There are concerns that the world may witness the re-emergence of a virus as a result of a deliberate release by terrorists. There is a long list of potential agents, including viruses, that terrorists might consider using. Smallpox virus, a member of the family Poxviridae (Figure 21.9), is high on the list. There have been no smallpox cases since the 1970s, smallpox vaccination programmes have been discontinued and most humans lack immunity to this virus. Some governments have stockpiled vaccine to be used in the event of a smallpox release.
(1) The lone individual, such as the Unabomber, is by far the most difficult to detect. This type of terrorist is a wild card, striking without a predictable motive or pattern, copying a previous event for the publicity, or just acting on a whim. Fortunately, individual terrorists have been the least successful. Lacking the funding, organization, and sophistication of larger groups, they account for many of the recently failed attempts and hoaxes. (2) Local terrorist groups and non-aligned groups form the larger threat of domestic CBRNE terrorism, as they have the funding, organization, and ability to build or purchase CBRNE agents. The primary differences between them are the cause, the home base, and the source of their funding. Local terrorist groups have one distinct advantage over foreign organizations -- the members fit into the local society and are often unnoticed until they strike. d. While knowledge of the capabilities and characteristics of chemical, biological, and...
National Center for Toxicological Research (NCTR), FDA. 3900 NCTR Road, Jefferson, AR 72079, U.S.A. URL http www.fda. gov nctr index.html. Mission Statement includes fundamental and applied research specifically designed to define biological mechanisms of action underlying the toxicity of products regulated by the FDA.'' Covers food safety, bioterrorism, biotechnology, information technology, fundamental and applied research, premarket activities, antimicrobial resistance, and HIV AIDS.
Nerve agents are considered military threat agents. The only known battlefield use of nerve agents was during the Iran-Iraq conflict. Intelligence analysts indicate that many countries have the technology to manufacture nerve agent munitions. A recent terrorist use of nerve agents was in Japan (1994 and 1995) when a terrorist cult dispersed Sarin nerve agent in a Tokyo subway. These incidents produced thousands of casualties.
The term biological warfare (BW) may cause feelings of terror and horror. The mere threat of a biological attack can be a psychological weapon that could lead to collapse of morale and panic. In biological warfare, biological agents are used to weaken the opposing force. A biological agent is a microorganism that causes disease in humans, plants, or animals or which causes deterioration in material. Normally, the term is used to mean a microorganism or the toxin from a microorganism that produces disease in humans. A biological agent can be used to injure, kill, or weaken soldiers and reduce their ability to fight.
Guidelines for medical and public health management of a potential Y. pestis terrorist attack have been developed that recommend streptomycin or gentamicin as the first-line treatment for pneumonic plague in a contained casualty situation, substituted if necessary by oral doxycycline or ciprofloxacin in the event of mass casualties.2 Postexposure treatment for 7 days with doxycycline or other tetracycline, chloramphenicol, or ciprofloxacin is recommended for persons who have had a known close exposure to a pneumonic plague patient in the prior 7 days. Oral doxycycline or ciprofloxacin has been recommended for postexposure prophylaxis in the event of a terrorist attack with Y. pestis.2 Pre-exposure prophylaxis may occasionally be recommended for persons who are unable to avoid visiting or residing in an area where a plague outbreak is in progress or who are screening or caring for plague patients in unusual circumstances, such as an outbreak. To reduce the risk of airborne droplet...
When questioned, he said that some of his dreams had become very vivid and violent in the last decade or so. His wife of 47 years reported that he always jerked a lot during his sleep, but this kind of behavior only began around the time he was forced to retire clue ro age. She said she could awaken him during these incidents, but only after screaming his name many rimes for what seemed like several minutes. When awakened, he reported vividly dreaming of protecting himself and or her from a variety of threatening criminals, terrorists, and monsters.
Plague in humans is a severe febrile illness caused by the gram-negative bacillus, Yersinia pestis. Historically, it is synonymous with catastrophic epidemics. Y. pestis is maintained in nature as a zoonotic infection of rodents and their fleas in scattered foci in large areas of Asia, Africa, and the Americas. It is an incidental infection of humans and mammals other than rodents. Humans acquire infection most often by the bite of rodent fleas, occasionally by handling or ingesting infected animal tissues, or by inhaling contagious airborne particles. The vast majority of cases of human plague now occur in underserved Third World populations where sanitation is poor and persons live in close association with rodent reservoirs of infection. The principal clinical forms of plague are bubonic, septicemic, and pneumonic. Bubonic (lymphadenitic) plague accounts for 85 or more of primary plague cases. Septicemic and pneumonic plagues occur most often as secondary complications of bubonic...
These most commonly are organophosphates, related to insecticides. They are thus easy to manufacture and can be possessed by 'rogue' military regimes or terrorist groups. They are potent inhibitors of acetylcholinesterase and are lethal at about 1 mg (G agents). One of the most toxic of such compounds is sarin (isopropyl methylphosphonofluoridate).
Two strategy documents24-25 led to the launching of new surveillance initiatives, including the Emerging Infections Program (EIP), a national network for population-based surveillance and research26 (Fig. 15-1). Several provider-based sentinel surveillance networks were established in collaboration with emergency room physicians, infectious disease specialists, and travel medicine specialists to provide early warning of events that might be missed by public health surveillance. Additional enhancements to the surveillance effort include development of the National Molecular Subtyping Network for Foodborne Disease Surveillance (PulseNet) as an early warning system for foodborne diseases, support for the Gonococcal Isolate Surveillance Project (GISP) to monitor antimicrobial resistance in Neisseria gonorrhoeae, strengthened surveillance for diseases of current concern (e.g., West Nile encephalitis), and surveillance for outbreaks that might be due to acts of bioterrorism. Surveillance...
Biological terrorism, emerging infectious diseases, and other public health threats and emergencies. The more than 120 federal, state, and local public health, veterinary, military, environmental, and international laboratories in the network have progressively stringent levels of safety, containment, and technical proficiency that enable them to recognize, rule out, confirm, or definitively characterize highly infectious agents using standardized protocols and reagents and to maintain communication through a secure web site.
Microbiology laboratories play a critical role in surveillance for emerging infectious diseases and bioterrorism threats by identifying the microbial cause of syndromes, detecting and reporting new or unusual pathogens, and assessing antimicrobial resistance.6,37 To carry out this role, laboratories require well-equipped and safe facilities, adequate human and financial resources, access to needed reagents, and robust quality control. Surveillance for Emerging Infectious Diseases and Bioterrorism Threats
Experts say there is enough material and know-how out there for terrorist to mount a lethal radiological attack with a dirty bomb, turning a US downtown into a death zone. b. Potential terrorist attack methods could include explosively dispersing a radioactive source, spreading radioactive material on the ground, dispersing the materials in the air, or adding the radioactive material to food or water.
In sharp injuries the vascular lesions are caused by direct penetration and give rise to vascular perforation, transection or dissection. The consequence is haemorrhage with the danger of exsanguination, hypotension and hae-modynamic shock, the treatment of which is standard. Fortunately a transected artery is apt to bleed less than a perforated or partially torn artery. Haemostasis in the case of a transected artery may be effected as follows the contractile tension of the lamina elastica interna shortens the artery, which constricts as the transected inner layers approach each other and then roll in, thereby occluding the vessel. Open warfare, civil war, terrorism and natural disasters all result in the assignment of doctors, especially surgeons, to scenes of extreme violence to which they were not exposed to previously in civilian life 4 . In war, management of vascular injury is primarily aimed at saving life and the chances of performing vascular reconstruction for limb salvage...
In war as well as in the course of terrorist attacks, explosions cause enormous injury to vital structures and life-saving procedures such as resuscitation, shock management and control of haemorrhage take precedence over selective repair of vascular injury. Very often guillotine limb amputation is the only solution. In civilian medical practice a hidden cause of limb ischaemia must be suspected at all times. Vascular injury and arterial occlusion may occur in association with bone fractures and during orthopaedic interventions. A high index of suspicion and the need to react quickly are of the essence.
Future challenges posed by infectious agents are difficult to predict but certainly include the continuing threat of an influenza pandemic, a recurrence of SARS, the emergence of other zoonotic agents that cross the species barrier to humans, the emergence of new bacterial strains that are more virulent or resistant to antibiotics, the possible deliberate release of pathogenic microbes by terrorists, and the likelihood of increased spread of dengue, cholera, West Nile virus, yellow fever, and foodborne diseases. The best defense against these mobile and resilient pathogens is timely and reliable infectious disease information obtained through global public health surveillance.29 The international community has made important strides in developing networks for detecting and reporting infectious disease events and enhancing capacity for
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