An overview of available literature on the use of protective facemasks by children for protection from respiratory infectious agents reveals relatively few articles dealing specifically with the topic, despite their use...An overview of available literature on the use of protective facemasks by children for protection from respiratory infectious agents reveals relatively few articles dealing specifically with the topic, despite their use during recent outbreaks (eg, severe acute respiratory syndrome, pandemic influenza). Little is known about the physiological and psychological burdens imposed by these devices and a child's ability to correctly use and tolerate them. This article focuses on the myriad issues associated with protective facemask use by children in the hope of educating public health personnel, healthcare professionals, and families on their limitations and associated risks, and in the hope of fostering much-needed research.
Decontamination and recovery of a facility or outdoor area after a wide-area biological incident involving a highly persistent agent (eg, Bacillus anthracis spores) is a complex process that requires extensive informatio...Decontamination and recovery of a facility or outdoor area after a wide-area biological incident involving a highly persistent agent (eg, Bacillus anthracis spores) is a complex process that requires extensive information and significant resources, which are likely to be limited, particularly if multiple facilities or areas are affected. This article proposes a systematic methodology for evaluating information to select the decontamination or alternative treatments that optimize use of resources if decontamination is required for the facility or area. The methodology covers a wide range of approaches, including volumetric and surface decontamination, monitored natural attenuation, and seal and abandon strategies. A proposed trade-off analysis can help decision makers understand the relative appropriateness, efficacy, and labor, skill, and cost requirements of the various decontamination methods for the particular facility or area needing treatment--whether alone or as part of a larger decontamination effort. Because the state of decontamination knowledge and technology continues to evolve rapidly, the methodology presented here is designed to accommodate new strategies and materials and changing information.
The case of Carol Anne Bond v the United States of America stemmed from a domestic dispute when Ms. Bond attempted to retaliate against her best friend by attacking her with chemical agents. What has emerged is a much gr...The case of Carol Anne Bond v the United States of America stemmed from a domestic dispute when Ms. Bond attempted to retaliate against her best friend by attacking her with chemical agents. What has emerged is a much greater issue--a test of standing on whether a private citizen can challenge the Tenth Amendment. Instead of being prosecuted in state court for assault, Ms. Bond was charged and tried in district court under a federal criminal statute passed as part of implementation of the Chemical Weapons Convention (CWC). Ms. Bond's argument rests on the claim that the statute exceeded the federal government's enumerated powers in criminalizing her behavior and violated the Constitution, while the government contends legislation implementing treaty obligations is well within its purview. This question remains unanswered because there is dispute among the lower courts as to whether Ms. Bond, as a citizen, even has the right to challenge an amendment guaranteeing states rights when a state is not a party to the action. The Supreme Court heard the case on February 22, 2011, and, if it decides to grant Ms. Bond standing to challenge her conviction, the case will be returned to the lower courts. Should the court decide Ms. Bond has the standing to challenge her conviction and further questions the constitutionality of the law, it would be a significant blow to implementation of the CWC in the U.S. and the effort of the federal government to ensure we are meeting our international obligations.
The Seventh Review Conference of the Biological Weapons Convention in December 2011 provides an opportunity to modernize the treaty to better address the challenges of the 21st century. The key to this modernization is t...The Seventh Review Conference of the Biological Weapons Convention in December 2011 provides an opportunity to modernize the treaty to better address the challenges of the 21st century. The key to this modernization is to redesign the treaty's Confidence-Building Measures (CBMs), the only formal mechanism for increasing transparency and demonstrating compliance with the treaty, to address changes in the global scientific, health, and security environments since the end of the Cold War. The scope of the CBMs should be expanded beyond state-run biological warfare programs to encompass a broader array of threats to global security, such as biological terrorism, laboratory accidents, dual-use research, and disease pandemics. Modernizing the CBM mechanism to take into account these new risks would extend the transparency-enhancing benefits of CBMs to a range of new and important topics, such as biosafety, laboratory biosecurity, and dual-use research oversight; make the CBMs and the treaty itself more relevant to the concerns and priorities of more states; and build on progress made during the recent series of intersessional meetings. To accomplish this, the CBMs need to be revised to shift their focus from hardware, the dual-use capabilities relevant to the treaty, to software, the political and legal institutions that govern the development and use of these capabilities. A more modern CBM mechanism should encourage greater participation in the confidence-building process, improve international cooperation against the full spectrum of biological risks, and promote the goal of universal membership in the treaty.
An attack with Bacillus anthracis ("anthrax") is a known threat to the United States. When weaponized, it can cause inhalation anthrax, the deadliest form of the disease. Due to the rapid course of inhalation anthrax, de...An attack with Bacillus anthracis ("anthrax") is a known threat to the United States. When weaponized, it can cause inhalation anthrax, the deadliest form of the disease. Due to the rapid course of inhalation anthrax, delays in initiation of antibiotics may decrease survival chances. Because a rapid response would require cooperation from the public, there is a need to understand the public's response to possible mass dispensing programs. To examine the public's response to a mass prophylaxis program, this study used a nationally representative poll of 1,092 adults, supplemented by a targeted focus on 3 metropolitan areas where anthrax attacks occurred in 2001: New York City (n=517), Washington, DC (n=509), and Trenton/Mercer County, NJ (n=507). The poll was built around a "worst-case scenario" in which cases of inhalation anthrax are discovered without an identified source and the entire population of a city or town is asked to receive antibiotic prophylaxis within a 48-hour period. Findings from this poll provide important signs of public willingness to comply with public health recommendations for obtaining antibiotics from a dispensing site, although they also indicate that public health officials may face several challenges to compliance, including misinformation about the contagiousness of inhalation anthrax; fears about personal safety in crowds; distrust of government agencies to provide sufficient, safe, and effective medicine; and hesitation about ingesting antibiotic pills after receiving them. In general, people living in areas where anthrax attacks occurred in 2001 had responses similar to those of the nation as a whole.
Native air sampling (NAS) is distinguished from dedicated air sampling (DAS) devices (eg, BioWatch) that are deployed to detect aerosol disseminations of biological threat agents. NAS uses filter samples from heating, ve...Native air sampling (NAS) is distinguished from dedicated air sampling (DAS) devices (eg, BioWatch) that are deployed to detect aerosol disseminations of biological threat agents. NAS uses filter samples from heating, ventilation, and air conditioning (HVAC) systems in commercial properties for environmental sampling after DAS detection of biological threat agent incidents. It represents an untapped, scientifically sound, efficient, widely distributed, and comparably inexpensive resource for postevent environmental sampling. Calculations predict that postevent NAS would be more efficient than environmental surface sampling by orders of magnitude. HVAC filter samples could be collected from pre-identified surrounding NAS facilities to corroborate the DAS alarm and delineate the path taken by the bioaerosol plume. The New York City (NYC) Native Air Sampling Pilot Project explored whether native air sampling would be acceptable to private sector stakeholders and could be implemented successfully in NYC. Building trade associations facilitated outreach to and discussions with property owners and managers, who expedited contact with building managers of candidate NAS properties that they managed or owned. Nominal NAS building requirements were determined; procedures to identify and evaluate candidate NAS facilities were developed; data collection tools and other resources were designed and used to expedite candidate NAS building selection and evaluation in Manhattan; and exemplar environmental sampling playbooks for emergency responders were completed. In this sample, modern buildings with single or few corporate tenants were the best NAS candidate facilities. The Pilot Project successfully demonstrated that in one urban setting a native air sampling strategy could be implemented with effective public-private collaboration.
The threat posed by infectious diseases has been increasingly framed as a security issue. The UN Security Council's Resolution 1308, which designated HIV/AIDS as a threat to international security, evidenced the securiti...The threat posed by infectious diseases has been increasingly framed as a security issue. The UN Security Council's Resolution 1308, which designated HIV/AIDS as a threat to international security, evidenced the securitization process. Using securitization theory as a theoretical tool, this article explores the securitization of infectious diseases in the World Health Organization (WHO). While WHO has tended to securitize infectious diseases since 2000, it has encountered a dilemma in the process because of the inherent asymmetry of interest between developed and developing countries. The act of securitization in WHO currently remains mostly a rhetorical device, since WHO's norms emblematic of securitization have not been backed by operational measures for verification or enforcement due to these asymmetric interests.
The ability to quickly dispense postexposure prophylaxis (PEP) using multiple points of dispensing (PODs) following a bioterrorism event could potentially save a large proportion of those who were exposed, while failure...The ability to quickly dispense postexposure prophylaxis (PEP) using multiple points of dispensing (PODs) following a bioterrorism event could potentially save a large proportion of those who were exposed, while failure in PEP dispensing could have dire public health consequences. A Monte Carlo simulation was developed to explore the traffic flow and parking around PODs under different arrival rates and how these factors might affect the utilization rate of POD workers. The results demonstrate that the public can reasonably access the PODs under ideal conditions assuming a stationary (uniform) arrival rate. For the 5 nonstationary arrival rates tested, however, the available parking spaces quickly become filled, causing long traffic queues and resulting in total processing times that range from 1 hour to over 6 hours. Basic planning considerations should include the use of physical barriers, signage, and traffic control officers to help direct vehicular and pedestrian access to the PODs. Furthermore, the parking and traffic surrounding PODs creates long queues of people waiting to access the PODs. Thus, POD staff are fully used approximately 90% of the time, which can lead to worker fatigue and burn out.
Since 2001, the United States government has spent substantial resources on preparing the nation against a bioterrorist attack. Earlier articles in this series have analyzed civilian biodefense funding by the federal gov...Since 2001, the United States government has spent substantial resources on preparing the nation against a bioterrorist attack. Earlier articles in this series have analyzed civilian biodefense funding by the federal government for fiscal years (FY) 2001 through proposed funding for FY2011. This article updates those figures with budgeted amounts for FY2012, specifically analyzing the budgets and allocations for biodefense at the Departments of Health and Human Services, Defense, Homeland Security, Agriculture, Commerce, and State; the Environmental Protection Agency; and the National Science Foundation. This article also includes an updated assessment of the proportion of biodefense funding provided for programs that address multiple scientific, public health, healthcare, national security, and international security issues in addition to biodefense. The FY2012 federal budget for civilian biodefense totals $6.42 billion. Of that total, $5.78 billion (90%) is budgeted for programs that have both biodefense and nonbiodefense goals and applications, and $637.6 million (10%) is budgeted for programs that have objectives solely related to biodefense.
Lipsitch M, Finelli L, Heffernan RT
… +3 more, Leung GM, Redd SC, 2009 H1n1 Surveillance Group
Biosecur Bioterror
· 2011 Jun · PMID 21612363
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This article synthesizes and extends discussions held during an international meeting on "Surveillance for Decision Making: The Example of 2009 Pandemic Influenza A/H1N1," held at the Center for Communicable Disease Dyna...This article synthesizes and extends discussions held during an international meeting on "Surveillance for Decision Making: The Example of 2009 Pandemic Influenza A/H1N1," held at the Center for Communicable Disease Dynamics (CCDD), Harvard School of Public Health, on June 14 and 15, 2010. The meeting involved local, national, and global health authorities and academics representing 7 countries on 4 continents. We define the needs for surveillance in terms of the key decisions that must be made in response to a pandemic: how large a response to mount and which control measures to implement, for whom, and when. In doing so, we specify the quantitative evidence required to make informed decisions. We then describe the sources of surveillance and other population-based data that can presently--or in the future--form the basis for such evidence, and the interpretive tools needed to process raw surveillance data. We describe other inputs to decision making besides epidemiologic and surveillance data, and we conclude with key lessons of the 2009 pandemic for designing and planning surveillance in the future.
We qualitatively examined the impact of the permanent closure of St. Vincent's Hospital in New York City on the remaining hospitals in the area and analyzed how these hospitals responded to this event. We conducted a des...We qualitatively examined the impact of the permanent closure of St. Vincent's Hospital in New York City on the remaining hospitals in the area and analyzed how these hospitals responded to this event. We conducted a descriptive survey consisting of interviews with clinical (n = 24) and administrative (n = 11) staff from 4 hospitals in lower Manhattan after the sudden closure of St. Vincent's Hospital. These hospitals experienced a sudden and sustained increase in patient volume. Each was faced with specific constraints (eg, finances, physical plant, bureaucracy), but they developed similar strategic responses. Generally applicable principles included: soliciting innovative ideas from clinical staff, reexamining previous proposals to improve efficiency, fast-tracking stalled capacity-building projects, and focusing on improving patient care and flow. Three broad tactical themes were apparent: increases in staff and staff hours, use of alternative sites of care, and implementing novel ways of operating. The impact on hospital operations resulting from the closure of St. Vincent's Hospital is a surrogate medical surge event and met thresholds for activating emergency operations plans. Novel operating methods used in response to this surge event offer practical and broadly applicable principles that might improve medical surge management in other hospitals.
Identifying vulnerable groups and ensuring that their needs are met during disasters--whether naturally occurring or manmade--are vital aspects of preparedness planning. Developing preparedness strategies that are respon...Identifying vulnerable groups and ensuring that their needs are met during disasters--whether naturally occurring or manmade--are vital aspects of preparedness planning. Developing preparedness strategies that are responsive to those at greatest risk is a moral mandate, justified by the principles of beneficence, justice, and respect for autonomy. Individuals with preexisting mental disorders and newly emergent psychological symptoms are particularly vulnerable to adverse outcomes during and after disasters. Without advance planning, these individuals might not benefit from necessary mental health services and treatments during and after disasters. In this commentary, we discuss ethical issues that arise in emergency preparedness planning for vulnerable individuals with psychological and psychiatric conditions and disorders.
The World Health Assembly is scheduled to decide in May 2011 whether the 2 known remaining stockpiles of smallpox virus are to be destroyed or retained. In preparation for this, a WHO-appointed committee undertook a comp...The World Health Assembly is scheduled to decide in May 2011 whether the 2 known remaining stockpiles of smallpox virus are to be destroyed or retained. In preparation for this, a WHO-appointed committee undertook a comprehensive review of the status of smallpox virus research from 1999 to 2010. It concluded that, considering the nature of the studies already completed with respect to vaccine, drugs, and diagnostics, there was no reason to retain live smallpox virus except to satisfy restrictive regulatory requirements. The committee advised that researchers and regulators define alternative models for testing the vaccines and drugs. Apart from other considerations, the costs of new products are significant and important. These include prospective expenditures required for the development, manufacture, testing, and storage of new products. This commentary provides approximations of these costs and the incremental contribution that a newly developed vaccine might make in terms of public health security.
Biosecur Bioterror
· 2011 Mar · PMID 21395429
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To address biosecurity issues, government agencies, academic institutions, and professional societies have developed policies concerning the publication of "dual-use" biomedical research-that is, research that could be r...To address biosecurity issues, government agencies, academic institutions, and professional societies have developed policies concerning the publication of "dual-use" biomedical research-that is, research that could be readily applied to cause significant harm to the public, the environment, or national security. We conducted an e-mail survey of life science journals to determine the percentage that have a dual-use policy. Of the 155 journals that responded to our survey (response rate 39%), only 7.7% stated that they had a written dual-use policy and only 5.8% said they had experience reviewing dual-use research in the past 5 years. Among the potential predictors we investigated, the one most highly associated with a journal having a written dual-use policy was membership in the Nature Publishing Group (positive association). When considered individually, both previous experience with reviewing dual-use research and the journal's impact factor appeared to be positively associated with having a written dual-use policy, but only the former remained significant after adjusting for publishing group. Although preventing the misuse of scientific research for terrorist or criminal purposes is an important concern, few biomedical journals have dual-use review policies. Journals that are likely to review research that raises potential dual-use concerns should consider developing dual-use policies.