest.”
  • “Despite being at large for most of the period from February 16, 1995 until December 12, 2001, there was no indication that during this time the applicant had transmitted the HIV virus to anybody, or that he had had sexual intercourse without first informing his partner about his infection, or that had not used a condom, or indeed that he had had any sexual relationship at all. Although he had infected the young man with whom he had first had sexual contact in 1990, this had only been discovered in 1994 after he had become aware of his own infection. There was no indication that he had transmitted the virus deliberately or through gross neglect.”
  • “The applicant's compulsory isolation had not been a last resort in order to prevent him from spreading the HIV virus. Moreover, by extending the order for his compulsory isolation over almost seven years, with the result that he had been involuntarily detained in hospital for almost one-and-a-half years, the authorities had not struck a fair balance between the need to ensure that the HIV virus did not spread and the applicant's right to liberty. Accordingly, there had been a violation of Art.5(1)”
  • Detention, Law, Sweden, Public Health, Europe


United States Government Accountability Office, "Information Technology: Federal Agencies Face Challenges In Implementing Initiatives To Improve Public Health Infrastructure" GAO Report To Congressional Requestors, June 2005.

  • "To encourage the integration of health care system response plans with public health department plans, the HHS has incorporated both Public Health preparedness and hospital performance goals into the agreements that the department uses to fund state and local public health preparedness improvements."
  • "In April 2004, the President established the goal that health records for most Americans should be electronic within 10 years and issued and executive order to 'provide leadership for the development and nationwide implementation of an interoperable health information technology infrastructure to improve the quality and efficiency of*"" health care.'"
  • "These networks are to allow for secure and timely sharing and discussion of essential information concerning bioterrorism and other public health emergencies, as well as recommend methods for responding to such an attack or emergency."
  • "Two major initiatives at DHS--primarily focused on signal interpretation and biosurveillance...more work remains, particularly in surveillance and data exchange."
  • "The Department of Health and Human Services has primary responsibility for coordinating the nation's response to public health emergencies, including bioterrorism."
  • "To improve the development of major public health IT initiatives, GAO recommends, among other actions, that the Secretary of Health and Human Services (to) (1) establish clear linkage between the initiatives and the national health care strategy and federal health architecture and (to) (2) encourage interoperability through the adoption of standards for health care data and communications.
  • Biosurveillance


"International Health Regulations", WHO, 2005, 2nd Edition. http://whqlibdoc.who.int/publications/2008/9789241580410_eng.pdf

  • to provide support to developing countries and countries with economies in transition if

they so request in the building, strengthening and maintenance of the public health capacities required under the International Health Regulations (2005)

  • to collaborate with States Parties to the extent possible in the mobilization of financial

resources to provide support to developing countries in building, strengthening and maintaining the capacities required under the International Health Regulations (2005)

  • The Director-General shall select the members of the Review Committee on the basis of the

principles of equitable geographical representation, gender balance, a balance of experts from developed and developing countries, representation of a diversity of scientific opinion, approaches and practical experience in various parts of the world, and an appropriate interdisciplinary balance.


Editors, "PATIENT DECONTAMINATION RECOMMENDATIONS FOR HOSPITALS". EMSA. July 2005. [12]

  • “In the case of a medical radiation emergency, response and recovery radiation exposure limits should be established to preserve lifesaving capabilities while taking into consideration risk to staff and facility operation.” (Pg. 13)
  • “After removal of contaminated clothing, patients should be instructed (or assisted if necessary) to immediately shower with soap and water. Potentially harmful practices, such as bathing patients with bleach solutions, are unnecessary and should be avoided” (Pg. 17)
  • “Patient clothing should be handled only by personnel wearing appropriate personal protective equipment, and placed in an impervious bag to prevent further environmental contamination.” (Pg. 17)
  • “Gloves should be worn when contact with blood or body fluids is anticipated. Gloves should be removed immediately, without touching non-contaminated surfaces, as soon as the patient care task is complete.” (Pg. 17- 18)
  • “Facial protection should be worn when performing patient care tasks likely to generate splashing or spraying of blood and body fluids onto the mucous membranes of the face.” (Pg. 18)
  • “Disposable fluid-repelling gowns should be worn to protect skin and clothing” (Pg. 18)
  • “Hospitals should plan for decontamination operations that will not exceed their capacity, but should also develop a contingency plan for mass decontamination when patient numbers do exceed their capacity.” (Pg 19)
  • "Ensure large quantities of water are available for decontamination in order to dilute the agent as much as possible. Direct excess waste water to the sanitary sewer and immediately notify the POTW and/or MS4.” (PG. 21)
  • Decontamination, Public Health, Quarantine, Nuclear, Biosecurity, Biosafety, Biotechnology, CDC, Bioterrorism, Biodefense



Brookmeyer, Ron, "Editorial: Biosecurity And The Role Of Statisticians," J.R. Statistical Society, 168, Part 2, pgs. 263-266, 2005.

  • "Statisticians who work in Public Health are most familiar with designing and analyzing large clinical trials and epidemiological studies to answer questions."
  • "We must use modern statistical tools to estimate model parameters together with sensible mechanistic models for the spread of infectious diseases."
  • "One way to shorten the silent period is to improve disease surveillance for new outbreaks. Statisticians have been actively engaged in developing and assessing methodological approaches for rapid detection of emerging outbreaks."
  • "One example of an approach to speed the detection of an outbreak is Syndromic Surveillance, which refers to the collection and statistical analysis of vast quantities of public health data to detect early symptoms of a new disease."
  • "Syndromic surveillance offers that tantalizing possibility of an early warning of an emerging outbreak from data mining rather than waiting until public health officials have been notified of confirmed cases of disease from traditional medical care settings."
  • "Another approach to speed recognition of a bioterrorist attack is air monitoring systems for contaminants and pathogens in the environment."
  • "Biomedical research is under way to improve diagnostic test, vaccines and therapeutics for the most worrisome pathogens."
  • "Statisticians should be at the forefront in assisting policy makers to determine how to apportion limited resources to increase public health preparedness whether the debates involve syndromic surveillance, air monitoring systems, or vaccination programs."
  • Bioterrorism
  • Biosurveillance


Rebmann, Terri, "Defining bioterrorism preparedness for nurses: concept analysis". Blackwell Publishing Ltd. Novembver 30, 2005. [13]

  • “Bioterrorism poses a major threat to the health of citizens around the world [Centers for Disease Control and Prevention (CDC) 2000, Miller et al. 2001]. Infectious diseases can spread rapidly through a hospital, community or around the world, making a bioterrorism attack occurring anywhere a threat to all nations.” (Pg. 1)
  • “Nurses are the largest group of healthcare providers and, as such, are a cornerstone in bioterrorism response. Because of this, bioterrorism preparedness has become a necessity for nurses, regardless of their education level, expertise area or practice setting (Malone 1999).” (Pg. 2)
  • “Despite this, the US National Institute of Nursing Research has asserted that bioterrorism preparedness is a necessity across nursing specialties” (Pg. 2)
  • “All-hazards preparedness efforts focus on biological as well as chemical, nuclear and radiological events. For example, planning is required for both all-hazards and bioterrorism response plans, but knowledge of patient chemical decontamination is only needed for all-hazards preparedness because patient decontamination will probably not be required after a bioterrorism attack” (Pg. 3)
  • “In preliminary research, Shadel et al. (2001) describe differences in bioterrorism knowledge for various professions. For example, infection control practices, triage, health education and mental health were topics identified as critical for nurses, while pathogen epidemiology and clinical diagnosis were essential for physicians” (Pg. 3)
  • “There are four attributes of nursing bioterrorism preparedness: (a) gaining bioterrorism management knowledge that is specific to the nursing profession; (b) planning response strategies; (c) practicing response behaviors; and (d) evaluating knowledge level and response plan content. These four attributes consist of protective actions undertaken to mitigate the potential outcomes of a bioterrorism attack” (Pg. 4)
  • “gaining bioterrorism management knowledge that is specific to the nursing profession. Topics include identifying and reporting an attack, casualty triage and management, implementing control measures and management of victims’ families (Steed et al. 2004).” (Pg, 4)
  • “Nurses, regardless of their level of education, area of expertise or practice setting should participate in at least one educational offering and one exercise each year to meet the minimum requirements of engaging in the bioterrorism preparedness process.” (Pg. 6)
  • “Hosting bioterrorism exercises is time-consuming and expensive; for example, most facilities in the USA conduct only one or two exercises per year, which is the minimum required by the Joint Commission on Accreditation of Healthcare Organizations standards [Joint Accreditation Commission on Hospital Organization (JACHO) 2001].” (Pg. 6)
  • “A group of school nurses believe that bioterrorism is a conceivable threat to themselves and their community, but feel that the risk of it occurring is low. Although they want to become better prepared for a bioterrorism attack and intend to do so at some point in the future, they currently have many other responsibilities that they believe are more pressing.” (Pg. 7)
  • Bioterrorism, Public Health, Emergency Response, CDC


Knauss, Tim, “U.N. to Get Bioterror Agent Decontamination Systems” NTI. Dec. 13, 2005. [14]

  • “Two $60,000 machines capable of cleansing mail of anthrax and other biological agents were completed”
  • “BioDefense said independent tests confirm that the system, which was created after the September 2001 al-Qaeda attacks, is capable of eliminating anthrax, smallpox, ricin, HIV, influenza, botulism and the plague”
  • Bioterrorism, Biodefense, Public Health, Anthrax, Smallpox, Ricin, Decontamination

2006

Mosquera, Mary, "DHS To Develop Biosurveillance System For Pandemic," Tech News (GCN), May 12, 2006.

  • "The Homeland Security Department expects to award a contract in mid-summer to develop the National Biosurveillance Integration System, a critical piece of the administrations strategy yo handle a pandemic, such as the avian flu."
  • "The biosurveillance system will aggregate and integrate information from food, agricultural, Public Health and environmental monitoring and the intelligence community from federal and state agencies and private sources to provide an early warning system for an outbreak or possible bioterrorism attack."
  • "The biosurveillance system will also send back to its system partner agencies completed situational awareness in real-time streams."
  • "Information will come from sources such as the Centers for Disease Control and Prevention BioSense system, which reports Syndromic Surveillance from hospitals and pharmacies, and the BioWatch system, which monitors aerosols for biothreat agents in major metropolitan areas."
  • Biosurveillance


Olmsted, Stuart, “Patient experience with, and use of, an electronic monitoring system to assess vaccination responses.”. Health Expectations. June 2006. [15]

  • “National Research Council (NRC) report, Networking Health: Prescriptions for the Internet, highlights the potential for information technology (IT) and the Internet to revolutionize health-care delivery in the near future” (Pg. 1)
  • “When applied to populations, electronic monitoring of many individual patients with chronic or infectious diseases can improve surveillance and management of chronic diseases, as well as reducing health-resource utilization.” (Pg. 1-2)
  • “In public health practice, a mass vaccination program, whether for pandemic influenza or smallpox, may be strengthened and easier to administer if an electronic system were used to monitor vaccine reactions and side effects.” (Pg. 2)
  • “Such a system can reduce the need for clinical assessments of vaccine responses, cutting travel time, work absenteeism and clinician time to assess vaccine sites. In addition, a system such as this can act as an early warning device for adverse events.” (Pg. 2)
  • “Users also reported that the picture on the web or pocket card closely matched the appearance of their vaccine site (143/169; 85%) and that they were confident that what they reported matched their true reaction to the vaccine (147/171; 86%).” (Pg. 3)
  • “While survey responders in this study were comfortable with a physician tracking their vaccination status via their electronic reports, and many were comfortable with having their take check determined electronically, half of the respondents were not comfortable eliminating the follow-up visit with a health-care provider.” (Pg. 6)
  • “a similar reporting system may prove useful in public health settings in which large numbers of people will need treatment and follow-up in a short period of time, such as a mass vaccination or prophylaxis during a bioterrorism event, an influenza pandemic or another public health emergency.” (Pg. 6)
  • Public Health, Bioterrorism, Biosurveillance, Biodetection, Emergency Response, Vaccination


Baker, Michael & David Fidler, "Global Public Health Surveillance Under New International Health Regulations," Emerging Infectious Diseases, Vol. 12, No. 7, pgs. 1058-1065, July 2006.

  • "IHR (International Health Regulations) 2005 identifies health-related events that each country that agrees to be bound by the regulations must report to WHO."
  • "These events include any unexpected or unusual public health events regardless of its origin or source."
  • "IHR 2005 also requires state parties ...to inform WHO of public health risks identified outside their territories that may cause international disease spread, as manifested by exported or imported human cases, vectors that may carry infection or contamination, or contaminated goods."
  • "IHR 2005 defines a 'public health emergency of international concern' (PHEIC) as 'an extraordinary event' which is determined by the WHO."
  • "IHR 2005 contains a 'decision instrument' that helps state parties identify whether a health-related event may constitute a PHEIC and therefore requires formal notification to WHO."
  • "IHR 2005 includes a list of diseases for which a single case may constitute a PHEIC and must be reported to WHO immediately. This list consists of smallpox, poliomyelitis, human influenza (flu) caused by new subtypes, and severe acute respiratory syndrome (SARS)."
  • "IHR 2005 also encourages state parties to consult with WHO over events that do not meet the criteria for formal notification but may still be of public health relevance."
  • "IHR 2005's surveillance strategy, especially the decision instrument, has been specifically designed to make IHR 2005 directly applicable to emerging infectious disease events, which are usually unexpected and often threaten to spread internationally."
  • "IHR 2005's purpose is to prevent, protect against, control, and facilitate public health responses to the international spread of disease."
  • "IHR 2005 makes surveillance central to guiding effective public health action against cross-border disease threats."
  • "Surveillance needs to be sufficiently sensitive to detect infectious agents that have not yet resulted in large numbers of diagnosed cases."
  • "One approach to this challenge is Syndromic Surveillance, but such surveillance has not been effective in detecting emerging infectious diseases early."
  • Biosurveillance

2007

Niska, Richard, “HOSPITAL COLLABORATION WITH PUBLIC SAFETYORGANIZATIONS ON BIOTERRORISM RESPONSE”. Prehospital Emergency Care, 2007. [16]

  • “During a bioterrorism incident, 68.9% of hospitals would contact EMS, 68.7% percent law enforcement, 61.6% fire departments, 58.1% HAZMAT, and 42.8% all four. About 74.2% had staged mass casualty drills with EMS, 70.4% with fire departments, 67.4% with law enforcement, 43.3% with HAZMAT, and 37.0% with all four.” (Pg. 1)
  • “Federal funding through HRSA for hospital preparedness, including mass casualty drills, has fallen from a high of $514.9 million in fiscal year 2004, to $474.2 million in FY 2006.8 But the HRSA National Bioterrorism Hospital Preparedness Program continues to encourage integration of hospitals with public safety organizations, such as fire departments, EMS, and law enforcement” (Pg. 4)
  • “Farmer and Carlton (2006) commented that a major factor working against developing a better interface between hospitals and communities in disaster planning was cultural differences between public and private entities, with 95% of police, fire, and EMS systems being public and 95% of the medical capability being private” (Pg. 5).
  • “The majority of hospitals involve public safety organizations in their emergency plans and drills, but some types of hospitals are more likely to do so than others. Higher hospital bed capacity was the characteristic most predictive of drilling with these organizations.” (Pg. 5)
  • Bioterrorism, Public Health, Emergency Response, Law Enforcement


Tyshenko, Michael, “MANAGEMENT OF NATURAL AND BIOTERRORISM INDUCED PANDEMICS” Bioethics, 2007. [17]

  • “The Spanish flu pandemic of 1918–1919 emerged killing an estimated 50 million people. Humans are still being assailed by infectious disease threats. In the past five years alone, several pathogens were seen in North America for the first time – West Nile virus, monkeypox virus, low pathogenic avian flu in commercial bird farms, mad cow disease and Severe Acute Respiratory Syndrome (SARS).” (Pg. 2)
  • “several researchers have called for stricter controls over biotechnology experimentation that provide dual-use information and technologies, dissemination of bioinformatics data and regulation of researchers as a way to manage infectious disease risks” (Pg. 2)
  • “Emerging diseases can be controlled but doing so requires significant funding and a coordinated effort. Implementation of strategies such as modern ‘ring containment’ where infectious disease was cordoned off by vaccinating individuals in a circle surrounding outbreak areas, and hospital quarantine under controlled conditions eradicated smallpox from the planet.” (Pg. 2)
  • “Genetic engineering is defined as the process of manipulating the pattern of proteins in an organism by altering its existing genes. Since the genetic code is similar in all species, genes taken from one organism can function in another, allowing traits to be altered or introduced. Either new genes are added, or existing genes are changed so that they are produced by the recombinant.” (Pg. 3)
  • “With 30,000 human gene targets, available biotechnologies, and scientific creativity just about any gene can be turned into a bioweapon target.16 The problem then becomes one of risk issue management as we try, as a society, to mitigate the risks of subverted uses of biotechnology.” (Pg. 3)
  • “We have reached a point through science and communication technology where we can detect, track and contain most emerging diseases in real time, no longer passive victims from the assault of infectious diseases.” (Pg. 6)
  • Bioterrorism, Pandemic, Emergency Response, Public Health


Capua, Ilaria, Marangon, Stefano, “Control and prevention of avian influenza in an evolving scenario,” Vaccine 25 (2007) 5645–5652.

  • Continuing outbreaks of highly pathogenic avian influenza (HPAI) across Eurasia and in Africa, caused by a type A influenza virus of the H5N1 subtype appear out of control and represent a serious risk for animal and public health worldwide. It is known that biosecurity represents the first line of defence against AI, although in certain circumstances strict hygienic measures appear to be inapplicable for social and economic conditions. The option of using vaccination against AI viruses of the H5 and H7 subtypes, has made its way in recent times—primarily as a tool to maximise the outcome of a series of control measures in countries that are currently infected, but also as a means of reducing the risk of introduction in areas at high risk of infection

Vaccination; Control; Poultry, Avian Flu


Good, Linda , “Addressing Hospital Nurses’ Fear of Abandonment in a Bioterrorism Emergency”. Slack Incorporated, December 2007. [18]

  • “A study of 212 Pentagon staff members indicated that respondents who were in or near the Pentagon during the September 11, 2001, attack were more likely to have posttraumatic stress disorder and major depression than coworkers who were at other locations” (Pg. 1)
  • “Residual post-event effects included fear of returning to the site, sleep disorders, eating problems, grief response, and a new sense of vulnerability in their place of work and community” (Pg. 2)
  • “Nurses on night shifts felt less prepared than nurses on day shifts because education and drills were usually scheduled at times they could not attend (O’Boyle et al., 2006). A day shift drill does not simulate after-hours resource issues, including concerns about access to supplies.” (Pg. 2)
  • “The stocks of disposable respirators, isolation gowns, and gloves are finite and would deplete quickly. Traditional standard precautions, such as frequent disposal of PPE, may not be possible, yet facilities may lack a contingency plan.” (Pg. 2)
  • “Biological attack adds elements of evil intention and activation of deeply rooted fears, resulting in the potential of strong psychological responses (Holloway, Norwood, Fullerton, Engel, & Ursano, 1997). Nurses have reported a lack of attention to their psychosocial needs in past domestic disaster events” (Pg. 3)
  • “Nurses anticipate that in the event of a bioterrorism disaster, they would be functioning in a chaotic environment without the presence of hospital administration or a clear chain of command (O’Boyle et al., 2006). Nurses who have actually experienced the chaos of disaster response reinforce the need for the visible, reassuring presence of leadership.” (Pg. 4)
  • "The focus group nurses anticipated that many coworkers would fail to report to work or even quit their jobs, rather than place themselves in harm’s way. Besides an unwillingness to report for duty, an inability logistically to get to work may exist in a disaster event (Qureshi, Gershon, Gebbie, Straub, & Moore, 2005). Consequently, the nurses in the study by O’Boyle et al. believed that resulting staff shortages would place even greater pressure on those remaining...... being free to attend to family safety. Qureshi et al. (2005) found this to be the most frequently cited reason for hospital employees being unwilling to report for duty in a disaster."(Pg. 4)
  • Bioterrorism, Emergency Response, Biodefense, Public Health

2008

Editors, “Disaster Planning for Schools”, Journal of the American Academy of Pediatrics. 2008. [19]. Last Checked October 4, 2012.

  • “Schools that are well prepared for an individual emergency involving a student or staff member are more likely to be prepared for complex events such as community disasters. Individual emergencies are covered in a separate policy statement from the American Academy of Pediatrics (AAP).”
  • “There are 55 million US children enrolled in kindergarten through 12th grade, attending 17 000 public school districts and 29 000 private schools. Children spend a large part of their time in school, so whether a large-scale crisis occurs during school hours, before or after school, or off the school campus, the school district plays an important role in the unfolding of events.”
  • “The guidelines are intended to give schools, school districts, and communities the critical concepts and components of good crisis planning, stimulate thinking about the crisis-preparedness process, and provide examples of promising practices. These guidelines focus on 4 stages of planning: mitigation and prevention; preparedness; response; and recovery. These school-focused guidelines are also designed to complement and integrate with the complex system of emergency preparedness in the greater community locally, regionally, and nationally.”
  • “In a 2004 survey of more than 2100 superintendents, most (86.3%) reported having a disaster-response plan, but fewer (57.2%) had a plan for prevention. Most (95.6%) had an evacuation plan, but almost one third (30%) had never conducted an evacuation drill. Almost one quarter (22.1%) had no disaster plan provisions for children with special health care needs, and one quarter reported having no plans for postdisaster counseling. Almost half (42.8%) had never met with local emergency medical services (EMS) officials to discuss emergency planning.”
  • “School facilities are often designated as disaster evacuation shelter sites. These venues provide shelter for many who have lost their homes as a result of disaster and also provide an opportunity for school officials to assess family and child needs. Likewise, disaster recovery centers operated by FEMA are set up in heavily affected communities to support the reestablishment of infrastructure and the provision of food, supplies, health care, and human services. It is recommended that school district officials, including mental health professionals, be present in all disaster recovery centers to disseminate information and provide guidance for parents seeking support for their children.”
  • “Each community has idiosyncratic elements that predispose it to possible crises such as tornadoes, earthquakes, hurricanes, toxic chemical hazards, radiation, and community violence. Pediatricians should have an office-based disaster plan that reflects these hazards and not only be prepared to treat the medical outcomes of these crises but also be aware of the school district’s attempts to prepare for these unique disaster issues.”

Emergency Response, Homeland Security, Public Health


Snyder, Michael and Sobieski, Thomas, "Decontamination Operations in a Mass Casualty Scenario" Joint Force Quarterly. 2008.

  • “principles of decontamination that also apply to a nuclear detonation scenario: expect a 5:1 ratio of unaffected to affected casualties, decontaminate as soon as possible, disrobing is decontamination: top to bottom, more is better, water flushing generally is the best mass decontamination method, after known exposure to a liquid agent, first responders must self-decontaminate as soon as possible to avoid serious effects” (Pg. 2)
  • “DSCA environment require special considerations by military CBRN planners in the following areas: determining who needs to be decontaminated, multisite operations, integration of decontamination operations with other plans, disposition of runoff, disposition of personal effects, accountability, crowd control.” (Pg. 3)
  • “It is reasonable to assume that not everyone within the evacuation zone would be contaminated. Identifying those who are “clean” would greatly reduce the resources needed and expended” (Pg. 3)
  • “To respond to the magnitude of need, several mass decontamination sites probably would be established around the plume perimeter.” (Pg. 4)
  • “Successful decontamination operations include planning initial medical triage and follow-on medical care, as well as providing subsequent transport, clothing, food, and shelter to all those who process through prescreening.” (Pg. 4)
  • “Keeping large groups orderly is essential for effective mass decontamination operations. Local law enforcement would vector victims to the various mass decontamination sites established upwind of the blast and outside the projected plume path.” (Pg. 4)
  • Decontamination, Emergency Response, Bioterrorism, Public Health, Homeland Security, Quarantine


Harris, Gardiner, "For F.D.A., a Major Backlog Overseas," NYT, A15, Jan 29, 2008.

  • "FDA is so overwhelmed by a flood of imports that it is incapable of protecting the public from unsafe drugs, medical devices, and food."
  • "Few checks of plants that make food and drugs sent to the US"
  • backlog of inspections, GAO, FDA


Fowler, Daniel, CQ Homeland Security, January 14, 2008, “ACLU, HHS Debate Pandemic Preparedness Strategies,” -Avian Flu- /leaning toward law enforcement and national security/George Annas/Wendy K. Mariner/Wendy E. Parmet/civil liberties/Public Health/disaster/catastrophe/


Hsu, Spencer, "Costly Weapon-Detection Plans Are In Disarray, Investigators Say," The Washington Post, A-Section, Pg. A15, July 16, 2008.

  • "Bush administration initiatives to defend the nation against a smuggled nuclear bomb or a biological outbreak or attack remain poorly coordinated, costing billions of tax dollars while basic goals and policies remain incomplete."
  • "Separately, a five-year-old program to detect the airborne release of biological warfare agents such as anthrax, plague and smallpox in more than 30 major U.S. cities still lacks basic technical data to help medical officials determine how to respond to an alert triggered by the sensors."
  • Public Health, Biosurveillance


Poltzer, Patrice, "Tuberculosis: A New Pandemic?", CNN, November 17, 2008. http://www.cnn.com/2008/HEALTH/11/17/tb.pandemic/index.html

  • "TB mutating into dangerous new strains for which there is no known cure"
  • XDR-TB = a drug-resistant TB, incurable, could lead to a pandemic, airborne disease,
  • 40,000 new cases of XDR-TB each year - WHO
  • disease primarily affects developing nations
  • TB is curable but if drugs not administered or used, disease can mutate into strands like XDR
  • strong link between TB and poverty
  • Developing Countries, Tuberculosis, Vaccination, Pandemic


Roni Caryn Rabin, “Preparing for a Bioterror Attack, Assisted Suicide on TV and Bird Flu in Hong Kong,” December 10, 2008. NYT [20] Last Checked, March 27, 2013.

  • “States Cut Funding to Combat Disease Outbreaks The economy is jeopardizing the nation’s ability to handle public health emergencies and bioterror attacks, as both the federal government and states cut funding for programs to combat disease outbreaks and natural disasters, USA Today reports.”
  • “Meanwhile Georgia, home to the Centers for Disease Control and Prevention, barely got a passing grade in a new report assessing its readiness to distribute stockpiled medicine and vaccines should a terror attack occur or pandemic break out, The Atlanta Journal Constitution reports. The stockpile is controlled by the C.D.C. and Georgia is one of 10 states that turned around a failing grade in the assessment last year.”
  • “Hong Kong is reporting another outbreak of avian influenza, or bird flu, among chickens at one of the city’s largest poultry farms. Officials are concerned because the chickens were vaccinated against the virus. The city is culling birds and shutting down the local poultry industry for 21 days, Time Magazine reports.”

Emergency Response, Public Health, CDC

2009

Verweij, Marcel, "Health Inequities In Times Of A Pandemic", PUBLIC HEALTH ETHICS, Volume 2, Issue 3, pgs 207-209, 2009. http://phe.oxfordjournals.org/content/2/3/207.extract

  • people in low-income countries may have no access to vaccination despite being more vulnerable to the significant negative effects of H1N1
  • "Australia, Canada, and the Netherlands expect to have sufficient vaccines to immunise the whole population"
  • Ethics, Developing Countries, Pandemic, Vaccination, Flu


Adams, Vincanne, Le, Phuoc V., Erwin, Kathleen, “Public health works: Blood donation in urban China,” Social Science & Medicine 68 (2009) 410–418,

  • Recent shifts in the global health infrastructure warrant consideration of the value and effectiveness of national public health campaigns. These shifts include the globalization of pharmaceutical research, the rise of NGO-funded health interventions, and the rise of biosecurity models of international health. We argue that although these trends have arisen as worthwhile responses to actual health needs, it is important to remember the key role that public health campaigns can play in the promotion of national health, especially in developing nations…. , we argue that there is an important role for strong national public health programs. We also identify the key factors that enabled China’s response to this bourgeoning epidemic to be, in the end, largely successful.” Developing Countries


S v H.S.E. (2009) IEHC 106 (11th February 2009) Judgement of Edwards J

  • “The patient (was) alleged to be detained unlawfully at the Mercy University Hospital, an institution operated by the (H.S.E), in purported pursuance of an order made by (the H.S.E.) pursuant to s. 38 of the Health Act, 1947…which provides for the detention and isolation of a person suffering from an infectious disease who is a probable source of infection.”
  • “the patient’s detention, although initially unlawful, became lawful once she was delivered into the custody of the staff at the Mercy University Hospital who were directly authorised by the s. 38 order to isolate her there in a specialised negatively pressurised room.”
  • “The key criterion is the need to ensure “effective” isolation. The section expressly provides that the power may only be invoked in cases where the patient cannot be effectively isolated in their own home. It is implicit in the section that the legislature intended that the power should be invoked sparingly and that it should not be resorted to save where absolutely necessary. It is difficult to conceive of any circumstances where it would be necessary to invoke the power save in the case of patient non co-operation with a proposed regime of isolation. Even in a case where a patient’s home is physically, or otherwise, unsuitable to provide effective isolation, it would be unnecessary to invoke the s. 38 power of detention in the case of a co-operative patient. He or she could simply be admitted to, and isolated within, a hospital or other suitable place on a voluntary basis.”
  • “The power created by section 38 supports an important public interest objective, namely, it assists in safeguarding against the spread of particular infectious diseases amongst the general population by facilitating, where necessary, the compulsory effective isolation of a person who is suffering from such a disease.”
  • “While it might be desirable that the section should contain more specific safeguards towards the defence and vindication of a detainee’s personal rights, the absence of such safeguards does not, of itself, render the section unconstitutional. A detainee may have recourse at any time to the High Court within the context of Article 40.4.2˚ of the Constitution for the purpose of seeking an inquiry into the lawfulness of his or her detention.”
  • “The combination of (i) such safeguards as already exist within the section, (ii) the presumption that the section will be operated constitutionally, and (iii) the existence of a readily accessible remedy for the person affected if it is not in fact operated constitutionally, provides an adequate level of protection for the personal rights of detainees. I therefore dismiss the claim of constitutional invalidity.”
  • Detention, Quarantine, Law, Ireland, Public Health, Europe


Hartz, Marlena, “Scientists Develop CW Decontamination Wipe” NTI. March 11, 2009. [21]

  • “A Texas-based team has used federal funding to create a wipe that would neutralize chemical warfare materials released in a terrorist attack”
  • “The thin sheet of carbon is included with a lotion-soaked sponge in a kit that could be distributed to U.S. military personnel and first responders. The items could be used to remove chemical agents from equipment, skin and even eyes and open wounds”
  • Decontamination, Bioterrorism, Public Health, Emergency Response, Military



Ryerson-Cruz, Geraldine, "As Flu Pandemic Declared, Leaders Must Focus On Poor Countries To Avert Bleaker Picture", WORLDVISION.ORG, June 11, 2009. http://www.worldvision.org/content.nsf/about/20090611-flu-pandemic

  • Africa and Central America
  • "With limited access to health services, extreme poverty, high malnutrition rates, and the slower-burning pandemics of HIV and AIDS, tuberculosis, and malaria already stretching society's coping mechanisms, the poor are more at risk than the general population," said Stefan Germann, World Vision International's Geneva-based director for global health partnerships.
  • Developing Countries, Pandemic, Flu


Shiga, David, “Report Examines Lifesaving Measures for Nuclear Strike”. NTI. July 13, 2009. [22]

  • “Since such an explosion would obliterate most structures and people within a roughly half-mile radius, the panel concentrated on measures that planners might employ to limit deaths outside the blast zone”
  • “The most effective way for people to protect themselves from the deadly fallout, the panel found, was to stay indoors or underground rather than try to outrun the lethal gamma rays emitted by the explosion.”
  • “Radiation exposure generally attacks the immune system and leaves victims extremely vulnerable to infections and uncontrollable blood loss. Recent pharmaceutical advances could mitigate these potentially deadly effects, though the need at any given hospital following an attack could easily outstrip the drug supply.”
  • Nuclear, Emergency Response, Bioterrorism, Public Health


Yamada, Tadataka, "Poverty, Wealth, and Access to Pandemic Influenza Vaccines", THE NEW ENGLAND JOURNAL OF MEDICINE. September 17, 2009. Volume 361, Number 12, pgs. 1129-1131., http://content.nejm.org/cgi/content/full/NEJMp0906972?query=TOC

  • do developing countries have the manufacturing capacity, cost, and delivery systems and resources available to get vaccines?
  • only a few countries in the world have plants for manufacturing influenza vaccine and 3 companies account for most of the world's manufacturing capacity: GlaxoKlineSmith, Sanofi-Aventis, and Novartis.
  • problem- "much if not most of the manufacturing capacity is already spoken for through purchasing contracts held by many of the world's wealthy countries."
  • steps to ensure global community has vaccinations: identify strategies and mechanisms to make vaccines more accessible
  • Developing Countries, Pandemic, Vaccination, Flu, Ethics


"Swine Flu Pandemic Will Reveal 21st Century's Poverty Pandemic", GLOBAL HEALTH POLICY AT NYU-WAGNER, Sept 27, 2009. http://globalhealthpolicynyu.wordpress.com/2009/09/27/swine-flu-pandemic-will-reveal-21st-century%E2%80%99s-poverty-pandemic/

  • historically influenza not an "equal opportunity" disease
  • "people with coexisting conditions are more susceptible to poor health outcomes" and "most developng countries have high incidence of malnourished children and adults with many coexisting medical conditions."
  • socioeconomic factors- "poor resources for clean water and sanitation, no health care system or inadequate resources to seek medical attention"
  • Ethics, Flu, Pandemic, Vaccination, Developing Countries


Moss, Michael, "Companies Strike Deal on testing for E. COli," NYT, A23, Oct. 8, 2009.

  • "Costco said Wednesday that they had struck a new accord on testing for the pathogen E. Coli."
  • "some of the largest slaughterhouses have resisted the added scrutiny for fear that one grinder's discovery of E. coli will lead to expanded recalls of beef sent to other grinders."
  • "'The U.S.D.A. is supposed ti be protecting public health and at the same time be promotig agricultural products, and my view is that those two things don't mix,' said Representative Rosa DeLauro."

E. coli, Oversight, Public Health


Suk, Jonathan, et.al, "Wealth, Inequality, and Tuberculosis Elimination in Europe", EMERGING INFECTIOUS DISEASES, Volume 15, No. 11, November 2009.

  • Europe- wealth inequality directly related to TB
  • "decline of TB incidence in Europe preceded the advent of anti-TB drugs and coincided with rapid improvement of quality of life"
  • "the current financial crisis could exacerbate the conditions of existing vulnerable groups as well as create new ones"
  • Tuberculosis, Europe, Pandemic


Harris, Gardiner, "E. Coli Kills 2 And Sickens Many Others; Focus on Beef," NYT, A12, Nov. 3, 2009.

  • "The New hampshire resident who died of it contracted hemolytic uremic syndrome, a disease that attacks red blood cells and can cause kidney failure. The New Yorker who died was an adult from Albany County who had several underlying health problems."
  • "Donna Rosenbaum, executive director of Safe Tables Our Priority, a food safety organization said ... 'contamination problems are not found by any checks on the products by companies. They're found when people get sick, and that's a failure in the system."
  • E. coli, Oversight, Public Health


Moss, Michael, "E. Coli Outbreak Traced to Company That Halted Testing of Ground beef," NYT, A14, Nov. 13, 2009.

  • "it was linked to an outbreak that has killed two people and sickened an estimated 500 others."
  • "E. Coli outbreaks in ground beef, which have now reached 18 since 2007, that the beef trimmings commonly used to make ground beef are more susceptable to contamination because the pathogen thrives in cattle feces that can get smeared on the surfaces of whole cuts of meat."
  • "But while slaughterhouses seek ti limit such contamination, and conduct their own testing for the pathogen, they have resisted independent testing by grinders for fear that it would cause expanded recalls."
  • "The United States Department of Agriculture, which banned the deadly E. Coli strain known as 0157:H7 in 1994, has encouraged -- but does not require -- meat companies to test their products for the pathogen. In the absence of such a rule, meat companies have adopted varied practices."
  • E. coli, U.S. Dept. of Agriculture, Oversight, Public Health


Sasaki, Asami, et al., “Evidence-based Tool for Triggering School Closures during Infl uenza Outbreaks, Japan,” Emerging Infectious Diseases , Vol. 15, No. 11, November 2009.

  • ”Using empirical data on absentee rates of elementary school students in Japan, we developed a simple and practical algorithm for determining the optimal timing of school closures for control of infl uenza outbreaks.”
  • ”Infl uenza pandemic preparedness and seasonal infl uenza control programs have focused on vaccine development and antiviral drugs, which are only partially effective and not always available to all persons at risk (1–3). Nonpharmaceutical interventions, such as social distancing, represent additional key tools for mitigating the impact of outbreaks.”
  • ”Because children are a major factor in the transmission of infl uenza within communities and among households, school closure may be a valuable social distancing method (4,5).”
  • ” We evaluated the optimal infl uenza-related absentee rate for predicting outbreaks of infl uenza.”
  • ” Our analysis suggests that a single-day at a threshold infl uenza-related absentee rate of 5%, double-days >4%, or triple-days >3% are optimal levels for alerting school administrators to consider school closure. The double- and triple-day scenarios performed similarly, and gave better results than the singleday. Thus, the double-day scenario might be the preferred early warning trigger.”
  • ” We used the Youden index for calculating optimal thresholds (7). The Youden index = (sensitivity) + (specificity) – 1. A perfect test result would have a Youden index of 1. For the single-day scenario, the optimal threshold was 5%, with a sensitivity of 0.77 and specifi city of 0.73.”
  • Flu, Public Health, Prophylaxis, Biosurveillance, Japan

2010

Nyamathi, Adeline, "Computerized Bioterrorism Education and Training for Nurses on Bioterrorism Attack Agents” SLACK Incorporated. 2010.

  • “Compared with other potential biological agents, anthrax spores are stable in the environment and the aerosolized form has a high mortality rate.” (Pg. 1)
  • “ Achieving the goal of bioterrorism preparedness is directly linked to comprehensive education and training that enables first-line responders, such as nurses, to diagnose infectious agents rapidly and assess and deal with risks appropriately to avoid widespread contamination, illness, and death. In the same way that the threat of biological attack is continuous and constantly evolving, bioterrorism education and training must take advantage of newer technologies and must be sustained and not limited to occasional seminars or a one-time symposium” (Pg. 2)
  • “Fewer than 50% of the nurses were able to correctly differentiate anthrax from an upper respiratory infection or smallpox from chickenpox. Furthermore, nurses scored lower than physicians on all 12 of the knowledge-based questions. Of the respondents, only 20% reported having previous bioterrorism training and fewer than 15% believed that they could respond efficiently to a bioterrorism event.” (Pg. 2)
  • “In a larger study of 651 physicians, an online program was used to train participants to diagnose and manage cases of smallpox, anthrax, botulism, and plague (Cosgrove, Perl, Song, & Sisson, 2005). Pretest/posttest scores for correct diagnosis increased from 47% to 79%, whereas scores for correct management increased from 25% to 79%. Thus, web-based, case-oriented programs were effective in educating physicians about agents of bioterrorism. (Pg. 2)
  • “This didactic module, which was adapted for nurses, included a background on bioterrorism, encompassing a brief history of bioterrorism and the reasons why biological agents could be used as weapons and an overview of the category A bioterrorism agents, including the differential diagnosis, diagnostic methods, and treatment.” (Pg. 4)
  • “Participants in the computerized bioterrorism education and training program were more likely to solve the cases critically without reliance on expert consultants. However, participants in the standard bioterrorism education and training program reduced the use of unnecessary diagnostic tests” (Pg. 10)
  • Public Health, Anthrax, Smallpox, Emergency Response, Bioterrorism, Biosecurity


Davis, Sara, “BALANCING PUBLIC HEALTH AND INDIVIDUAL CHOICE: A PROPOSAL FOR A FEDERAL EMERGENCY VACCINATION LAW”. Health Matrix: Journal of Law Medicine, January 1, 2010. [23]

  • “Since 2001, the U.S. government has devoted considerable time and effort identifying potential vulnerabilities to biological attacks, promoting prevention strategies, and anticipating how best to respond should a large-scale biological attack ever occur.” (Pg. 2)
  • ““The more that sophisticated capabilities, including genetic engineering and gene synthesis, spread around the globe, the greater the potential that terrorists will use them to develop biological weapons . . . . Prevention alone is not sufficient, and a robust system for public health preparedness and response is vital to the nation's security.'” (Pg. 3)
  • “The changes generally grant broad sweeping powers to state governors and health officials, including the power to order forced treatment and vaccination without specifying which exemptions….Such changes could increase the chances for state abuse of power and lead to confusion during a mass vaccination campaign.” (Pg. 3)
  • “Currently, the federal government lacks authority to exert control over a state's emergency vaccination plans, regardless of whether the plans are too lenient and severely risk the public's health or too rigid and unnecessarily restrict individual liberty” (Pg. 4)
  • “Maryland, the state's attorney summoned parents of more than 1,600 children to court, giving them a choice between vaccinating their children and facing penalties of up to ten days in jail and fifty dollars a day in fines.” (Pg. 7)
  • “Three key factors determine the percentage of the population that must be immunized in order to reach the herd immunity threshold: (1) the degree of the disease's infectiousness; (2) the population's vulnerability; and (3) the environmental conditions.” (Pg. 8)
  • “The Court explained that the state had a duty to protect the welfare of the many and to refrain from subordinating their interests to those of the few.”(Pg. 12)
  • “The Court determined that an individual's belief qualified as a religious belief, if it was "sincere and meaningful" and it "occupied in the life of its possessor a place parallel to that filled by the God of those admittedly qualifying for the exemption."” (Pg. 20)
  • “The district court warned that while an individual may possess sincerely held beliefs, instead of being rooted in religious convictions, those beliefs may merely be framed in religious terms to feign compliance with the law.” (Pg. 21)
  • “The Sherr case raises two issues. First, how much proof an individual must provide to demonstrate to the government the sincerity of the individual's religious beliefs. Second, how public health officials in an emergency will determine quickly and fairly whether an individual meets the requisite burden of proof.” (Pg. 22)
  • “Current state public health emergency laws inadequately address mass vaccination situations and leave wide-open the potential for the abrogation of individuals' rights” (Pg. 29)
  • “The model law, drafted by The Center for Law and the Public's Health, at Georgetown and John Hopkins Universities, seeks to "grant public health powers to state and local public health authorities to ensure strong, effective, and timely planning, prevention, and response mechanisms to public health emergencies (including bioterrorism) while also respecting individual rights." (Pg. 31)
  • “Additionally, MSEHPA fails to address the need for a consistent and coordinated nationwide approach to mass vaccination in a multi-state emergency….."To prevent the spread of contagious or possibly contagious disease the public health authority may isolate or quarantine . . . persons who are unable or unwilling for reasons of health, religion, or conscience to undergo vaccination."' (Pg. 31)
  • “The Public Health Emergency Medical Countermeasures Enterprise ("PHEMCE")" is likely the most appropriate government body to be in charge of implementing the new informed consent requirements, the medical and religious exemptions, and the right of refusal conditioned on a discretionary requirement of isolation or quarantine” (Pg. 35)
  • Bioterrorism, Public Health, Vaccination, Law Enforcement, CDC, Quarantine, Pandemic


Beam, Elizabeth. “The Nebraska Experience in Biocontainment Patient Care”. Public Health Nursing Vol. 27 No. 2, April 2010. [24]

  • “The Centers for Disease Control (CDC) set health protection goals and objectives that address preparation for these emerging health threats in the current era of international travel (2007)” (Pg. 1) .
  • “Public health nurses in local health departments may receive the first call regarding a potential case of avian influenza, monkeypox, or viral hemorrhagic fever. In some cases, caring for the index patient and their direct contacts in the diagnosing hospital is the most logical approach.” (Pg. 1)
  • “Early access to a biocontainment patient care unit (BPCU) for isolation during a bioterrorism or a public health emergency event along with appropriate use of epidemiological and therapeutic interventions in the community may dramatically impact the size and severity of a disease outbreak” (Pg. 1-2)
  • “The collaboration of many organizations in Nebraska led to the development of a BPCU for the care of patients with potentially dangerous, highly infectious illnesses.” (Pg. 2)
  • “Plans are most effective when routinely practiced. Under the direction of the lead registered nurse, NBU personnel drill on a quarterly basis to test the adequacy of policies and procedures, learn new equipment as it is introduced, and test various care processes.” (Pg. 2)
  • “Community education is required for an isolation unit to be successful in achieving its public health mission. The NBU personnel provide education and training focused on communication and decision making in a situation requiring isolation of a potentially dangerous emerging infectious disease.” (Pg. 3)
  • “Some examples of unique policies to the NBU include: Transporting a patient to the biocontainment unit from the emergency department; Transporting a patient to the biocontainment unit from another patient care area within the Nebraska Medical Center; Obtaining and processing laboratory specimens; Laundry and biohazard waste removal from the biocontainment unit; Contingency plan for hospital surge capacity; Removal of patient remains.” (Pg. 3)
  • “Beyond moving a patient inside the hospital, vehicle transport for those who require intense isolation continues to be a concern among local, state, and federal organizations charged with this responsibility.” (Pg. 4)
  • “The continued success of the NBU has been a function of several key factors. These factors include three major areas: strong leadership, an engaged professional team, and successful collaborations.” (Pg. 4)
  • “The role of the lead registered Beam et al.: Nebraska Biocontainment Patient Care 143 nurse includes managing day-to-day operations and guiding routine monthly meetings and quarterly procedural drills.” (Pg. 4-5)
  • “A BPCU would allow health care workers to maintain their personal safety while providing care to a patient with a hazardous infection. The personnel who work in this specialized care unit could also become a resource for a larger public health emergency.” (Pg. 5)
  • Public Health, Bioterrorism, Emergency Response, Biosafety, CDC, Quarantine


Editors, “Bioterrorism Decontamination Could Cost Trillions, Report Warns” NTI. April 13, 2010. [25]

  • “The United States might need to spend trillions of dollars to decontaminate the site of a major biological attack”
  • “The federal government has not assigned clear-cut cleanup research and execution duties to the federal entities that would be most involved in dealing with the aftermath of a biological strike”
  • “The paper urges the Homeland Security Department to designate clearer decontamination duties to each federal agency, and it presses lawmakers to increase spending on biological-weapon cleanup studies and personnel”
  • Bioterrorism, Public Health, Decontamination, Quarantine, Emergency Response


Bouri, Nidhi & Franco, Crystal, "Environmental Decontamination Following a Large-Scale Bioterrorism Attack: Federal Progress and Remaining Gaps," Biosecurity and Bioterrorism: Biodefense Strategy, Practice, and Science, Volume 8, Number 2, 2010. April 7, 2010.

  • "The process of environmental decontamination is a key step in a successful response to a large-scale attack involving a biological agent. Costs for the decontamination response following the 2001 anthrax attacks were estimated in the hundreds of millions of dollars, and some facilities could not be reopened for more than 2 years."
  • "However, a large-scale biological attack would likely result in an even greater amount of contamination, more areas that need to be cleaned and made safe, and a much greater cost to the American public."
  • "The Select Biological Agents (biological organisms of particular concern) can be categorized along a continuum of decontamination difficulty, ranging from not problematic to very problematic, with a range of difficulty in between. Factors influencing the difficulty of decontamination for a particular agent following a biological attack would include both the natural stability of the agent in the environment and added man-made stability through weaponization."
  • "Bacillus anthracis, the causative agent of anthrax, is considered to be the most problematic agent of concern. Anthrax is both a threat to human health and extremely hardy in the environment. Thus, anthrax requires extensive environmental decontamination following a release."
  • "The main purpose of this analysis is to identify the gaps in decontamination policy and technical practice at the federal level, including safety standards, that must be addressed in order to facilitate a successful response to a large-scale attack involving a biological agent."
  • "The U.S. intelligence community, including the Central Intelligence Agency (CIA), the Defense Intelligence Agency (DIA), the Department of State, the National Intelligence Council, and the Defense Science Board, has assessed the threat of an attack on the U.S. using biological weapons, and they have determined that the threat of a biological attack on the U.S. is current and real.14 Yet, as noted by the Com- mission on the Prevention of Weapons of Mass Destruction Proliferation and Terrorism (the Commission) in their World at Risk report released in December 2008, the U.S. remains vulnerable and unprepared to deal with such an attack."
  • "Decontamination is the process of removing or inactivating a hazardous substance (in this case, a biological agent) from contaminated environments or surfaces, including skin, clothing, buildings, air, and water, in order to prevent adverse health events from occurring. Remediation fol- lowing an attack with a biological weapon will involve a number of different phases of response, including: Sampling, Testing, and Analysis; Containment and Mitigation; Decontamination, Confirmatory Sampling, and Testing"
  • "Although efforts are underway and advancements have been made in the field of biological agent decontamination, there are a number of high-level policy and scientific questions that have not yet been resolved. These gaps will be major stumbling blocks to a successful decontamination response following a large bioterrorism attack. Gaps include challenges in leadership, research coordination, funding, and decontamination response."
  • "Numerous federal agencies have responsibility for portions of the decontamination response to a bioterrorism attack. Yet, federal plans do not sufficiently delineate decontamination leadership roles and responsibilities."
  • "Currently, the U.S. lacks a coordinated and sustained federal research program in biological decontamination."
  • "The federal government does not have the human resources to carry out a decontamination response on its own, even for a small biological event."
  • "The nation must be ready to effectively and efficiently respond to and recover from a large-scale bioterrorism attack, and the federal government must take steps now to ensure that the U.S. has the technical and operational capabilities necessary to re- cover after an attack."
  • “The DOD Chemical and Biological Defense Program (CBDP) strives to develop capabilities for decontamination research and response ‘‘that enable the quick restoration of combat power, maintain/recover essential functions that are free from the effects of CBRN hazards, and facilitate the return to pre-incident operational capability””(Pg. 3)
  • “Investment now in biological decontamination research to improve technologies and methods has the potential to save the country tens of billions of dollars in clean-up costs for the next event” (Pg. 5)
  • “The risks of secondary aerosolization are important to understand, because they will greatly affect decontamination methods and standards, as well as policy decisions surrounding evacuation, transportation, and population movement” (Pg. 6)
  • “The federal government does not have the human resources to carry out a decontamination response on its own, even for a small biological event” (Pg. 7)
  • Decontamination, Anthrax, Biodefense, Biosafety, Bioterrorism, Emergency Response, Public Health, Biosecurity, Quarantine,


Editors, "Detection of Enterobacteriaceae Isolates Carrying Metallo-Beta-Lactamase — United States, 2010," MMWR Morbidity and Mortality Weekly Report, Vol. 59, No. 24, CDC, Published June 25,2010. [26]

  • "Current CDC infection control guidance for carbapenem-resistant Enterobacteriaceae also is appropriate for NDM-1–producing isolates (5). This includes recognizing carbapenem-resistant Enterobacteriaceae when cultured from clinical specimens, placing patients colonized or infected with these isolates in contact precautions, and in some circumstances, conducting point prevalence surveys or active-surveillance testing among other high-risk patients. Laboratory identification of the carbapenemresistance mechanism is not necessary to guide treatment or infection control practices but should instead be used for surveillance and epidemiologic purposes."
  • “Current CDC infection control guidance for carbapenem-resistant Enterobacteriaceae also is appropriate for NDM-1–producing isolates.”
  • “Carbapenem resistance and carbapenemase production conferred by blaNDM-1 is detected reliably with phenotypic testing methods currently recommended by the Clinical and Laboratory Standards Institute (3), including disk diffusion testing and the modified Hodge test.”
  • "Clinicians should be aware of the possibility of NDM-1–producing Enterobacteriaceae in patients who have received medical care in India and Pakistan, and should specifically inquire about this risk factor when carbapenem-resistant Enterobacteriaceae are identified. CDC asks that carbapenem-resistant isolates from patients who have received medical care within 6 months in India or Pakistan be forwarded through state public health laboratories to CDC for further characterization. Infection control interventions aimed at preventing transmission, as outlined in current guidance (5), should be implemented when NDM-1–producing isolates are identified, even in areas where other carbapenem-resistance mechanisms are common among Enterobacteriaceae.
  • NDM-1, Public Health, CDC


Associated Press, "NDM-1, Superbug Gene, Could Spread Worldwide, Doctors Warn," September 6, 2010 1

  • "People traveling to India for medical procedures have brought back to Britain a new gene that allows any bacteria to become a superbug, and scientists are warning this type of drug resistance could soon appear worldwide."
  • "Though already widespread in India, the new superbug gene is being increasingly spotted in Britain and elsewhere. Experts warn the booming medical tourism industries in India and Pakistan could fuel a surge in antibiotic resistance, as patients import dangerous bugs to their home countries."
  • "The superbug gene, which can be swapped between different bacteria to make them resistant to most drugs, has so far been identified in 37 people who returned to the U.K. after undergoing surgery in India or Pakistan."
  • "The resistant gene has also been detected in Australia, Canada, the U.S., the Netherlands and Sweden."
  • "The gene alters bacteria, making them resistant to nearly all known antibiotics."

NDM-1, Public Health


Associated Press, "Austria reports 2 cases of superbug gene," September 6, 2010 2

  • "The ministry says experts at the medical university in the southern city of Graz detected the gene, known as NDM-1, in two people, both of whom are believed to have been infected in hospitals abroad."

NDM-1, Public Health


Editors, "Planned Malaysian Biolab Raises Security Concerns," Global Security Newswire [27] September 8, 2010. Last checked September 10, 2010.

  • "Plans to construct a high-security biological research laboratory in Malaysia have caused some worry over possible proliferation of highly lethal disease materials, ProPublica reported yesterday."
  • "Maryland-based Emergent BioSolutions and Ninebio Sdn Bhd., which is funded by the Malaysian Health Ministry, in 2008 announced a joint plan to construct a large complex at an industrial site not far from Kuala Lumpur for 'vaccine development and manufacturing.'"
  • "Emergent is the producer of the only U.S.-licensed anthrax vaccine. The Emergent-Ninebio venture intends to manufacture halal-compliant vaccines for the international Muslim market. The complex is currently slated to begin work in 2013, according to an Emergent release."
  • "The two firms intend to construct a 'biocontainment R&D facility that includes BSL ... 3 and 4 laboratories,' According to online architectural plans for the 52,000-square-foot complex."
  • "Biosafety Level 4 laboratories perform countermeasure research on diseases for which there are no known cures, such as the Ebola and Marburg viruses. There are fewer than 40 such facilities in the world and none in Malaysia. The nation has three BSL-3 laboratories, which handle potentially deadly pathogens like anthrax and plague."
  • "U.S. Assistant Secretary of State Vann Van Diepen said during a House panel hearing in March that a critical aspect of today's biological weapon fears is 'the growing biotechnology capacity in areas of the world with a terrorist presence.'"
  • "Malaysia's history with terrorism includes the 2002 bomb attack by Malaysian-based extremists from Jemaah Islamiyah that killed 202 people at a popular nightclub in Bali, Indonesia. Kuala Lumpur served as the 'primary operational launchpad' for al-Qaeda senior operatives planning the Sept. 11 attacks, according to the FBI. The Malaysian capital was also a key hub in the nuclear technology smuggling ring operated by Pakistani nuclear scientist Abdul Qadeer Khan (see GSN, March 14, 2005)."
  • "Security specialists argue that having a U.S. firm such as Emergent involved in Malaysia's growing biotechnology industry would give Washington some degree of clout and authority over international biodefense work."
  • "Malaysian authorities want the high-tech laboratories to respond to local epidemics of diseases such as SARS and Japanese encephalitis in addition to advancing research on cures for biological materials that could be used in acts of terrorism."
  • "Kuala Lumpur has started to develop new biological security regulations that would meet U.S. standards. It has received assistance in the effort from the U.S. Energy Department's Sandia National Laboratories, ProPublica reported."
  • "...and monitoring of biological manufacturing installations under the Biological Weapons Convention. The United States and Russia, however, are against site inspections and the likelihood of more effective oversight controls being put into effect is not known."
  • "'We currently do not have [BSL-4] labs in Malaysia but we would be happy to collaborate with the government of Malaysia on biosurveillance, safety and security in the future,' a Defense Department spokesman said (Coen/Nadler, ProPublica, Sept. 7)."
  • BSL, Malaysia, Vaccination, Nonproliferation, Bioterrorism, Public Health, Military, State Department


Shino Yuasa, "Japan confirms its first case of new superbug gene," AP September 7, 2010 [28]

  • "Japan has confirmed the nation's first case of a new gene in bacteria that allows the microorganisms to become drug-resistant superbugs, detected in a man who had medical treatment in India, a Health Ministry official said Tuesday."
  • "The WHO says NDM-1 requires monitoring and further study. With effective measures, countries have successfully battled multi-drug resistant microorganisms in the past."
  • "It recommends that governments focus their efforts in four areas: surveillance, rational antibiotic use, legislation to stop sales of antibiotics without prescription, and rigorous infection prevention measures such as hand-washing in hospitals."
  • "Researchers say since many Americans and Europeans travel to India and Pakistan for elective procedures like cosmetic surgery, it was likely the superbug gene would spread worldwide."
  • "President of Indian Association of Medical Microbiology Dr Abhay Chaudhary, said, “Drug-resistant bacteria are not new. Whenever we use a particular antibiotic, bacteria will always try to develop resistance to it. This is a natural phenomena.”"
  • ""The potential of NDM-1 to be a worldwide public health problem is great, and coordinated international surveillance is needed," said a widely publicised report in the Lancet in August, which pinpointed India as the country of origin."
  • NDM-1, Public Health, WHO


Kumarasamy K., Toleman M. et,al., "Emergence of a new antibiotic resistance mechanism in India, Pakistan, and the UK: a molecular, biological and epidemiological study," The Lancet Infectious Diseases, Vol 10(9),Pg 597-602, doi:10.1016/S1473-3099(10)70143-2, Published August 2010, Last checked September 17, 2010.

  • "Enterobacteriaceae with NDM-1 carbapenemases are highly resistant to many antibiotic classes and potentially herald the end of treatment with β-lactams, fluoroquinolones, and aminoglycosides-the main antibiotic classes for the treatment of Gram-negative infections."
  • "Most isolate remained susceptible to colistin and tigecyline."
  • "Nevertheless, NDM-1-positive K pneumoniae isolates from Haryana were clonal, suggesting that some strains could potentially cause outbreaks. Most blaNDM-1 positive plasmids were readily transferable and prone to rearrangement, losing or (more rarely) gaining DNA on transfer."
  • "This transmissibility and plasticity implies an alarming potential to spread and diversify among bacterial populations."
  • "This scenario is of great concern because there are few anti-Gram negative antibiotics in the pharmaceutical pipeline and none that are active against NDM-1 producers. Even more disturbing is that most of the Indian isolates from Chennai and Haryana were from community-acquired infections, suggesting that blaNDM-1 is widespread in the environment."
  • "Several of the UK source patients had undergone elective, including cosmetic, surgery while visiting India pr Pakistan. India also provides cosmetic surgery for other Europeans and Americans, and blaNDM-1 will likely spread worldwide."
  • "The potential for wider international spread of producers and for NDM-1 encoding plasmids to become endemic worldwide, are clear and frigthening."
  • NDM-1, Public Health


Leung, Gabriel M. and Nicoll, Angus. "Reflections on Pandemic (H1N1) 2009 and the International Response". PLoS Medicine 7.10 October 2010.[29]Last checked Feb. 21, 2011

  • “The pandemic virus was detected and isolated reasonably early, although too late for any attempt at containment.”
  • “…late clinical presentation and delayed initiation of antiviral treatment have been implicated with more severe complications worldwide, indicating gaps in identifying and treating patients before disease severity increases.”
  • “Clear communication of public health messages will remain a particular challenge and not confusing what could happen (and should be prepared for) with what is most likely to happen.”
  • “One challenge faced initially in this pandemic was for timely collection and sharing of clinical data to inform optimal management of critically ill patients worldwide.”
  • “Greater access to antiviral and influenza vaccines worldwide is an ongoing challenge.”
  • Pandemic, Flu, Vaccination, Emergency Response, Public Health


Matishak, Martin, "Homeland Security Says Radiation Detector Decision Coming Within Year" NTI. Oct. 1st, 2010. [30]

  • “The detection office was established by presidential directive in 2005 to coordinate federal efforts to protect the United States against nuclear terrorists and designated to be the lead agency in domestic nuclear detection.”
  • “It has also deployed 1,500 radiation portal monitors and 3,000 hand-held detectors to the nation's borders to support Customs and Border Protection and set up 6,500 detectors with the Coast Guard, he said”
  • “The new machines were designed to not only detect radiation but identify the nature of its source. Proponents claimed the devices, each expected to cost approximately $822,000, would eliminate time-consuming secondary inspections to determine whether a material was in fact dangerous.”
  • “Congressional auditors in June said a comprehensive strategic plan against nuclear terrorism could involve installing radiation detection equipment at all U.S. border crossings and ports of entry; addressing vulnerabilities and risks; identifying the mix of detection equipment that would be at various entry points and when those devices would be deployed”
  • Nuclear, Public Health, Biodetection, Biotechnology, Bioterrorism


Editors "New detector tests for illegal drugs, superbugs in minutes" Homeland Security Newswire, October 2 2010.

  • "A new method of detecting illegal drugs and super bugs will be used in a government-backed handheld device that analyses saliva. The Vantix portable reader will be able to test for chemical substances or bacteria such as MRSA in human or animal saliva within minutes"
  • "Things like feces, urine and saliva are dreadful samples to work with; even in ground up animal feed where we’re detecting illegal use of antibiotics."

NDM-1, Public Health


Jeffery Bigongiari, "FDA gives grants to fight tuberculosis", Last accessed October 18, 2010. 2

  • "The U.S. Food and Drug Administration on October 4 announced that it has awarded nearly $3 million to fund research that will support the diagnosis, treatment and prevention of tuberculosis."
  • "TB remains a major public health threat and continues to rise in prevalence globally. The FDA said that help is needed to shorten therapy and to treat drug resistant forms of the disease."
  • "The six projects and their research teams that FDA will grant funding to include Aeras Global TB Vaccine Foundation's discovery of biological and immunological biomarkers for TB vaccines and the Global Alliance for TB Drug Development frozen trials for developing a repository of clinical trial specimens."
  • Tuberculosis, Public Health


Editors, "Sea floor organisms offer response to bioterrorism" Homeland Security Newswire October 7, 2010 [31] Last accessed October 21, 2010.

  • "The U.S. Defense Threat Reduction Agency recently signed a $29.5 million contract with San Diego-based Trius Therapeutics and the Scripps Institute of Oceanography to search for new antibiotics at the bottom of the ocean that could be used to fight bioterrorism."
  • "Ted Purlain, citing a SignOnSanDiego.com report, writes that over the next four years, the two organizations expect to find treatments for the bubonic plague, Yersinia pestis, and other bacterial infections that could be utilized by terror groups for an attack on the United States."
  • "Researchers at the Scripps Institute for Oceanography have spent much of the last fifteen years scouring the seas for useful microorganisms and have built a library of more than 15,000 strains of bacteria, yeast and fungi that are kept on ice at their laboratories."
  • "Trius will use its Focused Antisense Screening Technology to evaluate dozens of potential treatment candidates every week. The process will measure how effectively a molecule can act against specific proteins that are known to be critical in the functions of specific pathogens."
  • "The scientists hope to find bacteria that precisely target a pathogen’s means of attack. If they are too toxic, they can cause unwanted side effects.“It’s quite easy to find compounds that are generally toxic,” Stein told SignOnSanDiego.com. “The challenge is detecting which ones of those are inhibiting the cell because they are highly specific and potent.”"
  • "The military has recently increased its efforts to find new treatments for the effects of biological weapons as more infections have become drug resistant and the pipeline for new antibiotics has begun to dry up."
  • "Currently, there are two compounds undergoing Phase II clinical trials that were found at the bottom of the ocean floor."
  • Biodefense, Public Health


Editors, 'U.S. Awards Contract For Radiation Treatment Work'. GSN. Sept. 7, 2010. [32]

  • “Funding from the department's Biomedical Advanced Research and Development Authority is to be used to develop a medical treatment which uses myeloid progenitor cells, which can develop into any type of blood cell. The medication, CLT-008, is intended to foster the growth of and assist the body's progenitor cells, according to an agency release.”
  • “The Biomedical Advanced Research and Development Authority also approved millions of dollars in new funding for additional work on a treatment for plague and tularemia -- two disease agents classified as potential bioterrorism threats, according to a press release.”
  • “The antibiotic could be used against tularemia and plague infections as well as more common illnesses such as pneumonia that are growing increasingly resistant to antibiotics.”
  • “"This new antibiotic is part of our push against antibiotic resistance for certain bacterial infections, and at the same time could provide a new treatment for plague and tularemia biothreats””
  • Bioterrorism, Biosafety, Public Health, Emergency Response, Pharma, Drug Resistance, Biodevelopment, Biotechnology, Quarantine



Sternberg Steve, "Drug-resistant 'superbugs' hit 35 states, spread worldwide" USA Today Published September 17, 2010, Last accessed October 27, 2010 [33]

  • "Bacteria that are able to survive every modern antibiotic are cropping up in many U.S. hospitals and are spreading outside the USA, public health officials say."
  • "The bugs, reported by hospitals in more than 35 states, typically strike the critically ill and are fatal in 30% to 60% of cases. Israeli doctors are battling an outbreak in Tel Aviv that has been traced to a patient from northern New Jersey, says Neil Fishman, director of infection control and epidemiology at the University of Pennsylvania and president of the Society of Healthcare Epidemiologists."
  • "The bacteria are equipped with a gene that enables them to produce an enzyme that disables antibiotics. The enzyme is called Klebsiella pneumoniae carbapenamase, or KPC. It disables carbapenam antibiotics, last-ditch treatments for infections that don't respond to other drugs."
  • "Carbapenam-resistant germs are diagnosed mostly in hospital patients and are not spreading in the community. They're far more common nationwide than bacteria carrying a gene called NDM-1 that made headlines this week, Fishman says."
  • "Although KPCs are most common in New York and New Jersey, Srinivasan says, "they've now been reported in more than half of the states." A decade ago, only 1% of Klebsiella pneumoniae bacteria reported to CDC by hospitals were carbapenam-resistant. Today, resistance has spread to more than 8% of these bacteria. No one knows precisely how many people have KPC infections because cases aren't routinely reported to the CDC."
  • "One of the only drugs that combats these bugs is polymixin, which was all but abandoned years ago because it is so toxic to the kidneys, Fishman says. As a result, he says, prevention is crucial."
  • "In March 2009, the CDC gave hospitals new guidelines for prevention. Among other things, doctors treating any patient diagnosed with carbapenam-resistant infections are advised to wear gowns and gloves to protect themselves and make sure they don't infect other patients."
  • KPC, NDM-1, Public Health


Graham Judith, "Drug-resistant bacterium raises alarms in Chicago" Chicago Tribune Last accessed October 27, 2010. [34]

  • "A dangerous, often deadly bacterium resistant to the most powerful antibiotics known to medicine is spreading in Chicago hospitals and nursing homes, prompting an effort to mobilize a regionwide response."
  • "Earlier this year, 37 health facilities in Chicago reported an average of 10 KPC cases each, up from an average of four cases in 2009 in 26 facilities, according to a new study presented Friday at the annual meeting of the Infectious Diseases Society of America."
  • "They're part of a class of organisms known as Gram-negative bacteria, whose best-known member is Escherichia coli, or E. coli."
  • "Over the last decade, Gram-negative bacteria have begun to evolve resistance to drugs once commonly used to fight them as well as to the drugs called carbapenems — medications of last resort that are used to treat infections that don't respond to other interventions."
  • "Another drug-resistant Gram-negative bacterium originating in India made headlines around the world in September when disease trackers noted its emergence in Europe and the U.S. That organism carries a carbapenem-disabling gene known as NDM-1, which experts worry might be transferred to other pathogens and hasten drug resistance."
  • "An outbreak of KPC in Rio de Janeiro this year claimed 18 lives. The epicenter for infections in the U.S. is New York."
  • KPC, NDM-1, Public Health


Pollack Andrew, "Antibiotics Research Subsidies Weighed by U.S." New York Times Last accessed November 11, 2010. [35]

  • "Worried about an impending public health crisis, government officials are considering offering financial incentives to the pharmaceutical industry, like tax breaks and patent extensions, to spur the development of vitally needed antibiotics."
  • "While the proposals are still nascent, they have taken on more urgency as bacteria steadily become resistant to virtually all existing drugs at the same time that a considerable number of pharmaceutical giants have abandoned this field in search of more lucrative medicines."
  • "The number of new antibiotics in development is “distressingly low,” Dr. Margaret A. Hamburg, commissioner of the Food and Drug Administration, said at a news conference last month. The world’s weakening arsenal against “superbugs” has prompted scientists to warn that everyday infections could again become a major cause of death just as they were before the advent of penicillin around 1940."
  • "For example, scientists have become alarmed by the spread from India of a newly discovered mutation called NDM-1, which renders certain germs like E. coli invulnerable to nearly all modern antibiotics. About 100,000 Americans a year are killed by infections acquired in hospitals, many resistant to multiple antibiotics. Methicillin-resistant staphylococcus aureus, or MRSA, the best known superbug, now kills more Americans each year than AIDS."
  • "Besides tax breaks and extra protection from competition, other ideas policy makers are considering include additional federal funding of research and guaranteed purchases by the government of new antibiotics. Measures like these are already used to encourage the development of drugs for rare diseases, through the Orphan Drug Act, and for illnesses like malaria that primarily afflict poor countries."
  • "The Obama administration is also taking some steps. The federal agency that oversees development of treatments for bioterrorism agents like anthrax is broadening its scope to encompass more common infections. In August, the agency, known as the Biomedical Advanced Research and Development Authority, awarded its first such “multi-use” contract, giving an initial $27 million to a company called Achaogen to develop an antibiotic that could be used for plague and tularemia as well as antibiotic-resistant infections."
  • "The Department of Health and Human Services is considering creating an independent fund that would invest in small bio-defense companies. Antibiotic-resistant germs would be one priority, according to a report that the department issued in August."
  • "The European Union is also working on a plan, based on proposals from the London School of Economics. A year ago, the United States and the European Union formed a task force on antibiotic resistance."
  • "Ramanan Laxminarayan, who directs the Extending the Cure project on antibiotic resistance at Resources for the Future, a policy organization, said the government should focus on conserving the effectiveness of existing antibiotics. That could be done by preventing unnecessary use in people and farm animals and requiring better infection control measures in hospitals."
  • "Only five of the 13 biggest pharmaceutical companies still try to discover new antibiotics, said Dr. David M. Shlaes, a consultant to the industry and the author of a new book “Antibiotics: The Perfect Storm.”"
  • "One reason is that antibiotics are typically taken for a week or two and usually cure the patient. While that makes them cost-effective for the health system, it also makes them less lucrative to drug companies than medicines for diseases like cancer or diabetes, which might be taken for months, or even for life, because they do not cure the patient."
  • "Another factor is that new antibiotics are likely to be used only sparingly at first, to stave off the emergence of resistance. While that might be medically appropriate, it reduces the ability of a drug company to recoup its investment, said Dr. Barry I. Eisenstein, a senior vice president at the antibiotic maker Cubist Pharmaceuticals. Another factor discouraging investment, some experts say, is that the F.D.A. recently made it harder for new antibacterial drugs to win approval."
  • NDM-1, Public Health, Prophylaxis, Pharma


Low, Donald E. and McGeer, Allison., “Pandemic (H1N1) 2009: Assessing the Response.” Canadian Medical Association Journal, November 2010. [36]

  • “Research published by Viboud and colleagues suggests that the first waves of the 2009 pandemic may have been more severe than is widely perceived.”
  • “…the estimate number of years of life lost was 25% greater than duing a usual influenza season.”
  • “The vaccine could not be made quickly enough to protect Canadians from the second wave, the complexity of delivering vaccine was badly underestimated, and attempts to deliver rapid public education about vaccination with an adjuvant vaccine failed.”
  • “…uncertainty and limited communication about vaccine supply hampered local and provincial coordination of delivery.”
  • “Last year’s events clearly show that our current methods of vaccine production are too slow for an adequate response to a pandemic.”
  • Flu, Vaccination, Pandemic, Emergency Response, Biosecurity, Public Health, Adjuvant


Kron, Josh, "Uganda Seen as a Front Line in Bioterrorism." NYT A8, November 11, 2010.

  • Uganda Virus Research Institute
  • "need to tighten the security of vulnerable public health laboratories in East Africa" - Andrew C. Weber, Asst. to Secretary of Defense for Nuclear and Chemical and Biological Defense Programs.
  • "preventing terrorist acquisition of dangerous pathogens, the seed material for biological bioweapons, is a security imperative."
  • Shabab insurgent group - "attention on East Africa as a fronteir in American security interests."
  • warm, wet environment fuels biothreats of anthrax, marburg, and ebola.
  • anthrax- killed hundred of hippos in recent years
  • marburg- tourist died after contracting disease at a natl park
  • ebola- outbreak 2007- killed over 20 people
  • relaxed security and poor funding/financing creates a security risk.
  • Biodefense, Anthrax, Bioterrorism, Lab Safety, Ebola, Marburg, Biosafety, Africa


Editors, "India, US join hands to set up global disease detection centre" The Economic Times, November 8, 2010, Last accessed November 26, 2010 [37]

  • "The US and India today signed a memorandum of understanding for establishment and operation of global disease detection centre here."
  • "The agreement would facilitate development of human resources, both in epidemiology and laboratory, enable sharing best practices for detection and response to emerging infections, wherever required."
  • "It would also facilitate advanced training in the field of epidemiology and surveillance for emerging infectious diseases, international health and mentoring of public health professionals."
  • "Building laboratory capacity in India for diagnosis of emerging infectious diseases using well characterised reference materials and advanced technology transfer are the other aims of the MoU."
  • Public Health, NDM-1


Glazier K., "Cargill: E. coli cattle vaccine promising," Denver Post, November 16, 2010, Last accessed November 26, 2010 [38]

  • "International food marketer Cargill announced Monday the initial results of a trial for the new vaccine, a test involving 85,000 cattle at the company's Fort Morgan beef-processing facility."
  • "Schaefer said Cargill was awaiting results from other researchers across the nation but that the company had plans to conduct a second trial next summer at a Midwest processing plant. The cattle had no negative reaction to the vaccine, Schaefer said."
  • "He said the vaccinated Fort Morgan animals showed positive immune system response and low levels of the strain of E. coli bacteria that can sicken and kill human beings if consumed. But Schaefer said nonvaccinated cattle at Fort Morgan also showed low levels of E. coli. A variety of factors influence E. coli levels in cattle, Schaefer said, including weather, living conditions and vaccine dosage."
  • "Minnesota-based pharmaceutical company Epitopix developed the vaccine used in the trial. It received initial testing approval from the Food and Drug Administration and the U.S. Department of Agriculture in February 2009."
  • Vaccination, Public Health, E. coli

2011

Kelly, Heath et al. “We should not be complacent about our population-based public health response to the first influenza pandemic of the 21st century.” BMC Public Health. 2011. [39] Last Checked October 18 2012.

  • “Prior to the pandemic, there was limited scientific evidence to support border control measures. In particular no border screening measures would have detected prodromal or asymptomatic infections, and asymptomatic infections with pandemic influenza were common. School closures, when they were partial or of short duration, would not have interrupted spread of the virus in school-aged children, the group with the highest rate of infection worldwide.”
  • “Australia used the pharmaceutical and non-pharmaceutical interventions detailed in its pandemic plan in an effort to delay entry of the virus into the country, contain the virus to limited areas once it had entered the country, sustain a response when widespread community transmission had been established and to protect the vulnerable.”
  • “In most countries it may be correct to conclude, as did an evaluation of the UK response, that the “pandemic and the response it generated have provided confirmation of the value of planning and preparedness.” It is also true that the apparent success of the response in 2009 must not lead to complacency. We now know that the relatively low virulence of pH1N1 meant we did not need to have implemented effective responses to get a good outcome.”
  • “It is generally accepted that children, especially children of school age, are responsible for amplification of influenza epidemics. An intervention targeting schools could therefore theoretically be effective in interrupting an epidemic.”
  • “There are obvious lessons to be learnt from the first pandemic of the 21st century, a pandemic which was much less severe than many plans had anticipated. If we think our response to this pandemic was adequate, we may be falsely reassured. A more severe pandemic may find us wanting. A mild pandemic may find us over reacting. However, with appropriate collection and analysis of data it should be possible to identify the severity of future pandemics early and to make a measured response.”
  • “Revised pandemic plans should include different responses for different pandemic severities. All areas of pandemic planning need to be re-examined, but perhaps by alternative processes to those that led to current plans. Certainly, new evidence about the practical difficulties and/or ineffectiveness of control measures, such as border control and school closures, needs to be considered seriously. The inadequacy of many plans has recently been publicly acknowledged by the head of the WHO’s global influenza program.”

WHO, Pandemic, Public Health, Emergency Response


Editors, "How To Prepare For A Terrorist Attack" Homeland. 2011. [40]

  • “Choose an out-of-town contact your family or household will call or e-mail to check on each other should a disaster occur. Your selected contact should live far enough away that they would be unlikely to be directly affected by the same event, and they should know they are the chosen contact”
  • “Having a predetermined meeting place away from your home will save time and minimize confusion should your home be affected or the area evacuated”
  • “You need to know if they will they keep children at school until a parent or designated adult can pick them up or send them home on their own. Be sure that the school has updated information about how to reach parents and responsible caregivers to arrange for pickup”
  • “If Disaster Strikes: Remain calm and be patient, Follow the advice of local emergency officials, Listen to your radio or television for news and instructions, If the disaster occurs near you, check for injuries. Give first aid and get help for seriously injured people.”
  • "Wear long-sleeved shirts, long pants and sturdy shoes so you can be protected as much as possible."
  • "Go to an interior room without windows that’s above ground level. In the case of a chemical threat, an above-ground location is preferable because some chemicals are heavier than air, and may seep into basements even if the windows are closed. Using duct tape, seal all cracks around the door and any vents into the room"
  • "People who may have come into contact with a biological or chemical agent may need to go through a decontamination procedure and receive medical attention."
  • Public Health, Emergency Response, Biosafety, Bioterrorism, Decontamination


Gray, Richard, "Swine Flu Spreading Faster in Britain than Rest of Europe." Telegraph. 1 January 2011. [41]

  • "The Department of Health denied claims the country was facing a national shortage of the flu vaccine after some doctors surgeries reported they were running out of stocks."
  • There has also been concern that flu vaccines were not offered for children under five years old this year despite advise from the Government's Joint Committee on Vaccination and Immunisation in January that it would be "prudent" to include children aged six months to five years in this winter's flu vaccine programme."
  • "The committee has subsequently said it did not believe healthy children under five years old should be given the flu vaccine, but insisted that "at risk" groups under the age of 65 years old, which includes those suffering from conditions such as respiratory, heart, kidney or liver disease, should be given the jab as a matter of priority."

Pandemic, Flu, Public Health, Vaccination, Pharma, Europe


AP, "Officials Warn Swine Flu Outbreak in Britain May Spread to Rest of Europe," AOL Health. 7 January 2011. [42]

  • "The annual flu season struck the U.K. early this year, with cases surging last month and doubling almost every week."
  • "The predominant strain infecting people is swine flu, which was responsible for the 2009 pandemic. Unlike most flu viruses, swine flu mostly affects people under 65 and many of its victims are previously healthy younger people with no underlying problems."
  • Vaccine Shortages: "In Britain, a vaccine shortage is forcing authorities to resort to leftover shots from last year's swine flu pandemic. Some hospitals have been forced to cancel elective surgeries to accommodate extra flu patients."
  • "According to the World Health Organization, the swine flu virus detected in Britain is similar to the pandemic strain and no changes have been identified to suggest it is more lethal or transmissible.
  • "Charles Penn, a WHO flu expert, said swine flu appeared to be the main virus spreading in Europe so other countries might soon experience an outbreak similar to Britain's. 'Any countries where (swine flu) is the predominant virus should be prepared for more incidents of infection in younger people than normal,' he said."

Europe, Pandemic, Pharma, Flu, Vaccination, Public Health, WHO

McNeill, Robert, G., Jr., "Response of W.H.O. to Swine Flu Is Criticized," NYT March 10, 2011,[43] Last checked March 14, 2011.

  • "A panel of independent experts has harshly reviewed the World Health Organization’s handling of the 2009 epidemic of H1N1 swine flu, though it found no evidence supporting the most outlandish accusation made against the agency: that it exaggerated the alarm to help vaccine companies get rich."
  • "The world is still unprepared to handle a severe pandemic, and if a more dangerous virus emerges, 'tens of millions would be at risk of dying,' the panel said in its draft report, which was posted on an obscure corner of the W.H.O.’s Web site on Thursday."
  • "Although millions of doses of vaccine ultimately went unused, the panel found 'no evidence of malfeasance.'”
  • "Later, when rich nations donated 78 million doses for use in poor ones, the health agency could not deploy them because it was bogged down in negotiations with vaccine companies over liability and costs."
  • "The panel, which has experts from 24 countries and is led by Dr. Harvey V. Fineberg, president of the Institute of Medicine, criticized the agency’s “needlessly complex” definition of a pandemic, which had six levels of alert, based on the virus’s geographical spread, not its severity."
  • "Nonetheless, it concluded, 'no critic of W.H.O. has produced any direct evidence of commercial influence on decision-making.'Communications were also clumsy. Ceasing routine news conferences after the disease was elevated to pandemic status was 'ill advised,' the report said, and the agency responded 'with insufficient vigor' when its integrity was questioned."
  • "Countries that needed technical help could not obtain it in enough languages..."
  • "Asking countries to submit counts of laboratory-confirmed cases created confusion, the report said, adding that knowing hospitalization and death rates would have been better."
  • "Although the W.H.O. excels at sending small teams to focused outbreaks like a village overwhelmed by Ebola, it fumbled even simple aspects of a prolonged effort, like food, lodging and child care for its staff."
  • "With help from national health agencies like those of the United States and Canada, the W.H.O. identified the virus quickly and got seed strains to vaccine makers. It also sent experts to countries that asked for help."
  • "Vaccine companies use slow 60-year-old technology, diagnostic tests are cumbersome, and virologists know too little about which mutations are the most dangerous."
  • "The panel urged the creation of a 'global reserve corps' of experts for emergencies, and a $100 million fund for their use. It urged vaccine makers to reserve 10 percent of their production for poor countries. It also criticized some international rules. For example, there is no way to punish nations that needlessly close borders or curtail trade. In 2009, many countries banned pork imports in the mistaken belief that a human flu with some swinish genes could be spread by bacon. Others closed borders or forcibly quarantined visitors with fevers."
  • WHO, Flu, Pandemic, Public Health, Vaccination, Pharma, Ethics, Misconduct


“Report of the Review Committee on the Functioning of the International Health Regulations (2005) and on Pandemic Influenza A (H1N1) 2009”. March 7, 2011.[44]

  • “The pandemic H1N1 is the first Public Health Emergency of International concern to occur since the revised IHR came into force…Because H1N1 caused illness that did not require hospitalization in the vast majority of cases, the question of severity of the pandemic and how to characterize it became a key challenge. As the H1N1 virus spread to several countries within days, the possibility of rapid containment, a tenet of planning in WHO’s multi-stage response, was never really feasible”.
  • “The world is ill prepared to respond to a severe influenza pandemic or to any similarly global sustained and threatening public health emergency…many State Parties lack core capacities to detect, assess and report potential health threats and are not on a path to complete their obligations for plans and infrastructure by the 2012 deadline specified in the IHR…Only 58% of the respondents reported having developed national plans to meet core capacity requirements, and as few as 10% of reporting countries indicated that they had fully established the capacities envisaged by the IHR.”
  • “The most important structural shortcoming of the IHR is the lack of enforceable sanctions. For example, if a country fails to explain why it has adopted more restrictive traffic and trade measures than those recommended by the WHO, no legal consequences follow.”
  • “The committee also noted systemic difficulties that confronted WHO and some shortcomings on the part of WHO: The absence of a consistent, measurable and understandable depiction of severity of the pandemic…Inadequately dispelling confusion about the definition of pandemic…A pandemic structure that was needlessly complex…Lack of a sufficiently robust, systematic and open set of procedures for disclosing, recognizing and managing conflicts of interest among expert advisors.”
  • “Despite the progress that the IHR represent and WHO’s success in mobilizing contributions from the global community, the unavoidable reality is that tens of millions of people would be at risk of dying in a severe global pandemic. Unless this fundamental gap between global need and global capacity is closed, we invite future catastrophe.
  • WHO, Public Health, Flu, Pandemic


Knox, Richard, "Decontamination After Radiation Exposure: Simpler Than You May Think". NPR. March 17, 2011. [45]

  • “"As a rule of thumb, 80 percent of decontamination is removing your clothes," says Toner, an emergency physician. "And 95 percent is removing your clothes and taking a shower — if possible, shampooing your hair. That's all that's involved. No fancy chemicals."”
  • “So a rain is a good thing at the time of, or after, a radiation leak. Rain washes the dust from the air, diluting it in runoff.”
  • “And this is the most worrisome form of contamination – internal contamination. The bad stuff on skin and clothes is easily washed off. But once radioactive particles get inside the body – through breathing in, but more importantly from ingestion – it can remain in tissues, possibly wreaking submicroscopic havoc, for a lifetime.”
  • Nuclear, Bioterrorism, Public Health, Decontamination



Hughes, Christine, M., Blythe D, Yu L, Ramani R, Jordan C, Edwards C, et al., "Vaccinia Virus Infections in Martial Arts Gym, Maryland, USA, 2008," Emerg Infect Dis. 2011 Apr.,

  • "To our knowledge, this is the first reported cluster of community acquired VACV in which an obvious source-person was not identified. This cluster highlights the need to reinforce transmission precautions to recent vaccinees and indicates that physicians should include VACV infections on the differential of vesiculopustular rash lesions and take appropriate infection control precautions, even in the absence of a known exposure to smallpox vaccine." p. 4
  • "Vaccinia virus (VACV) is the virus used in the live vaccine against smallpox. Smallpox was declared eradicated by the World Health Organization in 1980, and routine childhood smallpox vaccination ceased after 1972 in the United States. Since 2002, smallpox vaccinations have again been administered to some military personnel and health care workers, and they continue to be recommended for laboratory workers who work with nonattenuated orthopoxviruses. VACV infections are transmissible and can cause severe complications in those with weakened immune systems." p. 1
  • "The patient was asked whether he recently received smallpox vaccination or had history suggestive of exposure to orthopoxviruses such as monkeypox virus (i.e., contact with animals, recent international travel). He reported having neither..." p. 2
  • "The patient reported belonging to a martial arts gym; he reported having several military personnel as recent sparring partners before the onset of his illness. He also reported that a recent sparring partner had exhibited a rash around the same time. This person, a 28-year-old man (case-patient 2), was contacted and described having a 4-day rash on his right forearm in mid to late June with no systemic symptoms." p.3
  • "In the absence of an explanation for these 2 VACV (ACAM2000) infections, Maryland public health officials launched an investigation at the gym to identify additional cases and pinpoint the source of infection. Approximately 400 surveys were distributed to gym members through email and by hand at the gym. Members were asked whether they had any recent skin lesions similar to those shown in an attached photo. They were asked whether they had recently received a smallpox vaccination or had contact with someone recently vaccinated. Ninety-five gym members responded to the survey." p. 3
  • "The source of virus introduction into the martial arts gym remains unknown. No further infections have been identified among gym members or health care workers exposed to case-patients." p. 4
  • "This cluster of community-acquired VACV infection was possibly the result of sequential person-to-person spread of virus through direct physical contact, although transmission through fomites cannot be ruled out. The ultimate source-person responsible for introducing the virus into the gym was not identified, but given the limited time that ACAM2000 had been available to providers in the region (late February 2008), the most likely source was a recent vaccinee. ... Unrecognized transmission of VACV among gym members may have been ongoing over several months." p. 4
  • "Multiple cases of VACV infection caused by secondary transmission have been noted recently (8–13). Materials such as towels and bedding used by the vaccinee should be treated as potential fomites and should not be shared with others." p. 4
  • Vaccination, Smallpox, Contact Tracing, Public Health


Lubick, Naomi, "Tools for Tracking Antibiotic Resistance", Environmental Health Perspectives. May 2011.

  • ““Misuse of antibiotics is obviously what creates the basic factors that produce drug resistance,” says Mario Raviglione” (Pg. 2)
  • “Agricultural use of human drugs adds to the threat of drug resistance.” (Pg. 2)
  • “They also have identified antimicrobial resistance genetic material in treated waste effluent and tap water in Michigan and Ohio,25,26 and researchers in Sweden recently documented multidrug-resistant Escherichia coli in the waste of migrating birds in the Arctic” (Pg. 2)
  • “In particular, monitoring is now lacking. “If anything, we don’t know enough about developing countries to understand the situation—what resistant bacteria are there?”” (Pg. 3)
  • “This device, connected to the Internet or with databases preloaded, could use the sequence to identify the microbes present to the genus or even species level, then spot genes they might carry for resistance to certain drugs. The test could potentially even predict the effectiveness of specific drugs in individual patients.” (Pg. 4)
  • Public Health, Bioterrorism, Drug Resistance, E. coli, NDM-1


Foley, Michelle, “Moffitt Cancer Center researchers use new tool to counter multiple myeloma drug resistance” Eurek Alert. Sept. 9, 2011. [46]

  • “The research team has employed a method called Liquid Chromatography Multiple Reaction Monitoring (LC-MRM) to monitor proteins determined to be involved in acquired drug resistance. This was based on the prior myeloma research conducted at Moffitt by William S. Dalton, Ph.D., M.D., Moffitt's CEO and center director, and colleagues.”
  • Drug Resistance, Public Health

Martin, David, “MRSA in U.S. Becoming Resistant to Over the Counter Ointment,” CNN Health, September 14, 2011 [47] Last Checked 9/14/2011

  • “Frequent use of over-the-counter anti-bacterial ointments in the United States may be leading to a new, antimicrobial resistant strain of MRSA, a study published Wednesday in Emerging Infectious Diseases, the Centers for Disease Control and Prevention’s monthly peer-reviewed journal.”
  • “Resistance to bacitracin and neomycin was only found in USA300, a type of MRSA found in the United States.”
  • “It use to be mainly transmitted in hospitals but is now increasingly acquired in community settings like athletic facilities. For some a MRSA infection can be deadly.”
  • “MRSA resulted in 278,000 hospitalizations and more than 18,000 deaths in 2005, according to one study, with most of those infections coming from health care facilities. An estimated 1.5% of the U.S. populations – more than 4 million Americans – are now carriers of the bacteria.”
  • “MRSA is resistant to common antibiotics like penicillin and amoxicillin.”
  • “The USA300 strain of MRSA can still be treated with vancomycin and other drugs, but doctors in the United States should be aware ‘the ointment therapy may not be effective in USA300 infections,’ Masahiro Suzuki said.”
  • Drug Resistance, Public Health


Paddock, Catharine, “Resistant TB Spreading In Europe At Alarming Rate, WHO,” Medical News Today, September 15, 2011 [48] Last Checked 9/15/2011

  • “Multidrug-Resistant Tuberculosis is a disease that could cause a pandemic in Western Europe and kill thousands of people if health authorities fail to tackle it properly.”
  • “‘TB is an old disease that never went away, and now it is evolving with a vengeance.’”
  • “Zsuzsanna Jakab said complacency has allowed the disease to resurge and it must be tackled now to avoid huge human and economic costs.”
  • “TB is an infectious disease caused by Mycobacterium tuberculosis bacteria that gives rise to over 9 million new cases worldwide every year and nearly 2 million deaths. It is the leading cause of death among curable infectious diseases.”
  • “WHO declared TB a global emergency in 1993.”
  • “However, the cause for the current alarm is the rising number of cases of drug-resistant TB, or MDR-TB (multi-drug resistant TB), which develops when the first-line drugs are misused or mismanaged.”
  • “The concern is that the resistant forms will rise to pandemic proportions unless TB control is managed properly.”
  • “The death rate for TB is about 7%: this can rise to 50% for the resistant forms, according to WHO figures that also show cases of MDR-TB and XDR-TB are spreading at the rate of around 440,000 new cases a year worldwide.”
  • “These resistant forms of TB are much harder and costlier to treat. It can take two years or more, and cost up to 16,000 US dollars in drugs alone per patient. If the patient needs isolation care in a hospital, then the cost is in the hundreds of thousands.”
  • “More than 80,000 of these annual cases of resistant TB occur in WHO's European region, which covers 53 European and Central Asian countries.”
  • Tuberculosis, Drug Resistance, Public Health, WHO


Editors , “Fact Sheet: Global Health Security” The White House. Sept. 22, 2011. [49]

  • ““We will focus on the health of mothers and children. And we must come together to prevent, detect, and fight every kind of biological danger – whether it is a pandemic like H1N1, a terrorist threat, or a treatable disease. This week, America signed an agreement with the World Health Organization to affirm our commitment to meet this challenge.””
  • “This week President Obama addressed the United Nations General Assembly and urged the global community come together to prevent, detect, and fight every kind of biological danger, whether it is a pandemic, terrorist threat, or treatable disease.’”
  • “Improving capacities to detect, report and respond to infectious diseases quickly and accurately lies at the heart of the global community’s ability to address all infectious disease threats”
  • “The BWC Revcon offers an important opportunity to revitalize international efforts against these threats, helping to build global capacity to combat infectious diseases, prevent biological weapons proliferation and bioterrorism, and bring security, health, and scientific communities together to raise awareness of evolving biological risks and develop practices to manage them.”
  • Public Health, Bioterrorism, Biodefense, Biosecurity, Developing Countries, Executive Order, Pandemic, Emergency Response


Matishak, Martin, "Experts Offer Measures to Save Lives After Nuclear Explosion". NTI. September 28, 2011. [50]

  • “The Rad Resilient City plan includes a seven-point checklist composed by an expert panel that communities can implement to better protect residents from radioactive fallout after an atomic blast.”
  • “It lays out actions cities and regions can take, starting with obtaining broad community support for nuclear incident preparedness; conducting an ongoing public education campaign on the effects of an atomic detonation and how people can protect themselves; having all building owners or operators assess the level of fallout protection given by different types of structures; and building local capacity to deliver public warnings following an incident. The plan also calls for establishing a rapid system for mapping and monitoring radioactive fallout; developing strategies and logistics for a large-scale, phased evacuation of a municipality; and then testing all the elements of the preparedness plan.”
  • “"The bottom line is the only way for us to be prepared is to know what to do in advance," Tammy Taylor”
  • “Today there is enough fissile material in the world to fuel roughly 120,000 nuclear weapons, Tom Inglesby, chief executive officer and director of the Center for Biosecurity told the audience.”
  • Biosecurity, Nuclear, Public Health, Al-Qaeda, Emergency Response, Pandemic, Biodetection


Editors, "U.S. Supplies Jordan With Radiation Sensor Trucks" NTI. Oct. 6th, 2011. [51]

  • "A 2008 bilateral agreement calls for Jordan to receive U.S. radiation monitoring technology that would be deployed at border checkpoints, seaports and airports. Washington also agreed to supply upkeep services for the equipment and to prepare local personnel to operate the technology"

Nuclear, Bioterrorism, Biotechnology, Public Health


Editors, “U.N. Should Address Chemical Weapons Disposal Deadline Busting: Iran” NTI. Oct. 6th, 2011. [52]

  • “Russia says it should complete chemical demilitarization operations by 2015, while the United States intends to finish off its stockpile in 2021.”
  • “The United States has destroyed nearly 90 percent of its original stockpile of more than 30,000 tons of warfare materials, while Russia is halfway through disposal of 40,000 metric tons of chemical agents”
  • Russia, Bioterrorism, Nuclear, Public Health


Editors, “U.S. Better Prepared for Bioterror, Experts Say,” 14 October 2011, Global Security Newswire [53] Last Checked 14 October 2011.

  • “Ten years after the anthrax mailing that killed five people, experts on Thursday said the U.S. government has made considerable strides in preparing the nation to respond to a potential act of biological terrorism, Bio Prep Watch reported.”
  • “‘It's been 10 years, we are better today,’ said Thomas Inglesby director of the Center for Biosecurity at the University of Pittsburgh Medical Center. ‘We have a Strategic National Stockpile, we have government agencies committed to supporting research development of new countermeasures, we have a method to procure these.’”
  • “Inglesby warned that the country risked backtracking on its preparedness gains if it did not stay committed to maintaining a "full" stockpile of anti-WMD materials and supporting the development of new medical countermeasures.”
  • "While vaccines exist for high-profile and lethal bioterror threats such as anthrax and smallpox, emphasis must be given to disease materials for which drugs have not yet been similarly prepared and stored."
  • “The biodefense experts agreed the U.S. government needed to maintain focus on biological preparedness while also dealing with budget cutbacks.”
  • "The Bipartisan WMD Terrorism Research Center issued a new ‘report card’ that found the United States failing in many areas of biodefense preparedness. Specialists involved in issuing the report said that gains made in preparedness have been offset to a significant degree by rapid advances in science and technology that could be applied by terrorists to weaponize and deliver pathogens in an attack.”
  • Bioterrorism, Biosurveillance, Public Health

Singer, Stacy, “First Case of Dengue Fever Reported in Palm Beach County,” The Palm Beach Post, October 13, 2011, [54] Last Checked 10/19/2011

  • “There are no medications available, only supportive care, nor is there a vaccine, said health department spokesman Tim O'Connor.”
  • “‘They won't be doing mass aerial spraying,’ O'Connor said. ‘They are doing less spraying. But they work very closely with us and respond very quickly.’"
  • “Other mosquito-borne illnesses, such as West Nile encephalitis, have not turned up locally, though northern Florida is seeing a spike in cases, he said.”
  • “The county is using trucks to spray the area where the case was confirmed. That location is not being released because of privacy issues.”
  • Dengue, Drug Resistance, Public Health


Editors, "Fukushima Cleanup to Cost Minimum of $13B" NTI. Oct. 21, 2011 [55]

  • “The Japanese government said it anticipates spending a minimum of $13 billion to rehabilitate all of the territory exposed to radioactive contaminants from the disabled Fukushima Daiichi nuclear complex”
  • “"At least 1 trillion yen will be budgeted as we take on the responsibility for decontamination,"”
  • “The six-reactor Fukushima atomic power plant was crippled by the March 11 earthquake and ensuing tsunami that left thousands missing or dead in Japan. Radiation emissions on a scale not recorded since the 1986 Chernobyl disaster necessitated the evacuation of some 80,000 Japanese citizens from a 12-mile area surrounding the hobbled atomic facility in Fukushima prefecture”
  • Nuclear, Decontamination, Public Health, Russia


Editors, "Debate Flares Over Testing Anthrax Vaccine on Children", NTI. Oct. 25, 2011 [56]

  • “The sole Food and Drug Administration-licensed vaccine for anthrax has only been tried on adults, meaning there is a lack of information regarding the product's effectiveness on minors, appropriate amounts to use, and any potential negative effects.”
  • “While children are known to contract diseases such as mumps and measles, they might never be exposed to anthrax through an act of terrorism or other means. Therefore, the risk-benefit analysis of administering the vaccine in a study to children is less clear.”
  • “The United States has allocated $1.1 billion for delivering anthrax vaccine to the Strategic National Stockpile. While antibiotics would be utilized to combat infections, the vaccine would be administered after an event to protect against any potential surviving spores that could re-emerge over a period of time.”
  • Anthrax, Public Health, Bioterrorism, Biotechnology


Goetz, Gretchen, “Wave of Mysterious E. Coli Outbreaks Hits U.S.,” Food Safety News, October 28, 2011 [57] Last Checked November 3, 2011

  • “None of them had been traced back to a source, making it impossible for authorities to warn customers about what foods or locations to avoid in order protecting them.”
  • “‘This strain of E. coli is very potent and troublesome,’ said Dr. Robert Graham, Medical Director at the Mid-Michigan District Health Department.”
  • E. coli, Public Health


Fitzgerald, Jay, "Terminator-like robot will help Army test anti-chemical clothing" Boston Globe. Oct. 31, 2011 [58]

  • “Boston Dynamics, a Waltham company that three years ago introduced the four-legged BigDog robot, a beast of burden designed to traverse rough terrain, is unveiling its newest creation: an improved version of a walking machine that is shaped like a human being.”
  • “plans to use it for testing clothing and headgear intended to protect soldiers from chemical warfare agents”
  • “Now, via a $33 million contract with the agency, the company has developed the four-legged successor to BigDog: AlphaDog, officially known as the Legged Squad Support System, or LS3”
  • “AlphaDog can carry a 400-pound payload, travel up to 20 miles, and move at 7.5 miles per hour.”
  • “He said he envisions robots such as AlphaDog being used to help fight fires and carry commercial equipment to difficult-to-reach locations.Robots like PETMAN may later be used commercially as stand-ins for humans in dangerous assignments, such as working in nuclear power plants”
  • Chemical, Biotechnology, Biosafety, Military, Emergency Response, Nuclear, Public Health



Editors, "Boosting "Natural Killer" Cells May Counteract Anthrax" NTI. Wednesday, Nov. 2, 2011 [59]

  • “The University of Texas Medical Branch in Galveston said last week that researchers there believe they have discovered a novel tool in combating anthrax infection -- naturally occurring "natural killer" cells”
  • “"People become ill so suddenly from inhalational anthrax that there isn’t time for a T cell response, the more traditional cellular immune response," UTMB assistant professor Janice Endsley said in released comments. "NK cells can do a lot of the same things, and they can do them immediately."”
  • “The scientists tested anthrax on mice that had their natural killer cells removed and those that retained the cells. Exposure to a high level of anthrax spores killed all the mice equally quickly, but the mice that still had the natural killer cells showed significantly reduced amounts of blood-borne anthrax bacteria than their counterparts.”
  • Anthrax,Public Health, Vaccination, Synthetic Biology, Decontamination, Bioterrorism, Biodefense


Editors, "U.S. Acknowledges Possible Threats to Pakistani Nukes" GTI. Nov. 8th, 2011. [60]

  • “The Atlantic and National Journal jointly reported last week that the Pakistani army had taken to transporting nuclear warheads around the country via unmarked civilian-style vans on congested roadways in an attempt to keep their whereabouts away from prying U.S. intelligence efforts”
  • ““The U.S. government's views have not changed regarding nuclear security in Pakistan," the U.S. embassy in Islamabad said in a statement. "We have confidence that the government of Pakistan is well aware of the range of potential threats to its nuclear arsenal and has accordingly given very high priority to securing its nuclear weapons and materials effectively."”
  • “These new recruits would comprise "handpicked officers and men, who are physically robust, mentally sharp and equipped with modern weapons and equipment, trained in technical skills to the best international standards and practices,"”
  • Public Health, Military, Chemical, Nuclear, Biosafety, Biodefense


Editors, "Survey to compile detailed radiation map in Fukushima begins". Mainichi Daily News. Nov. 8th 2011. [61]

  • “Measurements will be taken by unmanned helicopters around woodland and rivers, while monitoring vehicles will travel along roads in residential areas, it said.”
  • “The survey is "the first step of decontamination work by the government," said Soichiro Seki, a senior Environment Ministry official."We will try hard to restore normal conditions in Fukushima, keeping in mind that Fukushima cannot be revitalized without decontamination."”
  • Chemical, Decontamination, Public Health, Nuclear, Biodetection, Biosafety, Biodefense, Biosecurity


Quinlisk et. Al, “Challenges in the Use of Anthrax Vaccine Absorbed (AVA) in the Pediatric Population as a Component of Post-Exposure Prophylaxis (PEP),” National Biodefense Science Board, October 2011 [62] Last Checked November 9, 2011

  • “In the event that Bacillus anthracis (B. anthracis) spores are released in the United States, the current plan of the U.S. Department of Health and Human Services (HHS) is to ensure that anthrax vaccine absorbed (AVA) is made available to adults and children.”
  • “In this emergency scenario, AVA would be used in conjunction with antibiotics to prevent the development of infection and illness following exposure to anthrax spores, a form of therapy termed ‘post-exposure prophylaxis’ (PEP).”
  • “The U.S. Government has stockpiled finite amount of AVA as a key component of PEP following an anthrax attack.”
  • “‘If there were a widespread anthrax release right now, we would confront a situation where anthrax vaccine has never been tested or used in children.’”
  • “There are no data about the safety or immunogenicity of AVA (for pre- or post-exposure prophylaxis) in children.”
  • “AVA is the only anthrax vaccine licensed in the United States; it is licensed for use in adults 18 to 65 years of age for pre-exposure vaccination.”
  • “If the Secretary of HHS declares a public health emergency following a release of B. anthracis spores, the FDA can issue an emergency use authorization (EUA) that allows adults to receive AVA as prophylaxis on a voluntary basis.”
  • “The vaccine would be offered to the pediatric population without knowing whether it is safe and capable of inducing antibodies against B. anthracis bacteria (that is, immunogenic).”
  • “The NBSB, (National Biodefense Science Board), formed the AV WG working group which held meetings and workshops to solicit input from academic scientists, physicians, and other healthcare providers, representatives from professional pediatric organization to hear their views and discuss the issue.”
  • “HHS should develop a plan for and conduct a pre-event study of AVA in children, to include a research IND (investigational new drug application).”
  • “The U.S. Government requested that the NBSB consider issues related to the use of AVA in children.”
  • “The impetus for the request was to strengthen public health measures against a biological weapons attack using Bacillus anthracis, the bacterium that causes anthrax, by ensuring that special populations are considered in U.S. preparedness and response activities.”
  • “HHS decided to focus on the pediatric population because they comprise a large percentage of the population; there are no clinical data on the use of AVA in children, whether for pre-exposure vaccination or post-exposure prophylaxis; and the HHS Food and Drug Administration has not licensed AVA for use in children.”
  • “The virulence of B. anthracis derives from its capsule and toxin.”
  • “The toxin is composed of three proteins: protective antigen, edema factor, and lethal factor
  • “Approx. 95% of naturally occurring human cases of anthrax are cutaneous, according to CDC, and the mortality rare for untreated cutaneous anthrax is 20%.”
  • “The Institute of Medicine report further states that, ‘if terrorists released B. anthracis over a large city, hundreds of thousands of people could be at risk of the deadly disease.’”
  • “There is no text to determine which individuals have inhaled B. anthracis spores.”
  • “The HHS plan is to offer antibiotics and AVA to all adults and children likely to have been exposed.”
  • “All the AVA available for use during a public health emergency is stored in the Strategic National Stockpile (SNS), which is maintained by CDC.”
  • “AVA has been licensed for human use in the United States since 1970, and is the only licensed human anthrax vaccine in the United States.”
  • “In the United States, AVA is used to protect military personnel, and at-risk laboratory.”
  • Anthrax, Vaccination, Public Health


Editors, “Georgia Bioterror Suspects to Appear in Court,” Global Security Newswire, November 9, 2011 [63] Last Checked November 9, 2011

  • “Two members of a fringe Georgia militia accused of plotting to develop a lethal biotoxin for use in attacks aimed at bringing down the government.”
  • “ Ray Adams and Samuel Clump have been charged with plotting to produce ricin, using castor beans that Adams allegedly grew in his yard and provided to Clump.”
  • “Ricin is deadly in even trace amounts and there is no known antidote.”
  • “Its potential applications as a biological weapon have been considered by various terrorist groups, due to the relative ease of acquiring the ingredients and directions needed to produce the toxin.”
  • “They potentially could have used ricin to poison a few people and used those attacks to fuel a widespread panic.”
  • Ricin, Public Health, Drug Resistance, Law Enforcement

Editors, “Militia Members Plead Innocence on Bioterror Charges,” Global Security Newswire, November 10, 2011 [64] Last Checked November 15, 2011

  • “They planned to produce and disseminate a deadly biotoxin in attacks aimed at undermining federal and state governments.”
  • “ Assistant U.S. Attorney Robert McBurney said the accused had gone as far as surveying potential government targets in Atlanta and taking steps to generate ricin -- a deadly toxin for which there is no known antidote.”
  • “If found guilty of the charges, the four men could face prison sentences of over 10 years.”
  • “Ray Adams and Samuel Clump denied they had plotted to generate ricin from castor beans.”
  • Ricin, Public Health, Drug Resistance. Law Enforcement


Sinha, Kounteya, “Drug resistance growing among TB patients,” The Times of India, November 15, 2011 [65] Last Checked November 15, 2011

  • “Drug resistance is spreading among tuberculosis (TB) patients in India.”
  • “According to India's revised national TB control programme (RNTCP), latest studies conducted in Maharashtra, Gujarat and Andhra Pradesh have found that around 12% to 17% of all TB re-treatment cases are drug resistant.”
  • “Dr. Kumar told TOI, ‘At present we have only 6-7 effective drugs against TB.’”
  • “Random and irrational use of these drugs, especially by private doctors, is making patients drug resistant.”
  • “There have been no new TB drug classes for nearly 50 years and irrational courses to patients is leading to resistance among whatever drugs are available.”
  • “The government has plans to put in place 43 labs to diagnose MDR-TB.”
  • “According to Dr. Kumar, ‘most patients start treatment of TB in the private sector. The private doctors use irrational combinations to treat them making them drug resistant. They finally land up in the government treatment programme.’”
  • “The direct and indirect cost of TB to India amounts to an estimated $23.7 billion annually.”
  • Tuberculosis, India, Drug Resistance, Vaccination, Public Health


Editors, “Georgia Militia Members to Seek Bail Release,” Global Security Newswire, November 16, 2011 [66] Last Check November 16, 2011

  • “A container of castor beans seized from the house subsequently tested positive for the presence of ricin.”
  • “‘Prior to that there had been a lot of talk. Once we determined they had the main ingredient, it significantly increased our concern,’ FBI Atlanta office domestic terrorism supervisor Doug Korneski said.”
  • “Recordings were aired in court on Tuesday of the men talking together about their desire to kill government officials.”
  • “ Samuel Crump and Ray Adams are accused of taking steps to produce ricin, which is derived from castor beans, is lethal in trace amounts and has no known antidote.”
  • “The four elderly Georgia men accused of scheming to build crude bombs and develop deadly biological toxins for use in attacks against government officials are scheduled on Wednesday to submit in federal court a request to be released on bail.”
  • Ricin, Drug Resistance, Law Enforcement, Public Health


Beaumont, Peter and Domokos, John, "Egyptian military using 'more dangerous' teargas on Tahrir Square protesters", 23 November 2011, theguardian, [67], Last Checked 23 November 2011.

  • "Egyptian security forces are believed to be using a powerful incapacitating gas against civilian protesters in Tahrir Square following multiple cases of unconsciousness and epileptic-like convulsions among those exposed."
  • "Suspicion has fallen on two other agents: CN gas, which was the crowd control gas used by the US before CS was brought into use; and CR gas."
  • "Both gases can be more dangerous than CS and can cause unconsciousness and seizures in certain circumstances. Concern began to emerge over the use of more powerful incapacitating agents after reports of gassed protesters falling unconscious and having attacks of jerking spasms. Those who have experienced the more powerful gas have described it as smelling different and causing an unusual burning sensation on the skin. Others have complained of rashes."
  • "We have been attacked with four different kinds of gas bombs," said Dr Ahmad Sa'ad. "I have never seen these ones before because the patients come in with convulsions. I've never seen patients like that before. You can see it yourself. You can be 100 metres away from the gas bombs [and it will still affect you]."
  • "Another concern, raised by the group Campaign Against Arms Trade, is over the age of some of the CS gas that has been used by Egyptian security forces. Gas canisters more than five years old can become more toxic, and some canisters that have been used in the last few days are up to a decade old."
  • "Describing the effects of gas, activist Ahmed Salah said he was still coughing blood 15 hours after being exposed to it. "I was wearing a gas mask. My eyes and mouth were covered as was my skin. As soon as the gas came people around me fell on to the ground in convulsions. I felt very weak and dizzy. I couldn't focus and I started coughing. Coughing up blood. "People have seen three different kinds of canisters. Most are marked CS but some have seen canisters marked with the letters CR and there is a third canister that has no markings at all."
  • "In a statement put out via Twitter, Ramez Reda Moustafa, a neurologist at Cairo's Ain Shams University, described seeing cases where exposure to gas had "caused extra-pyramidal symptoms [involuntary jerks in extremities and trunk mimicking a convulsive seizure, oculogyric crisis, etc] and little respiratory distress". He added: "The type of gas used is still uncertain but it is certainly very acidic and is not the regular teargas used in January."
  • "Karim Ennarah, who works with the Egyptian Initiative for Personal Rights, has been trying to collect evidence about the gases used in Tahrir and the surrounding area since the weekend, and in what circumstances, amid claims the gases have been used in a way that violates international norms."We are still trying to put together what has been going on. We have seen different symptoms and reactions to gas from what we saw in January," said Ennarah. "I still have not seen a canister with CR markings but there are accounts of people seeing them."But we can't say that it has been confirmed. We have seen more and more videos, however, of people suffering seizures."
  • "What is clear is that gas has been used differently and far more heavily than was used at the beginning of the year and in enclosed areas like Mohammed Mahmoud. The basic principle of the way the gas is being used is not for riot control but as a punishment and that raises questions of violations of its use."
  • Chemical, Africa, Military, Public Health



Editors, "US fears Dutch research could be biological weapon". RNW. 25, November 2011. [68]

  • “Fouchier showed that with a small number of mutations in the virus DNA, he was able to change it into an extremely infectious variant.”
  • “Avian flu is rarely transferred from animal to human, but, when it happens, the result is usually fatal.”
  • “By deliberately modifying the virus’ genes, Dr Fouchier was able to induce H5N1 transmission between ferrets, which are commonly used to study flu transmission between humans because of similar immune systems.”
  • Bioterrorism, Public Health, Flu, Japan, Pandemic, Biosafety


Editors, “Saudi may join nuclear arms race: ex-spy chief”, Yahoo News. Dec. 5th 2011. [69]

  • “Saudi Arabia may consider acquiring nuclear weapons to match regional rivals Israel and Iran, its former intelligence chief Prince Turki al-Faisal said on Monday.”
  • “Israel is widely held to possess hundreds of nuclear missiles, which it neither confirms nor denies, while the West accuses Iran of seeking an atomic bomb, a charge the Islamic republic rejects.”
  • “Abdul Ghani Malibari, coordinator at the Saudi civil nuclear agency, said in June that Riyadh plans to build 16 civilian nuclear reactors in the next two decades at a cost of 300 billion riyals ($80 billion).”
  • Nuclear, Biosecurity, Bioterrorism, Biodefense, Biosafety, Public Health


Editors, “North Korea making missile able to hit U.S.”, The Washington Times. Dec 5th, 2011. [70]

  • “New intelligence indicates that North Korea is moving ahead with building its first road-mobile intercontinental ballistic missile, an easily hidden weapon capable of hitting the United States, according to Obama administration officials.”
  • ““We believe this new intelligence reiterates the need for the administration to correct its priorities regarding missile defenses, which should have, first and foremost, the missile defense of the homeland.””
  • “Mobile missiles are difficult for tracking radar to locate, making them easier to hide. They also can be set up and launched much more quickly than missiles fired from silos or launchpads.”
  • ““North Korea has three paths to building ICBMs. One is using the Taepodong-2, with a range of up to 9,300 miles, as its main strategic missile. A second way is to further develop the ranges of existing missiles like the Musudan, and last is to “use the very large launch facility that is being constructed on the west coast of North Korea to launch a very large missile,” the cable said.”
  • “North Korea also has a new solid-fueled short-range missile called the Toksa, with a range of 75 miles, and has sold a number of shorter-range Musudan missiles to Iran, the report said.”
  • “Pressed for details, he said, “I don’t think it’s an immediate threat, no. But on the other hand, I don’t think it’s a five-year threat.””
  • ““They are developing a road-mobile ICBM. I never would have dreamed they would go to a road-mobile before testing a static ICBM. It’s a huge problem. As we’ve found out in a lot of places, finding mobile missiles is very tough”
  • Nuclear, Biosecurity, Biodefense, Bioterrorism, Biotechnology, Emergency Response, Military, Public Health, CWC, Russia, North Korea, Homeland Security, Biodetection



Editors, “France admits lapses after breach of nuke reactor security” CNN. Dec. 6th,2011. [71]

  • “Interior Minister M. Claude Gueant said there have been lapses in the nuclear plant's security system and has ordered a search of all nuclear plants, a spokesman for the ministry told CNN.”
  • “"This action shows how vulnerable the French nuclear centrals are: Peaceful activists have managed with a few means, to reach the heart of the nuclear central!”
  • Biosecurity, Biodefense, Public Health, Law Enforcement


Swaan, Corien, M.; Appels, Rolf; Kretzschmar, Mirjam E.E.; van Steenbergen, Jim E.; “Timeliness of contact tracing among flight passengers for influenza A/H1N1 2009, BMC Infectious Diseases, December 28, 2011. [72]

  • ”During the initial containment phase of influenza A/H1N1 2009, close contacts of cases were traced to provide antiviral prophylaxis within 48 h after exposure and to alert them on signs of disease for early diagnosis and treatment.”
  • ” Passengers seated on the same row, two rows in front or behind a patient infectious for influenza, during a flight of ≥ 4 h were considered close contacts.”
  • ”This study evaluates the timeliness of flight-contact tracing (CT) as performed following national and international CT requests addressed to the Center of Infectious Disease Control (CIb/RIVM), and implemented by the Municipal Health Services of Schiphol Airport.”
  • ”In a retrospective study, dates of flight arrival, onset of illness, laboratory diagnosis, CT request and identification of contacts details through passenger lists, following CT requests to the RIVM for flights landed at Schiphol Airport were collected and analyzed.”
  • ”24 requests for CT were identified. Three of these were declined as over 4 days had elapsed since flight arrival. In 17 out of 21 requests, contact details were obtained within 7 days after arrival (81%). The average delay between arrival and CI was 3,9 days (range 2–7), mainly

caused by delay in diagnosis of the index patient after arrival (2,6 days). In four flights (19%), contacts were not identified or only after >7 days.”

  • ”CI involving Dutch airlines was faster than non-Dutch airlines (P < 0,05). Passenger locator cards did not improve timeliness of CI. In only three flights contact details were identified within 2 days after arrival.”
  • ”CT for influenza A/H1N1 2009 among flight passengers was not successful for timely provision of prophylaxis. CT had little additional value for alerting passengers for disease symptoms, as this information already was provided during and after the flight.”
  • ”Public health authorities should take into account patient delays in seeking medical advise and laboratory confirmation in relation to maximum time to provide postexposure prophylaxis when deciding to install contact tracing measures. International standardization of CT guidelines is recommended.”
  • Contact Tracing, Flu, Public Health, Netherlands

2012

µµ Editors, "Thompson seeks health care for veterans; DOD tested chemical weapons on servicemen during 60s and 70s", 24 February 2012, times-standard.com, [73] Last Checked 24 February 2012.

  • "Congressman Mike Thompson said that veterans subjected to chemical weapons testing during the 1960s and 1970s must receive medical benefits and disability compensation for their health conditions during an Institute of Medicine study committee in Sacramento on Thursday."
  • "Thompson, D-St. Helena, introduced Humboldt County resident and Navy veteran Jack Alderson, who has been diagnosed with melanoma, prostate cancer and has had four occurrences of asbestos in his lungs. According to a press release from Thompson's office, Alderson commanded some of the ships that were subjected to experimental tests by the Department of Defense from 1964 to 1967. The department sprayed live chemical and biological agents on ships and sailors to test the Navy's vulnerability to toxic warfare."
  • "In late 2002, the Department of Defense revealed that it had tested chemical and biological agents by spraying them on ships and sailors between 1962 and 1974. These tests -- known as Project 112, which is part of Project Shipboard Hazard and Defense -- exposed at least 6,000 service members to harmful chemicals without their knowledge -- including Vx nerve gas, Sarin nerve gas and E. coli."
  • "Many of those veterans currently do not receive priority care from the U.S. Department of Veterans Affairs or disability benefits because the VA does not officially recognize any long-term health consequences from exposure to these tests, according to Thompson's office. In 2010, Congress passed a law requiring the VA to contract with the Institute of Medicine to consider long-term impacts on veterans that were part of Project 112."
  • "If the institute finds a connection between the chemical testing and the veterans' medical issues, the VA could be required to provide all service members with medical care and full disability compensation."
  • ”Our country must ensure that any service member who has become sick or developed a disability because of these tests is provided with the treatment they deserve and benefits they've earned,” Thompson said in a press release."

Public Health, Chemical, Military


µµ Editors, "Army called after chemical drum ruptured", 29 February 2012, MSN.CO.NZ, [74] Last Checked 3 March 2012.

  • "A Southland man has been taken to hospital after puncturing a drum of soil fumigant so toxic that it has been used in chemical warfare. The drum, containing chloropicrin, was ruptured by a digger being used in a dairy farm conversion at Branxholme, north of Invercargill."
  • "Environment Southland compliance manager Mark Hunter told the Southland Times at least five drums had been found buried on the property on Monday. A digger had punctured one of the drums and a man had been taken to hospital suffering the effects of exposure to chemicals, he said."
  • "Fire crews, wearing protective equipment, were called in to help deal with the drums. The army, which has experience with such chemicals, will clear the site on Wednesday. Public health, the regional council and police had also attended the scene and the chemical had been covered, Mr Hunter said."
  • "Chloropicrin had been used in the past to kill bugs in the soil and to fumigate rabbit burrows, Mr Hunter said. During war it has been used as tear gas. "You have got to be very careful how you handle it. It would not be something Joe Bloggs would want to be handling, that's for sure."
  • "At this stage it was unknown who had buried the drums or why. He expected it to take a few days to clean up the area properly. If the chemical could not be used locally it might have to be disposed of overseas."
  • Chemical, Public Health, Military


µµ Martin, David, "Vets feel abandoned after secret drug experiments", 1 March 2012, CNN.com, [75] Last Checked 3 March 2012.

  • "From 1955 to 1975, military researchers at Edgewood were using not only animals but human subjects to test a witches' brew of drugs and chemicals. They ranged from potentially lethal nerve gases like VX and sarin to incapacitating agents like BZ."
  • "The moment 18-year-old Army Pvt. Tim Josephs arrived at Edgewood Arsenal in 1968, he knew there was something different about the place."It was like a plum assignment," Josephs said. "The idea was they would test new Army field jackets, clothing, weapons and things of that nature, but no mention of drugs or chemicals.""
  • "This top secret Cold War research program initially looked for ways to defend against a chemical or biological attack by the Soviet Union, thought to be far ahead of the United States in "psycho-chemical" warfare. But the research expanded into offensive chemical weapons, including one that could, according to one Army film obtained by CNN, deliver a "veritable chemical ambush" against an enemy. "This incapacitating agent would be dispersed by standard munitions, and the agent would enter the building through all nonprotected openings," the film's narrator boasts."
  • "President Nixon ended research into offensive chemical weapons in 1969, and the military no longer uses human subjects in research on chemical agents, said a spokesman for Edgewood Chemical Biological Center, as the facility is known now."
  • ""Sometimes it was an injection. Other times it was a pill," Josephs told CNN Chief Medical Correspondent Dr. Sanjay Gupta. Josephs said he didn't know what drugs he was getting. "A lot of chemicals were referred to as agent one or agent two." Some weeks, he would undergo one test; other weeks, more, Josephs said. And when he questioned the staff about whether he was in any danger, they reassured him: "There is nothing here that could ever harm you."
  • "But Josephs, 63, believes the chemical agents he received during his two-month stint at Edgewood did harm him, triggering health problems that continue to plague him four decades later. Even when he talks about Edgewood, he said, "I get a tightness in my chest." Days before his Edgewood duty ended, in February 1968, Josephs was hospitalized for days with Parkinson's-like tremors, symptoms he said have followed him on and off throughout his adult life.
  • "From Edgewood, Josephs said he went to an Army installation in Georgia, where he experienced tremors so severe, he had to be admitted to the base hospital and given muscle relaxers. The Army then sent Josephs to Air Force bases in Thailand, in support of the war effort in Vietnam. He was told never to talk about his experiences at Edgewood and to forget about everything he ever did, said or heard at the Maryland base."
  • "In his mid-50s, Josephs was diagnosed with Parkinson's disease, a progressive neurological condition that forced him to retire early. Medications cost $2,000 a month, which he was paying for out of pocket. Josephs applied for veterans benefits based on chemical exposure at Edgewood. Last year, the Department of Veterans Affairs granted him partial benefits for his Parkinson's for Agent Orange exposure during his time in Thailand, giving Josephs 40% disability. The letter granting him benefits made no mention of Edgewood."
  • "Gordon Erspamer, lead attorney in the suit, has reviewed the partial Edgewood medical records that Josephs was able to obtain with the help of his wife. Erspamer said Josephs probably received an injection of sarin or another nerve gas, because the records show that he received the drug P2S on February 1, 1968, to treat "organophosphate poisoning."
  • "Erspamer said he sees a connection between Josephs' Parkinson's disease and the drugs he received at Edgewood. "Those substances affect the same region of the brain," Erspamer said. "Tim clearly had adverse health effects because they gave him such high doses that he ranged from overdose with one substance to the antidote, back and forth, and he actually had to get ... a very powerful antipsychotic drug because, in the vernacular, he flipped out."
  • "Erspamer said the government has reached very few of the 7,000 or so Edgewood veterans, and the VA has turned down almost all Edgewood-related health claims. Court documents show that the Veterans Benefits Administration rejected 84 of 86 health claims related to chemical or biological exposure. Josephs has not received any health benefits related to his time as a human test subject at Edgewood. "They're hoping we die off, so you apply [for benefits], you get turned down," Josephs said. "And it just goes on for years and years, and they just want to wear us down. They want to use young men as guinea pigs and throw them away."
  • "The Department of Defense and Department of Veterans Affairs declined face-to-face interviews with CNN, citing pending litigation. In a statement, the Defense Department said that it "has made it a priority to identify all service members exposed to chemical and biological substances ... and the VA has contacted and offered free medical evaluations to thousands of veterans." At the Army's request, The Institute of Medicine, an independent nonprofit organization that is the health arm of the National Academy of Sciences, produced a three-volume report in the 1980s on the long-term health of Edgewood veterans. The IOM decided in the end there wasn't enough information to reach "definitive conclusions."
  • Chemical, Public Health, Military


Zimmer, Carl, “Amateurs Are New Fear in Creating Mutant Virus”, New York Times, March 5, 2012, [76]Last Checked. October 11, 2012.

  • “This disturbing question has been on the minds of many scientists recently, thanks to a pair of controversial experiments in which the H5N1 bird flu virus was transformed into mutant forms that spread among mammals."
  • “On the question of who, while terrorists and cults have long been a concern in biosecurity circles, some scientists also fear that publication may allow curious amateurs to recreate the mutated virus — raising the risk of an accidental release.”
  • “Over the past decade, more amateur biologists have started to do genetic experiments of their own. One hub of this so-called D.I.Y. biology movement, the Web site DIYbio.org, now has more than 2,000 members.”
  • “There are many ways to make a virus. The simplest and oldest way is to get the viruses do all the work. In the 19th century, doctors produced smallpox vaccines by inoculating cows with cowpox viruses. The viruses replicated in the cows and produced scabs, which were then applied to patients, protecting them from the closely related smallpox virus.”
  • “More recently, scientists discovered how to make new viruses — or at least new variations on old ones. The biotechnology revolution of the 1970s enabled them to move genes from one virus to another.”
  • “Scientists have also learned how to tweak individual virus genes. They remove a portion of the gene and then use enzymes to mutate specific sites. Using other enzymes, they paste the altered portion back into the virus’s genes.”
  • “Another way to make altered viruses is to harness evolution. In a method called serial passage, scientists infect an animal with viruses. The descendants of those viruses mutate inside the animal, and some mutations allow certain viruses to multiply faster than others. The scientists then take a sample of the viruses and infect another animal.”
  • “Viruses can change in important ways during this process. If it is done in the presence of antiviral drugs, scientists can observe how viruses evolve resistance. And viruses can become weak, making them useful as vaccines.”
  • “The scientists used well-established methods: First they introduced a few mutations into the H5N1 flu genes that they thought might help the bird flu infect mammals. They administered the viruses to the throats of ferrets, waited for the animals to get sick and then transferred viruses to other ferrets. After several rounds, they ended up with a strain that could spread on its own from one ferret to another in the air.”
  • “A DNA-synthesis company would then send back harmless segments of the flu’s genes, pasted into the DNA of bacteria. The scientists could cut out the viral segments from the bacteria, paste them together and inject the reconstructed virus genes into cells. If everything went right, the cells would start making mutH5N1 viruses.”
  • “Some of the equipment that scientists use to work on viruses has grown so inexpensive that it is no longer limited to university labs. Devices for duplicating pieces of DNA sell for a few hundred dollars on eBay, for example.”
  • “It is hard to predict how the future evolution of biotechnology will affect the risk of homegrown pathogens.”
  • “And some experts say that regardless of how a lethal virus might arise, the important thing is to be able to defeat it when it appears, so that we can avoid a global catastrophe like the 1918 flu pandemic, which killed 50 million people.”
  • Public Health, Lab Safety, Open Science


µµ Dodson, Don, "UI researchers develop effective, less costly way to remove contaminants", 18 March 2012, new-gazette.com, [77] Last Checked 24 March 2012.

  • "Jim Langer and Weihua Zheng have come up with a relatively inexpensive — but effective — way to remove perchlorate from water."
  • "Perchlorate is a rocket-fuel component that has found its way into water sources, sometimes near air force bases. Exposure to it can affect the thyroid gland."
  • "But by using "clever chemistry," Langer and Zheng have been able to develop a filter material that can remove the contaminant from water. The filter can be used on a faucet or in a pitcher, and the researchers see commercial potential for it."
  • "Already, the company has received two Small Business Innovation Research grants — $150,000 from the National Science Foundation and $100,000 from the Department of Defense."
  • "The NSF grant will be used to commercialize the technology for removal of perchlorate and possibly other contaminants from water. The Defense Department grant will be used to develop ways of protecting facilities from chemical warfare — possibly by using the filter material in heating, ventilating and air-conditioning systems."
  • "Langer, 32, of Urbana said the filter is made possible by composite materials known as "ion-exchange fiber composites." The technology involves coating tiny fibers with resin and activating the material by chemical or temperature means. In Serionix filters, ion exchange is used to convert perchlorate to chloride."
  • "Langer said Serionix is working with Champaign-based Serra Ventures to develop corporate strategies. He figures Serionix may work with corporate partners to manufacture materials for Serionix — or the firm may license the technology so interested companies can integrate it into their products."
  • Chemical, Public Health, Decontamination

µµ Editors, "Alert over sale of deadly Jequirity bracelets containing terrorism toxin", 22 March 2012, halifaxcourier.co.uk, [78] Last Checked 24 March 2012.

  • "An alert has been issued after potentially deadly bracelets were found on sale. The jewellery, which is known to have been sold through 36 retailers across the UK, is made of poisonous red and black Jequirity beans."
  • "They contain abrin, a controlled substance under the Terrorism Act which can kill in doses of just three micrograms if swallowed. The toxin is chemically similar to the chemical warfare agent ricin."
  • "It follows a country-wide safety warning from the Public Health Agency (PHA) earlier this month. Anyone who has one should bag it and then wash their hands and avoid touching their eyes. It can then be safely disposed of in normal household waste."
  • Chemical, Public Health, U.K.


µµ Cannon Jeff, "Does the beauty of the Withlacoochee State Forest behold danger?", 9 April 2012, NewPortRicheyPatch, [79], Last Checked 15 April 2012.

  • "This full blown testing program started in mid-1943, when job advertisements, placed by the U.S. Army Chemical Warfare Service (CWS), began appearing on the bulletin boards of several colleges. The CWS ads sought graduate students in the fields of chemistry and biology for work in Bushnell, Florida."
  • "According to Army Corps of Engineers records, on October 26, 1943, through a special use permit from the U.S.D.A., the United States War Department acquired 18,240 acres of public land for use as an Army Air Force air-to-ground gunnery range, known as the Lacoochee Bombing Range. Within a month of the acquisition a new army air field, known as the Bushnell Air Field, began appearing on military maps and the top secret operations were soon underway."
  • "The CWS Mobile Unit, a satellite unit of the Dugway Proving Ground in Utah, conducted 23 separate tests using non-persistent agents or short lived gases like chlorine, hydrogen cyanide, and phosgene. However, subsequent testing began in January 1944, when armed forces conducted their field experiments, both aerial and ground level, with persistent and miscellaneous agents such as nitrogen based mustard gases (HN1, HN3) and CNS, which is a tear gas mace consisting of chloropicrin-chloroform mixture. These toxic chemical agents were dispersed in a variety of ways including with bombs, mortars, rockets, cluster bombs, spray tanks, and “Comings Candles.”"
  • "The subsequent tests consisted of 358 experiments, but one major problem was losing bombs because of the dense forest and swampy lands, according to the Army Corps."
  • "While it remains unclear when testing of persistent agents ceased, by October 1, 1945, tests had moved from chemical means to biological. Reports show the final test at the Lacoochee Bombing Range took place between October 1, 1945 and December 1, 1945, and included the spraying of the biological agent DDT in unspecified forested areas."
  • "Beville said, “There were wire coops about ten feet, by ten feet, by three feet lined up along the runway [Bushnell]. In them were dead and dying animals; chickens, hawks, pigs, goats, etc. Some cages contained the rotting carcasses of farm animals.” What Beville witnessed were those test subjects from the military’s top secret chemical weapons testing."
  • "On December 18, 1945, the Locoochee Bombing Range was determined surplus to the needs of the Army Air Force, and, on October 7, 1946, the U.S. War Department determined that the site was excess and relinquished their special use permit on December 6, 1946. According to the Army Corps of Engineers, range clearance and disposal operations began on February 20, 1950 and were completed on May 31, 1950."
  • "Of these 262 unexploded munitions, the map indicates the recovery locations of 197, M-4 bombs containing mustard gas, one chemical mortar containing mustard gas, and 15, M-89 Target ID bombs also filled with mustard gas. The map also shows approximately two-square miles of dense swamp that contained at least 202 unexploded munitions."
  • "In 1984, Wayne Wertz was drilling a well at the former Bushnell Air Field when he suffered severe chemical burns after being splashed with water from the new well.Neither the Army nor Florida officials would say that Wertz had been burned by remnants of wartime experiments, but did say the man’s legs were blistered by chemicals. A Sumterville doctor diagnosed Wertz as having “chemical dermatitis” and the incident even drew attention from the Pentagon."
  • "The most recent investigations into the use of chemical weapons within the Withlacoochee State Forest came in 1993 when the U.S. Army Corps of Engineers conducted surveys using geophysical and visual reconnaissance. More specifically they concentrated on several of the areas that had been previously restricted to surface use. The survey report noted that of these areas, some now contain hiking trails, hunting areas, primitive campsites, and, in one case, a site used by a nearby boys rehabilitation center."
  • "Some researchers have recently grown concerned about the affects of WWII chemical testing on our drinking water since parts of the Green Swamp were within the Lacoochee Bombing Range. During a 1984 interview with the Tampa Tribune, Sumter County environmental health supervisor Warren Maddox said, “There wasn’t spraying in the Green Swamp, but they dropped bombs (of mustard gas) and artillery shells on pigs and goats to test the effects.”
  • Chemical, Public Health

µµ Pollick, Michael, "Rapid Pathogen Screening secures Homeland Security deal", 3 May 2012, heraldtribune.com,[80], Last Checked 7 May 2012.

  • "Rapid Pathogen Screening Inc. -- the local company developing test kits aimed at spotting the flu and other diseases -- has landed a contract with the U.S. Department of Homeland Security."
  • "The contract from the agency's Chemical and Biological Defense Division is for the development and manufacture of a rapid, point-of-care diagnostic test for use during a biological attack or pandemic. All the test would require from a patient is a finger stick for blood."
  • "There is a certain combination of things that the Department of Homeland Security gave us a grant to develop a test for," said RPS marketing manager Laura Lovejoy. "This would be used in a pandemic or a biological attack, with some sort of virus being released into an urban area."
  • "Theoretically, the kit format developed by RPS can be aimed at spotting almost any virus or bacterial threat, by measuring the presence of the antibody the body creates on its own to fight the invader."
  • "The company, which now employs 30, is beginning to market a second generation of its original test kit, designed to spot the highly contagious viral form of conjunctivitis, or pink-eye."
  • "The new version of this kit, called AdenoPlus, was designated this week by the U.S. Food and Drug Administration as being a test with the lowest possible complexity. This means that the new version can be used by anybody in the medical office, including, for example, technicians or aides as well as doctors and nurses."
  • "If the test shows positive for viral conjunctivitis, the patient would know that antibiotics would not be useful."
  • "RPS already has received grants from within the Defense Department establishment to develop a test kit aimed at four different nerve agents, including the two best-known, Sarin and VX."
  • Biodetection, Biotechnology, Public Health, Flu, Chemical Surveillance


Olson, Dean., "Agroterrorism: Threats to America’s Economy and Food Supply," FBI Law Enforcement Bulletin, 81(2), 1-9 [81] Last checked: September 16, 2012

  • “Terrorists consider America's agriculture and food production tempting targets. They have noticed that its food supply is among the most vulnerable and least protected of all potential targets of attack.”
  • “A subset of bioterrorism, agroterrorism is defined as "the deliberate introduction of an animal or plant disease for the purpose of generating fear, causing economic losses, or undermining social stability.”
  • “The agroterrorism threat emanates from four categories of perpetrators. The foremost threat is posed by transnational groups, like al Qaeda -- widely believed to present the most probable threat of inflicting economic harm on the United States,...economic opportunists tempted to manipulate markets,...domestic terrorists who may view the introduction of FMD as a blow against the federal government,...[and] militant animal rights or environmental activists pose a threat because they consider immoral the use of animals for food."
  • “Now, al Qaeda places its emphasis on smaller, independent attacks following a “‘death by a thousand cuts" strategy to exhaust, overwhelm, and distract U.S. Department of Homeland Security forces’”
  • “Usama Bin Ladin consistently had argued that attacking the U.S. economy represented the best way to destroy America's ability to project military power abroad”
  • “Analysts believe that al Qaeda's evolving tactics increasingly will "focus on targets that will yield the most economic damage."
  • “The ability to employ cheap and unsophisticated means to undermine America's economic base, combined with the added payoff to potentially overwhelm its counterterrorism resources, makes livestock-and food-related attacks increasingly attractive”


Editors, “Schools Unprepared for Pandemics”, Discovery News. September 21, 2012. [82] Last Checked. September 25, 2012.

  • “To assess school readiness for bioterrorist attacks or flu outbreaks, researchers at St. Louis University Medical Center surveyed about 2,000 nurses in 26 states who worked with kids of all ages, ranging from elementary to high school.”
  • “Still, fewer than half of schools around the United States have adequate plans in place to deal with the next pandemic.”
  • “Fewer than half of the plans specifically addressed pandemic preparedness. And just over 40 percent of schools had updated their plans since the 2009 H1N1 pandemic, which spread through 214 countries, killed more than 18,000 people, and hit school-aged children hardest.”
  • “Some models suggest that a future pandemic could make 90 million people sick and cause more than 209,000 deaths in the United States alone. Yet, just 20 percent of schools have stockpiled alcohol-based hand rub, according to the survey's results.”
  • “U.S. schools must continue to address gaps in infectious disease emergency planning, including developing better plans, coordinating these plans with local and regional disaster response agency plans, and testing the plans through disaster drills and exercises.”

Emergency Response, Pandemic, Public Health


Redden, Molly. “How to Tell If FEMA is Doing a Good Job, or a Lousy One.” October 30, 2012. The New Republic. [83] Last Checked November 15, 2012.

  • “First you’ve got the response phase, and then you’ve got the recovery phase. We’re in the response phase, which is what you saw even before the event hit, and in the immediate aftermath. Depending on how bad an event is, it can go for a couple of days to a couple of weeks … During that time, FEMA is in a supporting role.”
  • “State and local government do what they can with their own resources, and they can reach out to FEMA for things they need that they don’t have or can’t get access to: helicopters for search and rescue missions, members of the Corps of engineers who can help coordinate infrastructure operations. From my discussions with FEMA officials and my obvservations of FEMA so far, this has gone as a textbook response. They learned from Katrina, which is a little scary, because these were all things they knew how to do when Katrina hit, it was just poorly coordinated.”
  • “What does FEMA provide in a disaster like this? Equipment, advice, direction, coordination—all of the above. A state might lack funding for all the overtime rescue workers—FEMA can provide that. They can cover fuel costs for helicopters and boats, the basics, like ice and water, and then the overall, big picture thing, they can provide funding. All these things that the states are doing are reimbursable through the Stafford Act. They help coordinate the departments of transportation to assist with evacuation.”
  • “I think in New York City, the mayor was on top of it. It’s a huge decision for any local elected official to order an evacuation, and when they do, they tend to wait ‘til the last minute … You don’t want to get caught crying wolf, there’s a huge economic impact, and no one likes to be told what to do by government. Throw on top of that that you’re talking about New Yorkers, and I think they did a top-notch job. The challenge with an island city like that, which sits at sea level, with a full moon, and high tide. I hate to reuse a used phrase, but this was a perfect storm.”

Emergency Response, Public Health

Editors, “Federal Support to New York for the Response to Hurricane Sandy” November 15, 2012. FEMA. [84]. Last Checked November 29, 2012.

  • “More than 198,000 New Yorkers have contacted FEMA for information or registered for assistance with FEMA and more than $421 million has been approved. More than 100,000 have applied through the online application site at www.disasterassistance.gov.”
  • “31 Disaster Recovery Centers (DRC) are open in the affected areas. These include mobile sites as well as fixed sites, and to date more than 23,000 survivors have been assisted at DRCs in New York.”
  • “1,241 inspectors in the field have completed 64,649 home inspections.”
  • “1,081 Community Relations (CR) specialists are strategically positioned throughout affected communities, going door to door explaining the types of disaster assistance available and how to register. More teams continue to arrive daily.”
  • “20 Points of Distribution (PODs) are open and providing supplies to the affected residents.”
  • “8 Disaster Medical Assistance Teams (DMATs) and 1 Rapid Deployment Force (RDF) team from the Department of Health and Human Services are deployed in New York.”
  • “More than 2.4 million liters of water, 1.3 million meals and more than 210,000 blankets have been provided by FEMA to the New York National Guard for distribution to survivors.”
  • “There are 13 New York counties designated for both individual and public assistance, including: Bronx, Kings, Nassau, New York, Orange, Putnam, Queens, Richmond, Rockland, Suffolk, Sullivan, Ulster and Westchester.”
  • “The U.S. Small Business Administration (SBA) has staff members at 14 Business Recovery Centers in the New York area to provide one-on-one help to business owners seeking disaster assistance.”
  • “The U.S. Army Corps of Engineers’ mission to remove debris from rights-of-way continues, with 77,237 cubic yards having been removed thus far.”

Emergency Response, Public Health

Satcher, David. Et al. “Americans Depend on a Strong CDC.” November 27, 2012, Politico. [85] Last Checked December 6, 2012.

  • “The steroids were injected into the spines of patients who needed pain relief in many health care facilities. So far, about 510 people have developed noncontagious meningitis. Sadly, at least 36 people have died from these contaminated injections. But many more could have died without CDC’s surveillance, rapid response science and communications with health experts responsible for diagnosing and treating patients.”
  • “First, CDC scientists worked with state and local public health leaders across the public health network CDC helps to support to identify the fungus that is causing most cases of meningitis. This was no easy task since the fungus is rare and was never before found in spinal fluid.”
  • “Then, CDC scientists established the best treatment options and shared them with health officials as well as more than 14,000 patients who received the potentially contaminated steroid injections. Amazingly, CDC and state and local health officials were able to contact nearly all of the patients exposed to potentially contaminated medications in less than 20 days from the time the outbreak was detected. In the meantime, CDC laboratory researchers tested samples taken from patients throughout the country to determine whether each patient was infected.”
  • “The fungal meningitis outbreak is just one of many outbreaks that required a major CDC response so far this year. Multiple food-borne outbreaks, emergence of new strains of swine flu in the Midwest and cases of plague in Western states require CDC’s full attention. Add to that global health concerns such as a SARS-like virus tracked to the Middle East and ongoing avian influenza in Asia, both just a plane ride away from the United States. Events like these underscore the critical nature — and potential vulnerability — of CDC and the public health network it leads to protect our nation.”

Emergency Response, CDC, Public Health


Roos, Robert, “Experts differ on HHS select-agent proposal for H5N1,” CIDRAP News, December 26, 2012, available at [86] last checked December 31, 2012. See also: [87] [88] [89]

  • ”Some professional groups and scientists think it's a good idea to classify highly pathogenic avian (HPAI) H5N1 influenza viruses as ‘select agents’ requiring special research precautions, while others say the step is unnecessary and would impede research, according to comments they have filed with the US Department of Health and Human Services (HHS).”
  • ”For example, the Infectious Diseases Society of America (IDSA), a physician organization, says H5N1 viruses should be in the select agent category, whereas the American Society for Microbiology (ASM) argues against the idea, noting that circulating H5N1 viruses have poor transmissibility in humans.”
  • ”Several vaccine manufacturers recommend that the attenuated H5N1 strains used to make vaccines should not be included in any select agent designation, because that could slow vaccine development if an H5N1 strain gained greater human transmissibility.”
  • ”Because of the threat they pose to poultry, HPAI H5N1 viruses are already listed as select agents in the US Department of Agriculture's (USDA's) Select Agent Program. But the viruses are not on HHS's select agent list.”
  • ”HHS's request for comments followed a determination by a federal interagency committee that H5N1 viruses may pose a severe threat to human health and safety. The finding came from the Centers for Disease Control and Prevention's (CDC's) Intragovernmental Select Agents and Toxins Technical Advisory Committee (ISATTAC), which includes members from various HHS and USDA agencies and the departments of Homeland Security and Defense.”
  • ”The committee considered the findings concerning the transmissibility of genetically modified H5N1 viruses among ferrets, along with the virus's virulence and the low level of immunity in the population.”
  • "’It is crucial that extensive biosafety and biosecurity measures be taken to prevent accidental release or an act of bioterrorism,’ IDSA President David A. Relman, MD, wrote in the comments. Noting that the USDA already regulates H5N1 as a select agent, he said an HHS designation would ensure that the impact on human health is considered.”
  • ”Relman also recommended that HHS consider "more extensive" biosafety and biosecurity requirements for work with H5N1 strains that have been lab-modified to increase their pathogenicity or transmissibility. Research on such strains is currently done in enhanced biosafety level 3 (BSL-3) conditions, according to previous reports.”
  • ”In contrast to the IDSA, the ASM voiced opposition to regulating H5N1 as an HHS select agent. ‘Due to the extremely limited number of human illnesses seen despite widespread circulation of the virus and very poor transmissibility, it is hard to argue that currently circulating viruses represent a severe threat to public health and safety,’ the group wrote.”
  • ”Because H5N1 is on the USDA's select agent list, "HPAI H5N1 already falls under the safety, security, and handling provisions of the select agent rule," the ASM said. "Adding HPAI H5n1 viruses to the HHS select agent list will not add any additional protections or oversight.’"
  • ”The group also said it ‘strongly disagrees’ with the idea of making HPAI H5N1 a ‘Tier 1’ select agent—a new HHS category that requires additional physical and personnel security precautions beyond those required for other select agents.”
  • "’Such a designation would inhibit important research activities related to these viruses,’ the ASM said.”
  • ”A Sanofi Pasteur official urged that lab-attenuated H5N1 strains used to make vaccines should be exempt from any HHS select agent designation. He did not comment on whether HPAI H5N1 strains should be treated as select agents.
  • ”If attenuated strains were classified as select agents, the additional regulatory burdens would delay vaccine development if a pandemic H5N1 strain emerged, Hosbach wrote. Similar views were expressed by two other vaccine makers, MedImmune and Novartis Vaccines and Diagnostics.”

Biosecurity, Open Science, Flu, Biosafety, Pharma, Lab Safety, Public Health

2013

Lazar, Kay, "NIH approves bio lab at BU", The Boston Globe, January 2, 2013 [90] Last checked February 21, 2013

  • "A decadelong push to open a controversial infectious-disease research lab in Boston’s South End neighborhood is one giant step ­closer to fruition, with federal regulators signing off on the project."
  • ". . . the National Institutes of Health said that after 'careful consideration' it has concluded that Boston University’s National Emerging Infectious Diseases Laboratories, which will work with some of the world’s deadliest germs, 'poses minimal risk to the community surrounding the facility.'"
  • "The NIH decision said analyses by an independent blue ribbon panel and by an advisory committee made up of specialists in infectious disease, public health, risk assessment, and biosafety determined that the risks of infections or fatalities to the public from an accident or planned attack at the facility are 'generally very low to only remotely possible.'"
  • "BU opened a small portion of the building, known as a BSL-2 lab, last March for work on less dangerous germs. The university plans to eventually use about 16 percent of the 192,000-square-foot, high-security building as a biosafety level-4 lab for work on the deadliest germs."
  • "The NIH decision noted that even after the high-security labs open, they will be subject to oversight by numerous federal, state, and local authorities, including the NIH, the US Centers for ­Disease Control and Prevention, the Boston Public Health Commission, and BU’s Institutional Biosafety Committee, which will include at least two members of the public who are not affiliated with the ­university."
  • Lab Safety, Public Health


Fouchier, Ron, García-Sastre, Adolfo, Kawaoka, Yoshihiro et al., “Transmission Studies Resumefor Avian Flu,” Science Express – Letters, January 23, 2013 [91] last checked January 24, 2013.

  • ”In January 2012, influenza virus researchers from around the world announced a voluntary pause of 60 days on any research involving highly pathogenic avian influenza H5N1 viruses leading to the generation of viruses that are more transmissible in mammals. We declared a pause to this important research to provide time to explain the public-health benefits of this work, to describe the measures in place to minimize possible risks, and to enable organizations and governments around the world to review their policies (for example on biosafety, biosecurity, oversight, and communication) regarding these experiments.”
  • ”The World Health Organization has released recommendations on laboratory biosafety for those conducting this research, and relevant authorities in several countries have reviewed the biosafety, biosecurity, and funding conditions under which further research would be conducted on the laboratory-modified H5N1 viruses. Thus, acknowledging that the aims of the voluntary moratorium have been met in some countries and are close to being met in others, we declare an end to the voluntary moratorium on avian flu transmission studies.”
  • ” The controversy surrounding H5N1 virus transmission research has high-lighted the need for a global approach to dealing with dual-use research of concern.”
  • ”Because H5N1 virus transmission studies are essential for pandemic preparedness and understanding the adaptation of influenza viruses to mammals, re-searchers who have approval from their governments and institutions to conduct this research safely, under appropriate biosafety and biosecurity conditions, have a public-health responsibility to resume this important work.”
  • ”Scientists should not restart their work in countries where, as yet, no decision has been reached on the conditions for H5N1 virus transmission research. At this time, this includes the United States and U.S.-funded research conducted in other countries.”
  • ”Scientists should never conduct this type of research without the appropriate facilities, oversight, and all necessary approvals. We consider biosafety level 3 conditions with the considerable enhancements (BSL-3+) outlined in the referenced publications as appropriate for this type of work, but recognize that some countries may require BSL-4 conditions in accordance with applicable standards (such as Canada).”
  • ”We fully acknowledge that this research—as with any work on infectious agents—is not without risks. However, because the risk exists in nature that an H5N1 virus capable of transmission in mammals may emerge, the benefits of this work outweigh the risks.”
  • Scientific Self-Governance, Dual Use, Flu, Biosafety, Biosecurity, WHO, Open Science, Oversight, Public Health, Canada, Risk, BSL, Pandemic


Roos, Robert, "NIH panel supports stronger safeguards for H5N1 research," January 25, 2013, CIDRAP News, [92] last checked Jan 26, 2013.

  • ”A federal advisory committee yesterday recommended increased biosafety precautions for research involving H5N1 avian influenza viruses that can spread among mammals, a step that stems from the ongoing controversy over studies involving lab-modified H5N1 strains that show increased transmissibility in ferrets.”
  • ” The Recombinant DNA Advisory Committee (RAC) of the National Institutes of Health (NIH) called for a number of additions to enhanced biosafety level 3 (BSL-3) precautions, which scientists have used in recent studies involving more-transmissible H5N1 viruses.
  • ”… the committee rejected the option of advocating the highest level of biosafety, BSL-4, a standard that only a few labs around the world can meet. Just one member of the panel supported going to BSL-4.”
  • ”. The steps include things like more personal protective equipment, a "buddy system" for workers, taking baseline serum samples, giving a licensed H5N1 vaccine, if available, to all lab workers, and requiring personnel to avoid contact with susceptible bird species for 5 days after working with the viruses in question.”
  • ” The recommendations come just a day after 40 leading flu researchers from around the world declared an end to a year-old moratorium on H5N1 "gain of function" research, meaning experiments leading to increased transmissibility or pathogenicity.”
  • ” The stated aim of the RAC meeting was to look at biosafety in research on highly pathogenic avian influenza (HPAI) H5N1 viruses that can spread among mammals by respiratory droplets.”
  • ” … higher containment than BSL-3 will be needed if an H5N1 virus isn't sensitive to antivirals. Any experiment designed to increase the virus's drug resistance would require approval from the NIH director or another federal agency, she added.”
  • ”… Corrigan-Curay said existing BSL-3 specificiations include PAPRs, a protective suit, wrap-back disposable gowns, double gloving, shoe covers, and a shower before leaving the lab. The working group recommended adding the use of protective sleeves over gowns in a biosafety cabinet, spraying or wiping down PPE with disinfectant, and a buddy system, meaning a requirement to have two people in the lab at all times when work is going on.”
  • ”The working group also recommended a personnel quarantine, meaning workers should avoid contact with susceptible birds for 5 days after working with mammal-transmissible H5N1 viruses. That recommendation imitates a US Department of Agriculture rule for those who work with HPAI viruses.”
  • Oversight, Biosafety, BSL, Law, Flu, Public Health, Scientific Self-Governance


Saskia van Rijn. “Bioterrorism Preparedness – The Forgotten Patient Population.” February 5, 2013. Global Biodefense. [93] Last Checked, February 11, 2013.

  • “Bioterrorism and preparedness have been highlighted topics since the 2001 “Amerithrax” attacks. The reality that the United States is particularly vulnerable to these attacks, while not a new notion, has become increasingly sensationalized in the media.”
  • “Hospital preparedness is being considered a source for vulnerability, which has ignited agencies like CDC’s National Bioterrorism Hospital Preparedness Program and the Hospital Preparedness Program (HPP) on a national level. Federal funds are trickling down via FEMA, DHS, and state health departments, aiding hospitals in their efforts to become better prepared for emergency situations.”
  • “Bioterrorism preparedness is by no means, a novel concept, but the involvement of hospitals has started to reveal a great deal of vulnerability within the public health system. Since hospitals are most likely to see the first wave of cases, their ability to detect, respond, and communicate this information is crucial. The unfortunate reality is that detecting these cases of Category A agents is extremely difficult. Aside from the diagnostic hurdles, most of the medical guidelines and emergency response protocols for disaster situations are adult specific.”
  • “Firstly, pediatric patients require specific medical attention, they are simply not “little adults”. Stankovic et al. emphasize that children are particularly vulnerable to biological agents, as they have higher respiratory minute volume, larger surface area to body mass, smaller blood volume, and are unable to fully communicate their symptoms given limited cognitive and motor skills.”
  • “A 2004 study performed in Washington D.C. assessed the ability for physicians to correctly diagnosis category “A” agents in patient cases. The investigators found that 50.7% were able to correctly diagnose smallpox, 70.5% anthrax, 49.6% botulism, and 16.3% plague.3 Interestingly, after the first testing, a training module was given, which led to an increase in correct diagnosis by about 70%.”
  • “Hospitals are uniquely vulnerable in emergency situations, especially bioterrorism events. Given their role as first responders for the initial wave of patients, their ability to identify and respond to these events is crucial. Pediatric hospitals are especially vulnerable to these disasters, as children are a highly susceptible patient population during bioterrorism events. The current protocols and initiatives in place, while aiming to close the gaps of communication, fail to focus on the unique needs of a patient population that has limited diagnostic guidelines in place, as well as difficultly communicating their symptomology.”
  • “Current emergency response and preparedness methodologies are generally lacking in the pediatric capabilities. It is crucial to incorporate hospital pediatric patients and their unique needs into preparedness protocols, especially in biosecurity plans.”

Emergency Response, Public Health, Pandemic


Kelland, Kate, "New SARS-like Virus Shows Person-to-person Transmission", Reuters, February 13, 2013 [94] Last checked: February 21, 2013

  • "The latest case, in a man from the same family as another patient, brings the worldwide number of confirmed infections with the new virus - known as novel coronavirus, or NCoV - to 11."
  • "Of those, five have died. Most of the infected lived or had recently been in the Middle East. Three have been diagnosed in Britain."
  • "The virus belongs to the same family as SARS, or Severe Acute Respiratory Syndrome - a coronavirus that emerged in China in 2002 and killed about a tenth of the 8,000 people it infected worldwide."
  • "'Confirmed novel coronavirus infection in a person without travel history to the Middle East suggests that person-to-person transmission has occurred, and that it occurred in the UK,' said John Watson, the HPA's head of respiratory diseases."
  • "The WHO said although this latest case shows evidence of person-to-person transmission, it still believes 'the risk of sustained person-to-person transmission appears to be very low'".
  • "If novel coronavirus were more infectious, we would have expected to have seen a larger number of cases than we have seen since the first case was reported three months ago."
  • "The WHO said on Monday that the confirmation of a new British case did not alter its risk assessment but 'does indicate that the virus is persistent.'"
  • "The WHO said at this stage there is no need for travel or trade restrictions, or for special screening at border points."
  • WHO, Public Health


Malakoff, David, "U.S. Announces More New Rules for Potentially Risky Research", Science, February 21, 2013 [95], Last checked February 27, 2013

  • "Researchers interested in conducting studies with 15 potentially dangerous agents and toxins—including the H5N1 avian influenza virus—face some new hurdles in getting funding from the U.S. government."
  • "Federal officials today released two policy documents that lay out stricter requirements for institutional and government oversight of studies that pose especially problematic safety concerns."
  • "One policy, released by the U.S. Department of Health and Human Services (HHS), applies only to scientists seeking funds for experiments that might create new strains of the H5N1 virus that can move between mammals in respiratory droplets."
  • "Experts fear that such mammal-transmissible H5N1 viruses could spark a deadly human pandemic if they escape from a laboratory or are intentionally released by terrorists. U.S. officials outline the new policy today in Science."
  • "The other document, released by the White House's Office of Science and Technology Policy (OSTP), asks for public comment on proposed new rules for scientists, universities, and other institutions working with a broader set of 15 especially dangerous agents and toxins—including H5N1—that could be used to cause harm."
  • "Both policies are direct responses to a global controversy that emerged in late 2011 after two laboratories, one in the United States and one in the Netherlands, announced they had engineered mammal-transmissible H5N1 viruses."
  • "Under the proposed rules, scientists would be asked to determine whether a proposed study met the definition of DURC—for example, whether the experiment might make a toxin more deadly or confer resistance to treatments, and whether the results "could be directly misapplied to pose a significant threat" to the public."
  • "Universities would also be required to establish a new committee—or use an existing one—to do DURC reviews, and appoint an "Institutional Contact for Dual Use Research," or ICDUR, to oversee potentially problematic projects."
  • "H5N1 researchers are likely to be happier with the new HHS rules, which were revised following a December 2012 meeting on the topic. The new language removes any mention of classifying problematic studies or results, for instance, instead clarifying that HHS will support only research that can be shared publicly."
  • Lab Safety, Public Health, Lab Security


Eric Lipton & Matthew L. Wald, Post-Fukushima, Arguments for Nuclear Safety Bog Down. February 26, 2013. New York Times. [96] Last Checked March 1, 2013.

  • “This was a simulation by Constellation Energy, the owner of the Nine Mile Point plant on Lake Ontario, for the benefit of two of the five members of the Nuclear Regulatory Commission. It was part of an intense lobbying campaign against a proposed rule that would require utilities to spend millions of dollars on safety equipment that could reduce the effects of an accident like the Fukushima Daiichi meltdown in Japan two years ago.”
  • “Ever since the nuclear accident in Japan released radiation into the atmosphere, regulators in the United States have been studying whether to require filters, costing as much as $45 million, on the vents of each of the country’s 31 boiling water reactors.”
  • “The filters, which have been recommended by the staff of the regulatory commission, are supposed to prevent radioactive particles from escaping into the atmosphere. They are required in Japan and much of Europe, but the American utilities say they are unnecessary and expensive.”
  • “Computer models, they said, may suggest that plant operators can prevent large radioactive releases without the filters, but real-life accidents come with unpredictable complications. The debate over the filters reflects a simmering tension that has been building inside the regulatory agency since the Fukushima accident in Japan. A tug of war among commissioners and between some commissioners and staff members has produced repeated votes that reject staff safety recommendations.”
  • “E-mails obtained by The Times also demonstrate the teamlike approach taken by the industry and the regulators in dealing with safety questions, as they have worked behind the scenes with the Nuclear Energy Institute, the leading trade association, to try to prevent a reaction against nuclear power in the aftermath of the Fukushima accident.”
  • “The filtered vent proposal, by far the most expensive, would be required only on boiling water reactors like Nine Mile Point, which are considered much more prone to leaking during an accident because they have unusually small primary containment chambers and pressure can build quickly.”
  • “But how well the filters work is unclear because the vents to which they would be attached have never been used successfully in an accident at a modern commercial reactor, experts said. The vents failed at Fukushima, which would have rendered filters moot. A panel of independent senior advisers to the commission opposes a strict requirement for filters.”
  • “The industry wants the regulatory commission to reject the rule mandating the filters, and instead allow a plant-by-plant evaluation in which filters would be required only if goals for radioactive emissions could not be met. Industry officials said that filters were not as effective as having water in the containment chamber, which would reduce fuel damage and thus help keep the radioactive material in the fuel. Water also would absorb contaminants that escaped the fuel. That approach is what Constellation executives and the industry trade group showed off at Nine Mile Point.”

Nuclear, Public Health, Japan


Robert Wood Johnson Foundation, Rebuilding Public Health in Haiti, February 26, 2013. RWJF. [97] Last Checked, March 1, 2013. Three years after a devastating earthquake took the lives of 200,000 Haitians, displaced millions more and disrupted the public health infrastructure of the country, two new public health buildings opened yesterday in the country’s capital city of Port-Au-Prince with funding by the CDC Foundation and several partners including the Robert Wood Johnson Foundation, the GE Foundation and Kaiser Permanente. The CDC Foundation was established by Congress to forge partnerships between the Centers for Disease Control and Prevention (CDC) and corporations, foundations and individuals to support CDC's work in the U.S. and abroad.

  • “‘Building back better’ isn't just a slogan, it's a reality in public health. These buildings represent an important step forward to save lives in Haiti,” said CDC director Thomas Frieden, MD, MPH, at the opening in Port-Au-Prince. "These new buildings have an importance far beyond their physical presence—they will serve as a basis and catalyst for programs that will save literally tens of thousands of lives,” Frieden said.”
  • “One building replaces the Haiti Health Ministry, which was destroyed in the earthquake. The second building will house some of the ministry’s surveillance, epidemiology and laboratory staff as well as Haiti-based CDC staff, who are now working side-by-side in the country.”
  • “Representatives of the partners critical to the funding of the new buildings were on hand in Port-Au-Prince for the buildings’ ribbon cutting ceremony, including Susan Mende, senior program officer at the Robert Wood Johnson Foundation. “The earthquake in Haiti wrought great destruction and suffering to some of the most vulnerable in society as well as to the health and public health infrastructure so critical to the nation’s health,” said Mende. “The Robert Wood Johnson Foundation made a $500,000 grant to help build a public health laboratory research center to be used by Haiti’s Ministry of Public Health and Population. The Foundation recognizes that a stronger public health system is the network that protects communities, saves lives and directly improves people’s health and well being.’”
  • “CDC has had a presence in Haiti for quite a few years, particularly working on HIV/AIDS so they had a relationship when the earthquake happened. They quickly saw the many needs when the ministry building and 60 staff members were lost in the earthquake. They asked the CDC Foundation first for help replacing a core building to serve as a home base for the ministry and then they let us know that a second building added to the national laboratory complex would be invaluable as well.”
  • “We like to say we help CDC to do more, faster. We help do things CDC can’t do otherwise, by bringing resources and partners to the table, and this is a perfect example. There’s a dramatic need in Haiti. CDC was willing to help. CDC had additional staff to commit, but no place to put them, and so they reached out to us to perform our traditional role of trying to bring other partners to the table that could bring the flexibility that was necessary.”
  • “One of the programs that we are funding from the post-earthquake funds from congress is a field epidemiology training program, and in Haiti before the earthquake, there really wasn’t a functioning reportable disease surveillance system, and there really wasn’t a regional laboratory network for confirmation of causes of illness. And now, this building where the field epidemiology training is located is on the campus of the national public health laboratory. [Haiti's Field Epidemiology Training Program (FETP) is a CDC project that works with health ministries along with other partners, to train public health workers to detect, investigate, and control threats to public health.]”
  • “Twice as many people now receive treatment for HIV than before the earthquake.HIV testing of pregnant women has increased by 55 percent. The government has trained technicians who are routinely testing water and providing education about improved sanitation throughout the country. Vaccination rates for children are nearly twice as high than before the earthquake. Before 2010, measles vaccine coverage was just 47 percent. Following the recent 2012 campaign, 91 percent of children sampled were vaccinated against measles-rubella. Haiti is on track to eliminate lymphatic filariasis. For the first time mass drug treatment is beginning to protect the entire population, which has been at risk from this permanently disabling, disfiguring, and painful disease. Known as elephantiasis, LF is caused by worms and carried by infected mosquitoes.”

Public Health, CDC, Emergency Response


Associated Press, “Energy Department says budget cuts could delay cleanup at highest-risk nuclear sites,” February 28, 2013. The Washington Post. Last Checked March 2, 2013. [98]

  • “Cleanup of radioactive waste at nuclear sites across the country including one in Washington state where waste tanks may be leaking 1,000 gallons per year would be delayed under automatic spending cuts set to take effect Friday.”
  • “Energy Secretary Steven Chu says the cuts would delay work at the department’s highest-risk sites…where six tanks are leaking radioactive waste left over from decades of plutonium production for nuclear weapons.”
  • “Hanford and other Energy Department defense sites where radioactive waste is stored would be forced to suspend or delay cleanup activities and even shut down some facilities.”
  • “The site, along the Columbia River, holds at least 53 million gallons of highly radioactive waste…an estimated 1 million gallons of radioactive liquid already leaked there.”
  • “The Energy Department is facing an estimated $1.9 billion in spending cuts, including about $400 million for the Office of Environmental Management, which oversees the cleanup at Hanford and other former military sites.”
  • Nuclear, Public Health, Executive


Rachel Oswald, “Most Nations Still Lack Required Disease Outbreak Response Capacity.” February 28, 2013. NTI. [99] Last Checked, March 12, 2013.

  • “ A majority of nations have yet to fulfill a 6-year-old U.N. mandate to develop certain critical public health capacities to respond to naturally occurring or man-made disease outbreaks, according to a senior U.S. State Department official.”
  • “All 194 member states to the World Health Organization are required to implement the International Health Regulations, which went into force in 2007. Nations were given to the middle of last year to have "established national core public health capacities," noted Bonnie Jenkins, Foggy Bottom's special envoy for threat reduction programs.”
  • “The IHR core capacities pertain to augmented domestic biosurveillance and bioresponse procedures and include mandates for securing certain border crossings, seaports, and airports, according to the U.N. public health agency.”
  • “Months after the deadline passed, "implementation of core capacities continues to present a challenge in many technical areas," Jenkins said in prepared remarks for a Feb. 23 event at Tufts University in Massachusetts. "To date, over 60 percent of member states have requested the two-year extension allowed under the IHRs, which gives these states until mid-2014 to come into full compliance."
  • “In order to help remaining countries meet their obligations, the Group of Eight's Global Partnership Against the Spread of Weapons and Materials of Mass Destruction has has provided financial support to five IHR regional stakeholders meetings that were used as vehicles for health, agriculture, travel, defense, education, and trade experts to "engage in direct dialogue related to technical issues concerning experience in IHR implementation and discuss pledges and statements about assistance in filling gaps in nations' capacities," Jenkins said.”
  • "Biological threats have dramatically changed in recent years due to globalization, increased pressure on land and water resources, new and emerging pathogens and sadly, new violent extremists who would resort to a biological attack on the United States or our interests abroad," Jenkins stated. "Therefore, we all are changing with it by improving our connections with others and increasingly recognizing the value of multisector approaches to meet our most important challenges and opportunities."

Public Health, Biosurveillance, Emergency Response


Denise Grady, “Deadly Bacteria That Resist Strongest Drugs Are Spreading” March 5, 2013. New York Times. [100] Last Checked, March 12, 2013.

  • “Deadly infections with bacteria that resist even the strongest antibiotics are on the rise in hospitals in the United States, and there is only a “limited window of opportunity” to halt their spread, health officials warned Tuesday.”
  • “The bacteria, normally found in the gut, have acquired a lethal trait: they are unscathed by antibiotics, including carbapenems, a group of drugs that are generally considered a last resort. When these resistant germs invade parts of the body where they do not belong, like the bloodstream, lungs or urinary tract, the illness may be untreatable. The death rate from bloodstream infections can reach 50 percent.”
  • “Most people who contract these infections already have other serious illnesses that require complicated treatment and lengthy stays in hospitals, nursing homes or long-term care facilities. One bit of good news, Dr. Frieden said, is that the infections do not seem to have spread beyond hospitals into the community at large. But that could easily happen, he warned.”
  • “According to a new report by the disease centers, among all infections with gut bacteria, the proportion caused by carbapenem-resistant types rose to 4 percent in 2012, from 1 percent in 2001; among infections caused by one type of bacteria, Klebsiella, 10 percent have become resistant, compared with 2 percent a decade ago.”
  • “The disease centers recommended a variety of ways to try to stop the infections from spreading. The advice includes the usual call for ruthless scrubbing of all surfaces and relentless handwashing. But hospitals are also urged to find out whether patients are infected, isolate those who are, and assign dedicated-care teams and equipment to infected people only, to avoid spreading the bacteria to others.”
  • “Catheters and intravenous lines should be removed as quickly as possible, because they can be avenues of infection, and doctors should prescribe antibiotics only when they are truly needed. Health officials also urge patients and their loved ones to insist that medical personnel wash their hands before touching a patient.”

Drug Resistance, CDC, Public Health


Roos, Robert, "Saudi Arabian death marks 15th novel coronavirus case", CIDRAP, March 12, 2013 [101] Last checked March 21, 2013

  • "A 39-year-old Saudi Arabian man died on Mar 2 of a novel coronavirus (NCoV) infection, marking the world's 15th case and 9th death from the mysterious virus, the World Health Organization (WHO) announced today."
  • "The WHO gave few details other than to say that the man got sick on Feb 24 and was hospitalized Feb 28. A preliminary investigation found that he had had no contact with other case-patients, but other possible exposures are under investigation, the agency said."
  • "Eight of the world's 15 NCoV cases, including six fatal ones, have occurred in Saudi Arabia."
  • "Reiterating previous comments, the agency said it is not recommending special screening at border stations or any travel or trade restrictions in connection with the new case."
  • Biodetection, Public Health, Biosurveillance


Butler, Declan, "Understanding the New Coronavirus: Receptor Discovered", Nature, March 15, 2013 [102] Last checked March 16, 2013

  • "This week, researchers identified the molecule that has allowed a novel human coronavirus to infect at least 14 people, killing eight, since its detection last year."
  • "In a paper published this week in Nature1, Stalin Raj at the Erasmus Medical Centre in Rotterdam, the Netherlands, and a largely European team report that spikes on the surface of hCoV-EMC bind to DPP4, a well-known receptor protein on human cells."
  • "The researchers did clearly show that the receptor is present on only some types of respiratory epithelial cells (about 20% of the total), which suggests that catching the disease might require inhaling high doses of virus, says Drosten."
  • "But another lab study, published last month in mBio4, found that the virus infects human bronchial epithelial cells as easily as the coronaviruses that cause the common cold."
  • "The nature of the DPP4 protein means that the virus could remain a persistent threat. The receptor protein is present in very similar versions in many mammals, including bats, non-human primates, and various domestic animals. The virus might therefore easily jump between species, and humans might continue to be reinfected from a potentially wide range of animal reservoirs."
  • "From a public-health standpoint, it will be important to learn whether human cases of hCoV-EMC — so far largely centred on the Middle East — are caused by occasional jumps from animal reservoirs, or whether the virus has adapted and is now a distinct human virus spreading between people."
  • "The biggest question is whether the novel coronavirus is truly the killer that the current data suggest — the mortality rate is more than 50% — or whether there are many undetected mild or asymptomatic cases."
  • "To answer this requires large-scale testing of the population, in particular of people living near outbreaks who have not fallen ill, to see if they have antibodies to the virus in their blood."
  • Biodetection, Public Health


Schnirring, Lisa, "Novel coronavirus lab studies hint at wide tissue susceptibility", CIDRAP, March 27, 2013, [103] Last checked April 4, 2013

  • "Experiments by Hong Kong researchers to gauge the susceptibility of several human and animal cell lines to novel coronavirus (NCoV) found signs that it can infect a broad range of tissues, which might shed light on the disease's seemingly high mortality rate."
  • "Tests suggested that NCoV can infect human respiratory, kidney, and liver cells, as well as histiocytes. The impact on neuronal cells and monocytes was much less."
  • "Researchers suggested that the range of human tissues that are susceptible to infection appears to be broader than all other human coronaviruses, including the SARS (severe acute respiratory syndrome) virus."
  • "'The presence of a receptor utilized by the virus which is common in bats, primates, pigs, civets, rabbits, and humans might imply a broad species tropism, which is unique among all the currently known human coronaviruses,' the group wrote."
  • Public Health


Editors, Be Prepared- The Boston Marathon and Mass Casualty Events. May 1, 2013. The New England Journal of Medicine. [104] Last Checked, May 9, 2013

  • "Three people were killed and 264 were injured,1 with more than 20 sustaining critical injuries. Yet in the face of these tragic and horrifying events, despite catastrophic injuries not commonly seen in civilian medicine and the fact that these were the first IEDs to cause mass injuries in the United States, the overall medical response has generally been considered successful.”
  • “Victims at the blast scene received immediate, lifesaving aid. Crucial stabilization of trauma injuries was provided in the medical tent near the marathon finish line. Patients were rapidly triaged and loaded into ambulances. Within 45 minutes, the last of the injured patients was transported from the scene. Each of the city's major trauma centers received approximately equal numbers of critically injured victims. No one who was transported to a hospital died.”
  • “The fact that there was not more loss of life is attributable to more than just providence and the extraordinary skill and courage of the volunteer and professional responders. As Kellermann and Peleg note in their Perspective article, the response was enabled by the medical community's prior efforts to build and sustain emergency-preparedness programs and, perhaps most important, to practice its response in exercises and drills.”
  • “For more than a decade, emergency managers in Boston's medical community, like those in other cities, have been refining plans for mass-casualty events. Every year, they review the literature to learn from others who have faced such events. For example, in 2008 and 2009, Boston hosted two symposia, cosponsored by the Centers for Disease Control and Prevention and the Harvard School of Public Health, on planning for and responding to terrorist bombing incidents. Speakers from London, Madrid, Mumbai, and Israel shared their experiences in caring for overwhelming numbers of patients after a mass attack and the lessons they had learned.”
  • “ One of the important medical lessons from military operations in Iraq and Afghanistan has been that early tourniquet use in those with blast injuries from IEDs dramatically reduces combat deaths from limb exsanguination.3 Although EMS personnel typically use tourniquets infrequently in civilians, Boston EMS has incorporated tourniquets and associated training into its hemorrhage-control protocol for years; more recently, it has begun preparing for active-shooter mass-casualty incidents by adapting concepts from Tactical Combat Casualty Care.”
  • “Immediately after the explosions, Boston EMS also mobilized an extensive network of communications and other resources, calling in available private ambulances to supplement its own. At the Boston EMS Dispatch Operations Center, a physician assisted the loading officer with the distribution of the most critically ill, or “red-tagged,” patients. All ambulance transports were centrally coordinated through that center. The initial 30 red-tagged patients were triaged, treated, and transported within 18 minutes after the explosions.”
  • “It's important to recognize that the response in Boston generally followed a very carefully crafted and much-practiced set of plans and that those plans owe much to the lessons of others in the unfortunate fraternity of cities that have experienced mass casualties from intentional attacks. We believe that the speed and coordination of the response is partially attributable to reviewing other cities' experiences, adjusting our plans, and repeatedly training staff in implementing those plans. In this context, it seems especially unfortunate that U.S. health departments, hospitals, and EMS are facing severe budget constraints, owing to cuts in federal funding that will undermine planning, training, and practice activities that have been so important in building health emergency preparedness capabilities.”

Emergency Response, Public Health

Return to Index Page

Personal tools
Namespaces

Variants
Actions
Navigation
Toolbox